#755 Bold Beginnings: Exercise
Bold Beginnings will answer the questions that most people have after a type 1 diabetes diagnosis.
You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - Google Play/Android - iHeart Radio - Radio Public, Amazon Alexa or wherever they get audio.
+ Click for EPISODE TRANSCRIPT
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 755 of the Juicebox Podcast.
Jenny Smith and I are back today with another episode of the bull beginning series and today Jenny and I are gonna talk about exercise. While you're listening today, don't forget two things. One, Jenny works at integrated diabetes.com. You can check her out and hire if you like, and to 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. We're becoming bold with insulin. If you're a US resident who has type one diabetes, or is the caregiver of someone with type one, in fewer than 10 minutes, you could go to T one D exchange.org. Forward slash juice box and fill out their survey. When you complete the survey. You've helped the podcast, you've helped people living with type one diabetes, and you may just have helped yourself T one D exchange.org. Forward slash juicebox. Hope you're enjoying the bowl beginning series. It's not done yet, there's more coming. If you've missed the earlier episodes, you don't even have to listen to them in order if you don't want to just go find them.
This episode of The Juicebox Podcast is sponsored by touched by type one, please go learn about my favorite diabetes organization at touched by type one.org and find them on Facebook and Instagram while you're at it. Today's episode of The Juicebox Podcast is sponsored by in pen from Medtronic diabetes in pen is an insulin pen that offers some of the functionality that you've come to expect from an insulin pump. I know you're thinking, Oh, Scott, please tell me more. Well, I will. Yes, the pen is a pen. But it also has an application that lives on your smart device. This app shows you your current glucose levels, meal history, dose history and activity log glucose history, active insulin remaining a dosing calculator and reports that you and your physician can use while you're trying to decide what your next step is. Well, well well, it's not just an insulin pen, now is in Penn today.com. That's where you're going to find out more information and get started. If you're ready to try the M pen, just fill out the form at M pen today.com or do some more reading. There's actually some videos you could check out too about the dosing calculator, the dose reminders, carb counting support, and the digital logbook. So if you want to lighten your diabetes management load, but you're not ready for an insulin pump in Penn is probably right for you in Penn today.com. In Penn also offers 24 hour Technical Support hands on product training and online educational resources. And here's something else that you'll find it in Penn today.com It is actually very exciting. Now this offer is for people with commercial insurance in terms and conditions do apply. But you may pay as little as $35 for the pen. And that's because Medtronic diabetes does not want cost to be a roadblock to you getting the therapy you need within pen $35 How crazy is that? In pen today.com in pen requires a prescription and settings from your healthcare provider. You must use proper settings and follow the instructions as directed. Or you can experience high or low glucose levels. For more safety information where to get started today, you can go to in Penn today.com What's next, Jenny? Hey, we're back with the ball beginnings series. And we're going to talk about something today. That's going to happen to everybody I hope exercise, but we're not gonna dig super deep into it. We just want to make sure that newly diagnosed people understand the impacts.
Jennifer Smith, CDE 4:20
Right? Absolutely. They think it's a neglected topic. At that initial like diagnosis and the overwhelmingness of everything that you're trying to learn about. Exercise is like way, way at the bottom and what to expect to try to learn right and also,
Scott Benner 4:40
I also think that when people think of exercise, they think of at 11 o'clock I'm gonna go to the gym and I'm gonna run on the treadmill and I'm gonna lift these things then I'm going to do this I'm gonna go back but exercise could be cleaning the house or cutting your lawn or your kid going to a store. Yeah, walking around it whatever. Do we say Walmart in the variable series? Yeah. So yeah, shopping, anything that takes your, your level of activity from where it kind of normally is to an elevated place because your settings for your insulin are usually set up for when you're sitting in school or at work or sleeping or whatever. And then, let's just explain. I'm going to ask you to do it. What happens when there's two kinds of exercise? Look at me, anaerobic, and your aerobic. What is
Jennifer Smith, CDE 5:39
it and the other one? You're so funny. Oh, my goodness.
Scott Benner 5:42
I made weightlifting like sign like movement.
Jennifer Smith, CDE 5:45
Yeah. Anaerobic. Yes, like resistance and weight training. In which you're not increasing or not for long periods, increasing your heart rate, right. And then there's cardio kind of exercise or aerobic where you're using oxygen at an increased rate, right. And they both do something different to your blood sugar
Scott Benner 6:07
or could Alright, so anaerobic like from my childhood, Lou Ferrigno, lifting weight. There you go, and aerobic. What's her name? married to the guy from CNN. Oh, yeah. Oh, my God, famous actress. Did that thing in Vietnam? People didn't want that. There you go. There you go. I knew how was it possible? I could, I could give you her entire litany of what she did throughout her life couldn't think of her name. That's ridiculous.
Jennifer Smith, CDE 6:38
I actually am very, very proud. Because my husband is like the trivia man. He knows. Like, he knows. He can look at somebody be like, he did this. And he did this. And this is his name. And like the song that I I'm like, I know the song. I tell you all the words and the group is hmm, I don't know who the singer is.
Scott Benner 6:57
I'm worried that I didn't go to Olivia Newton. John. I was just trying to think of like people who used to make VHS tapes of them working out in leotard. So you would work out in your living room. But but so the point is, is that you're there's two different kinds of exercises you might get involved in. And they have two different impacts. Is that correct? Yes. Okay. So aerobic exercise may make my blood sugar drop down. Yes. And weightlifting and resistance stuff could make my blood sugar go up? Correct. Okay.
Jennifer Smith, CDE 7:30
In fact, the anaerobic or the weightlifting resistance. The heavier the load, the more that you're doing in that is more of an adrenaline kind of released, right? It's the more pumping kind of and so that can be the reason it's causing a rise in blood sugar. And the others, typically, aerobic, whether it's running or jumping on the trampoline, and a trampoline and the past couple of years. I've heard more comments about trampoline, blood sugar than any other sport for kids.
Scott Benner 8:07
I think they cuz I think it's the, it's kind of what I was bringing up at the beginning. Like your kid is like eight. And they're like running, you know, sitting down watching TV, and then all of a sudden, they look up like a puppy that saw something, jump on the trampoline now. And then they run outside and do that. And you're like, Wait, stop.
Jennifer Smith, CDE 8:27
We just hit they're all shiny dangly objects. That's what it is. They're they're here, you they look content. And then they're like, Oh, look at all it is. It's like a puppy. It's like it, there's a squirrel over there. So there's
Scott Benner 8:39
these two situations, you might fall in one, you know that soccer practice is at six o'clock. And you can prepare for it in one way and to have your kids start chasing each other around the house and run up and down the stairs 75 times 45 minutes after they ate with a bunch of active insulin inside and your blood sugar tax. Right, right. So no one tells you about that when you're diagnosed with diabetes.
Jennifer Smith, CDE 9:03
No, not at all. And if you are, again, in the kid category, or even the teen category, and teens are very much in that sedentary might move up, somebody comes over. It's the same really. And so you have to consider those really, like quick spurts of activity could be lengthy. They could be 10 minutes and your kid is done. And they're like, I want to sit down and read a book again. Right? So paying attention in those times, can give you like future vision then to what to maybe do. But it's it's all learning. Really. It's it's paying attention. It's not going to be perfect. Don't expect it to be perfect. Know that you have the tools to manage and some idea that if something's planned, you can try to accommodate and see how it works out. If something's unplanned, one of the best things is just making sure you got some carbs to manage. Because that's all you can do to fix it.
