#75 Think Like a Pancreas, Chapter 3: Beyond the Basics with Miranda

Katie: 0:00

This episode of the sugar mama's podcast is sponsored by sugar medical, the very best place to get all your diabetes supply cases and accessories. You're listening to episode 75 of the sugar mama's podcast. And today I am going over chapter three of the book, think like a pancreas by Gary Scheiner with T one D mama Miranda. Chapter three is called beyond the basics and it gives a really nice review of the different types of diabetes. And then it discusses the five major factors that affect blood sugars. I've said it before, but I will say it again. You need your own copy of this book. It has been by far the most helpful when it comes to learning about diabetes and teaching me how to manage my daughter's insulin. It is never too late to get your own copy and follow along with us. There's really so much in this book that you're going to wanna see with your eyes like graphs and charts and tables. That there's just no way I can really do it. Justice trying to explain it with my words. I'll definitely put a link in the show notes to where you can get your own copy either on Amazon, or if you wanna be fancy and get an extra special sign copy from the author, you can go to his website, integrated diabetes.com. There'll be a link in the show notes for that as. Okay. Without further ado, let's get started You're listening to the sugar mamas podcast, a show designed for moms and caregivers of type one diabetics here. You'll find a community of like-minded people who are striving daily to keep their kids safe, happy, and healthy in the ever-changing world of type one. I'm your host and fellow T one D mom, Katie Roseborough. Before we get started. I need you to know that nothing you hear on the sugar mamas podcast should be considered medical advice. Please be safe, be smart, and always consult your physician before making changes to the way you manage type one diabetes. Thanks. before we start the show. I wanna take a minute to tell you about our truly delightful sponsor sugar medical. We all know that sugar medical is the place to get all your diabetes, supply cases and accessories. But did you know that they are also top notch when it comes to keeping all your precious type one essential, stylish and safe? That's right. Sure. They have backpacks, sling bags, travel bags, and insulated cases to make your life with diabetes easier and more organized on the go. But why stop there? They also carry a huge selection of trendy sticker decals and silicone sleeves to keep your vials of insulin, your PDM and your other pump parts fortified against falls and fashionable, you know, what's worse than missing the mark on that pizza bolus, missing the mark on that pizza bolus and shattering your bottle of insulin on the floor of the Italian restaurant. Yeah, let's try and avoid that. Wanna see for yourself, head on over to sugar, medical.com to take a look at all their super sweet styles. Plus get 10% off all one time purchases using code sugar, mama that's code S U G a R M a M a for 10% off. You'll find a link to the sugar medical website, along with the offer code details in the show notes. Thanks. Everybody. I am here with Miranda today and Miranda and I are talking about chapter three of the book. Think like a pancreas by Gary Scheiner. And this chapter is called beyond the basics. But before we dive head first into diabetes, we're I, I wanna ask Miranda a few questions. So Miranda first, why don't you just introduce yourself to the listeners and tell us what your connection to type one is.

Miranda: 3:55

my name is Miranda Zbars. I am a mom to two little girls. My oldest four year old is a type one diabetic, and we aren't quite to that first full year yet. June of 2021 was our diagnosis. So this is. been a wild nine month ride for us.

Katie: 4:14

I know. You're, you're kind of a newbie. At what point do you think you, I feel like it was a year for me. Like, I couldn't call us a newly diagnosed family anymore, but like up until a year, I was still claiming that status. What do you think?

Miranda: 4:25

I think? we probably have a little bit more to go. Like we are, I laugh at the name of this chapter beyond the basics, cuz I feel like we're just now starting to get into that where we, my husband and I have a better handle on like figuring out things on our own or managing adjustments that we need to make versus like relying as heavily on our team. And yeah, so hopefully at a year we'll feel a lot more confident. getting there.

Katie: 4:52

Yeah. I feel like, gosh, where are we? We're like a year and a half now. And really, it was probably at like a year and three months that I really felt not that I feel confident every single day, but I really felt like the heaviness of it all kind of lift and some days are still hard and heavy, but I mean, I literally felt like I had a heaviness sitting on my chest until that point. So I'm sure it doesn't take people that long, but for me it seemed like it was like a little bit over a year before that went away.

Miranda: 5:18

Yeah, and I. feel like for us, the part of us that are figuring out all the intricacies of her dosing is new, but like equipment changes or feeling like we know how to do this on the go or talk about it with people or help her be calm during things like that part feels good. And doesn't feel like we're a newbie at that stuff anymore. It's more just like the tweaking part of it.

Katie: 5:46

mm-hmm I agree. All right. Well, I wanna know a little bit about you because I feel like we always just jump right into like, talking about our kids and diabetes. So would you just tell us a little bit about you? Like, what do you like to do for fun? What are some of your hobbies? Whatever you got, favorite place to travel, whatever you wanna tell us.

Miranda: 6:02

Yeah. So My work prior to taking a leaf was in early childhood intervention, which means I visit with parents and babies and toddlers and their homes and, or virtually with the pandemic visiting with them and providing services such as parent coaching and connecting them with therapies needed. So that is a huge part of my life. And with that, I'm an Instagrammer So I love content creation and I do a lot of that based around early intervention. And I've continued that things that I like to do at gush, I like baking. I like all kinds of crafty kinds of things. And Right now though, I'm a toddler, I'm a toddler mom. And that consumes so much of my life that

Katie: 6:49

Mm-hmm

Miranda: 6:50

we're, we're uh, kind of in it, in the middle of that. right. Yeah.

Katie: 6:52

Yep. I've said it several times on the podcast before, but I don't know how you toddler moms do it while also working and managing type one. It's ha having a toddler toddler was very difficult. In my opinion. Like, I, I will remember those years fondly cuz my children were adorable, but I don't wanna, I'm glad I'm out of the toddler years. So God speed. Mama. You're gonna get through it. There is a light at the end of the tunnel.

Miranda: 7:15

Yes.

Katie: 7:15

Um, yeah, so Miranda is if you'd like to see a little bit more about what she does for work on Instagram, she is at early intervention mama. That is her Instagram handle. And I think what you do is so interesting, cuz it's kind of like, you're like a rescuer for like new parents and, and parents of toddlers. Like you just kind of come in and like coach them through some of the tough times and yeah. Just get them in touch with the different therapies or, whatever it might be that they need. So I think it's pretty cool. Would you mind telling us a brief diagnosis, like a brief kind of recap of your, your four year old's diagnosis story?

