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Aug. 18, 2022

#81 Think Like a Pancreas Chapter 9: Taming the Highs and Lows with Samantha

#81 Think Like a Pancreas Chapter 9: Taming the Highs and Lows with Samantha

Who's ready to think like a pancreas?! This is the ninth episode in our 10 week, Think Like a Pancreas Book Club Series and today I am covering chapter NINE called, Taming the Highs and Lows. My guest for this one is a spicy and strong T1D mama named Samantha who has also been living with type 1 diabetes for many years. This chapter gives some great tips for avoiding those scary lows and those pesky after meals spikes. Take a listen and, as always, let me know what you think!

Listen, if you have type 1 diabetes or your kid has type 1 diabetes or someone you love has diabetes or perhaps you have type 2 diabetes and are taking insulin, I can confidently say you need to own a copy of this book and actually read it. I call it my diabetes bible and refer back to it often! It will teach you how to manage your insulin better and empower you to make all those hundreds of daily diabetes decisions faster and with more confidence. I sure do hope you will follow along with us. See links below to get your copy from Amazon or get your signed copy from the author, Gary Scheiner, on his company's website,  integrateddiabetes.com. Enjoy!

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Episode on alcohol and Type 1 Diabetes!
https://www.sugarmamaspodcast.com/60-teen-series-part-8-drinking-and-diabetes-with-rachel-halverson-rn-cdces/

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Transcript

Katie:

This is episode 81 of the sugar mamas podcast, And we are still chugging along in our think like a pancreas book club series today, we're going over chapter nine, which is called taming, the highs and lows. My amazing guest today has not only been living with type one diabetes for several years, but she is also the. Of a little girl living with type one. In other words, she has a lot of insight and wisdom to share with us. I love this chapter, another great chapter. That's going to talk all about how to prevent lows and highs before they become a major problem as always, you can check out the show notes to find a link to where you can buy your very own copy of think like a pancreas and follow along with us. All right. 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 Roseboro. 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. All right, everybody. I am here with Samantha today and Samantha and I are gonna be going over chapter nine of think like a pancreas and chapter nine is called taming, the highs and lows. So this chapter is all about, it has a really big focus on preventing low blood sugar, cuz those are just not good and are the most dangerous. But then also the second half of the chapter talks about preventing uh, high blood sugars and after meal spikes. So this is another great really practical chapter in my opinion. But before we get started, Samantha, I would love it. If you would introduce yourself and just tell the listeners how you are connected to the world of type one diabetes.

Samantha:

hi everybody. My name's Sam. I am located all the way across the country here in Pennsylvania. I have been a type one diabetic since I was 11 discovered by my mom. We have a whole mess of diabetics in the family. And my grandmother was sitting at the table and noticed me like chug a glass of water, which I'm told was abnormal. I was like a soda girl, I guess. And I have no, I don't remember it whatsoever, but they checked my blood sugar, like on the spot. And I was, my mom tells me correctly, four 60, something like that. So I was actually diagnosed with diabetes the day after the. Nine 11 attack. Oh. So I was in a hospital bed with the news being just awful. It was just mm-hmm so September 12th was my day, but it was just awful, but yeah, so I've been diabetic now for about 21 years. And then I also had a nine year old daughter who has been type one for the past two years.

Katie:

I just have to know, like, as you've obviously been living with diabetes for a while now, which it's, first of all, it's crazy to think that nine 11 happened that long ago. But anyway, I know, I know madness. I know. But so how is it like living with type one and then having a, now a daughter that is diagnosed with diabetes? Like, is there any part of you that's like, okay, we got this or just as a parent, are you still just freaking out? Like what? Just take me through the emotions of that whole scenario.

Samantha:

So for me, diabetes is. Eventually, I, I always like to say, to tell people that either just got diagnosed or other kids got diagnosed, like eventually it's just such a part of you that it's, it's just something you have to do every day. It's not something that you dread or you're annoyed with or it's whatever, it's just something you do. So I get a little, like, I wanna use the word, like frustrated when I see some posts, like from different diabetic communities that are like, they really come down hard on themselves because, and they're newly diagnosed and it's like, man, you just wanna be like, it gets easier. You know what I mean? Like you just want to be like at first it's so frustrating it for you to have it. And then. eventually, it's just, you just do it. Like you just have to carry on, like, there's, there's no one at the end of the day, if you have a breakdown and you're like, you know what? I can't do this. No one else is gonna save you, but yourself with diabetes, like mm-hmm you gotta just keep on keeping on scenario. So it's like, Ugh, gosh, we have that moment of frustration. Like, let yourself be annoyed that you were super low or super high, but like, it has to be something that you think about every day, but doesn't consume you every day. Does that make sense?