Scott Benner 10:07
Yeah, I. So kind of the way I think about it is, you ever see those beach houses up on the stilts? Okay? Those people said, I know that one day water is going to come rushing in here. And I'm gonna put my house up where the water can't get to it. And I think it's water. But I don't understand how to say. So that's fine. It's pre planning, right? Yes, somebody else built their house in the ground, the water comes rushing into the house goes back out into the ocean. They're like, I don't know what happened. What happened? You didn't plan very well. So the way I see all this is not that Arden doesn't have fluctuations around exercise if she's not prepared for it. But rock solid settings, and rock solid understanding of how to Bolus for meals so that you don't end up with a lot of insulin. In the body. It's not accounted for correctly for need. So if if Arden does not prepare to like, go downstairs and get on the treadmill and run she will get low? Absolutely, absolutely. Well to Yeah, but she'll get low like 66. And then she'll need something and it'll bring her blood sugar back up. She doesn't go from like 95 to 20. Like it's not like some crazy drop, because she won't go running when she's got meal insulin active, because she knows better at this point. Right? Right, because that's going to make her blood sugar low. So I think most of activity is not having active insulin, or cutting your Basal, if you're on a pump in a way prior to the activity, where you kind of create one of those black holes so that the drop, can't drop, because there's nothing there to pull it down, because we call it a drop. But it's not really a blood sugar drop in this scenario. It's a poll. But that doesn't make any sense, right? Well, I
Jennifer Smith, CDE 12:01
think what I've seen in a timeframe, which might make sense for again, more newly diagnosed is the common time period when you haven't accommodated before more spontaneous exercise. Whether it's insulin or extra food, or however you're going to do it, if you haven't accommodated 15 to 20 minutes into movement, that aerobic is a drop zone, and again, not dropped, like over a cliff, it's you might have been floating along pretty stable. And it's definitely going to start nudging down, right. Yeah. So that's a timeframe at least that may give a little bit of reference to people who are new to trying to figure out what to watch for,
Scott Benner 12:44
right. And I think if you find yourself in a scenario where blood sugars are dropping and rising, and you don't understand why you're going to be more susceptible to a problem during exercise as well, right? It just really did strike me as I just said that. Calling a blood sugar drop a drop makes it feel surprising, the word usage makes it feel like it's unknowable, it just happened, it just dropped out of nowhere, like those are the phrases people use. But that's not really the case. In most situations, it's you have some active insulin, it's, it's taking sugar out of your blood, your blood sugar number is falling because of that, then suddenly you start exercising. And there it is. I mean, I would think that if you made me just give one piece of advice, I'd say do not exercise, aerobic ly with active insulin on board.
Jennifer Smith, CDE 13:37
And if you do know how much carb you may need to cover, the active insulin that's there with, again, spontaneous activity and whatnot in kids is pretty much the whole day, I would say to what you can play on in schools and that kind of thing. But if it's spontaneous, and you've got active insulin, because you didn't plan to go out and jump on the trampoline with four friends after lunch, you got this insulin, it's going to need some additional food beyond what it was given to cover. Yeah, because the exercise is mobilizing that insulin faster
Scott Benner 14:09
and not just in a situation where you unexpectedly find yourself doing something but what happens when you eat dinner and then go to baseball practice. Right, right. Like that's what here's a plan. Yeah, there you go. You can also you have to sort of understand Jenny mentioned adrenaline a little while ago. Baseball is a good example. Because it's not a ton of running around for the most part, right? But people will say how come my kids blood sugar gets high in a baseball game, but not at a baseball practice. And it could just be because there's no competition at the practice. They don't feel a sense of competition. So there's no adrenaline rise. These things take time to figure out honestly do but I and I'm not just self promoting here. But if you listen to the Pro Tip series, that should teach you how to keep things more stable. And then you should have an easier time being able to see what's going on in these situations so that you can adapt to them. Absolutely. Some stuff from people here, how do I adapt existing routines and lifestyles for diabetes, like swimming, summer camping, hiking, that's what we're talking about. It might be what you're eating, you might eat something with more protein in it more fat in it to hold your blood sugar up longer. You may do Temp Basal decreases before activity to help that, again, all that's in those episodes. But I just think it's important for people who are newly diagnosed to understand that it's going to happen because people don't tell you that and no, then there you go. Right. So
Jennifer Smith, CDE 15:48
and then it's scary. It becomes scary, because nobody told you to expect that this activity that your kid loves to do, but it's sporadic is going to do this versus this.
Scott Benner 15:59
And you see this this feedback from the person said, My son was in baseball and swimming, when he was first diagnosed, the doctor flat out told me he would have to rethink the sports he was playing. And that crazy for things that would work around his diabetes. While we were learning how to manage the disease. I was led to believe he could not live a normal life with sports. Oh, but of course, he
Jennifer Smith, CDE 16:23
could oh my gosh, I'm, I feel so bad that they were told that Yeah, that's really
Scott Benner 16:29
terrible. It really is. Meanwhile, the tight end for the Ravens has type one diabetes, and you have type one diabetes, and you run for some reason I don't understand why. And it's so to a lot of other people right there professional has been professional baseball players on this podcast, who have type one, it is very doable. But you need to, you need to do the things you need to do that you you have to have your basil, right, you have to understand how to Bolus from meals, you have to understand the impacts of different foods. And now you have to add understanding how to keep active insulin away from certain activities. Or you if you become a bodybuilder, you might find yourself bolusing before you workout,
Jennifer Smith, CDE 17:15
correct, absolutely anaerobic exercise, can for many people, not always, but it can depending on the length and the weight. And you know, all of that it can drive blood sugar's up again, when it's going to be based on on your response, it could be that you start out in a really great place. And by the end of your lifting session, you're riding high or you're kind of nudging up, essentially. But overall, you have to just pay attention to you. Some of the lifters that I've worked with have taken a Bolus at the beginning of lifting session to accommodate and avoid and avoid arise. Some of them have set a temporary basil to accommodate for that. Some of them end up doing a little bit of both anaerobic and aerobic exercise, knowing that their blood sugar is going to get driven up by weights, they end up allowing that drift to happen to a certain point, and then following it with aerobic exercise, which they know is going to navigate it down and tends to kind of smooth things a little bit more on the back end rather than a dramatic drop, like we often see with cardio. Yeah. So
Scott Benner 18:24
you also have to, you know, when we talk about mixed meals, right, like it's easy to pick one food and Bolus four. But what do you do when you're having meatloaf and mashed potatoes and applesauce and these all have different impacts. Also, you could head out into the backyard to move a pile of rocks, which you would think well that's lifting except what if the pile of rocks is 45 feet from so now you're lifting and then you're walking, right and then you're lifting and you're walking, you're you're having two different impacts, you could end up doing something like that in the backyard for example, and it not looking on your blood sugar like anything happen, because you could be getting a pull down from the aerobic and a push up from the anaerobic and this all you know what I always say the podcast makes things seem simple, but Jesus. But it's very doable. And I think that's the important thing. But everything starts, in my opinion with understanding how insulin works, like with Absolutely. Well thank you very much. I appreciate course, always I'll talk to you soon.
A huge thank you to Jenny Smith for being here with me again today. And I'd like to remind you that you can hire Jenny integrated diabetes.com. I'd also like to thank Ian pen from Medtronic diabetes. If you're looking for an insulin pen that does more, you're looking for the in pen in pen today.com In a few moments, I'll tell you a lot about the show, but one of the things I'll tell you is how to find the series. So if you've just stumbled upon this one, and you'd like to find the rest, there's a way to do that. And I'll be telling you about it in just a second.