Miranda: 7:47

for us, it kind of starts like almost a year. Before her diagnosis, we had gone through her actually getting a lime diagnosis. So she contracted Lyme and we went through several months, well, like half a year of figuring that out and trying to figure out what was going on with her body resulting in a lime diagnosis and treatment for that. And so when we got to the point, like about 10 months later, post that incident happening, we were wondering like, is this a full air up of that? Or what's going on? We started noticing like some similar behavioral kinds of things, which now knowing like it was her having high glucose. But you know, we just knew she didn't feel good and trying to figure out if it was related to that Lyme disease that we had been managing or if something else was going on. And so We noticed that she was having a lot of accidents. She had been toilet trained for a long time and all of a sudden we were having a lot of accidents and it got to the point where, I mean, I would describe it, like somebody had filled a bucket up and like just jumped it on the floor. Like we had a couple incidents like that, where we were like, okay, after two times of like full, complete Bladder explosion. We, we knew something was going on and and then she was excessively thirsty, excessively hungry. And the thirst for us, like I can remember one night I was like, this is not normal. And we thought maybe it was a toddler behavior. She's delaying bedtime. And I said, I don't know if that's it. Let's just see how much water is she gonna drink. Let's see, you know, if this is so I'm like, we'll just let her have as much as she wants. And I think by like cup five, I was like, this, this is, definitely not a delayed bedtime behavior. This is um, a big concern. And that all happened. Like. Bladder issues, the thirst, the hunger, like all that creeped up within a week and us trying to figure out. So we, of course it was like over the weekend that we were really got to that point, that we were super concerned, contacted our physician. And by Monday we were in having a urinalysis. And I think I left the doctor's office in five, within five minutes of dropping off the sample. I had a call that was like, go to the ER

Katie: 10:05

mm-hmm

Miranda: 10:05

I'm positive. You have di you know, she has and we ended up at the ER but we were not in DKA. and I actually just looked back this morning and like her sugars were not even over 300

Katie: 10:18

Hmm.

Miranda: 10:18

at that point that we were in. So I'm surprised that we caught it

Katie: 10:23

Yeah.

Miranda: 10:23

did and happy that we did, but. Yes.

Katie: 10:26

Yeah, that was, that was kind of like one of the things that really tipped me off to when my daughter was going through all that too. Like just the quantity of urine, like, cuz of course at first I'm like maybe she has a UTI but you know, when you have a UTI, like you have, you feel like you have to go to the bathroom a lot, but when you try to go, you hardly anything comes out. So, so I followed, you know, I kind of went into the bathroom with her, her a few times and I'm like, okay, this is like a lot of urine coming out. This is, I don't even remember her drinking a whole lot. Honestly it was mostly just the frequency that she was gonna the bathroom, but it was summertime in Florida. So she could have been drinking a ton. And I just wasn't really thinking anything of it.

Miranda: 11:02

Yeah, it's you're right. That, that quantity. And for us, like I said, just trying to F she, we say she's got an iron bladder too. Like she can hold it. fact that are just trying to figure out, like, are you holding it so long? that this is what's happening? Or or is it a problem?

Katie: 11:19

Mm-hmm And it is hard to drink. A lot of water. I, I recently was just like for fun. I was like, I'm just gonna try to drink a gallon of water today. Like, let's see what that feels like, because my husband and I wasn't really trying to, we weren't in a challenge, but I was like, he always, we always laugh at him because his big thing is like, are you drinking enough water? Are you drinking enough water? Are you hydrated? Like, if, if anybody, if anybody has anything wrong, his first thing that he says is like, we have how much water have you had today? And, and so I'm always like, I'm pretty sure I'm really well hydrated, but just for fun, I'm gonna Dr. Try to drink a gallon of water today and see if that feels like my normal, cuz I, I was saying like, I feel like I kind of, I probably do drink about a gallon of water a day and lemme tell you something. I do not drink a gallon of water a day because I filled. A empty milk carton, full of water and drank it all throughout the day. And by like 10 o'clock at night, I was like, I cannot, I cannot not getting more water. So these poor kids that are like chugging glass after glass, after glass, after water, I know they feel thirsty, but it also has to feel miserable to be drinking that my, maybe not cause it is leaving their body, but anyway, just a thought

Miranda: 12:25

but yeah, just that constant process of in and out. Ugh. Yeah. Oh,

Katie: 12:30

All right, well, we are gonna dive in cuz like every chapter in this book it covers a lot of information and there are a few sections in this chapter that we're just gonna quickly breeze over and I'll explain why when we get to 'em. But like I said, this chapter is beyond the basics. So Miranda, in your opinion, what do you think the author's goal for writing this chapter was.

Miranda: 12:51

I mean, I think he's really just trying to give us an overview of all of the medications and factors that go into diabetes. No matter what type of diabetes you're treating.

Katie: 13:05

Yeah, I totally agree. I mean, I feel like this chapter is kind of divided into two sections. The first section just goes over the different types of diabetes or he calls it diabetes or something like that. He makes a joke out of it. And then the section section goes over the five major factors that affect blood sugar. And yeah, I mean, I think this is just like the foundation of it all. I kind of think of it as, you know, you go to kindergarten and you, well, not, not really kindergarten anymore cuz people learn their letters and numbers in preschool now. But if you, if you don't learn your letters and your numbers and the sounds that they make the letters at least like you're not gonna be able to read, you're not gonna be able to write. You're not gonna be able to do math. So, so this is kind of like those building blocks to build a solid foundation before you can kind of. Move on to the next level and progress. And I mean, could you manage diabetes well without knowing any of those things? Yeah, probably, but I think it's, for me, at least it's extremely helpful to understand kind of the differences between the diabetes and the nuances and, some of the other major factors that affect blood sugar. So I think it's a great chapter. So before we dive in to the different types of diabetes, I'm gonna briefly go over what a normal pancreas does. So this would be normal pancreatic function in someone without diabetes. I think this is fascinating and it, because the pancreas is a tiny slimy organ, but it is extremely complicated and, and everything it does, it's extremely important. So I think we take our pancreas for granted, for sure. Those of us that don't have diabetes.

Miranda: 14:38

absolutely.

Katie: 14:38

Yeah. And it helps me too on really rough days to remember how complicated the pancreas is, because, as you'll hear in a second, like it's not just the fact that we, our, the, you know, somebody with diabetes, their body can't make insulin anymore. It's it's, it affects the whole line of communication within the pancreas. Okay. So first I'm gonna give a brief overview of the eyelids of longer Hans, which I'm. I probably butchered that, but whatever we're gonna go with it. So the, those cells within the pancreas, there are three types of cells that make up the eyelids of lung longer. Hans there's the alpha cells and the alpha cells make the hormone glucagon. The gamma cells. make the hormone somatostatin and then the beta cells, which we all know and love constantly measure blood glucose levels and make insulin as needed. And then they also secrete a hormone called amylin. That helps regulate how quickly food is digested. So essentially amylin slows down digestion. So, you know, everybody thinks like, oh, type one, the beta cells get destroyed and there goes the insulin. Well, it's not just the insulin, right? You've lost your monitor for how high or low the blood sugar is. And you've lost that other hormone amylin, which is really important in digestion. And is one of the reasons why people with type one. A lot of the times have really bad after meal blood sugar spikes because that amylin is also missing. So these four hormones are constantly working together. They're constantly communicating to control the flow of nutrients, mainly glucose into and out of circulation. So a normal pancreas. I love how the author compares a normal pancreas to a thermostat in a house. It is constantly monitoring blood sugar or in, in this case, you know, comparison with the AC unit, the temperature or the thermostat, the temperature in the home, and it's adjusting insulin accordingly. So under normal circumstances, when someone's blood sugar drops, the pancreas will back off on the amount of insulin that it's secreting and it increases the production of glucagon from those alpha cells. So glucagon, you know, if you're the parent of a type one or type one, you carry it around with you. Glucagon triggers the liver to release its stored glucose. So that job. So then again, under normal circumstances, when blood sugar rises, the pancreas increases its secretion of insulin. So insulin can help transport glucose into our cells for energy. And then this is fascinating to me under normal circumstances, the pancreas keep your blood sugar between 60 and one 10. That was the normal reference range given in the book and Miranda. I don't know. I wanna, I wanna know if you've recently had any blood work done cuz I had to do, I have to do fasting labs a couple times a year cause I have thyroid issues and my fasting blood glucose level last time and I had it done at 7:00 AM because I'm a wimp and go more than like two hours without eating. So so I schedule my appointment for real early so I can eat breakfast, but it was 73 and I felt fine. I was breathing. I was, you know, I was, I felt perfectly fine. I didn't feel shaky or any of those symptoms that we, you know, think of for low blood sugar. you know, I, I think that's, I, I just want parents to know that and hear that because, you know, do I want my daughter sitting around 73 all the time? If she's watching a movie on the couch, sure. I'm fine with that. But I think a lot of us kind of freak out when we see that number. So just, you know, just FYI that's kind of normal. So have you had any blood work done recently?

