#301 Diabetes Pro Tip: Glucagon and Low BGs

Scott and Jenny Smith, CDE share insights on type 1 diabetes care

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

Scott Benner 0:00
Hello, everybody, welcome to Episode 301 of the Juicebox Podcast. Today in a pro tip episode, Jenny and I will talk about glucagon, emergency Lowe's, just you know, how they manage that kind of a scenario and what happens if you need glucagon and how do you use it? That kind of stuff? It's not a bummer. Don't worry, Jenny and I laughed more during this one than most of them. So we're gonna go over how to use the glucagon what glucagon is, what is it? Do the three different kinds that we could think of that are on the market? Pretty much it's a nuts the bolts glucagon extravaganza talking about low blood sugar somewhere else you're gonna talk about people having seizures, and hearing them laugh at the same time. I mean, who else is putting out diabetes content laughing about a seizure? It's not funny By the way, it's just the situation was funny. You'll see when you get to it Don't get upset. This episode of the podcast is sponsored by the Contour Next One blood glucose meter and the dexcom g six continuous glucose monitor hmm you can go to dexcom.com Ford slash juice box or Contour Next one.com To find out more about the sponsors and what they got going but trust me what they got going is some amazingly accurate blood sugar measuring tools. Arden uses both of these devices daily and they are exceptional dexcom.com forward slash juicebox Contour Next one.com take a look at both of them support the sponsor support the podcast last thing I'm going to be at the Dallas let's see how they build themselves type one nation summit northern Texas This is the greater Dallas in Greater Fort Worth slash Arlington chapter, big chapter. You're gonna be able to see me and I don't know if you know this Kyle Cochran guy's been a Ford he is a four time American Ninja Warrior. Warrior. Warrior I would not pronounce they are any? Well, any Well, I think I'm having a stroke people. This is the last episode of the podcast. Anyway, Kyle Cochran is gonna be there, I'm gonna be there, there's gonna be some other great resources. It's a really wonderful type one nation event, check them out, you can go to Juicebox podcast.com. Scroll to the bottom, click on events and there's a link right there to buy tickets. It's a great event, February 16. It's a Sunday, Please don't make me fly all the way to Dallas, and not see you. Alright, we're gonna get started. Just remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And always consult a physician before making any changes to your health care plan, or becoming bold with insulin. And now, Jenny Smith, and I do the chit chat about the glucagon.

I liked your idea, a lot of doing a pro tips for glucagon. And I was wondering if we couldn't meld it together with like emergency situation ideas as well. Yeah, you know what I mean? So I just realized that what we'll talk about what we're talking about it? Yeah. I don't know how to start this. Honestly. I can tell you that. We buy glucagon religiously. I always have some, when it expires, we always get more. We've never used it. We've had opportunity to use it twice when Arden was little, and both times opted to try glucose gel instead. which worked. Here's the best place to tell the story, I guess. And I'm sure I've said it here before, so I'll encapsulate it a little bit. But, you know, when Arden was really newly diagnosed, she was probably like two and a half years old. And thinking back now knowing everything that I know, she was probably honeymooning still, right. And I had no one ever spoke those words to me ever. I didn't know that was a thing back then. And we got kind of ahead of ourselves one day and Kelly was getting ready to leave on a business trip. She was gonna go overseas. And it was like, six or seven hours before her car was gonna come to take her to the airport. And she's like, hey, I need another piece of luggage. Like, let's go to the mall, get a little piece of luggage looks like alright. So we get over to the mall, and it's a Sunday. And we're hungry while we're there. So we grab, you know, the worst thing in the world like mall, chocolate, Chinese food, just not just more food, more Chinese food. And I was just like, boom, I can have my carbs and I was like, pull up my insulin and the needle, bang go ahead and eat. I figured this out. And she ate the food. We ate we bought the bag we went home. Arden was super little so she fell asleep in the ride home during the ride home only like 15 minute ride. And I carried her into the house and put her in her crib. My wife's packing and my son's watching the football game and Everyone's living their life. And all of the sudden, it sounded like there was a wild animal trapped in the house. Right? There was like this grunting and grunting and grunting. And you know, it's like anytime like, I'm just like, What is that, and they start moving through the house towards the sound that's coming from Arden's room, and I get into a room and look in the crib, and she is having a seizure, you know, and I was just like, I did not 100% know what to do. So I picked her up, and I went through the house to where Kelly was. And we had just this kind of little area rug. And I said, I'm like, Arden's having a seizure. And so I put her on the floor, and I got out the glucagon. So the the red box, you know, it has the, it hasn't changed it forever. And this is the one Lily cells, right. And so the red box, I pop it open, and there's a needle in there, the needle needs to be put together, the needle has liquid in it, I know the liquid needs to be shot into the powder, that it has to be reconstituted and drawn back out. And I'm going to be 100% honest with you, I was so freaked out that I fumbled with that thing. And I was nowhere near getting it put together before Kelly was rubbing glucose gel into her cheek. Right? And I'm not embarrassed because I look back on that time. And I remember when they gave it to us, the nurse made such a big deal of saying, This is life saving glucagon. But don't worry, you'll never need it. And so when she said that, I was like, well, I'll never need it. No, I never, you know, and so good thing is

Jennifer Smith, CDE 6:44
that you knew where it was in the house, at least it wasn't like, you know, in the bottom of the dog's bed or something right, just giving me credit knew where it was. So he knew where it was.

Scott Benner 6:55
So So literally, during you know, the Kelly put the glucose in her cheek, she started to come out of it. I will tell you 100% of the the experience of watching art and have a seizure will never leave me I have never forgotten any of the details of it. She was blind, like she couldn't see anybody. She couldn't talk. But I don't think that meant that she wasn't aware of what was happening. Because there's a I've shared it on the podcast recently. But there's, um, you know, there's a video of her from a year or so later explaining how it felt to have a seizure. And so you even when you touched her, it scared the crap out of her when you touched her, you know? And and so I just never even figured out how to put it together. I had shown it to nurses, I had shown it to people like everything, but when the time came, I was like, not very helpful. Right? Anyway, glucose gel did work. And then we went to the hospital, we call 911. And we went to the hospital. And then you get to the hospital and then the hospital kind of treats you like, you don't really need to be here. Like, there's that kind of feeling. And then you realize like, Oh, it's over now. Okay, yeah, it's okay. So, later, while we're talking, I'll tell you about the second time our next seizure, people are gonna be like, why am I listen to this podcast when we happen to voice? It was in the beginning. So I guess, let's really start at the very beginning, right, like, what is glucagon? And what does it do when you inject it? I don't know where you are right now. But I'm on Contour Next one.com you gotta cut me a break. There's only so many ways to do these ads. Okay. I want you to know about this meter, I'm not messing around about it. Arden started using the Contour. Next One, like I told you before, like a year or so ago, maybe it's a little less a little more. I don't know, my grasp of time is uh, you know, I'm getting old. I don't really know how long ago it was. Here's what I do know, the damn thing is accurate. It's easy to carry around. The test trips are amazing, you can miss on your first try go back again without ruining the test. So you're not wasting test trips. Again, the accuracy this meter is just wonderful. So frequently matches with Ardennes Dexcom. It's amazing. And you can get a free Contour Next One meter at Contour Next one.com. So why not go see if you're eligible for it, it's only going to take you clicking on it to find out where the next time you find yourself at the end, just tell him Look, I'd like to use a more accurate meter than what I'm using. Now. Let's write me a prescription for this one. Get some test trips and get moving with the Contour. Next One. I'll tell you what the next one is next level. The Contour Next One is a highly accurate, easy to use meter. As unique smartlight feature it instantly shows you if your blood glucose is in target range, and that can help you make dosing decisions. Right like real management decisions. You know what else they have wonderful. The contour diabetes app that seamlessly connects via Bluetooth. Understand that you test with a meter boom it pops up magic, like on Your phone. And then this app is more than I can describe to you right now. But it's free, and you want to check it out. So whether or not you use my link found at Juicebox podcast.com, or in the show notes, or if you ask your doctor to get the meter, or whatever you end up doing, in the end, just make sure you click on Like, I'm just kidding. Just make sure you get the meter. It's really wonderful. It's gonna be a great addition to your diabetes toolkit. I cannot stress enough how much we're enjoying it. What is glucagon? And what does it do when you inject it?

Jennifer Smith, CDE 10:30
It's made by the body to begin with glucagon, right. And so in the human body, it's a piece of the glucose management system that your body has in place without diabetes in the picture, right. So you've got this management system of your body releases insulin, your body also releases glucagon, which enables the body to break down glycogen, which is stored form of glucose, right? And so you get this drip, drip, drip, drip, drip, drip drip of both. And that helps to keep things stable through the course of your life. So you know, in a person without diabetes, you've got blood sugars that might start dipping down your body releases a little bit of the glucagon, which enables the body to break down the glycogen into glucose, and it starts to navigate things back up, but it's a seamless system, right? I mean, nobody walking around on the street right now, right now, even the most highly educated biochemist, whatever is probably thinking, well, I wonder what my body is doing. But

Scott Benner 11:33
just one of those things that happens,

Jennifer Smith, CDE 11:35
it happens like breathing, you don't think about it, it happens. But in diabetes, we, we kind of have, like a faulty system, obviously, right? Our body isn't making insulin anymore. But we still do have this like drip drip drip of glucose into our system, or we wouldn't need bazel insulin, right? Yeah. glucagon, however, is, as you explained, well, it's an emergency, we know it as an emergency, we have to use this if this situation is here, right? A low blood sugar, treat a, you know, a friend, a child, a spouse, whoever it might be. So when we inject glucagon, it stimulates a very large amount of breakdown of the glycogen, the stored form of glucose, so that the glucose can get into the system, thus bringing the blood sugar up,

Scott Benner 12:29
it's stored in your liver, right?

Jennifer Smith, CDE 12:33
glycogen is stored in both liver and muscle cells

Scott Benner 12:36
themselves, okay? So in a functioning person who doesn't have type one diabetes, your body really is bumping and nudging on its own, it's giving you is giving you insulin, and then it's saying, Oh, this person needs a little more glucose. And so I'll release a little here, I'll release that. And that's happening constantly back and forth, back and forth all the time. So So when we're diagnosed with Type One Diabetes, when someone's diagnosed, we always I mean, for me at least, like, in my mind, what happened is Arden's pancreas stopped making insulin, but more happened in that right, but we just don't talk about the rest of it usually, like, you know what I mean, like, right in because you hear people say like, my pancreas is dead, but it's not that does Oh, no, it does way more things than

Jennifer Smith, CDE 13:24
that. Absolutely. Absolutely. It doesn't mean you've got more things in your pancreas than just the beta cells 100%. In fact, the the the glucagon actually is made in the alpha cells of the pancreas. So a completely like different little cell hanging out, you know, Lahti die here I am to do this thing, right. So, overall, our pancreas isn't dead. It's just a piece of it. That's nice.

Scott Benner 13:49
It's not purposeful function. Yeah. And, okay. So it's interesting, right, like, so how often do you think how often do you speak to someone who's needed to use glucagon in an emergency situation?

Jennifer Smith, CDE 14:05
Hmm. In if I had been doing this

one years ago,

likely more.

Mainly, because I think that with the influx of the technology that we have now, we've got alerts to actually tell us when things are dipping, before we would even get to the place of needing

Unknown Speaker 14:33
glucagon.

Jennifer Smith, CDE 14:34
Now, I mean, that doesn't mean that it isn't potentially, you know, necessary. We've got the standpoint of prolonged exercise, you know, where you've had, like, people who do like a whole entire Iron Man triathlon, and that's a huge depletion in your body's glycogen stores, even if you've been fueling along the way as you should be. That's a huge depletion. Your body has tapped into your stored glucose to fuel that long duration movement. So, I mean, if you have exercise like that, potentially, you're going to need something to boost glycogen out of the system to bring a low blood sugar up and or you've got too much insulin there to begin with, for whatever reason the dose was wrong or the dose was wrong along with a long, active active day or whatever the scenario, glucagon will potentially at some point be necessary. I knock on wood, I'm not really superstitious, but that's like my grandmother's thing to do. It's like knock on wood. Whatever works, right, but I mean, in 31, in plus years with diabetes, I've never had to be given glucagon. I haven't. I mean, my husband knows how to use it. My parents knew how to use it. My teachers at school, my girl scout leaders, I mean, everybody that I interacted, they all knew how to use glucagon. I went to sleep overs with the glucagon in my bag, I did. Never had to use it. Thankfully, in the amount of people that I now work with, I would say, it's not, it's not common to have had to use it, at least not. I mean, we may talk about this a little bit later, like different kinds of emergencies settings of use, but there is the benefit of also mini dosing. And some adults, especially the adults that I work with, are much more proactive in in trying to offset something they know is not working right, you know, and so, ability to micro dose a glucagon injection and offset a low that you don't pass out from and nobody needs to help you. You can help yourself, right.

Scott Benner 16:52
It's funny the way you put it, because I'm thinking back now, you know, Arden's very infrequently low, but she has like a crazy low once a year that just comes it appears to come out of nowhere, right? And we think back on one of those, you realize that without the sensing technology, like if she didn't have a dexcom those she would have seizures in those moments. Yeah. Right. Because it's, it's unexpected. First of all, it's not like I've done anything different that day than another day. I'm not standing around all day going, who this is gonna be the day never happens. It never happens. When you're like, something's gonna get squirrely today, right now that day, right? Oh, and so you know, you're it's one two o'clock in the morning, and you get the alarm, and you realize she's falling way faster than you would have any expectation for. So there's something, whatever it is pushing down on her blood sugar, and nothing to resist it in the other direction. And it's just falling and falling and falling. So we get, you know, we get an alarm go in, you give her I mean, for me, I give her juice first, because I find that works very quickly. Like it's it, the way I think of it is like let's get something in there working. While we do the rest, right? Then I look at things like they're like palatable quick. I always look for like a banana in that situation. Because it's not hard to eat a banana. It's sugary, right. And then you know, I'll roll back to another juice if I have to. But you'll see those, those crazy lows go like 70 6050. And they fall really quickly. And before you know it, you're treating it 50. And you would have treated sooner you just there was no time you're treating it 50 you're into the 30s. Now you're testing now you're doing the like, Okay,

Jennifer Smith, CDE 18:30
this number,

Scott Benner 18:31
let me double check this right. So you're, you finally have a second there's some food in. So now you hit a finger stick, and it says something like 30 or 26 or something ridiculous. And you're just like, okay, now I'm here waiting for her to either have a seizure or not. Like that is really what it feels like, like I've put the food in, it's in there, it's going to do something. And you know, and you're just, I don't know about everybody else, but I test and then I wait like, not long, you know, it's like four or five minutes later, you test again, and you're looking for just any sign of stability. Did the 38 stay at 38?

Jennifer Smith, CDE 19:08
Did he come to 40? Did it go to 40? Because

Scott Benner 19:10
if it was 40? I don't think she's gonna have a seizure. Right, like, and so I think everyone needs to know how to handle a moment like that. Yeah, you know what I mean? But I'm now now, you know, having seen that moment, a few times in my life. I see, as you're talking that without the sensing technology, she would have went from 50 to 30. And the, the alarm I would have gotten would have been the grunting and the right to see it would have been the seizure. Right. Right. And then and

Jennifer Smith, CDE 19:38
without. Yeah, and without this technology, I mean, I I think fully even to this point, I I still have symptoms for Lowe's. I do even with the technology that I have that alerts me and whatnot. I still know when I know usually even before my system is going to tell me I can tell where I am. What's your number when

Scott Benner 19:59
you know You're low.

Jennifer Smith, CDE 20:01
My number is usually in the 60s

Scott Benner 20:03
Arden's at 60. She knows Yeah.

Jennifer Smith, CDE 20:06
But you know, years ago when I was first diagnosed, in fact, a good a good case where my parents probably could have used glucagon, but didn't. It was the summer like several months after I was diagnosed, we were camping, had been out playing, you know, rafting in the pool at the beach, doing everything that you would normally do when you're on vacation, you know, and it was the evening and my dad was making popcorn at the fire. And we were all gonna sit around and whatever you do at play games, and it was time for me to check my blood sugar because it was like nighttime, right? It was bedtime almost. I sit down, I check my blood sugar. And my mom was like, that numbers not right. And I looked at the number. And I mean, I was the age that I knew numbers, and I knew where my numbers should technically be. And it was 26. You might either like those old like old meters that took like four minutes to test. You just swipe the blood off, stick it back in the machine, push another button, wait for it to actually give you a value. But yeah, 26 my mom's like, That's not right. She's like, Did you wash your you know, all the things I washed my hands again. And like, I tested again, my was like, How are you feeling? I'm like, I feel like I did like 30 minutes ago. I'm like, totally fine Mom, you know, she has to get it was like 25 it was like literally it hadn't moved. Mm hmm. I was like, like, my mom is the kind of person who's just like, oh my god, like, seriously, you know, and my dad was right there. And he's like, well just give her some juice. And my mom. My mom's like, this number isn't juice. This is like we got to do and he's like, give her the juice. She's talking. She's fine. She's answering questions. You know, I mean, I can remember this very vividly. Give her the juice. I drank the juice. You know, my mom's like, okay, let's check again. You know, like, all the thing is certainly, it started coming up. It was slow. And it's a painful Wait, it really is. But my main my mom was like, there. She was like that glucagon is gonna be here in 15 minutes if this juice that your dad wanted to give you is not working? I mean, and who knows? What was the accuracy of a machine like 30 years ago? You know, I mean, my blood sugar could have been 50. Who knows? But, again, I think you also have to judge those scenarios. Like, okay, she can take something into eat, she's talking, he's talking the person's, you know, with me? Can we actually like do the glucose gel? Can you do glucose tablets? Can? Is it safe to do something to chew? Should we just do some juice? I mean, but glucagon is always there, if you don't know. And you can't tell us the glucagon. It's, it's going to work for you. It's the only thing

Scott Benner 22:39
you have at that point to it, right? Because, you know, just as I describing Arden having a, you know, a bad low, she could still eat and reason and talk and all that stuff, right? And so that's fine. But when she was seizing, you couldn't have she couldn't have drank anything or eaten anything that wasn't happening, she was gone. You know what I mean? So she needed she, you know, perfect world situation, we would have used the glucagon in that scenario for certain. You know, it's just it's, and it's, listen, I have to say this, too. It's frightening. But if you think you're going to live a whole life with type one diabetes, and not get into a situation where you test and see a 26. And I think you're wrong. I think it's going to happen at some point I used to tell. It's funny, because you described how everyone in your life knew how to use glucagon. And I've done the same thing, right? You've explained to a million people that it never comes up. And I think that sort of builds a false narrative in those people's heads like, Oh, this diabetes isn't as bad as these people say, right? Because they showed us this emergency thing. We've never used it. It's a it's not a real concern, because it never happens. I do think that's one thing that happens, but But the other thing is that is that you have this kind of feeling of I don't know, like, like, it's it's never going to happen. But it could, it just really could happen. And and if it does, you can't be freaking out in that moment. because trust me, I freaked out once. And if Kelly wasn't there, I don't know what would have happened too hard, because I was like, not processing. Well. And then since then, you know, the second learn. Yeah, you know, storytime the second time Arden had a seizure. We were Disney. And we had spent the entire time day at a park. And we were coming coming back later and I was hot. We were walking. She was eating we were giving her insulin you know, the way we thought we should we were testing she didn't have a glucose meters long time ago. And we're we're within like visual sight of our hotel walking back through the park. And this popsicle salesman's walking on us. It's like 1030 at night. And I remember looking up and seeing this guy holding these giant popsicles thinking like, what devil sent you in my path. You know what I mean? You know, and so But the kids are like, Can we get those? And we're like, Yeah, of course. And we gave her some insulin for it and gave it to her right? Looking back now, I never would have given her insulin for a popsicle. And that's a scenario of knowing your blood sugar or not knowing your blood sugar. And so we you know, she eats the popsicle, we walk back to the hotel kids are again, exhausted, she goes to sleep. The about an hour later, the grunting sound happens. And I'm like, this time, I'm like, oh, there's no raccoon in the house. Arden's having a seizure. I know what this is. And so it was both comforting and hilarious and scary. All three, excuse me, not both, but all three. I went into the other room, goddaughter, sure enough, she was having a seizure, we went right for the glucose gel, because you're like, Well, we know this works. And take the cap off the glucose gel and go to squeeze some out, it won't come out. And in the panic, I just thought, I don't know what I thought. But just the little silver paper was still over the thing, the freshness seal, they squeezed it way too hard. The freshness seal did not come off. But it sprung a pinhole in the back corner of like the sealed part of the tube. So imagine icing tubing, and I'm squeezing it and I am writing in calligraphy all over the ceiling of the hotel room in this laser thin beam of glucose,

Jennifer Smith, CDE 26:23
right? Oh, no,

Scott Benner 26:25
we all look up, everyone laughs we spin the thing around and shoot the glucose gel under our mouth out of the pinhole and out of the thing rubbing her cheeks, she wakes back up again. She's fine. She's kind of looking at you like Yo, what's up, and we get we get her stable, make sure she's not falling, and we put her back to bed. The whole thing took like 15. And that was sort of the end of it. And she's never had one since then. You know, but we learned a lot in that in that time. Absolutely. So if you don't think that's gonna ever happen, I hope it doesn't happen to you. But to live like it can't happen. That's a mistake. And so back to my original point, when when I used to spend time before when I was younger going into school and saying, look, here's what you really need to understand about diabetes, and I would go over the stuff. But I would always end with I know you feel like we're sitting here today, getting ready for when it happens, because it's something we can prepare for. I'm like, but the secret about the diabetes in an emergency is you sort of can't prepare for it. Like, if you knew it was coming, you'd stop it. And that's always the weird part about this stuff is it always happens just when you would never expect it to happen, like because otherwise you'd be sitting around going, Oh, you know what's going on this afternoon. It's totally a seizure situation. Like no one thinks that way. And so I don't know, I just, I think it's incredibly important to be prepared.