If you're into helping people, especially people with type one diabetes, I'd like to ask you to go to T one D exchange.org. Forward slash juicebox. When you get there, fill out the survey completely. And you've helped somebody, all you need to be is a US resident who has type one diabetes, or is the caregiver of someone with type one, t one D exchange.org. Ford slash juicebox. Join the registry, complete the survey, help someone with type one diabetes, help yourself perhaps, and support the Juicebox Podcast, you will do all of this in the fewer than 10 minutes that it will take to go to that link and complete the survey. The survey is very simple, you will know all the answers to all the questions. It is also HIPAA compliant, and completely anonymous, T one D exchange.org. Forward slash juicebox. There are links in the show notes of your podcast player and links at juicebox podcast.com. To all of the sponsors. And to T one day exchange, when you take the time to click on my links or to type them in a browser. You're telling the sponsors that you came from the Juicebox Podcast, and that is a wonderful way to support the show. Are you looking for a vibrant and intelligent community around diabetes? look no farther than the Facebook page, the private Facebook page for the Juicebox Podcast. It's called Juicebox Podcast type one diabetes. The group has over 28,000 members. And those members are responsible for between 70 and 110 new posts every day, on the Facebook page. Every conceivable conversation around diabetes is happening at Juicebox Podcast, type one diabetes on Facebook, you're gonna see great questions, thoughtful answers, and supportive people. No matter if you're an adult living with type one diabetes, or the caregiver of someone with type one, this group is for you. Doesn't matter if you eat low carb, or high carb or somewhere in between your questions and thoughts are welcome on our Facebook page. I hope you check it out. Last little bit if you're looking for the diabetes Pro Tip series, or the defining diabetes series or any of the other multitude of series that exists within the podcast, you can find them in a number of ways. They are at juicebox podcast.com. They are at diabetes pro tip.com. And if you belong to the private Facebook group, you can find them listed in the featured tab. Now if you're enjoying the podcast, please consider sharing it with someone else that helps the podcast grow more than anything word of mouth is definitely how the show has become what it is. If you have already shared it with everybody you can think of and you've bought it on the pod or index comm or supported one of the other sponsors. You've done the T one D exchange survey. And now you're looking for another way to give back to the podcast. Super simple. A five star rating and a thoughtful review in whichever audio app you listen in would be amazing. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.
Test your knowledge of episode 755
1. How does physical activity impact blood sugar levels?
2. How should insulin doses be adjusted based on physical activity?
3. Which types of exercises are beneficial for diabetes management?
4. How should one prepare for exercise to avoid blood sugar fluctuations?
5. What is the role of consistent physical activity in long-term diabetes management?
6. How should blood sugar levels be monitored in relation to exercise?
7. How should low blood sugar episodes during exercise be handled?
8. What are the benefits of incorporating different types of physical activities, such as aerobic and anaerobic exercises?
Please support the sponsors
The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here. Recent donations were used to pay for podcast hosting fees. Thank you to all who have sent 5, 10 and 20 dollars!
#751 Bold Beginnings: School
Bold Beginnings will answer the questions that most people have after a type 1 diabetes diagnosis.
You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - Google Play/Android - iHeart Radio - Radio Public, Amazon Alexa or wherever they get audio.
+ Click for EPISODE TRANSCRIPT
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 751 of the Juicebox Podcast.
Jenny Smith and I are back today with another episode of the bull beginning series and today Jenny and I are gonna talk about sending your type ones to school. While you're listening today, don't forget two things. One, Jenny works at integrated diabetes.com You can check her out and higher if you like, and to 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. We're becoming bold with insulin. If you're a US resident who has type one diabetes, or is the caregiver of someone with type one, in fewer than 10 minutes, you could go to T one D exchange.org. Forward slash juice box and fill out their survey. When you complete the survey. You've helped the podcast, you've helped people living with type one diabetes, and you may just have helped yourself T one D exchange.org. Forward slash juicebox. Hope you're enjoying the bowl beginning series. It's not done yet, there's more coming. If you've missed the earlier episodes, you don't even have to listen to them in order if you don't want to just go find them
this episode of The Juicebox Podcast is sponsored by touched by type one, please go learn about my favorite diabetes organization at touched by type one.org and find them on Facebook and Instagram while you're at it. This episode of the podcast is also sponsored by in pen from Medtronic diabetes, get yourself the insulin pen that gives you much of the functionality of an insulin pump in pen today.com. Jennifer, we're back. Yay. We're gonna do for the bowl beginning series today. Just the very simple headline here school. Now I was surprised. And then I thought about a little bit. There weren't a ton of questions about school. And then I thought oh, maybe that's because they didn't know the questions they ask. So I started adding more stuff to the list because it hit me pretty quickly. Okay, all right. So what ends up happening, if you hear most people's stories, they're diagnosed and school starts a week from now, it's always it's always that story, right? Like you don't get the whole summer to figure it out or something. It's like,
Jennifer Smith, CDE 2:43
it's over a break. Often, right? It's like somebody comes home for like Thanksgiving break or like the the winter holiday or something. And parents, especially for kids who have just gone to college, their parents are like, you don't look, do you feel okay? You know, and, and there's a new diagnosis. And now you get to go back to school two weeks later, let's figure it all.
Scott Benner 3:06
Anecdotally, I've always believed for like, a long time before I'm started making this podcast, just hearing people's stories and writing about diabetes, that people's lives are very like frenetic. And then when you hit a holiday or a vacation, or a long weekend, even you slow down enough to look up and go, there's something wrong with that kid. You know what I mean? Right? So
Jennifer Smith, CDE 3:30
right, well, and I think when kids go away, you also you miss the everyday visual that you usually have of them. So then when they do come back, and they look very different. I mean, not just like hair color, or how they're dressing now, there's a very visual, physical difference. And you can say, you didn't look like this. When I sent you to school in September.
Scott Benner 3:54
It's the same problem I have is when I'm walking through the house, I'm like, no one's gonna notice I've lost five pounds. So you just go up somebody's like, do you see it? Do you see the five and they're like, You look exactly the same. Thanks a lot.
Jennifer Smith, CDE 4:07
So take a beach vacation and then come back. And they'd be like, See, I do look different.
Scott Benner 4:13
So you know, just people say, Well, how do we transition? Back to school? Two big question. People want to understand about 504 plans, which I think are I always thought were widely understood. But then I I just realized I only know about them because of Hardin. And so we'll start but we'll start here. This person said it was crazy to me that after diagnosis, I was teaching my daughter's teacher about her care when it was so new to myself, and I didn't really know what I was doing. So I felt like I needed support and resources about transitioning. And she just said she said the schools can't really do much and they don't know anything. I either. And I will say from my own personal experience, the schools would try to how do i mean this? Sometimes principals are politicians, and it's their job to go, everything's fine, you're going to be fine. Your kid is going to be fine. Leave your kid with us. But they're not used to dealing with diabetes. It's always like, like, my, my daughter had a principal one time I swear to you, if you showed up at the front door, and the building was on fire, and people were jumping out the windows, she would have said, Go home, everything's fine. We've done this before. Oh, okay. She's just glad handing you right into, right into hell, you know, so, but when it's diabetes, specifically, what I find they like to say is, uh, we had a kid here last year with diabetes, or there's cars where there's two kids here. And it, it struck me finally, I don't know, the management style of these two kids at the level of their health, like, you know,
Jennifer Smith, CDE 5:58
absolutely. That's what I was gonna say. And it's a big one that a lot of when parents asked me, How do we approach this? What do we do about it, and that's one of the first things is to make sure that you have structured the needs to your child, like you said, Many schools have had experience or the nurse has been there long enough that they've had at least one student probably with, with type one diabetes. Again, the school might have a couple, but your child's plan is your child's plan, just because this other child doesn't seem to need accommodation or assistance with things. Their management style is very likely different than what you're doing with your child. And so they're very well we'll need to be some instruction and schools differ school to school system to system private versus public what they have in terms of resources, and allowances, some nurses travel between schools, and they're not always there. So it means establishing somebody that is always at the child's school, for the really young kids who may need somebody to check in with, versus the nurse that's always there. There are so many things that I've heard and seen that I mean, there are 1000s of ways that people address the needs. Yeah.
Scott Benner 7:19
And it does really begin with the scenario you're in. I mean, you just said it. But it's, you could be in a school where there's literally no nurse, and right, they're telling you like I don't know if you've ever met Mrs. You know, Smith, she works at the front desk, she's lovely. She'd be happy to give your kids a shot before from you're like, Okay, who she was, she answers the phone. And, you know, and she might end up being a godsend to you like, I have no idea. And but you have to you can't run in there and have all these expectations, and they don't have the infrastructure to handle it. Correct. Right. And you can't just force them. What I've learned dealing with schools, is that they're just people at work. Like you want to think of them as special somehow, because they're a teacher and etc. But they're people, they're at their job. They're not look, I mean, imagine if someone came to your job, Jenny, and they were like, Hey, we saw the things you do every day. That's great. Here's what else I'd like you to do. Right? This is Billy, don't let him die. You're like, Wait, hold on. I don't want that to be my responsibility. And that's what I would run into all the time. I had trouble finding people to be glucagon delegates, because they were like, wait, I'm like, Listen, if this should happen, if Arden has a seizure, you stick this thing in her butt and push the plunger, and you're going to say that's it. Yeah. And you're gonna save, you're gonna wait for 911 and hope and try to keep it from hitting your head on something like, You know what I mean? Like, nothing different than you would do if a kid needed an epi pen? Or? Oh, no, no, I don't want to be involved. The our school nurse had to search the school to find a handful of people who were willing to do what do it. Yeah. And I think,
Jennifer Smith, CDE 8:57
oh, sorry, go ahead.