Katie:

Yeah. Yeah. Like. Yeah. And I mean, OB I don't have type one, but I just, as the caregiver of one, I just feel like the longer time goes on too. You do, you really do have to adopt a little bit of an attitude of like, whatever, man. I mean, that's not to say that we're like being reckless and just, I mean, obviously we wanna manage my daughter's diabetes as well as we possibly can, but it's just as, you know, diabetes just doesn't always play by the rules and never just forget things. Like sometimes you just forget to pre bolus or you did you screwed up the carb count or whatever it is. Yeah. And now you're at 300 and it's just like, you just have to learn to be like, whatever, like we're gonna get through it. Yeah. We're gonna get the number down and tomorrow's another day. Like you really that's exactly how

Samantha:

I feel with Amelia. Like yeah. You know what, like it's, it was a crappy day. I totally get it. But at the same time, like you're gonna be fine. Like, yeah, you were SU you were super low. Oh man, take a nap. We gotta we'll come back for the day after that you're super high. Let's get your blood sugar down and let's like, go for a jog together. Like it's just something you have to do while it's frustrating for everyone involved at the same time. You like, can't let it ruin your life. So it's like gotta learn how to just figure it out day by day.

Katie:

And, and just move on, move on. Yeah. Yeah. Yep. Well thank you for, for that insight. And okay, so I'm sorry. Your daughter was diagnosed when she was two. How old is she now?

Samantha:

She, that was when she was seven. That was like August of 20, 20.

Katie:

Okay. I'm sorry. You said two years ago, I thought. Oh yeah, yeah, yeah. I thought you said when she was two. Okay. Okay. Got it. Okay. So yeah. Oh, all right. Well, my daughter was diagnosed right around the same time as your daughter. Cause my daughter was diagnosed in August of 2020, so yeah, man, you had like the two world tragedies, like you were diagnosed the day after nine 11 and then your daughter is diagnosed in the middle of a pandemic. Exactly. No, no, no more a mess, a mess. A mess for sure. Oh, that was not fun. Still not fun. No, but okay. So real quick, before we jump into the chapter, I'm just curious, would you share with listeners, like what you guys use in terms of like, are you doing MDI? Are you doing pumps? What are y'all on?

Samantha:

Yeah, so I was on the tandem T slim for the longest time. That kept me the best in control while we were attempting IBF with my now son who's here. Oh. But he I'm MDI now because after he was born long story short, I didn't need insulin for like a month so I was like, oh my gosh, I just took everything off. I'm like, do you know what? We're just gonna like, hold insulin until I can figure out what I need. Mm-hmm so I'm MDI Lanis and no blog for now. And Amelia is a Potter. She just got the.

Katie:

Okay. Oh, that's very exciting. We are also potters. We are actually on the old, the classic, the arrow system at the moment. Oh my gosh. And now we just got approval for both the dash and the Omnipod five, like officially letters in the mail. Which is great. But I don't know. I'm like hesitant to switch to five just cuz we're doing DIY loop now, which you know, is another automated system and I don't know. I just, I don't, I can't decide if I wanna, I actually emailed the endocrin just this morning and I was like, can I, I just. This is just like a general question. Like, can we flip flop cuz like right now? Yeah. You know, like, can you write us a prescription for the five, but like two, three months from now, if we don't like it, can we try the dash? And I don't know. I just wanted to feel her out for it. Like I don't, if you're approved for everything, like if you can get coverage, is that really that big of a deal to just

Samantha:

so for the five, this is probably good for info for you to have. Okay. We have the dash, but the five you can do automated or manual. So doing it manual is just like the dash. Okay. Okay. So, and that's honestly what we have Amelia on, because I don't know about you. I'm a little bit of a control freak with Amelia's diabetes. Like I wanna know that the insulin she needed, I gave to her, or if, gosh, forbid she would go low. Like I was the reason not like her pump malfunctioning or, you know, so mm-hmm, yeah. I'm having a little bit of a control problem with the automated system, but I'm, I'm working on it. I'm working on