Jennifer Smith, CDE 27:48
It is well and one additional to that, like preparation. Let's say you are prepared. You've done all of your homework, you know, you've got the glucagon, you know how you know to use it, your friends know how to use it or whatever. And I, I bring this in because it's something that I do discuss, especially with like older teens and like college students and anybody who does a lot of socializing within their job. I think it's, it's really important to know that there may be a point at which glucagon may not work. That's right with alcohol. Mm hmm. And I mean, there really is, there's a real reason it's not like the glucagon is like, Oh, I'm just not gonna work today.

Scott Benner 28:32
Like, you know, Jenny trust too much. She doesn't deserve for me to work.

Jennifer Smith, CDE 28:37
Right. Right, right. He she had beer and I would rather she has, like, you know, a Mai Tai or something. No, not at all. It's just, you know, it's the there are biological reasons, right? I mean, your liver again, your liver is like this phenomenal organ in your body. It really is. It's, it's fantastic. And it does a tremendous amount of stuff for you. One of them is and we kind of call it your body's detoxifier. Right? I mean, that's a really like nutshell term for the things it does. But the livers task of ridding the alcohol out of the system, which it sees as a toxin. It's going to do that first. Before it does that's its first thing that is its job, it's going to see a toxin is gonna be like this body doesn't need this, let's get rid of it.

And it takes

a while for your body to process that alcohol. So I think it's like one drink takes about an hour and a half to process out of the body. Okay. So in that time period, your liver isn't going to as he efficiently areas effectively check into what's happening with your blood sugar.

Scott Benner 29:45
Yeah, it's a task I really do. Right? It's not

Jennifer Smith, CDE 29:49
but in that if you give glucagon in that scenario, and now you're asking the liver to do another task, it's not a multitasker.

Scott Benner 30:01
doesn't already so are you? I feel like Jenny's saying that a liver is more like a guy, like you give it a thing to do when it does that thing until that thing's over, and then it moves on to something else. I know, this is a generalization, it's sexist. But, you know, I don't know that it's, I don't know that it's that wrong.

Jennifer Smith, CDE 30:20
Yeah, yeah. And drinking in and of itself can also, you know, do some crazy things just to blood sugar levels in general, right. So if it's got carbs, and if it doesn't have carbs, and it's pure alcohol, etc, you may not have been eating with the alcohol. So I mean, there are a host of other things that could go into a low blood sugar in terms of alcohol consumption. But one of the things, of course, is that the livers not doing that drip drip of glucose, right or glycogen to turn into glucose, etc. So your bazel, then that's dripping in the time period that it was beautifully tested, it should be working great. Your basals managing without the normal

Scott Benner 31:03
bukal. They're very important point.

Jennifer Smith, CDE 31:08
So if it's not doing that, then what happens you get a little blood sugar. Now when you take the glucagon, you're now telling your liver, like I said before, to do something to release this glycogen and to give you some extra glucose to bring the blood sugar up. And there's either a major delay or it doesn't, it doesn't do it. They're really in drinking some emergency, you know, if you're with it enough to know that your blood sugar's dropping, obviously, simple carb, you can do the juice you can do that is if you're with friends, college friends, a spouse, a significant other, whatever, they should know where the glucose gel is something safe. If it's not glucose gel, they should know where the honey is, if they don't know where the honey is, make sure it's cake frosting, something that can be squirted into the cheek can be rubbed in massaged in, it starts to absorb and it can bring the blood sugar up.

Scott Benner 32:00
We don't want to have to swallow it to make this process happen. We want it to absorb through the lining in your mouth back.

Jennifer Smith, CDE 32:07
Correct. Exactly. So that's one I think one in that like emergency time of potential Oh, get the glucagon out.

Scott Benner 32:17
Try some other stuff first. Right? stuff first,

Jennifer Smith, CDE 32:20
obviously even calling you know, emergency services, obviously, you're with somebody you really don't know what to do.

Call 911. Yeah. And it's so

Scott Benner 32:29
it's so interesting, because what you just said about, you know, when the liver stops making, you know, it stops dripping out this glucagon, this glucose, we always talk about, you know, you need your basal insulin setup, I'm always saying, right, it's like timing and amount, it's the right amount of insulin at the right time against carbs or body function. And you know, then we talk about body function being like stress or anxiety or pain, or, you know, all that or your liver and what you're doing, that's a body function that's causing your blood sugar to try to go up. And if all of a sudden, it's not trying to do that anymore. Now you're bezels too much. It's too much, right? It's actually off the topic,

Jennifer Smith, CDE 33:06
right? I mean, it's actually the reason that with alcohol, our standard of education that we say to do is for every alcoholic beverage to take your basal rate, if you're using a pump, that is take your basal insulin down by 40%, and set it to last duration, at least two hours for every drink consumed. If at the end of the night, you've had, you know, four drinks, that's eight hours worth of a decreased bazel.

Unknown Speaker 33:37
So

Scott Benner 33:39
right, so let me so now I have this question as we're having this conversation, and maybe I'm wrong. But this thing that we call glucagon that we inject inject in emergency situations, is it actually glucagon? Or is it something that makes your body produce glucagon? cliffhanger? You got to go check out the dexcom g six continuous glucose monitor. You have to if you don't have one, I can't even understand you. I really don't. At least looking into it. I don't understand. How would you? How would you hear all this stuff every week and not think to yourself, I need to see my blood sugar. I want to know what direction it's moving. And I want to know how fast it's going. I want to see my kids blood sugar while he's at school. I want to know what my daughter's blood sugar is at a sleep over. I want to know before I get low, I want to know before i get i three days ago, and by the way, let me say this first. These are my results and yours may vary. Okay. Three days ago, I started helping a person with a blood sugar that was completely out of whack. I'm talking about over 404 hours a day, that low and then when it sat steady, it was well over 250 it was a mess, right? And I was able to help that person make adjustments to their insulin just by seeing their Dexcom that's it took like two days. If I could do that in two days, imagine what you could do with the Dexcom for a lifetime. Please, really, really think about it. I hear all kinds of excuses from people, I don't want to, I don't want to hear it, beep, I don't want this, I don't want that. It's gonna beep to help you. And once you learn how to use your insulin, it's not going to beat that much. Because you're not going to be jumping out of range all the time, like you are now, that's a real tangible thing that could happen for you. dexcom.com forward slash juice box, the links in your show notes or Juicebox podcast.com, Please, I'm begging you just look into it.

Is it actually glucagon? Or is it something that makes your body produce glucagon?

Jennifer Smith, CDE 35:52
No, it I, I understand that it's glucagon.

Scott Benner 35:55
So glucagon makes your body make more glucagon,

Jennifer Smith, CDE 35:58
glucagon injected makes your liver release glycogen and transition it into glucose. Okay,

Scott Benner 36:05
so is this stuff that we're injecting helping bring up our blood sugar? Or is it just making that function happen?

Jennifer Smith, CDE 36:12
It's making the fun, right? It's the glue gun that you inject is telling your body to release the stored glucose and send it into the system. That's what raises the blood sugar.

Scott Benner 36:23
Gotcha. It seems like such a simple thing. But as we were talking, we're a half an hour into this. And I'm like, maybe I don't understand what's in the vial.

Jennifer Smith, CDE 36:32
Unless somebody else knows something else. I've all the years it is glucagon in the it's in that little vial. And it's not as very stable compound at all. I mean, that's why it's in that

Scott Benner 36:43
like the way it is

Jennifer Smith, CDE 36:44
pill form shift the way it is. That's why it expires so frequently. It's why you have to mix it and use it. I mentioned briefly before even using mini glucagon, a small portion of what you mix up, if you are, you know, alone, and you can use it yourself. That vial that you mix up, then it's only good for 24 hours. Yeah, kept in the refrigerator. So

Scott Benner 37:09
and so you're talking right now about the one that comes in the red box, the one that's made by Lilly. So I guess let's break them down a little bit because now there's suddenly on the market more glucagon it forever and ever it was the you got the red box, right. And so inside of that red box really is a vial like a glass smile. And it's got powder inside of it. Then there's a, a needle with and it's an inter muscular needle, it's not an under this, it's not under the skin, like little insolently looks like a all the way all the way in.

Jennifer Smith, CDE 37:40
And it's a pretty good sized needle. It's a hunk of

Scott Benner 37:42
a needle is what it is. And so you pull out the vial with the powder in it. You take the needle, and you inject the liquid, it's in the needle into the vial, then you kind of spin it together, you know, between your two hands. I know you can't see what I'm doing. But anyway, that Yeah, then it, it constitutes it, it mixes the powder with a liquid, then you have to draw it back into this syringe. And then you're supposed to stick that syringe like into the muscle in your butt, right? Or something like that. Or they

Jennifer Smith, CDE 38:08
usually say right into the body. Yeah, I mean, yeah, that's the easiest way checking

Scott Benner 38:13
that glucagon into the muscle. All right. Now that's one glucagon but since that's happened, another company made a nasal glucagon who made that? Do you remember?

Jennifer Smith, CDE 38:24
Um, gosh, I don't remember the name of the company. It's back semi is the name though of the okay. Nice. Oh, God.

Scott Benner 38:31
No, that's sort of like, you know, everyone, I think assumed it was like an aerosol, but it's more powdery. Right? Have you talked to anybody that's used it yet?

Jennifer Smith, CDE 38:41
I've not talked to anybody who used it. I have it myself. I did get a prescription for it. And part of the reason quite honestly, that I got a prescription for it is well, twofold. It's it's certainly much easier to use from all of the research and all the studies. The there's a significant decrease in accuracy of use, okay, or a significant increase in the accuracy of use with the back semi compared to the mixed injectable.

Scott Benner 39:11
Okay. Let me let me take it personally, I'm looking at it so it's actually also made by Lily. Oh, and it's so it looks like it comes in a thing that looks like you know, sailing you'd see it the tube, alien thing you'd spray in your nose, but I'm reading it here it is a powder, dry powder spray in a portable single use ready to use device now. I've only heard from a couple of people who have tried it and so far the people who've tried it have said to me that it burned their nose. So the inside of their nose I don't they didn't say about how well or not well it worked but Jenny's hearing that it works more that it works better than the this

Jennifer Smith, CDE 39:51
in terms of accuracy. It was from what I know it works the same as dosing but the accuracy if somebody else has to give it to you More accurately delivered. Okay,

Scott Benner 40:02
so in a panic situation, your friend is a little more able to stick something in your nose and squeeze it than it is to everything I just described and then stick it in your butt.

Jennifer Smith, CDE 40:12
Correct. Okay, correct. I mean, I guarantee you that, you know, when Arden was two and a half, if you had had something like this, taking it out of the bottle, sticking your nose and pushing it in, you would have had no trouble doing that, you would have been able to figure it out. And I, you know, a big part of having it in the house is because with little kids, you know, I, my seven year old is a smart kid. And while he would know to call 911, he would know to go to the neighbors if I was a home loan with them, and I wasn't right. This is something that I easily showed him in two minutes. And I was like, this is all you got to do and then run to the neighbors. That's that's all you gotta do.

Scott Benner 40:55
You know, you're gonna sleep soundly one day and wake up with a burning, burning in your nose and their front door wide open. Gonna be like mommy's down, and you'll be like, Nah, he's just sleeping. So now there's a third one on the market. And I just left Arden's appointment the other day, and I got our glucagon change to G Volk. So, g Volk, comes in a syringe still, but it is the I think the kind of the genius of what this company figured out is, is that it's, it's pre constituted, you don't have to mix. It's not a powder and illiquid. And it's incredibly stable. So my assumption, I'm making an assumption that you might, you know, maybe people who used to think, oh, one day, we're gonna make a closed loop system with glucagon in it, but we couldn't, because they couldn't figure out how to keep that glucagon stable long enough. I'm starting to think maybe that that might be the next step after these algorithms, you know, I mean, maybe it will be a dual chamber pump with an algorithm. And this, but I went with this one, and I will be 100% honest, why? There's two things. The nasal thing to me, seemed everything what Jenny just said, like, seems super easy to do, and all that stuff. As soon as I started hearing about the burning, I thought, okay, like, that makes sense. And I still was going to go with it. Until and again, this is being very honest, the makers of GE Vogue said, We'd like to come on the podcast and talk about the glucagon. So sometime in the future, you're gonna hear an interview with the CEO, and he's going to tell you why the company started and all this stuff. And it was super interesting and incredibly interesting life. I it's possible that when you listen to it, I mean, if you listen to this podcast enough, you might not be surprised by this, but I don't know exactly how much we're gonna talk about the glue gun, how much I'm just gonna be like, so what did you do after college? That's weird. And, you know, but but that, so I went with it. For two reasons. One, because it's stable. And you know, I don't have to it doesn't have to be metal. Yeah, the injection isn't intermuscular. It's just, it's just a normal like, little needle. And I thought, maybe I can use it for bumping, like doing glucagon. Like little bumps, too. And then and that wouldn't be possible with the nasal. Right.

Jennifer Smith, CDE 43:19
And there is I mean, there is a guide, certainly for using you're talking about like that mini dosing, kind of of glucagon. And there is a guide for it. In fact, it's, it's actually a guide that starts with, you know, a tiny, tiny amount for little people.

Scott Benner 43:34
And you talked about it on the pro tip about celiac illness. We talked about that, right? Yep. Yep. You people can check that out if they want to hear that, but and so incredibly, ironically, I guess, not long after you and I recorded the the illness pro tips, Episode ardyn got sick for a number of days. And unlike most people who are like, Oh, I got sick and my blood sugar went up, Arden gets second or blood sugar goes down. So there was this one time her blood sugar was you know, it was at 70. And I'm like, it's gonna hold it's gonna hold eat something. And then the food didn't do anything to her. And it kept drifting down. And I gave her more and more. And then there was this moment, you know, we're like, 45 minutes into this since she's now 55. And I'm like, Jesus, none of this food is touching her. And so I'm thinking to myself, what's next? Like, I have to do something right now. I walked up to her with a juice box. She goes like this. puts her hand up and she goes, if it's my time, it's my time. But I'm not drinking another juice. Girl super serious and trying to be funny at the same time. I said, Right on, okay, I hear what you're saying. She's like, seriously, if I drink another juice, I'm gonna throw up and I was like, gotcha. So I went downstairs. This is probably the first of all this is completely off label. But it's also why at the beginning of the episode, I tell you, this isn't I'm just telling you what I did. It's not medical advice. And I took my Old no red kid warm Lily and I mixed it up. I went back and listen to what you and I said to each other. This is me like, I'm like, I wonder what I'll do. You know, there's a podcast episode about this Hold on. Then but and I remembered and I drew up like I kind of spit balled it a little bit. It was off based off of weight, I remember that I drew up seven units. And I gave it to her. And it took a little while, but no lie, her blood sugar went back up, not too far. And it leveled out. It stayed there. And I was like, right on, I am definitely getting the gfo instead of the nasal stuff, because this might happen again. Now, that was my reasoning for going that way.

Jennifer Smith, CDE 45:39
The big question about the Evoque would really be the pen itself, how? How, how much is in the pan? Like how many? You know, what's the dosing because when you look at how much to give, it's, I think it's if you're over 50, in the doses, 15 units of mixed up glucagon. And that would be given kind of like we talked about before, and the other, the other episode, a certain amount of time. And then if it doesn't bring the blood sugar above 80, then you re dose with the double the amount. So just with the G Volk, my question would really be how, how much do you know that you're giving

right as a mini dose? Because

Scott Benner 46:20
I used to find out because you're 100%? Right. And and so I'm going to try it? I'm going to find out. And if it's not right, I'll switch to something else. I you know, yeah.

Jennifer Smith, CDE 46:28
Yeah, I pre mix that you don't have to do any of that extra stuff. That's really awesome.

Scott Benner 46:34
I think that as a replacement for the Lilly one, this one's a no brainer, right? Because you don't have to mix it up. And it's not this giant needle. But I think and this is not something the company said to me, my but my assumption is, the real excitement here is about the possibilities for dual chamber pumping, tested stable. And not only that, I think the bigger excitement and I think the CEO alludes to this, if I'm not mistaken, I'd have to go back and listen. But my assumption is, they figured out the science of making something liquid stable, which now means that science could get applied to other things. Sure. I'm guessing I'm guessing this is the very infancy of this company is what I'm thinking and run by nice people. So that's cool. Oh, okay. So we went over the three different kinds of glucagon. What and the when? Right, you're going to use glucagon when somebody can't physically take something in their mouth anymore? Right, right. When Arden had a seizure, we only use the gel and rub it into her cheeks. We were trying to get her to swallow it. If you try to get somebody having a seizure to smell something, you get them to aspirate. It's bad. Right? Right. Right. Right.