Scott Benner 8:59
I didn't blame them.
Jennifer Smith, CDE 9:01
Right? Not at all. And, and you do. I think there are two definite, like mindsets that you have to have when you're coming up with a plan for your child one, a teacher is first a teacher, that is what they are, therefore, they have all of the other students as well. That doesn't mean that the needs of your child are not important. But you do have to understand that there's there's teaching that needs to happen. There's a purpose for going to school. So then establishing people that can be the check in person. Many times I've found that it's it's a little bit easier when schools have or your child's classroom has a designated like Teacher's Assistant. That's always there. The teacher has the instruction but has the chance to keep teaching where the TA is kind of there to help and assist behind and maybe more the one that you end up teaching more to because they've got a little bit more ability To help, right. But again, each school I think the biggest thing to go to first is whoever the head of the administration is, whether it's the principal or whatnot, what are your accommodations? Have you experienced this before? What What have you seen as protocols, this is what we like for our child. This is what we do. This is how we navigate and manage and have a plan or an idea already. And again, newly diagnosed, you may not know where to start. And that's where the community is very beneficial. And I've seen many, many plans posted, we've done this for our child, or we have these instructional like, you know, decision matrix that if this, then this, and it's very cut and dry and very easy to follow. Some teachers and people in the school are very willing to follow the CGM data, others don't want to do anything other than just respond to an alert message. So again, everything is very different. You kind of have to see what the school can accommodate. Yeah,
Scott Benner 10:59
we had a wonderful woman who was like, I have diabetes, I can help. And then we're talking to her and she had type two. And you know, she had never taken insulin before. And she was on Metformin, or something like that. And I was like, Oh, sure. Your skills are not going to translate here. But thank you very much. But we still, you know, she was willing to listen, and so there and learn people, and those are the people we taught, and I think that expectations are important. But it's always the seasol to me, you know, it's like, Well, I think my kids should have stable blood sugars at school. And then your school might say, Look, we're not comfortable bumping 150 blood sugar for your kid, like we're not going to do well, we'll treat over whatever the the orders from the doctor say. And that's, that's where I'll tell you, there's a simple sentence that you can put in your order from your doctors, if you can get your doctors to write this. Like, I don't you'll learn it any way you will. But basically, what it says is, these are the rules, unless the parents say otherwise. And then we and then we defer to the parents, and that way you can make to help make decisions. Yes, but you still might run into a nurse or somebody at the school is like, look, there's five kids that have diabetes, the school, we don't do this for any of them. And somehow they think that's a rule, then, you know, and so the way I always think about it is this. School is a long process, you're going to be in the same building. For a number of years, you might move to another building for a number of years, it's still the same system. These people work with each other, they know each other. You have to find a way to get what you want. Without being a pariah. You can't be the person that when you walk in the front door, they look up and they go oh, God, it's Jenny, you.
Jennifer Smith, CDE 12:48
Oh, right. Oh, yeah. Absolutely.
Unknown Speaker 12:52
With this Johnny, with a
Jennifer Smith, CDE 12:54
fake smile on your face, and like, Hi, how are you today? In the back of your mind, you're like, oh, no, hate
Scott Benner 13:01
me. Because I because I'm in here going, like, you know, I need you to correct a 120 blood sugar because I don't want my kids blood sugar to be that high. Right? I think that in the end. To break it down. You need, you need to have a plan that you can teach to someone else. Correct. If you're newly diagnosed, I think you need to explain to them, listen, we're just figuring this out. This whole thing is going to be kind of malleable for a little while. I'd appreciate it. If you could roll with this a little bit. I'm also figuring it out. I think you have to understand I don't want to say this. I don't mean this poorly. But I don't imagine that there are many nurses who are one minute at the premier children's hospital in the country working in the PICU that wake up one morning and go you know, I think I want to be a nurse at a middle school in my town. Like, these might be people towards the end of their career. Their training might be older, who knows what what the situation is right? But they're probably not Doctor House is what I'm getting at? Probably not Yeah, it's so they might have ideas in their head that are from a kid they helped three years ago, years ago, five years ago, 20 years ago, you have no idea. So you're, you're educating yourself. You're educating them along with them. But what I ended up figuring out, and then we'll go to some people's questions. I know I've said this in different places on the podcast, but it belongs here in this episode. For kindergarten, first second grade, Arden went to the nurse on a schedule. There was no there's no CGM at that point. So she was she was just going to nursing finger sticks shooting we had her like broke. I basically broke up the day in a way that I thought it seems unreasonable that she'll be she'll get low in my gaps of time, and I look back she never did get low. Oh, of course Ray once he was like eight, so her blood sugar's were pretty elevated to begin with
today's episode of The Juicebox Podcast is sponsored by Ian pen from Medtronic diabetes in pen is an insulin pen that offers some of the functionality that you've come to expect from an insulin pump. I know you're thinking, Oh, Scott, please tell me more. Well, I will. Yes, the pen is a pen. But it also has an application that lives on your smart device. This app shows you your current glucose levels, meal history, dose history, and activity log glucose history, active insulin remaining a dosing calculator, and reports that you and your physician can use. While you're trying to decide what your next step is. Well, well, well, it's not just an insulin pen, now is in pen today.com. That's where you're gonna find out more information and get started. If you're ready to try the pen, just fill out the form at him pen today.com. Or do some more reading. There's actually some videos you could check out too, about the dosing calculator, the dose reminders, card counting support, and the digital logbook. So if you want to lighten your diabetes management load, but you're not ready for an insulin pump, in pen is probably right for you. In Penn today.com. In Penn also offers 24 hour Technical Support hands on product training, and online educational resources. And here's something else that you'll find it in Penn today.com. That is actually very exciting. Now this offer is for people with commercial insurance and terms and conditions do apply. But you may pay as little as $35 for the in pen. And that's because Medtronic diabetes does not want costs to be a roadblock to you getting the therapy you need within pen $35. How crazy is that? In pen today.com in Panama requires a prescription and settings from your health care provider, you must use proper settings and follow the instructions as directed, where you could experience high or low glucose levels. For more safety information where to get started today, you can go to in pen today.com.
Jennifer Smith, CDE 17:27
But you started I think what you're saying here is that even a couple years in, you were really going off of not only technology that you had, but also a baseline that you could teach. That worked easily because it was a structured schedule. And for the newly diagnosed going into a school type setting, I think that's the best that you can really start with is these are the basics that need to be done to keep my child safe. And to allow learning because that's obviously the reason you're sending your kid there to is is to learn. Yeah, and if they're getting interrupted all the time, because of of alerts and alarms and things that are too aggressive for this point in diagnosis. It's not helping anybody
Scott Benner 18:16
well, and and what ended up happening was I basically spent the time from an origin was to till she was five, figuring out an ebb and flow to the day where she wouldn't get low. And then I sent her to kindergarten with that. The school was resistant about some of the things I wanted. And they didn't help her with a couple of things I'll bring up in a second. It happened, we had it set up where she tested, tested, tested, then at lunchtime or snack time even she'd go to the nurse's office, they would test her call me Tell me the number. And I would tell them how much insulin to use. And then they would send her back on her way. And she'd come back and test again. And this would happen before it would happen before snack recess at lunch where she'd get tested. And one day, my timer went off for for recess, and no one called me. So we did a couple of minutes. And I waited a couple more. And I have to tell you, I mean looking back on it. It was I was in like abject horror at that point. It just like we haven't total panic mode is going on, you know, is she is she having a problem? And they're helping her is like, I don't know. So finally I just call the school and I was like, Hey, Scott, you didn't call me about Arden. And the woman. The nurse said, Oh my god, Arden and she slammed down the phone and she was gone. And I was like, and you're like okay, what uh, what is that mean? So I sat there for a second and I thought, well, now she knows I know. And she knows she seems to know something to our way. Right? And she calls back and she goes Hi Arden's with me. She's fine. And I'm like, okay, And then they test her. So a little boy came in with a heart issue and had to be put on a monitor. And they just forgot Arden. And Arden went right from school. And because the nurse didn't come together, she was in kindergarten, she went right out on the playground. So they chant, they plucked Arden with a 50 blood sugar off the top of the monkey bars, and brought her inside. And I then went to the school and said, Look, this is what I was telling you about. Like, we can't just hope that the nice person in the nurse's office remembers to save our son's life every day at 1015. Like, you know, like, we need to and then they were more willing to listen to the ideas that I had. Right. When Arden left second grade, maybe one of the luckiest things that ever happened to her was that her teacher and teachers will know this phrase, I don't know what it is, but her teacher wanted to move from second grade to third grade with the kids. Okay, so she did that. She taught the kids in second grade, went to third grade and taught the same group of kids.
