#881 Best of Juicebox: Crush it and Catch It

April 2, 2023Scott Benner

Originally aired on April 7, 2021. Scott and Jenny talk about how to crush and catch a high BG.

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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.

Scott Benner 0:00
Hello friends, and welcome to episode 881 of the Juicebox Podcast.

Hello, and welcome again to the best of the Juicebox Podcast. Today we're going to revisit episode 463. It's a defining diabetes episode called crush it and catch it. As originally aired on April 7 2021. This episode is definitely a fan favorite. I don't think a day goes by where I don't see someone in the Facebook group say hey, I crushed it and caught it. While you're listening today, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan or becoming bold with insulin. Are you a US resident who has type one or the caregiver of someone with type one, please go to T one D exchange.org. Forward slash juicebox. Join the registry complete the survey. When you complete that survey. You are helping type one diabetes research to move forward right from your sofa. You also might be helping out yourself and you're supporting the podcast T one D exchange.org. Forward slash juicebox.

This episode of the podcast is sponsored by cozy earth. Now you can get 35% off your entire order at cozy earth.com Just by using the offer code juicebox at checkout, I'm wearing cozy Earth joggers and a sweatshirt right now these joggers are like the best and our sheets are super duper super, super cool. And silky and soft. Also from cozy Earth. Cozy earth.com use the offer code juice box to save 35% The podcast is sponsored today by better help better help is the world's largest therapy service and is 100% online. With better help, you can tap into a network of over 25,000 licensed and experienced therapists who can help you with a wide range of issues. Better help.com forward slash juicebox. To get started, you just answer a few questions about your needs and preferences in therapy. That way BetterHelp can match you with the right therapist from their network. And when you use my link, you'll save 10% On your first month of therapy. You can message your therapist at any time and schedule live sessions when it's convenient for you. Talk to them however you feel comfortable text chat phone or video call. If your therapist isn't the right fit. For any reason at all. You can switch to a new therapist at no additional charge. And the best part for me is that with better help you get the same professionalism and quality you expect from in office therapy. But with a therapist who is custom picked for you, and you're gonna get more scheduling flexibility, and a more affordable price. I myself have just begun using better help. Better help.com forward slash juicebox that's better help h e l p.com. Forward slash juicebox. Save 10% On your first month of therapy. Hello friends and welcome to episode 463 of the Juicebox Podcast today, Jenny and I are going to define a diabetes term that I made up

don't tell the other episodes. But I quite like the defining diabetes series. What was once just in my head and idea of like, Oh, I'll tell people the definitions of words so they know the tools they're using and what they're supposed to do. But I've come to see these episodes is more than that as time has passed. I think they're their own special little. I don't know, I just like them. It's like a mini pro tip series defining diabetes. They're just good. And they're helpful. Actually, they're made even better with the presence of Jenny Smith, my friend and certified diabetes educator who helps me on these end the pro tip episodes. Today Jenny and I are going to define crush it and catch it. There's a little more to it actually, there's crush it, catch it and you'll find out in a second but I just like crush it and catch it. The rest of its like implied once you understand you'll see in a second. Please remember while you're listening that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise please Always consult a physician before making any changes to your health care plan. We're becoming bold with insulin. Hey, new listeners. Did you know bold with insulin actually comes from the title of episode 11. I thought I would tell you that because now that the podcast is seven years old, it's possible you don't even know how this thing got started. This episode of The Juicebox Podcast is sponsored by the Contour Next One blood glucose meter. It's the meter my daughter uses. It is the most accurate meter I've ever held my hand. And it's absolutely lovely. Check it out at contour next one.com forward slash juicebox. You know what else? This show is sponsored today by the glucagon that my daughter carries, G voc hypo Penn, find out more at G voc glucagon.com. Forward slash juicebox. I have come to I've broken down the idea of how do I get a blood sugar back down into three simple words I crush it, catch it and start over. Okay, so if I see if I see a blood sugar that's high, and it's stuck, instead of messing with it, I crush it, catch it and start over. Now sometimes I crush it and it catches itself. And those are days when I'm like oh, I really did it. And then there are some days when I crush it so hard, it needs to be caught with some sort of fast acting glucose. This comes up a lot when I'm talking to people because I just feel like I feel like staring at high blood sugars is a bad idea. Now when I used to say this, people say oh, it's not good to bring your blood sugar down too quickly. And I know it isn't. But is it not a good idea when your blood sugar is high all the time to bring it down too quickly. But what about a person whose blood sugar is normally like 85 to 105 and it sits there most of the time, but then you get this big spike from something you messed up or did wrong or bad pump site or whatever? Is there any value in watching it and bringing it down slowly over four hours versus crush it catch it