Jennifer Smith, CDE 47:49
They may be even a you know, something for, as we know, symptoms of low blood sugar, even if you're not passed out or having a seizure, you could be not together with it, right? I mean, many people complain about their spouse, significant other child child getting very violent, or very abusive, or whatnot. I mean, getting them to eat something is impossible, maybe impossible. So using glucagon, in a scenario, like that may be your only option.

Scott Benner 48:19
Yeah, you might be tackling a,

Jennifer Smith, CDE 48:21
you may be tackling that and holding them down.

Scott Benner 48:25
I'll tackle them that hand me the needle, it's gonna be a lot of fun.

Jennifer Smith, CDE 48:28
Right? Right. So

Scott Benner 48:30
well, that really is, you know, I've heard the stories too. And there's been people who've come on here and told them, but I've heard them privately two of the worst scenario ends up being when you're two adults, and one of us physically smaller than the other one. And the larger person, you know, becomes combative or angry. And I've heard I've heard about people throwing furniture and, you know, saying terrible things. And, you know, yeah, and everything in between. So

Jennifer Smith, CDE 48:58
and from a safety standpoint, you know, if the person is up and moving and in, let's call it like a violent sort of behavior, and you're not safe, just call 911. I mean, that's really, I mean, don't try to get close to them with a needle in China

Scott Benner 49:16
is not a good idea. It's such a bad television show, like you're just standing across from each other one guy's ranting and raving and holding a lamp and you've got a needle in your hand. Every bad movie I've ever seen in your life. Exactly. I think the goal would be not to get that low if you absolutely can. But like we said, these are emergencies. They don't happen on purpose. I think it's just very important to remember, like, you can't plan for an emergency. I mean, you can plan for what to do when it gets here, but you can't plan for when it's going to happen. Right? Right. So let's talk about since we're in this vein right now, and we're using a part time and we have a couple more minutes. Let's talk first about low symptoms. Some of the things you've heard people saying I will start with the one that Arden tells me What is happening? Why or why am I being treated buddy wants to reach you? Oh, you know what actually this is funny. It's um, Express Scripts I have to say okay to prescription glucagon prescription. I'll call them too funny to call them back in a little bit. But I know that's what that is. Now my wife has picked it up downstairs and she's busy listening to a recording. And she's trying to figure out why she's listening to a problem. So are we the other day? She She got a little low, right? And we were going right into our restaurant. So she went like quickly from like, 75 to 60. And I was like, hey, you're dropping, and she's like, Yeah, I know. And I was like, How do you know? And she said, My lips are numb. Mm hmm. And I was like, really? She goes, Yeah, she's like, that's the one that I like, that's my physical tell. She's like, my lips get numb. And she goes, and if you don't take care of it, she's like, I didn't realize before. So she told me a story. She said one time she was out with my wife. And this happened. And my wife gave her a drink to have. And she drank it and orange like, Oh, this tastes terrible. And my wife's like, really? And my wife tried it and said, Kelly's like, no, it seems fine. And Arden kept drinking a little while later, I think we were at a baseball game for my son and I was on the other side of the field. So I came back over eventually. And my wife said, Hey, Arden was low earlier, but we took care of it. She drank this. She said it tasted weird. And so I tasted it. I was like, I'm zone tastes fine, you know. And so it took Arden she said, it took her years to figure out that when that numbness comes, it's affecting, like her tongue in her mouth, too. She feels it on her lips. But she's like everything. Everything tastes weird. At that moment, I was like, Oh, no kidding. So I was wondering if that happened, anybody but what are some of the of like, what happens to you?

Jennifer Smith, CDE 51:51
So and I think that's, it's good to acknowledge symptoms and understand that there are many symptoms because they can also change over the years. Like I, you know, when I was younger, my symptoms were the classic like, I would get, like, visibly shaky, I could hold my hand out and I was like, visibly shaky, beyond just the internal symptom. It was there was a visible cue there too. In college, I also had something very similar to what Arden is describing. But it was more It was more like an internal mouth numbness. It wasn't really my my lips, it was more like an internal mouth like it almost like you know what it feels like to be numbed at the dentist. Like you feel like your whole mouth is thick, and like pudgy. That's what it felt like to me. Okay. Um,

Scott Benner 52:44
hello, now is there for you ate, like, after you brought your blood sugar back did it last?

Jennifer Smith, CDE 52:50
Ah, gosh, I mean, I would say it probably lasted a bit of time after my blood sugar was actually normal. Because I specifically remember it. Like in college, I was still on injection. And so I would often have that as I came into lunch, because they had pretty full mornings of like zooming around on campus and getting back and forth, the classes and whatnot. And so I would often have that at lunchtime. And I can say that, before I headed out into my next course of classes in the afternoon, I still had that feeling even though my blood sugar was already back off from having eaten. So I guess for a bit of time, it seemed to last. Whereas my symptoms now don't last after I've treated, they don't last long, unless it is, unless it's been a significant drop. That's happened very, very quickly. And it takes a while for the carbs to kind of start to make me feel better. My symptoms now are much more like this, like, feeling of everything rapidly moving. Like I feel like the world is spinning and moving. And my thoughts are fast. But I I feel like I'm walking through mud. I feel like I just I can't keep up with the way that my brain is thinking about things.

Scott Benner 54:24
So I wonder if we'll never know, obviously, but I wonder if your thoughts are at regular speed and your body is slowed down? Or if your thoughts are sped up and your body's that regular. I'm so interested in that. There's no way to know but because it's right, like you're one part of you is being fooled about something about something and it feels like it's like you feel like that might be what it is. Maybe it's like that maybe you feel like you're in slow motion. I don't know. Isn't it weird? It feels like if it makes me feel like you're in like a dream right? And you're like, kind of screaming like, you know what's going on, but you can't affect anything. Is it that kind of a feeling or no? Am I wrong?

Jennifer Smith, CDE 55:07
It's somewhat Yeah, the other one is kind of feeling like drunk. Like I get kind of tipsy. And I'm like, I've literally been like drunk maybe three times in my whole entire life feels like and but that's not every time but some of my lows feel. And I'm a I'm a very happy like, drunk person. Like, whenever Everything is fine and happy, I'm not an angry drunk. Ah. So I get kind of tip with a low blood sugar sort of like, Ah ha ha, that's funny when it really isn't funny at all.

Scott Benner 55:47
It's like I'm describing with Arden to like, because she's done that a couple of times. Like, you know, I'll be like, Arden get up you have to do some your blood sugar's low. And she'd be like, I'm just gonna die over here, like, but that's very jovial when she says it, like she's very like jokey about it. Like it's cold and

Unknown Speaker 56:02
funny and totally fine.

Scott Benner 56:04
Just be fine. But you know, yeah, I think it's interesting. So when people have you heard from other people like some of this stuff, because they are, before we go into that, let me ask you this one. When you wake up after you've been low for a while, and you didn't know, why are you so sweaty? Do you know? Why did they did well, though,

Jennifer Smith, CDE 56:23
it's an it's a body response to the low blood sugar. All of the physiologic like mechanisms that make it happen. I can't, too, but I do know, it's very, very common to wake up in a sweat.

Scott Benner 56:38
Yeah, like mad, like, change your clothes after you treat blood sugar, like, yep, take the sheets and wave them around for a while. Yeah.

Jennifer Smith, CDE 56:48
That's exactly right. Even kids. You know, I've heard some parents that comment to that, you know, an older child, obviously, wouldn't be wetting the bed anymore. With a low blood sugar may have mainly because they've not got the conscious, I guess, ability during that time period for their brain to wake them up to actually get up and go to the bathroom. Because they're low, you know, so But I mean, outright symptoms, you know, even blurred vision can be one of those sort of like a tipsy feeling on your feet. The shakiness in the hands, people talking kind of like, kind of like off the rocker sort of like, yeah,

Scott Benner 57:29
they don't make sense. Yeah, we're confused. Yep. And it, I guess it it's funny to like I, I've read, you know, back in the day, like all kinds of blog posts from people where they talk about being low, and everyone describes it like slightly differently, but I think it's situational, too. It's really interesting. There's somebody I keep thinking of having on just to describe below one time because this person's love was, like an amazing story to see if I can figure that out someday. Okay, treating things. Like let's so let's talk about it for like to finish up real quick. My blood sugar's falling, but I don't want to get high again. I'm ahead of it now. Like, you know, I know people know Arden's a juice box person, if you know if, if she's looking for a quick hit, if she's not hungry, juice boxes work for us, we use this very specific juice box. I think it's important to remember that you're not looking to drink so I found the smallest box I can with the most carbs in it, so that she's not having to like I I started helping Arden's friend the other day. Yeah, and you're gonna and she's doing great by the way. Oh, yeah. And but you know, if the first time was like, hey, I need you to drink some juice. She pulled out this juice box and it was huge. And I'm like yeah, you that's here. I sent her a link I was like get these like you're killing yourself you drinking eight ounces of juice to get 15 carbs. Yeah, I only want you to know the juice is medicine. It's not for fun like you don't even so juice boxes work I've talked to people who use jelly beans glucose tablets Skittles like so you're you're looking for something that's a real simple sugar that's getting absorbed in your mouth and then hitting your body quickly when you swallow it like that's it so what sometimes people say milk but I don't think milk is fast right?

Jennifer Smith, CDE 59:16
So that's Yeah, I mean ages ago that was one of the treatment things even on my list when I was little for low blood sugars it was milk right well when you consider like whole milk one there's fat there there's protein there and the body actually have to has to break down the milk sugar in order to get the glucose part out of it. Which is what actually brings your blood sugar up so I I don't ever recommend milk. I really don't I wouldn't. I don't think it's a I don't think it's a good low I mean obviously if you don't have anything else around have added drink your milk, but there are much better simple sugar things to carry along with you. Even dried fruit. And you know when I was little, my mom actually used to give me a little mini mini boxes of raisins. Okay. And then I had, at the end of the school year had these like, dead raisins sitting all over the bottom of my backpack that had to be like, they were disgusting. They were like, you know, full of dirt. And they were gross. But that was what worked. I mean, raisins were easy. They they worked well. They got the glucose tablets when I was little were horrid. They were horrid. I mean, if you think they're bad now, they were like, bad, bad years ago. I mean, now, the only ones and I don't even I don't I don't know if they're on backorder still, but the gluco lift brand is the only one that I love. They taste good. They don't come from a GMO glucose source. All the colors and the flavors come from natural fruit and fruit extract. So they're not artificial. You know, nail Lake number 70, or whatever it is. So but something simple. I like your juice box though. I actually have kind of the opposite. I look for the smallest juice box that has the least amount of carbon it because

Scott Benner 1:01:07
when I drink I

Jennifer Smith, CDE 1:01:09
either have I'm either I'm like half awake. If I ever do you have to treat a low overnight, which thankfully, I haven't had to do in a really long time. But I don't want at two o'clock in the morning to have to be completely fully conscious.

Scott Benner 1:01:21
I say to yourself, I really need this juice box,

Jennifer Smith, CDE 1:01:24
right? I mean,

and so the juice boxes I get are actually there. They're four ounces, and they're only eight grams of carbs apiece. Okay. Yeah. So you know, they work Nice,

Scott Benner 1:01:35
nice. I know, Arden also carries those little pouches or fruit snacks with her. And they always have like eight or nine fruit snacks in them, and it will sometimes texture and be like eat for two for snacks. So the other morning, we were heading to school and she was here, throw this out for me. And she gives me a package of open fruit snacks. I still have four in them, but they're hard as a rock, you know? And she's like, they're hard. And I was like, Okay, I'll get rid of them for you. And but yeah, she always has one of those. So in her bag, she has a juice, a small juice box and a small pack of fruit snacks. And she always has that weather. And yeah, and then there's juice boxes sort of spread around the school. So Martin's in high school, so she changes obviously, you know, Ross's Yeah, so there's, you know, in a closet somewhere, there's a couple of juices in each class. And then wherever she is, and she has to take one out and drink it from reverse. If she does, she just hits the closet and replenishes her purse. Yep, you know, I have to say that we don't you know, the beginning of the school year, it's not as it's not as intense when you're older. And you've done it for a while, we just take two bricks of juice boxes and spread them around like, you know, right rose petals at a at a wedding. We're just like, there are some here are some here, throw some there. And you're done. And then maybe once a year are they'll be like, hey, I need more juice boxes. So she might go through. I don't know, she might go through 1020 of them a year at school. But that's pretty much it.

Jennifer Smith, CDE 1:02:56
Yeah, pretty new. That's pretty minimal. That's actually pretty good. You know, when you when you get to be an adult with diabetes and have kids in your house,

you actually have to be

kind of good at hiding thing,

Scott Benner 1:03:09
or disappears.

Jennifer Smith, CDE 1:03:10
Or it or it disappears, like literally, I mean even I mean even my husband don't drink them or eat them. And he I mean, you know, he'll tell me if they're obviously not there anymore. But I mean, my kids if I have my glucose tablets out, they'd love them. So I hide them and so it's like it becomes really important like purses, by purses, I have like these internal like hidden packs, pockets and many of my purses because when they see an open purse on the table or the floor, they're like, oh, does mommy have any of her stuff in here? Like mommy stuff is for really important reason.

Scott Benner 1:03:44
reminded me that during during a family vacation once there was an argument, because we were we were in a moment where it was summertime. And we need help by the way we now because of Disney new hell like magical popsicles were right they give you a little bump, but they didn't make you go too high or anything like that. And for our net lease, and so we bought these box of popsicles like you know, you get to a shore house you go out and go shopping. And someone said Oh, I'm gonna have a popsicle and cozy Hey, you know, I just needed not to touch those. We've got them in case Arden gets slow, which prior to all the technology was going to happen like you were going to use those popsicles. And one of the parents said that's not fair to the other kids. And I remember Kelly going will tell them to get diabetes and then they can have all the popsicles they want to know but like for right now just don't touch the popsicles. But it actually caused it was like a like you know, that's that's not fair. Our Kelly's like, are we talking about fair because my kids are measuring fair. I think I win. Anyway, right. Do you feel like we did a good job here if you needed to? All right, cool. So I will so let me say goodbye let you get back to your business and Jenny's businesses she does this for a living at integrated diabetes.com this is not an ad. This is just me telling you that Jenny is the bomb diggity. Check her out at integrated diabetes.com there's also a link to her email address right there in the show notes look in your player right there. Thank you so much to Dexcom for sponsoring this episode. Don't forget to take a look at the Dexcom g six continuous glucose monitor today by going to dexcom.com Ford slash juice box or clicking on the links in your show notes. Were the ones you'll find at Juicebox podcast.com. And of course, you need to run out and get yourself a Contour Next One blood glucose meter Contour Next one.com

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#300 Saira is the Trif3cta

Saira has T1, loves a T1 and gave birth to a T1

Saira has type 1 diabetes as does her husband and daughter. She also has a great T1 blog www.type1basics.com

+ Click for EPISODE TRANSCRIPT

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

Scott Benner 0:00
Hello, everyone, and welcome to Episode 300 of the Juicebox Podcast. It's kind of a cool little. We call that when you reach them. Point. It's a milestone, isn't it? That's what they call that. It's a bit of a milestone. I don't know if it means anything, but it's cool. 300 episodes is a is a bit of a milestone. Would you like to help me celebrate 300? Here's how you could you guys are like, oh god, he's gonna ask us or something. You're right. I am. A number of you. When asked what your favorite episode of the podcast is, or who some of your favorite guests are. A lot of people say Sam fold the former Major League Baseball player who's been on twice now and has type one diabetes himself. Well, Sam does a sports camp every year for kids with Type One Diabetes. And he's running a GoFundMe right now to help pay for the camp for these kids. Now the camp happens on February 8, so it's coming up really quickly. And any money that Sam can collect to help with this camp on would be a big deal. So I'm gonna put a link in the show notes that you can click on to its charity, GoFundMe, but it'll take you right to Sam's page. And if you can throw in a couple of bucks, anything you can to help Sam continue to work with kids with Type One Diabetes, it would be terrific. So perhaps you're very excited about the podcast reaching 300 or something else going on in your life and you need a way to celebrate where you found like, four or five bucks in the cushions of your chair, something like that. You're like us found money. I wonder what I'll do with it. He said I'll probably buy like a bag or rolos or something. I don't buy a bag or all those. Give it to Sam, let him help kids. Have a great time. Fine. Thanks for considering that. And now let's get to the show. I'll play some music. And then I'll tell you more.

On this live 300th episode of the Juicebox Podcast, I will be speaking with a lovely person who has diabetes, whose husband has diabetes, and whose child has diabetes. Am I What are you thinking right now you're like, well, that's three people. You're right, your math is rock solid. All you need to do while you're listening is remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And always consult a physician before making any changes to your health care plan, or becoming bold with insulin. Also, I have some events coming up in Dallas, Wisconsin and Atlanta, very soon, go to Juicebox podcast.com. Scroll to the bottom click on events to find out more there are still tickets available to each of the events. Let's strap in get ready to talk to Syrah about her life with Type One Diabetes. That person living with type one, the spouse of someone who has type one in the mother of someone who has type one diabetes.

Right now I can feel you thinking oh my god, there's no ads. This is great. Now there's ads. This episode of The Juicebox Podcast is sponsored proudly by Dexcom Omni pod and dancing for diabetes. But do we call them dancing for diabetes anymore? Or do we say touched by type one.org? Hmm, think about it. It's touched by type one.org. Don't forget that on the pod makes the world's only tubeless insulin pump, the insulin pump that my daughter has been using since she was four and she's 15. So if you can do the math, that's a long time. And of course Dexcom, makers of the G six continuous glucose monitor. Find out which way your blood sugar is moving and how fast with the dexcom g six continuous glucose monitor. Find out more about all the sponsors. You can find links in your podcast app right in the show notes. You can go to Juicebox podcast.com, where you can type in these addresses my omnipod.com Ford slash juice box dexcom.com forward slash juice box or touched by type one.org

Sarah Gallo 4:13
My name is Sarah Gallo and I have been living with type one for 25 plus years in multiple capacities including myself, my husband and I are older.

Scott Benner 4:26
Okay, so let's start slow. There's an AI in your name and you're seems to be pronouncing it so go slow and tell me one more time.

Unknown Speaker 4:34
like this the whole intro? No, no, no, no,

Scott Benner 4:36
no. Your name is it do you don't say you don't say Sarah you say

Unknown Speaker 4:40
no. It's Syrah Syrah. Got it? Okay.

Scott Benner 4:45
Got it. I'm good. I just didn't want to like threw in the entire thing. Because you don't know me. Well, Sara, but I will just say Sarah over and over again. And I don't want you to be on the other side going. That's not my name.

Unknown Speaker 4:57
I would I would stop you like this

Sarah Gallo 5:01
At least on a podcast anywhere else if I just met you in person, I guess Fine, whatever.

Scott Benner 5:06
So sort of sigh like a sigh and I got it. Okay, now we all know, and I'm gonna butcher it with my my northeast accent at some point, which I didn't realize I had to I had a podcast and then people started telling me Oh my god, you talk just like me. And I was like, wait, but Okay, so you said a lot in a very short amount of time you've been living with diabetes and a lot of different capacities. So let's start with you because you've known you longest. Do you have type one?