Jennifer Smith, CDE 20:59
That's a nice school that does that was very cool. And a frequent thing. By
Scott Benner 21:03
the way, that person that teacher was that Arden's graduation, like she showed up at her high school graduation and went around and found every one of those kids and took a picture with them. It was very, very nice. But what ended up happening for Arden was, we had we had fresh eyes that also knew the past. And Arden was struggling in math. So the woman calls me one day. And she says, I know why are you struggling with math.
Jennifer Smith, CDE 21:30
And I said, why she where she is with her blood sugar at that time of day
Scott Benner 21:34
when we sent her to the nurse. So the math instructor would start five minutes into it every day, Arden would get up and quietly leave the room and go to the nurse's office, come back five, seven minutes later missed the instruction, and then put her head down and try to do the work. Yeah, no one ever noticed. It just it just because it was such a part of the day. And it took her a couple of years to rebound and catch up from that because they were still moving forward. She had to learn the back stuff. And it was that moment. I was like, Okay, we're done. And that's if you go to episode for the podcast, I talked about how I figured out how to text diabetes. And Martin has never been to the nurse's office since that that moment. So the last day of like the last day of second grade. Because she contacted us over the summer and told me that.
Jennifer Smith, CDE 22:21
And that's something to navigate to, you know, because some school systems again, with these plans, you really have to think about how they're written. Because if they're not written specific to what you have worked out and is safe with your child to do texting, diabetes, not having to go to the nurse, the nurse is there in case of need or somebody else. But otherwise, it's just navigated between you and your child. I would say that that's, that's less common. And it's it's kind of a special school or a special written plan that really worked out that way. I've seen much more the, the child has to check in with somebody. And even if your child is very able to do majority of what they're doing on their own, because they do it in the summer, on their own or on weekends or whatever. You have to kind of almost prove that they can do that. Before they'll let you not check in with someone. Yeah,
Scott Benner 23:21
no, I mean, I very specifically on my end, I don't I didn't you know, I was a stay at home parent. So I wasn't at a job. But I could make that part of my day. I mean, if right. I don't know how it would work for other people. But it it definitely. It definitely freed her up to move around the building better. It actually helped us fix problems more quickly, right? Like she didn't have to go to the nurse to find out that she was low and get something like we would do it in the rain. It's how she started bolusing like she would Bolus in class before going to lunch stuff like that. It's not going to work for everybody, for sure. But it was the way I found to get around this stuff that just kept coming up, you know? Yep.
Jennifer Smith, CDE 24:05
And that's it. I mean, that's important. Absolutely. I've even seen many comments from parents who have problems with any accommodation at all. My my teachers won't do that. They don't have time to do that. Your child isn't special. They don't need this kind of accommodation. I mean, I've seen the total opposite in terms of assistance, which obviously is not what you want to walk into.
Scott Benner 24:31
Why what I would do is every year in the summertime, I'd go and meet with Ardens teacher, and I would explain diabetes to them. Because they're not going to know right? And so you say things like you don't want their blood sugar to get low. They don't know what that means. Yeah, like a great like, why? Because when I'm 60 I don't feel well and when I'm 50 I'm dizzy but do they know like your brain will shut off when you're 20 like I don't know what they know and you will also want to be able to tell them listen And this is a real concern. And we need to guard against this. Having said that, I don't imagine it's going to happen. But then again, correct, yeah, a light doesn't go off on your forehead before you're going to your blood sugar goes to 35. Like, it's just no, nobody tells you ahead of time, you know,
Jennifer Smith, CDE 25:17
well, and one thing that does hit from a teacher level, obviously, that's their job is to instruct, right? One thing that really sort of comes across in terms of the importance of glucose. And what their job is supposed to be is giving some baseline information about blood sugar level, and learning ability. blood sugars here and here outside of this range, are going to mean that my child may be fidgety may not be paying attention may be causing problems, when it's not, it's not what they want to be doing. It's because their blood sugar isn't right. Thus, my kid isn't going to be learning what you're trying to teach them, it's going to be disruptive. So if you help us to keep their blood sugar in this range, you can continue instructing better, my child will keep learning better. And it's a win win. Right? That's a point that often makes sense from the teacher angle is the association between learning ability, attention ability, and glucose levels.
Scott Benner 26:24
And I, I shone a light on security and, and health and I told them about long term health too. I said, Yes, we because they're like, Well, why don't we just leave our blood sugar higher? And I said, because, you know, there's, there's damage that comes from that, to that it's more long term. I think the way I put it in one meeting one time is I said, Listen, if you want to keep Arden's blood sugar at 200, all day, why don't I just pull her out of school, send her to an island and let her live her life? You know, it's like, because at least she'll be healthy. Like, maybe she won't have an education, she won't know how to, like,
Jennifer Smith, CDE 27:00
work or help herself or know how to pick coconuts. But she'll be
Scott Benner 27:03
alive. And you know, like that. I'm like, That's not okay, either. And they're like, Well, I don't understand why this kid. We don't we don't help this kid until their blood sugar gets to 200. I was like, well, that's their decision, like, No, it's not okay. And you're right, you have to, you kind of have to be both sides of the conversation, you need to get what you need, without upsetting anyone. And you have to be helping them. It's in negotiation, that you're the only one who cares how it goes. I don't know if that makes sense or not. Right. So you almost have to defend the person who you're negotiating with the same time I used to put, every year I would find something in Arden's 504 plan that we didn't need any more. And I would give it away at the 504 meeting to make them feel better. I'd be like, no need to do this anymore. Like you know, you're doing this, you don't need to let's make this easier for you and get rid of this. And then that we'd leave the room and they'd be like, Oh, good. I got. And, and, and meanwhile, you were never really adding things to 504 plans, you were kind of just manipulating them to make them work for the age range, like all the sudden, like standardized tests, or the technology
Jennifer Smith, CDE 28:14
that you now have. Right, right, right, God, yeah. I mean, as that changes there, and especially with the technology that's changing the way that it is right now, with all of the FDA approved products, there is less attention that a teacher or a nurse may need to give, it doesn't mean that they don't need to know how to help in the case that it comes up. But this technology can certainly be something to educate them. While their system is going to do this, it should be catching these kinds of things, they still need to touch base, or they still need to check in with you about this. So again, those might be the touch points, kind of like you're saying that you don't have to really do as much. They got something here helping but we still need this in this in this.
Scott Benner 29:01
In the end, you can set up a 504 plan, which is going to give you some legal backing, like once it's in the 504 plan, they have to do it. But there are you do need to understand private schools don't need to accept kids no matter what. Right.
Jennifer Smith, CDE 29:20
That? That's an interesting question. I mean, private schools typically have different rules than public schools. And if they don't have accommodations, it often falls to the parent to find the accommodation so that their child can stay in that private environment.