Katie:

it. Yeah, no, I am. I'm the same exact way when we switched to the DIY loop, our control. Yeah. I think I was, I think we honestly had better control when we weren't on the automated system. It's getting better. I mean, I think we're getting to where it's like the same as it was before, but man, it's taken us several months to get there. Yeah. Or a few months. Um, But yeah, I'm, I'm also control freak, so, And the author of this book says that in the little section that he writes about the automated systems, he's like, if you already have really good control of your diabetes, like these systems might really frustrate you. So, yeah. And I was like raising my hand. Okay. That's good to know that the manual mode is this basically the same as dash. Let me tell you what I'm let me tell you one of my biggest hesitant the thing I'm most hesitant about is that you can't, there's no view app. So I can't see. What she's done. Like if I tell her to do this many carbs, like I can't actually yeah. See that she's done that. Because there's been times where she hasn't and then of course that right. Results in really high blood sugars and stuff. So, and I know they're working on it, like the Omnipod FAQ section says that they are working on a view app for the Omnipod five, but like right now with DIY loop, I use night scout and I can see everything that she does. Yeah. And I. Again, with the control freak situation. I'm like, I don't know if I wanna lose that. So yeah.

Samantha:

So with the five too it's not compatible, I don't know if you're a Samsung girl or an apple girl, but it's not compatible with iOS yet. And that had me wow. Up. I was like, oh my God, come on. Like, I was so excited to get rid of the phone. Like she, everyone, her kids in her class were like, why doesn't they have two phones? Why doesn't they have two phones? And I was really hoping to just get rid of one and yep. They were like, maybe someday soon. I'm like, do you know what on the pod come on, man.

Katie:

I mean, I, they have to be working around the clock to get that done because I would say over half the population uses iPhone. Like they've got to get that done. So, yeah. And they, they have said several times, like we're working on it, we're work working on it, we're working on it. And I know that Apple's kind of a pain in the butt when it comes to like jumping through their hoops and getting across their red tape. So I think it's just a matter of time, but yeah, I think Same. I, I totally agree. I'm like, can we just get rid of one device? That would be so great. Yeah. I

Samantha:

know she would be less mortified when she got them out. For

Katie:

sure. Yes. Yeah. Okay. Well, I guess we should talk about this chapter yeah, yeah, of course. Alright, so we're gonna dive in again, the, the name of the chapter is taming, the highs and lows. Again, I just wanna encourage people. The author, Gary Scheiner is amazing. He was so kind in giving me the green light to do the series, and I just highly recommend that you buy a copy of the book. I refer back to it all the time when I just need to be reminded of something. don't rely on me and Sam to give you every single detail of this chapter. Like there's just too much for us to talk about in an hour long podcast. And there's also lots of graphs and tables that you're gonna wanna see with your eyes that I really just cannot possibly do a good job of describing with words. So get a copy and follow along with us. Okay. So the first thing that I loved about this chapter is the author reminds us that even people who manage their diabetes to a T and meticulously still spend around 25% of their time out of range. So everybody just take a deep breath. Perfection is rarely achieved without losing your mind, at least. So just keep that in the back of your mind. But he really starts off strong in the chapter about encouraging people to do whatever they can to prevent low blood sugars because there's really just no benefit to having. Multiple low blood sugars. I mean, as his wife, the author's wife. So lovingly said, she said, any idiot can have a decent A1C if they're taking too much insulin and going low all the time. So, and that's true, right? Like you can be having these major crashes, which will lower your A1C, but it's just not safe and it's not healthy for anybody. So you know, I'm gonna, I'll give some reasons soon other reasons why you wanna avoid the lows. The author kind of de defines mild lows as like in the, kind of in the seventies getting closer to like upper sixties moderate lows, he says are like in the fifties and forties and then severe lows are more like in the twenties and thirties, or if you just have a really prolonged, like moderate, low but mild lows. Okay. So here's the reasons why you wanna prevent these things. They cause poor physical and mental performance, which can be embarrassing. They can impair judgment, which can be dangerous. And then they can cause mood changes, which just can just be frustrating for everybody involved. They also can cause weight gain and rebound high blood sugars, which in other words is known as the diabetes roller coaster. And that's definitely not a ride that you wanna, that you wanna get on. And then the severe lows you know, are super dangerous. They can cause. Seizures loss of consciousness, coma, or even death. So, and they, they actually, if you're having several severe lows, they can increase your risk of developing dementia later in your life. God, I know, right? That's happy. that you like one be high all the time. I know, actually, after reading this chapter, I've like made it my goal this summer to avoid low blood sugars at all costs. I'm like, OK, let's, let's focus on this. Cause I think I was more focused on preventing the highs, which. I still don't like, but now I'm like, okay, let's try to prevent those lows. Okay. Yeah. This is interesting. He also says that too many lows can actually lead to like a dev. He calls it a devolution of symptoms or just kind of a breakdown of low symptoms over time which is also known as hypoglycemia and awareness. So this is when you do not feel or experience signs of low blood sugar just until it's too late. And then at that point in time, you really can't think clearly enough to treat your low properly. And then research has also shown uh, good news that this can be reversed if you spend several weeks above 80 milligrams per deciliter deciliter. So you're trying to avoid lows altogether. And of course that may cause like a small bump in your A1C number, but to regain the ability to self detect those signs and symptoms of lows, it's like absolutely worth it. So I have some questions from you, Samantha. Hit me. I'm curious to know, like what low symptoms do you and your daughter experience, and then have you ever experienced the evolution of symptoms that he talks about?