Sarah Gallo 5:37
I do. I was diagnosed. I'm in third grade. And yes, it was a little about 20. Actually, 23 years ago,

Scott Benner 5:47
okay. Okay. 23 years ago, you're in third grade. Do you remember anything about that time at all?

Sarah Gallo 5:54
Um, yeah, actually, I remember a decent amount. And I'm actually in fourth grade. Sorry.

Scott Benner 6:03
By the way, all that staying in the podcast because you said you remember but then you said the wrong grades. So listen to everyone listening. Now. This is probably just fanfiction about Cyrus. diagnosis. Okay. This is the best she can recall.

Sarah Gallo 6:20
I was sitting here thinking I could just leave it at third grade. But then I was like, my mom's gonna listen. She's like, no, it was fourth grade.

Scott Benner 6:25
My God, you do not have to watch your mom down. Exactly. Alright, so

Sarah Gallo 6:29
I think it'll make her feel better that I was older than I then if I say I was younger,

Unknown Speaker 6:33
doesn't like

Sarah Gallo 6:34
that. It's okay to be younger than they really were when they were diagnosed.

Scott Benner 6:38
Okay, so Okay, so fourth grade, which I had a terrible fourth grade experience. So I bet you mine, even though mine was worse? Probably not. I was gonna say, I bet you mine's not as bad as yours, because I didn't end up with diabetes when it was over. But I did have a really horrible teacher didn't seem to like me, but that's neither here nor there. So you're diagnosed during the school year?

Sarah Gallo 6:57
Yeah. Um, so I was actually diagnosed a handful of times. I remember going to the doctors a lot that year. And I was living in Pakistan at the time. That's where my family's originally from. And the doctor told my mom that I was just that I just didn't like school. And I was trying to make excuses and to send me back. And, yeah, so it wasn't until I went into decay that they figured it out. And was in the hospital. And I was sitting, I was there for at least a week. And I remember the thing I was most upset about when I like, woke up and you know, they told me Hey, you have you have type one diabetes, and they told me I couldn't eat grapes. And like, that was my absolute favorite thing in the world. I was like obsessed with grapes. And they're like, you can never eat grapes again. And I just started bawling like that's what got me upset. I didn't care about shots. I was like I could never eat grapes again like that's what

Scott Benner 7:58
by the way red grapes are green What do you prefer? READ WRITE nice and and I did you get to see the doctor again. Who told you you were just didn't like school and you were faking? Because faking BK is like, next level thing.

Sarah Gallo 8:12
And but that doesn't that's not really a thing you do.

So yeah, definitely. Definitely never saw him again. Excellent. I think I would, I wouldn't. I would recognize him if I saw him. I think

Scott Benner 8:23
as as the dumbest person you've ever met in your life?

Unknown Speaker 8:26
Yeah. Like you were you were totally wrong.

Scott Benner 8:32
That's crazy. I don't even understand why that would be with the why that would jump into someone's mind. Like, were you like a malcontent? in other ways?

Sarah Gallo 8:42
Well, I'm perfectly happy child. I had lots of friends. Like, I wasn't like this moody kid that like

Scott Benner 8:48
you weren't like lighting a cat on fire and saying you didn't feel well. Like it was just yeah, by the way. I don't know why that jumped into my head. I've never thought of hurting an animal before. But anyway, I guess that's my guess that's the back of my dark minds idea of what malcontent children think to do. Any please. Public Service Announcement don't harm animals of any kind. So okay, so you go in, you've been, you know, misdiagnosed pushed off a little bit, you go in there, and then you finally find somebody I guess to tell you how to type one or did not even go that easily.

Sarah Gallo 9:18
I mean, like I said, I was DK I was unconscious when they took me to the hospital. And that was how they figured it out. The primary care doctor was bad, there's nothing wrong with you. But then when I passed out, and they do awesome, like yeah, there's definitely something wrong with her. It's amazing. Um, and they knew to check my blood sugar, but the family care guide did not

Scott Benner 9:40
because you were unconscious, and they figured maybe this is not dead. Oh my gosh. Alright. So how is life with Type One Diabetes growing up then do you ease into it? Is it rough for you or your parents involved? Do they kind of leave it on you? How did it all go?

Sarah Gallo 9:56
So it was really hard for me in the beginning. Like I said, I was living in Fox on and I had to switch schools, because the kids thought I was contagious. And, and even then after I switched, it was still like, there's a lot of stigma attached to diabetes in the developing world in general. And so inbox on, especially back in, in 93, when I was like, knows, I'm sorry. So I obviously have bad memories and numbers I'm giving her all wrong, but whatever. Here it was, when I was in fourth grade 96.

Unknown Speaker 10:33
That's what it was, I'm having such a good time with these

Sarah Gallo 10:37
90 days a year, my friend, that's what I was thinking maybe six was when I was diagnosed. And yeah, so it was just, it was there weren't a lot of people with type one out there. And not a lot of people knew about it. And then like I said, there's, there's just a stigma associated with anything being wrong with you. Regardless of what it is, it was like you don't talk about it. And unfortunately, type one, especially as a kid, it's not something you can't talk about. And, you know, going through it as you as anybody knows, and you speak to a lot of families that are you know, within the first year of being diagnose, there's a lot to learn. And so I was I was low a lot. And so I had to leave class a lot. And a lot of the kids used to make fun of me and be like, Oh, she's just making excuses to get out of class. And I remember, like, teachers yelling at me, like, Why are you sleeping in class, and it was like, I'm not sleeping. I'm, I'm low. And it was like, it was it took a lot to kind of get over that. And I didn't actually honestly realize that, like, it had impacted me the way it did. until after I met my husband. Like it was just I turned into this like, oh, because all these people are always telling me like, that's the girl with the problem. I think I tried to hide that I had it. And in high school, it was to the point where like, friends didn't even know I had type one. And I was proud of that. It was like, Yes, I really don't even know that I'm living with this. Like that was a badge of honor for me.

Scott Benner 12:14
Okay, that you were able to keep it from people? And what was the impact on you? I guess two ways, from keeping it keeping it from people. Was there an impact psychologically? And was there an impact? medically like, were there things you didn't do? Because you didn't want people to see?

Sarah Gallo 12:31
Yes. And so that didn't start until a little when like, you're at that point where you just want to be normal. You don't want to be this kid isn't doing anything differently. So I think it was one more year Honestly, I'm just something I've never talked about. But I I went through like that's when my my diabelli Mia started and essentially I I was going through puberty so it was like taking care of your blood sugar's is really hard. This is pre loop day is this is like pre anyone else helping you figure it out. I was still on MDI, back then. I I say it was Lantus by them. And either way it was. So it's a lot harder to like, be in control at that point. And I remember like a couple of times, my mom is very absolutely love her. But she was he was always like, if I was ever high, it was like, why are you high? Or why did this go wrong? And again, as like a 14 year old and the 15 year old that like, doesn't really want to have to spend that much time thinking about diabetes at a time where it took a lot of effort. I kind of got to the point where I was like eff this. If it's not in control, even though I'm trying, I'm going to be out of control because I chose it. Does that make sense? Like that was like my reaction to it. So that was kind of how I managed to hide it because I just didn't I just didn't do what I needed to I didn't take shots that often I would skip doses on a lot. And yeah, that was kind of like my way of dealing with it where it's like, I can't, I can't figure out how to take care of like the hand controls. I'm just not

Scott Benner 14:11
going to so I'll be in control of the audit control part. Exactly. Right, right. That's really, I'm not surprising, honestly. How long did that go on for

Sarah Gallo 14:22
way longer than I would have liked probably a good 10 years. And then it wasn't till I met my husband and that kind of like, really soft. So I would go on and off. But like, I'd be good for a couple of months. But then I was like, it would get hard again. And it was like forget this. I'm not gonna do it.

Scott Benner 14:43
So I'm interested you met your husband, and was it his support that helped or was it like there's so many people who come on here who seemed to indicate that when someone else in their life appears that they love and care about they suddenly want to do better? for themselves, sometimes it's having a child, sometimes it's falling in love. It's really interesting. And so common that I think it's a, it's a rule at this point, people who struggle with their diabetes, meet somebody they love. And all of a sudden, they, I don't know what it is, I don't want to oversimplify it and say it's a reason to live. But it's, it happens a lot. I was wondering how it happened to you.

Sarah Gallo 15:20
So, for me, it was a little bit more of like, Oh, I can do it. And diabetes seems so easy for him. Like it was not the struggle. He had a very, very different story and diagnosis and everything, but it was like, hey, if he can do it, I don't why why is it so hard for me kind of a thing. So that was like, one of the motivations. And then, you know, there's something to be said about, like someone else doing things differently. So like, if he was high, he was like, I can't eat that right now. And I'd be like, oh, and that's perfectly okay. Like he was just, he's always been unashamedly diabetic. Like, if he's gonna stop what he's doing. That's what he's doing. He's like, I don't understand why the world can get on board with that, like, to him. This is what it is. And it's he's not gonna try and pretend that things are different. So he needs help. He needs help. And that's it. So that was, that was really helpful for me to see like, people still love him. Nobody has any issues with him. Even though he will stop whatever he's doing when he's low. He'll literally stop people mid conversation and be like, I'm really sorry, I gotta eat something. Or like, while they're talking, he'll just grab something out of his bag and start eating. It does. Anybody? Yeah,

yeah. Whereas for me, I'd be like,

well, how come you didn't like just wait till later, or like, it was just, it was just something I had never, I'd never done it that way.

Scott Benner 16:48
I don't know what you're doing right this second, besides listening to the podcast, but you're not just listening to the podcast sitting down, you're doing something else. When you're done that something else I want you to run, be safe, but run to a computer, click on my link, or type in the words my Omni pod.com forward slash juice box. And I want you to get an absolutely free 100% no obligation on the pod demo sent to you right now. When it arrives, there'll be an explosion of excitement in your home. You'll be like, Oh, cool. We have Omni pod demo, but we do with it. But what you'll do with it is you'll put it on either yourself for the person with diabetes, you'll find a place you'll think this is where I will one day where my Omni pod, slap it on there. And you go about your life so that you can see what it would be like to wear an omni pod tubeless insulin pump, no tubing, no connection to something else. Just this little thing. It's just it's hard to put into words. That's why you need a demo. So you can see it. Little tiny, stick it on holds the insulin inside. Now one day you'll have it for real, you know, you'll need to tell it what to do. So they just give you this little thing. It's like a little diabetes manager. With the Omni pod dash, it looks just like a little Android phone. Right? You tell the you push on the buttons. I'm gonna have a unit it's on here, Polish and then wirelessly. It tells the pump like now put the insulin in it does it? It's magic. It's not magic. It's you know, like Bluetooth, which is kind of magical. When you think about it. You touch something across the room and something on the other side of the room does something magical. Miami pod.com forward slash juice boxes links in your show notes are the ones you'll find at Juicebox podcast.com. Don't forget when you're looking through those show notes and those links check out Sam fold sports camp. Do me a solid. Do Sam masala has been a great guest on the show twice now. And we can get him to come back. Yeah, well, you bumped into you bumped into the wrong people in the beginning.

Right? Like what?

stuck with me. So random. But to that just you get diagnosed and you're around some people who are like, Oh, she's contagious. And then the you move to a different school which is running away like you don't I mean, like, you're like, Oh, these people are bothering me. I'll run over here. And now you've taught yourself. When I have trouble with diabetes, what I should do is leave the place that's giving me the problem. And then it then that builds, you know, it builds and builds and builds and then your mom gives you a problem and you ran away you know, you ran away from that. And she's like, why is your budget are high and you're like, ah I'll just do the opposite. Like I'll go I'll move away from like, You kept moving away from conflict, I guess. If that if that if I'm reading it correctly from your conversation. It's it's um, it's completely understandable. It's just it's just did it start? Like what if you would have been diagnosed around 10 like local kids who were like, Syrah? It's okay, we love you. We've got this will help you. Like would that have just changed everything? You know what I mean?

Sarah Gallo 20:00
For whatever, I have no idea what the trajectory of my life would look like in that case. Um, I think there's a lot and I think that's, that gets into like, a differently I parent I love versus my husband because of like, me having the lens of what I went through, and him having the lens what he went through, obviously. So it's just, it's, it helps put us into the perspective of like, your story isn't her story for both of us. Whereas if it had been just me, I would have been like, this is what type one looks like for children. And because that's what it was for me and having him I can easily feel like that's not the case. And I don't have to project my experience on there.

Scott Benner 20:37
Yeah, Ellison that's, that's how generations are supposed to work, right, you're supposed to figure something out. And then your kids supposed to get the start on your shoulders, not in a hole, right. So we all just keep lifting each other up until one day one of our kids is going to be able to fly. That's what I'm assuming. That's a little fanciful, but I'm saying I, we, you know, I have parents who were blue collar hard working people didn't have many expectations for themselves. And, but they gave me the idea that there could be more for me. And so I went out and found more. And now my kids get to start with the idea that not that there can be more for you. But that more already exists. And it's theirs for the taking, which is which is differently than I thought it I thought it is something I had to go get. And now they just think of it as something they have that they're just trying to hold on to or make better. And so your idea of diabetes started work did you met a guy who had a completely different aspect that you know, completely different upbringing, his perspective was different, you guys blended that together, and now you're gonna have your daughter starts on your shoulders, you know what I mean? So it's really wonder it's beautiful, really, it sucks for you personally. But, but it's great for the world and for your daughter. Because like, you know, you're putting, you're putting better stuff out there than the people who you met. And very likely, when your daughter was diagnosed, she was not surrounded by a bunch of people who were just like, pointing at her and trying to witch trial, you know what I mean? So,

Sarah Gallo 22:03
yeah, I've, I've tried really hard to make sure that diabetes is extremely normalized for her to the point where she thinks that wearing an insulin pump is just as common as wearing glasses. Which I think is, is something all kids should see. And we talk about in the context, especially of type one, but in the context of any kind of difference, whether it's, you know, kids that are in wheelchairs, versus whatever it is, be, like, you know, being different is just That's all it is. People have different skin colors, people like different people's bodies need help with different things kind of a thing, and I didn't have that growing up,

Scott Benner 22:39
whatever your thing is, is your thing. It doesn't I mean, to be to be disappointed in who you are sad to begin with, but then did want to hide it is I don't know. And it's funny, too, because you and I are talking you're completely reasonable, thoughtful, intelligent person. And, and yet, that pressure was enough to, to push you in that direction, which I just think indicates how easily that kind of wrong exterior force can can move somebody, especially when they're a child, you know. So what was your husband's secret that he was he like, that he grew up with parents who were just like, whatever, don't worry about it keep going. Or what was their vibe? Do you know isn't?

Sarah Gallo 23:22
Um, I mean, he was telling us a little bit earlier. So I think there's a little bit to be said about that. He was a little over 10. And it was like at a routine checkup. And the way his mom approached, it was like, she literally made it this game when she went to school for the kids where they were, like, excited to learn about type one. And they got to win getting their blood sugar's checked if they got answers about diabetes, right. And, like, she went in and talked to the school about it and stuff. And I think a lot of it is just where he was, as well, versus like, the stigma and the community I was in, and a little bit of it having to do with, you know, the way his mom handled it as well. I think she did do a great job with that, where, you know, it was just, this is what it is. And the other kids were like, Oh, that's cool. All right. That's it, you know, like his friends would go to like the jdrf walks with him every summer or not summer, but whenever it was back home, and yeah, that was just it was always just something that was that was normal, and it was okay. And it wasn't it wasn't a big deal. And then all honestly, his control has always been different. I have always been told that I'm infertile diabetic, so it's just, it was harder for me to do. And even before I started looping, my husband and I are totally different people, we do very similar things, the amount of effort he put into his diabetes, you know, at a certain level, but if I put in the same amount of effort, my blood sugars would have been all over the place. So it just it's always been harder for me to do At the same level of control for him, if that makes sense, like it took less work for him.

Scott Benner 25:04
Yeah, no, I mean, let's just come out and say your husband got easier said have diabetes than you did. And he sucks. I get you. I hear exactly what you're saying. He can, he can, he can chirp all he wants about how well he's doing. But he got the easier one. And that's that. No, no, no. So, so it's funny because the term brittle. strikes me wrong.

Unknown Speaker 25:22
I don't love it. Yeah.

Scott Benner 25:24
And, and, and, and at the same time? I don't know. I mean, I'm not arguing with anybody who thinks that I just, there's it to me, it's always about insulin. And

Sarah Gallo 25:34
I actually I actually agree, I don't think brittle diabetic is actually a thing. I think it's more like, you haven't figured out the way to manage your diabetes in the best way possible. And just because this is what works for him is that doesn't mean that's what works for you. And so he happened to work with the standard procedures that were prescribed right? Like, this is how you do it. This is how you carb count, this is what you do. And it worked for him. Yeah. And that that's kind of how it's always been taught. Like, there's a certain way that you handle type one across the board. versus a there's other dynamic ways of doing it, whether it's, you know, how you talk about being bold with insulin, or whatever else it is. And I think that that's what it was, it was like what everyone else is doing isn't working for you. So you're brittle, there's something wrong with you versus like, there's something wrong with the way we're managing you.

Scott Benner 26:22
Don't forget to check out touched by type one.org. The next time we get a chance you're on your phone, you're a little bored. You type it in touch by type one.org. Take a look around. Same thing if you're at the home. I mean, you kind of click through Facebook one too many times, you know, like, Oh, I'm too tired to get up to board to keep looking at Facebook, check out touched by type one.org. That way you can remain lazy and sedentary and still do something different new environment. I remember a time when I would give my daughter insulin and count carbs, like give her some insulin and wait three hours and test your blood sugar. And her blood sugar would inevitably be really high or really low. And then I'd give her food if she was low or more insulin if she was high. And more often than not, she was high and there was another meal coming and Oh, just was terrible. And then one day, Arden got a dexcom continuous glucose monitor. And all of that changed all of it. Because now suddenly we could see the direction and speed that Arden's blood sugar was moving in. And we could sort of readdress our insulin decisions. If they weren't right. Now, sometimes, you know, like a couple hours after a meal, you're still like 180, it won't budge. Well, instead of staring at it and watching it go up and up, we address it with insulin and get it back down safely. And we do that with comfort, because we can see Arden's blood sugar in real time. And of course Dexcom has user definable alarms that I can set to give me a little like, Hey, yo, you might be moving a little quicker than you think or get a little higher than you want it to a little lower etc. And so Arden's blood sugar really never leaves a range that we've preset without us knowing that allows us to readdress with insulin or with carbs. And that helps contain for blood sugar in one sort of stable place. So instead of staring and wondering and waiting to test, we can look and see and know and feel comforted and decide to dexcom.com forward slash juice box or please use the links in your show notes, or the ones you'll find at Juicebox podcast.com. To find out more about the Dexcom g six continuous glucose monitor today, I promise you will not be disappointed.

Sarah Gallo 28:37
That's what it was. It was like what everyone else is doing isn't working for you. So you're brittle. There's something wrong with you versus like there's something wrong with the way we're managing you.