Scott Benner 29:41
And preschools fall into that heading to Yes, it's might be hard difficult to find a preschool who's willing to do this for you. Right? Yeah. Yeah, it is very interesting. Okay. So some of the things that I've run into no matter what you're gonna Get your kids schedule, and they're gonna have gym right before or after lunch or lunch and you're gonna be like,
Jennifer Smith, CDE 30:08
a lot of fun, I've got a couple little kids who got, they've got recess, then they've got snack time. And then they go to gym class. That's fine, yay,
Scott Benner 30:20
write it off, and then pour it in, then put insolate in, and then have him run some more. Yes,
Jennifer Smith, CDE 30:26
that's fun. And it's not every day. So you can't even accommodate like an everyday like, pattern or something. It's like Tuesdays and Friday. And this is what
Scott Benner 30:36
I know, I actually did have in one of Ardennes accommodations that they couldn't put activity right next to lunch. But it took me a couple of years to get them to agree to that. And so and it was hard. I mean, it was hard to get them to do that, to be perfectly honest, that was every year,
Jennifer Smith, CDE 30:54
because it's a manipulation of what the schedule is going to look like for everybody, then it doesn't just affect her, every kid in her class is going to also not be able to have
Scott Benner 31:04
or you have to put a class where she doesn't belong to make it work, etc. And in the end, I never made them do anything. We always did come to an agreement along the way, because I was never looking to be like I I mean, I don't know if I was or not. But I was trying very hard not to be like, Oh God, here he comes, you know, like, I don't want to talk to that guy hide. When Arden went into high school, and the nurse said, I actually brought along the nursing staff. So I learned this in elementary, from elementary school to middle school, I brought the nursing staff from the elementary school to my first meeting with the nursing staff from the middle school, that's a great idea. Because I was like, I'm gonna say I do a bunch of stuff, it's gonna sound crazy to you. And this person right here knows how it works. And so that made the next person. So when I got to the high school, I did it. But the nurse was just like, well, that's not how I do it here. And she pushed back and she had like a big personality. And she goes, I like having a relationship with all my type one students. And I said, Well, that sounds lovely. But in my world, I would love it if my daughter didn't know you. Right? That's what we're shooting for. Okay? Just like every other kid in the school does not want to end up in the nurse's office. I don't, I'm sure you're wonderful. I bet you make it fun for the type ones. But that's not our goal here. So she pushed, she pushed back and pushed back and I was like, listen, it's not what we're doing. Like, it's not gonna happen, like, we're gonna bring some supplies. And if something gets completely upside down, or Arden has to swap a pump or something like that, you'll see her, right. And that's how it ended up going. And she was okay with that after a while, you know, but it took way to talk about it. They had to they had to wait and take time. Nobody ever yelled at each other. That's the other thing. If you're yelling, it's over. Like don't don't lose your don't lose yourself there. I think. You know, as we're talking about this, I wonder if I couldn't create a place online where people can upload their 504
Jennifer Smith, CDE 33:03
plans. That would be I think, a really great resource. I mean, kind of like, kind of like you have a place online for people to look for good endos, or good doctors or good educators? That would be a really great resource.
Scott Benner 33:18
Yeah, I wonder if we couldn't just turn them into PDFs and put them so people could look at them can look at them. Because
Jennifer Smith, CDE 33:23
you I would even say maybe categorize them, like, toddler age, like almost preschool, you know, grade school, middle school, high school, so that as you filter through them, you can go age appropriate. Yeah. For what your accommodation might look like, or how it might change. Like you said, you took your nurse along to prove to the next entry level of kind of school age, this is what work this is what we did, it is just fine. You know, please accommodate.
Scott Benner 33:51
I'm thinking that because like I'm looking at a question here, like, what do I do if my kid wants to skip lunch at school? Like, I don't know how to answer that question. Like, yeah, I mean, I do. But it's, it's not something you're going to put in a 504 plan or something like that in so there's going to be more, there's going to be more scenarios that are really going to be on you to kind of like dance with then just hoping that there'll be in this document and that fixes everything.
Jennifer Smith, CDE 34:16
Right? The document really should be very specific needs, right? Not what ifs. In right in what if my kid doesn't want his snack in the morning or doesn't want the snack that was packed and prefers the cupcake that came in as the birthday treat? Yeah, what if what?
Scott Benner 34:33
Yeah, no, the 504 plan can't incorporate everything that your anxiety might put into your head on from day to day like it's like Ardens was stuff like Arden has a bag with her. It'll have these things in it. If there is an emergency in the school, you need to make sure that bag goes with Arden and that was when she was younger. Right? And then as she got older, the language changed slightly to like you can't restrict Arden from taking the bag, you know, once it was on her to remember the bag, right? You know if Arden's load, do this, then do this then call 911, after you've done that call the parents or we had stuff like you have to get the school bus driver trained to understand basic, like stuff like that. Yeah, it wasn't like if Arden decides at 3pm that she wants to x, then you have to, like you can't. I know, that's what people want. But this documents not going to be. It's not everything, you know, it's just it's, it's the stuff.
Jennifer Smith, CDE 35:35
And if anything, that kind of detail may make it very confusing as to the very, very real and important things that really should be being done every single day. The same way.
Scott Benner 35:47
Yeah, right. But little things like as Arden got older, she would write her blood sugar on the top of a test before she started taking it. So she'd look at her CGM and write her blood sugar on the top. And that way, if the test came back, crazy, wonky, different than you expect her skills to be, we could say, hey, look, her blood sugar was high, maybe you could let her take it again. Right we've ever
Jennifer Smith, CDE 36:09
done with a CGM, you could have followed what happened to the blood sugar, you know, maybe blood sugar started out fine at 101. But then in test taking, she's not really paying attention. And it really starts to dip there too. You can follow that information to be able to go back and say, you know, could we potentially do you do this?
Scott Benner 36:25
It's funny. So if I, if I started this episode over and decided to make it two minutes long, I would say you're in a relationship with these people. Now. It needs to be harmonious. There might be times where you have to bite your tongue. You don't want to get into a fight with anybody. It's a long process. You might be with them for 12 years. And there are going to be times they're gonna say things that you're like, that's not right. But you got to understand their perspective, too. And make it work. Yeah, it's like being married. Except I'm just gonna say without the sex. But you know, if you've been married, I've been married.
Jennifer Smith, CDE 37:05
Yeah, there's give and take. Yes, exactly.
Scott Benner 37:07
You give a lot and somebody takes a lot. If you're lucky, your kid gets his lunch on time. Okay, all right, Jenny. Well, thank you very much, of course.
A huge thank you to Jenny Smith for being here with me again today. And I'd like to remind you that you can hire Jenny integrated diabetes.com. I'd also like to thank Ian pen from Medtronic diabetes. If you're looking for an insulin pen that does more, you're looking for the in pen in pen today.com. In a few moments, I'll tell you a lot about the show. But one of the things I'll tell you is how to find the series. So if you've just stumbled upon this one, and you'd like to find the rest, there's a way to do that. I'll be telling you about it in just a second.
If you're into helping people, especially people with type one diabetes, I'd like to ask you have to go to T one D exchange.org. Forward slash juicebox. When you get there, fill out the survey completely. And you've helped somebody, all you need to be is a US resident who has type one diabetes, or is the caregiver of someone with type one, t one D exchange.org Ford slash juicebox. Join the registry, complete the survey, help someone with type one diabetes, help yourself perhaps, and support the Juicebox Podcast, you will do all of this in the fewer than 10 minutes that it will take to go to that link and complete the survey. The survey is very simple. You'll know all the answers to all the questions. It is also HIPAA compliant and completely anonymous. T one D exchange.org. Ford slash juicebox. There are links in the show notes of your podcast player and links at juicebox podcast.com. To all of the sponsors. And to T one D exchange. When you take the time to click on my links or to type them in a browser. You're telling the sponsors that you came from the Juicebox Podcast and that is a wonderful way to support the show. Are you looking for a vibrant and intelligent community around diabetes? look no farther than the Facebook page, the private Facebook page for the Juicebox Podcast. It's called Juicebox Podcast type one diabetes. The group has over 28,000 members and those members are responsible for between 70 and 110 new posts every day on the Facebook page. Every conceivable count conversation around diabetes is happening at Juicebox Podcast, type one diabetes on Facebook, you're gonna see great questions, thoughtful answers, and supportive people. No matter if you're an adult living with type one diabetes, or the caregiver of someone with type one, this group is for you. Doesn't matter if you eat low carb, or high carb or somewhere in between your questions and thoughts are welcome on our Facebook page. I hope you check it out. Last little bit if you're looking for the diabetes Pro Tip series, or the defining diabetes series are any of the other multitude of series that exists within the podcast. You can find them in a number of ways. They are at juicebox podcast.com. They are at diabetes protip.com. And if you belong to the private Facebook group, you can find them listed in the featured tab. Now if you're enjoying the podcast, please consider sharing it with someone else that helps the podcast grow more than anything word of mouth is definitely how the show has become what it is. If you have already shared it with everybody you can think of and you've bought it on the potter Dexcom are supported one of the other sponsors. You've done the T one D exchange survey. And now you're looking for another way to give back to the podcast. Super simple. A five star rating and a thoughtful review in whichever audio app you listen in would be amazing. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.
