Scott Benner 2/16/25 Scott Benner 2/16/25

#1435: Small Sips: All Carbs Aren't Created Equal

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.

Carb counting isn’t just about numbers—it’s about understanding how different carbs affect blood sugar differently.

+ 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, welcome to the sips series.

These foundational strategies were nominated by listeners. They told me, these are the ideas in the podcast that truly made a difference for them. So I distilled them down into short, actionable insights. There's not going to be any fluff or complex jargon, just practical, real world diabetes management that you can start applying today. And I know your time is valuable, so we're keeping these short. Another small sip will come out once a week for the foreseeable future. If you like what you hear, check out the Pro Tip series or the bold beginning series for more. Those series are available in the menu at Juicebox podcast.com and you can find complete lists of all of the series in the featured tab on the private Facebook group. 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. The questions you have, I guarantee you there's answers to them in the Juicebox Podcast, and it's all free. You Jen,

Jenny, broccoli, mashed potatoes, white bread, rice,

Jennifer Smith, CDE 1:35
lollipop. I like broccoli in there. They're

Scott Benner 1:37
all food, right? They're things people put in their mouth, they

Speaker 1 1:41
are all food. I like the fact that they are technically all food, yeah. Now,

Scott Benner 1:46
if we took 10 carbs of broccoli, 10 carbs of mashed potatoes, 10 carbs of brown rice, 10 carbs of basmati rice, 10 carbs of all giant lollip, how much? How big would a lollipop have to be to be 10 carbs? Probably not that big, right? Well, yeah, no, your

Jennifer Smith, CDE 2:02
typical lollipops, like the little round, circular ones that are like a quarter size, are usually five to eight grams a piece, depending so, you know,

Scott Benner 2:10
I'm old enough to think of that as a doctor's office lollipop. It is. Yeah, I don't think they give this away. Lollipops

Speaker 1 2:16
that had the curved bottom, they had the two sticks that were a curve. Do you remember

Scott Benner 2:21
those so excited? She's so excited. She's like, I love that lollipop. I have to tell you. I went into a place the other day to order something, some food, and it wasn't gonna be ready for a half an hour. And I said, I'm gonna go wait in my car. You know, it's that time of year. I'm like, hey, these people are sick. I know they are. I gotta get out of here. And they had a, like, a bowl of lollipops. And I was like, I'm just gonna take one of those. I just I rolled outside, sat in my car with my lollipop. But I bring these things up because if we took 10 carbs, 30 carbs, and made equal piles, carb wise, of all these different foods, it doesn't mean that those carbs are all going to impact your blood sugar the same way. It doesn't mean that they're going to require, and they think this is the part that throws people off the same amount of insulin. So 10, you know what I mean? I want to talk about that.

Jennifer Smith, CDE 3:08
Yeah, no, I think it's valuable to bring up, because I think in the world we live in now, with the technology we have, we can actually see more of what you're saying. We can see that 10 grams of broccoli versus 10 grams of mashed potatoes, let's say are all worth they're all worth the same amount of insulin. But because we have the quality of technology in delivering that insulin, we have a better way to push that insulin out, to cover the food. And we also know a lot of people, thankfully now know a lot more about Pre Bolus thing for certain things versus not other things. So that the understanding of how insulin works and then how food digests, they're really they're the two factors that are so very important, and a carb is a carb as a carb is not true when you're trying to deliver insulin to match the effect that that CARB is going to have once it hits your

Scott Benner 4:13
bloodstream, right? I have to tell you that we did a defining diabetes episode called carb absorption and digestion. It's 668, was a long time. It was a very long time ago, and I understood by then, through my experience with Arden, that all carbs weren't created equally. Like, that's how I thought about it, and it's how it comes out in the podcast. It wasn't until one day, I think, in one of the pro tip episodes, where you started talking about the digestion. And I have to admit, like, I don't know if I ever told you this at the time, but I was like, oh, that's why. Like, you know what I mean? Like, I was like, I knew it was happening. I saw it happening. I knew how to combat it, like, the whole thing, I didn't know why it was happening. And I found that's been such a almost set a delightful path, because I think it. Really opened up the podcast a lot, because it's led to so many other things, like, great, like, you know, initially, just the conversation of, like, Look, if you put those potatoes in there, the makeup of those is going to, you know, kind of dictate how it gets digested, how long it stays in your system, how long it's impacting but if you like, go flop a little sour cream, you know, or some butter on top of it. Butter is a great example, because no carbs and butter. So you know, if your mashed potatoes are really just a butter delivery system, and it slows down your digestion, well, then those potatoes, they sit in your stomach longer, they impact longer. And that's what I mean by it like, yes, it's 10 carbs of potatoes, but the impact over the timeline of digestion, the life of the insulin, all the things that are going on at the same time are not going to all be equal. You can't just push the button put in the insulin, wait however long you're going to wait, eat the mashed potatoes, have the experience, and then do that again with broccoli and have the experience. I think that's why people with diabetes so often say things like, I did the same thing today that I did yesterday, and it didn't work out the same, except you didn't do the same thing. You just aren't seeing the variables that make yesterday different from today

Jennifer Smith, CDE 6:19
correct, sometimes Absolutely. And when we talk about there are, you know, working with as many little kids as I have the opportunity to, there are a lot of little kids and even adults, but who have likes, and they stick with those likes for an amount of time before they decide, well, I just don't like that anymore. I'm not going to eat it. But that makes it a little bit easier to determine the impact, and then you have to take into consideration the variables around that. So you may have figured out your grilled chicken with steamed broccoli, and you have it every single day for dinner because that's your favorite thing to eat, but the variable surrounding entry into that meal time, or even after that meal time, can then make a shift in how the insulin gets in in a timely manner versus a more lengthy manner, versus, you know what I mean, like exercise you're doing volleyball for three hours ahead of that meal, versus the next day you've had three tests, and you come into dinner time and you've had no activity, because if you've just been sitting, there are those variables that are going to impact this meal needs two units in a given scenario, but the variables surrounding that are going to change day to day.

Scott Benner 7:39
I have probably 1000 times said to people, if you're really struggling to figure out how your insulin works, get boring for a few days and eat the same thing for breakfast, the same thing for lunch, the same thing for dinner. You'll get better at it, like, because right then, at least you can see like, oh, I tried a 10 minute Pre Bolus. This didn't work. You know, like, there's nothing worse than somebody being so bum fuzzle that they start saying things like, I saw someone lying the other day. Said, This is what's making me think of it. She said, I don't understand. I'm up to a one hour Pre Bolus. And I was like, Oh, well, that's not your problem. Then right? Like, your basal is wrong, or you're, you know, the meal before isn't being addressed correctly, or any number of problems. But like, if you're up to, like, trying to Pre Bolus your meal for an hour, you're looking at the wrong problem, you know. And I just think that if you simplify, you can see how like this food works, and then you can see, well, now I can figure out like this food mixed with this food on a plate might work differently again, and that's a little easier for me. I'm a very boring person. You and I are going to get done here. I'm going to go downstairs. I'm going to take two I'm going to take two eggs, I'm going to take a little bit of protein, I'm going to put it in a pan with like, half a tablespoon of butter, I'm going to fry it up on a throat and a wrap, and I'm going to eat it like I do every morning. I don't care. Doesn't bother me. But do that for a few days, you'll start seeing consistencies. Start realizing, hey, my Pre Bolus was a little short. It was a little long. This carb ratio doesn't work for this meal, but it does work for lunch for some reason, like, who cares? Why learn that you know, right? Expect that what's going to happen is going to happen, and do it again the next day. Have some success. And then, like you said, now you've got actionable tools that you know how to use. Start applying them to different scenarios, right? And

