#473 Sneaking Food
The Psychology of Type 1
Erica is a licensed marriage and family therapist who herself has had Type 1 diabetes for over 30 years and who specializes in working with people with diabetes and their families and caregivers—from those newly diagnosed to those experiencing it for decades. She and Scott discuss sneaking food and constructive ways to prevent it. http://erikaforsyth.com
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Scott Benner 0:00
Hello friends and welcome to Episode 473 of the Juicebox Podcast.
Today, Erica forsyte this back. You know Erica, she's the licensed Marriage and Family Therapist from California. She's been on the show a number of times, and she's here today to talk with me about how to address sneaking of food. Please remember, while you're listening that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. Please always consult a physician before making any changes to your health care plan, or becoming bold with insulin.
California residents if you're looking for a therapist, look no further than Erica forsyth.com. I'd like to remind you that if you're looking for the diabetes pro tip episodes or the defining diabetes episodes, they are right here in your podcast player. But you can also find them at Juicebox Podcast calm or diabetes pro tip calm. If you're listening in a podcast player, please hit subscribe or follow. Thank you very much. The T one D exchange is looking for type one adults and type one caregivers who are us residents to participate in a quick survey that can be completed in just a few moments from your computer or phone. This survey is 100% anonymous, completely HIPAA compliant, and does not require you to ever see a doctor or go to a remote site. Why you say what a survey require that? Well, because this data is actually helping people living with type one diabetes, and I wouldn't want you to get confused and think oh, this is a trial. I might have to go see a doctor, huh? No, no, you can actually help people with type one without being in a trial. And without visiting a physician. You just go to T one d exchange.org. forward slash juicebox. Click on join our registering now, and then simply complete the survey. Once you've done that, your information, which again is completely anonymous, will be used to help other people living with Type One Diabetes and it supports the podcast. Past participants like you have helped to bring increased coverage for test strips, Medicare coverage for CGM, and have brought changes in the ABA guidelines for pediatric a one c goals. And I'm excited to imagine what your participation may lead to T one d exchange.org. forward slash juicebox. There's also a link in the show notes at Juicebox. Podcast comm a bunch of people who listened to the show sent in questions for you. And you distilled them down into topics. Is that fair? Yes. Okay. Great. Great. And so as I'm looking at them here and trying to decide where to start, I feel like I want to start with sneaking food. Are you comfortable with that?
Unknown Speaker 3:18
Absolutely.
Scott Benner 3:18
Okay. I am at a, I'll just say that I'm at a loss when people ask this question of me. And it does get asked of me a ton. You know, Mike, I don't know what to do. And I'll tell you what, it's almost heartbreaking. Because it usually ends up being these people who have figured out they think they've got it all figured out. And then they keep seeing these like anomaly type blood sugars, and they kill themselves. Maybe it's the basil, maybe I didn't Bolus the meal at lunch, right? And it's protein coming. And they really they just they're killing themselves trying to figure out what it is. And then one day they realize that their kids are eating innopolis thing for it. And it's um, it seems heartbreaking when it happens to them to the parent, you know, but I want to understand I mean, obviously I want to let you talk your way through it but I feel like what we want to understand here for the parents perspective is why does this happen? And how do you work through it? Does that make sense?
Unknown Speaker 4:20
Yes the why and then the house okay
Scott Benner 4:22
yes great. So I mean go What do you think
Erika Forsyth, MFT, LMFT 4:26
first of all, I think removing type one out of the equation this can happen in you know with children and teens anyway. of sneaking food but with looking at it through the lens of type one. I would consider has it become has a certain what type of food are they sneaking Is it is it just sweets? Is it crackers? You know what is has a food group in your house become known as bad or forbidden? And is that what the what your child sneaking. Okay. So are they, they're feeling like oh my gosh, I'm not supposed to eat candy. And that's just eat crackers, whatever it is, I would want to examine, has it become a forbidden fruit sort of speak in your household? And is that why the child is seeking it? Because they know they're not supposed to have it? And, and really just looking at, okay, why? Why has that? If that is the case? Why has that become forbidden? Is it because you don't feel comfortable? bolusing for it, is it that your child just you cannot figure it out, and your child reacts in a certain way? So I would look at is it? Is it something that they have learned, or they've been told that they're not supposed to have it? And that implies, like some excitement around maybe it's like, they don't really even care, but it's exciting to sneak it. And so that's kind of I would look at that is those first two things? Is it? Is it forbidden? And maybe they're getting some kind of emotional response out of it to?
Unknown Speaker 6:05
Go ahead?
Scott Benner 6:06
Is it not possible that it could have become forbidden by mistake? Meaning maybe the kid has seen you have some weird reaction to a number at some point. And you've said like, Oh, this, you know, cereal? Always does this? And then maybe they think, well, I don't want to put that on my parents.
Erika Forsyth, MFT, LMFT 6:26
Yes. And I think they're trying to avoid maybe any shame that has been, like placed on them by accident. Or, you know, gosh, I when I eat this cereal, and I go high, and then mom or dad gets frustrated or angry. And maybe they're not frustrated or angry with me, but they're angry at the number, but it's pretty common then for the child to internalize. I've been a bad kid. I've been a bad, whatever. I've made bad choices. I'm not supposed to eat this food. I don't want mom and dad to be angry. I don't want to see that number. So I'm just going to sneak it and pretend like it didn't happen. And then to avoid the shame, but then we know that you know, shame can just creep in and grow. So yes, I think it can happen by accident. Absolutely. Not necessarily just by like clear, don't eat this food ever write statements.
Scott Benner 7:23
So what you just said made me think of one thing. And I have a second question. But then Couldn't it be possible that adults living with type one who have no one watching them? Like you're not even like a spouse? Like somebody that's there could end up in some odd way stealing food from themselves by not bolusing for it? Is that the same problem? Like I do you see what I'm saying? Like if you know that this Bolus is going to go poorly. Is it easier to just like say, well screw it, I'm just going to eat this anyway. And I'll deal with it later. Rather than put myself as a scenario where I make a Bolus, it doesn't work. And then the whole thing feels like a failure throughout.
Erika Forsyth, MFT, LMFT 8:00
Yes, I would say yeah, and there's a lot of right, there's a lot of steps that you're going through in your mind. And it may be just becomes a pattern to behavior, where I somehow have either learned or establish this pattern in my life, where if I eat this certain food, whatever it is, I can never get it right. I'm just going to eat it. And then I'm going to figure it out later, I'm going to try and correct it later. Or I'm just going to avoid the whole thing. And just move on without my day. And then you're running high. And you kind of go to the next thing, right? So I think even as adults, you can if as a kid, you have learned that you weren't supposed to eat a certain food group. And this, this happened for me for sure. As a child, 30 years ago, I wasn't allowed to eat sweets. And so of course, I snuck them. And then in that pattern, I became like, it became shameful to eat. And then the other issue that I think is maybe ask answering the question, why is that maybe as a child or even as an adult, you've been eating a cookie in public, and maybe some kind of peripheral friends or peers or colleagues know you're diabetic? And they say, Are you allowed to eat that? I mean, this happens to me still. And it depending on how I want to respond, I'll just say yep. And keep going. Or if I feel like I want to give a response, I'll explain how I can eat it. But that can if you're hearing that question all the time, particularly as a child who might not have all the development, developmental, you know, ability to kind of process through Yes, I can eat it and it's okay. They're not trying to shame me.
Unknown Speaker 9:47
That happens and so you that you then feel like oh my gosh, am I supposed to have this? Why does everyone keep asking if I can have this?
Erika Forsyth, MFT, LMFT 9:53
So forget it. I'm not going to eat it in public. I'm going to go hide this and ate it in my room.
Scott Benner 9:57
So So shame Right is, in this scenario, the diabetes, like the function of the diabetes and how it impacts blood sugar gets commingled, it gets melded with who you are. And that's why you feel shameful about it. Is that I mean, yes, because I hear people all the time talking about, especially like old time type ones, they're very careful to warn people about not conflating you with your diabetes. And I've always understood, like, I've always felt like, I've understood that, but in this specific scenario, I can see now as you're discussing it, where the impact comes in, if I am my diabetes, then the failure of my insulin use is a failure of me. This all gets pulled together into one thing, and therefore, I'd rather not have this experience even for myself, but I but also not let somebody from the outside see it.
Erika Forsyth, MFT, LMFT 11:02
Yes. And and then equating, if you're saying, Okay, and then I'm bad. I'm a bad person, not even just even a bad diabetic. Yeah, I'm a bad person. If I've eaten this cookie, and I didn't Bolus correctly and now I'm 300. And I, I'm a terrible person.
Scott Benner 11:21
And inside in your brain and your psyche, there's no difference between that number and you at that point.
Unknown Speaker 11:26
Correct. Correct. And so
Scott Benner 11:28
when you hear somebody who loves a person whose, by the way, is sneaking food the right way to say it? I'm not usually the word police. But is, is that? I guess it really is. Right? It's
Unknown Speaker 11:40
it's eating? Well, I
Erika Forsyth, MFT, LMFT 11:40
think Bolus Yes. Yeah, I think eating without bolusing is one thing. But if you're doing it, or even bolusing correctly, but if you're doing it in a way that you you're taking food, and either you're actually physically hiding while eating, which I know happens. Or you're sneaking it without kind of if you are under that's I'm thinking from more from the lens of like a child, and you're eating something without disclosing it. Which sounds so terrible, right? Like without saying, Hey, Mom, I want Hey, Dad, I want to have this apple. So are you sneaking it? I guess it just that it's a tough? Yeah, eating without your eating without bolusing. But then I think there is a category for you actually are sneaking the food, hiding it because you've you've learned and you're hiding and you've learned and you feel like you weren't supposed to eat it. So you're going to hide it hide it
Scott Benner 12:36
you for a moment, if we take a side shoot here for a second, if we take diabetes out of this for a second. People sneak food, right?
Erika Forsyth, MFT, LMFT 12:44
Absolutely. I mean, particularly if like, let's say you're on a diet, you will say oh, I'm not supposed to have this, I'm gonna sneak this in into my diet, or as a kid who knows that they can have maybe one treat a day. But then they find, you know, some old Halloween candy in a cupboard. They might sneak it because then they feel like it's it's like forbidden. It's not allowed.
Scott Benner 13:07
What about adults that hide food from family members and co workers and stuff like that? Are we really just replacing the acceleration of blood sugar with the acceleration of of weight? And so all the rest of it's the same. It's the it's just the thing that you're trying to hide is different. Does that make sense? Well, yes,
Erika Forsyth, MFT, LMFT 13:27
yes. And I think then you ask the question, Well, why is that person hiding? whatever they're doing? Yeah, because they have developed this kind of shameful pattern thinking that, like, I'm bad. I'm not supposed to do this. So I don't want anyone else to see it. And so I just, I need to hide and do this. before. It's sad. You know, it's It is sad.
Scott Benner 13:47
I have one more question before I go to my next. My next question, which is okay. In a person's psyche. Is it possible to hide something from yourself?
Erika Forsyth, MFT, LMFT 13:58
Interesting, is it? Well, you can think that you're hiding it from yourself, right? by either mind mindlessly doing something, right. Like if we're staying on the topic of sneaking food, and you're thinking in through the lens of also diabetes, like, Okay, I'm going to pretend like I'm not eating this. I'm thinking about, like, let's say you have a piece of pie, or a whole pie. And people just say I'm just, I'm just cleaning off the edges, right? Like, you think that you're not really having a piece of pie because you're just having a little bite, but then by the time you go back and do that 20 times you've had the piece of pie. Yeah, I think they're, you're kind of like trying to pretend and not trying to sneak or hide it from yourself, but
Unknown Speaker 14:43
kind of make it like you're not
Scott Benner 14:44
really eating it. Does that make sense? It's excuses. That's like it. Yeah. So there's a thing when I'm when I'm eating lower carb for myself, I get a sweet tooth. I try to have a little dark chocolate. Right. And that works great for me. But it's a little bit of dark. If there's a time where I started seeing myself having the dark chocolate too frequently throughout the day, like Normally, it would just be once there is there's a part of me that's like, Oh, I just used the dark chocolate too. But there's the, the rational part of me is like, you're about to break this diet you're on. And this is the way you're getting into it. Like, I can feel it happening. And I'm intellectually I understand it's happening. But I am able to lie to myself for sometimes a day or two, before I go, Oh, come on, you know what you're doing. And put a stop to it. It's just, it's really I mean, you're not lying. You can't lie to yourself, right? Like, you can't, you can't punch a hole through a wall and tell yourself, you're picking flowers. But you but you, you can say, It's okay, if I punch this hole on the wall, I'm giving myself permission to do it. I know it's wrong, generally speaking, but I'm not going to punish myself over this right now. And and I wonder if that because because like, with so many things with diabetes, sometimes we look so hard at the type one, or the diabetes in general, that we forget that, like, people who don't have diabetes go through the same thing. It's like exactly what I mean, like the that's where the idea of real people set comes from, because people, right, because people with diabetes, tried to blame everything on their diabetes. And sometimes you just, you know, there's a difference between sneaking food because you don't want somebody to see because of a blood sugar thing, etc. Because it's become verboten somehow in your life. And maybe just the fact that you're just sneaking food for other reasons. And I just wanted to be clear about that. So then, here's the next heartbreaking part of this, especially when it's a child. Someone will say, I, I've been working on this for years, I figured out there, basil. I know how to Bolus for anything asked me I can Bolus for anything. I figured it out so that they can be healthy. It's not hard. It is not difficult to do we do it every time. Why would they sneak food and cause themselves a problem? When it's not even necessary, when we're so good at this, that it wouldn't be a problem to eat whatever thing it is they're thinking of. And that part for me is particularly interesting. Because I just I'm gonna tell you the 20 minutes before I came up here, Arden and I intersected in the kitchen. And she's hungry, but she didn't know for what she's like, I don't know what I want. And she's kind of there's nothing in the house like that whole dance. Like you're like, Well, what about you name nine things now? Like no, right?
Unknown Speaker 17:30
Yeah.
Scott Benner 17:32
And so then I was like, you just want a bowl of cereal. And she said, I don't have time to eat that. And I was like, What do you mean? I said, Sure you do just Bolus and we'll we'll do it. No, there's I don't want to wait. I don't want to wait for the Pre-Bolus She told me. So I was able to say Don't worry, we won't wait for the Pre-Bolus will over Bolus it. But I know how to handle not Pre-Bolus even even for something like vicious like cereal, right. And so I know how to over Bolus that meal, so won't cause a big problem. And even if it gets out of whack a little bit, we'll I'll knock it back down and show it or show Bolus again or however, you know, whoever intersects with first. But why would a kid knowing that you are proficient at diabetes? avoid something still, like that, to me is the thing that I watch parents, they can't make any sense of it, especially after they've put so much time and love and effort into figuring it out.
Unknown Speaker 18:31
Mm hmm. What do you think?
Erika Forsyth, MFT, LMFT 18:33
I think it's Yeah, it's a very common question and concern and struggle really because I would look at I would want to know, it's hard to kind of give blanket say without like, choosing an age because I would say Are they they had an age of trying to demonstrate some independence or control over their life and is this one way of them feeling like hey, I can eat this on my own without anyone telling me what to do or how to Bolus or you know, feeling like is it that is it the wanting to have some control over their own life and decision without consultation? Is it is it wanting to maybe be like their peers if it's in a peer group situation and they're all quickly deciding to go eat whatever it is hamburgers or ice cream? And they just don't want to deal with it? Are they Is it is it I want to I don't want to be different I want to be like appear. Or maybe going back to the basics of you know, when this worked for one family where they went shopping with their child to the grocery store, and they said pick out everything you'd ever want to eat, you know, from all the aisles, whatever, no judgement, nothing. And just really kind of demonstrating to this this exercise helped for the family and for the child. The See, look, you can eat anything, I mean, Grant grant it within the guidance of maybe the family's expectations of eating or protein, vegetable and car, or whatever, whatever they're well about nutrition looks like. But to say you can also you can eat the Oreos, you can eat the Doritos, whatever you want, whatever kind of, quote, junk food or food that you think we don't approve of, you get it, buy it, let's fill up our cart, and take it home. And let's lay it on the counter. And you just get all we need to know is, you know, before you want it, let's Pre-Bolus or whatever, whatever the decision that works or to do what you're you're able to do with Arden. And so really kind of going through that exercise of allowing the child to see to feel to have control over picking what their favorite snacks are at the grocery store, and giving giving them some control of their life in that way. I guess. Yeah, I'm saying, and that bleeds
Scott Benner 20:53
into everything, right? Like, you know, what you're making me realize, like, You're making me think of something. So when I was growing up, there was a public school and a private Catholic school, kind of in the neighborhood. And as you got older, this thing would happen when the Catholic school girls would graduate, they'd all cut their hair, it was the strangest thing, right? Or they would start dressing completely different. Or in some cases, like having a lot of sex that they didn't have in high school, like they they made, like, big changes to their life. And I always felt like that was because they had grown up. So I kind of controlled, and I carried that remembrance into my parenting. And, and I did, I didn't give my kids like, you know, drugs when they were 10 and stuff like that. But but I tried to let my kids have a lot of agency over themselves, and to make as many decisions as they could on their own. And I'll tell you, it's a pain in the ass. Sometimes when you're raising kids, and you give them a lot of input, because there are times where you're just like, Alright, well, let's go figure out what the seven year old wants. Now, you know what I mean? And you're like, and you just need to go where you need to get something done. But it ended up paying off long term. Because my children do not feel like they're being controlled by us as much as they could. And trust me, they still do because they're young people. And you're always gonna feel like there's something to break away from. But is this another place where we're conflating diabetes with just being alive? Is what made me wonder when you were discussing it, like, I get the I get the Pierce thing, we're all out, we're gonna stop somewhere real quick, I don't have time to Bolus for it, or to count the fat in it, and then do an Bolus for the fat like, you know, you're 14 trying to decide how much fats in french fries, you know, like that kind of stuff? Like, hold on a second, there's a simple equation my mom taught me. Oh, my God, let's go over that while we're joy riding. You know what I mean? I understand that I understand. But I do also understand just the idea of wanting some sort of control over your life. And I'm wondering if you're able to hand that control to them in other places? Would it lessen their desire to find that control in this?
Erika Forsyth, MFT, LMFT 23:17
Absolutely. And I think yeah, that's, I think we, we've talked a little bit about that. In our we talked about teens. I know, we'll probably talk about that as well later. But I think, yes, giving them finding the opportunities and the kind of Windows where you feel like you can hand over that control instead of micromanaging every aspect of your child's life and gret. And obviously, this changes over time and developmentally what they you feel like your child can handle and demonstrate that responsibility? But yes, I think giving them some other opportunities to say, okay, you can decide whether you want to wear your pink sweater or your blue sweater, you know, just like building that in letting them have those decisions in their lives where it doesn't really matter, I think will help in the long run. Yeah.
Scott Benner 24:04
So from a caregiver perspective, I, my two questions are, how do they approach this problem and address it? And what could I be looking in to myself for that would get in the way of me handling this? Well? Because I feel like that, like why would they do this, to me, is a vibe I get from parents sometimes, like I put all this into this, why is this being like, why are they doing it? And you need to understand like, your kids are not doing anything to you. Like it's not an attack, but it feels like it. You know what I mean? And I think sometimes it feels like it more to some people than others. And I would imagine that has something to do with their problems growing up. But those are my two questions that I'm interested in what you think about the rest of it?
Erika Forsyth, MFT, LMFT 24:47
Yes. Okay. So how how to kind of move how to address the issue. You've seen your child, Snake food just based on either evidence of the blood sugars or you've caught them in the act so to speak. Or they've shared with you later, I think the first and foremost, I would always want to, if your child does come out and say, Well, yeah, you know, I did eat this two hours ago, to immediately go to just being grateful and thankful that they were being honest, as opposed to kind of going down the pathway of punitive. Because I think when we Google grant, we don't want to punish, at least from my perspective, personally, and then from my experience, collectively, professionally, working with families, children, if they are punished for making bad choices, or high blood sugars, that is going to spiral into the shame and avoidance and sneaking further, but saying, gosh, thank you so much for for sharing this with me. Let's How can we and having a dialogue, even if they're five years old, or two, or even three, I mean, granite younger than that might be challenging. But let's say 345 10, whatever age your child is, even up into teenagers, like how can we avoid this wetter and asking them like, are there? Are there foods that you feel like mommy or daddy or whoever's your caregiver doesn't allow you to eat? Because they might make a list of things that you have never, like we talked about in the beginning, you have maybe never have said you cannot eat these foods. But somehow they have learned that from yet externally public shame or questioning or from your response that you weren't aware of when you saw the number. And so asking them, are there things you feel like we can't You can't eat in this house? Right? I would start there. And then I would also go to, okay. What if they're a little bit older? If they are able to break it down? Like, were you thinking anything before or was I not around, and without assuming that they were sneaking to, maybe you were on a phone call, maybe you're busy, maybe they were just really hungry, and just were like, I need to eat this food right now. They get you know, they can be impulsive.
Scott Benner 27:10
I have a note here right to myself to remind my to say at the end of this, that to be careful not to blame people if you're not 100% certain to because you could actually cause the problem. And you're just saying like, what if I just got so hungry, and I'm four years old, that's not sneaking food. It's right, I'm hungry. Yeah. You also made me remember that this might be a little too much. But um, when I was growing up, when I was 13, my father left my mom. And my brothers were five years younger than me, and five years younger again. So I'm 13, that makes my middle brother eight, and my youngest brother three. And my mom goes off to work to try to make up the difference. And I'm basically raising these two little kids after school. Now, I'm 13. Trust me, I did not know what I was doing. And you know it now in present time, I'll joke with my brothers all the time. And thank them, because I really got a lot of my bad ideas out on them. And really saved my as a
Unknown Speaker 28:09
child parent,
Scott Benner 28:10
is it Yeah, as a 13 year old parent, teaching myself to drive and take care of a three year old and stuff. But nevertheless, I saw that with my younger brother, I didn't know what to do. And punitive was the way any bad thing was addressed. Because it's all I could think of. And I will tell you that that was tough for him. And all it would do is cause him to hide things. Like we used to have this joke like Rob's either in trouble, and you're aware of it, or getting in trouble and you haven't found out yet. And and as we joked about that, and that rang in my head while you were talking, it really made me realize that all he was doing like, I didn't curb his behavior. He just hit it better. And that's not a resolution for him or me. He's okay, right now, for anybody who's listening. He's Yeah, he's not jail or anything like that. But that is, that's what you were making me think of when you were saying that. I don't know why I said that. But it felt like Yes, yeah.