Samantha:

So for me, I'm like, unfortunately hyper aware of being low. Like my, my DCOM might be reading. Like, let's just for example, say like 2 0 1, but I stacked a ton of insulin and I start to feel low at 200. So Amelia, like will sometimes do that too. She'll be like, I think I'm low and I'll check her on. Like, you're not low. Like your dots are fine. You're 180. You're not low. And she has three units on board and then don't, you know, it, she gets up, walks around for five minutes and is crashing. Like, so it's, we both just get like a little, like, I think like everyone else, just like a little bit sweaty. I can feel that my pulse is going up. Like, I get a little, I can tell my pulse is higher and I'm shaky, but she, she more or less is just, just shaky. Like she starts to feel a little offbeat mm-hmm. But that's

Katie:

really it for her. Yeah. Okay. Does she, and she, you and say, mommy, I feel low or how does she verbalize it? Well,

Samantha:

I feel so bad because I used to like, she'd say it and I'd be like, you're not low Amelia, go sit down. Cause I thought she wanted a snack. You know what I mean? Like I would be like, you're not eating a snack. We've just had lunch. Like every other mom and then like 10 minutes later she'd be low. So yeah, she always comes to me. She'll be like, and she just recently started like checking the Dexcom on her own. Like, she'll be like, am I low? And I'd be like, look at your phone. Like really trying to like encourage a habit because again, control freak mom. I'm like, oh, I'll check it for you. I'm watching your blood sugar every 10, you know? Oh my gosh. But yeah, she just recently started like checking on her own, like, you know what? I felt weird and I'm 85 sideways down. Like, should I eat something? And that's so that's like a huge turning point for us.

Katie:

That's awesome. Yeah, Sarah, I feel like Sarah still has the ability to recognize her lows for the most part every now and then there it'll go unnoticed, but like, she'll say I feel low and her hand, she always holds her hands out and you can see her, me do visibly shaking. Yeah. Yeah. Yeah. And I don't even, I don't even at that point in time, if she's having symptoms, like I don't care what the Dexcom says. I'll just give her like five Skittles, just really just to give her peace of mind. And then I'll be like, okay, let's do a finger prick and double check to see where you're, where you're really at. Cause you know, sometimes other things can present like lows, like anxiety or maybe you've been out in the heat for a really long time. And you just, I don't know. You're you feel like headed or high, you know, it's true. Ugh. Mm-hmm yeah. Okay. Have you ever experienced, like I'm, I'm assuming no, just based on what you tell me, but like, so you've always been able to detect your lows. You've never like, lost that ability?

Samantha:

No, never the only time that I might miss it and anytime a million might miss, it would be more like in the middle of the night, like when you're dead asleep and wake up trenched and mm-hmm before the Dexcom, it used to be so bad. Like the Dexcom is life changing because before that came out, it would be, I would just be like living on a prayer. just, oh my God, the way things I said to me all the time, like the way that diabetes had changed for you, like it used to be so bad and now it's like, oh my God. Yeah. I have 25 minutes. I. It's so different. It's so different.