Miranda: 18:11

I haven't recently? but reading this and I, I would say probably like in the last six months, yeah. I've had blood work done and I think I was about 89 for fasting, but when I was pregnant, I think I had had a 68 at some point that was like, you know, that made sense to me with all the nausea and all of that that goes alongside with pregnancy. But I love hearing you talk about that number being in the normal range, right? Like that 73 and not freaking out about it, because I think so many people that are newly diagnosed, you're like, oh my God, we're under 75, pull all the juice out, all of that. And then all of a sudden you've spiked their sugar really, really high. And I think it just takes a bit to get comfortable with being okay in the, you know, in the seventies to like watch and see what's gonna happen.

Katie: 19:02

mm-hmm

Miranda: 19:03

with the tools, once you have the, the tools there to help you monitor that and know which direction your glucose is going in. But Yeah. hear 60 to one 10, it definitely makes you, makes you think a little bit more when you're trying to be the, pancreas parent

Katie: 19:20

Yeah.

Miranda: 19:20

for your child.

Katie: 19:21

I keep meaning to check my blood sugar. Like sometimes I do get lightheaded. Like if I, if you know, I haven't eaten in a while and I just went for a walk or, you know whatever, I get a little nauseous and lightheaded, and I'm curious to know, I'll have to try to catch it if I have my daughter's glucometer to see if it's you know what it is? is it 60? Is it 50? I don't, you know, or is it 85? And I just happen to feel lightheaded. Who knows?

Miranda: 19:42

Right. And we've done, we've done that too where we've checked our glucose and it's been like, oh man, like I kind of almost feel guilty.

Katie: 19:51

yeah.

Miranda: 19:51

I ate more sugar than you in my body is working really well to manage that and yours isn't. With her younger sister, we went through a period where a younger sister wanted to be tested all the time, too. And so there was a couple moments where we did test her and it was like, oh, you're at 80. And your sister's at one 60 and you had the same food, same lunch. And interesting to see those things alongside each other.

Katie: 20:16

know that comparison. I know we kind of stopped doing that just cuz I would feel bad, you know, I'm like, oh I'm at a, I'm at 95 and yeah, you're at 1 75. Yeah. And it's funny too, when you have the perspective of a type one, like you like for instance, I've, you know, one of my family members, I guess recently their D doctor was concerned cuz their fasting glucose was high. And I was like, oh, what was it? And they were like, it was one 20 and I was like, oh one 20 that's that's great. I would love to be at one 20 all the time. But anyway, everything

Miranda: 20:46

yeah.

Katie: 20:46

fine with in that situation, but. It's just funny when you have those type one glasses on, you're like, oh, that's not that bad.

Miranda: 20:51

Right, right.

Katie: 20:52

Yeah. All right. We are gonna dive into the different types of diabetes, mainly type one and type two there of course are other types. And I will briefly go over those, but we'll spend a little bit more time on type one. So Miranda, I'm gonna let you talk about type one first, if that's okay with you.

Miranda: 21:07

yeah. So with type one diabetes, what happens is the beta cells are attacked and destroyed by the body's own immune system, which really is an autoimmune disease. So beta cells are no longer able to provide insulin or produce insulin. And this could really be diagnosed at any age, which is why the author kind of makes it clear that we no longer call it. Juvenile diabetes. We really label it as that type one diabetes. And it can be triggered by many things, illness, stress, exposure to food, chemicals, trauma. Those with type one are dependent on insulin, but they can also become insulin resistant, which is what we typically see with a person that has type two diabetes or is the main cause of type two

Katie: 21:50

Yep.

Miranda: 21:51

So the signs and symptoms include weight loss. And for us, we didn't actually see a lot of weight loss, but with a growing tether, we didn't see weight gain. that was one of our big indicators, the reason. You experience weight loss, your body is breaking down fat a rapid pace to use it for in energy. And you're urinating out most of your calories because the glucose is spilling out of, into the urine you experience. Excess of thirst. The kidneys are constantly trying to dump out all the extra sugar and that sugar is pulling a ton of fluid out of the body. Along with it. Think back to what we talked about, those like buckets of urine coming out. And so your brain constantly thinks you're thirsty. Along with the excess of thirst, excessive urination, your body's trying to get rid of all that sugar dehydration, low energy, your body doesn't have access to the fuel that it needs to

Katie: 22:46

mm-hmm

Miranda: 22:46

which is glucose. not able to U utilize it. And then excessive hunger. your blood sugar is high, your body can't use it. So your brain's getting signals that you're starving, is just leads to a vicious cycle.

Katie: 23:02

Yeah. Yeah. Cuz then you eat and then your blood sugar goes higher and around and around we go. Yeah. So that's that's really it for type type one. Well I say that's it, we all know it's way more complicated than that, but but I, you know, reading this chapter, I'm like, okay, it seems like type two is way more complicated than them type one. So I'll go over type two diabetes. Approximately 90% of diabetes out there is type two. I. Actually accidentally hopped onto a live Instagram video with a WebMD doctor a week or two ago. And he just happened to be talking about diabetes and I'm like, well, this is convenient. And, but it, it was type two. And he, the numbers that he was giving out were astounding. And I'm pretty sure he was only talking about America, the us, but over it's like a little bit over 50% of the population of the United States has either type two diabetes or prediabetes. That's crazy. So type two diabetes, unlike type one is not an autoimmune disorder. So the beta cells in the pancreas continue to produce insulin. However, the body is no longer able to use insulin properly or efficiently, and this is called insulin resistance. So this can be caused by a combination of genetics and lifestyle choices. There are three stages to type two diabetes that the author describes in the book. Stage one, he calls the resistance. I feel like there was a star wars theme going on here. Yeah. So stage one, he calls the resistance. So just in everybody's body, insulin attaches to a receptor on the, the wall of every cell that there is in the body to allow glucose in. So if there are not enough receptors on the cell walls, or if the insulin in the body cannot find or fit properly into those receptors, then insulin resistance occurs. So things that can cause insulin resistance genetics, like we just said. So the natural aging process, we all become a little bit more insulin resistant as we get older. Certain ethnic groups are more at risk and I apologize. I did not write those down, but certain ethnic groups are more at risk for insulin resistance. Polycystic ovarian syndrome, pregnancy hormones can cause insulin resistance, stress and illness, a lack of physical activity. So sedentary lifestyle insulin resistance, inducing hormones, which we're gonna talk about that in a little bit. Steroid medications, such as prednisone and cortisone. And then the number one cause of insulin resistance is weight gain. And this is a, a crazy statistic to me. It says gaining as little as 10 pounds over a 15 year period can cause insulin resistance to double y'all. I gained 25 pounds over the pandemic. So over the course of two years, I have gained 25 pounds. I'm just slowly working to get that off. But I was like, oh my gosh. As little as 10 pounds over 15 years can double it. That's that's crazy.