Erika Forsyth, MFT, LMFT 29:11
Because you think you know, as a four year old who's coming home from preschool and needs a snack, they and they know where the snack buck bin is, or whatever, and they eat and that's it, you know, the child doesn't have type one, then you're not going to say well, how could How dare you go and get a bag of pretzels without telling mom? Yeah, I'm assuming mom, baby as we know, it could be dad or whoever is in the home. But I so I think we have to remind ourselves like okay, how would I yes, he has type one and I want to prevent the highs and I'm fearful of long term complications, because I think that's the sequencing. You know, your thought pattern, is that right? Or at least from what I've been told, and so going back to like, Okay, he's four, he's hungry. How can we How can we address this next time? Is it like, okay, like, and maybe going back to like, why as your second question is, okay, why the parent has clearly has solid competence and confidence and Bolus and for any food. And you've told your child time and time again that they can eat anything. And reminding them that we just need to Bolus beforehand whatever the timeframe is. And okay, so why is the child doing it couldn't be all of those factors. And now it's a you had all those conversations you've eliminated, okay, the child knows he can eat anything the child knows, he just needs to tell the parent that he wants to eat something. And yet he's still doing it, I think I would then look at Okay, how often is that happening? Is it is it a one off experience, because you know, just like, as caregivers, we are going to make mistakes, we are going to, we're not going to Bolus enough, we're not going to Pre-Bolus in enough time. And we have to practice that grace and forgiveness towards ourselves. We can offer we can model that for our children, and seeking from like a caregiver lens. And then we can also offer that to our children, because they're going to make mistakes. Now, if visit isn't happening every day, then I would go to my first two points of Okay, the child must feel like he can't have it. Or maybe he's just hungry, and we need to figure that out. But if it's a one off occasion, then I would just say you know what? We need to you know, offer that grace and forgiveness and you correct and move on.
Scott Benner 31:41
Right? Hey, and if it happens over and over again, as a parent as the adult, do you at some point have to look at yourself and say, there must be some way I'm impacting this, it's causing this behavior to some degree.
Erika Forsyth, MFT, LMFT 31:54
I think that would be a helpful first or second step. Yes. If you've asked all the questions and say, Okay, how am I? What kind of messaging Am I giving whether explicitly or implicitly whether it's my facial expression, or noise, like you're looking at the if it's CGM, or meter, and you're like, right, like these simple things aren't, you know, toddlers can pick up on those noises and those size and even your body language, right? And so maybe kind of checking in with yourself is what is your your kind of gut response when you're looking at the numbers? Yeah,
Scott Benner 32:30
so you and I haven't recorded together that much at this point. But I have learned one thing about you that I can't ask you to make a blanket statement because you won't do it. And but I do want to ask you because I want to close out this episode, but I want to just do one thing. How much of an adult's actions are they unaware of? Like, how many times do we do something for what we think is one reason, but really, it's not for that reason? Is it frequently throughout the day?
Erika Forsyth, MFT, LMFT 32:58
even as a child, how much are they aware of no idea
Scott Benner 33:01
as an adult person who thinks that we're control of what we're doing? Like? How many how many times? Are our actions driven by something that we don't understand?
Erika Forsyth, MFT, LMFT 33:12
Wow, yeah, that's a whole nother episode. I don't know. I think it depends on how self aware are you?
I mean, have you done the work in learning what your your thought patterns are? And how your thoughts affect your feelings? which affect your actions?
Scott Benner 33:28
Let's say no. Right?
Erika Forsyth, MFT, LMFT 33:28
Like that. That's all connected? Yeah. Let's Oh, no, then yeah, you probably don't have a whole lot of self awareness. And so everything from you're raising your eyebrows, very subtle things that others can pick up on, you know, eyebrow raises size hands, like you haven't said a word and you've communicated a lot. Yeah. And so I think if you're not aware of, of your thought patterns, which connect to your actions, and also your feelings, then you probably are, you're communicating a whole lot more than you might even you are aware of.
Scott Benner 34:02
Okay, and I want to add to that, thank you. I want to add to that, that it takes longer to fix than you think it would, because I've been absolutely I've been battling with this for a decade and a half now. And I'm much better today than I was. But at the beginning, anything that went wrong with diabetes, I was like, like it, like I just edit. And it just felt like it felt like you were trying to conquer something and you were falling off of it all the time. And I never had any intention of mirroring that to anybody in my life, but I did the people around me were like, Oh, my God, he's upset. And so I never felt upset. I just felt like God dammit. Like those little micro things. So anyway, I just wanted to make sure to put that in there. Thank you very much.
Unknown Speaker 34:40
This was wonderful. He welcome. Thank you.
Scott Benner 34:52
I want to thank Eric again, and remind you that if you live in California and are looking for a therapist, go to Erica Forsythe Calm, there's links in your show notes. If you're looking for the diabetes pro tip episodes, they begin at Episode 210 in your podcast player, or you can find them at diabetes pro tip.com or at Juicebox Podcast comm if you're just finding the show and getting started with management ideas, I really think you should begin with the defining diabetes series, which is also available diabetes pro tip comm or in your podcast player. And if you're listening in a podcast player right now you haven't subscribed or followed the show, please do. If you're enjoying the show, please share it with others. If you'd like to find some good conversation about type one diabetes, I suggest you check out the private Facebook group for the show Juicebox Podcast type one diabetes, answer a couple of quick questions to make sure you're a real person and you'll be let right then and there you will find GS over 10,000 listeners just like you talking about type one diabetes. I'm going to remind you again to go to T one d exchange.org. forward slash juice box and fill out that survey just takes a couple of quick minutes. If you're a type one yourself, or the caregiver of a type one, as a US resident, you'd really be helping other type ones and the show if you took the time to fill it out. And I thank you very much for considering that. This episode did not have any ads today. But I still want to thank the sponsors the Dexcom g six continuous glucose monitor the Contour Next One blood glucose meter, the Omni pod tubeless insulin pump, g Volk hypo pen and touched by type one.org. There are links everywhere to all the sponsors. And all I ask is that if you're looking for a great CGM, an accurate meter, a tubeless insulin pump for some really cool glucagon use my legs and of course, touched by type one is it touched by type one.org. They're also on Instagram and Facebook. I hope you go find them and check out what they're doing. Because what they're doing is wonderful. So if you're considering getting a Dexcom g six continuous glucose monitor, please use the link in the show notes or type in dexcom.com Ford slash juice box hey you know you may be eligible for a free 30 day trial of the Omni pod dash tubeless insulin pump on the pod comm forward slash juice box Arden uses the Contour Next One blood glucose meter and I find it to be the most accurate and easy to use blood glucose meter she has ever had. Contour Next one.com forward slash juice box find out about the G vo Kibo pen the glucagon that my daughter carries g vo glucagon comm forward slash juice box. I want to thank you again for listening to the show for making it the most popular type one diabetes podcast around and for sharing it with others because that is truly how it grows. There are days and today is one of them where I wish I could give you everything that I have recorded right now. Because there's so much good stuff coming. I feel weird, not just releasing at all but things don't work that way. And if I did that you'd never find it. So come on back next week, where there'll be three new episodes of the Juicebox Podcast just like every week. We'll see what we can find that fits your needs. I hope you know how much I enjoyed making this podcast for you. I'll talk to you soon.
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#472 After Dark: Living with Bipolar
ADULT TOPIC WARNING. Today's guest is a type 1 living with bipolar disorder and thyroid issues.
TRIGGER WARNING: This is a frank discussion with a female living with bipolar disorder.
You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - Amazon Alexa - Google Play/Android - iHeart Radio - Radio Public or their favorite podcast app.
+ Click for EPISODE TRANSCRIPT
DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.
Scott Benner 0:00
Hello friends and welcome to Episode 472 of the Juicebox Podcast. Today's show is another in the after dark series, the After Dark series deals with topics that people don't often speak about out loud topics such as, believe me, and type one diabetes, heroin addiction, PTSD, sexual assault, bipolar disorder, divorce, intimacy from both male and female perspectives, in all, a lot of things that you just don't talk about that frequently in mixed company, but we talked about it here on the podcast, I'm always looking for more people to add to the afro dark series. So if you've had an experience that you think fits, or you'd like to talk about something that's normally a little taboo, send me an email.
Even though in Episode 384, we did bipolar disorder and type one diabetes. That episode was with a guest who was much younger, and had different perspectives. Today's guest is a little more mature, has been dealing with type one and bipolar for longer. And to be honest, their story's completely different than the first one we heard. I hope you enjoy it. Please remember, while you're listening that nothing you'll hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan. or becoming bold with insulin. You're going to hear short gaps of silence in today's episode. That's where the guests name was spoken, and we later took it out. The Substance Abuse and Mental Health Services Administration is here to help you the SH m h essays national helpline is free, confidential, open 20 473 65. their phone number is 1-800-662-4357 where you can find them at www.samhsa.gov. Today's episode of The Juicebox Podcast is sponsored by the Dexcom g six continuous glucose monitor, find out more and get started dexcom.com/juicebox. Want to find out if you're eligible for a free 30 day trial of the Omni pod dash tubeless insulin pump omnipod.com/juicebox. And of course, whenever you want to see good things being done for people with type one diabetes, all you have to do is go to touchedbytypeone.org or find them on Instagram, and Facebook.
Anonymous Speaker 2:54
My name is and I've been diabetic since December 12 1994. So this December will be 27 years and I was diagnosed with bipolar on September of 2003. And I don't work right now. No one else's.
Scott Benner 3:16
It's so hard for people to describe themselves as fascinating. It's my favorite part of the show. I'm going to a clean piece of paper here on my thing. How old were you when the bipolar came?
Unknown Speaker 3:28
2323.
Scott Benner 3:30
And you probably thought, well, things can't possibly get worse. And then next year you got diabetes?
Anonymous Speaker 3:36
No, I was diagnosed with diabetes in 1994.
Scott Benner 3:39
Oh, how much? So how old were you when the diabetes came?
Anonymous Speaker 3:43
I was a month after turning 14.
Scott Benner 3:46
Oh, I'm sorry, 14. Let's just do that joke backwards. So you got diabetes, you probably thought this can't get any worse. And then right? Yeah, nine years later. I got it. Okay, we're good. Okay, now I understand. Oh, wow. So I guess let's talk first, about your recollection of diabetes through your teens in high school, etc. Well, I
Anonymous Speaker 4:09
was just listening to your interview with Caitlin. And we sound very similar. I actually didn't have to go to the hospital. When I was first diagnosed. They told me I was tied to and then pretty soon after that, I went to a place in Denver called the Barbara Davis center. And it was like an intensive Type One Diabetes camp. And then I don't know I remember going to the grocery store. And like bawling because my mom was like, Oh, you can't have this anymore. I can't have this anymore. You have to have sugar free and it was really emotional.
Scott Benner 4:44
Yeah. So your mom took you to the grocery store to show you all the things you couldn't eat.
Unknown Speaker 4:49
Yeah, that's horrible.
Scott Benner 4:50
Oh, nice. That's great guy. Does anyone remember Cocoa Puffs, as if it was a version therapy. Do you think she was like She wasn't smacking you as we're looking at. No.
Anonymous Speaker 5:03
No, I think she was trying to be honest.
Unknown Speaker 5:05
I know I understand hit
Unknown Speaker 5:06
me hard.
Scott Benner 5:07
I can't imagine it wouldn't at 14 like it is interesting. I have to say from a parenting perspective. You try to be very honest with your kids. And honesty comes, I mean, at least for me, it comes in, like sort of a dry adult way, like, hey, you're going to get a test today, they're going to draw blood, this is going to happen, like you're trying to lay it all out. It is almost impossible as an adult to put yourself in a child's shoes when they're hearing it. Like, yeah, you're kind about it, and you want to be gentle. But you also want to be factual. And at the same time, I don't know if there's actually a way to impart some pieces of information that are Stark and an in, like, firm contrast to how you've been living your life prior. without it being upsetting. You know, I mean, can you you don't I mean, like, what, what would the way have been? Exactly. And how long ago was that? You're 14? Would you say? 20? How long ago? Was this? 27 years?
Anonymous Speaker 6:07
Yeah, yeah, this December will be 27. So,
Scott Benner 6:11
I mean, what could anybody have possibly taught your mom about Type One Diabetes 27 years ago? That's probably what they told her. Right?
Unknown Speaker 6:19
Yeah. Yeah.
Anonymous Speaker 6:20
We went to the Barbara Davis center, and the nurse bless her heart was having my parents give her a shot. The poor lady had this arm, and she probably gotten how many shots from people learning. So instead of putting in an orange, she had my parents do it in our arm. And that was an interesting experience, having to deal with arm shots. But then they first put me on regular, right, and NPH and I had to wait 30 minutes before I could eat and my mom would freak out. If we go to a restaurant and the food took a little longer. She's like, she needs to eat something right now. And she would freak out.
Scott Benner 7:01
We're getting to this. So you met a sadistic CDE in Colorado, who was getting strangers to help her with her love of being stuck with needles. It sounds odd.
Unknown Speaker 7:15
Yeah. Like why
Scott Benner 7:16
not a banana or an orange or something? Like why my arm? Do you think? Oh, all right. We can't dig into that. But if that woman's listening, you're on the show. I want you. And is your mom. Is your mom alive? Yes. Okay. Are we going to is she is your mom. reactionary? in general? Or did this really get ahold of her? Do you think?
Anonymous Speaker 7:41
I think it really got a hold of her.
Scott Benner 7:43
Yeah. I can imagine we wish she married then.
Unknown Speaker 7:47
Yes, she still is.
Scott Benner 7:48
So was your dad. Like? Like, I mean, was it like classic? Dad? 30 years ago? Was he like, I'm just gonna go make money while you girls take care of all this? Was it that vibe? Yeah, it was. Yeah,
Unknown Speaker 7:59
he nailed it.
Unknown Speaker 8:01
I'm gonna go to work. You guys. Good luck. Yeah, as my dad was like, we see people arguing he just he just like, boom, right out the door.
Scott Benner 8:13
Goodbye. My job. Title doesn't include Listen, everybody yell at each other for some reason. While that sucks? Is there any? Do you guys ever talk about it now in present day?
Anonymous Speaker 8:27
Um, she's still old school and on things that I can't have anything with sugar in it. And when I do, she really kind of glares at me. Which, which is kind of hard because I'm trying to explain to her I can't I can't have it. I just watched myself like I test afterwards and stuff like that. But she thinks that I should live in eliminate it completely. So I'm under a lot of stress when she's here. Not only with the bipolar, but with the diabetes, too.
Scott Benner 9:01
Yeah. Oh, so she's just she got indoctrinated at a certain time. And you probably only I mean, how long did you live with her after you had diabetes?
Anonymous Speaker 9:11
Well, I was in eighth grade. So three years, five years.
Scott Benner 9:15
And then that's it. So her her understanding of diabetes is 27 years old. And that's it. And she stuck on that. Yes. Yeah, that seems fun for you. And when you when you explain it to her, she doesn't care to hear it. Have you stopped trying to explain it to her?
Anonymous Speaker 9:30
I really want her to listen to 371 your episode that explains it. And I think that would be a less of a blow. Like it's nicer than me saying, Oh, I can't eat it and like starting an argument.
Scott Benner 9:44
I have to tell you, the older I get, the more I believe that people who you are close to need to hear things from somebody besides you. Exactly. It really is difficult for people to accept new or challenging information from someone that's too close to them. It really I it's just you just need to hear it from somebody who you don't have other entanglements with, I guess, you know what I mean? Like, who doesn't look at you like you're a little kid, or right? Or even? I mean, I know, a couple of people who are bipolar. And as supportive as I see their family be like, to their face, like behind their back. I always, it's, it's judged as a you know, it's a mental disorder that is judged by other people. Like, it just really is. It's how do you find that? I mean, I'm sure you have like, some people in your life, we're just like, you're that's that. But are there other people who don't see it that way? You mean, like, do you think? Do you think you're judged harshly by others? For the bipolar? Like, you know what I mean?
Anonymous Speaker 10:58
Yes, yeah, I try and keep it hidden. But then sometimes my, I act impulsively, or I go on, spend a lot of money or do something that kind of, I'm embarrassed on myself. And that's when I'll be like, well, I am bipolar. And this is what's going on and talk about my mania. And just say, this is one of the symptoms my my brain isn't working correctly. I'm sorry, I said something. mean, I didn't mean it harshly. I don't know my tone.
Scott Benner 11:26
Yeah. So you can't I get your so you can't have it. In a moment when it takes over. You can't not explain it to somebody.
Anonymous Speaker 11:35
Yeah, do you? Sometimes it takes me a little bit to apologize, because I don't realize they did it.
Scott Benner 11:40
So yeah, let's um, do you mind digging into that? Like, what's their? What's the, the general flow of how this goes? Like? Does it go in blocks? Like are you like, like manic sometimes? And how long does that last? And then what like, what's the transition? Is it just in a circle? Does it just happen over and over again? How does it work?
Anonymous Speaker 12:03
Um, when I was first diagnosed, I was on my honeymoon. And it's hard to describe, my husband can explain it better than me. But he's told me that I would hide myself in the place that we slept and I would lock the door, and he would freak out. And then I wouldn't sleep when I walk around the boat. And I want to we came back because we were on a cruise boat, we came back into to the emergency room, and they didn't know what was going on. So I think my diabetes is kind of put on the back burner, because of me dealing with a bipolar. And I've been in the hospital twice. And both times I needed to change my medicine drastically, in order to see an inpatient to see how it's gonna affect me before they let me go. Um, but I, I know that we try and stay under the best control and my husband has like this radar. And he's like, Okay, we got to nip this in the bud before you have to go to the hospital again.
Scott Benner 13:07
So there are things he sees behaviorally that indicate medication needs to be fine tuned. Exactly. Okay. So can you stay in front of it that way? I mean, I realize you're waiting for a symptom to change the medication so you're not really in front of it. But that's the goal. You're just it's sort of like changing basil rates for for a woman who's of menstrual age, like you just like you're like, oh, something's happening. More basil here, like, and then you go through the cycle and you're like, take it away. But do you ever take it away? Or is it always just increasing?
Anonymous Speaker 13:41
No, I'm fall as usual, my hardest time of the year. That's when I was first diagnosed. And just because everything happens within the span of four months. Um, so we have taken away over the summer.
Scott Benner 13:57
Oh, so not not completely gone. But
Anonymous Speaker 14:00
no, not completely. We've lessened it.
Scott Benner 14:02
Right. Wow. And he's helping you. I'll tell you what, first of all, good guy. I might have jumped. Oh, yeah. I'll be honest, I've been like, I don't know. I haven't been around that long. I got to go. on a cruise ship. Yeah. Oh, my God. That sucks. Yeah, I
Unknown Speaker 14:21
don't even know another way to say that.
Scott Benner 14:23
You were on your honeymoon on a cruise ship when someone realized you had bipolar disorder. And may I ask what happened that made someone realize was it just the locking in the room thing? Was that it?
Unknown Speaker 14:37
Oh, no.
Unknown Speaker 14:38
There's a story.
Unknown Speaker 14:40
There's what?
Scott Benner 14:41
There's got to be a story like you were in Puerto Vallarta at a stop and what happened? You know what I mean? Like that kind of thing.
Anonymous Speaker 14:48
Well, my mind wasn't really there. Like my mind was racing so much. I remember like waiting in line for one of the buffets and getting pizza or I don't remember what food was. But I, my mind was racing so much that I felt like everybody else was moving really, really slowly. And so I flipped out. And we had landed, or we had docked someplace and my husband was snorkeling or something like that. And I freaked out not knowing where he was, like, had a run in the water. We knew something was going on. But it took a while to get the diagnosis.
Scott Benner 15:26
Do you? Um, there's, there's a little bit if you do some googling, right? bipolar and immune, autoimmune, are a little connected, aren't they? Do you? Do you ever? Have you ever read some of the articles that say that?
Anonymous Speaker 15:43
No, I've always felt like I'm the only one.
Scott Benner 15:45
One of the more recent discoveries in the study of bipolar disorder is that autoimmune disease may play a role and it's in the conditions development. Studies have found that having an autoimmune disease or suffering a severe infection increase the risk of also having bipolar disorder. I mean, you got to be like the third person who's on the show who's like, hey, I've type one diabetes and bipolar disorder. And I'm thinking that I remember, you know, when you meet somebody you don't really know about their extended family, like my wife has extended family that I've never met, like, real extended. And I feel like there's a bipolar person back in her line to somewhere just super interesting. Like I I mean, I don't know, obviously, anyone who listens to the show realizes I have no medical training, but I just I make sure wonder, I mean, it just, it's weird. For certain I don't know that you're the only one Have you never heard Jonathan on here?
Anonymous Speaker 16:43
No, I'm actually new to listening to the podcast. Oh, wait, he was the child right.
Scott Benner 16:50
Now, there's another person, another person you? I'll show you later. But there's a there's a an afterdark, about bipolar? And so how does it? How does it intersect with the diabetes? Because you said it one's got a backburner? And I understand what you mean, you know, there's only so many hours in the day to apply to trying to figure out your medical things, call doctors get appointments, do stuff like that make changes the medication? Does. Does your diabetes take a big hit? Like Where does your a one c set?