Jennifer Smith, CDE 9:22
then you can take that even further. Let's say you love your protein wrap that you're eating, and you decide, well, goodness, you know, I'd really like to get some good antioxidant quality into this meal as well. I'm going to start throwing some blueberries or some raspberries into this right? Well, that's an addition to what you had figured out. So now, if things go sideways and you didn't expect them, it's okay. I added this extra. How do I need to compensate for this? It's an do I add a secondary Bolus at a different time? Do I Bolus a little bit longer Pre Bolus? Do. So what do I do? Right? So you can take your again foundation of things that you do most of the time, and most people have about 80% of the same foods over and over and over again in a week's time. You can figure those out. You can start throwing in the oddities and figure it out in an easier way. Yeah,

Scott Benner 10:21
I mean, listen, I don't have diabetes, but that wrap can sometimes have I'll tell you what I'll do. Sometimes I smoke sausage and I put it in the refrigerator and I put it with my wrap. Sometimes I do chicken, sometimes I do shrimp, sometimes I do beef. Sometimes I'll get crazy and put bacon in there. I'm crazy. Just losing weight for the last two years has been a lot of fun, but the bacon, if I was using insulin, would slow down digestion differently than the chicken, or the chicken would digest 45 minutes later, an hour later, versus maybe the beef would do it a different time. Or the shrimp might not really impact me very much. It's all there. But like you said, you throw, not that you're putting a berry in with shrimp, but all of a sudden you like, throw some berries into it. You could, I guess. But now, all of a sudden, you might get hit with some fast acting carbs, because that wrap, prior to that is eggs. It's a protein in the wrap. I try to use a fairly low carb wrap. That's probably a slow, consistent impact. All of a sudden, I have a little bowl of blueberries on the side. Now I'm gonna get a zing of, you know, fast acting sugar, it changes Pre Bolus time. It changes the amount of insulin. You know, yeah, all of a sudden now, if I was getting a 50 point rise out of the wrap that I was getting rid of in two hours, that fast acting sugar could throw that 50 point rise another 50, 100 points higher if I don't hit it correctly, one way or the other. What I can tell you is that people report back that the phrase not all carbs are created equal really help them understand diabetes episode 668, 739, and 1068, are some places you can hear that discussed. Awesome. Thank you.

Unknown Speaker 11:54
Thank you.

Scott Benner 12:02
If you or a loved one was just diagnosed with type one diabetes, and you're looking for some fresh perspective. The bold beginning series from the Juicebox Podcast is a terrific place to start. That series is with myself and Jenny Smith. Jenny is a CD CES, a registered dietitian and a type one for over 35 years, and in the bowl beginnings series, Jenny and I are going to answer the questions that most people have after a type one diabetes diagnosis. The series begins at episode 698, in your podcast player, or you can go to Juicebox podcast.com and click on bold beginnings in the menu. Are you starting to see patterns, but you can't quite make sense of them. You're like, Oh, if I Bolus here, this happens, but I don't know what to do. Should I put in a little less, a little more? If you're starting to have those thoughts, if you're starting to think this isn't going the way the doctor said it would, I think I see something here, but I can't be sure. Once you're having those thoughts, you're ready for the diabetes Pro Tip series from the Juicebox Podcast. It begins at Episode 1000 you can also find it at Juicebox podcast.com up in the menu, and you can find a list in the private Facebook group. Just check right under the featured tab at the top, it'll show you lists of a ton of stuff, including the Pro Tip series, which runs from episode 1000 to 1025 Hey everybody. I know there's so many episodes you might be like, I don't know where anything is, but if you go to Juicebox podcast.com or go to the private Facebook group and look in the feature tab, you'll see a complete list of all the series that exists within the podcast. And I'm talking about after dark ask Scott and Jenny algorithm, pumping bold beginnings, defining diabetes, defining thyroid, diabetes, pro tip, diabetes, variables, mental wellness, type two diabetes, how we eat, and if we add something else, like, say, my weight loss diaries, which we did, you'll find them there as well. And as a matter of fact, we're about to add a new list right now about GLP medications, because we have a seriously nice grouping of episodes on that topic. This is a good way for you to keep up with what's going on on the Juicebox Podcast, and even a better way to find those series that are, you know, compendiums at this point, 1020, episodes that are all on the same topic. So.

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!

Donate

Scott Benner 2/15/25 Scott Benner 2/15/25

#1434 Small Sip: Are You Stacking Insulin

Stacking insulin is often misunderstood. If insulin is still needed, it’s not stacking—it’s effective management.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends, welcome to the sips series.

okay, Jenny, I'm at the office talking to the endocrinologist. Kids just been diagnosed. I've just been diagnosed, and I ask the question if I ate dinner at 7pm and at 7:45pm someone brought out ice cream. Should I Bolus for that too? And my doctor, for some reason, says to me, no, don't do that. You don't want to stack your insulin. Stack

Unknown Speaker 1:55
your insulin. Okay, so not right. So

Scott Benner 2:00
whether they get told incorrectly, where people develop the idea on their own, somebody is going to say to you after being newly diagnosed, don't stack insulin. What do you think of when you because there is a world where you can stack insulin. So what? What is 100% what is that? Stacking

Jennifer Smith, CDE 2:21
insulin is taking insulin that isn't meeting the need for another lovely, I guess, little saying, right? It is insulin that really is kind of being almost given willy nilly, right? You may not think that you're doing it that way, but it is a okay, I've given insulin my blood sugar is still high, or, goodness, the air was going up. Now I'm gonna give more insulin. I think of it as not really having a thoughtful delivery reason,

Scott Benner 2:51
purposeless, except for the fact that you have a high number and you're trying to squash it right, correct, exactly.

Jennifer Smith, CDE 2:57
I mean not stacking insulin or taking insulin for, what you need it for is not stacking, even if you're adding insulin within the defined time period of a three to four hour action window, which is what we call IO B, or insulin on board, is essentially the time frame that we're given to watch for This concept of stacking, right? And if you need the insulin, though, such as, somebody brings brownies over an hour after you finish your lunch and you really want to eat the brownie, do you need insulin for the brownie? 100% you need insulin for the brownie.

Scott Benner 3:33
And here's where the saying that helps people came out of the podcast. It's not stacking. If you need it, that's bolusing, right? That's it. That's the thing that apparently helps people more than anything. Is that phrase, yes. So I don't want you to stack your insulin. That would be bad and wrong, and you're gonna end up low, or like, panicky low later if you do that. But you have to cover the carbs that you take in. That's that you just

Jennifer Smith, CDE 4:00
do sometimes other pieces. This consideration comes up a lot when I start talking to people about why blood sugars might not seem to be responding to that initial amount of insulin, and then they bring in the idea, but if I add more, I'm stacking right? No, you're not. Let's look at the meal content. Is your meal high fat. Is it high protein? Because now you've Bolus for carbohydrates here, and in the end, hours later, you might have an impact from other pieces, other macro nutrients in that meal that are going to require more insulin. Are you adding insulin within the original Bolus? Is time frame of action 100% you are. But if you don't, your blood sugar is going to sit high.

Scott Benner 4:44
If you misunderstand the impact of a food item, like you said, it's got more fat and it's going to extend its time whatever, like you You misunderstand. You count the carbs, or you just count the carbs wrong. You count the carbs. You say, Oh, it's 10, but it was really 20. If you Bolus 7pm eat 10 carbs, you think, Bolus for 10 carbs, 20 minutes later, realize, oh, gosh, that was twice as many carbs as I thought it was. If you put in the rest of the insulin, you're just covering the carbs. You're not stacking insulin, right? It becomes one of those. It's like a boogey man, I think for diabetes, like, right? Like, somebody's going to tell you very early on after you're diagnosed, do not stack insulin. And then that phrase is going to override all your common sense in the future when you're like, I think I don't have enough insulin here, because what does it

Jennifer Smith, CDE 5:33
bring in? It brings in fear, yes, teaching somebody to be afraid of putting in extra of something that might cause, again, a place of fear is brought in with talking about low blood sugar or hypoglycemia, right so, oh my goodness, if I take more insulin right now, it's going to cause a low blood sugar, and I don't want to do that. And again, with today's technology, thankfully, you've got more information to actually be able to stop any detrimental outcome from taking more when you need more. You would

Scott Benner 6:07
think that the new technology would have squashed the better high than low theory, but it hasn't for every clinician, and I'm always interested by what we choose to say, like, better high than low means like, well, I'd rather you have a higher blood sugar than be, you know, like, fighting with a low or passing out, or something that, well, like, okay, I guess I can agree with that. But like, what if we would have just said, like, better stable and in range than low, right? Come that wasn't the thing, but probably because of no CGM. Like, it's easier for me to say that because glucose monitors exist now,

Jennifer Smith, CDE 6:40
I would expect absolutely and I I also think within that realm, there are some people who take it to another place of saying, Okay, I only have these time frames of available eat and Bolus. Within this time frame, I can't do that. I was told I can't take extra insulin. It could be dangerous to take extra so I'm going to eat a breakfast, I'm going to eat a lunch, which is well outside of that action time, and I'm going to eat a dinner, and that's it. Well, goodness, if you're hungry, if you're metabolically up or down, if you're a training athlete, that is not going to be a stretch.