Miranda: 26:02

Yeah, that, I mean, that just shows you like how sensitive of a system

Katie: 26:08

Yeah, I know it is wild. And unfortunately, those individuals that are obese are seven times more likely to develop type two diabetes. Okay. So that was stage one, the resistance insulin resistance. So stage two of type two is the production shortfall. So it's not enough to just have insulin resistance, like just cuz you are insulin resistant doesn't necessarily mean you have type two diabetes, but it's the combination of insulin resistance and a pancreas that cannot keep up with the extra workload. again, I think we go back to the air conditioning unit analogy or metaphor with this one. He, the author compares a pancreas to an air conditioning unit on a really hot summer day. So he says to think of the heat and then humidity outside, like insulin resistance. So that's working against your air conditioning unit, right? Like it has to work extra, extra hard to keep up with that heat and humidity and keep your house cool. So an efficient system, like an efficient pancreas can meet the challenge and can keep up with that. But a lesser system cannot. So early stage type two diabetes. You can, people can usually manage with diet exercise, and maybe some medications that kind of like help out the pancreas or help out the insulin that's already in the system. But it doesn't usually stay like that forever because type two, diabetes is a progressive which means it does get harder to control over time. And then the last stage of type two diabetes is stage three function reduction. So like I just said, it's a progressive disease. Insulin resistance does tend to get worse as you get older and the pancreas tends to struggle more. So eventually it starts to break down just from overuse, just like an air conditioning unit that would be constantly 24 7 running to try to keep a house cool in, you know, blazing, hot temperatures. It's running at full blast all the time and it just eventually starts to break down. And apparently if you have high glucose, you know, high blood sugar levels, that is, that is very toxic to the pancreas. So that glucose toxicity can actually start to cause pancreatic breakdown. So it's usually at this point that type two diabetics have to start taking insulin. So I think this is a, a good thing to remember, cuz I've, I don't know about you Miranda, but I've had some people say like I'm, I'm gonna word it wrong, but they've kind of asked me like a version of the question, like, okay, so your daughter has type one. Like, is there any way that she can have type one and type two or you know, things like that. And the author makes a point that it's what causes the diabetes that defines what type of diabetes it is not how it is treated. So like someone with type one who develops insulin resistance, it's not like they now have both type one and type two or a combination. And then similarly, someone with type two who eventually needs to be on insulin does not now have type one or a combo of both. It's what causes the diabetes to uh, to define it

Miranda: 29:04

Right. I think that was a really clear distinction he gave.

Katie: 29:07

Yeah. Let's see. Let's. Well, before I move, I'm gonna briefly touch on the other types of diabetes, just a quick breeze over, but any, anything to add or say about type two? I like covered a lot of it.

Miranda: 29:20

Yeah. I mean, I just love his analogy about an AC unit running and just the thought of like, not every individual person's body works the same. Right?

Katie: 29:30

Mm-hmm

Miranda: 29:30

expect that the same behaviors are going to lead to have two where their pancreas is struggling. So, I mean, just remembering that your body is different. Some from somebody else's and doing what you need to take care of your own system

Katie: 29:47

mm-hmm

Miranda: 29:47

I, I just really liked his

Katie: 29:49

Yeah, I did too. All right. We're gonna go over those other types of diabetes, which in the book. He compares 'em to ice cream flavors. I won't, I won't, I won't throw those names out right now, but I'm a, again, I'm gonna, I I'm gonna say this at the beginning of every episode in this series, but like, do not rely on me and my guests to tell you everything about, like, you need a copy of the book because there's a ton of charts in here and there's graphs that you're gonna wanna see, like get yourself a copy. It's 1299 on Amazon people. We can do it. Okay.

Miranda: 30:21

Yep. Yep.

Katie: 30:23

all right. And the author sense of humor is is definitely great. I really appreciated his sense of humor. Throughout. So let's see, there are other types of diabetes, secondary diabetes is insulin dependent, just like type one, but the cause is different. So it's something other than an autoimmune condition. So like somebody who was being treated for cancer and had radiation or part of their pancreas removed somebody who was in a really bad car accident and had trauma to the pancreas heavy doses of steroids can cause it alcoholism pancreatitis or infection of the pancreas. So. Kind of treated the same as type one, but the cause is different. Then there's gestational diabetes. This is usually a temporary situation when women are pregnant. Because as I briefly mentioned before, pregnant women produce a whole lot of insulin opposing hormones, and that causes insulin resistance. And that type of diabetes can usually be controlled with diet and exercise. But a lot of times women who are pregnant do wind up taking insulin while they are carrying their child. And apparently I did not know this, but women who develop gestational diabetes are more at risk for developing type two later in life. I did not know that.

Miranda: 31:32

That was definitely something that was shared with me when I was pregnant.

Katie: 31:36

yeah. yeah. And fortunately, I did not have to, to deal with gestational diabetes, but I have some good friends who did. Yeah.

Miranda: 31:44

I didn't. So I didn't have gestational diabetes, but like just those statistics, I think. So for myself being a plus size mom and having those statistics put out there and like failing the first sugar test and then going for the second one, you know, they're sharing all that information with you.

Katie: 32:01

Yeah. That was side note. That was like one of the worst mornings of my life, especially with my first child, because I was already so nauseous. Like I was one of those people that was vomiting all the time and to make me not eat and then have to go and drink. Liquid. Oh, it was, it was awful. It was so awful. Whew. It's get, it's like making me sweat, just thinking about it right now. So glad that's over. All right. Another type of diabetes is I think you say it Modi. At least that's a, that's how I say it. So Modi stands for maturity onset diabetes of the young. So this involves a single genetic defect that limits the pancreas's ability to secrete sufficient amounts of insulin. This belongs to a group of conditions known as monogenic diabetes, and is usually diagnosed during puberty. And it says they may require oral medications or insulin to treat neonatal diabetes develops in the first six months of life cannot even imagine having a itty bitty infant with. Diabetes. But like Modi it's also monogenic and a single genetic mutation. It's a single genetic mutation that limits the beta cell's ability to produce insulin. So interestingly enough, a lot of times it disappears in infancy, but then will reappear later in life. And it almost always requires insulin to treat because otherwise the baby can't grow and develop properly. And then the last diabetes on the list is, again, I say Lata. But I guess it could be later, I don't know, latent autoimmune diabetes of adulthood. So Lata people call it type one and a half because it shares many characteristics with both type one and type two it's it's almost like an extremely slow progressing type one diabetes. So the beta cells get attacked, but the, the tack is like incomplete. And so you're, they, they can still produce a little bit of insulin and it can last for years and years. Oh, did I cut out? Okay. I, it still recorded me even though it went out so we don't need to worry about it. Oh, Can you hear me now?

Miranda: 34:03

I can.

Katie: 34:04

Okay. So the good thing with this program is even if like I cut out on your end, it's still recording me. So that's,

Miranda: 34:12

Okay.