Anonymous Speaker 17:25
Um, the last time that I was supposed to go in to get my a one c tested, because I go every three months? It was right around seven. But when I was pregnant, it was in the sixes.
Scott Benner 17:38
Yeah, well see, that's not too bad. But you're saying that sometimes you just you can't think about it. Because like, what, what keeps you from thinking about it? I guess is my question.
Anonymous Speaker 17:49
I guess I'm so focused on trying to be normal. And having both of these conditions makes me not be normal in my mind. So I guess I try and pretend like I'm not diabetic. And I try and watch what I say and watch what I do. And to not make it obvious that I'm bipolar.
Scott Benner 18:15
So you don't want to be in a situation where somebody just real really sees either of those things about you
Anonymous Speaker 18:22
know, right. And usually I talked about being bipolar or diabetic over being bipolar. Because sometimes my blood sugar will drop or sometimes that I, I can't drive because on the Starburst haven't kicked in. And that's when I'm like, Oh, yeah, I'm diabetic.
Scott Benner 18:40
I have. I can't drive right now. Are there any people in your life who know that you have one, but not the other thing?
Unknown Speaker 18:51
Um,
Anonymous Speaker 18:53
you mean like family members? Or just people?
Scott Benner 18:55
I don't know, right? I'm not sure what I mean. Like, I'm wondering if you've like, had to tell somebody about the diabetes, but the other things never come up. So that just stays away. By the way, everyone has medical issues. No one runs around telling everybody about them. It's it's the stuff that's forward facing that might impact somebody else, like you're saying, so you feel like you have to say, you know, my outburst or I'm sorry, I'm dizzy or that kind of thing. That's just I guess, common sense, honestly. But nobody, like I have, you know, I struggle with like low iron. It's not anything like this, but I don't meet you and go Hey, how are you? Sometimes? Not the second thing that comes out of my mouth when I meet somebody and I really understand the idea of wanting to keep it private. Especially when, hmm, but but how much of a struggle is that for you? Like, is that a portion of your day? like trying not to tell people you have these things?
Anonymous Speaker 19:48
Oh, yeah, trying to hide it. Yeah,
Scott Benner 19:50
the best that I can show the hidings a job.
Anonymous Speaker 19:55
I really don't feel like I like to explain it to like I almost want to say okay, bye color. This is what happens by,
Unknown Speaker 20:02
huh?
Scott Benner 20:02
Have you ever seen that? That card that Steve Martin carries? It's a business card, and it said you've had a brush with greatness. And when people ask him for a signature or something like that, he just hands it to them. Maybe you need that.
Unknown Speaker 20:17
That's great.
Scott Benner 20:19
Maybe you need to like, you know, bump into somebody yell at them for no reason. Just pull a card out of your pocket and go, boom, here you go and wander away from them.
Unknown Speaker 20:28
I wonder if.
Scott Benner 20:32
So my question is when you do end up telling people, is it bad?
Anonymous Speaker 20:38
Now most of the time, they're very receptive.
Scott Benner 20:41
So then, you know, the question, I'm gonna ask you Next, right?
Unknown Speaker 20:45
Why don't you
Unknown Speaker 20:46
get why are you bothering hiding it from them?
Anonymous Speaker 20:49
If it's cost, I want to try and be normal, I think.
Scott Benner 20:54
Listen, those two things feel in Congress just so you'd like. Because what we've learned so far is, it doesn't seem to my people don't seem to mind when you tell them but you don't like explaining it. But once they know it's no problem, but hiding it from them is stressful.
Unknown Speaker 21:11
You nailed it.
Scott Benner 21:12
Thank you. And I've googled Steve Martin's card. It's signed by him. So he's not a not a deck. He actually signs it. But it says, this certifies that you have had a personal encounter with me, and that you found me warm, polite, intelligent and funny. Steve Martin.
Unknown Speaker 21:31
There you go.
Unknown Speaker 21:32
Let's get you a business card company. I think we're
Unknown Speaker 21:35
all love that idea.
Scott Benner 21:38
Oh, my God. Apparently, Nathan Fillion does it too. This is to certify that you just met Nathan Fillion. How did you do? Great. He was impressed and now calls you friend. You called him captain. And it was good. It was friendly. Oh, it's got like choices for you to tell people about what people are geniuses. Alright. Can you imagine? How many people bother Steve Martin?
Unknown Speaker 22:03
You know, they
Scott Benner 22:03
mean, like if Steve Martin, I think I would like a little girl yell. Oh, my god, you're Steve Martin. Then he'd be like, Yes, I know. And people tell me every 25 seconds. Thanks so much. Here's a card Leave me alone. Even the cards probably not fun anymore. But okay, so back to you. Seriously, listen, everybody in the world does something that doesn't make sense, right? Because of some sort of, you know, you know, an internal reason. But I don't you just described something. It sounds like you like better when you tell people but you want to be normal, but I don't know what normal is. So
Anonymous Speaker 22:43
I feel like I have to be in the mood. Like I understand. When I had the insulin pump, I whip it out and I do my Bolus and train my banglori or cover it in the movie theater. I said when I first got it, like, that's when you turn on the light is when you're in a movie theater, and you have to cover it with insulin. But if I pull it out, and you're like, Oh, that looks like a pager? Or what is that kind of thing, then sometimes I'd go into detail as much as I wanted to. And other times, I'm like, it's just an outside pancreas. Don't worry about it.
Scott Benner 23:16
So when we sit in a movie theater, if we're right up on people, I will turn to the person next to me and say, Hi, how are you? And then they have a horrified look on their face because they're trying to see a movie and not gonna bother you again, just wanted to let you know my daughter has type one diabetes, I might have to take my phone out to give her insulin, I'll do my best for it not to bother you enjoy the show. And then I turn away from them. And that's that. But I am not encumbered by the need to feel normal, which I'm assuming everyone listening is not laughing about because they know but I don't have like I don't have that I heard somebody talking about recently about people rush through lines, like when you're in, you know, in line getting food and there's people behind you that a lot of people rush to they feel very pressured that there are people behind them. And I thought Huh, I've never really felt that way. Like I mean, I want to do I am one of those people like I sit at a traffic light and when it's my turn I go because I am cognizant that there are people behind me. I am cognizant of other people, but I don't feel rushed by the knowledge that they're there. And but it feels awkward to see you have a much different like, you know, story like you were diagnosed when you were 14. When did you first get a pump?
Anonymous Speaker 24:38
Right before I went to college in 1999. I had good old Kaiser. So I did do all kinds of readings and my agency and I think I had to fast and I think the two things I could have or mustard and celery and get blood sugar readings for that. So it took a while. That's actually the only time
Scott Benner 25:00
What you just said something that most people can't even fathom? That's how long ago you've had diabetes. So you had to prove what did you have to get to show them fasting blood sugars? Yes. Because if they were still high, then you needed a pump.
Anonymous Speaker 25:15
Apparently I needed to be under good control to be enabled. Yeah, it's kind of backwards.
Scott Benner 25:22
It's all just inch. I bet you I have no idea but I bet you it's all just insurance bs that they were just looking for ways to restrict what they had to pay for for some people. Because that, that literally sounds like three people have never seen anyone with diabetes. You forgotten a room. I was like, what should we do to make them get a pump? We can make it a little girl eat celery. That'd be great. Let's do that. My maniacal laughing. So you had to prove to them you needed a pump. You got it right around college. That's a real new thing at that time in the world. So that's definitely something you were trying to hide. I imagined but yet, not real high level back then. Right?
Unknown Speaker 26:03
Oh, yeah. Yeah.
Unknown Speaker 26:05
How are you?
Anonymous Speaker 26:06
Well, it was able to be hidden because at that time, people had pagers.
Scott Benner 26:12
Oh, so you can play it off that way?
Unknown Speaker 26:14
Right. Gotcha.
Unknown Speaker 26:16
Can you just pretend that you're a drug dealer?
Anonymous Speaker 26:21
Well, I heard I actually went to diabetes camp, and one of the lady said that she was giving herself her insulin in the bathroom. And someone came in and saw her and she they thought she was taking illegal drugs.
Scott Benner 26:37
So they called the cops
Anonymous Speaker 26:39
now that I think they just approached her and they're like, what are you doing? And she's like, Oh, I need to do this. It's okay. Please don't turn me in. See.
Scott Benner 26:50
I my friend Mike used to just tell people he was shooting up. And then he would say things like, I can't I can't deal with you guys. Unless I'm high. Like stuff like that. I had to, you know, and he would shoot right in his stomach. Do you remember where you would give it like, you know, I said, the ordinary day, you've never given yourself a needle in your stomach. And she's like, people do that. Oh, yeah. All the time. She goes, Oh, I'm not doing that. I was like, okay, she went to her buddy there. Oh,
Anonymous Speaker 27:20
I have a funny story about that. My, my routine when I was in high school is I would test my blood. And then my mom would leave a needle and then I take my insulin, do my shower, get ready and stuff like that, and come up and have breakfast. And before that she used to give me a shot. And she did it in my butt and got a big old bruise. And after that happened, I was like, okay, you're you. It's my turn. From now on. You lost your excuse me? You lost your privilege. Yeah, you're not doing that again.
Scott Benner 27:52
Isn't that great? She hit a blood vessel and you're like, that's your fault. Aren't we be like you she stills? Like, we don't do it that often. But we do it so infrequently that everyone looks at it sort of like Pulp Fiction, you know, where it's just like, remember how to do this. Let's try here. It's just it's interesting how, how things have changed, but at the same time you hit off the college. any signs of man, can you look back in retrospect and see bipolar coming? Or does it just come like a light switch? How does it start? Was it a slow progression or quick?
Anonymous Speaker 28:34
Honestly, I think the stress of the wedding just finally caught up to me. And then you would think that honeymoon would be like I would be relaxed and not a stress. But I think that leading up to it didn't really cause a bipolar but kind of made it come into fruition.
Scott Benner 28:55
You just got pushed over a line. You hadn't been passed, but was planning a wedding. That's stressful.
Unknown Speaker 29:01
Yes. Is it? Yeah,
Scott Benner 29:02
I don't know. If I got my wife and I decided to get married. And we're married like I think seven days later so I didn't have a lot of Oh my goodness. Yeah. But that's so what is it like a year lead up to a wedding and you're like buying cakes and dresses and is it pressure from outside? What makes it stressful wanting it to be nice or people's expectations?
Anonymous Speaker 29:28
Well, both of those and also financially. Ah,
Scott Benner 29:31
so you're trying to hustle money to pay for it as well? Yes. We got married to park I think we had to pay a fee of $20 to the park for us. For them to let us use it and we had to pay a justice of the peace. I think $100 to show up and do the ceremony. The whole Wow. Yeah, that we went on the cheap. We did buy a dress for Kelly. Very nice.
Anonymous Speaker 29:55
We got married at the top of Vail pass and Um, my father in law helped build some cabins up there. Yeah, for cross country skiers. So we did it off season. And it wasn't for everything that we chose to do.
Scott Benner 30:18
Yeah, I am. I remember, one of my sister in laws was getting married my father and I was like, I'll just give you $20,000 if you don't have a way. And, and I think if you found her today, she'd be like, I should have taken that 20. But I understand it, I understand the idea of it, and I get the pressure. So the pressures building because of the wedding, it just you make it to the thing. So not that like if you said to your husband, like, How long were you guys courting before you were married?
Unknown Speaker 30:51
Um,
Anonymous Speaker 30:53
I had just gone to college in August, and then I met him that January or that February? So I told him, I wouldn't marry him until I graduated. So in May of 2003, I graduated. And then that September, we got married.
Unknown Speaker 31:10
Yes, you did college stress and marriage stress on top of each other? Yes, that's interesting. And I said, courting, which I've never said before in my entire life.
Scott Benner 31:22
I really don't know where that came from. Sorry. I'm all over the place today.
Unknown Speaker 31:28
We might want Okay,
Scott Benner 31:31
we might want to test me. I just there's a lot to wrap your head around. When you're when you don't really understand that a lot. And it just is. It's a it's hard not to feel like a lot of compassion for you when I'm talking. And at the same time, I don't want to in any way in for pity, because I don't feel pity. You don't mean? Like it's it's hard to try to be compassionate without seeming or maybe that's just my hang up? I don't know. But I wondered if the medication for the bipolar affects your blood sugar at all?
Unknown Speaker 32:15
Um,
Anonymous Speaker 32:18
I think it depends on which medication I'm on.
Unknown Speaker 32:22
does it vary?
Anonymous Speaker 32:24
Yeah, it's changed throughout the years, but I really don't think it affects it because I've always thought that stuff with hormones checks it. But all the medicine that I take is anti psychotic or seizure medication and mood stabilizers. So in all honesty, I don't think it affects my blood sugar, but other stuff that affects my blood sugar, but not my meds.
Scott Benner 32:49
do those things have other impacts? Like what are some of the side effects of the meds that you take?
Unknown Speaker 32:56
Well,
Anonymous Speaker 32:59
I recently had a colonoscopy, and they put me on oma protocol. And I have to wake up an hour beforehand, because I also take thyroid medication, and then I have to test my blood and then eat 15 minutes later. So my morning is pretty chaotic, and then I have to take medicine throughout the day.
Scott Benner 33:19
Okay, so it's like scheduling, it definitely throws you off. So I hear what you're saying. So the weight the oma persol What is that for? What do they find in your colon?
Anonymous Speaker 33:28
know if something my stomach, your stomach, like some, some juices or I don't know, I could look at it, but don't
Scott Benner 33:34
pick with stomach juices. That's better for the podcast. Okay, so they found some weird stomach juices put you on a med, but you can't overlay that med with your thyroid medication you left out? Are you hypo or hashimotos?
Anonymous Speaker 33:49
Um, I don't know the difference, but I know that I'm on a pretty high dose. Okay. And they took it out completely. Oh, it's gone.
Scott Benner 33:56
Gotcha. Was there a cancer?
Anonymous Speaker 33:59
They had, they had ultrasound it. I guess that makes sense. And so they checked it and they found some nodules. And then when they checked it a year later, they had gotten bigger and they're like, we don't want to mess with his he's got to come out.
Scott Benner 34:14
Okay. So when they found the nodules the first time did you go on medication?
Unknown Speaker 34:19
Not then. No.
Scott Benner 34:21
What year was this? Where are you living in the country? We need to get you to a to a population center so you can see a doctor. Wait, no. Wait, so wait, what year did you find out about the thyroid?
Anonymous Speaker 34:32
Um, not that long ago. Okay, maybe three or four years. I guess the dates kind of mixed up on
Scott Benner 34:38
that but three or four years ago, they find nodules on your thyroid, but don't give you thyroid medication, which by the way, would have helped with that. And so what did they tell you like your your? You they tested you and said you're in range? Did they tell you that bullshit?
Friends, the Dexcom g six continuous glucose monitor not only shows you your blood sugar, it shows you what direction it's moving in. If it's moving in a direction, and what speed, it's moving in that direction. I do this almost every ad I will now open up my cellular telephone, go to the Dexcom app and tell you that my daughter's blood sugar is 79. She's in school right now. And I can see the last three hours of her blood sugar. I can actually turn my phone and just run my finger along the graph. Listen to the numbers 9190 490-685-9491 80 780-580-4380 7877 This is me just dragging my finger through the last three hours of Arden's life. Isn't that magical? You can do that on your iPhone or Android phone. And not only can I follow Arden but so could nine other people if that's what we wanted. up to 10 people can follow her blood sugar's and see them in real time, and get alarmed if they go above or below a setting that we decide on. My alarms, for instance, are set at 65 and 120. My wife's alarms are set at 70 and 139. Interesting customizability you get to decide you want your alarm set at 150. That's where you put it. You want to set it at. That's where you put it. And it will tell you hey, Scott, you're dropping below 80 you're going over 150 BB a little beep. What does this mean? I see even the beeping tells you two beeps is higher. Three beeps is lower. You get to know this information is at the core of how we make decisions about Arden's insulin. Does she need more? Does she need less? Should she take in some carbs? Or just a few carbs enough to stop this fall? This information is I don't want to say life changing because people say that all the time, but it is it's life changing information. If you're using insulin, check it out. dexcom.com forward slash juice box. You can learn more for Get started today, right there at that link. That's talking about having your life changed. When Arden was four years old, we decided to get her an insulin pump. And luckily we got her the Omni pod. She's been using it every day since then. Since she was four years old. She's going to be 17 soon 13 years wearing an omni pod every day. You heard those blood sugars back there in the Dexcom add. Where do you think they come from? They come from the ability to change. Basil rates make timely boluses extended boluses through high fat meals. Arden can wear the Omni pod without convergence while she's showering, sleeping, running, playing, working out doing whatever it is she does. Arden has a tubeless insulin pump. It doesn't get caught on doorknobs. It doesn't have to be taken off to bave shower or swim. It's a special device. One that I'm thrilled My daughter has. And you can find out right now if you're eligible for a free 30 day trial the Omni pod dash at Omni pod comm forward slash juice box. There are links in the show notes of your podcast player and at Juicebox Podcast comm to Dexcom on the pod and all of the sponsors, even in fact touched by type one.org. You have to be impressed I did that all in one take off the top of my head and use the word cumference properly.
They tested you and said you're in range.
Anonymous Speaker 39:02
Yeah, I think they did test my blood. But then they also gave me the option of taking out half of it.
Scott Benner 39:08
But they never just tried to give you like Synthroid
Anonymous Speaker 39:12
not until I was sticking out
Scott Benner 39:14
until it was until it was gone. Okay. Alright, so you need to the Synthroid, you take and it needs to be away from food or other medications. So that's what I'm talking about. So you have to get up in the morning. Take the Synthroid, wait 30 minutes, take more and then eat or something like that. So your whole morning's kind of like screwed up like that. Yes. And Okay. And then the, what's the cocktail for the bipolar? Like? Do you mind sharing that?
Anonymous Speaker 39:42
You mean the specific drugs?
Scott Benner 39:43
I mean, if you want to if you don't want to, if you don't have to,
Anonymous Speaker 39:48
um, I take Seroquel. Um, I take Depakote and what's the other one? lamotrigine,
Scott Benner 40:03
I don't know why they can't give you things better names. And
Unknown Speaker 40:07
would be easier to remember.
Unknown Speaker 40:09
Really,
Scott Benner 40:10
why not call it like, I don't know, nevermind, I just I don't I actually understand the naming system through the FDA and why they make it, why they make them do it like this. But it's just, it's just difficult to remember when someone's on a drug their whole life, and they can't say it, that's a problem happens to everybody. So you take these three medications, that they have to be with food, or at certain times a day or anything like that.
Anonymous Speaker 40:34
Um, the circle needs to be spaced out through the day. Um, I take a pretty high dose that night, and then I take the other one in the morning. And then in the middle of the day, I take another one at lunchtime. And it usually makes me sleepy. So I'm probably the best time for me to drive is in the afternoon before dinner. So this is because of the medication. So
Scott Benner 40:58
this is one of these things has a very short half half life in your bodies, you have to keep taking it to keep the efficacy built up. Is that how that works? Yeah. Okay. And if you don't take that, what happens?
Anonymous Speaker 41:12
Um, the mania starts kicking in.
Scott Benner 41:14
Okay. Do you know what mania looks like? Or do you not know, you're like, do you not recognize like, I'm talking to now the person you are right now on using the medications? Do you fully understand what it looks like when you're not? Or do you not have that kind of recollection of it?
Anonymous Speaker 41:32
Um, I'm aware of it. But my impulse control is not there my tone, I could go to the grocery store. And in my mind, saying, I, I need this when it's actually a want. So I'm like, oh, like throwing things in the cart that I don't need. But my mind, I'm like, Oh, I, I need this, I just don't want it. And then so I spend a lot of money. And then I don't have a filter. So certain things that I say, should not be said to a certain person, or they can take offense to it. And that's not what I'm doing. And for some reason, I send out a bunch of cards, to friends, and like people that I know is thank yous and stuff like that. And if I start like, doing five or seven a day, it's kind of a red flag.
What else happens? I can't think of anything else that happens right off the top of my head. Well,
Scott Benner 42:30
greeting cards is, I mean, at least it's not like I kill five or seven cats a day, it's I send five or seven greeting cards. I mean, there's a high side here for certain, but spend a lot of money like, have you ever gotten in a situation where you've had to go and say, Look, this happened? I need to return these things. Like, is it been that bad? Or is that always something you guys can kind of cover on your own?
Anonymous Speaker 42:54
My husband really doesn't like returning anything. So he just kind of holds it over my head. Like,
Unknown Speaker 43:01
is there a mania room full of stuff you don't use?
Anonymous Speaker 43:04
No, it's actually not that bad. Because we usually hate sometimes when I'm at the store, I have to contact him and I'm like, Can I get this? And he'll either say yes or no. But I went to Costco, and which is not a very good place to go when you're manic. But I had bought this huge thing of powdered Parmesan cheese. And I and then I returned it and he needed it. He's like, Well, where is it? I'm like, well, you got so mad at me I returned it.
Scott Benner 43:39
Just imagine you're carrying a 50 pound bag of Parmesan cheese or something. He needs three pinches for something then goes for it. It's not there. And so some stuff, but we had 50 pounds of it now I just need three little benches.
So So anything you ever tried to hurt yourself or anything like that,
Anonymous Speaker 44:00
um, I was on material for a little while. And one of the main symptoms that got me was confusion. And that's when I had suicidal thoughts. with one eye when I was confused again, it's different from psychosis. psychosis is my mind. wouldn't let me go to sleep and it would just keep running. And then like I would walk around in my underwear, I would do like weird stuff. Like I would stare at the ceiling. It was bizarre, so I forgot where I was going with that.