Test your knowledge of episode 751
1. Why is early diagnosis and treatment of type 1 diabetes important?
2. What are the common symptoms of type 1 diabetes?
3. What is the role of insulin therapy in managing diabetes?
4. Why is carbohydrate counting important in diabetes management?
5. How should blood sugar levels be managed during exercise?
6. How can stress and emotional health affect diabetes management?
7. What are the benefits of having a diabetes care team?
8. Why is it important to stay informed about new research and advancements in diabetes care?
Please support the sponsors
The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here. Recent donations were used to pay for podcast hosting fees. Thank you to all who have sent 5, 10 and 20 dollars!
#747 Bold Beginnings: Flexibility
Bold Beginnings will answer the questions that most people have after a type 1 diabetes diagnosis.
You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - Google Play/Android - iHeart Radio - Radio Public, Amazon Alexa or wherever they get audio.
+ Click for EPISODE TRANSCRIPT
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 747 of the Juicebox Podcast.
On this episode of bold beginnings, Jenny Smith and I are going to talk about flexibility. Don't forget the bold beginnings series is all about things that listeners of the Juicebox Podcast wish they would have known in the beginning. While you're listening today, don't forget 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. If you enjoy Jenny Smith and you'd like to hire her, she works at integrated diabetes.com. If you're liking what you're hearing in the bulb beginning series and want to expound learn more, you're looking for the defining diabetes episodes, and the diabetes pro tip episodes. There are lists of them at the Facebook page Juicebox Podcast type one diabetes. In the featured tab that's a private group with over 27,000 members. If you're not on Facebook, check out juicebox podcast.com or just search in your favorite audio app.
This episode of The Juicebox Podcast is sponsored by in pen from Medtronic diabetes, take the right insulin dose at the right time. The right pen is a reusable smart insulin pen that uses Bluetooth technology to send dose information to your mobile app. Offering dose calculations and tracking in pen helps take some of the mental math out of your diabetes management. You can get started right now within pen at in pen today.com. Or perhaps you're ready to talk to a healthcare provider about m pen. Again, in pen today.com. Head over there now to hear about the app that has current glucose on it meal history, dosing history and much more like dosing reminders, carb counting support and that digital logbook, lighten your diabetes management load with in pen from Medtronic diabetes seriously, in pen today.com. Just head over now and check it out. impendent is an insulin pen that you may pay as little as $35 for offers available to people with commercial insurance terms and conditions apply. But $35 for an insulin pen that talks to an app on your phone and keeps track of things. Not unlike an insulin pump. This sounds like something you want to learn more about in Penn requires your prescription and settings from your healthcare provider, you must use proper settings and follow the instructions as directed. Or you could experience higher low glucose levels. For more safety information visit in Penn today.com. I don't have the energy to pretend that we haven't been recording for the last hour, Jenny. So we're back. We're back with the bold beginning series talking about flexibility. Maybe an unsung tool along with texting as far as I'm concerned about diabetes. So yes, this first person says that in the beginning, we were not educated on the needs of insulin, and how they would change over time or with exercise or with growth. It was just about finding the settings that fit at diagnosis at diagnosis. I wish I was told that these things would change and the diabetes was a marathon and not a sprint. And that I would need to be flexible. So do you see that a lot with people they're stuck in like this number used to work, I don't know what happened.
Jennifer Smith, CDE 3:54
I do especially for people who have a level of an endo I would say or a level of somebody that they are only really only checking in with, you know, every six months, they're kind of left to their own ability to manage. And even though what was working isn't working anymore. They don't have the tools to evaluate how to make a change, or they don't necessarily maybe feel safe making a change because they've had enough. I call it hand slapping when they go into their physician's office. Well, why did you change this? You know, this number is different in your download. Why did you not do what I recommended six months ago? Well, I mean, there's some explanation something changed. Yeah, I tried to navigate it. Right. So I think that's a reason that some people end up sticking with where they are even though they know it's not working or they realize that something's changed. Because they may not have the know how or the care team to really help them.
Scott Benner 4:57
I think to add to that one of the sadder things I say is when people know that they should be doing something and they let their fear of what's going to happen when they get to the doctor's office stop them. That takes me into this person's statement. I thought that insulin, the initial insulin dose was it and it was set in stone. And then we know we learned very quickly, that the more flexible you are, the more successful you could be that you could change a dose if it's not working. Or, you know, if you're worried about changing themselves, or call the doctor, the nurse, she said she called her CD every day for two weeks. But her takeaway here is don't suffer, try something else. And you will find something that works. I mean, that's just that's a great statement, you have to just keep experimenting and trying things. And if something doesn't work, try something else. And I think the way I put it in the Pro Tip series is that when you're learning to Pre-Bolus a meal, you can if you have a CGM, see what happened. And then the next time say, Well, look, I'll do a little more, a little less, a little sooner or a little later, you adjust your timing and your amount until it starts working for you the way you expect it to or the way you want it to forget. Expect it like the way it the way it can work.
Jennifer Smith, CDE 6:08
Right. And I think the comfort level, from another piece of understanding can you can get comfortable faster, if you understand that. You're going to try something. And if it goes the wrong way, meaning you're not higher, but you're actually lower than you ended up being. You are not in the middle of a desert without tools to help write that drop or that low. Right. I mean, maybe you are in the desert. And if at that point, you clearly need to have supplies.
Scott Benner 6:41
Someone stuck in the desert, they're listening to this podcast they have they're misusing their, their their resources, are resources at their disposal. Use the phone to call someone.
Jennifer Smith, CDE 6:51
Yes, exactly. But you know most of us have, thankfully have something to treat that drop with. And if you are experimenting, have those things on the ready, right? Have them in your pocket, have them in your purse, have them in your glove compartment, whatever. Because you may with experimentation, find that things don't necessarily the first time go the way that you want them to go.
Scott Benner 7:14
Yeah, yeah, be ready for it not to go. Ready. Ready, that's for sure. Be ready. That's right. Yes. Well, here's this next statement says that what I didn't understand was that the carb ratio was a guide even. And the Basal insulin which needs would change, she said, I had a magical idea that if I measured everything, I would nail down the doses. And that would be it, they'd be done. Right. Like she just wasn't measuring the food correctly, she wasn't assessing the amount of carbs. But go to the pro tip about glycemic load and glycemic index to understand that all carbs aren't created equal. She said that we would glide through diabetes with no problem was her expectation, if she just measured the food correctly, the endo made it seem like that as well. And I wish someone would have told me that you have to be flexible, and that dosing changes would have saved me quite a bit of time and stress.