Katie: 34:12

that's a bonus.

Miranda: 34:13

I'll do my best to not talk over again. I'm sorry. I, I, after I was like, oh shoot, it's still recording her. And I'm interrupting. So I'm sorry.

Katie: 34:21

Oh, it's quite all right. We we, yeah, the technology is the funnest part about having a podcast. And I say that with very sarcastically

Miranda: 34:30

right.

Katie: 34:31

all right. So again, you're gonna need a copy of the book because on page 46, there's like a super handy chart that condenses all the different types of diabetes, the causes and the treatment options. all right. We are moving on to part two of the, this chapter, which are the major factors that affect blood sugar. And he mentions five major factors that affect affect blood sugar. And then at the end of this chapter, there is another very handy chart that mentions all of the other smaller, secondary factors that affect blood sugar. Cuz we all know that it's not just five factors that affect blood sugar. The list goes on and on and on. So, but these are the five main ones. before we jump into that blood sugar comes from two sources, internal and external internal means like your body is the one producing it and it's, that's the main culprit in this is your liver. So it secretes It's stored up glucose, which is called glyco gin. so it comes from your liver and then apparently your muscles secrete some, some glucose, so that can affect your blood sugar. And then of course, external that would be the carbs we eat. And sometimes protein protein, especially if you follow a low carb diet. So regardless of where it comes from, the body will break it down into glucose, whether it comes from internal or your brain and your nerves can only be fueled by glucose and the, your muscles also require it during exercise. So bottom line, you cannot live without glucose. All right. The first major factor that affects blood sugar is. Insulin surprise. Surprise. am not gonna sit here and list out all the different names of insulins that are on the market. Cause there's a lot and I don't think anybody really wants to hear that. Again, table three, three in the book compares all the different types of insulin. So it gives you a really nice visual about how each insulin takes to start working when it peaks. So like when it's the strongest and how long it typically stays in the body you know, without naming brand names, there's rapid acting insulin, ultra rapid acting long acting, regular acting, which is one of the older insulins and then intermediate acting, which is NPH also known as NPH, which is usually associated with kind of like back in the day, an older type. So Miranda, what about you guys? Are you on Is your child on MDI still? Are you guys on a pump now?

Miranda: 36:59

actually. Pushed for a pump and were to that point within about a month and a half of diagnosis.

Katie: 37:06

Okay. Real a month and a

Miranda: 37:07

yeah. We we, we switch, we switched endocrinologists to somebody that was really supportive of technology. I mean, we felt very confident with our skills, with MDI and just knew were gonna be

Katie: 37:20

half.

Miranda: 37:21

of technology and,

Katie: 37:22

Mm-hmm

Miranda: 37:23

and went that way quickly

Katie: 37:25

yeah, that's awesome. It took took us six months. So what insulin do you guys use in your pump?

Miranda: 37:30

FIAs. We

Katie: 37:31

Oh,

Miranda: 37:31

with Novalog and or no, I think that I'm thinking back on it, so we are on FIAs, but we've been on FIS the whole time that we've pumped.

Katie: 37:41

and you guys are on Omnipod.

Miranda: 37:43

Mm-hmm

Katie: 37:44

Yep. Okay. I had it on my list of things to talk about at our last appointment is to maybe try, give FIAs, but try because our insurance will cover it, but we, we have so much Novalog in our refrigerator right now that I'm like, we're just gonna, we're gonna work our way through some of this. Like, I would feel bad wasting all this insulin. But so FIAs, do you have the book sitting in front of you? Any chance? Yeah, I'm gonna actually grab my copy. It's like sitting right over there. Hold on. So FIAs works really quickly, right?

Miranda: 38:12

Yes. It, it definitely works really quickly. And for us, we were not as comfortable her. ahead of time. This is why we kind of, our endo said, let's try, give FIPA try because with the toddler, I mean, you never know they, you know what they're gonna say, they're really, really hungry. And then all of a sudden you've eaten two green beans or maybe not two green, maybe two goldfish crackers. And then and then of if you have already predo them. So if FIAs was the recommendation for us, just so we could a little bit closer to meal time and we think it's worked well for us. We do know sometimes it hits her faster than her carbs. So we've just constantly are kind of figuring that out. Or maybe we encourage her to eat something that we offer on her plate that we know will spike her. Like if we notice her numbers are starting to go down, oh, well, you know, have the dip some more ketchup in your fries or whatever, you know, to it, her sugar back up as she's eating.

Katie: 39:11

Yeah. I that's so interesting to me. Well, I do wanna try it one day, but yeah, so like this chart for instance says, FIAs will start working in five to 10 minutes and I've heard you can even give it like right when you eat or even a little bit after you eat, because remember digestion usually takes like 15 or 20 minutes to get, get going. Well, well, I guess that depends, but anyway, so my daughter's on Novalog and that. It's a little bit different it's it starts like it starts working 10 to 15 minutes after you give it. And honestly, for us, it's longer for us. It's usually 15 to 30. It depends on the time of day and how active she's been. But I really like that handy chart. You guys can get a copy of the book and check it out. The most interesting thing to me though, is the comparison between the long acting insulins, which we're not on a long acting insulin anymore since we're on a pump, but we were on, well, we started out on Bela and then we switched to Traba and the. I'll tell you what I, this is not an ad for Truva. If truce would like to sponsor the show, I'm here for it. So, you know, gimme a call, but I love Truva like, I can't even explain. Cuz if you look at this chart, it BA are in Truva look like they're pretty much pretty, pretty darn similar other than the fact that TBA stays in your system a little bit longer. But it just, it just was amazing. It just, I held my daughter study so well, especially at night, which if we're getting more sleep, we're all, we're all happy about that. Right?

Miranda: 40:35

Yeah. I agree. We, when we were on MDI, we switched from the, I think we were on LTIs to Truva and we liked Truva a lot more too.

Katie: 40:45

Yeah. So I'm gonna briefly kind of go over just so the action of insulin depends on of course this is all in the book, but the concentration, apparently there's different concentrations of insulin. Like for people that are super insulin resistant, need a higher concentration, or maybe a toddler might need a lower concentration, So it's not a strong the rate at which it's absorbed into the bloodstream. So the abdomen absorbs it, the quickest, then the arms, then the legs, then the buttocks. Unfortunately my daughter will only wear her Omnipod on her thighs right now. So I feel like we maybe have to push more insulin than we would if it was on her abdomen or her arm. But that's just my theory. Um, And then of course, how sensitive the body is to it. Some people are just more sensitive than others. Let's skip two. So we all know these tips and tricks to keep your insulin working well. Well, I shouldn't, as, I shouldn't assume some of us might not, but you wanna rotate your sites, right? You wanna store your insulin properly. You don't want it to bake in the sun or freeze in the snow apparent. Apparently you can use insulin after it expireds. It just might not be quite as potent. For those who are mixing insulin like MPH you, you wanna make sure it's mixed properly. So like rolling it in between your palms. I don't have any experience with that. So I can't talk about it, but apparently you want it to have a nice even cloudy experience. You wanna get out all the air bubbles, and it's easier to get out the air bubbles when the insulin is at room temperature. So maybe have it sitting out for a little bit before you fill up your pump or your syringe. you wanna find the right injection depth? So the goal is to get it the insulin into the fat. So needles can be too long and they can also be too short. And if they're too long, you risk. Having the insulin go into the muscle, which like supercharges the insulin and it acts really, really quickly. And that's for short acting insulin or fast acting insulin and long acting insulin. Like if you accidentally injected your long acting insulin into the muscle, it can cause severe hypoglycemia cuz it can speed up. That insulin uptake like significantly. So anyway, kind of good, good rules of thumb are to pinch up the skin. If the needle is longer, maybe inject at an angle, but pinching up the skin and counting to 10, to make sure all the insulin gets in to your body. And then if you, you or your child are terrified of needles, there are a lot of things that can help you with that. There's lots of devices to help you with that. And chapter 10, that's what chapter 10 is all about. Like all the resources that can, can help you. So we'll get to that. So do you have any like comments or personal anecdotes on any of that, like storing insulin or using expired insulin? Anything.