Scott Benner 44:40
You were just telling me about psychosis. But I think we all got lost imagining you're walking around in your underwear and thinking we all thought holy real psychotics because it was walking around in my underwear like two hours ago. psychosis may occur as a result of psycho psychiatric illness. like schizophrenia and other instances that may be caused by health conditions or medications or drug use. So this one medication gave you these, these symptoms, you had to stop taking that. Yes, gotcha. How do you feel? Like, personally, can you separate the illnesses from you? Like, are you sad that this happens to you? Or have you made your peace with it that this is like how your life is? Do you not? Or you're not able to think about it that way?
Anonymous Speaker 45:33
No, I feel like I'm still in denial that I have it. I wish I could get over it and just kind of embrace it.
Scott Benner 45:41
Yeah, I don't I mean, how old are you again? 40. You're halfway there. I mean, I know we all want to think we're gonna live forever. But yeah, I saw my mom trying to get out of a chair the other day. Trust me. If you're still alive. It's not great. You're not in a you're not in a commercial. hanggliding 78 years old? Yeah. You're at home going? I hate the news. But I watch it. So Well, look, I gotta be honest with you. It's gotten me this far. I don't know that that's a terrible thing. And I don't is it denial? Or is it just the idea that you don't want to say it out loud? Because you're afraid of what will happen? Right? Because it's not Yeah,
Anonymous Speaker 46:30
I don't want to be judged.
Scott Benner 46:32
But it's not like you think the bipolar thing will go into another gear, if you just say, I'm bipolar. And I have type one diabetes and all this stuff, socks, but this is what I got to do. You don't think it'll get worse if you like, just give yourself over to it?
Unknown Speaker 46:49
You mean?
Scott Benner 46:51
Like, I guess what I'm asking is, are you worried that you're on a precipice, and by not fully accepting that you have bipolar disorder that you're stopping yourself from? something worse happening? Or he just is to just suck to say out loud?
Unknown Speaker 47:10
It just sucks to say it out loud.
Unknown Speaker 47:11
Okay. All right.
Anonymous Speaker 47:14
That's why it was so scared. Like, that's why I kept emailing you and be like, Okay, I need to prepare for this. I don't know what I'm gonna say. Can you ask me the questions beforehand, so I can be ready with the answer. Well,
Scott Benner 47:27
that's why that's why my next question was going to be why in the hell did you want to do this? Is this you're trying to accept it. thing?
Unknown Speaker 47:35
Yeah. No,
Unknown Speaker 47:36
do you think it's gonna work your help?
Anonymous Speaker 47:39
Well, I can listen to it as many times as I want. You definitely can.
Scott Benner 47:43
Hey, that's a good point. If I just had enough people with enough problems, come on, I could get my downloads up by them just re listening to their basically, free therapy thing that we do here on the podcast.
Unknown Speaker 47:54
That's why I'm feeling it's like,
Scott Benner 47:56
is it hell? I mean, we're 45 minutes in How are you feeling?
Anonymous Speaker 48:01
Like I have more to say. lay it all out.
Scott Benner 48:05
Yeah. Well, then go ahead. What do you want people to know.
Unknown Speaker 48:09
Um,
Anonymous Speaker 48:11
one kind of fun thing is when I went to diabetes camp, they were called juice ferries. And because you're so active, and you had to walk to do everything and walk to the bathroom and walk to eat and stuff like that. They would test you before you went to bed and they would come and they would test your blood and give you juice and graham crackers with peanut butter. And they're called the juice fairy and then they leave you alone.
Unknown Speaker 48:39
So the juice fairy comes and Jacks up your blood sugar and then lets you sleep.
Anonymous Speaker 48:43
Yeah, basically. Well, if your blood sugar was high enough, obviously, they wouldn't give you anything. But
Scott Benner 48:51
I'm just thinking that the next time I have to go into Arden's room, I'm gonna say, hey, the juice fairies here. Never thought that before my life, but now I say it out loud. Yeah, I don't it's that that makes sense. It. The juice fairy is a is a nice way to how old were you when people you weren't like 20 years?
Anonymous Speaker 49:14
No, um, I think it was right after I was diagnosed. I was diagnosed in December. And because I was 14, I was still able to go to diabetes camp. Yeah. So I hadn't been diabetic for very long before I went there. Okay, I guess is what you do.
Scott Benner 49:32
I think if I ran a diabetes camp, it would look much different than other people's diabetes camps. And back in the day, I mean, 20 years ago, I did use very makes a lot of sense, but I was just thinking about that. I was like, what would you do? I get everybody together and we get their bases all straight and get their blood sugar stable, and then we go do a bunch of stuff. And that'd be it.
Anonymous Speaker 49:54
No, this is when everybody was on shots.
Scott Benner 49:56
Yeah, right. Just shooting and Hoping and if you got dizzy ate something
Anonymous Speaker 50:03
that was like a bonding time.
Scott Benner 50:06
I get that, like you're all waiting around to be dizzy. Did it happen to some people more than others? Yeah, were you one of those people? Or were you fairly? Not Not so much. So
Anonymous Speaker 50:21
what cuz I was still trying to figure out what to do. I think they had to test me a lot. Yeah.
Scott Benner 50:27
All right. Okay. Listen, a minute ago, you were like, a split second from your coming out party. And I was like, tell people what you want to know. And you're like, there were juice fairies a diabetes camp. That is not the way I thought you were gonna go? Did you check it out? Or is that the first thing that popped into your head?
Anonymous Speaker 50:44
No, when I was going over this morning, in my head, what I wanted to talk about that was the first thing that I thought was kind of fun,
Scott Benner 50:50
cool. It's definitely fun. But I want you to unburden your soul. Like, I want you to get out of this at the end and be able to walk around and treat your self the way you want to be treated. Because I feels like you want to be one way and you're stopping yourself. Because you don't want people to know. But I mean, you're aware, because I have not hidden it from you. I got a lot of people are going to hear this. So you're good now, like you told people and it's green because as many people here it, probably not one of them will know you. So it's true. Yeah. So you have you get the you get to have the reality of unburdening yourself and telling people without the unpleasant part of your dentists looking at you and going, I didn't know you had diabetes, or you know, something like that. So, I mean, I guess put yourself in that position, somebody is in front of you, and you want them to know, but you don't want them to judge you. What do you want them to know? You said, What do I sorry? You just cut out? No, I'm sorry. What would you want them to know? about you?
Anonymous Speaker 51:58
I think that I'm, it's not my fault. Like, I want them to know that. Because I have bipolar, there's something in my brain that's not working like you would think. And then it wasn't my fault that my pancreas decided to die. Like, I want to be able to express that and explain why I do the things that I do. And it's not my fault, that what I do, yeah. Does that make sense?
Scott Benner 52:26
No, it does. So similar to the idea of, you know, you're afraid if you if you if somebody is afraid if I say I have cancer, someone's gonna think well, what did you do to get it? diabetes? What did you do to get it you? Do you? I hope you understand, and maybe you don't, but my belief is that that reaction from other people is self defense. Like, they don't want it to happen to them, which is an obvious reaction. And the end, because it's nebulous, because there's no reason why you have bipolar, and I don't, or my daughter's thyroid works, not as well as someone else's. There's no reason for that. So the fear when you see it happen to other people is Oh, my gosh, this could just randomly happen to me. I don't want to deal with that feeling. So I have to ascribe a reason why this happen, and then avoid that reason. So you smoke, you have cancer, that's your fault. I don't smoke. I'm never going to get cancer. And then which isn't true, but makes people feel comfortable. Yeah. And, and for you, the most important thing is for people to know, like you didn't make some bad decision that made you bipolar, or, you know, eight, you know, 819 pounds of sugar, like some people just seem to assume that's how diabetes happens. And yeah, and that makes a lot of sense to me. It really does. Because, like, you didn't like smoke some like laced crack or something like that. And like, all of a sudden, you were bipolar. It just happened. Right, right. And even if you did, by the way, I want to say, I've never said this before. If you did smoke crack, and it messed you up, it's still not a good reason to just like, make you feel bad about it later. Like, I mean, it already happened. You don't mean, you didn't hurt anybody but yourself if that's what happened. So I don't know. I definitely understand what you're saying. So what's the fear? What happens to you if they say to you some version of what did you do to yourself to make that happen? If that's what they think, why does that matter to you?
Anonymous Speaker 54:41
Basically, I shut down.
Scott Benner 54:43
Ah, okay. So just the assumption that they think you've done something to cause it kind of pushes you into a different and bad place.
Unknown Speaker 54:54
Yeah. Got it. Okay.
Scott Benner 54:58
So you can't just ignore it. The way I would write, alright. Like, I don't actually care what other people think. I mean, I do in some very specific and important situations, but like in the grand scheme of things, small things that don't matter, your opinion of, you know, my politics, I don't care about you like that kind of thing. Like, you know, if I, my neighbor cuts his lawn in a really specific pattern that makes me think he has a mental illness. And I just sort of go around the perimeter of my house and cut wherever, like, I don't think I've ever cut my lawn the same way twice. I'm just like me, and I got the edge and it means nothing to me. I don't want to wake up And see the lines in the grass. I don't care. I just want the grass to be shorter. But if someone said that to me, like you don't cut your lawn, right? I'd be like, what? Whatever. And then that would be and then I would never think of it again. But that could actually make you go inside and say, I don't cut my lawn right? And you shut down, then how long does? How long does that last for? If you get pushed into that situation?
Anonymous Speaker 56:10
I think it depends on the person.
Scott Benner 56:13
So how much you feel it from them dictates how long you feel badly about it afterwards? So it would mean more coming from your husband or your mother than it would from someone you just met in the store or something like that?
Unknown Speaker 56:28
Yeah. Okay.
Scott Benner 56:31
You alluded earlier that having your mother talk to you about your diabetes was not good for you? How often does is she involved still? How often does she get to say to you, you shouldn't eat that?
Anonymous Speaker 56:47
Only when she comes to visit? Oh, well, we ever since COVID, we've been talking or playing a game called trickster online. So we're able to play cards with with them in Colorado, because we're in South Carolina. And she doesn't really get to say what I eat until she gets here. And then my anxiety is going up because of her visit. And then my blood sugar's way out of whack.
Scott Benner 57:17
And just saying to her, Mom, I need you very I need you not to comment on my food. Why? And I don't want to see any side eye or stinky face or anything like that, when you see me do anything, because it really is bad for me. That wouldn't stop her from doing it.
Anonymous Speaker 57:33
I don't know what happened because I've never tried it.
Scott Benner 57:36
This is while we're playing trickster, we start we start talking about this a little bit. Or maybe you just have to. I mean, I assume the obvious answer is you need to call her on the phone and say, hey, look, there's no way you would ever know this. And I'm certainly don't want you to feel badly about it. Although I imagine you might. But please try not to for long. This is got an impact on me, I really need for this not to happen, you know, very matter of factly. Like, this is what happens. This is how it makes me feel. Can you please not do that? I know you have an understanding of diabetes that's a couple of decades old. And I appreciate everything you did for me back then. But the way people manage is really different now. And so when you tell me not to eat something or judge it, it's really hard for me, I really need you not to do that. Would that not put an end to it? Do you think
Anonymous Speaker 58:32
wide open would open our eyes to how she's been acting and that she's is living in the 1990s rather than in the 2020?
Unknown Speaker 58:46
range? feel bad, but a long time later. Right?
Anonymous Speaker 58:51
Yeah, don't. But that's why I want her to listen to your episode. And then we can talk about it afterwards. And I can like you, you know, I've kind of been feeling like when you come here I'm attacked. And that's not healthy for either one of us.
Scott Benner 59:09
Yeah. Well, you know, normal situation. By the way, it's not healthy for either one of you. But you have an extra layer with the bipolar. By the way, why could it not get a better name than bipolar? Maybe it's
Anonymous Speaker 59:21
exactly what used to be called manic depressive. manic depression.
Unknown Speaker 59:25
That's not it either.
Anonymous Speaker 59:27
No, that's not
Scott Benner 59:28
what's the name of that elephant in that Pixar movie? Maybe they should just pick like a random word. You know, Billy, and then just go you know, Billy, oh gal upset. And then I think it would be nicer anyway. We are not having a contest to rename bipolar disorder here on the podcast. Well, I hope that helps. I hope that um, that letting me basically let me do the heavy lifting part and then you come in and say, Hey, you heard that like, please don't do that anymore. Yeah, well, if she ever Listen to this like, Mom, you know, ease up. It's not that big of a deal. Like just she's doing something you don't understand and, and people don't. She's not using that old what we're using back there regular and mph mph. Yeah. Your daughter's using this fast acting insulin now it works so much differently. You don't have to do things the way you used to. And you can still get really great outcomes. And and you know, reduce variability. Are you going to CGM. Now surely I'd like you to have a CGM. But do you think it would make you nervous or upset?
Anonymous Speaker 1:00:41
No, I did try it probably in the pre stages. And I couldn't figure out how to make it. Oh, it wouldn't beep when I would become an arranger, because I was, I probably should have learned more about it before I put it on. But it would wake me up in the middle of night and he get mad. So I got so frustrated with that I even donated all the supplies back to my endocrinologist. But I I do feel like I've had it for long enough that I can tell when I'm higher low and I just have to test to confirm it.
Scott Benner 1:01:17
Okay, two things. Did we just assign the pronoun heat to bipolar? Or were we talking about your husband, he would get mad
Unknown Speaker 1:01:25
husband, okay.
Scott Benner 1:01:26
It's like maybe we're renaming bipolar right now. Just calling him. And that's not how that's gonna work like you. So you don't stop it from beeping, by learning how to turn the beeping off. You stop it from beeping by learning how to use your insulin. So you don't leave the range. Right? Yeah. But you didn't have the time like so you basically threw it on before you knew how you were going to use it. And then that starts beeping all night long. And I will say this, and I mean this with love. How you feel is not important to what your blood sugar is. If if people could just know what their blood sugar was by how they feel, then that's what everyone would do. And no one would be wearing a CGM. But the truth is, is if you put a CGM on and you can start looking at how different foods impact your blood sugar's you can start making different decisions about when the insulin goes in and stop those spikes and those falls. I know you haven't listened to the podcast that long, but if you ever feel like digging into the pro tip episodes, it was it'll walk you through all that stuff. And CGM work. I mean, I don't know how long ago you tried it the first time? Which one? Did you try it? Was it the Medtronic back then? Or was it the Dexcom? Like, seven plus, which one did you have? Do you remember?
Anonymous Speaker 1:02:44
I think, yeah, cuz I was on a mini med pump.
Scott Benner 1:02:47
So you had the Medtronic one. It is widely accepted that that Soc. So so now that Now Dexcom has something called the G six, or the g7 should be out pretty soon. There's another company called libri. That does like a flash CGM where you like hold your phone up to the thing and it gives you your blood sugar so you can see it more frequently. There's a lot of different ways to do this, where you could really kind of like manage your stability. And not I would tell you that I think that most most days, my daughter's blood sugar does not go over 140 even with food. And a major mess up would be 180.
Unknown Speaker 1:03:36
Wow. I used to have to calibrate it.
Scott Benner 1:03:39
Not anymore.
Unknown Speaker 1:03:41
Oh, wow.
Unknown Speaker 1:03:41
I mean, that was huge.
Scott Benner 1:03:42
Yeah, the caliber it used to be had to calibrate like every number of hours or something like that. g six does not require calibration. I have found sometimes at the end of a sensor, it you know, it starts to get a little wonky, then it might need a little help to get you to the last day, but it's fascinating. I'm looking at her last 24 hours now. And actually to go to our last 12 hours. Arden's blood sugar has been between 112 and 71 for the last 12 hours. And over, over 24 hours, there's Chinese food in there.
Unknown Speaker 1:04:22
Oh, wow.
Scott Benner 1:04:23
On a pump after a pump change, so her pump ran out of insulin, right. And we changed it and ate Chinese food in the same 20 minutes. 169 was our highest blood sugar. Wow, it only lasted for about 30 minutes before we got back to 118. So I think you can do that. I think anybody can do that. be perfectly honest with you. And I do wonder how much better you'd feel. If you cut some like spy And variability out of your life. Like maybe maybe you could maybe you could take some of the, you know, the thinking you have to do around diabetes and lessen it over time. Like I'm not saying you would learn in a day. But if you gave yourself time to absorb the ideas, listen through the episodes, got a CGM, I'd say six months later, you'd be in a better place. And you wouldn't have to rush yourself in that. Do you have the the my real question is do you have the ability to do something like that without letting it overwhelm you? Or do you? Can you do that?
Anonymous Speaker 1:05:37
If I take small steps?
Unknown Speaker 1:05:39
Yeah, you should.
Scott Benner 1:05:42
I mean, you should pick something. Tell your mom. Get a CGM. Do one of those things. Seriously, right outside your house right now. yell out loud. I have diabetes and bipolar disorder. Okay. By the way,
Unknown Speaker 1:05:58
if anybody's listening, well, that's
Scott Benner 1:05:59
perfect. Then you get the freedom of feeling like you did it. No one knows. So you said something earlier that I just have to ask about you said you. You were pregnant. Like how many children? do you have?
Anonymous Speaker 1:06:11
Just one, one of them?
Scott Benner 1:06:12
How weird is it to make a decision to have a baby when you have bipolar?
Anonymous Speaker 1:06:18
Well, when I was pregnant, it was under pretty good control.
Unknown Speaker 1:06:21
Okay.
Anonymous Speaker 1:06:23
I don't even remember it. She's 12. So it's been a little while. I was vegetarian at the time working in on the pump. So I would have to go to see the endocrinologist every week, every other week. And then the times in between those I went to get ultrasounds to make sure that she was okay. And diabetics typically have bigger babies. So she was nine pounds, nine ounces. And she was one day shorter being three weeks early.
Unknown Speaker 1:06:52
So
Anonymous Speaker 1:06:55
that's my pregnancy in a nutshell. Can
Scott Benner 1:06:57
you take the meds for the bipolar while you're pregnant? See, that's
Anonymous Speaker 1:07:00
what I was wondering. I think I had to lessen or I didn't have to have any at all.
Scott Benner 1:07:06
You had to for the baby. Yes, gotcha. But it's so longer you don't really remember the whole thing like,
Anonymous Speaker 1:07:14
this is not that long.
Scott Benner 1:07:15
Are you kidding me? What would you give to me? 12 years younger? I mean, I don't think I'd murder a stranger. But I think there are some things I would do to be 12 years younger, like, I think you can pretty much get me to probably like commit a small crime. I think 12 years is a lot I would take it. But there's no fear about like, even just like, did you think about what if I have a baby that ends up having type one diabetes? Was that a concern? Yes. Okay.
Anonymous Speaker 1:07:47
She's actually had the antibodies test and she passed it. So it it supposed to predict whether she has antibodies in the next five years to develop type one.
Scott Benner 1:07:59
Does she have What does she have any of the anybody's if there's like five they test for?
Unknown Speaker 1:08:04
Nope. Oh, that's lovely. She's good to go.
Scott Benner 1:08:07
Excellent. And do you worry about the bipolar thing? Like do you owe yourself like, try not to stress her and things like that?
Anonymous Speaker 1:08:16
Right. And try not to call attention to it. Anything if I start seeing symptoms in her I don't want to make her even more self conscious. Yeah, right. She's, she's in middle school and wants to fit in. Yeah.
Scott Benner 1:08:30
And aren't there certain ages? That bipolar rears more than others? preteen teen like 1314 and then college age, right? Aren't those the two? I think I think it seems to come it's more specific ages. But I don't know if you've ever heard that or not?
Anonymous Speaker 1:08:50
No, I have.
Unknown Speaker 1:08:51
You have?
Scott Benner 1:08:55
Yeah, I mean, that would I just I think in general. I feel like that all the time. Like with the kids. I'm like, oh, if you can just get them past this age right here where this stuff usually happens. And then this you don't I mean, like you always just sort of feel like, I mean, while it's nothing you can you really can't control anything, right? Like what are you going to do just not be stressed out your entire life? Yeah, doesn't seem reasonable. The average age of onset is about 25. But it can occur in the teens were more uncommonly in childhood. Okay. So, you talked a lot about mania, but do you get depressed?
Unknown Speaker 1:09:33
No. You
Scott Benner 1:09:35
get more on the manic side but you don't ever get depressed. That's interesting. So is that definitely bipolar.
Anonymous Speaker 1:09:44
I don't even know if it's should be considered bipolar because bipolar obviously with the by it's the depression and the the mania or the anxiety. And you could also be rapid cycling. So you could have both but No, not really.
Scott Benner 1:10:01
Alright, I'm googling mania without depression. Okay, I'm gonna second.
Anonymous Speaker 1:10:06
I'm curious to know what it is to.
Scott Benner 1:10:08
You shouldn't go to all this stuff but I will Don't worry about there are lows minutes depressed. Wait, what's bipolar two? bipolar two involves a major depressive episode. Well, it's not you mean he is.
Anonymous Speaker 1:10:29
Bipolar two usually doesn't have psychosis. But
Scott Benner 1:10:32
do you think that's from the medication?
Anonymous Speaker 1:10:37
For type one,
Unknown Speaker 1:10:39
or type two? No. Do
Scott Benner 1:10:40
you think the psychosis came from that medication? Or do you have that with or without the medication?
Anonymous Speaker 1:10:45
When I was first diagnosed it, I had no medication. Right.
Scott Benner 1:10:49
Oh, okay. And that was what was happening. Yeah. So you there's so many different like, so self centered concerns and attitudes inflated self esteem, grandiose ideas. Do you have any of that?
Anonymous Speaker 1:11:03
grandiose ideas? Yes. Okay. Like you feel like you can take on the world and you, I can do all these projects in the house. And I'm like, I'm going to clean my closet and give everything away. And I'm going to clean every room in this house. So it's like speaking spans, so people can come over and visit and usually I don't finish the projects. Like in my mind, I'm like, Oh, yeah, it's gonna happen. But then I get distracted. You're very swell.