Jennifer Smith, CDE 7:04
there when I'm glad you kind of brought it up. Because that was like the first thing on my mind to like spit out was it really does depend I mean, somebody who's typically sitting in a nice, beautiful, you know, glucose range that they're happy with. And now oh, you know, grandma's apple pie came along, and I thought I'd only eat one piece. And now I've eaten three and oh, by the Pre-Bolus that I you know all the things that go into a higher blood sugar that happens occasionally, the occasional high blood sugar that you do your little you know, crush it catch it kind of component. Is that detrimental? No, I mean, you're taking care of the high blood sugar, you're bringing it down, you're doing it quickly. I would say that the opposite of that though, you know, for a high blood sugar, that's, that's randomly high. And you're kind of worried about doing that and bringing it down so quickly is there is there trauma, the same way and just leaving it hanging high and come down slower, by just taking a small amount and gradually getting it down? I think they're both honestly about the same in terms of any potential like you know, back in, which I don't see there at all, you know, problems and you either take care of it on the back end or on the front end quick and it comes down. And now you don't have to do with the high blood sugar anymore. Or you end up with a high blood sugar for hours watching. It's like slowly come down. And you may not feel great during that lengthy time. But on the same if you crush it early, and it drops really fast. You also might feel the drop, too. So you know in either of those, I don't think that it's necessarily bad. The long term of consistently doing that, like if you are the roller coaster, and you're constantly crashing highs and on the back end catching them with a load of extra food. They're in something needs some adjustment, right?

Scott Benner 9:07
And so that phrase would not come into my mind if Arden was constantly Hi, I would think oh, there's so many other things that I don't understand. I am really talking about specifically when you just have this, like out of nowhere like right where did this come from? Because I think one of the problems with messing with it for hours is that that runs into another meal. And now you don't have any resolution of the carbs and the the insulin right like there's no like I found myself years ago always saying to my wife, look, we need to get this down, get it level, get this insulin out of her so we can start over again. Because if not you have all these other variables going on. You don't know which ones are impacting and then you go into another meal and it takes years to be able to just on the fly go okay, there's still some act of insulin but the food's gone. now so i'll Bolus this and I'll take away 10 carbs because I know there's some insulin left like you most people can't do that off the top of their head right? So I my my theory has always been get it down as fast as you can. Because the insulin you use to get it down is kind of gone after that, like it gets. I don't know if this is a technical term but it feels like it gets used up dealing with the carbs Does that make sense?

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Are you or your child carrying around an old busted up nasty blood glucose meter? Are you not even certain if it's accurate? Does that sound like the situation you find yourself in because if it does, it would be very easy and possibly financially advantageous to check into the Contour Next One blood glucose meter. This is the meter My daughter has been carrying now for a couple of years. It is phenomenally accurate for us, I'm talking about a good old fashioned blood glucose meter that just works. It's got a bright light. So when you're using it at night, you can see what you're doing. The test strips allow for Second Chance testing, meaning you can hit that blood drop not quite enough and go back in and get more without messing up the accuracy of the test or wasting a strip. And it's possible that you could be eligible for a free meter. And you could just find that out right now. At contour next one.com forward slash juicebox. Alright, so go check out that G voc glucagon, the Contour Next One blood glucose meter. Even there's a link in that show notes there for Jenny. It's a lot going on there. You can find these links. Like I said in the show notes to the podcast player. We're at juicebox podcast.com. I don't know if this is a technical term, but it feels like it gets used up dealing with the carbs. Does that make sense?