Miranda: 43:26

not an expired insulin. We haven't gotten to that point yet. we felt comfortable. Storing. I mean, we, we keep it in our butter dish area in our fridge, like they all recommend. And like

Katie: 43:38

Hm.

Miranda: 43:39

of ways to assist with like the fear of needles, we did get a buzzy right after we outta the hospital. But that didn't last for very long. Honestly, it turned into more of a toy than than a, you know, she wanted to play with it more than she wanted to have it actually be used during And honestly for us, our best tool has been distraction. You know, we Don. don't watch a ton of TV all, all of the time. So utilize that when we do pump changes or when we have to do injections or any of that that works as a good tool for us. And actually recently when we're doing Omnipod what works for her is kind of desensitizing her by like, we just take our fingernail and we poke around her we're injecting. And it desensitizes her, I think kind of in the way, like those shot blockers do, but we just kind of go all around her pump with the hand that we're not using to, pinch up with, and that has worked really well to desensitize her and from an early intervention perspective, on my end, I think about like OT protocols, where they do brushing or things to desensitize the skin. And so it makes sense to me that, you know, having some other sensory input to the area prior to injection or at the same time kind of diffuses that.

Katie: 44:58

That's great advice. I love that. Yeah, we, we had never had to buy anything to help with that. Thank goodness. But I mean, I've heard like, like I've heard of the buzzy that you had, I've heard of the tickle flex, which kind of, I think the tickle flex kind of does what you just mentioned. Right? It's just this little device that kind of. Almost tickles the skin around the injection site. So it takes your mind off of it. And then, and then what, oh, the Medtronic eye port is a big one that people use to help with all that. So it's just, well, I there's a whole episode on that. I'll link to it in the show notes, but okay. So that was factor one insulin factor, two diabetes medications, other than insulin. Okay. Listen, we are not going into detail on this section because I could probably sit here and talk for 45 minutes about the other medications that you could take other than insulin to help manage diabetes. So the reason why I'm not gonna talk about it, at least not on this episode, I think it's fascinating. And I am considering doing a completely separate episode where, where I go over it, cuz I, I think some people would like to know, but the vast majority of these medications are for type two diabetics and. Every one of them, except for one which is Metformin is, are not, is not approved for use in children. So since the majority of the listeners on the podcast are parents of type one diabetics, we are gonna, I'm gonna just briefly breeze down this list and then we're gonna move on to the next factor. So there are all types of ORMA medications that you can take other than. There are pills that make you pee the sugar away. There are pills that help the pancreas indirectly. There are pills that block digestion, there are pills that increase the sensitivity of the body's muscle and fat cells to insulin. There are pills that reduce the liver's production of glucose, and there are pills that help you make more insulin. And then I will briefly go over Metformin, just cuz that's the only one approved for children, but pills that reduce the liver's production of glucose. So that is Metformin. Apparently your liver can over produce glucose and Metformin inhibits this. It is approved for ages 10 and up. I do not know anybody with a type one diabetic child that has their kid on Metformin. If you are listening and your child is taking Metformin, I would love to talk to you and learn more. But apparently Metformin can also improve blood pressure and insulin sensitivity. It's safe to use during pregnancy and it's often used with other medications. And then the, the warnings against it are, do not use it. If you have any type of kidney disease or if you have liver problems. Yep. So those are the ones you take by mouth. There are also two injectable non-insulin treatments for diabetes. Again, not going over these in detail, at least not in this episode, but they are GLP one receptor agonists. Those are mainly for type twos sometimes for type ones. And then there is pramlintide also known as Simin. So that's for type ones and type twos who take mealtime insulin. So pramlintide is the synthetic form of the hormone amylin, which is the other hormone that the beta cells secrete, which helps slow down digestion so that medication can help with like, after meal spikes. I kind of wish this one was approved for use in children. But at the same time, I've heard there's some pretty bad side effects. So I don't know if I'd really wanna go down that road.

Miranda: 48:11

I thought that was interesting. I hadn't read that before, and I'd be curious as they use that or, you know, have more trials on what ends up happening or being recommended if that gets used in collaboration with insulin more frequently.

Katie: 48:27

Yep. I would too. I, I would too. All right. We're gonna move on to factor three, which will come as no surprise that the third major factor that affects blood sugar is food So every single thing we eat affects blood sugar. It is not just carbohydrates. This was not something that was covered in the hospital with me. I, we were BA carbs. It was all about the carbs, but protein, especially in the absence of carbs. So if you're gonna wake up and have a breakfast of eggs and bacon protein can affect your blood sugar, it just usually happens hours after the meal. But your liver can break down dietary protein into glucose. So that's why it affects blood sugar. But again, that's usually when there are, there are not any carbs mixed into the meal when there's carbs mixed in the body, usually ignores the protein and doesn't need to break that down into fuel fat. Affect blood sugar for sure. The usual effect is pretty minimal, but if it's like a really big fatty meal, I like to think of pizza Fe Alfredo gives us a really hard time. This will slow down digestion and will slow down the breakdown of carbs. So in other words, it just takes a while for the carbs to kick in. It's not that you, well, you might have nailed the bolus, but a lot of times it just takes a while for those carbs to kick in. Apparently also when there's a lot of fat in a meal, it increases the level of triglycerides in your blood, which causes the liver to become very insulin resistant. And when the liver is insulin resistant, it releases more of its stored glucose. I don't, I don't feel like I really understand why, but just know. That that's what it does when it's insulin resistant. So again, like I've already said high fat meals can cause a delayed rise in blood sugar hours after a meal's consumed and it can usually keep your blood sugar up for a very long time. The last thing in the food section of course, is carbohydrates there. All sorts of different types of carbs, simple and complex. We're not gonna go into a detailed discussion on that right now. But I guess it's worth saying that simple carbs are usually the more processed foods. They affect your blood sugar a lot quicker than a complex car that might take a little bit more time to, to break down. I just wanna make a note about artificial sweeteners because. I just want like read the food labels carefully because just because something is sugar free does not mean that it will not affect your blood sugars. Like it's could still have a very big impact on your blood sugar. The only sugar substitutes that have a little to no effect on blood glucose are saccharin. I'm gonna say this one wrong, but it's K SLO Stevie leaf extract in Aspert tame. So those are the ones that have been shown to, to have little, to no effect on blood glucose. But you guys be careful with those because they can cause tummy upset. They can cause joint pain, headaches. I had a really good friend who legit thought she had multiple sclerosis because she was having so many neurological symptoms and they did every single test under the sun to figure it out. And it turns out she was drinking too much Coke, zero. So

Miranda: 51:29

Wow,

Katie: 51:30

so, and she stopped drinking that and all of her symptoms went away. So it can, it can affect your nerves as. So read your labels

Miranda: 51:38

right.