Scott Benner 1:11:29
You're so sweet. Like you thought of grandiose ideas is cleaning the house not like I think I can fly like nothing like heightened levels of energy, decreased need for sleep. Increased physical activity, feeling jumpy. any of that. Yeah, all the above. Okay. Rapid abstract speech. Excessive talkativeness. talkativeness. Frequent interruptions.
Unknown Speaker 1:11:50
Yes.
Scott Benner 1:11:52
You're not doing that today.
Anonymous Speaker 1:11:54
But I am random today.
Scott Benner 1:11:56
No, I am, too. It's not very helpful. Plus, I didn't like whoa, hold on. We'll talk about that in a second. racing thoughts, abrupt changes of mind frequent shifts in topic?
Anonymous Speaker 1:12:06
Yes. randomness. When it first starts happening. And my husband tells me afterwards, we'll be at dinner. And sometimes I make like they'll be talking about spaghetti and all of a sudden I'm like, oh, what about meatloaf and it completely Besides its food? It just completely blindsides everybody.
Unknown Speaker 1:12:26
You keyword it,
Anonymous Speaker 1:12:27
I didn't see that bridge
Scott Benner 1:12:29
you keyword jumpers that even more random than that, like, I know.
Unknown Speaker 1:12:33
It's topics.
Scott Benner 1:12:35
Like I know somebody like you could be talking about the fall of the Roman Empire. And and at some point in that conversation, like someone could just say, it was it was there were blue skies that day, and they're like, we should go on vacation. Like Like, right, like that. Okay.
Anonymous Speaker 1:12:51
Right. But in my mind, it makes sense.
Scott Benner 1:12:54
Yeah, well, why not your blue skies. Hyper focus on non essential tasks excessive and idealistic planning for future conduct? restlessness, motor agitation, like, I guess your limbs. Not so much. Not so much impulsive decision making poor judgment, reckless behavior, what's the most expensive thing you've ever bought? That you shouldn't have bought.
Anonymous Speaker 1:13:21
Um, I went to my eye doctor and had gotten my eyes dilated. And I told my husband that I was going to go to Costco and get like those really cheap glasses, like reading glasses, or universe caption but get the frames that are really cheap. And I went to the I looked in the Yellow Pages and found an ophthalmologist and went to see them. But $600 frames are with my glasses. He was not happy.
Scott Benner 1:13:52
You really are delightful. Like your biggest like, even with bipolar disorder. Your biggest spending spree was a $600 pair of glasses. Yeah, is that you didn't buy a car or person like you didn't like nothing crazy, right? You didn't like you didn't get involved in like human trafficking. Like you just just bought a pair of glasses. See your I think it's possible. This isn't as bad as you think it is. No, but seriously, it's it's very, I think, I think quite obviously the medications working like if you didn't have this medication, you'd you'd be out like yacht shopping or something like that. Oh, yeah. Yeah. Okay. So well, that's good. That's really great. Your husband's not independently wealthy or anything like that.
Unknown Speaker 1:14:39
No, no.
Scott Benner 1:14:42
worries. doesn't tell you. A giant pile of money somewhere. He's like, Oh, we can't tell.
Unknown Speaker 1:14:50
So take it go.
Unknown Speaker 1:14:52
Oh my god show by so many parents.
Unknown Speaker 1:14:57
are like by the glasses by the sunglasses.
Scott Benner 1:15:00
I thought for sure you're gonna tell me like you got laser eye surgery or something like that. Like you're like I, you know, decided screw this I'm getting my lenses reshaped. They're doing that now. Did you know that there? It's sort of some version of like the cataract procedure, but it's for nearsightedness, so you don't need reading glasses anymore?
Unknown Speaker 1:15:19
Wow.
Scott Benner 1:15:20
I'll tell you, I might do that. I hate that. As I get older my visions. Like that's one of the things that bothers me more than anything else. It's just like me complaining to you.
Unknown Speaker 1:15:32
I can't read close up. Here's like my pancreas. Working.
Unknown Speaker 1:15:41
Sorry.
Scott Benner 1:15:45
Oh, my gosh, you are really lovely, by the way. Oh, thanks. Yeah. What was the concern about not knowing what we were going to talk about? While we were talking? How did that make you feel?
Anonymous Speaker 1:15:58
anxious. Well, excited and nervous. Also,
Scott Benner 1:16:02
did it end up mattering? where an hour and 15 minutes into this didn't matter? Oh,
Anonymous Speaker 1:16:07
my goodness. Seriously?
Scott Benner 1:16:09
Yeah. Did it end up mattering to you? No, no. Is that a lesson that you can do? Is that a lesson you can take with you? Or will it not work that way?
Anonymous Speaker 1:16:19
No, it's definitely a lesson.
Scott Benner 1:16:21
Yeah. I there's a handful of people and I don't remember them by name anymore. But it's fascinating like, because I'm very loose about how I booked the show. Like, there's, there's certain little protocols you kind of jumped through. And then once you've done that, you have to pick a time to record that significantly in the future. Now, you didn't have to do that. Because I've learned that people who have depression, or anxiety or mania, that kind of stuff, it's not good to put something too far off in the future for them. Like for the same reason, I'll put your episode up sooner, I will not make you wait six months for this to come out. Because it'll kill you. Like I've learned that. It's so I know out of kindness to you, this needs to go up pretty soon, right? You need a little time to think about it. And then it needs to appear. But for most people, most people have to like there are it's February right now. Actually, my son's birthday today. And oh, well, happy birthday to him, I will definitely tell them that. And I can tell you that I can scroll forward. There is someone booked to record this show as far out as the latest one I have right now is a woman named Leanne who's recording on November 2 2021. And there are so many recordings between now and that date, like well set up. And then so you have to want to be on the show because you have to book something out in the future then. And then I do very little to make sure that you're here. There's like I think two automated emails you get right, like one the day before and something. And then, but do you know that I've never turned this thing on and the person's not been there. They're always here. And that's how I make sure that I get people who really want to be on the podcast. Right. But that process did not work for you at all, and has not worked for a handful of people in the past. And I've learned to like accommodate that. But the problem is, I don't know what I'm going to talk to you about. And so I can't give you questions ahead of time. That makes me feel terrible. But I felt like you handled it. Okay. But I probably had to reassure you four to four times you think
Unknown Speaker 1:18:37
at least
Scott Benner 1:18:38
Yeah, we were married there for a minute. I was like, hold on let me help. But, but you never got to to work. Like you were worried. But it seemed like every time I I explained it to you were okay again. Was I reading that writer? Were you not okay.
Unknown Speaker 1:18:57
No, you were reading it right. I just need to be reassured.
Scott Benner 1:19:00
That's what I thought. Yeah, like, it's gonna be fine. Don't worry, it's gonna be great. You're gonna be great. I'm not gonna ask anything you don't know the answer to. And you even before we started, excuse me, you said like if I asked, like, if you ask something that I don't want to answer, what should I say that I come close to asking you something you didn't want to answer. Can you hold on a second? I apologize. What's a question? I don't know if this is the right thing to ask or not. But what question Could I have asked you that you would have said no, I'm not going to answer that.
Um, it does one come to mind without even telling me.
Anonymous Speaker 1:19:51
Um, maybe the fact that I've been hospitalized because it's such a stigma that in Till now, I don't like to talk about it.
Scott Benner 1:20:03
Interesting because the craziest thing I thought of asking you that I didn't ask you was Has this ever led to any weird sexual encounters that you regret? that literally is one of the questions I had.
Anonymous Speaker 1:20:16
That was one of the symptoms of bipolar Taiwan, right?
Scott Benner 1:20:19
I don't know. I'm just I just been like, since you emailed me months ago. I'm like, I wonder if they just run around banging people before they know about the medication and stuff. Does that but I don't want to ask like that. Because well, seems rude. But that's that's one. You don't have to answer by the way, but like, that's one of unless you want to
Anonymous Speaker 1:20:38
know, I can answer. It's not that's not the case.
Scott Benner 1:20:41
Didn't happen for you like that. No. Does it happen to some people?
Unknown Speaker 1:20:45
Oh, yeah. Yeah.
Scott Benner 1:20:47
Everything's just bang, bang time. Right, just based and that's the impulsiveness. And I would imagine there's impulsiveness involved feels like there's probably that whole like intensity and love. And like all that stuff probably gets mishmash together.
Anonymous Speaker 1:21:04
That's no conscience.
Scott Benner 1:21:05
Yeah. So it's just you don't have to worry that you don't know the person or anything like that. But that hasn't happened to you. does it impact your personal sex life?
Unknown Speaker 1:21:18
Stop
Scott Benner 1:21:18
jealousy. We found one I knew I could be if I tried hard enough. So yeah, you don't I that's, that's, that's all I was saying earlier. Like, just say, Don't ask me that. So now, how do you like knowing you're not going to have to answer that question? Does it still make you uncomfortable that it was asked? Yes. Gotcha. Did I ruin something? Like, Did I ruin your day? By asking that or? No?
Unknown Speaker 1:21:44
I'll get over it.
Scott Benner 1:21:46
But it sticks with you for a second. Gotcha. Does it like? Is it like being excited or scared? Does it feel like somebody walked up behind you and said, boo? Or is it deeper than that?
Unknown Speaker 1:21:57
Think it's deeper? Yeah,
Scott Benner 1:21:59
that's really interesting. I appreciate you sharing this, because there's no way for me or other people to know about any of that. And the only way is going to be if people like you are willing to tell stories and answer questions and tell other people how they feel. Because there's no way for me to like I've had people ask me questions that I didn't want to answer. And, you know, eight seconds later, that experience is over for me. It's really something I'm sorry, by the way that this happened to you because it is really random. And you obviously didn't do anything to cause any of this. just bad luck, right? Is that how you want to think of it? What guide I'm sorry to mean to stop you.
Anonymous Speaker 1:22:44
I don't remember as in say, maybe that's a symptom of my medication.
Scott Benner 1:22:52
Seriously, it's just the thing that happens when you get to 40. I had a little glitch here. And then we had to stop for a second. But we were just really kind of up on it. And I wanted to, I wanted to thank you for doing this and see if there's anything left that we didn't talk about that you wanted to talk about.
Anonymous Speaker 1:23:11
When I was reviewing in my mind what I think I wanted to talk about, um, you had mentioned that asked me if I become depressed? And I said no. And it's usually because the little things in my life. Like I love wearing fun earrings, and I love wearing fun socks. And like my socks right now have little mice and cheese on them. So I think that's kind of puts my mind in perspective to not be depressed.
Scott Benner 1:23:40
So you have like, just little like things around you that that help you stay kind of focused on happy stuff. Is that fair?
Anonymous Speaker 1:23:48
Yeah. Yeah, pictures and good movies. And
Scott Benner 1:23:52
that's excellent. I that so that that's a part of your process for for living? Well. That's excellent. That and how did you figure that out?
Anonymous Speaker 1:24:06
Like, well, I was. I don't know about the Sox. I feel like that's always happened. But after I got my ears pierced at 10 it was just fun exchanging them and being like, okay, it's Halloween. So I'm going to put a jack o' lantern on my ears and it's gonna be Fourth of July. So I'm gonna put on red, white and blue and stuff like that.
Scott Benner 1:24:27
Just a happy memory from when you were a little.
Anonymous Speaker 1:24:30
Well, that's my golden birthday. Because I was born on the 10th of the month.
Scott Benner 1:24:35
Your golden birthday. I don't know what that means. Tell me what that means.
Anonymous Speaker 1:24:39
Well, whatever day you were born, like the number day, it's your golden birthday when you turn that age.
Scott Benner 1:24:45
Oh, so if I'm born in the 10th when I turned 10 years old. Yes. I think I've never heard that before my life.
Unknown Speaker 1:24:52
Did I make it up?
Scott Benner 1:24:53
I don't know if he made it up. But I totally missed my golden birthday when I was 12. I wish someone would have said something At least had to have been worth an extra gift. And now I got nothing out of it 24 maybe I can, I already missed my 48th I'm gonna have to wait forever for the next time for it to come around. Alright, I got this I got screwed. I I never know why people in situations similar to yours want to do this. But I'm always very grateful that they do. I think that for you this hour and a half will be one thing. And I think for people listening, it'll be something completely different. And so I wanted to share with you something that a listener shared with me recently, they said that they've learned so much about the world listening to the podcast beyond type one diabetes, because so many different people come on and tell stories that aren't, you know, specifically connected to type one all the time. And, and they thought they said that, you know, it's just, they never thought they would learn something about, you know, I, you know, I forget what the example was back then. But they learned something completely disconnected from diabetes from the show. And I think that you sharing this will help somebody else understand how you feel, and maybe that'll maybe that'll move people's opinions in a certain direction. So that one day someone in your position won't have to worry that, you know, a person will believe that they broke themselves or, you know, did something on purpose or, you know, by being just not careful and led to something like diabetes are order bipolar. So, I think you did that I think you definitely explained to so your, your you spoke to me for the last hour and a half. And I have to tell you, and I I don't know if you would believe this, but if you didn't tell me you had bipolar disorder, we could have just talked about diabetes, and I would have known. Well, that makes me feel good. I'm just gonna say, Are you aware of that? Or do you think that the minute you open your mouth, people are looking at you going there's something wrong?
Unknown Speaker 1:27:05
Um,
Anonymous Speaker 1:27:10
I don't know how to answer that. That's okay. Because it might be both.
Scott Benner 1:27:15
Well, okay, that's fair. But from my perspective, it's not. And I talked to a lot of people, a lot of people. So you don't, you don't make me think like, Oh, I wonder what else is going on here? You know what I mean? Like, it just doesn't, it doesn't seem like you're a person who's got some deep, dark secrets that they're hiding. You seem very real and honest. And then, yeah, you're lovely. You just seem nice. Cheers. Thank you. You're welcome. Plus, you said he threw you threw me off in the beginning, because you said Barbara Davis. But then you said bless their heart in like the same five seconds. How'd she get from the south to Colorado? And then I didn't want to get I didn't want to get sidetracked. So I didn't ask you. But But no, you honestly, if you think that people are looking at you thinking something's out of your out of line? I mean, I can't see you. But from talking to you, I have no, like, if you're wearing like a tinfoil hat, then maybe. Maybe you're not are you?
Unknown Speaker 1:28:20
No. Okay.
Unknown Speaker 1:28:24
I think you're okay.
Scott Benner 1:28:28
Can I ask you one last question before we stop? Yes, sir. Do you have any idea of how it feels for your daughter? To have a parent who has bipolar? Like, what's her? What's Is there a change to her life because of that or not particularly?
Anonymous Speaker 1:28:45
She definitely is her personality being an only child that she likes to be bossy. And when I would go through that confusion state, she would always say that she flips being a child to being an adult and to take care of me. So that's her, and she's very proud of it. She'll tell anybody. She's like, I gotta take care of my mom. She needs my help right now.
Scott Benner 1:29:12
Probably like being a lion tamer in those moments. Sharon a whip, right? She's like, I'm trying to keep her from buying glasses and a big bag of Parmesan cheese.
Anonymous Speaker 1:29:25
Well, she's just as bad as me when we go to the store.
Scott Benner 1:29:29
Well, listen, everybody loves to go shopping. I don't know. I think that there'd be a great game show or a reality show where we just take you off your medicine from it and give you $1,000 and see what happens.
Unknown Speaker 1:29:40
Oh, my.
Scott Benner 1:29:42
I feel like he would just buy bulk food. Oh my god at least promised me that the next time you lose it and go do something like that you pie something fun. Get yourself some air pods or something? I don't know. Oh my god. Alright, let's Let me say goodbye. And thank you very much for doing this.
Well, I want to thank you very much for being on the podcast today and opening up about her life with Type One Diabetes, or thyroid issues. And her bipolar disorder. Not only did we hear a real vibrant, lovely person, we have a better understanding now of bipolar. We heard it from a person who has a wonderful sense of humor, and a great sense of purpose. coming on the show to share these things cannot be easy. I really appreciate it when people do it. Thank you. Thank you very much. I won't say your name. Because I don't wanna have to bleep myself again. But I really appreciate you doing the show. You know what else I appreciate it, appreciate Dexcom on the pod and touched by type one. In fact, thank you to all the sponsors of the podcast for supporting this kind of content. Find out more about the Dexcom g6 continuous glucose monitor dexcom.com/juicebox. See if you're eligible for that free 30 day trial the Omni pod dash tubeless insulin pump at Omnipod.com/juicebox and of course, the greatest things in the world seem to happen at touched by type one.org. There are links in the show notes of your podcast player links at JuiceboxPodcast.com where you can just type those addresses into any internet browser. I'd also like to thank you for listening today for supporting and sharing the show and for leaving those amazing reviews. Wherever you listen. If you have a story that you think would be great on the Juicebox Podcast, either in these after dark series or otherwise, send me an email. I currently have some space available in the last third of 2021 for some recordings, maybe it'll be you.
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#471 Bolusing Insulin for Fat
Learning to bolus insulin for the fat in your food with Michelle from Waltzing the Dragon.
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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 and welcome to Episode 471 of the Juicebox Podcast. Today,
we're gonna talk about bolusing for fat in your food, and it might be easier than you think, to figure out. Michelle is here, from the website waltzing the dragon to try to help us understand. If you're thinking right now Wait, that doesn't make any sense. There are no carbs and fat I only Bolus for carbs. Well, you ever eat pizza and in a weird high Three hours later, french fries, milkshake, anything like that, where you think it's gone, you've handled it But suddenly, two and three hours later, this persistent high. If that's happened to you, you're gonna love this episode. And let's be honest, if you're using insulin, this has happened to you.
We're gonna get started in just a moment. But first, I'd like to remind you that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, please always consult a physician before making any changes to your health care plan are becoming bold with insulin. I'd also like to say right up front, that I've put a link in the show notes and a link at Juicebox Podcast comm to Michelle's website. And that link will take you directly to everything that we've spoken about today. And the way Michelle talks about it on her space. But I think this conversation will be enlightening. And I hope you enjoy it. At the very end of this episode, I will actually read from Michelle site in case the conversational nature of today's show. didn't let you take notes or or kind of walk through things incrementally. So after you hear the whole thing at the very end, I'll walk you through it one more time. Alright, little more music and we'll get started.
This show is sponsored today by the glucagon that my daughter carries g vo cuyp open, Find out more at G Vogue glucagon.com forward slash Juicebox Podcast is also sponsored by the Contour Next One blood glucose meter. You can find out if you're eligible for a free meter, check into contours test trip program. Or while there's a lot more you can do so I can't just list it all but all the information you need about the Contour Next One meter. It's a Contour Next One comm forward slash juice box there's links in your show notes. Links at Juicebox Podcast Comm. Let's talk about bolusing for fat now with Michelle.
Michelle 2:57
My name is Michelle and I am the mom of two kids. Gemma who is 12 just turned 12 and Max who is 13. It's max who has type one diabetes. He was diagnosed at just over a year in 2007. Actually 14 months to the day.
Scott Benner 3:15
Well was how old he was. Wow, that's pretty damn young. Jeez, that was Yeah.
Michelle 3:24
It was tough. I think it's tough at any age. You know, I think they're just different challenges.
Scott Benner 3:29
I agree with that. Yeah, I agree that it's that it would it's not like, Oh, I got lucky. I was diagnosed at 46 perfect age to be like, it's that's not how it is. But but that 14 months thing with a low body weight not being able to communicate well, it's just an end back then. I mean, you didn't even have the ability to to break Bolus down into smaller bits. And
Michelle 3:52
now although he got his first pump at three years old. So that's when things really changed in terms of being able to break it down. But before that, for the first two years, we use diluted insulin to try and get smaller boluses. Like really half as much as you could drop in a syringe. Yeah, I don't know if you did that with Arden. I know she was quite young to where she's two years old.
Scott Benner 4:14
She was Yeah, she was just after her second birthday. What I did was I took expired insulin, squirted it into a dish, added food coloring to it, drew it up into a needle and I would practice pushing the plunger slightly to make a drop come out. I just used the food coloring so I could see the liquid and then kind of think about Okay, this much pressure made a drop come out. And that way when I used insulin for real and the needle was in Arden, I could put that same pressure on.
Unknown Speaker 4:46
Interesting. Yeah,
Scott Benner 4:47
yeah. So it was a it was a good motivator to put weight on her. That's for sure.
Michelle 4:54
We're still trying Max's skinny as a rail. And I'm like, Where can we put these infusion sets? We need some fat No
Scott Benner 4:59
kidding. Oh, Yeah. Well, do you know how you ended up on this podcast today? Um, do you listen enough that
Michelle 5:07
you messaged me? And I responded? Okay, so that's I'm guessing Jenny had something to do with it
Scott Benner 5:12
right? So Jenny and I sat down. So I not, I mean, I can pull the curtain back here a little bit like you people listening here, Jenny, like every couple of weeks on the show or something like that. She is awesome. She's my favorite person. But what, but what I do to make that for everybody is Jenny and I carve out some time. And we power through topics. And I do not tell her what we're going to talk about first.
Unknown Speaker 5:41
So did you say that?
Scott Benner 5:43
Yes. So I said, Okay, like we finished a topic. And I said, Hey, Jenny, Next, I want to talk about how to translate fat into carbs for bolusing. And she goes, I don't think I'm the right person for that. And I said, Oh, okay, that's no problem. And I just put it on my list, like, find somebody else. And she says, Do you know that blog, and then she told me about your blog, which of course, I know, because of the the unique name, but tell people your your, your blog title.
Michelle 6:12
So the website is while it's in the dragon. And it was started in 2011, with another diabetes mom, Danielle, and I started it. Because we realized that when we talk to other parents, we just got the most helpful tips. Like other parents knew how to put the theory into practice. Yeah, they knew what kind of infusion sets worked. They knew you know, how to get around things, like you're talking about, you know, food coloring and making some really small boluses. When you're still using syringes, that's the kind of stuff that we learned from other parents. And we just thought, wouldn't it be awesome if we had a place where the theory and those practical tips existed in one place where I could look up? I don't know, illness management strategies at 2am, or my kids throwing up, and they would be there. I wasn't like shuffling through that jumped or looking for that handout that I got. Yeah. So that's, that's where Walton dragon came from.