Scott Benner 7:18
I don't know, like I just, I just want to say this one again, right? So just put it here at the end. You can stack insulin. I don't want you to do that, but it's not stacking if you need it, that's bolusing correct, okay? And that is one of those phrases that the feedback comes over and over again, like there's a lot of people's light bulb moments. Yeah. So awesome. I appreciate you talking about

Unknown Speaker 7:39
with me, of course,

Scott Benner 7:50
if you're not already subscribed or following in your favorite audio app, please take the time now to do that. It really helps the show and get those automatic downloads set up so you never miss an episode? Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast if you're ready to level up your diabetes care. The Diabetes Pro Tip series from the Juicebox Podcast focuses on simple strategies for living well with type one. The Pro Tip episodes contain easy to understand concepts that will increase your knowledge of how insulin works. And so much more, my daughter has had an A, 1c, between five, two and six, four, since 2014 with zero diet restrictions, and some of those years include her in college. This information works for children, adults and for the newly diagnosed, and for those who have been struggling for years, go to Juicebox podcast.com and click on diabetes pro tip in the menu, or head over to Episode 1000 of the Juicebox Podcast to get started today with the episode newly diagnosed. We're starting over and then continue right on to Episode 1025 that's the entire Pro Tip series. Episode, 1000 to 1025 i.

Please support the sponsors

Donate

Scott Benner 2/14/25 Scott Benner 2/14/25

#1433 Fox in the Loop House: Part 4

Kenny is back!

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends, and welcome back to another episode of The Juicebox Podcast.

It took some time, but I got Kenny Fox to come back. If you're not familiar with Kenny, go look for Fox in the loop house part one, two and three. Those are episodes 312, 313, and 420, if you're interested in looping, you should listen to the fox in the loop House series straight through. Today, Kenny and I are going to talk about night scout and data tracking. We're going to talk about basal adjustments and insulin on board Kenny's new coaching service, understanding loop predictions and adapting to stress and daily routine changes. Please 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. Don't forget to save 40% off of your entire order at cozy earth.com All you have to do is use the offer code Juicebox at checkout. That's Juicebox at checkout to save 40% at cozy earth.com when you place your first order for ag one with my link, you'll get five free travel packs and a free year supply of vitamin D drink, ag one.com/juice box. This episode of The Juicebox Podcast is sponsored by Medtronic diabetes and their mini med 780 G system designed to help ease the burden of diabetes management, imagine fewer worries about mis Bolus is or miscalculated carbs, thanks to meal detection technology and automatic correction doses, learn more and get started today at Medtronic diabetes.com/juice box. Today's podcast is sponsored by us Med, US med.com/juice box. You can get your diabetes supplies from the same place that we do. And I'm talking about Dexcom, libre, Omnipod, tandem, and so much more us, med.com/juice box. Or call 888-721-1514, if you're looking for community around type one diabetes, check out the Juicebox Podcast, private Facebook group. Juice box podcast, type one diabetes. But everybody is welcome. Type one type two gestational loved ones. It doesn't matter to me if you're impacted by diabetes and you're looking for support, comfort or community, check out Juicebox Podcast, type one diabetes on Facebook. Ken, you are on three of maybe the more popular episodes in the podcast about algorithm pumps. So let me see, do you know the episode numbers, or should I look for them?

Kenny Fox 2:52
I remember they're, like, almost a year apart. I remember that part. I just looked at the numbers this morning. They're in the hundreds, like 300 or something. Wow. So

Scott Benner 3:01
you were on originally, episode 312, Fox in the loop house part one. We did part two. Episode 313, so it was just one after the other. Was probably just a thing. I split up into two, but then we had you back again on episode 420, for Fox and the loop house part three. Your last name is Fox, and we talked about loop, and for some reason, that's the title that came to me. So there's no other reason why they're called that, but they're very popular, because I think not only do they do a good job of going through what loop is and how you use it and how I used it back then. But also, because a lot of that information, I think it grows people's understanding just of how algorithms work in general. And you can apply that to honestly, if you're on control IQ or, you know, Medtronic or omnipotent, like wherever you're finding your algorithms at, you know, I don't know what else is there now. Twist is coming, and I let. No, I let. I guess you can't really do much with but, you know, like all these different algorithms that are out there, the way they work informs you about how you think about insulin, and then you can kind of reverse engineer what you've learned and put it back into your management I think that's where, like, the leveling up comes from. Do you agree?

Kenny Fox 4:20
Yeah. I mean, we tried the control IQ for six weeks, we had a pump given to us, and we tried it out, and we got similar results to loop using some of the same techniques and the base understanding that comes with using a system like loop, and you can definitely translate major pieces of this to other systems. I've helped a few friends on Omnipod five, and just adding things like knowing that fat and protein needs some insulin and carbs can really help balance out that total daily dose piece of the algorithm sometimes people end up staying higher just because they're not bolusing enough, and therefore it thinks they need to hire basal. And you can fix that by just making sure. You dose more, and you dose more by adding in the fat and proteins. It helps pretty much in any system that we've used before. And the twist one will be using a form of loop when it comes out.

Scott Benner 5:10
Oh, that's awesome. See, I just learned something. Though it's awesome using tide pool. Tide Pool loop. That's excellent. Okay, great. Anyway, so listen, even if you're not a looper, my point is, check this out if you're using trio. If you're using, I mean, what else is there that's DIY at this point,

Kenny Fox 5:24
Android, APS, trio, the main ones, yeah,

Scott Benner 5:29
loop. Or one of the, one of the systems that you can get retail. I think the information here is going to help you in one way or the other. So let's just jump right in. Tell me where you want to start.

Kenny Fox 5:38
I guess I'll start a little bit with me. I been in the DIY community for a while, helping out, doing videos on loop and learn and on the podcast with you, and just helping people in the Facebook groups. And late last year, I got laid off and decided I wanted to take my coaching skills. I was doing financial coaching, budget coaching for couples, and that was fun, but it was kind of a little side hobby, and I thought I could probably do this and teach people how to use loop better and do it all the time, and help more people that way. So that's what I'm trying to do. We're starting off early 2025 with a course on how to change your settings, how to know how to read the data and know how to change your settings and loop. And we'll go from there, see how it goes. Help

Scott Benner 6:19
people your web address because I want you to say it, because I'm I'm delighted by it,

Kenny Fox 6:23
because a lot of people reach out to me, saying, Hey, listen to your episodes on the podcast. You know the podcast is Juicebox Podcast. In case you don't know, I went ahead and just leaned into Fox in the loop house. So my website is Fox in the loop house. Calm. You can find me Fox in the loop house on Facebook and Instagram and YouTube, so just lean into that identity piece of it, since that's where a lot of people find me. So I thought I'd just go with it, and you told me I could years ago when I mentioned it. So you made my

Scott Benner 6:51
day when you told me that was the URL. I have to say, it's like, oh, that dumb thing. I thought up, I've reshaped Kenny's life with it. I

Kenny Fox 6:58
thought I was a little dumb too, but I couldn't think of anything better, and that's how people know me, plus it has my name in it. And so it means I don't have to worry about, where do I slip my name in, or making a whole LLC, or whatever I need to do for that, because my last name's in there. Well,

Scott Benner 7:11
the way I have to tell you, the way I think it occurred to me back in when I when I thought of the title, was that to me, like the DIY algorithms, you know, are this not siloed, but a thing that not many people knew about? So I thought of it as almost the club. And then I was like, oh, and Kenny's like, he's going into that house and, like, showing it to people. And then, I don't know, then your name was Fox. And I was like, this is good enough. I like this. I like, I like the idea of you, like going into this place. It probably seems secretive to other people. It isn't, but maybe it feels like unapproachable, and you were just in there going, like, look, here's all the eggs. Let me show you. You can just have them too.