Scott Benner 28:46
instead of hitting the first roadblock and saying, look, here's the rules, you know, the proceed rules at that time for diabetes. Oh, they didn't work for me, oh, well, you just doesn't work, then you're broken somehow. Like, what a fascinating leap? And how do people even get out of med school thinking like that? You're like, like, Why? Why wouldn't your thought be? Okay, well, that didn't work for you. I wonder what would it not not just suddenly like, because how do people not look back especially doctors and say, hey, look, the what we're teaching right now today isn't the same as what we were teaching three years ago, or five years ago or 10 years ago, that won't be the same thing we're teaching next year. So why don't we look at the fact that maybe the person just needs more personalized care? And it's a really fascinating because liquid liquid did the deal with like, again, someone who was like, Look, do this, you did it, it didn't work. And you're like, well, I'll say it doesn't work.

Sarah Gallo 29:37
That's termed as a brittle or non compliant patient right away.

Scott Benner 29:42
Yeah. Instead of like, just somebody who needs a little more help. We're you know, the tools don't work the same for them or whatever it ends up being it's just all it's it's really infuriating. Honestly, you're gonna get me upset if we keep talking about it. So we're gonna move past that now. Okay. And I won't ask you any more questions about dates or times because I realize your recollection is is,

Unknown Speaker 30:02
is young children coming.

Scott Benner 30:06
So listen, you said you went about a decade with, you know, not really caring for yourself the way you hope to do. Are you having any side effects from that decade? Or are you doing okay?

Sarah Gallo 30:17
Hopefully I'm extremely lucky and that I have no side effects. Then you know my routine bloodwork and eye checkups and everything, and we have no side effects that we, that we know of yet. I'm honestly in the back of my head, I'm always wondering, like, Did I do anything that's going to hit me later? And we won't, we won't know. And it really pulled me out was more wanting to get pregnant, like you said to somebody else that you cared about being you know, that, that drive to do better. Because even when even getting married and being with someone that has type one that did a lot help me actually start you know, whether it's actually testing my blood sugar's or, you know, trying to take care of myself, but it wasn't, honestly until I wanted to get pregnant that it was like, Alright, you got to really lock down and like care about what your agency is, and really make it make a change in your management. Um, and then, and then after I was diagnosed, I was like, oh, there's no way you're ever gonna not be allowed to take care of yourself. Because what are you gonna teach your kid?

Scott Benner 31:23
You don't want to be a bad you don't want to be like the wrong kind of influencer example to her. So you have two kids, right is either younger or older.

Sarah Gallo 31:31
All the older she's four years old now. And she was diagnosed when she was 10 months old.

Scott Benner 31:36
Okay. So I mean, listen, you guys are just, you know, you were clearly gonna make a baby with type one. Just to like, Chase like your whole house is diabetes. It would be we I'm assuming that your other child who doesn't have it probably feels left out at this point.

Sarah Gallo 31:50
She really does. She's the one I work with. As honestly, we do a lot of like, diabetes community stuff locally. And so we're we're around other kids in the pipeline pretty often and just other people in general. And she's, whenever we do Islas pod changes, she she always wants the time. And I'm running out of demo pods.

Scott Benner 32:13
That's excellent. So is that something that you're? Is it in the front of your head yet? Like? How do I keep her from feeling like she's different? Because, because here's my example for you. I'm adopted, I've shared that a bunch of times on the show, I was adopted by very nice, average blue collar people. And as I started to get older, it was clear that I thought differently than they did. And so like, you know, like a problem would come up around the house or, you know, a problem with a bill or anything like that, like something you heard discussed in the house, then my mother and father and my brothers would have this almost instant reaction to something. And they all seem to match each other. And I was off on the side thinking like, Oh, that's not what I would do in this situation. Or that's not how it strikes me, or I'm not worried about that, because of this, and they would all get focused on one thing, and I would get focused on something different. And it always made me feel weird, that I never once just reacted the way they reacted. Like it wasn't my you know what I mean? Like, it wasn't my first indication to be like they were and I don't know what they could have done or not done. Although your husband's mother's example of running headlong into the world being like a one man like, you know, diabetes information crew seemed like that works pretty well, you know, but like, you know, what is it you'll need to do without going so far that your, your other child, you know, your Nandi one child is is like, just like, Oh, my God, this woman's always covering for me because she thinks I can't take that I don't have diabetes, like so there's a line in there, obviously. But what do you do? Have you thought about the roles or stuff you're doing now?

Sarah Gallo 33:57
I mean, honestly, right now she's two years old. So the amount that we talk about her feelings is limited. her feelings are around the fact that her sister stared at her for too long right now. Those are the kinds of meltdowns we have.

Unknown Speaker 34:15
So

Sarah Gallo 34:17
we we are going to be going to friends for life this summer for the first time as a as a family. And the one thing that I love about what they offer is like the sibling program. And so I know that's something I want to kind of have as an outlet for her to talk to other people who are caregivers type ones. And then honestly, she will always have my sister to talk to because she she grew up as like the older sister that me like my older sister have to go on sleep overs with me because this was pre CGM, so it was like a sister's going with you to make sure you're alive in the morning kind of a thing. As she she felt she gets what it's like to be a caregiver. And you know, my daughter and like, my, my type one daughter, she's, she's, she's been a type one caregiver essentially, I feel like she'll always have her as someone to talk about and vent about, like, type one taking over. Because I know that my eldest sister had a times where like she, she has a guard because something bigger going on with my type one at that moment, and I know she'll have her as a resource. And then the other thing that we are really big on in our family is just doing what we call special time. So like, I like it's time to hang out with just me and hang out with just her dad. And same with an IRA, we have time to hang out with both me and just her dad to kind of be like, okay, we all have relationships outside of just being a family of four. And, you know, letting her have that time honestly, like, I feel kind of guilty for this sometimes, but like, I took an hour to Disneyland ones just in her and it was like, I don't worry about Pre-Bolus and knew her about, you know, going low while we're standing in the heat or any of that stuff. And it was like, I felt guilty that it was easier to be with her. And I've always kind of wondered if that's how it doesn't mean I love her differently, or any more or less than, than Iowa. It's just a different experience when I'm just with her. And I've always wondered like, how is this how my parents felt with me? Yeah. Like not that they didn't love being with me. But it's a little bit more to think about when you're with me. No, I listen, I started taking care of it myself.

Scott Benner 36:39
I imagine I would. I mean, wondering about that. How does it make you feel like do you? Does it make you feel sad to think that they might have been like, Oh my god, I'm so happy not to be with her right now? Because it's just easier and I need a break? Or do you see that as just being human and reasonable? Or does

Sarah Gallo 36:57
it I if anything, if I wasn't a type one parent, I would maybe think of it differently, but feeling the exact same way myself? Yeah, I get it. I can't blame them. And it's totally fine. Um, yeah,

Scott Benner 37:11
yeah, I was just I went away for one night to do a speaking thing recently. And you know, there's a little dinner at night and people like, well, what are you gonna do now? It's like, Oh, my God, I'm gonna run upstairs and go to sleep. Yeah, I just I can't, I'm so excited to go to sleep. Because I'm going to send my wife a text and be like, Hey, good luck. And then I'm gonna go shut my eyes. Yeah, basically for nine hours in a row. And that's exactly what other people are planning for things. And I'm just like, ah, your lives are way too exciting for me, I I'm seeing some unbroken sleep calm, and I gotta get going. I get it. Like it just it is easier. And I have a similar situation. I go away with my son, sometimes for baseball stuff. And there's less to think about. And there's it's nice not to think about things. Sometimes. It's actually it's not even just going away. It's, you know, I mean, an hour and a half ago, I was running around the house on a phone call with someone taking down you guys really getting a good look into my life taking down like these little curtains that need to be laundered. And I'm putting them in the washing machine. And it just hit me out of nowhere. I'm like, I should look at Arden's blood sugar, because it was like 1045 in the morning, and I had not looked at it yet. I was like, I really should look. So I just kind of whipped out my phone. And I'm walking and trying to see what our blood sugar's at the same time. And I thought for a second. Other people don't have to do this. Like, that must be nice. And you know, I guess I'll never really know, but just sound nice. You don't I mean, like, and to your point, it doesn't it has no impact on how I feel about Arden whatsoever. Yeah, it just, you don't I mean,

Sarah Gallo 38:47
yeah, we still love our children. And in hindsight, we would do it all over again. We wouldn't ever be like, Oh, you know, I had a lot of people ask, like, if you knew which occur in children? Yeah, yeah, I spoke to another mom of a guy with type one the other day and I straight up was like, I would do it all over again. I wouldn't not have islands. As you told me. She was gonna have type one. And she looks really surprised. And I was like, Really? You're you would you would say you wouldn't have had your son because, yes, they've won. Like why, especially in hindsight,

Unknown Speaker 39:18
and what other reasons would you give him away for?

Sarah Gallo 39:23
And then also,

I mean, we had some, like, really not necessary comments about like, Oh, are you guys trying to breed diabetics when we have our second and it was like that not funny. To you.

Unknown Speaker 39:36
A person we don't talk to

Sarah Gallo 39:37
anymore. I personally don't talk to anymore. Yeah.

Scott Benner 39:41
Do you think they were trying to be funny, or do you

Sarah Gallo 39:44
think they were they thought it was funny because they like laughed, and you know, and I like you could tell on my face like that. But I just, I just kind of like, boxed away. I think I've ever seen that. It wasn't it wasn't a friend. It was like appointment so it doesn't matter. I've never seen him again. Yeah.

Scott Benner 40:03
It's, it's it's it's interesting what happens when people are trying to be like, real quick or off the top of their head or get any mean like flipping or fun. And then they just say something stupid and everyone stares like, oh geez, I went too far, or I didn't realize where the line was or something like that. It's very, uh, it's very telling, actually, I'm more interested in the woman who said, Would you have done this if you knew? Because that's, I mean, I mean, how far into that? Are we going to get it Really? Because my kids are kind of annoying. Like, if I knew they're annoying, would I not have had them? You know? I mean, I know I look at my wife sometimes. And I realized that she's like, oh, if I knew all this, I definitely wouldn't have married this guy like that. I can tell. You know, like that. That seems obvious to me. But I don't know. It's such an odd statement. Like I go back a lot to Sam fold was on the show, and he's a white coach for the Philadelphia Phillies now, but he was on and I and I said to him, like something similar like the Did it ever occur to you not to have more kids because of diabetes? And, or to have kids at all? Because the type of cuz he's type one his kids aren't? And it's funny, his answer was just so like, No, of course not. Because I realized when he said, he has type one, he has no trouble with it. It doesn't cause him. He doesn't think of himself differently. And because of that, he wouldn't be concerned if he had a child who had it. I was like, Oh, it's more about his. It's how he feels about himself, not how he feels about the diabetes. And you're not me, like he doesn't see that. It's no different than if you were incredibly short. And I said to you, Oh, are you thinking of not having kids? So your kids wouldn't be short? Like you would think Well, that doesn't bother me. Like I I'm fine with my height. So they're very, very, very interesting how how that all goes plus? I don't know. I'm looking at your I have a little picture here for you guys. You're a delightful family. Why would you not want this to exist? You know, Amy? Yeah, very cool. She's a pretty funky little girl. And I would never ever change anything about her even when she's having a meltdown. I I'm so delighted at the idea that, that I can look at her younger daughter or sister and freak her out by staring at her like she doing that on purpose. Do you think? Is there anything? Yeah.

Sarah Gallo 42:19
Oh, am I looking at me? Excellent.

My oldest.

Unknown Speaker 42:28
You looking at me and my mother. Like,

Scott Benner 42:31
you broke up for a second, but I got it. I got it enough. I'm hearing that you did it with your older sister. Oh, yeah. That's so cool. So all right. Let's see. I do have questions. Management ideas. So you were pens for a long time. I'm assuming you went to a pump at some point. Did you

Sarah Gallo 42:48
never Pound those all like straight up syringes, syringes? No kidding?

Scott Benner 42:51
Okay, syringes, right, from syringes to a pump? Did you have a pump before a CGM?

Sarah Gallo 42:57
I did. So I get a pump until my junior year of high school. And then I took a break. For like, I'm gonna say a year. Because we lived in point at the time, it was kind of hard to get supplies. And there was like a couple of different reasons. This was also when I wasn't taking care of myself anyway. So it was like, I didn't want a thing on me. And I did. back, I started with Medtronic. But I've always had. And that was like the first pump that came out. And it was like, the best at the time. And then I've had probably three Medtronic pumps at this point. And I got on their first VM when it first came out. I hated it. It was like the worst thing ever. It was always wrong. And so I stopped I stopped using it. I had a really bad experience with fans, basically. And I was like, No, I don't trust them. They like do worse than you know, because I'll like treat a low when I'm not low kind of a thing. And then I got on Dexcom when we decided we wanted to get pregnant. And so I wanted I wanted to get my agency down. I wanted to know like I wanted to be in control because you know, to tell you that you want your UNC a certain amount before you even try to conceive so yeah, and I've never ever got off of it after that.

Scott Benner 44:25
Nice. Yeah, I mean, my understanding of that, that early on Medtronic sensor, the CGM that they had was just that it was terrible and like, yeah, I think anything that I've heard people describe as a harpoon is something I would try to.

Sarah Gallo 44:44
Yeah, I mean, I was on there. The first thing they had where it was like where it for, I want to say three days, but you can see the readings that the doctors could like you would, you would take it back to them and they would see what your blood sugar's were. Yeah, the whole time. I tried that. Like, you know, they did that in the Beginning and then we switched over, whatever, whenever they came out with the first one. My dad's always been really big on like the newest diabetes technologies. As soon as like a new pump with a new thing came out. He was always like all about switching to that one, even if it's not what I what I wanted, like, I'm fine with MDI. And he's like, no, this is better.

Unknown Speaker 45:20
And better at it.

Sarah Gallo 45:22
It was it was out here, there's more tools that we can use to help. So we always try, like the newest thing that came out. And yeah, I just I hated I hated the Medtronic CGM I, I've been on I've been on the, you know, whatever version of Dexcom has been out ever since then we're on. I'm right now looping with the G six, and old Medtronic legacy pump, which is the same pump that I met my husband through, ironically,

Scott Benner 45:51
met your husband through an insulin pump.

Sarah Gallo 45:52
Yeah, that's how we met. I was in the Peace Corps when we met. And so nobody there knew what an insulin pump was or what diabetes was really, that actually ended up being my project. And the Peace Corps was working with the Diabetes Association to help break the stigma around type one around there, ironically. And so he, I want to say I was walking into a building and he was walking out the story is always better when he tells it for the record. And I was I think I was bolusing. And I was I was holding my palm. And he looked at me, he was like, Hey, nice insulin pump. And I was so excited. Because I was just like, I just been fighting. Like, why? You know why diabetes needed to be something that was talked about? And like, then here, there's, there's somebody that I already knew what it was, and I was like, How did you know? And he pulled his insulin pump out, which was like, the same one as mine. And we just never stopped talking after that. That's really cool.

Scott Benner 46:50
And oh, wow, I did that sweet and simple and easy. And you're nowhere near home. And, and that still happens. And you guys, how long have you been together now?

Unknown Speaker 46:59
Um, we I know I'm taking

Scott Benner 47:01
a risk. Yes, you have a date related question.

Sarah Gallo 47:06
We've been married seven years, but we've basically been together for nine.

Scott Benner 47:09
Okay, that's really sweet. That's excellent. So you, you said, you said a couple of things that, that I'm gonna like, circle back around on. So at one point, he said, I guess like to start, tell me a little bit about your, your background. So tell me again, where you grew up? And

Sarah Gallo 47:27
a loaded question. Um, I was born here in orange, California, I moved back to the black side, which is where my parents are originally from. When I was seven or eight. I want to say eight. And we lived there for about five years, we moved back to closer to my grandparents. And then my dad, job moved away, where we lived for another five years or less I did when I graduated from high school, moved to DC for college, left for the Peace Corps, and then finally moved back here to California.

Scott Benner 48:08
Okay, and can I ask like, what ethnic background Your parents are? And I have a reason for asking if you'll, if you'll go to the Pakistani. Yeah. Okay. So how much of like, so it's interesting, you said that because I live in a community that is there's a fair amount of Indians and Pakistanis near nearby. And when you said your father was like, This is the newest, this is the best, we should use this that struck me very much to be in sort of the way a lot of my friends think, who are have had that background. And I was wondering if that's something like, was it just around diabetes? Or was it was your dad is your dad sort of like that, to begin with?

Sarah Gallo 48:51
He is an engineer by background. Um, so he's all about, like, technology is his thing. And he always I mean, he, he's always got, he works in telecommunications, now, or he did. He's kind of switched around what he's done. So he's always been like, the newer phone, and this is the newer, you know, whatever technology is there. That's what he's always been excited about. He's always been in that field. for him. Tech is kind of like, a thing. And it was something he felt like he had control over and how he could help.

Scott Benner 49:23
so and so and so also then kind of thing in the thought for a second, he talked about stigma around diabetes. That's also something I'm now seeing. It's in the Indian community, but with type two. So a lot of a lot of Indians are sort of developing type two as they get older, but none of them really appear to talk about it too much. And, and they are really hesitant to move away from kind of cultural foods that I think they know they shouldn't be eating, right, that they just sort of, it's this very, they're so proud of their culture, that it's just like, Look This is what I eat. And so I see it's not good for my blood sugar. But, you know, if I got to go down with the ship, it's very reminiscent of, of type two in the south really in like the 70s and 80s, where like we drink, you know, I drink tea with sugar in it. That's what I do. And like, so it's like how I grew up. And it's hard to break away from

Sarah Gallo 50:19
hard to break habits. And I always feel bad for people that are diagnosed later in life, whether it's, you know, adult onset type one or type two, because as hard as childhood Davies's, it's easier to change habits earlier on. Yeah. Versus like, this is how you've lived your entire life now do things differently.

Scott Benner 50:41
Yeah. I mean, I brought it up. Because I imagine that, you know, you don't have to be from Pakistan to have something about the way you grew up that influences how you think or how you won't change, you know what I mean? Like there's, everyone's got something culturally that they are, you know, attached to, and don't want to get away from. And it's just, I don't know, I want for everyone listening to realize that, that it's cool to want to do what you want to do. But at the same time, if what if what you've been taught or what you've grown up with is moving you in a bad direction, then you need to get away from it. You need to do what you know, Sarris husband does just he's like, I don't care. He's like, you know, I'm talking to you, my blood sugar's low, that's over now. Now I'm doing what I need to do. I think that what you need to do, is the most important thing. And I talked to too many people who have the, you know, the situation that you described, where it's like, I wouldn't treat my low if I was in the middle of a conversation with somebody. And for whatever reason, I just, I don't know, I just really want people to be more focused on themselves first and not care so much about what other people think because, like, I always say, like, this, that person that's hassling you, they're not going to be around. Don't be mean like, that's not like, it's not like they're your your spouse, or you know, changing your arm, like you can just walk away from them. In a tougher when you're a kid, and you're trapped in a school with them, but in a real world situation, you're in charge, you know what I mean? So,

Sarah Gallo 52:11
be in charge. Yeah, but when you when your kid kids can be cruel. So like, it's, um, I think that's part of why I might overthink a little bit like how I, I like, make type one normal for eila. I know my husband didn't have that experience. But like, for me, it was like, I was made fun of for a bunch of different reasons. And so I and I've already noticed, like, certain interactions that I was had, where I remember there was this mom on a playground at this like Co Op that we were going to, and she had one of those massive bags of like it was like grandma's cookies or something that are sugar laden and just yeah, you know, from like, they were just awful. I don't even know how many carbs are. That wasn't the point and she was like, handing them out to all the kids and I was blood sugar just happened to be really high. I'm never like, I'm going to restrict what your what you eat. But if you're like 267 double arrows up and you already just ate a snack. There's no need for you to eat that

Scott Benner 53:09
cookie time. Yeah,

Sarah Gallo 53:10
yeah. And so this time, I was like handing them out to everybody. And she is she's not the type of guy to take food from from somebody says this grandma was like holding it out. And she's like, they get tickets with her and she kept pushing. And finally, I was like, You know what, she really doesn't need that like that type one diabetes, and it's fine. Just, you know, stop pushing it on my kid, basically. And then she just like, took them away and made a point of being like, they're like all the other kids like, okay, here I haven't but then she looked at Island back but not used to be hard. These aren't for you. It was like really was that necessary woman like this thing? Oh, my child out make her feel bad. And now she wants the cookies, obviously. because someone's telling her she can't have it. Yeah,

Scott Benner 53:51
yeah. Wait, like, there are so many stupid people. I I wish that could be the episode title of almost everything we do. It just there are just so many stupid people, and you're gonna bump into them, especially when you bring them into your world like that. Where? Because like, look what you were doing. You're like, Look, she's got diabetes, leave her alone. Like, you know, you're trying to give her the reason I'm not being rude to you about the cookie. There's a real good reason here. why she's we're not going to take the cookie from you. Thank you anyway, and then her, her idea of how to make it better, just makes it like seven times worse. It's really fascinating. And at the same time, so incredibly expected. So I just yeah, there's nowhere to run. Sometimes I'll say to my wife, like, we need to move and she's like to where and I went Yeah, that's a good point. Like, we're, we're gonna run to exactly.