Scott Benner 7:11
It's interesting. I don't want to go too far into the weeds here. But it's interesting that you can't just devise one repository, and it exists everywhere. Because that's not how people find out about things don't mean like the, the best movie I've ever seen in my life you may never have seen or ever heard of. And so that other places keep popping up is a is a gift to people because the internet is sort of, it's sort of cyclical, and at the same time, it's bubbled like you're in a sphere, you don't realize it, you're not seeing the whole internet, you're seeing the part of it, you see. So if somebody you know, has a blog like yours, that's great. And it can be frustrating for people listening. I imagine Michelle has felt this before too known how valuable the information you have is, and there's just you can't figure out how to get it to more people. Because you're not in charge of that. It's and I figured that out a long time ago, if the if people don't know immediately to go to the ADA to get information about something right, then that means that the ADA is information isn't so amazing that everyone who's ever seen it runs around telling everybody else about it, right, which is not to denigrate their information. It's just that that's not how it works. It's why you see somebody who's incredibly popular on Instagram today, who 11 months from now, you'll never see again, because everything just keeps going. But I always felt badly about like all this great information that just, you know, just kind of its cycles away. And so the podcast for me is, is an idea of like, how do you bring it alive. So that it It keeps existing and it keeps drawing people in and they keep finding it. So as soon as Jenny said the name of your blog, I was like, I've heard that name a million times. Now I don't read diabetes blogs. And I never have. But that was always a creative decision. I didn't want to, I didn't want to read something you wrote and then find myself saying it not realize that I had heard it from somebody else, right? So I always stayed very kind of insulated around it. But immediately is like, because how can you not remember that name like waltzing the dragon is just so you know, unique. So anyway, I go there, don't please. And there's all that information. And I was like, Okay, I'm gonna send someone an email and ask. And I picked around I think I think I figured out how to get you through Facebook. So I really appreciate you doing this. Because I want to take what you know about this one specific subject and kind of blow it up and leave it here inside of the podcast for other people. So awesome. Yeah. So tell me how you first realized that fat made blood sugar go up.
Michelle 9:52
What would happen is we would go somewhere like McDonald's like we had good control. You know, I wouldn't say it was fantastic. But you know, our overnights for good. We knew how to handle this kind of foods that we made at home. Max was pretty little. So we weren't eating a whole lot of high fat food. And then when we started to, like I said, go to McDonald's or have a pizza, we would have these incredibly high persistent highs that I just kept correcting and correcting and correcting and he wasn't coming down. And it was changing. Like, it was frustrating for me. And it was changing our family's lifestyle. Like I felt like diabetes was winning. I felt like okay, we're No, we're not going to go to McDonald's to get fries today, because I don't want to deal with the highlighter. We're not going to have pizza tonight. Because I don't want to deal with being up all night and correcting and correcting and correcting. And that was incredibly frustrating to me. Because we've always lived like diabetes, we have to pay attention to it, but it's not going to control us. And it was definitely controlling our family. So So I went looking for ways that I could cope with that. And within a couple of weeks of each other two different people brought up this idea of bolusing for protein and fat. Shannon, who was one of the CDs, one of the nurses at the Alberta Children's Hospital diabetes clinic, which is where Max is seen. And also Lorraine Anderson, who is a registered dietitian here in Canada, she worked for at the time animus was my son's pump company. And so I had had contact with her over that. They both brought up this idea of both protein and fat, which we had never done. But it seemed perfect. And it seemed almost divine that they were both talking about at a time when I really needed to hear it. Yeah. So we started experimenting, as a family. And just to back up, I guess that's, you know, I remember talking at a conference and people said, Well, wait a sec, you know, I guess I should start bolusing for fat because we've never done that. And you through the conversation, it came to be that they didn't really have post meal highs due to fat or protein. So So I was like, well, then you don't if it ain't broke, don't fix it. I mean, you don't, you don't need to do this unless you're seeing this pattern. That is one aspect of of diabetes management that you would like to address. But many people I mean, if you eat the same amount of protein, and most meals, or the same amount of fat in most meals, then you don't need to do anything different. Your insulin to carb ratios and your Basal rates after that are probably covering it just fine. I think the problem for us as a family was that we tend to eat low fat, but we didn't binge very often on things like pizza or, you know, burgers and fries at McDonald's. And so when we did I could really see the difference. Yeah.
Scott Benner 12:54
Well, almost divinely. Yesterday, Arden had a five guys double cheeseburger with bacon, french fries, and a milkshake. So she took her SAP, and she came out of the SAP and she's like, I want some food. And I was like, okay, actually, she took a sap prep class and the guy said, when she's done, she's gonna want to eat and take a nap. And I was like, Oh, you don't know Arden right? Like she won't boom, she ate this food, walked upstairs and fell asleep.
Unknown Speaker 13:25
seen a few of these kids,
Scott Benner 13:26
he's aware of what was gonna happen, but what I knew for certain was much like you are not gonna have a cheeseburger every day. Right? It's not going to be a meal like that every day. So now we have these fries. That are potatoes, which we know are difficult to Bolus for soaked in peanut oil. There is the protein in the burger plus the fat in the burger. There's cheese, there's bacon, then there's bread. And then she has a it's a milkshake. A real milkshake like real ice cream, you know? No, she actually says
Michelle 13:55
not ice milk. But ice cream.
Scott Benner 13:57
Can I get an ice cream? Can I get a milkshake with Oreo pieces and Oreo cream? So they put the ice cream in and then they scoop in chunks of Oreos and extra cream. Right? So what that tells me in my head, the way I think about it is, is that the the range of time that this meal is going to impact her in my mind goes right up to about five or six hours. Like that's how I first think about it. And then and then I just dump in as much insulin upfront, as I think she can handle. And then any indication that there's going to be arise gets re attacked along the way. The problem is when people are saying, Well how do i Bolus for fat and protein? That's not a real, you know, that's more of a here's what I do. You can try to see if it works for you. Do you have more of a formula for something like that? Absolutely.
Michelle 14:50
It's not my formula. No, but let me back up because you know, I've heard you talk about how you do like a Temp Basal, to deal with those sort of rises that come from food and we tried that. Danielle, the other original co founder of waltzing the dragon. That's what she did with her son, right? If she would set a Temp Basal after the meal for, you know, whatever, and her gut said was the right amount, and she had done all this experimentation. But when I tried it, it was an abysmal failure. Okay, like, I tend to be very systematic Anyway, I'm not a, I'm not a kind of a, you know, let's see what this does. I want I want to have something concrete, you and I are probably the Yin to the other's Yang. But in any case, we tried it a couple of times, and it just didn't work. Either he bottomed out, or he was still super high later. And I thought I do not have the mental energy that it's going to take to experiment with these rates and ratios. And, and, you know, pull numbers out of the air for the next two years until we get it right. I just don't, right. And so what both Shannon and Lorraine had brought to me was what's called the Warsaw school program. in Eastern Europe, they Bolus for carbs just like we do here in North America. But there's also a more of a practice of bolusing for protein and fat. So they've spent some time figuring out Well, what does that look like? Yeah. And so that was the program that I did more research on. And so what they basically say is that protein is kind of complicated, it protein creates in your body create some insulin, but it also stimulates the release of glucagon, which we know rises, raises blood sugar. And so the effect of it is a, like, if you if all you ate was protein, the effect is a longer rise in blood sugar longer after you eat it. So it might be three to five hours, if all you ate was protein without carbs, it might be three to five hours, you'd give a maybe an extended Bolus or a Temp Basal. I don't know, maybe three hours, I think Jenny said something like 50%, I'm trying to remember she had a great way of looking at it. You do that after the meal, and then it covers that slow rise of protein. So that's part of what they talk about. Then they also talk about the effect of fat, which is not at all unpredictable, that raises blood sugar. And the reason is you get insulin resistance, you've got fat in your bloodstream, that makes your insulin less efficient. But you've also got that fat is harder to break down. So it takes longer to digest. So what we found with Max was that when he would eat a high protein slash high fat meal, he would go low first, and then he'd be sorted me high. And the reason was, if we gave all of that Bolus up front, so let's say he had cheeseburger and fries. And that would be think like, maybe at that age, it was like the McDonald's Happy Meal. So it might have been like, I don't know, 3640 grams of carbs for the fries. And then the burger might have been another 20. So we're talking about, let's say 60 grams of carbs. And with that would come maybe 3040 grams of fat, I'll say 30 at that age. So we would give the Bolus for the 60 grams of carbs, which you would think okay, that's great. If he just eaten the bun and potatoes that weren't, as you say, soaked in peanut oil, then that Bolus up front would have covered that. And everything would be great if we do the correct timing to the insulin and all that. But what's happening is because there's such a high fat content, it's digesting more slowly. So that initial Bolus is all getting in before all the food gets in. So he'd go low first, which of course we would correct. And then that correction would add to his high blood sugar later, right. So then we were fighting both
Scott Benner 19:02
because it's so incredibly difficult to say to yourself, oh, I've gotten the meal and so on ahead of the impact of the meal. Now I'm going to correct with food. I actually have to Bolus the correction right now that is the hard right leap to make in your mind. But
Michelle 19:15
I have to Bolus that correction with an extended Bolus. Or perhaps if you're still on injections with like a split Bolus because I need it because if I Bolus it now, he may go lower dam. And we've found that that depends on the amount of fat to like, we don't do this. We won't even consider the amount of fat if it's under about 10 to 15 grams. Okay, so under 10 I don't even think about it. 10 to 15 maybe depends what else has been going on in his day hasn't been you know, fighting some highs has been exercising hard. Whatever that I might consider but over 15 we will almost always Bolus for the fat. Yeah. Because that's where we see the impact. Right. So getting back to This Warsaw schools, what they do is they talk about fat protein units. And there's this process that they go through to calculate fat protein units. And I don't know Do you want me to? It's all on Walton, the dragon. I'm looking at it. Do you want me to go through it? Yeah. Okay, Joe, I'm gonna go through it basically.
Scott Benner 20:16
Yeah. I'll just tell people now Oh, geez. Alright, so it's your Canadian. So it's waltzing the dragon.ca. And I'm actually
Michelle 20:25
ta although the.com will get you there, too.
Scott Benner 20:28
okay.com will get me there too. But on this specific page, it's got kind of a long title. So is there a quick way that you can tell people to get through your website to get to what you're
Michelle 20:38
watching the dragon.ca slash fat,
Scott Benner 20:41
slash fat? Okay. I'm doing it to waltzing the dragon.ca forward slash fat. Okay, how fat and protein affect blood glucose? Okay.
Michelle 20:56
So there's two articles, the first one that how fat and protein affect blood glucose, just sort of the introduction, it just talks about the fact that what we just talked about, right protein will raise blood sugar, slowly, fat will make you insulin resistant and give you a resistant high later, okay. And then the second article is how to reduce those spikes. or avoid them might be a better word like, if you if you use the Warsaw formula, then you can you can have a pretty close to flatline, if you you know, sort of tweak it enough for your own personal needs.
Scott Benner 21:33
Yeah, if you actually go through and figure this out. So this, this episode really is for people who want to look at a nutrition label, and say, I want to apply this to that. And I do want to agree with you, before we start, that I don't Bolus for all the fat or needs. I do think, though, that it's an elusive idea to people because I'll take I'll take a very basic example, every once in a while, like once or twice a year, I make my own potato chips. That's how bored I get. Okay, so you start with an amount of I use peanut oil, because it holds a nice steady temperature, right. And however much peanut oil you start with, you make your potato chips, you put your potato chips aside, each one's thin and crispy and doesn't even have a hint of oil on it. But then you go back and look at how much oil has been absorbed by the potatoes. And it's a fascinating amount of oil, right? So if you eat handfuls of these potato chips, you might as well take a cup, fill it with peanut oil, and drink it because what you're doing eating those potato chips, right as an example, or cheeseburger, or you know, all kinds of things like that, that have grease in them have way more grease in them than you imagine. And so, you know, did I know, fat from ice cream plus fat from cheese and fat from beef and oil from French fries and potatoes and bread was gonna crush Arden. It did. And if I told you that based on the carb count of that meal, even though it was an insane car mount, I mean, gosh, by the time you go through the burger, the roll, the roll is the rolls like 25. And then I just throw in five for the burger, because why not and a couple of more for the cheese. And now I'm at 35 and then the fries are probably 50. And now I'm at 85 and the milkshakes probably like 80. And like, in my mind, I'm like it's like 180 carbs, right? And even though you give that insulin for that, it comes back to haunt you like a bad acts. Absolutely. You know, every couple of hours. It's and you're putting in another, you know, oh, it's gonna happen again, here's two or three more years before you know it. You've used by half more insulin than the actual carb count. Kind of would indeed
Michelle 23:51
Oh, absolutely right. And the amount I've found since we've started bolusing, for fat, I found that the amount of insulin we use up front as an extended Bolus is a fraction of what we will have to use to correct it. Right. It's absolutely insane. Like we might add a I don't know, like a three unit extended Bolus. If we you know, do it at the front, if we forget to or when we were learning this, we might have to use like eight or 10 units to get him back down to range. And so the difference is just striking. Right? There's doing it proactively is is a huge benefit.
Scott Benner 24:28
You will being ahead of it. You're using far less than you will if you chase it, and absolutely when you're ahead of it, you most likely won't cause a low later because it's almost like that food, it almost precludes a low from happening. You know, it's almost the it's sort of the antithesis the idea of when people are newly diagnosed, someone will tell you to like oh, give them like a little protein and a fat at bedtime. If you don't want their blood sugar to fall like that kind of note that'll just not but except you're doing it times. Like 30. So, yes, so you're very aggressive. You know, the way I think about it is balancing the impact of the in some, or the impact of the carbs with the action of the insulin, trying to keep everything working at the same time, so that when the foods finally digested and the insulin is finally gone, you don't crash later. But yeah, once you're chasing fat and protein like this, especially high fat, you're just it takes so much more insulin than you could imagine. And your basil rate is nowhere near up to the challenge that you've that you've given it. Absolutely. I'm sorry. I love our conversation, but I'm not letting you get to what you're trying to say. So,
Michelle 25:38
no, that's okay. I just want to back up for a minute because you mentioned a lot of things like if people are curious what sorts of things that we do this for. You've mentioned a lot of them, like we talked about pizza. We've talked about burgers, cheeseburgers, french fries, funny if we have french fries, if we have homemade frozen french fries made in the oven, they don't have enough fat and we don't need to worry about it. But any restaurant we go to those fries will need a fat Bolus. Mass loves nachos lately. So the tortilla chips have fat, which we don't really notice if he had say, tortilla chips and salsa or hummus. But if he has nachos, so he throws all that cheese on top of it, and sometimes even like ground beef on top of that. Absolutely. He'll need a fat Bolus for that. Yeah. Real ice cream.
Scott Benner 26:26
Yeah, go ahead, jump on your Nacho thing. Arden loves kaiso from Moe's which, which might not be all over the countries and everything but it's a it's a restaurant you go into they fried the you know, the tortilla is right there for you. She buys the case. So we throw the chips away. And she uses like a toast Tito's brand like instead. And it by half makes this an easier project for us.
Unknown Speaker 26:53
Absolutely. I
Scott Benner 26:53
don't know how, let me hear I'll say this and to people who really are probably believe in me listening to the podcast, I I can't figure out how to Bolus for most chips for Arden. Like I haven't had the nerve to put in enough insulin yet to those chips in the heat and pretty aggressive. You know, so I'm sorry. And you were gonna say ice cream in a second real ice cream. And and that that's where people's confusion comes in online. Somebody will say, hey, you have to do this for ice cream. And another person will say oh, no, you don't. We don't have to, except there's no context the one person might be actually eating ice cream. And the other person might be buying something out of the freezer section that's 17 chemicals and might actually have very little bridal ice cream in it to begin with. So
Michelle 27:36
right or what we do we have here in Canada a brand called Chapman's, which their frozen yogurt tastes just like ice cream. It's awesome stuff, but it's got a fraction of the fat. So when we're having it at home, I buy Chapman's frozen yogurt because then we don't have to stress about it. McDonald's for example, there softserve is ice milk. It's not ice cream. So if you had a huge one that maybe we might have to but like if we go to Dairy Queen there softserve is ice cream. Right? So it's got a much higher fat content. What peanuts if he has a great big bowl of peanuts, we might have to Bolus fat for that. compared to any other nut like not almonds, not even walnuts. I mean maybe it doesn't eat enough walnuts. But like eats it down with a bowl of peanuts. You know, like salted roasted peanuts. Those we would have to Bolus for sometimes chocolate bars. Again, it depends on how much fat is in them. Do they have things like cocoa butter or coconut oil in the ingredient list will make them kind of perk up? Um, oh, all the meats. pepperoni sticks. You know, if you have like a footlong pepperoni stick, they could have 1418 grams of fat in a single stick. Bacon. Yeah, big Tam. Like if we have ham for supper, probably that will have to be Bolus for and on the idea of pepperoni sticks to like if you can get turkey pepperoni. It's much lower fat. So sometimes we'll do that instead. sausages. Yep. sausages. Absolutely. Yeah, they have probably like the lighter turkey ones even have like three grams of fat per like regular breakfast sausage.
Scott Benner 29:14
Do you know what I do that? doesn't know. I keep Turkey and regular bacon in the house. And if she has pancakes or French toast, I put the turkey bacon with it. And if she has eggs, I put the regular bacon with it. And I don't I don't know that I tell her that I do that. And they're actually now Well, she she won't listen to us. Don't worry, we're good. Yeah, so there are times when she'll specifically say I want to have french toast with regular bacon and I'll go Okay, then Bolus now. And you know, and I don't she doesn't see the difference. And I'll tell she'll be on the show one day and I'll tell her little stuff like that. So she knows but yeah, that that's just the kind of stuff that I think is intuitive for you a person who paid so much attention to this or to me, somebody who talks about it so much that I hard for me to forget Got it even, you know, but for most people, most people are not going to think, oh, there's a higher carb value here with some more fat. I won't pair it with the same fat as I, you know, I just think that's, it's a bridge too far, especially when you're first diagnosed. And in your mind, you're thinking bacon, no carbs. Good. Right. You know, I'm sorry, I keep cutting you off. But you're doing terrific. No, no, that's, that's great. Good. Good. Yeah.
Unknown Speaker 30:26
So what were we talking about? Well, listen, I want to,
Unknown Speaker 30:29
I want to tell you to do about all that. Right, before we
Scott Benner 30:32
get back to the calculation, you're gonna have to thank Michelle in your own mind here, or at least by visiting your website cuz she's got lists in front of her. And I have never sat down and made this podcast without anything written down in front of me ever. She's trying very hard. And I am just over here going like,
Michelle 30:45
Scott, you got to be systematic. That's why this process works for me,
Scott Benner 30:51
I win. That's why I love you being here. Because there are, listen, I think there are a fair amount of people who pick up what I'm putting down, like they used to say, in the 80s. But I think there are also people who hear it, and whose brains work like yours. And they're like, you got to tell me a number or something, you know, and I just don't, I don't know how to do it. I am literally a person who looked at a plate two nights ago, it had chicken and carrots and rice on it. And I looked at it, and nothing was measured. And I just looked at it. And I was like chicken 10 carrots, I don't know, 10 rice looks like 40 do 65 carbs. I literally counted the 60 and then said 65, which even made me wonder why I counted? Like why did I just like, wasn't it just look at and go
Unknown Speaker 31:41
process to get there? Sure.
Scott Benner 31:42
A weird thing. And, and that that's a you know, I do believe that most people can, with most meals get to it. But there's some of these things that we're talking about today that are just, they're just too much, you know,
Michelle 31:56
and just on that idea of looking at a plate, like I think we've had to teach yourself systematically over the last 12 years how to do what you do intuitively. So what I would do is I would measure that whatever pile of strawberries or that, you know, mashed potatoes, or whatever it was French fries, I would I would guesstimate what I thought how many carbs were in it. And then I would measure it and see how far off I was. And then from there, if you do that enough times, now you can start looking at a handful of cantaloupe. You know, a handful of potato chips, you can start looking at that and going, Oh, this is what I think. But I had to get there through very systematic like teaching myself, this is how far off you are right? Next time, guess a little higher, gets a little lower. So I had to get there very systematically, and you do it very intuitively, which I admire. But I would never be able to do with that kind of pull a number out of your bum approach.
Scott Benner 32:54
I imagine that that's my skill. If I put that on my CV, I'd never get a job.
Unknown Speaker 32:59
skill.
Scott Benner 33:00
You were able to figure it out in a way that's quantifiable Trust me, I don't mean, quantify it is to tell people stories about potato chips. get something out of it. Alright, so this.
Michelle 33:12
So just to point out, I didn't figure out how to make it quantifiable. I took a program that already exists. And I applied it to our family. And it worked. Well
Scott Benner 33:20
see that was a huge, you're very, you're very kind to give attribution where it's deserved. And I didn't mean that you've made it up out of thin air. I know. But you still went and found it and put it into practice. Like you could have showed me that at a certain time and Arden's diabetes, and I would have been like I can't read that. That would have been like the end, I've
Michelle 33:37
been told I can complicate things a little bit. Yes, it's my nature to go into it in deep, deep detail. And this is an aside all of the information on the website. So it's it's less of a blog and more like collecting information repository and only because what you do very easily sharing your personal experience does not come as easily to me, I'm much more comfortable sharing the information than I am sharing my life, which is why I kind of have a love hate relationship with social media. But there's a whole other topic for a whole other day. But what we've done on watching the dragon is set things up as beginner, intermediate and advanced articles. And this one is solidly in the advanced. It's like not for the faint of heart because it does look intimidating. But if you follow it through, follow the example through it makes sense.