Kenny Fox 7:49
And back then, it was a little chaotic. It's definitely matured, you know, the loop and learn groups. Got a whole group of volunteers, and so sure, we're funneling information a lot easier to people, but definitely back then, it was a little chaotic. So little fox and the hen house sort of play on words. Works out how it

Scott Benner 8:03
felt to me. So, oh, so that's awesome. Okay, so let me ask before we jump right in, doing financial coaching for people, there must be things that you've learned about how people learn and how they're motivated that you're moving over to this. Am I wrong?

Kenny Fox 8:17
No, I mean, part of it is just communication. When I was doing the coaching, I tried to make sure that, like, both the husband and wife, for example, if it was they were married, were both showing up because they're both trying to engage in goals, where you're going stuff you're trying to achieve, and putting people on the same page, even if one person that wasn't totally bought into it, at least they heard the words, had a common vocabulary to like work through problems together, and so I thought about doing the same thing for loop coaching, making sure that you know both parents are there, or that the type one is there, maybe with their spouse. I haven't carried that over, but it has been good to reinforce, or I'm finding that people reinforce the same language and words that I'm giving them with their kid, if they're old enough to start taking it in, and so they're picking it up on their own. It's been good that way. That's

Scott Benner 9:06
excellent. I'm just it's interesting to see how people's careers build and and sometimes lead to similar but different things. So this is the

Kenny Fox 9:13
well, knowing that you need to acknowledge the emotional side of things too. I'm a little more technical and just trying to solve the problem, but trying to make sure you they people feel heard, and that they can express their concerns, that you can empathize with them, gets you a lot further. And they and they, they listen, they take stuff in better. Yeah, so it works all the way around. Cool. So where

Scott Benner 9:34
are we going to start? We'll start with night scout. Diabetes comes with a lot of things to remember. So it's nice when someone takes something off of your plate. Us. Med has done that for us. When it's time for Arden supplies to be refreshed, we get an email rolls up and in your inbox says, Hi, Arden, this is your friendly reorder email from us med. You open up the email. It's a big button that says, Click here to reorder. It, and you're done. Finally, somebody taking away a responsibility instead of adding one. US med has done that for us. An email arrives, we click on a link, and the next thing you know, your products are at the front door. That simple, US med.com/juice, box, or call 888-721-1514, I never have to wonder if Arden has enough supplies. I click on one link, I open up a box, I put this stuff in the drawer, and we're done. Us. Med carries everything from insulin pumps and diabetes testing supplies to the latest CGM like the libre three and the Dexcom g7 they accept Medicare nationwide, over 800 private insurers, and all you have to do to get started is call 888-721-1514. Or go to my link, us, med.com/juice, box. Using that number or my link helps to support the production of the juice box podcast. Today's episode is sponsored by Medtronic diabetes, who is making life with diabetes easier with the mini med 780 G system. The mini med 780 G automated insulin delivery system anticipates, adjusts and corrects every five minutes. Real world results show people achieving up to 80% time and range with recommended settings, without increasing lows. But of course, Individual results may vary. The 780 G works around the clock, so you can focus on what matters. Have you heard about Medtronic extended infusion set? It's the first and only infusion set labeled for up to a seven day wear. This feature is repeatedly asked for, and Medtronic has delivered. 97% of people using the 780 G reported that they could manage their diabetes without major disruptions of sleep. They felt more free to eat what they wanted, and they felt less stress with fewer alarms and alerts you can't beat that. Learn more about how you can spend less time and effort managing your diabetes by visiting Medtronic diabetes.com/juicebox

Kenny Fox 12:07
uh, yeah, I'll just kind of mostly step through the modules of my course at a high level, and so people can get an idea of what we're going to cover. And it's a lot of this stuff. I'm not worried about keeping the information locked up behind my portal. The information is free. The DIY system is free and open source. If someone wants the help to be with me or my community, then that's when they can show up. So we'll cover, you know, most of what I cover here, if it's helpful and it helps people, then that's great, well, but usually, yeah, I just kind of call it Module Zero, as we kind of start with night Scout, because we're going to be looking at that a lot. It's your dashboard, it's your view into all the data, especially as a caregiver, but loop only holds only shows you about six hours of information in the past, so you can't always go back and, you know, look at how the morning went, or your overnight basal was by the time you're off work or school's over or whatever. So night scouts, where we're going to live, there's just a few things. I don't take a lot of time to teach people how to use night scout. We kind of just do it as we go, and it's integrated into the process because through repetition. But there's a couple annoyances I'd like to highlight for people that people don't like about night scout. One, it's busy, and can't really fix that, because there's a lot of data that's important. But what we can do is make sure that some of your like pills, a little squares, little nuggets of information on the screen are turned off that you don't need, and then make sure there's stuff that is on that you do need. Some people use their night scout and don't have the prediction visible or the basal rates visible, so they're missing out really important pieces of information when they're doing it. So we just go through the settings and figure out that one. But there is this one cool setting that if you're using night Scout Pro. It's built in otherwise, if you have access to your little configuration variables that you have to go in and tweak. There's this one called device status, one word, underscore, days. And what that does is, on that first screen, that dashboard of night Scout, you can actually see two days worth of information on the lower graph, and it shows you, like a little snippet, you know, the bigger version on top. It's like a smaller section of time. But what you do is you scroll backwards and you click and drag on that bottom section of night scout. You can only go back 24 hours before you lose the kind of prediction information, all the details. But if you add this variable, device status, underscore days, and change it to two, you get two days of information there. Well, 48 hours. That's really helpful. If you know you're trying to figure out there's a pattern, and I feel like most patterns you would look at are within the last two to three days. So if you can access most information, you pretty much don't need to leave that front screen of night Scout, which people appreciate, because while the reports are useful, they don't want to really want to go digging into it. They just want to pull it up and take a look at it. So okay, that's one of them, and then the other one, the other big one, is the alarms. It makes a nice, loud, annoying alarm that's hard to tune out in night Scout, but most people have Dexcom follow, or they'll using the loop follow app or something else that has alarms, and they just don't need them. So they might remember to go into the menu on the side and check all the. Boxes and turn them off. But then you got to do it. Every time you are on a new device or whatever, it goes off. When you're in a meeting. You have it up at your computer at work or whatever. If you go into your configuration variables, you can find all the things that say alarm, and it's usually like a ON, OFF or true, false option. You can go turn those off. I walk through those, I'm going to put out a little cheat sheet for how to just buzz through and turn these things off on my website at some point, so everyone can go look at it, but yeah, just turn off the alarms by default. And that way, if you want them on, you can turn them on if you want them on for the school nurse, and you can talk to them and have them turn them on, but at least they're not on all the time. And you pull up night scout on your phone, and all of a sudden there's an alarm going off when you're in the middle of a meeting or whatever. So that's kind of the big stuff.