Jennifer Smith, CDE 8:06
And in terms of like clearing that up dosing changes, there are a couple of thoughts around that right dosing changes, meaning as you grow, or as your child or your team grows, their doses will change. Yes. But another like way to think about dosing might be the strategy of the dose might not be the amount that changes meaning your insulin to carb ratio. But this type of a meal may use this type of dosing strategy for insulin. So doses will change. Many people have different insulin to carb ratios through the through the day, depending on the time of day. And as precise as you can be, with a label or with estimation. Absolutely. That goes a long way. But
Scott Benner 8:53
Arden doesn't eat a lot of like sugary candy, but when she does, it requires a longer Pre-Bolus with less insulin than the carbs would indicate. So if she's gonna eat 15 carbs of gummy bears for fun and not for you know, as as low, then, you know, it might not be the exact like in Arden's case, 15 cars would be like three units and 3.2 units or something like that. So she probably doesn't need the whole 3.2 She might need more like two, but she's gonna need it with a longer pre loss because the sugar is gonna hit her so quickly. And but it also doesn't punch with the same weight as a baked potato does. So you don't need as much insulin that might sound in the beginning you that might I might have just somebody who's newly diagnosed could have heard that and thought, why don't you just tell me I have to build my own rocket and fly to Jupiter. Because I don't know how to do any of those things. But this stuff is not difficult once you get it's
Jennifer Smith, CDE 9:53
not and I think one thing to kind of clean that up in terms of the insulin to carb ratio is B Because most people eat a complex type of like meal, there are a little bit of all the different macronutrients carbs, proteins, fats within a meal time. ratios. For most people are really adjusted with that idea in mind of a lingering effect of a meal. So ratios are often more aggressive than they would need to be if we just lived on simple carbs. Simple carbs have a very quick process, they go in fuel the body, they come out. And that's why if you really eat only carbs, you're constantly driving this hunger road, right? So that might explain the difference between ratios for a meal versus ratios for a handful of gummy bears that I just want to eat.
Scott Benner 10:51
By the way, there are some brands, gummy bears are better than others. But I'm not here to push up gummy bears. This person just wants me to make the point that because things are dynamic, and flexibility is important. It's another reason to say that a person who you only see every three or six months might not be the best judge of how to make adjustments was a nice way of saying that. I think the most important thing that someone could have told me is that insulin to carb ratios, Basal rates, correction factors will change forever. I don't know if they change forever. But it changed a lot when you're young. And you're growing. Because I had this notion again, that they wouldn't change little things like Right, like, why would? Why would these things change, you could have been a more sedentary person and suddenly become more active, those things would change. You could gain weight or lose weight, those things would change, you could change the way you eat from more complex meals, like Jenny just described, to plant based or, you know, correct, whatever these things would all change how much insulin you're using. These are not. These are not like set in stone numbers that no matter what happens forever and ever are going to work. This person says My biggest help was just hearing on the podcast that I needed to be fluid that nothing was going to be absolute. A lot after I was diagnosed, I spent five and six hours a day researching how why? What can we do like just everything I didn't know what to do. And after my daughter got her Dexcom we would watch the numbers all day just and it burned them out. Yeah, this is flexibility coming from a different like we've been talking about flexibility about using insulin, but this person is talking about flexibility. Yeah, for life and to pace yourself. It was you know, I would say that took me some time as well. Because I was at one point not good at diabetes, then got much better at it. And then as my daughter started having impacts from hormones, it got hard again. And I had this expectation set in my head that I could keep her blood sugar under 140. No problem. And then all of a sudden, it started to go up more. And those higher numbers gave me made me stressed. Yeah, you know, and I had to say to myself, I'll figure it out. But while it while we're figuring it out, I can't torture myself the whole time. And so that is sort of flexibility with how I was thinking about the numbers, you know,
Jennifer Smith, CDE 13:32
right hand because people get a CGM. Many people not everybody, but many people get a CGM very quickly after diagnosis. Now. So you have you have this scale of information to be able to watch. And I think, you know, in this person's case, obviously, it was the watch from a well, I don't know what any of the variables are going to do. So I just have to watch. All day long. I just I and maybe they were doing it initially from a standpoint of learning. But then you can get into this almost OCD habit of if I don't watch it, what if something happens when I don't see what's going on? Right?
Scott Benner 14:16
Right? Yeah, for me, if you have a CGM, the the key to losing that feeling is to set reasonable alarms high and low. And do not think about that thing. If it's not beeping, just correct. Let's go Yeah,
Jennifer Smith, CDE 14:31
absolutely. And that they meet those targets might get, you know, a little bit more narrow or narrower as you feel more confidence and more comfort and understand insulin a little bit better. Understand. I treated the low. It's good. I know that this amount works. I don't have to worry about it. You know, again, I can say that. I mean, I did so many finger sticks before I got my first CGM so many finger sticks today. Mine might have back They looked like a line of CGM over the course of the day. But I, you know, I was constantly setting an alarm. Oftentimes, I didn't even have to wait for the alarm to go off for an overnight like fingerstick. Because I, I did worry about overnight lows. Yeah. And without a CGM, I had no way to know other than what my blood sugar was at bedtime. And then what it was at like two o'clock in the morning, which when I was on injections with a Basal insulin was my time to go low. And once I was on a pump, and then I started on a CGM, not too long after I had my pump, it became very, like, visible to me that I didn't have to have that alarm anymore. Okay, again, with the alerts and everything that I set well in my CGM, I stopped setting an alarm. I was like, if my blood sugar goes above or below, like you said, I will get alerted. And if I don't get alerted, I can just sleep. It's great.
Scott Benner 15:58
I think it's a great way to just alleviate that stress. It's just I mean, our hours are very tight, I think 70 and 120. But when it's not beeping, we're staying between 70 and 120. And there's no reason to think about it. And they're so tight that if she gets the 120 and she's rising, it's not difficult to come back around and fix it. It's not like you can't, you can set it like, you know, 70 and 300. And go I don't know, I don't have to worry about this thing's not making noise. But yeah, flexibility around diabetes. I mean, listen, flexibility around everything is really important. But around diabetes, it's going to, it's going to help you. I mean, you just heard it a number of different ways, not just dosing, but I think psychologically, too. Absolutely. Cool. All right. Well, Jenny, thanks so much for doing
Jennifer Smith, CDE 16:49
absolutely always fun.
Scott Benner 16:59
Thanks so much to Ian pen from Medtronic diabetes for sponsoring this episode of The Juicebox Podcast. Check it out at in pen today.com. If you can't remember that there are also links at juicebox podcast.com. And links in the show notes of the podcast player you're probably listening in right now. And if you're not listening in a podcast player, I mean, can you please subscribe and follow on a podcast app it helps the show and honestly it's easier for you. The episodes come right to your phone, and the phone is right with you constantly. Mine's right here. See, I just picked it up. Everyone always has their phone.
So let me just tell you again, because I know there are a lot of episodes of the podcast if you're looking for the defining diabetes episodes, or for the diabetes pro tip episodes there of course, right in your podcast player, just go to all episodes and you scroll around and you can find them or search and find them by searching for something like diabetes, pro tip or defining diabetes. There are also lists available in the private Facebook group, which by the way, is completely free Juicebox Podcast type one diabetes, so not only you're going to find a Facebook group, with 27,000 members in it, people just like you were sharing experiences and ideas. But at the featured tab at the top, you'll find all the lists of not just these series, but all of the series that exists within the podcast and there are many. There's even a special website diabetes pro tip.com, where the defining diabetes and diabetes pro tip episodes are even if you just needed to see the episode numbers that correlate with each episode so you can go back to your podcast app and and look for that episode. I may have just made that sound more difficult than it is juicebox podcast.com diabetes protip.com Juicebox Podcast, type one diabetes on Facebook, or just scroll through your podcast app or use the search feature. The defining diabetes series is amazing, as is the diabetes Pro Tip series. You don't want to miss it. If you've been enjoying these bold beginnings episodes and you want to dig down deeper, those two other series. Those are the place to go. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.
Test your knowledge of episode 747
1. Why is it important to understand the different types of insulin?
2. What is the importance of regular blood sugar monitoring?
3. How should insulin doses be adjusted?
4. What role does diet and nutrition play in diabetes management?
5. How does physical activity impact blood sugar levels?
6. How should diabetes be managed during illness and stress?
7. What are the benefits of using diabetes technology, such as insulin pumps and CGMs?
8. Why is building a support network important for diabetes management?
Please support the sponsors
The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here. Recent donations were used to pay for podcast hosting fees. Thank you to all who have sent 5, 10 and 20 dollars!