Scott Benner 34:29
Well, let me tell you that anybody who's made it 34 minutes into this wants it so go ahead and give it to them.
Michelle 34:36
No Holds Barred. Let me tell you what to do that.
Scott Benner 34:48
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Look, if you're the kind of person that's here learning about how to Bolus for fat in your food, then your data is important to you. And that data begins with your blood glucose meter. Are you using a good one? is it accurate? Is it reliable? How do you know you just take the one the doctor gave you or buy the cheapest one at the pharmacy, maybe you should check into the Contour. Next One blood glucose meter. This is the meter that my daughter Arden uses, it is absolutely the most accurate and fundamentally easy to use blood glucose meter that she has ever had. You can find out more about it at Contour Next One forward slash juice box. The Contour Next One blood glucose meter has Second Chance test strips meaning you can touch some blood not get quite enough, go back and get a little more without changing the accuracy of the test or wasting a test trip might not seem like a big deal. But till I get 3am it will be is the light on your meter nice and bright. The one on the Contour. Next One is now allow you to see in low light situations. And the screen is simple and easy to use. And if you'd like you can connect the meter to your phone, they have an app, it'll Connect by Bluetooth. And you can share your data back to your phone and make better sense of it later if you want. But if you don't want to use that app, you don't have to, you can just use the meter, it's absolutely up to you. Go to Contour Next one.com forward slash juicebox. To learn more about the meter, and all the products that you'll find on the site. You know it's possible you'll even be eligible for a free meter. It's possible that the meter and the test trips will be cheaper cash out of your pocket than through your insurance company for other meters. This stuff is mind boggling. My mind is boggled. Before I get you back to Michelle and she talks in depth about how she Bolus is for fat. I'd like to remind you to support the T one D exchange, please go to T one d exchange.org. forward slash juicebox. Take a few minutes to answer some simple questions and make the lives of people living with Type One Diabetes better. If you are a type one who lives in the United States, or the caregiver of a type one who lives in the United States, this is for you. It is super simple to do, you can do it right there and your phone or your laptop. Again, it only takes a few minutes. It's 100%. HIPAA compliant, is 1,000% anonymous. And the answers you give go a long way towards helping people live better with type one. That's all you need to do. When you do that. You're helping those people. And you're supporting the show. T one d exchange.org. forward slash juicebox. Please take a couple of minutes. Alright, you ready for Michelle, she's got a whole system here. She's gonna tell you all about it.
Michelle 38:20
Basically, you start with figuring out how many grams of fat and how many grams of protein are in whatever you were about to eat. So you know, for your, for your cheeseburger, and fries. example, you could go to the company website and see what do they say is the amount of protein and fat in that meal, you could put something at home on a nutrition scale, you could look at the nutritional panel of the packaged food. You could look in a food database, like calorie King has a book or there are all kinds of apps that do it fig we and calorie King and our ones escaping me track three. Anyway, any of these ways. It will tell you the grams of protein and the grams of fat. You add those together. And then you can convert that into units of energy, which is just kilocalories I don't fully understand this except that I know that they've given me a formula, which is to convert the grams of protein into kilocalories I multiply by four. Why I have no idea. Maybe Jenny, as a dietitian has a better idea. I don't know I just take it on faith. To convert the amount of fat into kilocalories you multiply by nine. So let's say the example that I've given on the website is for an ice cream bar covered in chocolate with nuts, real ice cream, as we talked about, it's a Klondike bar, you know, ice cream chocolate covered. So on the nutritional panel, it says there's three grams of protein and 14 grams of fat. So I multiply the three grams and 14 by four, the 14 grams of fat by nine and I Come up with the total kilocalories, which I've got here is 130 830 for
Scott Benner 40:10
the fat, so that's 14 times no
Michelle 40:12
138, for both. So it is 12 kilocalories of protein, and 126 kilo calories from fat. Again, those are just units of energy. Okay? Just think about how much energy your body can take from that. So then you add those two together, you come up with that 138. From there, you calculate the fat protein units, which is just dividing by 100. Again, why I don't know gotcha, the Warsaw school people, no dieticians? No, I just do what they tell me to do. This gives me fat protein units. The reason that this is relevant or why that number is important is because it tells you how long to extend your Bolus. Okay, so they have a handy little chart, that just tells you, if you come up with one fat team protein unit, you extend your Bolus over three hours. If you have four fat teen protein, you fat protein units, you extend your Bolus over eight hours. So they just got this chart that's got 123 and four fat to protein units. I just looked at the chart. And that's what my extended Bolus is. So then we go, we got fat protein units, but how do we figure out how much extra insulin we need? What is the size of this Bolus that we are going to extend. And what they say to do is to multiply by 10, and divide by your insulin to carb ratio for that time of the day. I often don't remember what it is. So for max, like his insulin carb ratios vary from 5.2 to like, 7.5, I just picked six. Because I mean, it's sort of like I'd like to be very precise, because there's so many variables of diabetes that I like to make as many of them a constant as I can, so that there's less variability overall and less, you know, mass in the system. But by just picking six, I sort of acknowledge that there is variability in this, that even if I'm absolutely precise, there's still a different day, it's a different food, it's a different, you know, he's eating different things with the meal, right? So I just picked six, because it can be complicated, and that works for him. But like, when I look back at this example, I was using 15. So when he was younger, his insulin to carb ratio was one to 50. That's a very different thing when he was six than it is now that he's 13. Sure. So that's where the insulin carb ratio does matter on an individual basis, but whether or not you call it six, or 6.5, or seven, probably doesn't change things,
Scott Benner 42:43
a heck of a lot closer than the way it was going to go down
Michelle 42:47
the gas. Right, right. Absolutely. So if you do that, you come up with a number of units. So in this case, if I took that 138, and I divided it, or multiplied it by 10, and divided it by his IC ratio, which for this example was 15, then I come up with point nine units of insulin. So I would have given him point nine units of insulin extended over three hours, 01 100, nothing up front, everything extended over those three hours for the Klondike candy bar when he was six years old.
Scott Benner 43:22
And that was that the entire Bolus or is the point nine, the extra on top, just the extra for fat, right. So
Michelle 43:30
whatever the carb amount was in the candy bar, I would have Bolus up front and Pre-Bolus. Again, depending on the amount of fat, you may not Pre-Bolus. But this doesn't have a huge amount of fat. This only had 14 grams of fat. Gotcha. So all the carbs up front with a Pre-Bolus as you normally would. And then after he's eaten, and sometimes a couple hours after he's eaten. That's when extendible is comes in. So now when it becomes a couple hours after is if there's a huge amount of fat, then even setting this extendible is right after he eats means he will go first.
Scott Benner 44:07
Yeah. So you have to understand then, when that second wave arrives MB just appropriately ahead of it with a Pre-Bolus. So your Pre-Bolus second wave, but using a number that you can rock solidly believe is going to handle the impact of it. Because you use the formula,
Michelle 44:27
because I use the formula, and I did some experimentation, right? So let me take this one step further and say and maybe I should have said this earlier, for anybody who's not listening to the whole thing. When they use the warsop program, they get a really high incidence of lows. So if you use it as I just described it, your chance of going low is what I think and what many people in Canada think is unacceptably high. This is not best practice according to the clinical practice guidelines. And that's one of the reasons why
Scott Benner 44:56
what's been known as it. Yeah, so I I'm sorry. I find that when I talk to people, one of the most fascinating things is the word low and high is not quantifiable between people. So we if you said, If you said to me, this will make you low.
Michelle 45:12
Yeah, I would be saying under 3.9 millimoles per liter, or I think for you guys, I've got my chart here somewhere. That's 70. Right? So under 3.9, or 70 milligrams per deciliter. Okay.
Scott Benner 45:26
And so for me, if you see if you were talking to me, you said, Oh, no, this is gonna make Arden low. I'd think oh, like under 60. You know, which would
Unknown Speaker 45:35
it could it absolutely can.
Scott Benner 45:36
And it could, it's just, it's, it's tough to just say, it's this, the one thing I've learned from doing the podcast is that people's idea of high and low are different, like when I say absolutely got art and got really high after a meal, I mean, 180 to 200. And when other people say it, they're like, my graph is just flat across the top. I don't know how far over 400 I am. So we can't
Unknown Speaker 45:57
tops out at 22.2. You
Scott Benner 46:00
can't have an equal conversation when you think high means 400. And I think high means 180. Sure, right. So I just always like to make sure that we're talking about that way. So I'm going to go back over this because I am not the target audience for this. And I think I understand what you just told me. So this kind of exciting for me as a person who could not be time. You don't realize how bad I was at school. So
Michelle 46:23
you see you take this hasn't hurt you one little bit. How's it I don't
Scott Benner 46:26
know, my wife mocks me openly about it sometimes. So I read in that, in that vein, perhaps. So you have this example here of a an ice cream bar that has three grams of protein and 14 grams of fat. It also has 27 carbs. So you would have taken this ice cream bar, you would have known from experience. I don't know it needs a 10 minute Pre-Bolus not too much for your son, whatever. 27 carbs was in his insulin to carb ratio, you put that insulin in, he eats the bar. But then you take this information three grams of protein, you multiply the protein by four you come up with 12k cows, which are our total k cow from fat and protein. What is k cow stands for? Why don't I remember?
Michelle 47:13
It's a unit of energy kilocalories kilocalories.
Scott Benner 47:15
Okay. So you come up with 12. Then you take the fat from the bar, which was 14, and you multiply that by nine 126. You combine these together, you get 138. You take that 138? You divide it by 100. Is that right?
Michelle 47:31
Yeah. Okay, that gives you fat protein units.
Scott Benner 47:33
So then you came up with 1.38 fat protein units, is that correct?
Unknown Speaker 47:38
Yep. Totally.
Scott Benner 47:40
You just rounded it to one. Because the chart only really works because
Michelle 47:44
the chart says 123 or four right?
Scott Benner 47:46
And one fatty one fat protein unit indicates a three hour extended Bolus two indicates a four hour three indicates a five hour four indicates an eight hour. Yeah, so So you came up with using his ratio. Now this is the part where I got a little behind. So you took the 1.38 times 10? Because that was his ratio. Is that right?
Michelle 48:09
Nope, because there are 10 fat protein units. So fat, protein, fat and protein get converted to a certain amount like glucose, okay, so one fat protein unit is converted in your body, about the same as 10 grams of carbs would be?
Unknown Speaker 48:30
Okay.
Michelle 48:31
So if you didn't eat any carbs, and you ate one fat protein unit, that would be like eating 10 grams of carbs.
Scott Benner 48:39
Okay? This is the moment where I'm going to say this out loud. And take advantage of the of how popular the podcast is. The person who made the conversion calculator for the website, if you're listening to this, and you think you can program this into an app for online, please comment. Yes, yes, yes. Okay. And that'd be awesome. Then you would you would get that code for your website if you wanted it.
Unknown Speaker 49:03
Oh, thank you.
Scott Benner 49:04
So, okay, so then you you do this, this last bit here. And you can you came up with, it's going to be point nine because you round it again, because you came up with point nine, two, you round it at the point nine because that's how the pump would do it pump
Michelle 49:18
1.929 you
Scott Benner 49:20
extended that over three hours. Now in this specific scenario. How long after the ice creams consumed? Did you end up putting this in
Michelle 49:29
one hour? Okay, we started the extend Bolus at one hour after he started eating.
Scott Benner 49:33
So is that an indication to you that that ice cream cone has about a four hour life in his body?
Unknown Speaker 49:39
Yeah, I guess so. Yeah. All right.
Unknown Speaker 49:41
Well, plus the
Michelle 49:42
longer because at the end of your extended Bolus, that insulin is going to last for another three hours. It's gonna
Scott Benner 49:49
hell as well.
Michelle 49:51
And I've heard Jenny talk about how fat can affect you for you know, she said eight or 10 hours. We have at times of found that Max is still resistant. The next morning, like we're talking 1215, even 18 hours later, they'll be there. Right? It depends on how much right not the content and other things like how activity how insulin sensitive is he right now? Or has he been, you know, as he had a long weekend and sitting around in video games all weekend? Yeah, in which case, all of this compounds,
Scott Benner 50:24
hey, let me tell you a fun story while we let this sink into people's heads before we move forward. All right, two hours ago,
Michelle 50:30
there is an easier way to do this to let me
Unknown Speaker 50:32
say, we're gonna get to that
Unknown Speaker 50:33
I take the whole thing and make it easier we're
Scott Benner 50:35
gonna do with your funny story. Michelle, listen, you get a tease it out. I want people listening through the whole thing. All right, my listen through rate is important to ad sales, just so you all know.
Unknown Speaker 50:46
So listen to the end, I go
Scott Benner 50:48
pick up artists contact lenses today, there they we placed an order and they had to be picked up. And they get there. And I'm in a in an office that. I mean, I've been taking my kids to for so many years. There's a lovely woman at the front, who's been there for forever. And we're standing around talking, and I said to the person that was helping me, Hey, I gotta go, I have to go record a podcast. And he said, What's it about? And I said, oh, we're going to talk about how fat and protein impact blood sugars kind of more long term than people that who use insulin, but you know, probably think they do. And the woman behind the counter goes, I have diabetes. I've literally known her for a decade. I had no idea she was I struggle with this all the time. She goes, What are you doing? And I started explaining to her, she's like, how do I find this podcast? And she's like writing it down and showing me her phone and asking where podcast apps are and stuff like that. And I walked out and I just thought like, how did I not know? But there she was she had a Medtronic pump on her belt. She keeps it covered with their shirts weren't a sensor, nobody can see it. And, and there, she was just like a while she said this topic vexes me. Just it just controls my life. And she's like, even if I just need a piece of chicken, I'm down to just trying to eat a piece of chicken. And two hours later, my blood sugar tries to go up 40 points. And I said, Well, yes, your body can take that protein from that chicken and it converts it and stores it as glucose and then impacts your blood sugar. And she's like, I have no idea. I've had diabetes for decades. And I was like, No, okay,
Unknown Speaker 52:24
I said so. Okay, common. Yeah, just
Scott Benner 52:26
it was crazy. I mean, very, like, if I told you, I just thought to myself, hey, I have a little extra time here. I can make it to the store and back again to pick up Arden's contacts, like I just tried to squeeze and
Michelle 52:36
you were supposed to be there because she's supposed to hear your podcast. So
Scott Benner 52:39
lovely. Like I had a very nice feeling about the whole thing. Okay, so we just went through something, which let's be honest, is not that convoluted. But it's more than it must be out. It's Yeah, yeah. Right. So you're telling me there's a simpler way I could have gone through this. What would that have been?
Michelle 52:55
Well, first of all, as I said, we don't Bolus for protein. And there's a couple of reasons for that. Number one, because we found when we first started using this formula, including protein max always went low. And one of the things about protein is that it really only affects your blood sugar in a significant way. If you're not eating carbs, and we're pretty karbi family, I mean, I don't I think there are very few times when Max, like he wouldn't sit down and have like a steak in a salad. He wouldn't eat a burger without the bun. I would do those things. I have celiac disease. So, you know, I tend to be I would eat more just protein alone, but he wouldn't. So in a way because carbs are the body's preferred fuel source. If he's got carbs in there, then it's just going to use the carbs for fuel, okay, and the protein isn't going to have the same effect as if he had protein without carbs. Okay. So like think, you know, steak and a baked potato. You probably don't have to Bolus for the steak, although it sounds like you do and it works. So maybe there's something I'm just missing there. But salad will be good. Yeah, I
Scott Benner 54:08
don't do a ton, like red meat. I did a little bit you know, and if it's if it's more lean, I do a little less. I just, I just throw five I'm always throwing five like because you know what kids will put like a little dip in a bowl like honey mustard or something like that. People like how much is it? I'm I don't know, five more. Everything's always five more because isn't it interesting? I think for everybody who's listening, think how specific you are with your insulin. Oh, this is 43 carbs. And it's gonna be 14.8 units or something like whatever you end up doing preaching to
Unknown Speaker 54:41
the choir.
Scott Benner 54:46
And you're more frequently never right to weak, then you are too heavy.
Unknown Speaker 54:53
Absolutely. I get
Michelle 54:54
because everybody, you're speaking my language. We laugh because if we go out to a restaurant, and there's No carbon permission, you're like at a mom and pop place. So there's no you know, Boston Pizza website to go to or whatever, you're just, you're there and the food's there and you have no choice but to pull a number out and just go blind, this many carbs. And it's funny when we do that, quite often his blood sugar is much better than when we systematically counted. Now, that being said, we still systematically counted because I think if I did that, all the time, it would miss necessarily work out in our favor. Yeah, there'd be
Scott Benner 55:35
where you'd be in the parking lot going, well, Max can't stand. No, I think I'll tell you a measurement I use very privately in my own head when you're out in a restaurant. If it's a chain, it's more, because I always think there's more just stuff in it. It's not food, and the better it tastes. There's more because the better it tastes always, to me means food and means fat and salt. Absolutely. Right. So the better it tastes, the you know, the more it hits your pleasure center and makes you go I don't care about anything else in the world, the more you feel like that, the more insulin it's gonna take
Michelle 56:13
five units of insulin. Yeah, exactly. So
Scott Benner 56:18
I just it, it became, like, evident as Arden got older. And now I'll tell you, you know, now that she's a full blown lady. That's a whole other aspect of it. There's a you know, there's some foods that hit her differently now that she's mature than they did when she was a kid. And I don't even know if that's if I'm right or wrong about that. It's just, it's what it is. And there's some foods lately, there's a simple one, she likes these little baked Ritz crackers, right, so, so not the regular round Ritz crackers that everybody thinks of in the in the sleeve, those those we Bolus pretty easily carb for carb. But these ones that come in a bag that are like rich chips or something like that, I just take whatever the carbs are and add half if it's 20. It's 30. If it's 30, it's, you know, it's it's 15. More on top of that. And these things, just hitter? I don't know what's in them, but it ain't good. You know, they mean,
Unknown Speaker 57:14
have you looked at the label? Well, no,
Unknown Speaker 57:16
that would take a lot more effort. I just figured out how much insulin
Michelle 57:19
I'm just curious about how much fat and maybe even protein is in there, I'm gonna look but or if it's a glycemic index thing, like if they you know, if they digest super slowly, then something
Scott Benner 57:30
hit her like a truck. And then the truck stays parked on top of her for a while. Yeah, it doesn't pull off and go, I'm sorry, it just stays there. And the reason I don't look too deeply into it. And this might be helpful for people to with younger children, is because she will cycle through these. Like, I don't know if other people's kids do that to
Unknown Speaker 57:49
be gone a month from now. So it would be a moment where she'll sound go, Hey,
Scott Benner 57:53
did you want some of these crackers that you love? And she's like, I hate those. I'm done with those and then she'll never eat them again the rest of her life.
Michelle 57:57
Yeah. And you go donate those six boxes that you just got on sale. Yeah, yeah,
Scott Benner 58:01
like here. So crush your blood sugar. Congratulations. They're free now. But yeah, but no, seriously, it's um, she doesn't do the same thing for like, She's on a grape kick. Right now. I have four pounds of grapes and four pounds of grapes in my refrigerator right now. Cuz she just two weeks ago said, Hey, everybody, I'm doing grapes now. Like, there are things so let's say stock then I was like, okay, so
Unknown Speaker 58:24
no worse things. Yeah.
Scott Benner 58:26
Right. So I'm like, okay, whatever, and then they'll be gone. Like, you know, I'll try to give her grapes three months from now. She's like, Oh, I don't need grapes. What am I gonna do? Anyway, I'm sorry. So, okay. There's an easier way to do this.
Michelle 58:41
Right? Okay. So what we do is we first of all, like I said, we don't include the protein. So what it comes down to for us is that we just take the grams of fat, we multiply at 5.09, which is the time sign and divided by 100, all in one step. And then I might multiply by nine or 10.
Unknown Speaker 59:07
So that's what's the multiplication for?
Michelle 59:09
That's the 110 grams of carbs, for one gram, one fat protein unit. Okay? So we, because he's still sometimes goes low, if we use this with the 10. If he's in a good place, and things are, you know, he's insulin sensitive, and all that's going well, then I will reduce that number. So when he was younger, I might reduce it all the way to eight. And so that's another way to make it more conservative, reduce that risk of bottoming out.
Scott Benner 59:40
Gotcha. Well, I like to ask you to go through it again in a second. But I like the way you just said if he's insulin sensitive, and you didn't mean that in a bad way you meant if the insolence working the way I expect it to work in this moment. So I'm going to get a reaction that I expect and by expect, I mean, ratios. Basal rates are all Doing what we expect them to do.
Michelle 1:00:02
Absolutely. Right. Okay. And as an aside on that, like, I'll notice that they have a long weekend. Like they just had a five day long weekend from schools, teachers convention and things by the fifth day, because he hasn't been walking back and forth to school. He hasn't had gym class. He's been spending more time on the computer or hanging around with us watching movies, that kind of stuff by the fifth day, but probably the third day, really. I know that we need to crank things up a bit. Yeah. And if I forget that, then it comes back to tell me we need to crank things up a bit.
Scott Benner 1:00:33
being sedentary to me hits exactly like an old and full set. You know what I mean? Yeah, you know, when you're the last part of your infusion set, and it's starting to get like, suddenly it's like, this should be a unit but it's two units. And and, you know, it almost feels like it almost can feel like a leaky sight. It's almost like everything I'm putting in there. It's not getting in there is it like but it's it's wrong. Yeah. But instead, it's everything I'm putting in there. It's not having the impact that it should because right sitting around for a week or etc. I right? I'm glad people cuz all of us, this is good.
Michelle 1:01:05
So on those days, I will absolutely lose us 10. So using 10 would be more aggressive because you're multiplying it by more. Okay, so going through eight would be more conservative.