Sarah Gallo 54:39
But on the other hand, we've also had, you know, times where I was like on the playground or in like a swimming pool or something and a kid will point it or pot and be like, what's that? Like? What's my pod? Where's yours? Like her? That's just yeah, everyone have fun? Yeah. I mean, she knows that like she has diabetes and and not everyone does, but she also knows that it's not Have it like, there's a balance and to find it, interview me in 10 years and interview her and see if I didn't Okay, job.

Scott Benner 55:09
Isn't that funny. That's what there's something about the podcast that makes me feel like I have to go on forever and double back and talk to everybody again a second time, like a decade later, which that's now my idea that someone else on another podcast is gonna steal, but that's fine. So I, but I think that, um, we don't do that often enough, like, my son and I were in the car the other day and Baseball Draft was happening. And they took some kid out of high school. And I said, I really wish they would just like, keep up with that person. Like, I want to know what happens next. Because you know, more often than not, what's going to happen is they're, you know, drafting a kid out of high school, he's going to go off and not be able to do it, or fail or get hurt. It's just very likely, statistically that he won't play baseball for much longer. But the part that young kids hear is, oh, that guy got drafted. And that seems like the win. You know what I mean? Like, can we never go back and follow up with people. And that's probably where the more interesting stories are. But you need to know the first part of the story to know the second part. And I did. I don't know if you heard me one time, but I interviewed a younger a younger girl, like she was like, 10 or 11 years old. And I said, I think I'm gonna have you back on every year for as long as I do this, just to see how your life has changed. I think there's something incredibly interesting about that. So don't Don't laugh. Maybe I will have you back on when will your daughter's or say, you can come back on and tell us how she's a stripper. And you're

Sarah Gallo 56:42
ready for kindergarten?

Scott Benner 56:45
Well, listen, it doesn't matter. I'm paying for college right now. You're gonna be broke and destitute. By the way it won't really matter. Very, very expensive.

Unknown Speaker 56:53
I always tell people in diabetes supplies

Scott Benner 56:55
just Oh, yeah, yeah, between insulin and college, I get retirement. Yeah, I'm assuming you guys should have six jobs. So you've said a couple of interesting things about like you were in the Peace Corps. Was your husband in the Peace Corps to when you met?

Sarah Gallo 57:11
No, he works in your construction. So you happen to be working on a project down there?

Scott Benner 57:16
I say and, and are you has your whole life sort of going in that direction, like doing things for other people?

Sarah Gallo 57:23
That's what I chose my path Initially, I I suppose I thought I wanted to join the United Nations. And so yeah, Peace Corps was like the first thing that I wanted to do. I worked in the nonprofit space for quite a while. And right now for the most part, my my full time job is being a mom, but I serve on the board for a couple of organizations and do most of my charity stuff through volunteer work instead? Because parenting type one kid this young and then just two and four year old is a lot of work. I know you've been stay at home dad for longer than I've been doing the mom thing. It's hard.

Scott Benner 58:04
It's in if my god i the people wouldn't people wouldn't believe it. I think that don't do it. But yeah, I haven't heard the television on. While the sun's been up in like, since the last space shuttle. That literally is the last time I turned on the television during the day, I thought to myself, I should probably watch the space shuttle launch. So go back to however long ago that was That's the last time I turned on a TV during the day. So let me let me kind of dive into some other ideas here for a second. So just very quickly, it doesn't sound like it. But I want to see, are you and your husband involved in each other's management at all? Do you ever, like bounce ideas off of each other? Is it stay fairly separate?

Sarah Gallo 58:42
Yeah, um, we we are. So I think I'm convincing him to switch over to Luke on the 670 g right now. And he's seen like how great it's been for me and, and he just is not a fan of the Medtronic sensor. We've had enough failures with it. And he's been on calm himself before. So he wants to go back to that. So that's probably the extent I've been hands off since he went on the six, seven AG, because I just I don't know that system very well. And I don't really know how to use it. I've, you know, I've put them in touch with friends who are on it, and had you know, in that way, but then we've analyzed, like, what it is about that system that, you know, makes it work the way it does for him and we've we've talked about it as much as I can without having actual experience with it. And most of our you know, my my help in managing his would be like a reminder to Pre-Bolus or, like telling him how many carbs you're eating and reminding him like, hey, there's a lot of fat in that one. But the 70s he doesn't know how to do that. It doesn't know how to extend the bolus. So instead, it's like, Hey, remember, there's a lot of fat in that. might want to add another 10 carbs in right now. Like an hour later, kind of a thing. I don't have to bet For myself, because I'll just put it into loop. And same for Iowa, but a lot of it was teaching him he. So when he switched to this energy and I switched to loop, which is or at the same time, about like a year and a half ago, we both kind of became a little more hands off, because what we both noticed was that when either I was doing well with diabetes, or he was like eila wasn't. So it was kind of like there was only so much headspace we had for type one. And so that's why we we made those decisions where it was like, we need something else to manage our diabetes, so we can focus on her. And so that's what that's what we chose, he chose the 670 G and I chose Lupe, and we kind of like stopped thinking about our, our own diabetes for a little bit. Because we were able, we were able to do that something else was kind of handling it for us.

Unknown Speaker 1:00:47
Yeah. And trying to figure out we were able to,

Sarah Gallo 1:00:50
yeah, and then we were able to kind of take care of her a little bit better. And then when the Omnipod loot became available, it was like a no brainer, because I'd already been doing it myself for a year that I was like, that's definitely what I want to do with her. And it wasn't like, in all honesty, usually it's like, you know, we would have these conversations about what we think makes sense for her. But it was one of those cases where I was like, this is what we're doing. And you're gonna get on board with it. And he was totally fine with it. Obviously, if it hadn't gone well, we would have would have switched back but but it has. And I think that's probably the the other thing is that he's kind of left a lot of those decisions to me, like I'm the one that decided to get the Omni pod for her. And like fight with insurance because they didn't cover the Omni pod. And I was like, I don't want to put too big on my on my two year old I'm sorry. And like he's kind of left that part to me. And as you know, just trust that I'm I've done my research and know what's what's best in that space. Because he's he's always been kind of like this is what's working and I'm you know, there's no need to mess with it. So despite him having like, I'm kind of going off on a tangent I realized I wasn't adoring him having been like, the reason that I started taking care of myself. Like, before me has a one sees are like seven and a half and eight. I honestly usually hate talking about agencies that I feel like they're not a true testament to how well you're doing because it could be like a balance of a lot of highs and lows, right? Um, but his were his were usually like seven and a half, eight. And it wasn't till like, I started taking care of myself. And we I started getting more involved with him that he brought us down to like 6.5, like between six and 6.5.

Unknown Speaker 1:02:38
And with

Sarah Gallo 1:02:42
I guess I kind of lost track of where Oh,

Unknown Speaker 1:02:43
where? Yeah,

Scott Benner 1:02:45
well, let me ask you then. So when he was more like seven and a half and eight Where were you?

Sarah Gallo 1:02:51
I mean, before I met him, I was like, in the 12. I was but remember, I wasn't taking care of myself. Yeah, sure.

Whatever. I

I was probably once I started taking care of myself was in the sevens, but it wasn't till we tried to we started getting you know, wanting to get pregnant I had been I'd been like in the 655 sevens free wanting to get pregnant. And then after I say I think what changed my mind a lot about my diabetes management was the endocrinologist Iris and an endocrinologist I had the second time around with inara. He was just amazing. He was basically like your I know, you're familiar with loops. So imagine everything that Luke does, he would do for me, like every week, I would meet with him every week. And he would change all the numbers he'd like, sit there and analyze every graph on my clarity on my on my pump and look at everything, and change literally like every hour and my bezels and my carb ratios and everything and just send me home and it would fix whatever was going wrong. And my uncle never been better. I was like, I was a six when I was pregnant, which is really amazing to have all these hormones, like there'll be that good. And that was what made me like change how I thought about I managed things. It wasn't like, oh, you're not trying hard enough. It was like I need somebody to look at the math and tell me like What does and doesn't work. And like the first the first highrisk under I had with eila was like he literally made me cry a couple of times because it was like you need to eat the exact same thing every day. I need the exact number of carbs that it says on this stupid little sheet that says how much nutrition you're supposed to have. And it's like that, that's an insane amount of food. I'm not gonna eat that much. Like a whole it was a really bad story with with my pregnancy with Iowa. But yeah, that was what made me really, really change how I thought about like managing type one and that kind of sent me on that trajectory of like being better and my agencies have been under six since then. That's

Scott Benner 1:04:59
that's really Go in and Islas is working progress are going well or how was it? She's looping now? I guess

Sarah Gallo 1:05:07
we haven't. She's only been looking for a little bit. So we haven't actually analyzed her her numbers, but she was as as we did the Jade study with lube and so she was a 6.4. Last we checked, I think is amazing. doesn't eat what you tell her to. And when you tell her when you're not looking? Yeah. How were

Scott Benner 1:05:31
you doing prior to like prior to that dude, listen to this podcast like were you doing like the stuff we talked about here? Or? No?

Sarah Gallo 1:05:39
I do listen to the podcast. I'm gonna be really honest.

Yeah. I hated you in the beginning. I love that. That's great.

Scott Benner 1:05:47
Why

Sarah Gallo 1:05:49
not? And you because I think the first podcast they listened was the one where you interviewed. I can't remember her name. I want to say, Chloe or not. The Girl with the diabetic alert dog. Oh, okay. And le le and coach for Mom, I talked to my mom. Right? Yeah. And I felt like you were you. You kept saying like, you would never get a diabetic dog. And here I was listening for the first time and I have an older dog. Sorry, I don't know what he's talking about. He's not in my shoes. Don't tell me to like bass Hi. Like, I got defensive. I was like, guys, like, he doesn't know what he's talking about my site. You know, the way we manage it is totally different. I that's how I felt it was like, I felt like who were saying like, you do things a certain way. And that's like, the only way to do it. And that was my like, reaction that was just

Scott Benner 1:06:44
no place. I remember doing that interview and actually feeling weird about doing it. She had approached me about being on and I was at a spot where I was like, I don't like I don't get the alert dog thing. Like I just didn't get it. So I was like, well let her come on. And I'll tell her I don't get it. And she can talk me out of it. And you know, or whatever. Like, let her you know, tell us how it goes. The stuff I don't understand. And it was also earlier in the podcast too, right? Like what? Yeah, it was I was still getting better at Yeah.

But that's cool. So but you stayed? Did you just want to like tune back in and be angry at me again? Is that what happened? Funny,

Sarah Gallo 1:07:22
it's so funny because I like I think that was the first one. And I was like yelling as I was listening. I was like washing dishes and it was like on on the speakers and I was like yelling at you. And then I like I think like a week later, I was listening to another one. And I was yelling at you again. And my husband was like,

Unknown Speaker 1:07:38
why are you still listening to this guy if you hate him so much. And I was like,

Sarah Gallo 1:07:44
I was like, I just I kept listening. And then yeah, eventually just like learned your personality. And I was like, Yeah, I bet you this is not gonna say I'm gonna like get my bloods gonna boil for a bit, but I don't yell anymore.

Scott Benner 1:07:57
So nice. This is a very interesting difference between, like us, you live in California, and like this place where people are just so nice to everybody all the time. And I just I don't know. Yeah, I just don't I'm not that nice. So, I mean, I, I'm not not nice. I just don't have the ability to talk around things. I don't know what that means. Exactly. That my wife's like, you know, there's a nicer way to say that. And I think, yeah, it takes up so many words. And then you know, like, let's get to the point. But I appreciate that you're still listening. I think it is an incredible testament that you really were yelling at me and your home and still listen to the podcast, I would I would accept that as a as a beautiful review. And thank you for

Sarah Gallo 1:08:38
and then in the beginning, it was like I can't stand on but these people is interviewing like, that's, that's what kept me because it was like, I want to hear what this woman has to say or I want to hear, you know, whatever it was that you were that you were talking about that day. And then eventually, it just listen to all of them because I is a dictate what we listen to in their house. But I do wish and I know that other people have asked you this as well. But there was a way to like search by topic. Yeah, like in the podcast app to be like, oh, let's see, I bet Scott has interviewed somebody about this.

Scott Benner 1:09:12
It's tough because the podcast, the way app, the way they all have it set up. It's not that searchable. I understand there's going to be an update to it that will be out by the time this us our conversation goes up that it's going to make them more searchable. It's tough, too, because I very much like the conversations to be kind of unwielding and just kind of keep going. Like you're talking on the phone with somebody. So like, like, here's an example. Tell me right now, if we were going to put it into a description, what's your interview been about? It's not that easy. Yes.

Sarah Gallo 1:09:50
I mean, for me, usually it's like, when whenever I talk to anybody, it's like, oh, the type one times three like to end tends to be family. That's like the gist. Anybody uses like, oh, here's someone living with them multiple pasties? Because that is kind of like we've talked about me and my husband and I, Ella, I guess I know what it would be you and I

Scott Benner 1:10:09
talked, here's what you spoke about in my memory right now, right? This is how I think about it. You and your husband, your daughter have type one, great. Your mom, you know, had some influence that you weren't thrilled about. You met people at school that pushed you away. They may have very well caused you to hide your diabetes, you met a person who helped you to bring it out because they were more open about it. You really started taking care of yourself better when you decided to get pregnant, you've moved into different tech like so I don't know how to. I don't know how to quantify. Right, right. And I don't want and here's my concern, is I think you said a dozen really valuable things in the last hour. And if I pick one of them and tell somebody, that's what the podcast is about, and they are not interested in that, then they're not going to hear the other 11 things you said. And that's Mike. That's why I make the podcast descriptions vague, because I figure you'll get in there and try to find out what it is to you. Yeah, I just I don't know. And and if I said to you, this week is about red, and next week's about blue and next week's about yellow, I'd get bored with that. And I wouldn't listen. So. I don't know. It's just my brains broken a little bit, I think. And I'm in charge. So this is what happens.

Sarah Gallo 1:11:31
Fairly fine. It works. I guess that is only sometimes where I'm like, Hey, I wonder if he's already talked about this?

Scott Benner 1:11:36
Oh, no, I hear you. I am I do, honestly, I mean, being 100% serious. I wish there was a better way. And I'm hoping that what Apple's about to implement might help that because apparently, they're going to index all of the words spoken in the podcast and make the make the text searchable. Somehow, I don't know

Sarah Gallo 1:11:56
what that sounds like. It's gonna complicate it to the level of like, needing to know SEO for podcast. I don't know.

Scott Benner 1:12:01
I don't know what mad genius is gonna either get that right or screw it up. But I'm interested to see what's gonna happen. So. But one way or the other, you're saying that the frozen urine of diabetes was not a good title for an episode?

Unknown Speaker 1:12:15
I mean,

Unknown Speaker 1:12:17
it made me gag.

Scott Benner 1:12:21
That's great. All right, listen, is there anything we haven't spoken about that you want it to?

Unknown Speaker 1:12:30
my notes.

Scott Benner 1:12:34
One day, I'm gonna make notes. But not today. Although I did write something down. I wrote down to one sibling interview, because you said something earlier that made me think it might be really interesting to talk to an incredibly open person who grew up with a person with diabetes and didn't have

Sarah Gallo 1:12:49
that would be really nice. So that's a perspective, I'd be really interested in hearing. Um, I was gonna say, if I listened to your interview with Amy from Omnipod, the other day or from a flood, and she said something about, like, you know, she has a unique experience speaking to other you know, adults with type one, and most people don't have that and how, like, she specifically said, you can never be both. And I like I like, like my hand up in the air as I was driving was like, Yes, yes, you can, you can, like understand being a parent of type one, and also having it yourself. And the one thing I like to tell any parents that I meet with kids that have type one who obviously don't, you know, they don't know, what it's like to have type one themselves, is that being the parent is much harder than being the one with type one. So like, I lived with it all my life was not half as big of a deal, as it was when she was diagnosed, like, what you're going through is way harder than what Arden is going through. In my opinion, well, that's good to know. Like, usually makes people feel better. Yeah,

Scott Benner 1:13:56
that's definitely good. I can see that, like 100% can see it from that perspective, and you have obviously a unique perspective, being a person who has it and is now the parent of someone with it. So I'm going to take your word for it. I and it absolutely makes sense to me that whatever a person's going through is just sort of normal for them. You know, and that's got to be the hope a little bit right that, yeah, I have diabetes, but it's my situation and, you know, I'm okay. It's going okay, like your I love the way you describe how your husband talks about it, just like this is what it is. And this is what I do. And you know, that's it.

Sarah Gallo 1:14:34
That's like a man thing because my dad was very similar. It was basically like, I remember my mom would tell, like my sister, my cousins or whatever to like, eat ice cream in the other room or something like that. And my dad would be like, no, why should anyone else do things differently? Like she's just gonna have to learn to deal with it. Don't make other people do things different around her. And my husband's kind of the same. He's like, it is what it It is cuz like he cried when she was diagnosed. And that's about it. He's never been upset outside of that. And I like I'm the one that gets emotional over like hard slight changes, or blood draws or whatever. And are random guys

Scott Benner 1:15:11
on the internet that you don't agree with?

Sarah Gallo 1:15:16
Not random anymore, though. Thank you. And

Unknown Speaker 1:15:20
you just like,

Sarah Gallo 1:15:21
yeah, it's hard, but I can't do anything about it. So why get upset about it? That's his attitude is like, if I can't change it, I'm not gonna dwell on it.

Scott Benner 1:15:29
Yeah, I feel like we talked about that with Amy, cuz you brought up Amy from insulin. I feel like I talked about that with her like is there is just sort of a guy perspective. Sometimes we're just like, this is what it is. Let's just keep going. Who cares? And, you know, maybe that's a defense mechanism where you don't want to deal with how you feel about things. And maybe it's a survival instinct. You know, I have no idea.