Katie: 51:38

that in mind. Yeah. Do you guys eat low carb?

Miranda: 51:41

we do not. I mean, we kind of prescribe to the, we're dose your insulin based on what you eat and you know, just try and do what we can to have a, be healthy, a balance diet for her.

Katie: 51:53

Yep. I agree with that. That's kind of what we do in our house too. Have you, what about the protein rise? Like in the absence of carbs, have you experienced that?

Miranda: 52:01

No, because we struggle to get protein in

Katie: 52:04

Mm-hmm

Miranda: 52:05

and she's still little so like our main source of protein is meatballs Other than that, she, it takes a lot to get her to include more protein in her diet. But from, from fat, oh my gosh. Bread. Like when we have pizza night bread sticks, we know we're gonna be, you know, giving corrections for like four hours or, you know, we can't give it all right away. We've made, we made that mistake, I think, twice of giving her, her whole dose and then that hitting her

Katie: 52:33

Mm-hmm

Miranda: 52:34

low. And then all of a sudden later on going, oh my gosh, are we this high

Katie: 52:39

Right, right. And then there's the whole issue with like, in that situation, cuz we've been there too, like then you have the rebound high too. So it's like not only this high from the delayed breakdown of the carbs because of all the fat, but you're also now dealing with a rebound high, which I think the book goes over rebound highs in more detail later. But if not, I'm gonna ask the author about that, cuz that's kind of a fascinating thing that I'd like to understand a little bit more. But yeah, we already talked about it. I mean heavy fat foods, Italian foods, pizza fettuccini Alfredo that's that is no good. I mean we gotta really come at that with a lot of insulin and usually we, especially when we're at a restaurant, what I like to do is give a lot of insulin, which I know some people think that's careless, but I don't give it all at once. Like with the Omnipod I'll give. Half of it up front and then extend the rest for like four or five hours. And that seems to really do well for us. But man, if you miss that bolus, yeah, she'll be high for the whole night. we have been there a few times. Alright. Factor number four is physical activity. This, this one is fascinating to me and I'll tell you why, but so every, when you are exercising, you have to have glucose. So everything needs more energy and fuel during exercise that fuel is glucose. Physical activity actually improves the way insulin works and increases insulin sensitivity. So it can actually physical activity can cause the body cells to make more receptors. So remember we talked about insulin has to attach to those receptors in order to open up the cell and let the glucose in. So when you're exercising, your cells actually produce more of those receptors. So it's easier for insulin to find and attached to. And then those, those, the like the part of the receptor that the insulin attached attaches to actually becomes bigger. So it's easier for that insulin to fit into. This is like the key going into the keyhole, right? Like it's easier for that key to fit in and open up the cell wall. Plus, and this is the really fascinating thing. Apparently new, special types of doors form. When you are exercising on the outside of a cell wall that will allow glucose in without insulin. And that's why people say that exercise is like free insulin. That doesn't last forever. It is temporary. It will kind of stop a little while after you're done exercising. But he, the author, the author refers to those special doors as like revolving doors that are just constantly letting the glucose in. So, and re remember people like physical activity does not have to be going for a run. Like my, I can work up a sweat, folding, a load of laundry or mopping my floor. So it's

Miranda: 55:15

tantrum. Right?

Katie: 55:16

girl. Yes. Do you see her? Does she drop with temper tantrums or rise?

Miranda: 55:21

We, have noticed drops when it's physical activity like paired with a temper tantrum. As of late, it's been learning to bike ride, which is like stressful for her or something new. So we got physical activity and then a meltdown, and then all of a sudden we crash and

Katie: 55:38

Hmm.

Miranda: 55:39

yeah.

Katie: 55:39

What if it's a tip or tantrum in the absence of physical activity, what do you see with her blood sugars then?

Miranda: 55:44

We haven't noticed like a market difference, but I think part of that too, is she's, she's a little bit beyond like that for us, it's like more of a other way. We're like, oh gosh, she's really high. Or, oh, you are dropping so fast. Like we noticed. Her numbers are off and then we're seeing the behavior. If that makes sense, like, it feels like the sugar is kind of sparking those behavioral changes instead of

Katie: 56:11

I see.

Miranda: 56:12

the other way around.

Katie: 56:13

Okay. Yeah, that makes sense. Okay. So I know a lot of, have you heard parents say like my kid's blood sugar goes up when they're, you know, physically active or playing sports?

Miranda: 56:24

Yeah. Yeah.

Katie: 56:26

I've heard a lot of people say that. And so the author makes an interesting note that all physical activity exercise burns glucose. So if you're seeing a rise in blood sugar, when your kid is being physically active, it's not because of the activity itself, it's BEC it's from something that he calls or scientists or the medical world cause calls the body's stress response. So this is all those stress hormones where. You know, like during a competition where there's, you know, there's high stakes or during short bursts of high intensity activity, like a sprint or if you're being judged, like in gymnastics sports that involve quick bursts of movement or any activity where like your adrenaline is up. So that, that kind of causes the body to go into a little bit of like a stress response and stress hormones are released. And then that, that can cause the blood sugar to go up. So it's not so much the activity, it's the stress response. All right. Let's see, we've talked about the physical activity. Sarah has to, it depends on the type of activity for the most part. it depends on, it also depends on how much insulin she has in her system. Swimming is the worst. I've talked about that on the podcast before she drops like a rock. If she has insulin on board, when she's in a pool. So we have to be extra careful. She goes to dance three nights a week that doesn't really seem, I don't have to do any type of temp basal decreases for her to go to dance.

Miranda: 57:47

how is that for swimming with like the ducks come, not reading when she's underwater.

Katie: 57:52

Yeah, I usually it, again, it depends on how much insulin she has on board. So if it's not that much I'll and the Dexcom's not picking up, I'll have her get out every 30 minutes. And, and then of course, if she's symptomatic, I'll check her before that, but I'll have her get out every 30 minutes. We'll do a check. If I know she has a lot of insulin on board, sometimes I'll make her wait to swim just cuz I'm like, Ugh. Or I'll check her more often. I, we have pretty good luck with our Dexcom in the pool. Like we put it in a water or put the phone in a waterproof pouch and put it right on the side.

Miranda: 58:25

Yeah, we've had, we've had not so good luck with the ducks come, like even in the bathtub with the phone really? close nearby. yeah. For whatever reason, but maybe it's cuz of where we place it. Like we put it right above her booty

Katie: 58:38

Mm-hmm

Miranda: 58:38

I've I've been wondering about that cuz we have, we had a few pool visits last summer, but we haven't kind of had those long days out at the pool and I

Katie: 58:50

Yeah.

Miranda: 58:50

be hitting that this summer, so

Katie: 58:52

Yeah. I, you bring up an interesting point because Sarah wears her decks come always on her arm. And so her arm is probably the part of, other than her face, which we're not putting the decks come on the face, but the, the arm is the part of the body that probably spends the most time out of the water. So that might be why we get better readings. Yeah.