Scott Benner 15:40
How do you turn off that crazy music that plays when it loses its signal? Yeah, that's the

Kenny Fox 15:44
alarm. So there's a setting in the back that's time ago or time ago, urgent and time ago worn. So if you find those, if they're not defined in your Heroku, for example, you can just go into the configuration variables and set those to false. I can, I'll put the I'll add those to the list as well. Those are the sneaky ones that you can't turn off from the main menu screen in night Scout, you only turn off, like the highs and lows, but you can turn off. There's a few more that are hidden in there, like when loop is not looping, or and a few others. So yeah, that annoying music is those alarms. And I think most people are already have alarm fatigue, and they don't need it startling them when it turns on after like, 10 seconds of loading the screen. So that's that's a big one. And then the last couple things, just make sure you can see in night Scout that I think is really cool since we talked last four years ago, now that when you start a new pod, or when you start a new Sensor Loop, picks up on that and updates this little section called the cage, or cannula age and sage sensor age, and it updates that in night scout. So now you can see how old the pump is and how old the sensor is, which is super helpful, because you as the caregiver don't have that information readily available, index con follow or anywhere else. So I find it useful. When you're looking at maybe sticky highs, you say, well, How old's the pod? If the pods getting to be closer to that three days, then you know we're increasing our chances that there's a problem there. Or just, uh, just for planning for the rest of the day, like, do we need to change the pod or the sensor before Tesla goes to school or whatever? So that information is helpful to have, and now it doesn't require manual logging, which I used to do, but now you just use loop, and as you change those devices, it uploads this night Scout, and it's nice and available for you. That's a really practical one for people. Cage

Scott Benner 17:20
and sage are big parts of how I use night Scout, and they're a huge help with me, especially when Arden's not living here, and you can say to her, hey, look, I don't know if you saw this or not, because I know you're busy and everything, but your pod's going to expire at five in the morning. Please don't go to bed with that pod on. And you know, there's been times where she said, Okay, great, I'll, I'll do it before I go to bed. And there's times when she goes, I'm gonna get up at five in the morning and change my pot. That's my plan. And I'm like, Okay, fine, you know. But at least you can kind of remember and remind, I guess, a little bit. But your point about using it for, hey, why is this not working all of a sudden? Like, I do it all the time, you know? I'm like, the Bolus happened. Nothing worked. I don't know why. Oh, look at this. This pod's two hours from being shot like that kind of thing. Or I don't trust this number, all of a sudden, and I can't see her Dexcom, so I go look and, oh, the sensor has been on for nine and a half days, or something like that. During COVID,

Kenny Fox 18:12
my wife's grandmother was living with us. She couldn't go anywhere in other facilities or whatever, and she has type one. I never really got good at managing it. And she ended up kind of forgetting to take her insulin over time and almost in DKA. And we sort of fixed that at home, got her drink water, and then from there, kind of took her management over and added, slapped a Dexcom on her, slapped a pod and loop on her, real fast, and then got those devices covered through her insurance, and had her looping. And at some point she ended up leaving our house too. So that became even more critical to know, like, when do the devices need to be changed? We found a nice place that would, without charging us extra, would take care of changing the hardware. They were super willing to do that. And so we just night scout was important to be able to track when those things changed. And so having those pills was pretty was pretty critical for that. So definitely nice for a caregiver perspective, for sure,

Scott Benner 19:02
and I realized we didn't do this. But if you are listening and you're like, Oh, this is all exciting. I don't know what night scout is. It's an app that I have on my phone, for example, and it just lets me see in real time, Arden, who's using trio, not loop, but in real time, it lets me see where she Bolus is how many carbs she put in the things that Kenny just discussed. It lets me see when her basal gets ramped up or taken down, etc. It's pretty awesome. Yeah, it

Kenny Fox 19:30
is intended as like a dashboard for caregivers, right? And we used it when Tessa was on shots at the beginning. And we would log all the shots and stuff in an app, and open another open source app, and it would push it up to night Scout so I could see when my wife was giving injections or Tessa was eating. I mean, sometimes we forget to enter it, but it was helpful for me to learn from afar while I was at work, just to see all that data laid out. And so it's really intended just for logging data, and yeah, now it's a dashboard you can use for having automated. Stuff like loop and trio upload data to it so you can see data in real time, which, you know, I take for granted after almost six years of using it, that people don't have access to, that you can't get the T connect data or the Omnipod data in real time to be able to see, did your kid Bolus and how much and what did they enter? Did they, you know, enter too much, or whatever that is. Yeah, you can make a lot of decisions on that. I have to

Scott Benner 20:23
admit, it's not a thing I look out every day, but when I need it, that it's there is irreplaceable, honestly. So, yeah,

Kenny Fox 20:32
awesome. Yeah, that's it for night scale, I mean. And then after we kind of get that settled so everyone can see what they need to see, and I don't have to worry about them saying, Well, where is that we're all set up. Then we start getting into the basics. Rather than go over the kind of core of the prediction pieces, which I do cover later, actually just start with basal. Because people want actionable stuff. They want to make sure that their settings are right. And as you've discussed multiple times, the basal is foundational right if you don't, if you don't build your diabetes house real well, which is on the foundation of basal then kind of everything is suspect, everything's out of control. Loop gives us a lot of data. I covered this in our one of our other episodes, so feel free to go back and listen to it, you know, for extra information. But we do cover how you can see when your basal is probably too strong or too weak in loop, because it gives you all this information to be able to see where it is. Using insulin on board a while ago when Arden was looping and we helped dial in some crazy basal changes for Arden basal information, I had a very similar think when we were working together, talking a little bit Arden's needs were dropping. And there's another kid I'm helping right now, who's 11, and he just went through, like, a big growth spurt, like all at once. There's no wouldn't matter what system he was on, it couldn't have he just had his he has basal rates increase like a half a unit now, more than half a nice coming up on doubling his basal rates all in about 48 to 72 hours. Just wild. But the mom's saying, Well, what do I do? And I can go back and look at this information. We'll talk about how to get it and give a good guess about where to set the basal. I mean, I wouldn't normally like nudge basal more than, you know, point oh, five or point one on the pod. We only had to change it, like point 4.5 in a single day, which once we did that went from cruising in the three hundreds and stressed and bolusing all the time just trying to get them to everything settling down to the 90s again, so within a few hours. So it's a definitely useful information.

Scott Benner 22:26
How do you do that? How do you look at the information and say, Hey, normally I would turn this dial very slightly to be careful, but in this situation, I feel very comfortable moving at this because what? Because I saw,