Scott Benner 1:01:16
Do it. Do it with me one more time. So let's just put 10 grams of fat in this imaginary thing we're eating? Yep. How do you do it?
Michelle 1:01:24
10 grams times point oh nine.
Unknown Speaker 1:01:27
Okay. Should I
Michelle 1:01:29
times 10. Okay, divided by the IC ratio, which for him right now is six. We just use six across the board.
Scott Benner 1:01:39
So in 10 times point oh nine times 10 divided by the insulin to carb ratio. Yep, that's it. Okay.
Michelle 1:01:48
So you'd end up coming up with what nine divided by six?
Scott Benner 1:01:52
Did I miss something on the second? Let's just do this the easy way, shall we? 10 divided by 10 times point oh nine.
Unknown Speaker 1:02:02
Oh, hold on. It's zero.
Scott Benner 1:02:07
10 times point oh, nine times 10 divided by four. It's 2.25 2.25. That would be ardens. Because our insulin to carb ratio is like four, four. So if there were 10 grams of fat in this thing that Arden ate, I would take 2.25 units and extended over three hours.
Michelle 1:02:29
Um, what did we come up with the fat protein, we have to pause at the grams of carbs times point oh nine because that tells us our fat protein units.
Scott Benner 1:02:39
My stupid idea. So that's
Michelle 1:02:40
so that's point nine. So just under one. So yes, it would be three hours. Yeah.
Scott Benner 1:02:45
So now
Michelle 1:02:46
and I should point out that we never actually would do this for 10 grams of fat. That wouldn't be enough fat for us to bother. Right. But I think for for example, purposes, screenings, round numbers
Scott Benner 1:02:55
for round numbers and simplicity, which is clear. But so that's a good point, though, because and why is that a good point? Let me Google something for a second. When I say five guys, five guys fries, fat.
Michelle 1:03:12
While you're googling that, I just want to point out that they go to a local mall to do Pokemon GO TO Pokemon 90. And they always stop for lunch. This is my husband and Max. And n W is the usual meal on that day. And it has 64 grams of fat for a cheeseburger, fries, and a pop
Scott Benner 1:03:33
Listen to this. This is from the Food Network. A large french fry has an unbelievable 1300 calories, 57 grams of fat, 1300 milligrams of sodium. So you're gonna get crushed if you eat if you eat this, because not only all of this, but the sodium is going to dehydrate you which also slows the insulin we're
Michelle 1:03:53
never even take that into account. polling numbers that on my phone like she's got
Scott Benner 1:04:01
a taste good more. So so there's a good example 57 grams of fat in just those fries yesterday. So leave the milkshake out of it leave everything else out of it when I'm telling you she used you know, just multiple 10s of units of insulin more it really isn't that crazy because in this scenario here, if we just round this to 60 right, hold on a second. If we just round this to 60 grams of fat for Arden for the french fries yesterday and I do 60 times point oh nine
Unknown Speaker 1:04:36
I get five minutes right?
Scott Benner 1:04:38
times 1054 divided by her insulin to carb ratio is four. She needed 13 and a half units more insulin for the fat in those french fries than the carbs in those french fries indicated and think about how many carbs are in the french fries. So Hold on a second, and five guys, large fries, carbs. Okay, there are 72 carbs. So So we've just decided Arden needed 13 and a half units of insulin for the fat in five guys fries. Now let's look at it as carbs 72 divided by 418. So while everybody's wondering why their blood sugar gets high, and they don't understand why it takes so long to come down, Arden needed 31 and a half units of insulin just for the french fries. But it had to be stretched out over the impact of the carbs because of how the oil is holding it up, which we've talked about a million times this podcast and anybody's listened to the pro tip series knows, the food goes in, it starts digesting, you're leaching out carbs, the more fat is in your stomach, the slower the digestion goes, the longer it takes, the longer you're slowly just basically infiltrating your blood with cart with sugar. So that really is telling honestly.
Michelle 1:06:09
And with that amount of fat, like I said, for the Klondike ice cream bar, we would start the extended bowls one hour after and by the way, we just say, Alexa, she's gonna listen to me. Now, we would just say Alexa set a one hour fat Bolus timer, which usually results in hilarity because she often says by balls timer. But anyway, all that aside, we just set a reminder,
Unknown Speaker 1:06:33
right?
Michelle 1:06:34
So that we actually do that an hour later, if he had this much fat. If I did that, an hour later, he would bottom out first, okay, because the food would take that much longer to reach his bloodstream and the ease in the car beat.
Scott Benner 1:06:50
Yes. And the easiest explanation for that, for most people is pizza, who you know, you look at pizza and you go, this is 30 carbs a slice, you put it all in, and 45 minutes later, your blood sugar's 40. And you're like, I don't know what to do. And you drink a juice, and that doesn't work and you drink another one, and then all of a sudden, the fat and protein hits you and the juice hits your 400. And you don't know what to do.
Michelle 1:07:10
Right? Right. And that wasn't a problem with the amount of insulin you took. It was a timing issue, timing that the insulin got in before the food did.
Scott Benner 1:07:18
I was talking to somebody today. And I said to them, in the end, all the things that we just talked about here, all we really said was right amount of insulin at the right time. It's all timing and amount. It's always it's always timing and amount.
Michelle 1:07:30
And fat messes with that in a big way. Because it's not just that you get that high, it's that it takes so much longer for it to digest that you can go low in the first place. Okay, or like you've said, on other podcasts, you've got this beautiful number and you think I nailed that. And then four hours later, you know, you're through the roof. And that's why, because you might have nailed the first two hours of it, but not the next eight. All right, Michelle, there's one
Scott Benner 1:07:57
thing I was I'm still lightly confused by. So it's the idea of one fpu, two, three, when we did it in the short version, we just said 60 times point or nine times 10 divided by insulin to carb ratio. Yeah, how what what would? How would I know if it should be over four hours or five? What number would change in that
Michelle 1:08:21
we stopped, we stopped at the 60 times point or nine. So that's the fat protein units. And that was 5.4. So for five units. Now here's here's the other thing that we run up against with 60 grams of fat. The chart only goes up to four protein units. Okay. So beyond that, I take the Scott Benner approach, and I just guess more. So for five units, I might say 10 hours because for fat protein units would be eight hours. So for five fat teen protein units, I might go 10 hours or maybe 12.
Scott Benner 1:08:52
Okay. I okay. So my confusion was, is that our original number that we started with? cabasse in the three hour range?
Unknown Speaker 1:09:01
Right, right. Okay, right,
Scott Benner 1:09:02
because we were only at 60. If we would have gotten two. Is there. Is there a cheat in there? Is there a number of FP us that makes it to like in your mind? I know you don't think of it this way, but pretend you were me for a second. And
Unknown Speaker 1:09:15
sometimes I do.
Scott Benner 1:09:16
Yeah. Yeah. So like, How many? How many? How many k Cal's would tell you, okay, this is going to be four hours. Do you have that number in your head? Um,
Michelle 1:09:30
nobody can reverse engineer it, like four hours would be to fat protein units.
Scott Benner 1:09:38
Yep.
Michelle 1:09:40
So then to fat protein units would be 18 grams of fat. Okay. So if you were looking at somewhere around 2020 grams of fat, you might say, yeah, let's extend that four hours. Okay, you can totally just do that shortcut. The other thing is insulin is insulin. So once you know that, you're looking at a four hour x Bolus, you can do a Temp Basal, that will equate to the whole thing,
Unknown Speaker 1:10:04
do the same thing I would normally do that,
Michelle 1:10:06
you know, it's a pump doesn't care if you do an extended Bolus or Temp Basal, it's the same thing. It just draws it out. Yeah, it's whatever makes sense to you in your head and whatever you can,
Scott Benner 1:10:16
you know, work with. So with 64, the French fries, that actually puts us up into the more like the five, six hour range, right?
Michelle 1:10:23
Yeah, when Max has a n w, and he's 64 grams of fat, we extend it over 12
Scott Benner 1:10:29
hours, 12 hours,
Michelle 1:10:30
which I believe is the upper limit of his current.
Scott Benner 1:10:34
And when you're doing that with a small person, what you're really telling the pump is I need extra basil for the next 12 hours because it is a small, it's a smaller amount of insulin once you break it up over 12 hours. Yeah. Okay, well, that's when
Michelle 1:10:48
you could convert that into Temp Basal. I guess my problem with that is like, he's still growing. So when he goes to bed, he's got growth hormone, and his basil rates almost double. So for me to go, Okay, how much of this would it you know, to tell it a Temp Basal, I would have to sort of figure out okay, well, between the hours of 11pm and 2am, his Temp Basal would be double. Yeah, but earlier in the evening, it's not gonna be like, it's a lie. Just go extended Bolus, yeah, just give me give me whatever, an extra five units over 12 hours.
Scott Benner 1:11:20
Yeah, Michel, the way if you if I'm sorry, if you've heard me say this, you have to suffer through it for a second. But I just think of, I've found a number of different ways to think about it over the time, there's an impact range that the food has, you know, from the minute that goes in till it's done, and I try to cover that range. With a heavier blanket of insulin. Sometimes I think of it that way. Sometimes I just think, you know, just basically like, Oh, it's going to be cold overnight, I need an extra quill. And so you know, my blood sugar is going to try to go up between here and here. Because I've eaten something with fat in it, I'll just lay something heavier in the form of basil overtop of it to hold it down. I've described as carpet bombing, before, you know, just picking the picking the range where the food is, and just try to decimate it, you don't I mean, just stay on top of it. There's all different ways to it. I mean, however, people can picture it in their minds. The idea here is that this fat is going to force your blood sugar up over, over hours, and the amount of hours is going to depend on how much fat it is and all kinds of other stuff. And And still, what we're talking about. While this while this method doesn't work for the idea still existed for some of you, protein will cause a rise a number of hours later, too. And if you can learn that you can count on that that a chicken breast with my meal is going to mean the two hours after I eat my blood sugar is going to try to go up 60 points, well, then an hour after you eat the chicken breast, you could do a Temp Basal to stop that or an hour and a half after you eat the chicken breast you could Bolus for it even so
Michelle 1:12:59
my problem was always how heavy of a blanket do I need? And how long am I going to put it on? So do I need that? You know that light summer blanket? Do I need the really thick dubay? What do I need here? And and so for me using this formula told me how heavy should the blanket be? I know you can have it on all night or just through the beginning of the night or what. So for somebody like that, who is eating the chicken breast and a salad and no carbs, and therefore needs to Bolus for it, you can use the same formula. But just the same way that I leave protein out of the formula and only do fat. You can leave fat out of the protein out of the formula and only do protein.
Scott Benner 1:13:37
It's fascinating. And I do mean this in a very kind way. Like I I would imagine you could take this wrong, so don't but the people who I've seen asked me for this information, as near as I can tell through the internet, have a similar personality to yours.
Michelle 1:13:55
What a shocker. Yeah, and it's I don't take that the wrong way. Yeah,
Scott Benner 1:13:58
it's fascinating because we're, those are the people who hear me go, I don't know, put in mourn, just don't let it cause a problem. They're like,
Michelle 1:14:06
No, no, try that, Scott, because my brain doesn't work that way. When I tried that, it just failed. And I was discouraged. And I was like I cannot put in the energy that it's going to take to keep trying and experimenting and figuring it out and trying this in China. I just can't. And the other thing is you have this incredible memory. I have asked to be introduced to people that I have met before people I have had in my home at my dinner table I have asked to be introduced to and so I don't have that memory. So if I don't write it down systematically and come up with a process that works, then I'm starting over every time I sit down with that food. I'm like, I don't know what to say. We're gonna try so I
Scott Benner 1:14:51
can't take credit for memory. It just occurs to me. Like I just look at it and then the answers in my head. I don't have a process to come to it. And I can also Yeah,
Unknown Speaker 1:15:01
that's awesome,
Scott Benner 1:15:02
please, it is an odd gift to have. But I would much rather
Michelle 1:15:07
the kid you've got that's incredibly valuable show.
Scott Benner 1:15:09
What if I ran a sub for 60 and could catch him was six feet five, then I could pay someone to do this, you
Unknown Speaker 1:15:15
have a different gift.
Scott Benner 1:15:18
But but it isn't it this conversation has been in an extended way interesting for me, because I can see now that you don't think in pictures. And I think in pictures No,
Michelle 1:15:30
right? Yeah, numbers in language, right.
Scott Benner 1:15:32
And the people who I hear describe me as Oh, it's this guy. It's just really aggressive with insaan. I was like, Oh, they think in numbers. Not in pictures, right? I sound like a lunatic who's just yelling, like pour it on and see what happens. But I don't
Michelle 1:15:48
you do that based on your sense of what is appropriate? And I'm saying I don't have that sense. Yeah. So I can take this formula. And then once I know, then, I mean, you don't have to go through the formula every time. It's not like I spent all my time, you know, doing Warsaw calculations, right. Once you know, when you have that same food again, you just use the same thing. And, and I literally kept track. I said, So what was the result? Okay, he went low first. Okay, I'm gonna give maybe less upfront and extend it more on, you know, I could tweak from there. But once we've tweaked it, and we get success, well, then when we have McCain's frozen pizza, this is what we do. Yeah. Or when we go out to a and W on Pokemon GO day, this is what we do. And so I think it gets us both to the same place, but just a different path to get there. No, I
Scott Benner 1:16:39
think the last 30% of the process is the same for you. And I, I think it's the how we understood it, how we made the decision. And when we use it, that yours is more calculated. And mine's more like, that feels like five units to me. But you know,
Michelle 1:16:55
and it also puts me in a position then when I get one that I don't know, and I don't know how much fat is in that I don't know how much protein it is. I can look at and go well, it looks like an A NW meal or it looks a little closer to you know, nachos, or it looks like then I can be in the ballpark. I can say well, I have no idea on this one. But I'm gonna compare it to something I do know something we've done before. And I'm going to try this. And that gets me in the ballpark. And it makes Max's blood sugar's post meal. manageable. Yeah. So that now we can do the the bumping and nudging that you talk about rather than this, you know, runaway freight train, but
Scott Benner 1:17:32
everything is held there is nothing maybe more confusing than seeing a blood sugar that's to at putting what you think is a massive amount of insulin on it and watching it go to 260 and then bounce back to to a again. Oh, yeah. Then your brains just like fried, because you're only thinking correction factor, and not considering any of the other things that are happening. And then you're just
Michelle 1:17:54
before we started analyzing this had no idea like I might think oh yeah, it's fat. But then when you think 64 grams of fat. That is that puts my understanding on an entirely different level for me to go, Oh, that's why when one unit would normally work, and I gave him three units thinking, oh, let's watch for the low. That's why it didn't even touch his blood sugar, right? Because we're talking about this astronomical amount of fat,
Scott Benner 1:18:19
right? Because and obviously Arden's insulin, insulin to carb ratio is different than other people's but because a large french fry from five guys for Arden needs 28 or 30, like 32 units of insulin 32 units of insulin, her pump only holds 200 for three days. Right? So I can. And so anyway, this was really great. Did we not say anything that you wanted to say? Did I find a way through it all?
Michelle 1:18:51
Um, I think so. Let me just look and see. Yeah, look at
Scott Benner 1:18:54
your notes, please. Ah, usually people with notes. So check it out. Make sure we're
Michelle 1:18:59
systematic. One other thing to think about is there are times that we would have he'd say, make himself nachos for lunch. And then we have pizza for supper, or, you know, we'd go to McDonald's for separate. If this happens twice in a day. The The effect is compounded. So like if I sort of imagine that, you know, his first is nachos for lunch, there's some fat swimming around in his blood, and that's making things a little bit harder to deal with. But we covered it and things look great, but underneath the surface. Wow, he's still got that extra fat in his blood. Now we go and we pile on more fat that's going to need even more of a hit. So yeah, you're more insulin, more insulin really applies if you're eating fat more than once in a day, which doesn't happen incredibly often for us, but we've seen the effects Yeah, and I think already Oh, sorry, go.
Scott Benner 1:19:53
I was gonna say I see it with Arden during her period like when she gets like cravings, sometimes craving They match each other. So it goes, you know, I've had days that have gone from nachos to Chinese food, you know, and you're just like, well, this is gonna be like, it really does feel like, you know, like, like the greatest football team of all time. So showing up the play you and you're like, Okay, I guess we're gonna lose. Let's try not to lose by too much.
Michelle 1:20:24
And that's where you you know, when you if you'd normally do Chinese food, you go, Well, this is how many units it needs. And we need to extend it over this many hours. The day that you have Chinese food after nachos, you need to ramp that up, it'll change or at least we find that we do because the effect is is cumulative. I definitely see that too. Okay, I'm sorry, cut
Unknown Speaker 1:20:44
you off. You're gonna say something else?
Michelle 1:20:45
No, I think that that might be I think we've I think we've addressed everything that I've got here.
Scott Benner 1:20:51
Well, Jenny was right, you were the right person to talk to about this. So thank you, I have to say this
Unknown Speaker 1:20:56
pleasure. No, I
Scott Benner 1:20:57
had a good time. But let me say this because I want to mention again, it's waltzing the dragon comm or.ca. There'll be links in the show notes for you to go find it. I'm going to try to talk Michelle into the day that this goes up to like popping up in the Facebook group and chatting with people about it if she wants to. I would love to but I want to say this and I mean this genuinely. She would never say this out loud. But there are not that many places where Jenny directs people for diabetes advice.
Unknown Speaker 1:21:24
So you
Michelle 1:21:25
ruin my day because I really admire her she is a smart cookie and has great advice
Scott Benner 1:21:30
is a big deal. She's I've outed her now she's only ever told me that privately but there are very few sources that Jenny will tell somebody about so that she brought was a big deal. So I that's how I knew right away to reach out to you because if she was willing to say it out loud, then I knew it was going to be a good conversation. So thank you very, very much. This was amazing. Thank
Unknown Speaker 1:21:49
you for your time. Scott.
Scott Benner 1:21:51
Are you kidding me? You stop it this is this is all all the things go to you. A huge thank you to one of today's sponsors. Je Vogue glucagon, find out more about chivo hypo pen at G Vogue glucagon.com forward slash juice box, you spell that GVOKEGL Uc ag o n.com. forward slash juice box. The episode was also sponsored by the Contour Next One blood glucose meter. Learn more at Contour Next one.com forward slash juicebox. There's links in the show notes and links at Juicebox Podcast comm for these and all of the sponsors.
You can support Type One Diabetes Research and the Juicebox Podcast. The T one D exchange is looking for type one adults and type one caregivers who are us residents to participate in a quick survey that can be completed in just a few minutes from your phone or your computer. After you're finished with the questions. And they're really simple questions. I did them in maybe seven or eight minutes. You'll be contacted annually just to see if there's any updates to your information and to be asked any further questions if further questions exist. This is 100% anonymous, completely HIPAA compliant and it does not require you to ever see a doctor or go to a remote site. Now every time someone completes the process using my link, T one d exchange.org. forward slash juicebox. You'll not only be benefiting people living with Type One Diabetes, but you'll be helping out the podcast. Just use my link in the bio, then click on join our registry now. And then just simply complete the survey. T one D exchange research has led to increased insurance coverage for blood glucose meter strips, changes in the American Diabetes Association's guidelines for pediatric a one c goals and even helped get Medicare coverage of CGM devices. So if you've ever wanted to help out people living with Type One Diabetes, or the podcast or maybe both, this would be a simple, quick and safe way to do all of that T one d exchange.org. forward slash juice box. Okay, now I'm on Michelle's website, waltzing the dragon, and she has examples here for you. This is very clear and easy to follow. She's got a lot of examples of what foods are high in saturated fat here. She talks specifically about the what the Warsaw approach is. And she walks you through an example number one identify how much fat and protein the food contains. And she has an example here that she used on the podcast. It's an item that has three grams of protein and 14 grams of fat. Number two, you convert into units of energy. It's k Cal from protein equals protein in grams times 4k cow grams. Now when you see that You're just like, Oh, my God, I don't know about you, my brain goes, Oh, I guess everybody's blood sugar is gonna be high because scouting and figuring this out. But if you've got the kind of brain who loves this, go look at it, because it is incredibly well I know, when I look at it, I think if my brain worked this way, I know I would appreciate how this is being shown to me. Number three, calculate the total calories. Number four, calculate the fat protein units. Number five, how long to extend the Bolus, it walks you through it very easily step by step instructions, gives you the amount of extra insulin that you need Step six. And then it talks about the end result. She says here to make a long story short, in this example, to cover fat and protein. Her son had this bar after supper, she would first give the usual Bolus for the carbs before he starts eating. Then later, she would deliver an extra 2.3 units of insulin in this example, in an extended Bolus that covered a duration of three hours. So you've heard her talk about it now for an hour we've been talking about in the podcast. If you want to see her step by step instructions, there's a link in the show notes for this episode. And there's a link at Juicebox Podcast comm for again for this episode 471. Now in the meantime, I'm going to be paying closer and closer attention to how I'm using this idea in our life. And I'm going to come up with a way to say it that doesn't involve adding, subtracting, multiplying or dividing. I'm going to come up with a way to talk to you about this. And I will be sharing it as soon as I absolutely can. You know me I'm just like there's a lot of fat in this and then I you know, I just got a lot more insulin and I stretch it out. You've heard me talk in the diabetes pro tip series. You know how I do it. If you've liked this and never heard of the diabetes pro tip series, I really think you should check it out because if you like this conversation, you'll love those conversations. The diabetes pro tip episodes begin at Episode 210. They're available at Juicebox Podcast comm in your podcast players, or if you just like to see a list of them diabetes pro tip calm. Hope you found this interesting. If you did, please share the show with someone else. And of course check out Michelle's website waltzing the dragon.ca or calm and there's of course links right there in the show notes and Juicebox Podcast comm to this exact article. I'll talk to you soon.
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