Sarah Gallo 1:15:53
I think it's a thing where men feel like that, and I'm totally generalizing here. But men usually feel like they need to fix things. And if they can't fix it, then it's either not broken, or it's just we're gonna ignore it.

Scott Benner 1:16:05
Yeah, we're not that bright. I hear what you're saying. But, you know, you can't make babies without us. So guess what? You're stuck? No, that's incredibly valuable. I can't wait for someone a year from now to come on to tell me about this stuff that you said that they disagree. I

Sarah Gallo 1:16:26
think that that was my biggest issue with listening to the podcast in the beginning was it was like, I'm a really big proponent for your diabetes may vary. There's a reason for like quite a while all three of us are on completely different systems, different influence different CGM, like everything was different. Because that's just what worked for us, like I was on MDI, and no sensor for a while. And that worked for when it worked. You know, I just, I think, the one thing I want people to know is that there's like, no right way to do diabetes, it's like you will figure out what works for you. And, yeah, it's not based off of necessarily what a doctor will tell you, because they'll tell you what they know. But they might they don't know you, they don't know how you live, they don't know what time you wake up or what labor what days you exercise or don't, and how that impacts like, everything is different for every person. So I think that's like, the thing I want people to know is that every, everyone's different, not just like, your bezels are different. But like, everything about your life is different than someone else's. And that unfortunately, diabetes has like how many variables so I can impact your blood sugar's there's no right way to do it.

Scott Benner 1:17:37
And so I 100% agree with you. And I think that, but there's probably times where I come off, like I'm saying, No, no, listen, it's just about how the insulin works. And it doesn't matter. Like the other things don't matter. The other things do matter. They just don't quite, in my opinion, matter as much as understanding how the insulin works. And so I, this is a long conversation, this podcast is it has to be like, it's not just an hour or a week, or a month or a day, like, in my opinion, you need to listen through all of them as best you can to hear one person say what you just said, and then hear another person say something different to find out that they both are having success or failure, you know, and it looks different. And how can I adjust? It's just, I just realized, at one point that people's expectations of sharing online are from blogs, and in a blog post, you can start off by saying all that stuff, your diabetes is going to be different than someone else's. And don't forget that this is dangerous. And this is, you know, you don't want to do this first. No, you know, you know, somebody will say you use a pre buy Temp Basal, but don't don't suspend your insulin, because then your pump won't show up at all the like, once you get done safety in all of your statements, a no one's reading it anymore. And be it's so incredibly long. It's not, it's not absorbable. So I just thought like, why don't I just say to myself, okay, there's gonna be times I'm going to say something on the podcast, and there's probably nine addendums to it, I should be adding, but I'm not going to, I'm going to just hope they listen next week when that comes up, or that they heard it two weeks ago when I said it the last time because because I think that we just weren't pushing hard enough. Like with the way people were writing about it, because I used to write about the same way too, is very careful about everything and measured. And what I can tell you for certain is that when I was just blogging, I would get a note every once in a while, every few days, maybe a couple times a month, hey, the blog is really helping me I appreciate it. I wanted to let you know, those notes now come six to 10 times a day. So there's something about this, that if you stick with it long enough, it'll get to you. And I don't know what it is. And I'm not even taking credit for it. I just it was my idea and it seems like it's working out more or less and look, you hated me and you still listen so I must have been Don't do something. And I just think that there's a bigger, there's a bigger thing to consider around all of this than what you can just maybe put into 300 words. And that you're going to have to resolve yourself to the fact that you're not going to learn it all in a day or in one sitting when, you know, that kind of a thing. I don't know if any of that made sense or not.

Sarah Gallo 1:20:21
But it does. I mean, at the end of the day, your podcast is an opportunity for people to have, like a diabetes community that doesn't involve just reading words, because I think tone is lost a lot in in text. And having a view into conversations with people with type one, especially for the people that don't have a really big, like, diabetes community around them, I think is, is extremely valuable. Not everybody has

Scott Benner 1:20:48
the ability to be a part of that for multiple reasons. It could be the time they have, it could be where they live, whatever it is. And you are giving people that that opportunity to be a part of something without having to leave the comfort of their home or their car, or whatever it is. It's amazingly interesting to me, when somebody will say to me, you know, what is the podcast about I'm like, Oh, it's about how to use insulin. And then someone will come up to me and tell me that for them, This podcast is a community that they didn't have otherwise. And I think, wow, that wasn't even my initial intention. But look, it ended up being that thing for that person. And so whatever it ends up being for you, whether it's a community or a way of using insulin, or somebody yell at whatever it is, it's like, to me, it's great. You know, like, if it does any of those things or other things for people, I'm happy about that. So anyway, I now I'm gonna get emails from other people are yelling at me in their house, but that's fine. I'll take that.

Sarah Gallo 1:21:42
Sorry for giving people permission to yell at you. No, no,

Scott Benner 1:21:45
no, please. I'm married. I'm okay with being I be disabled. Goodbye, because we've been at this for a long time. And then I'm gonna I'm just gonna tell you, thank you privately. We're not being recorded. So thank you very much for coming on the show. I appreciate

Unknown Speaker 1:21:59
you having me.

Scott Benner 1:22:03
Huge thanks to Dexcom ami pod and touched by type one for sponsoring this the 300th episode of the Juicebox Podcast, the Juicebox Podcast, the Juicebox Podcast, and thanks so much to Syrah for coming on and telling the story of her family with Type One Diabetes. It is not too often we're going to get someone who is the spouse of someone living with the mother of someone living with Type One Diabetes. She's like the trifecta. She is the trifecta. Oh my god. Syrah is the trifecta. I just thought of the title for this episode.

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Pandora - Spotify - Amazon Alexa - Google Play/Android - iHeart Radio -  Radio Public or their favorite podcast app.

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#299 Ask Scott and Jenny: Chapter Ten

Answers to Your Diabetes Questions…

Ask Scott and Jenny, Answers to Your Diabetes Questions

• Can a fast drop in blood sugar values affect your health?

• How do you help your body recover from a high?

• How do you know when to adjust basal rates, correction factors and insulin sensitivity?

• Let’s talk about basal to bolus insulin ratio.

• How do you figure out what type of insulin to use?

• What are the impacts of diabetes on your dental health?

• What is the best insulin pump for you and how do you choose?

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Pandora - Spotify - Amazon Alexa - Google Play/Android - iHeart Radio -  Radio Public or their favorite podcast app.

+ Click for EPISODE TRANSCRIPT

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

Scott Benner 0:00
Hello, everyone, welcome to Episode 299 of the Juicebox Podcast. Today's show friends is sponsored by the Contour Next One blood glucose meter, this is the meter my daughter uses, it is incredibly accurate, easy to carry around. And if you go to the link right now that's in your show notes are the one that's at Juicebox podcast.com. And click on it, it will take you to Contour Next one.com. When you get there, top right corner, there's a yellow button says about getting a free meter, click on it, scroll down a little bit, fill out a little bit of information. And you're on your way. There are some limitations and restrictions that apply. But it'll only take you a second to find out if you're eligible. If you're not go to your doctor and be like, Yo, I want to try the Contour. Next One write me a prescription for that. Think about it. How long have you had that meter that you're using? Is it old? Is it out of date? Is there technology that exists? It's better than the one you're carrying around right now? I bet you there is. And I bet you it's the Contour. Next One.

Welcome back to another episode of Ask Scott and Jenny. This is sort of a super sized episode. What are we going to talk about today? Among other things, how to help yourself coming back from high blood sugar. When should you adjust your basal and bolus rates, different types of insulin the impact diabetes can have on your dental health, which sounds boring, but isn't. And Jenny talks about insulin pumps, she kind of rates them it's fun. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And always consult a physician before making any changes to your health care plan. We're becoming bold with insulin. And if you'd like to get Jenny Smith, working for you go to integrated diabetes comm and click on Jenny's email address. Actually, the email addresses in the show notes. It's the Juicebox podcast.com On this episode, and all the episodes Jenny's involved in so you just want to email Jenny and say something like hey, Jenny, I'd like to hire you. And then you'll start that conversation with her. Now you guys ready? Here comes don't? Don't it's gonna jump up now. Done ready?

I haven't asked Jenny question. My wife met somebody recently, who said that their adult child lived for a fairly long time with higher elevated blood sugars higher a one C, they kind of pulled themselves together, all at once out of nowhere, got it come to come down quickly, but then had like neuropathy problems that the doctor told them was from a fast drop. I'd love you to explain that to me, because I only heard that one other time, but not even put that way.

Jennifer Smith, CDE 2:59
And from the physiology standpoint, I mean, I'm certainly not a neurologist or anything to explain it from the physiology component. But it's the same as I think not that long ago, we had talked about changes in AI as well, with really fast changes in blood sugar. So it's the same thing it's your body has adapted to the high values. And as such, the neuropathy if it was probably there, as well as probably getting worse along the time of the blood sugars being too high. Now with the quick change in blood sugar. The change to how the sensation of those nerves are, I guess, feeling things because of the change in the glucose level, which has been impacting the health of the nerve cells. That's what brings on a more significant and more profound pain than they may have been living with when their blood sugar's were just high.

Scott Benner 3:59
So is that a bit of a false narrative then then the queen? Yeah, it was coming anyway, it might have just come a little quicker because you took this thing that your body was accustomed to, and so greatly changed it

Jennifer Smith, CDE 4:11
and greatly changed. Exactly if

Scott Benner 4:13
I'm diagnosed today with an 11. And I somehow end up with a five, two months from now, I'm not going to give myself neuropathy.

Jennifer Smith, CDE 4:23
No, no, no, the neuropathy was there to begin with the pain symptoms were something that were exacerbated essentially, because of the major shift in glucose that the body was not used to again it I mean, it does take some time to bring blood sugars down and you know more power to the person who was like gosh, I can't live with you know, 400 blood sugars anymore. I'm going to get them down to be like 150 Now instead, but still, that's a major shift for the body to handle. If you do it all at once great but you you may have some of those typical symptoms like again, you may have major shift in the way that you see things, you may think that you are seeing things great when your budget was at 300. And now one is down in normal, now you can't see anything, we have to give your time your body time to a climate to that new, what is healthy value, and then go see the doctor, if it doesn't. If it doesn't get better, you know, within like a month or so of being in target. Same thing with the neuropathy. While it may help to go and see, you know, your neurologist, or whoever's helping you to manage that, likely, they're not going to change too much other than potentially maybe prescribing some additional pain management strategy for you until the glucose levels are stable enough at that target value. And the symptoms kind of go away, or they come to a more normal stable, you know, range. And at that point, then of course, they're preventing further further damage from happening. So okay,

Scott Benner 6:01
well, I'm keeping stuff together here in a little bit of a blend. So elanco wants to know about helping her body recover from high blood sugar. So she's just talking about I think, a day, you know, where you have six hours and you're elevated, and you finally get back down? Is there something she could be doing to fortify yourself to feel better sooner to? Like, I don't know, like other than hydration, I wouldn't know what to say. Like, how do you make that blog go away?

Jennifer Smith, CDE 6:27
Yeah, if it does, it takes some time. I don't think there's necessarily any one cut and dry kind of strategy. Hydration certainly is a big one. Absolutely. Also, you know, if things like regular food intake, or snacks, or even activity, sometimes those can sort of help you clear. That mental fog, as things are changing to even just getting out in sometimes the fresh air and getting a walk and getting movement and whatnot can help as well. So

Scott Benner 7:05
is it a diabetes thing and more of just a human thing? Maybe because you've been put through this situation. And now you got to kind of bounce from it's like, almost like, I guess, like being sick. And then you wake up and you're like, Oh, you have that weird, like, lost feeling. I don't know what being obviously, I don't know what being high feels like. So my job, I just know people's descriptions of it. Okay, let's see, I feel like we've said this before. But correction factors, and insulin sensitivity, basal rates? When do you

Unknown Speaker 7:40
adjust? Like, like you said, when you know what? To a job?

Scott Benner 7:44
Yeah, yeah. Well, when do you When do you know when to adjust? Like, let's say, you know, it's your base, or, you know, it's your insulin to carb ratio or something like that? How long do you wait before you save yourself? This is my new normal, I need to make an adjustment in my pump to cover this is it? To me, this is another one of those like somebody wants you to tell them how much time? I don't know how to answer that. Like, I know doctors will tell you what three days is that sometimes

Jennifer Smith, CDE 8:09
even longer than that some doctors want like a week's worth of data to see that it's a definitive trend. I mean, I usually, I usually say, you know, if you know that, now, all of a sudden, whatever reason is happening, you're waking up at 150, when you used to wake up at 100. And it's been happening in the last three nights, and you have literally not changed anything, clearly something changed. So go ahead, make a change to the Basal or if you're kind of wary about changing your profile set at Temp Basal. In this instance, set a Temp Basal increase at bedtime of a certain percent and see if it hits the mark. If you wake up where you were great. Go in see how much the pump was delivering based on the temp you instituted and make that change into the Basal profile.

Scott Benner 8:54
Great. I would say that this is one of the things that led me to say things like more insulin, because I just kept looking at these scenarios like Jennifer's talking about here. And I just thought there's not enough of a rhyme or reason to this, that I can say to myself, okay, what I'll do is I'll wait X amount of days every time this happens. So just I just decided like, I'm gonna stay fluid. And if it's like this today and tomorrow, great, and if it changes, you know, the next day, right, what am I gonna do? I know, I'm, I'm gonna have to do what I have to do.

Jennifer Smith, CDE 9:31
Right? I mean, sometimes it takes I would say, for me personally, I always look at things after like a two day, you know, if it's tonight, for some reason, in the morning, I wake up in the morning higher than normal. And that's one night, I don't know. Let's see. I'm gonna go to bed at my normal rate where I would usually go to bed. If I see a rise again overnight tonight, in the middle of the night, if I wake up, I'm probably going to pop in some change of some kind, just that I don't wake up high again. And tonight, then I'm going to say, I'm going to go in and change my Basal profile, I'm not going to deal with this, right, I'm not going to wake up to alarms and alerts if I don't have to. And you know what, if I end up dipping down, then well, just two nights that I needed some extra insulin. And I'll go back to what I needed. But an overall change, usually, most people have had diabetes, a number of years, kind of get this intuitive sort of feeling about something has shifted, I know that something has shifted, I don't know why it shifted, I just need, quote, unquote, more insulin.

Scott Benner 10:37
Put that in there. I genuinely think that that's, that's one of those scenarios where you just have to, you just have to stay fluid and take care of it. You know, right? It comes. Because I would rather because I know what the fear is, right? Like, what if I turn it up, and then all of a sudden, five days now that causes a low? In my mind, that would be another time to adjust? And at least for the last five days? You haven't been high? Right? You know, I think it's all in the way you want to look at it. Right? Hey, welcome to the new age of smart diabetes management. Welcome to the Contour Next One blood glucose meter. By integrating your blood glucose meter with a smartphone app, you can simplify the management of your diabetes, blood sugar results captured through the day can be automatically synced and logged in over time, the results may create meaningful insights into how your activities affect your blood sugar levels, which can help improve your understanding of your diabetes. All of this while being on the same platform you use for so many other aspects of your life. Yes, smartphone. So check out Contour Next one.com. There's links in the show notes and a Juicebox podcast.com. That'll take you right there. When you get there, you're going to find out about the simple to use, and remarkably accurate Contour. Next One smart meter, and the contour diabetes app. It seamlessly connects via Bluetooth technology to capture all of your blood sugar readings, and help you to manage your diabetes smarter. When you combine the Contour Next One meter with the contour diabetes app, you're going to have a smart system that allows you to engage the level that is right for you to manage your diabetes. All right, so head into the show notes, hit the link, check it out, some people will be eligible to get the Contour. Next One meter for free. There's a little yellow box at the top of the page, check it out, you might be the one where if you'd like to talk to your doctor about the Contour Next One meter, just be like Yo, I want to use the same meter that the guy on the podcast kid uses. And then tell them it's the Contour. Next One, you will not be disappointed this meter or rocks. Please use my link. It's available at Juicebox podcast.com. We're in the show notes of your podcast player. Okay, very quickly. I'm not going to seem to make sense when I start talking in this next bit with Jenny. But what happened was while Jenny and I were talking Arden's pump ran out of insulin at school, and Jenny and I took a break, I ran across the street, and we changed the pump real quick. Right? So now that'll make sense for you. Ready in 5432 you have to be a little impressed.

Jennifer Smith, CDE 13:17
I'm actually really impressed. Like, your school literally must be like right across the street.

Scott Benner 13:23
It's um, that's pretty close. It really is across the street, right? it's it's a it's a four minute ride. You know, she met me in the office, we rolled down to the nurse and and bing bang, boom, I'm back. So eight. I think I think I was going for 18 minutes total. So

Jennifer Smith, CDE 13:42
yeah, it wasn't long. So awesome.

Scott Benner 13:45
Next time I do an on the pot. And I tell you, you can swap it on the pod fast. you believe me? We've done Arden's on the bench of a softball field. Keep the dust away for a second, right. Anyway. All right, I think we can get through a couple here. Okay. I like this one. Tara wants to know, about bazel bolus ratio. So she says that her endo tells her you know 5050 but then Becky comes in and says we're 30% bazel 70% bolson. Are those fine with it? I feel like I'm gonna say if you are too heavy on the Bolus side, you're probably bumping in nudging too much. And you could probably get some back from Basal. But what is the like why do people say well, what do you say? Because I've heard 5050 to

Jennifer Smith, CDE 14:32
5050 is a starting place It really is. And that's why endo is kind of look at that as a place to start with potentially where adjustments might need to be made. But you also have to consider some other things from the standpoint of like, metabolic bazel insulin need, what I've seen in practice, and seems to you know, be kind of correct is that If you have a pretty active lifestyle, metabolically, you are probably more at an appropriate body weight, and you will respond to insulin better. So sensitivity will be higher. So from a standpoint of background bazel insulin, your basal insulin and an active life may actually be less, you may be kind of one of those people whose bazel bolus ratio is more like 4060 40%, coming from bazel. Because without food in the picture, your body just responds nicely to insulin, it could even be more than that. Maybe it's 35. Or you know, whatever. More commonly, though, for most active, it's about like 4060, give or take kind of thing. On the opposite of that, if you have a really busy life, but you're mostly sedentary and you really are only able to get to the gym once or twice a week, you're probably on the other end of that you probably have a higher metabolic need, because your body's just not responding as well to insulin. So your basal needs may be a lot higher. And it may seem like your boluses aren't really that heavy, then, as far as like an analysis, another good place to look is at the breakdown of your bolus insulin, like how much of your bolus is truly derived from just covering the food that you're putting in. And how much of it is actually corrective. Because if you're constantly like you just said, if you're constantly nudging, by correcting with little bits, because it's just not getting down to target, it may very well be that your background is also not high enough, it could be that you're covering with more Bolus, because in the back, there's just not enough there to keep you you could be using more Basal,

Scott Benner 17:00
right. And so there's a lot of different scenarios. This is interesting. So you know, your activity, if you were a person who didn't need very much bazel to keep you stable, but you had big meals, you might even see a swing like that. Right? Right. Right. So then there is no right ratio, there's no correct ratio, there's a correct ratio for you. But there is a way to check to make sure, hey, let's make sure that we couldn't be doing some of this with Basal and take away some of that bumping in. And I think that's specific to people who listen to the podcast, like the bumping and nudging is great. But if you're bumping and nudging, and your kid puts on 10 pounds, because they're growing, you're going to just keep pumping and nudging when you should be thinking more based

Jennifer Smith, CDE 17:43
on a problem or bazel. Exactly. Yeah, yeah. And you're right. I mean, from the standpoint of somebody who, like I think I commented, I don't know when we talked a couple times before about mango man. He's a type one who is an expert in like nutrition. He's got like a PhD. I don't, I don't remember too much more about him. But he, I mean, he eats like hundreds of grams of carbs in a day, but he's also really, really, really active. And so I would, I would estimate that his Basal needs are probably pretty low. But his boluses are probably fairly big, given that he eats so much carbon at a time. And then it covers it, and it drops him back down to his target. And his bazel holds him there until the next time he eats you know, 200 grams of carbs.