Kenny Fox 22:38
yeah. So the iob overnight is one of them. And I think one of those things that's helpful is that I try to keep a pretty simple basal profile. I on the podcast before, we were using one basal rate. And I, you know, I've come to learn that that is a little more common with the younger kids, but also more common with, like, mild honeymoon. We were out of like, major honeymoon, for sure, but having slight variations in your basal rates. Totally fine. People shouldn't feel bad about that. I used to be a pretty big proponent of one, just to kind of get people to simplify. And I think keeping this simple as you can is good. And so when things change, I just kind of changed all so that's the first thing I do. Is pro Tesla. She's got, I'll explain this a little bit, but I have some like normal stuff, but we've only got one rate, maybe two rate, maybe the night and a day rate. And you kind of play around with that looks like. But when I find a pattern that works for Tessa, it's about a point one an hour difference. She uses, like a one and a half units an hour. It's a lot, but so like, a 10 20% difference or something between night and day for her has been working in the last few years. And so when I look at this data, I'm going to talk about, I'm just to make the change everywhere. All the rates change when I look at it overnight. So here's how I do it. In loop, it's modeling insulin pretty well six hours, nice even like small decay rate. It's got a pretty accurate representation based on the like, if you open up the paper inside your insulin vial and actually look at the graphs in there, it shows the insulin last six hours, and loop uses a pretty close line to that. And so what I'll do is I'll just grab the bottom section of night, scout the lower graph, and just slide backwards and look at the history, and we just look at, you know, how the night went, especially, you know, 345, AM, multiple hours away from food or anything else you might have messed up with the fat and protein and whatnot from dinner, and see where everything settles out. And look at how much insulin on board there is as you go across that line. If you're pretty flat and have consistently, like, positive insulin on board or negative instant on board, you'll find that there's generally around the same number kind of across that line. For example, the kid I was helping with earlier had over a unit on board just and he's like, high at like, 170 and just constantly over a unit, and whenever it would get under that, his blood sugar would go up. And so what we do is we can use that information to say, Okay, well, obviously the basal is not right. So how much insulin is this? How much more we have to move the basal up to make this? Instead of one unit on board, how about zero units on board? Like be nice and flat and level. So. And so we just take the kind of average iob in units and divide it by the length of time that insulin lasts, which is the DIA duration of insulin action at six in loop. So we just take the iob and you divide it by six. So an easy example is point three units of insulin on board that's keeping you level, but usually probably a little higher than your correction range. Divide that by six, and you get a unit per hour. You just divided units by hours, and so you get a point, oh, five unit per hour, basal rate change that you should make. And if you make that change, that point three units will actually turn into zero insulin on board, and you'll be level and probably more likely down into your range. And if you're seeing negative, you just add the negative in front of the answer there, and that means you need to decrease your basal rates by point oh, five units per hour. It works out pretty well in the case of this kid with like, one 1.2 ish insulin on board was at a point two change in insulin needs. So that's, I mean, that's a pretty dramatic change that would take some guts to modify without a lot of experience, but instead, you can supplement that experience with math. So yeah, point two unit per hour basal change. So we bumped his basal rate up, and then Bolus a little heavy, because the insulin on board isn't real, right? The insulin on board says he's got a unit, but that's really should be, you know, your new kind of zero set point. So you Bolus little extra to get him down. And as Luke turns the basal off to get him down, the numbers sort of like fix themselves, the iob becomes a little more accurate. And then, you know, within a couple hours, he's down in the 90s, instead of, like the 170s when he woke up. So then you can go about the rest of your day with more confidence. And in his case, he kept needing more and more insulin as the day progressed. And then you could see it in the nighttime numbers for sure. And then you get a nice number again. You make the modification increase the basal rates, and then the next and the rest of the day is, you know, mostly good till the evening, when he's starting to need more again. And so he did his three days in a row. For Tessa, it's usually like kind of a day, and then hold that for a day or two. And then we're done times a week. And then, you know, maybe it'll change back down or up, but you get some consistency. Sometimes you gotta change it every day. Sometimes it's, you know, a week or two without having to make a whole lot of change. But that's basically the math that gives you. It's the only real objective thing you get with the data. The rest is kind of art. You're gonna be tweaking carb ratios and ISF and dealing with activity and counting food is difficult, but the basal stuff is pretty objective. When you look at that information. Do you work with adults ever? Yeah, I've had a couple of adults that I've helped this year trying to figure out my course content. They've had a lot of, lot of fun, lot of learning, and it's been great. Naturally, the caregivers ended up coming to me, because, similar to you, we're parents, that's what we do, and we talk from a perspective without trying, because that's what, that's our lived experience. But yeah, I get I get both.

Scott Benner 27:43
Now you were just talking about how to make this adjustment. Are you planning on just taking people for coursework, or are you going to do a la carte too? Can someone get a hold of you and just say, like everything's upside down here? I don't know. Why? Could you just figure it out and tell me? Why? Do

Kenny Fox 27:58
a quick look? Yeah, I've done that. That's kind of been my MO. Throughout my time in the DIY space has been someone asking for a lot of help and to get all the information and context. You know, maybe they'll, they'll reach out to me, or I'll say, Hey, if you want, you can send me your night scout. We'll take a look together. I'll ask a couple questions around, like activity and other stuff that may not be obvious, and it within a few minutes, I can take a good stab at, you know, doing this math and a few other adjustments to get people in the right way. I don't know if I'm going to be offering that as a service, kind of standalone, probably, but most likely to be the course. And then I'll have a I'm going to create, like a little support group on the back end that's pretty affordable, so people get through the course. If they want to keep hanging out for not too much. We can hang out and, um, go over that stuff regularly, but I'll probably open up the doors for just a quick check in. And I don't mind people messaging me occasionally. If I have space, I'll, I'll message them back, but that time is going to become a little more, a little more limited. And the other thing is, I can, I have a couple of videos on loop and learn right now, and I'll put a few more on my YouTube channel in the near future that are just me talking through that exact scenario, somebody sending me something, ask them a couple questions and make some changes. So again, none of it's hidden. It's all it's all up there on on the YouTube. So you can kind of see me talking out loud with someone on the phone, usually a parent, and the adjustments we made. So yeah, yeah. Well, I

Scott Benner 29:19
mean, there are going to be some people who definitely just want to understand and the course, makes a lot of sense for that. And I wonder if the people who are just really flustered, if you could unfluster them a little bit, if that wouldn't open up some mental space for them to say, hey, you know what? I could learn more about this. Like, maybe just get out of the hurricane long enough to, like, settle yourself and think All right, now let's figure out how not to get back in the hurricane again. But I don't know if it's possible to do the figuring while you're spinning is what I'm saying. It

Kenny Fox 29:50
helps. It does help. I've seen it help people. I That's why I just reach out sometimes and help people, because they are spun up so much they can't take in any more information. They're. Fighting the system. They were maybe fighting it before loop or something big happened, like these basal rate changes, this puberty stuff kicking in, and now they they feel like loops been great for years, and now they're sideways. So it's definitely something I'll be looking into. You guys can pay attention to my website and see if I offer that. Right now, I'm just focused on trying to get the course out the door, but it's definitely I love meeting people and hanging out for a bit and putting them on the on the right way, so they feel like they can walk away and have things a little more sane, so they can start to make more mild adjustments, right? Yeah, it's been fun.

Scott Benner 30:29
Okay, do we have more in this section? Or can I ask a disjointed question before we move forward?

Kenny Fox 30:34
I would just highlight a couple things in the basal just so people know if they have kids with low basal rates. I remember doing that being the point 1.1 5.2 those kinds of things. And with this kind of exacting math loop does with the insulin on board. It expects zero insulin on board to make you level. And sometimes your kids just live between the rates their actual basal needs are just between what the Omnipod can deliver, which is a benefit to something like a tandem or something else where they have smaller increments, you can step up the basal. So if you guys are in that boat, just like give yourself a little bit of break, use the numbers the iob to help guide you, and just pick on which side of the of the fence you want to be on, on the slightly heavy basal or a slightly lower basal. And just try to maybe adjust the carb ratios and other things to kind of compensate knowing you're either heavy on the basal or light on the basal, it's a tricky spot to be in to get it just right, considering loop kind of really wants it to be exactly right. It's not very forgiving in that sense. So I think that's important to know. I was going to ask you a question about this. One thing I find challenging lately, as test has hit puberty, more near 11. You had mentioned before that sometimes Arden would get real sensitive in the evening, going to bed. I experienced for the first couple times in the last few weeks, like just a big drop, a big it looks like you collect a bunch of negative instant on board in loop terms, where blood sugar just drops and falls out, and we treat it. And she comes back up, and she goes back to sleep, and then she's fine, but it's just crazy. It's like, almost like she didn't need any insulin for like, a half an hour or an hour. Did you ever experience any of those weird drops? I hadn't had those in my six years of doing this until just recently. I

Scott Benner 32:14
don't know how to explain them, other than it feels like when she closes her eyes and relaxes her insulin needs go down. So

Kenny Fox 32:26
I don't know the whole night, though, right? I think you've expressed it's the whole night, though.