Miranda: 59:09

I'm gonna have to think about that. Cuz maybe, maybe we'll change our placement. Come summer for See if it makes a difference.

Katie: 59:17

Well, if you do, and you see a difference, let me know. I would wanna know. All right. Miranda, we've made it to the last major factor.

Miranda: 59:25

yay.

Katie: 59:26

I know factor number five is stress hormones. There's a lot of. We're not gonna go over all of them in great detail, so stress, hormones, sex, hormones, growth, hormones, and glucagon all cause the liver to secrete glucose back into the bloodstream. Cortisol and growth hormone are produced in a 24 hour cycle. And those two cortisol and growth hormone are usually responsible for like the nighttime or, or early morning rise that people often see in blood sugars. The stress hormone epinephrine, which is also called adrenaline. Is produced when our body needs like a rapid influx of sugar for energy purposes. So like we kind of just talked about like sports that involve a lot of quick rapid movements. And then there's emotional stress. So fear, anxiety, anger, excitement, tension can cause the body to create stress hormones into the system. And then that causes the liver to secrete glucose and then physiological stress. So things like illness, pain, infection, injury can cause the body to secrete again, stress hormones into the system, which acts on the liver. What about, have you like, what's what stood out to you the most? When I was talking about all those different situations that kind of caused those stress hormones to be released.

Miranda: 1:00:43

Yeah. Honestly, what stands out for me? And this is just like my background. We talk about cortisol a lot in early intervention when I'm working with families on sleep and

Katie: 1:00:53

Hmm.

Miranda: 1:00:53

timing, getting their kids to bed. Right. Because if you don't, if you miss your window, the body cortisol to keep your child awake. And so that's the one that stood out for me. Like do see higher blood sugars on times when we have like, Big family parties. And we're gonna just be out later,

Katie: 1:01:12

Mm-hmm

Miranda: 1:01:13

and it's not even related to the food that she ate because she's usually so distracted that she doesn't eat a ton of food at big family parties. Like we had a, not that we've had a ton of family, big family parties, but like we had a we had our birthday party with my side of the family on Friday. And, know, we saw some rise there just because she was up later than

Katie: 1:01:35

mm-hmm

Miranda: 1:01:36

And that's the one that stood out to me cause I was like, cortisol. I know more about that. And you know, thinking about little ones with sleep. If, if they're up later than normal, they're gonna be producing more cortisol and you're gonna be seeing some changes as a of type one,

Katie: 1:01:51

Yeah.

Miranda: 1:01:52

watching for that

Katie: 1:01:53

Yeah. There'll be a lot more insulin resistance. Yeah. We've, we've, we've seen that for sure. Like on literally late nights, like new years and stuff like that, like it's well, and of course, new years, there's usually a bunch of junk food involved then too. So, you know, it's a whole, whole combination of the things. We, I see a lot in my daughter with test taking at school. That seems to be a very stress inducing time for her because I don't think she there's ever been a big testing day where she hasn't been significantly higher. And, and and I struggle with that because I want her to stay in range, but I also, if she's taking a test, I don't want her to also now have to be worrying about her glucose, like crashing. So I usually do a temp basal increase and maybe add a little bit of extra to her, like mealtime bolus on those days, but I don't go. Overboard. Like I'm okay with her. You know, I, I'm thinking about mostly like the St standardized testing, like the state standardized testing that we have. That's like a all day testing event. It's hard cuz you want her brain to be able to think clearly you want her to be in range, but yeah, it's just, that's a tricky situation for us. So we're working on it.

Miranda: 1:02:59

Absolutely. And I think those are some of the factors that a lot of like those of us parents who haven't experienced a school age will have to manage, but maybe that people don't recognize like one of the, the misconceptions that I've observed is people think like now that we have a pump or we have a CGM that we don't have to monitor and like, no, I mean, that's just such a great example of like, no, like I have to make all these changes to and adjustments to help her do something that maybe a child without type one, diabetes can just, they, I mean, they're gonna gro and and complain about having to go take a test, but don't have to have somebody in the background making sure that their sugar is not gonna affect their ability to take that test. I, I think, just think that that gets taken for granted sometimes that these technology, maybe yes, they make it. more convenient for us, but it doesn't take away that burden of. Balancing and managing all those intricate, intricate things that the pancreas does on its own when it's working properly.

Katie: 1:04:01

Oh, absolutely. And you're reminding me that I need to email her teachers about because she has those state testing. She has those state tests coming up. And I, I asked her, I gave her the choice. I'm like, do you wanna be in the room with everybody else? Or do you want cuz last year she like was in a separate room and she said she wants to be in a separate room again this year. And she's like, do I get extra time? And I'm like, well, you don't like if you have to stop testing because you're treating a low blood sugar or you're treating a high blood sugar, then yes, you get extra time. But like, you don't just get extra time because you have type one diabetes. Like there are.

Miranda: 1:04:35

Right's

Katie: 1:04:37

Right. yeah, I thought that was funny. I think she thought she was just gonna get to take her sweet time and do whatever, whatever she would like to do. Yeah. Gosh. Okay. So, and like I said, we're definitely not going over these, but there is a very handy chart in the back of this at the very end of this chapter that goes over all of the little, little things that can affect blood sugar and like, you know, it's things like caffeine and alcohol and, you know, so, so kind of the smaller stuff I think actually excessive sleeping and lack of sleep we're on the list is too. So that's an interesting chart to check out. Alright. The next, so we've kind of like chapters two, well, one, two and three kind of go over, like building the foundation. The benefits of managing type one. Well, and now the rest, most of the rest of the book actually dives into, you know, giving you tips and tricks on how to adjust insulin doses to keep blood glucose fairly stable in all the situations and with all the factors that we just talked about. So it's really gonna pick up in like the practical use and applying it to your everyday life from here on out. But Miranda, thank you for taking a deep dive with me into the nitty gritty. I appreciate it.

Miranda: 1:05:47

Yeah, thank you for the opportunity. And this has been a good, helpful push. I think for me to dive a little bit deeper myself as we're getting more comfortable with her management and yeah, I, I appreciate getting the chance to be on here and talk with you.

Katie: 1:06:01

I really loved it. And you were a great guest and, I appreciate your time for sure. I'm sure you have stuff to get done. You're a working lady.

Miranda: 1:06:10

Yeah, try and

Katie: 1:06:12

Yeah, I know. All right, well, thank you again. Have a fabulous day.

Miranda: 1:06:16

All right. Thanks so much, Katie.

Katie: 1:06:17

You're welcome. That's it for our show today. I hope you learned as much as I did with that one. The human body really is so fascinating, even when it's being a total jerk again, get your very own copy of think like a pancreas by Gary Scheiner today. So you can follow along with us. There will be links in the show notes for that as well as a link to Gary's company's website, integrated diabetes.com. Also in the show notes, we'll be a link to Miranda's Instagram handle at early intervention mama. So you can see what she's up to. Along with links to a few of the products we mentioned to make insulin injections hurt less. Last thing I recently recorded an episode with a mama whose daughter is taking Metformin, and I thought that was pretty fascinating. It's episode 70, and I will leave a link to that episode in the show notes as well. In my opinion, it was definitely worth a listen. It was a great conversation. Take a look and join us next week for chapter four, called the three keys to better control. All right. I will chat with you soon until then stay calm and Boless on.