Jennifer Smith, CDE 12:37
Yeah, I usually say it gets eaten up faster. Yeah, it's like there's so much sugar for it there when you've got a high blood sugar that all that insulin gets sort of used up faster. There's it's kind of like the same concept of a Pre-Bolus is you're getting the insulin action going now to hit what's coming and get it used up. And on the back end. If you've done it right. And you figured it, you should have a smooth landing.

Scott Benner 13:05
It's always it always appears in my mind like a fistfight that just goes to the death that just like when it's over, both fighters just drop over backwards and on their way down. They're like well done, and then they're they're just gone. They ever get back up again, you know? And, and you're right. That is how I talk about and how I think about Pre-Bolus thing, which is to put both people's aggression at the same time make the insulin working while the carbs are working. So that one's not not doing its job without the other one. Because how you get a higher low blood sugar. But so in a bigger idea. I hear it's exactly right, like so what do you do in that situation? Like, how does Jenny handle have a high blood sugar that she gets?

Jennifer Smith, CDE 13:47
She's like, Hey, I like your I like well, one, you know, with using the system that I use for managing. I don't typically deal with that unless I have a pump site that's gone bad and hasn't been dealt with obviously. And for some reason, I haven't paid attention to any alerts and alarms that are going off on my CGM. So there are lots of catching points that obviously I haven't I know a lot of people use similarly, but with high blood sugars, I do the crushing catch it kind of thing more than not think there's I don't want to sit high. I don't like sit and kind of like you with my day the way that it goes. I don't want to have to wait out a high to eat because often my meals are with my kids, and I don't. I don't want to sit there while they're like chowing down and I'm like Mommy's got to sit here.

Scott Benner 14:50
Kelly's not saying she feels that her kids will feel odd if she's not eating. She's saying she doesn't want to watch somebody eat and not

Jennifer Smith, CDE 14:57
be eating at the same time. That's the intro I meant to have a meal together.

Scott Benner 15:01
I think it's abundantly clear why you and I get along about talking about diabetes. So I was like it now for the alternate viewpoint. Here comes Jenny with exactly what I just said. Yeah, I just think that I think it leads to so much more success. Because that staring at highs is stress inducing, and like people are like, well, I don't know, I'll make myself low. And I get that, like, if you're hearing this episode, first, go back and listen to the Pro Tip series. Don't start with this. This is like ninja level, like, I already understand what's going on 1000 times over. And I've got a high blood sugar, you know, if you Oh, sorry, no, no, I was gonna say if you usually have high blood sugars all the time, your basil is wrong, you don't understand how to Pre-Bolus Like, all these other things are first not this. This is not step one.

Jennifer Smith, CDE 15:53
No, no. And I was also going to just sort of go back and say, you know, my, my day to day like crush, it is definitely much more the case. overnight. I mean, my husband will wake up to an alarm. But he is definitely much more the like, sleep through a train coming through the wall than I am now have being a mom and waking up to everything. So overnight, I can say because I am, I am my own manager. I don't have anybody catching or following or anything for me. So if there was a conservative time that I'm going to do less aggressive correction for a high, it's definitely going to be overnight. And it's usually if I've had a highlight that overnight, it's usually like, the pump site is bad, or it's gotten pulled out and like I've got this dangling pot on my body and I haven't obviously gotten insulin, and then it leads to well, how much insulin do I have left? So it's kind of a questionable, and I'm a lot more conservative. Sure, for my own self overnight. Because yeah,