Scott Benner 32:29
Arden uses a different basal rate from bedtime until she wakes up, right? Yeah, and if she sleeps in, then that's the only time you have trouble, because the the new basal rate comes on for like, general days, you know, the day she wakes up. But if she's suddenly like that, I don't have a class, I'm gonna sleep till noon. I almost have to remember to get up in the morning and do it like I'll do a Temp Basal through night scout and take her basal down to another level for a few hours, and then hopefully I notice when she wakes up, because I want it to go back to where it is as soon as she's awake. So to be honest, I don't exactly know, but to me, that's what it feels like. There are things that I've seen in throughout this time that I just trust now, like, here's an example of one, if your blood sugar stuck a little high and you go make a number two, I expect your blood sugar to come down afterwards. I don't know why. I don't even think I care why. I just know that I've seen that so many times it happens. I mean, Arden's a young person living in the world. She's got anxiety and stress like everybody else, and I expect that part of her settings are due to that. And I expect that when she closes her eyes and relaxes, that her needs change drastically, pretty quickly as soon as she falls asleep. The problem with a 20 year old is they don't just like go to bed every night at 10 o'clock. I found myself like I can't turn the basal down too early in the evening, because what if she sits up till two in the morning? That's a different problem, right? So I look a lot at the when she goes to bed, and the insulin on board. Even though you've explained it to me in the past, I think somewhere in here, I'd love for you to explain again, how you use the insulin on board number to fix a low blood sugar. Like, how do you know based on negative iob that this many carbs is what? Anyway, we'll get to that. But like, let's not forget to get to that. It's a note I made. She goes to sleep. She seems to relax. That happens. I think the same thing. When people say they get in the shower and their blood sugar goes down, I wonder if the hot water doesn't just hit the back of their neck and they just forget about their worries for a while, and suddenly they've got more insulin than the adrenaline and stress. Yeah,

Kenny Fox 34:38
I've, I've appreciated that more. I used again, used again, used to be kind of like, oh, we always need a lower basal rate during the day than we do at night or a flat one. But I have seen working with people more intensely that I even have a friend as an adult, same thing, going to work, going to school, raises their blood sugar. They just need more insulin as a result of what I can only imagine is. Stressed. My daughter, Tessa, got the same problem when we moved across the country just in August and started a new school, and she was super amped up to go to school. I think she was just excited to have a different school. She's kind of partially hybrid home school before now she's going to public school and middle school, right? And she just needed more insulin, you know, for the first few hours of the day, and then she would get off, you know, we're not the bus, so we get her from school, and then her blood sugar would kind of drop. So definitely, and it's like gone away, that that impact has disappeared, yeah, as we've gone through the school year. So it's definitely, there's definitely other things to pay attention to that you got to watch out for. I have a question for you real quick, though, does Arden need the same increase in basal on the weekends, or is it just

Scott Benner 35:38
school days on the weekends or school days. Yeah, her basal, her No, her daytime basal is seven days a week, so whatever her level of life is, it's pretty consistent with her. I mean, I'll joke, like, not just joke, but you can see her walking to a test because her blood sugar just like, like, if she leaves her dorm room and she's going to a test, I watch her blood sugar start to rise. It can go from 80 to 160 and the algorithm jumps in and it's like, Hey, what's going on? And it'll like, hold at 160 now my inclination in the past would be like, let's Bolus. But what I've learned to recognize is that when the test is over, it comes back down on its own. So,

Kenny Fox 36:21
yeah, that adrenaline or something like that, that's causing that rest. I

Scott Benner 36:24
wouldn't ask her to touch that. It's just a benefit of using an algorithm that you you know, because, you know, without that algorithm, you wouldn't just be 160 it would be 300 you know, like it would just keep going, because it's, it's pushing, it's pushing with basal, it's pushing with boluses, etc. It's magical. Kenny,

Kenny Fox 36:42
yeah, it's nice to have an algorithm, I kind of call put a lid on it, right? So even with that, with Tesla, when she has basal right knee changes overnight, or this growth spurt thing we were talking about earlier, yeah, he was 170 which is obviously a problem, if the target and loop is like 100 but what would it have been if you tried to sleep the whole night. You know, without that, with just a regular pump or shots or whatever, making that adjustment would be very difficult to do. I wanted

Scott Benner 37:07
to go back to one more thing, that if you are listening and you have a smaller child who's experiencing overnight growth spurts like what I just said might sound crazy to you, because your kid might go to sleep and their blood sugar shoots up all the time, but Arden's beyond that. Now it is really interesting. The thing that you mentioned earlier about basal rates, because I can even though it's been years since we recorded those episodes together, I remember you advocating for one basal all day long. And I don't know if I said it out loud in the episode, but I do remember thinking, Well, that's easy for you to say, because your kid hasn't hit puberty yet, I

Kenny Fox 37:43
think you did. I think you sneak it out, or maybe it was after the call or whatever. But yeah,

Scott Benner 37:47
you know, your bigger picture understanding has to evolve, as you know, if it's a kid, growth spurts happen, I mean, but also could just be weight gain. If you're an adult, you gain 20 pounds, like a lot of these things are going to change for you. I just saw something really interesting the other day where, when Arden would make the trek home from school and drive herself, her blood sugar, she I noticed her having to Bolus a little more. But the other day, she made the trek home, and my wife was with her, and my wife, I think she suckered my wife into driving and like, she didn't need as much insulin for the ride home, because, I think just the she wasn't, you know, hold on to the steering wheel, staring at the road, trying not to die, like, you know, like it's just it was more relaxing to be in the other seat. So there's a lot of stuff that's going to impact your insulin needs.

Kenny Fox 38:35
Maybe, maybe when it starts settling and she's driving, you'll feel like she's matured in her ability to drive. It'll correspond, right? I

Scott Benner 38:41
don't know she's a good driver. I just think she might be a fairly aggressive driver.

Kenny Fox 38:47
Nice, nice. Yeah. I mean, I've seen I was counting through my messages, like, a year or two ago, and I think I have more than 600 different people or more that I've like, gotten messages from in Facebook over the years. And so, yeah, since those episodes, I've seen a lot more graphs, a lot more ages, and then experienced more too with my own daughter. So it's definitely, like, opened it up. But you know, the idea of keeping it simple is definitely guiding for a lot of people. Hey,

Scott Benner 39:12
let me jump in here and ask you a question with opening up box in the loop house. Calm, you're not a doctor, I guess is my statement. Like, so like, how do you set something like this up? Like, what, what was the back room to getting something like this set up? A little

Kenny Fox 39:24
bit of concern. I definitely have a lot of like, notices that say, Hey, I'm not a doctor. Everyone understands that. And when I'm going to be talking about whether it's one on one or with the course, I'm always talking about how this is what I do for my daughter, this is the and then we'll talk about the data. I don't get into the code, but I do reference the algorithm, so part of it's just strictly teaching math and function. And I'll reference some, you know, studies and things like that, just to look at, like the facts. And then I'll tell how I apply it to Tesla's life and the numbers we just talked about and why that math. Works, and so I might make suggestions, say, if this was my daughter's graph, or I've seen something like this before with my daughter when she was that age, if it if it applies, I might change something like this based on the information we just described. So I'm definitely trying to stay clear of saying you need to change this. But this is why the emphasis is on educating people how the system works, and then how I tend to apply it so people can keep up. Because I do find that, in general, my drive to do this lately has been, I just feel like I'm not working quite as hard as some of these other people that are trying putting in more energy and effort into looping and getting worse results. And I don't think that's fair, and I think I've settled on, I worked on dialing back my own involvement, and we do just a couple things that with you understanding builds on. But the couple of things is, wake up in the morning, scroll back, look at night Scout, try to see if we need any basal changes, or if she's starting to run higher. Then I check to see if her pods leaking first, and we address that. And then, you know, we just avoided a catastrophe for the rest of the day, or running higher or running lower. And so it really only takes a minute, maybe less longer if you have to go, you know, change the pod, yeah, but we do those things. And then the rest of the information I can just glance through the rest of the day, maybe end of the day, take a look at the meals, and we'll talk about how we adjust meals a little bit. But I kind of have a certain order. I go through the settings and prioritize those, but the big ones, the basal every night, if it's just a couple minutes. Once I started doing that and making the adjustments, ever since I was on the last podcast four years ago, I've just gotten better at it. If I can teach people to do the same thing, I think they'll be able to put in less effort and get better results, or at least the same results with less stress, they'll know what to what to change. That's one of the feedbacks I've gotten from people is, hey, how do we feel at the end of this? Like, your numbers may not have improved dramatically at the beginning, but the amount of energy and effort it takes to get those numbers is significantly less. You're like, No, I know what to change now. I know right. Basal, I know that's a carb ratio, and I can make the change. And then we adjust, and we move on, rather than mentally, like mulling it over in your head for way too long, trying to figure out what it is. Yeah, that's really what a lot of people get out of the initial modifications, is just knowing where to start. It's interesting

Scott Benner 42:12
to hear you talk about it, because you sound like me talking about making the podcast. There's a way I do it. I don't know. It just works. Here it is. I don't care. Try it yourself. You know, take some of it, take all of it, do whatever you want with it. I do get the same kind of responses back. It's great, like, so in the end, you've, you've got this compendium of information in your head, and you're just going to share it back with people and and let them try to put it into play and see what they do with it. I think it's awesome. So yeah, this is

Kenny Fox 42:36
exactly like the podcast is trying to zero in on loop and and slightly more technical, just so I feel like I can talk objectively about it, and people can make their own decisions. I love it. It's a fine line to walk, but you're my inspiration, Scott.