Scott Benner 18:36
I think that that makes 100% sense. And I think that is the clarity for this question. So I think we did good there. Okay, so here's one that I don't know that there's any truth to this one. Katherine's asking about figuring out what type of insulin they should be using. And I know that technically, there's not a big difference between the insolence right, the fast acting insulins, but some people do see differences differences when they use them. But is there anything that we could like literally say, like humalog novolog, a Piedra? Are there fiasco? I mean,

Jennifer Smith, CDE 19:16
are there discernible differences between them? I mean, the fiasco obviously, there, there should be a discernible difference with fiasco. If you get response by using it. Yes. For the most part, the two that are the most similar and action that I would say a good majority of people who've switched between novolog humalog novolog because now their insurance covers it up. Now you're covering human logs. So let's switch you back. They usually don't notice much of a difference in its action. There are people however, who do notice a difference. I personally don't notice the difference between novolog and human log at all. I tried to Piedra and it it didn't work the same for me at all, I especially noticed it when I was using extended boluses, it just didn't have the same emphasis or work the same in an extended fashion as my human log normally did. I've got a friend who she knows that if she's on human log, she uses more insulin on human log than if she goes back to novolog. She knows that. So I, you know, definitively again, majority of people don't notice much of a difference novolog to human log, I think the two outliers there, a Piedra may work a bit differently for you. Again, there are people who can use interchangeably all three of Piedra novolog, humalog and have no difference whatsoever. fiasco is kind of in its own category, really, I think there is there's a definite difference, mainly because it's action is faster. And then there are some people of course, with ABS, but it works great, like me, worked for five months, and it was done. It didn't want to work for me at all anymore. I'm done. That's it. Yeah.

Scott Benner 21:04
I you know, I would say for Arden, she used novolog. And she she used a pager. With novolog, we saw a ton of like double arrows up double arrows down, you know, big spike after a meal, then a crazy crash later kind of a feeling. And for Arden, I've only ever been able to explain it that a PG appears to just work smoother for her. Like it's just more constant and it and predictable for me. And that's it. You know, I don't know that human log wouldn't be better. I never tried it. Right. And and you know, people all the time, like, you know, don't you want to try fiasco? And I'm like, Well, I don't I want to hear about fiasco is that it works for the people it works for and others don't. And here's the other thing about crowdsourcing this information, right? It's that we don't know everybody's other details that they don't share with you like, oh, you're all you see someone line who says, human doesn't work for me. They don't say, by the way, human doesn't work. For me. My blood sugars are mainly in the 250s. Most of the time, I eat an incredibly carb heavy diet. And I don't have a CGM, like you don't mean like, they don't give you all the details about their life. They just say something like, you know, I didn't like that television show. But you know, you don't I mean, like, you don't get enough of the details to know why crowd sourced information is tough sometimes, because it lacks the details that you you often need. The one thing I'll say is that it can't hurt to try, you know, a reasonable endocrinologist should let you try if you want to. Right, Arden did need more a pager than she needed. novolog. So her ratio went up a little bit when we switch,

Jennifer Smith, CDE 22:42
but it worked better, but it works way better, less spiking, dropping. So yeah. And I think that it takes evaluation, you know, if you if you have a sense that there are that there's something that just doesn't seem right. Ask your doctor for, you know, as many doctors have some sample bottles, ask them for a sample bottle of the opposite type of insulin and see if you don't get better response from it. I mean, if and if you don't notice anything different well, then maybe something in your settings needs to change or something in your strategy needs to change, you know, but at least you've tried and you've kind of addressed

Scott Benner 23:20
to see whether or not I will just tell you that for Arden with a Piedra I have. I don't I mean double arrow in either direction. I don't remember. Like it just, it just does not happen. So, um, okay. Uh, let's see. We're doing well, by Well, I mean, we have time left. That one seems like it's a little too much for now. Let me uh, that one's pretty obvious. I could get answered there. Oh, okay. Here's a pretty simple one. What are the impacts that type one diabetes, if any has on your dental health?

Unknown Speaker 24:03
Um, well.

Jennifer Smith, CDE 24:06
Overall, we know that diabetes can affect most places in the body. Here oral health included. People with diabetes more commonly have a potential for bleeding gums, more ginger vitus gum diseases, more potential for receding gums. And, you know, the interesting thing about it is it seems to be for the most part, the higher blood sugars again, can cause more oral health problems. So long story nutshell short, just keep your blood sugars contained to try to avoid dental problems. Does it mean that everybody with diabetes is going to end up with some type of gum disease because of, you know, mismanaged blood sugars. Not necessarily, you know, but it is certainly one of the potential, I guess complications of, of life with diabetes. Now, the interesting thing is, I mean, I have receding gums myself, I've had them for years. But the interesting thing is that, to me, I don't know how it could relate to my blood sugar control.

Scott Benner 25:30
Pills really good. Yeah, it's

Jennifer Smith, CDE 25:31
good. I haven't let my blood sugar's run at like 300 or 200. Even, you know, for years and years. The interesting thing is that it actually started after I had kids. In fact, I didn't have my first cavity. until after I had a child. And my I asked my dentist about it actually, at the time, I was like, are you sure there's a cavity there? Are you sure? Like, I've never had a cabinet in my whole entire life, you know? And he, he said, Well, interestingly, we do know that the oral health of women during pregnancy, because of all the hormone changes, there are some things that can impact like the natural bacteria in the mouth of a pregnant woman. And so he said, it can provide a better environment for bacteria to start causing

Scott Benner 26:19
problems. That's a technical way. Yeah, let me let me tell you what I've witnessed in my life, making a baby drains the life out of you. And for women worse, your feet get bigger. That's not a good thing. anybody whose feet get bigger while they're pregnant, it doesn't go back. So congratulations for that one. And I just think of it as like a demon in a movie that sucks. Like, you know, they go face to face, you can see the life pulling out of like the live person and bringing in the demon back to life. That's what happens. That's what your kids are their life suckers. So um, I will add this, and this isn't specifically about diabetes. But if you are bouncing around on that roller coaster and correcting a lot with sugar, especially overnight, that could impact your dental health.

Jennifer Smith, CDE 27:07
Absolutely.

Scott Benner 27:08
Because you're taking this juice in your mouth. And then it sits in their mouth and gives them cavities when Arden had baby teeth. And we were not good at this. I'm almost horrified to tell you that I think she had they were on her baby teeth. But I think she had 10 cavities one time, like all at once. And you know, she had to, she actually had to go to the hospital to be put under because they were so worried about blood sugar, because we were so bad at her blood sugar back then. You know, like, like now when she goes to the dentist, I'm like, it'll be fine. I'll take care of it. You do your thing. I'll do my thing. Her blood sugar will be okay. But back then had to go to the hospital insurance didn't want to cover it. Yeah, my wife's company actually stepped up and forced the insurance company to do it, which was lovely at the time. It was like a $15,000 bill to put her in the hospital to fix it was crazy. But it was just from the juice. Now. We had it all worked out. And then one time she told me she was sick of the juice she was drinking. But I had found this kind of like impactful juice that wasn't it has fairly natural stuff in it. So I switched her to something else. And in that six months, she got a cavity. And nothing had changed about it. She wasn't using a lot of juice, but that so we switched away from that juice. And she hasn't had a cavity since then. Hmm. So interesting. Yeah, it's not from diabetes directly, but it is indirectly from it.

Jennifer Smith, CDE 28:31
Correct? Correct. And that it's also a hard thing, that overnight component and I'm glad that you brought that part up. Because who overnight really, even as an adult, a knowledgeable adult who wants to treat their low blood sugar and then oh, yep, got to go to the bathroom. I gotta brush my teeth, we got to floss and like chewed on gummy bears, right? Eat the juice or whatever. Nobody wants to do that two o'clock in the morning, right? I don't want to do that.

Scott Benner 29:00
You've already and I do know, some people keep water next to the bed just to swish at least to try to. And that's better than nothing, right? But yeah, to your point. I mean, you're gonna drink juice and then Go brush your teeth. And then imagine 15 minutes later you get low again, a drink some more juice, you're brushing your teeth again. And, and at the same time, you know, to avoid a cavity. Maybe it's not a bad idea. But I mean, I, you know, I'm supposed to take like, one over the counter and acid before I go to bed at night. And sometimes I'll brush my teeth and then I'll take it. I'll be like, oh, like do that for and now again. You know, it doesn't have to be constantly it happens every once in a while, you know? A great while. Okay, well, that's a big question. I'm skipping right over that. We get to that one later. But that's a huge question. That's not a that's not an ask Scott and Jenny. that's a that's a bigger one. Um,

Unknown Speaker 29:56
that's an episode one is

Scott Benner 29:57
a complete episode. I don't know that. I have an answer to any of It. So

Jennifer Smith, CDE 30:03
that's a you need an appointment to discuss this

Scott Benner 30:05
girl again, therapist and six friends. Oh, I see Chris here says that I should just say what are a couple of times so you can make fun of my accent. He doesn't care what we talked about there is satin Jenny as long as I say whatever. And by the way, I've noticed I've never brought it up but when Jenny accesses her brain so when I ask her a question, she accesses her brain to think of it. her left eye closes more than a right eye. And I wonder if she? Oh, yeah, I don't think she knows that. I don't know. It's almost like she's a supervillain. And she's got information somewhere. And she's like, Huh, and she pulls it right out. Because for you guys listening. I don't tell Jenny this stuff up. Like I'm just throwing questions at her. And she's like, okay, answer you like on the spot. Yeah, yeah, it's it's like a driver's test. But you're driving in a car. And you know, they're like, turn now turn now.

Jennifer Smith, CDE 30:53
That's really funny. I've never noticed that.

Scott Benner 30:56
Yeah, exactly. So Alright, so here's one that I think we could finish up our time with. Is there in your mind? Because you deal with everybody in the you know, who uses all kinds of different pumps? Mm hmm. And obviously, you use Omni pod? And that's to you, the best for you. But But is it the best for you? Or if I got you secretly off in the corner? Is it the one you think would if I made you the king of the world? But you put one on everybody or no? And what are the pros and cons of the other pumps at all of them? Actually?

Jennifer Smith, CDE 31:30
Yeah, this is actually a great question. Because I think it's also a big part of the reason that oftentimes people end up coming to work with us is because we, we don't push to one specific direction when somebody comes to us and says, Hey, you know, I'm considering a pump coming from MDI, or, hey, I've been on this pump for like, eons. And do you think that there's something that would be better for me? Should I be considering this one? Should I be considering this one? What's coming out? What's, you know, which company is heading development and kind of moving the fastest and blah, blah, blah, blah, blah? Um, I, I personally would, I've got reasons for staying on Omnipod right now, which, you know. And there, I mean, the reasons really are such that it provides me with a system that allows me to get the best management.

Scott Benner 32:30
So So Jenny is talking around something so I can put ads on my epic, correct? Yeah. So um,

Jennifer Smith, CDE 32:36
so I'm trying really hard. If, if that wasn't a potential, I would say, put on the spot about another pump that I would consider changing to I would consider changing to tandem? Why would I think they are being the newest pump company of the three that are currently on the market? I think tandem has stepped up, they've done a fantastic job of development of making a product that's user friendly, touchscreen, small, convenient to use. And they're continuing to quickly move ahead with their technology. They're they're trying to bring to the table management that can help people better they are. So I mean, if I had to choose, you know, within the next month, because my current setup was no longer going to be available to me, I would say, yeah, I'll, I'll choose tandem, I like it.

Scott Benner 33:45
And so what you think tandem brings overpowers the tubeless nature of Omni pod for you.

Jennifer Smith, CDE 33:52
That's the only drawback I can definitely say the tubeless nature of Omni pod is a huge step above the other two companies on the market. But from I feel like that tubeless piece is it's more aesthetic. It really is. It's something that I as an adult, I can get over it. I don't I don't love tubing by any means. But I can get over it. If a system provides me with something that helps my management, the to versus non tube. I don't really think it has anything to do with what I get from a control perspective. Right. It's more my lifestyle that the tubeless is huge benefit for but I can deal with the tubing. If it means the pump provides me with what I need for good management a

Scott Benner 34:52
gun to your head right now though. Pick a pump,

Unknown Speaker 34:56
Omni pot okay.

Scott Benner 35:00
Good second for you.

Jennifer Smith, CDE 35:01
tandem is a good second and I hate you know, saying I mean Medtronic has been on the market a long time. They're they're also, it's a really good pump it truly is. But for I think for a fair number of people with the current system they have on the market. I've got a lot of people I work with who they like their Medtronic pump, but they choose to use a different CGM, because they're CGM is just not meeting the mark. For many people, myself included I did the pump was okay. It was fine to use. It was a tube pump, it did what it was supposed to do, blah, blah, blah. But their sensor has never worked for me. So you know, from an all around, encompassing, that's why I said, you know, if I had to choose because I no longer could use my Omnipod. I would choose tandem, because at least it still connects and works with Dexcom.

Scott Benner 35:54
Okay, if so, Omni pod ads, say the FDA goes to phone control. And that's okay. That pretty much levels the playing field, and tilted towards on the pod for you away from tandem. Like if you get the same kind of like one screen touchy feeling from it,

Jennifer Smith, CDE 36:13
the ones green touchy feeling getting rid of a PDM that feels like

Scott Benner 36:18
you're carrying a thing? Yeah,

Jennifer Smith, CDE 36:19
I'm carrying like a thing around like, it's even bigger than most glucometers

Scott Benner 36:25
are the new ones. You're so you're, you're you're stuck with the PDM because of what you're doing. And so and, and Right, so the dash is smaller. Right. But still, it's you're carrying an extra thing? Right. And I think to this, this whole question becomes moot, probably within the next 1012 months. Right. Like when, when horizon, you know, if if horizon comes out and, and the other companies are going to, you know, they're going to make their changes again, and it's just a lot of stuff is going to change. The insulin pumps are gonna change a lot in the next year and year and a half, I think.

Jennifer Smith, CDE 37:03
We hope

Scott Benner 37:04
Yes. Yeah. Well, yeah, those are their timelines, right? Like, or what if it all comes out? You're just like, sort of the same?

Jennifer Smith, CDE 37:11
right? Exactly. I do know that there are there are definite nuances between the three, what are considered kind of those hybrid control hybrid, closed loop systems with the FDA approved pumps, right? I mean, 670 G is already out, control, like you, hopefully will be out sometime soon. Even that compared to Medtronic, it's different, the system will work a bit differently, the you know, what it does for you will be a bit different and horizon from everything I know about it, which isn't a heck of a lot. It will also have its specific pieces that are different compared to control IQ and six, seven Digi. So I think each system will do something better than a current conventional pump does. But you know, you'll have to figure out which one is best for you.

Scott Benner 38:04
Yeah, there's gonna be a lot of choosing and I think to a no, I can say that. What I thought was really cool with the pod said was, look, when, when our horizon system comes out, we're gonna have an algorithm. But if you want to use the tide pool algorithm, then use that one, like, they don't care which algorithm you use, which is a is is a huge step towards trying to give you choice. Now, having said that, I don't exactly know when tide pools gonna make it through the FDA either. So there's a lot happening and at the same time, it's unsure. It's uncertain until it actually happens. So all right, well, that was good. I have a bazillion more for next time.

Unknown Speaker 38:38
Okay.

Scott Benner 38:41
Okay is right Jenny. Thank you so much, Jenny Smith for coming on the Juicebox Podcast and sharing your wealth of knowledge with everyone. Don't forget, you can hire Jenny at integrated diabetes.com or right there in the show notes is her email address, you can just send her an email. Thank you so much to the sponsor, Contour. Next One meter, this is Arden's blood glucose meter, it is terrific and it can be yours. Click on the links in the show notes go to Juicebox podcast.com. If you don't have shown us that you can find by the way you do you just might not know how to get to them. Or you can go to Contour Next one.com to see if you're eligible for a free Contour Next One meter. mm meter scrape I swear to God, it's amazing. You're thinking like it's just the blood sugar meter but new stuff bomb diggity. Hey, friends, couple of things coming up on February 16. I will be speaking at the type one nation event in Dallas. He says questioning whether or not he knows where he'll be. Let me click on the link. You get to Juicebox Podcast com scroll to the bottom of the page, click on events and you'll see these there. Type One Nation summit North Texas they call it the greatest Dallas and Greater Fort Worth Arlington chapter. This event is on Sunday, February 16. I'm doing a one hour talk there about being bold with insulin. You can also see me coming up in Atlanta, Georgia, Saturday, September, Saturday, September, I said September. Let's try again. On Saturday, February 29. I am doing a ton of speaking there that day, I'll be speaking in a bunch of different sessions. And one of my sessions will actually be with Jenny, Jenny and I are gonna do a q&a together. That'll be fun. Come out and witness Jenny and I meet each other in person for the first time. You can still get tickets. There's links again here on my page. I'm going to be at the jdrf in Wisconsin on March 26. It's a Thursday night from think five to 8:30pm. It's just three solid hours of me chit chatting about the stuff on the podcast, show up at five leave at 830 a new person while we're rolling through the events, Saturday, May 30, had touched by type one in Orlando, Florida. And they will be at the type one nation event in Virginia. That's rich from Richmond, Virginia, August 22. That's a long time from now. I just had to turn one down the other day that broke my heart. I wanted to do it so badly. But it conflicted with a date. I had something set up on already, but we're trying to figure out something else to do. So I can come out. I can't tell you where because you'll all be bummed out and they really wanted me there and I wanted to come so you can't be like, you can't be like up their butts about or anything like that. They really tried. It was my fault. My schedule didn't link up but I so wanted to go. I love that part of the country. Okay, so yeah, Juicebox podcast.com, scroll to the bottom, click on events, get yourself tickets. Thanks so much for listening. I hope you have a terrific weekend. I hope I see you at one of the live events. I can't tell you how much it means to me that you are listening to the podcast and sharing it with other people. January is well on its way to being the most downloaded month of this podcast. So that's because of you guys. And I really very much appreciate all the effort you put into getting the word out about the Juicebox Podcast. I'll talk to you soon.

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About Jenny Smith

Jennifer holds a Bachelor’s Degree in Human Nutrition and Biology from the University of Wisconsin. She is a Registered (and Licensed) Dietitian, Certified Diabetes Educator, and Certified Trainer on most makes/models of insulin pumps and continuous glucose monitoring systems. You can reach Jenny at jennifer@integrateddiabetes.com

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