Scott Benner 16:58
I would think that for an adult, it's different than for a caregiver for certain. And I don't want to give anybody the impression that I use, you know, 50% more insulin in the situations needs. And then I just give her like a filet mignon dinner at the end, like, although, I could go into how you can get out of a high and go into a meal by correcting the high end Pre-Bolus in the meal, even sometimes hours ahead of time, and then just introducing the food at the exact right time. Maybe that does fit in here. But we're not talking about that right now. So I don't I mean, I don't want anybody to think that I'm overdoing it over time, I've learned that, you know, I can be really aggressive here and maybe I'm gonna miss by eight carbs worth of insulin, right like just a little bit and you can kind of, you know, add a little bit in I there's an episode called Utah Gen, where I talk about how I, how I help the person over the phone, this is probably not something I should have recorded. But how I helped the person over the phone bring like a seven year olds budget or from 400 to 70 in like two hours. And it involved crushing it and then introducing a meal at the right time. And back kids blood sugar went like 76 I think if I'm remembering it just leveled right out, it was like that was one of my, my most happy moments in my life. Walk around my house with my head. So I was like I did it. And then she ruined it by feeding him. But that's not the point. Anyway, it's a great episode, but not what I was talking about. Alright, Jenny, I'm gonna stop putting his

Jennifer Smith, CDE 18:28
reference to it, though. I mean, in terms of like that introduction of the meal at the right time, I think when you said this is like ninja level. Yeah, I agree. Because over time you have an idea, you have a sense of how much to potentially crush it with. And where, with hindsight, you can tell where you're going to need to add something because it's you're not going to it's not going to catch it on its own. You're going to have to help with the catch.

Scott Benner 18:54
Yeah. So and if somebody's listening to this and thinking, oh, yeah, I try that all the time. And I always mess it up. I really genuinely think go listen to the pro tip episodes, because then you'll get through the little reasons why you mess that up. Because you know, I could go one of them is that people are constantly chasing blood sugar's, they're always like on the wrong timeline. I don't like no one other way to put it other than to say, insulin you use now is for later, but a better way to think of it is that insulin from before is affecting you now. And if you're trying to affect before, now, you're caught in a time travel movie and you're on the wrong end of it. So anyway, try the Pro Tip series. Okay, Jenny, thank you very, very much. Yeah, you're welcome.