Scott Benner 42:49
People need the help. Like, they just do, you know, we went from just fast acting insulin and in a pump, you know, however many years ago, and people would just go, like, I don't know what's happening. Like, it's all over the place, like, you know, nobody helps. Doctors don't help you. Like, you know, then that's your hell. That's you go live that life, and you say to yourself, like, well, that's just diabetes. I guess this is what it is. And then that's the level of torture that you now live with every day. And I came along and said, like, I don't think that's right. I think you should maybe move some of these settings around. Learn how this insulin works a little bit, and then these algorithms came along, and it's great for the people it works for, but for everybody else, you know, they used to say, well, that's just diabetes, and now they say the thing doesn't work. Like, you know, I bought the thing. You told me it works. It doesn't work. And now they're just, that's their hellscape, and it goes on forever, like, people need to understand how insulin works, no matter where they're using it. And, you know, I think this is awesome. I'm really excited that you're that you're doing this. Do you think we stop here, call this an episode and move to the next thing? Or do you think we keep talking? I'll

Kenny Fox 43:55
add one more thing, and then, yeah, we can probably go on to, like, food in a different one. I think one of the things you mentioned here is like clarifying things for people, looking at the all the variables that exist, I think with loop, loop is unique in that it's trying to model everything. Is just trying to you, just tell it, and it trusts you. And so it puts the settings out there, and it calculates everything with a fair amount of accuracy, as long as you, you know, do your part. There are other systems that try to handle the fudge factor, which is great, try to help the fuzziness of all the stuff you're entering. But what's cool about loop is, once you settle on like you get basal rates kind of dialed in. It seems to me, when I'm talking to people about this, that it kind of clears the fog. What people say is, Oh, I see so many more things now. So they level their basal rates out, kind of find what works, and they understand what the basic pieces of the data they're seeing in loop is like, Oh, well. Now I see when there's a bad pump site. Now I see when activity is causing a problem. Now I see when fat and protein is causing the problem. I found the same thing for me. Is once, you know, you talked about fat and protein, and we had pretty good settings, that was like, Oh, now I know why there's a rise, you know, 345, hours after a meal. So instead of looking at a meal on a graph as like, oh, well, there's two hours. I don't the meal seemed fine. I don't know why we're going high now and now, as you can see, those pieces, once you understand what the variables are, and you get really good basal. It sort of clears the fog, and people can now know what those things are very quickly, without too much energy, and they can just fix it. They can address it. We can add more carbs or fat and protein or whatever we'll talk about that later, but that's the clear and the fog thing. People need the help. I think because of that, there are systems, DIY systems, that are working on adding layers on top of those basic models to help with that fuzziness, to help to the point where maybe you don't even have to enter carbs, like with trio and all that kind of stuff. But I think to start with loop helps you learn. So either you can learn it by listening, you can learn by watching the videos, or you could try loop out for a little while, and it'll force you to see variables that maybe you didn't quite see so clearly before that have been talked about on the podcast all over the place, especially in like the pro tips and those kinds of things. And you'll just be able to see them working and then be able to address them without really spinning your wheels a lot. So I think that was that's been helpful. The way loop is designed, it really externalizes and draws the picture of all these other things that you can then see. So

Scott Benner 46:22
I really enjoy talking to you, because you do a very good job of contextualizing the thoughts in your head. Whereas I can tell you that by watching night Scout, I've learned a lot about diabetes, but I don't know that I can tell you what, like, I watch the graph, and I look at the graph and I go, Oh, I think the pods going bad, or, you know, like that kind of stuff. It didn't happen the other day, like, I said to Arden in the middle of the day, she's home, and I was like, I don't like this pod. Something's wrong with a pod. And she's like, it's fine. Leave me alone. I was like, Okay, fine. I pinged her a couple times during the day. I was like, Look, that Bolus was too big for what just happened here, and it didn't move. There's something wrong with the site. The site's not right. Blah, blah, I got such a begrudging text from her. A couple of hours later, my pod just errored, and I was like, do I be an adult here? How do I handle this? Exactly? And I just responded back, Scottie knows. I mean, I guess I could really, like, talk it through, but I don't know mathematically. Like, what did I just see that told me that, but I can just tell you that things were happening. There were Bolus is happening and basal adjustments happening, and the results were not matching my expectations. And I was like, this has got to be a site.

Kenny Fox 47:31
Yeah, there is a lot of that. For sure. I have the same kind of thing, and I'm working on trying to articulate what it is that I'm seeing. But part of it is just, I think everyone else is pretty sharp at picking up those things. Once you can get the basal pretty good, like, Oh, now you have more consistent. We'll talk about meals next time. But once you get consistency in your meals, then you when you lose it, like something's wrong, exactly we discussed, like you're, yeah, there's a big Bolus, but it just didn't move. That's strange. And I see the same thing when the pod site. And I get pushed back. Now that my daughter's 11. She's like, I don't really want to change it. So I'm like, Well, looks like there's some staining around the the tape on the on the pod, it's probably leaking. Well, can we just run it for a while? Sometimes we do, right, but at least I know what's wrong once, if she ends up high. Okay, well, we need to change it. And, you know, yeah, let's Bolus it and get it back down. And it's not confusing, it's annoying, but it's not confusing, and I let her make that decision. So

Scott Benner 48:24
yeah, okay, yeah. Well, we'll get to that, because, like you said, once you can clear out some of that noise, everything comes into focus much easier. So we'll do that in the next one. Thank you.

This episode of The Juicebox Podcast was sponsored by us med. Usmed.com/juice box, or call 888-721-1514, get started today with us. Med links in the show notes. Links at Juicebox Podcast com, thanks for tuning in today, and thanks to Medtronic diabetes for sponsoring this episode. We've been talking about Medtronic mini med 780 G system today, an automated insulin delivery system that helps make diabetes management easier day and night, whether it's their meal detection technology or the Medtronic extended infusion set, it all comes together to simplify life with diabetes. Go find out more at my link, Medtronic diabetes.com/juice, box. Are you an adult living with type one or the caregiver of someone who is and a US resident? If you are, I'd love it if you would go to T 1d, exchange.org/juice, box and take the survey. When you complete that survey, your answers are used to move type one diabetes research of all kinds. So if you'd like to help with type one research, but don't have time to go to a doctor or an investigation and you want to do something right there from your sofa, this is the way t 1d exchange.org/juicebox It should not take you more than about 10 minutes if you or a loved one was just diagnosed with type one diabetes, and you're looking for some fresh perspective. The bold beginning series from the Juicebox Podcast is a terrific place to start. That series is with myself and Jenny Smith. Jenny is a CD CES, a registered dietitian and a type one for over 35 years, and in the bowl beginnings series, Jenny and I are going to answer the questions that most people have after a type one diabetes diagnosis. The series begins at episode 698, in your podcast player, or you can go to Juicebox podcast.com and click on bold beginnings in the menu. Hey, thanks for listening all the way to the end. I really appreciate your loyalty and listenership. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. The episode you just heard was professionally edited by wrong way recording, wrongway recording.com, you.

Please support the sponsors

Donate