A huge thank you to one of today's sponsors, G voc glucagon, find out more about Chivo Capo pen at G Vogue glucagon.com forward slash juicebox. You spell that? G VOKEGL. You see ag o n.com. Forward slash juice box. Have you been thinking about that Contour Next One blood sugar meter? Have you been thinking about that Contour Next One blood glucose meter since I brought it up earlier, this is your time, go check it out. Contour next one.com forward slash juice box, you can find links in the show notes to hold on a second, I'm gonna run out of music. You can find links in the show notes to today's sponsors to Jenny Smith, and all of the sponsors of the Juicebox Podcast right there. In your podcast player. There are show notes in your pocket, podcast podcast, there are show notes in your podcast player, you can click on them from there. And you know the links are there. Or I don't want to get too technical when I say the links are there, or you can find those links at juicebox podcast.com. Allow me to take this moment to thank you for listening to the Juicebox Podcast for sharing the show with other people. And for making last month March of 2021. The most popular the most downloaded month ever in the history of the podcast. I'm not giving away the numbers. But last month did by a multiplier better than the first year of the show. Is that not crazy? Anyway, I have you to thank. So thank you. I appreciate it. Again, when you share the show when you subscribe in a podcast player, when you tell somebody about it, when you leave a review, and you're like, oh my god, I love this podcast as a review, and you give like a really thoughtful reason why those reviews are very helpful. Mostly for listening. That's the best thing you can do for the show, listen and tell someone about it. I really appreciate this. I feel like I've gone on too long about this now, but there's no going back. And I don't feel like editing it out. So I'll see you soon with another episode of The Juicebox Podcast. I'm just gonna keep talking, you can leave if you want to. But some people don't know about the other episodes that I think would be really helpful to them. So I'm going to take a moment juicebox podcast.com is the website for the show. Everything you need is there, there's menus at the top. And you'll be able to find the diabetes pro tip episodes. And the defining diabetes episodes. Under one link is the link that says diabetes pro tip. If you can't remember that you can just go to diabetes pro tip.com, where I've also put those episodes. I know a lot of you find the show. And people tell you Oh, if you listen, this podcast, like your variability will get better and you're able to go down, you'll just have a better idea what you're doing. And everybody's like, why do you do that? I think it's by listening to the show. I think that listening gives you a firm understanding through conversations with many people who are parents of children with type one diabetes, or adults who have lived with diabetes for a long time. Just hearing the conversations, hearing ideas come up, things get spoken about, I find very helpful. It builds your kind of diabetes knowledge. But if you really just want to dig into management ideas, you are looking for the defining diabetes episodes, just like this one, and the diabetes pro tip episodes. So again, diabetes pro tip.com. They're also right there in your podcast player, the thing you're holding right now with your phone. The Pro Tips begin at episode 210. They do not run concurrently. So you have to find them. And I think I say I think but I'm looking so it seems disingenuous. I was buying time the defining diabetes episodes begin at episode 236. There are many of them actually. Probably number in the dozens. And I don't see any end to them as we define. You know, I don't even see them as like definitions. I started talking about this the beginning like it's not just like Bolus means this. It's Jenny and I, we define it but then we talk it through. And now you know what that tool is. It'd be like, I'm gonna be like if you came from another planet, and someone handed you a hammer and a pair of pliers and a screwdriver and told you to go put together a bed. You might not know what the hammer is for. You wouldn't even know what it was called. So if you were helping me and I said pass me the hammer you wouldn't know. So I like for you to know what a Bolus is what Basil is why hydration is important. What's an insulin deficit? is feet on the floor a thing? What is the fat and protein rise a compression low or rage Bolus? Like I want you to? I want you just to instinctively know this is a hammer. I know what a hammer does. And that way when you need the hammer, you won't hesitate to me that's what the The finding diabetes series is about and then while there is no doubt that I would love for you to listen straight through this podcast started first one and listen all the way through. I know not all of you are going to do that. If you did, you would glean everything that is inside of the pro tip episodes. Don't skip the pro tip episodes just listen to them straight through episode 210 diabetes pro tip newly diagnosed are starting over and they go on from there. If you're not an MDI, still listen to the MDI episode. Right if you're on MDI, still listen to the Pre-Bolus episode. If you're on MDI, listen to the insulin pumping episode. If you've never had to CGM in your life still listen to the mastering a CGM episode. Don't miss bumping and nudging the variables exercise like don't just skip one because you think oh, this isn't for me. Those are going to lay down a firm foundation around your diabetes management in my opinion. And they're free So why the hell not right. Okay, thanks so much. Now I'll really see you next time. Bye. Bye. Hit subscribe

thank you so much for listening to this episode of the Best of the Juicebox Podcast. I hope you enjoyed crush it and catch it. It is definitely something we use around here. Would you like to save 35% on this sweatshirt that I'm wearing here? Are these silky joggers? Am I rubbing my legs while I'm saying it? I'm not gonna tell you because it sounds creepy, but they're super soft, cozy earth.com Save 35% at checkout with the offer code juicebox. And of course you can get 10% off your first month of therapy@betterhelp.com forward slash juice box just by going through that link. It's all you have to do. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. If you enjoyed this conversation and you're not in my private Facebook group, it's absolutely free. And I think you would love it Juicebox Podcast type one diabetes on Facebook private group 35,000 Plus members. That's over 35,000 members, tons of conversations, opinions, perspectives, and great conversation absolutely free. Go check it out. If you enjoy the Juicebox Podcast or this episode or any episode, please go into the audio app you're listening in and leave a five star rating and a thoughtful review that will help someone else to understand why you love the podcast.