Katie:

Oh yeah. I, I don't even know that life and I don't know how y'all did it, so my hat is off to you. No, I don't wanna that's right. No. All right. Well, the author then jumps into like treatment of mild to moderate lows which that just depends on a variety of factors because your diabetes may vary. Everybody's different and responds differently to, you know, carbohydrates. But it definitely, you know, usually depends on how big you are. So like the bigger your body size is usually you're gonna need more carbs to kind of bring your number up table nine. One in the book kind of gives several examples of different body sizes and like about how many carbs you would need to bring you up. And then it also depends on like, What is the blood sugar level, like the lower, the blood sugar is at the time. You're obviously obviously going to need more carbs to, to bring that up. It also depends on the rate of change, which is like the arrows that you see on your CGM graph. So, you know, if, if you're treating a 90 you know, straight arrow down, which I guess that's not technically a low at that point in time, but it's heading in that direction, you know, versus a 50 double arrow down, you're gonna need more carbs to correct that 50 double arrow down than you would for the, for the 90, with just one arrow down. And then you also need to pay attention to the dots. This is Katie's advice, not the author's advice. But I, that has been such a huge help to us. And I actually did a whole episode on it. It's episode number 50. But your Dexcom or I don't, I, I'm not super familiar with Libra, but for us, like our Dex com might say. a hundred double arrow down, which at the beginning of all this would've sent me into a panic, but I've learned like, if you look at the dots, you know, sometimes the, the arrows have not caught up with the dots, cuz sometimes you'll, you'll look at the dots and you can see that that line is straightening out. So it's not continuing to go straight down. And that just has helped me be like, okay, wait, we are leveling out. I think the arrows just need a minute to catch up. Like I don't wanna over treat the slow cause then we're gonna be dealing with a high. I would encourage everybody to pay attention to the dots. Do you guys, do you do that?

Samantha:

Yeah, so we, that my husband was actually the one with the clarity on that because I was a big arrow girl for the longest time. Mm-hmm and it kind of like would send Amelia into like a panic because she would see the double arrows and just lose her mind. We're huge on saying like to ourselves, like. Remember, it's like how we feel, not what the Dex comp says. So if you ate and you feel like you're starting to feel better, then if the Dex console says double arrows, think about how you're feeling. Don't read the number we've even gone as far as. Turning off the Bluetooth and not hear the sound cause, oh my gosh. It's like the, it's the it's that external stuff that like really shouldn't matter, but your body's not like trained to like your, your brain's reading these dots and arrows like, oh my God. Oh my God, my God. But in reality, like it's, it has how you're feeling inside has nothing to do with what the dots or thes are telling you. Unfortunate.

Katie:

um, I know like Sarah, you know, you, you said you guys turned the Bluetooth off or, or turned the alarms off. Yeah. But we had to change, we our, I guess it was our low alarm used to be the crying baby, because I wanted, I'm like, oh my husband too. yeah. I'm like, what's gonna really get my attention. And it was that whaling baby. And and, but that would give Sarah so much anxiety when that baby would start crying that like I had to change it because she could just could not handle it. She, she would like, it was so bad. I'm like, okay, well, we can't do the crying baby anymore. Let's pick a different alarm. That was us. Exactly us work forward. I, I thought about doing the ambulance one, but I'm like, I don't want that to go off when I'm in the car, cuz I'm gonna think there's like a cop right behind me or, or fire truck or whatever the siren is. What

Samantha:

I, so did did yours, like originally like sound like her high chime and mine do obviously, but her high chime and low chime sound different. So like the high is like a, Hey me, but the low was like a deeper mm-hmm you know what I mean? Is her, was hers originally like that?

Katie:

I don't remember what it was originally. Cuz I feel like we changed it pretty quickly from the oh, like list of options that you can choose. Now we have it, her high alarm sounds like she just won a video game. It's like do do or whatever and my, my husband always says new high score. Like funny. Yeah. And then her low is, is like a, it's like a, it's just like the beeping, so yeah, All right. The author does briefly talk about what foods are best to treat a low. So obviously like high GI foods. So glucose tabs are a good example. Smarties candies. Those are like straight up dextrose sweet tarts, those gels that you can inhale pretty quickly. Spree, candies, Airheads, ruts, nerds, and bottle caps. And then just like a juice box. Those are all probably the best thing to treat a low quickly. I know when Sarah went to, was getting ready to go back to school after her diagnosis, the, the nurse that was there, training the staff on type one, diabetes was like, What are you bringing to treat Lowe's? And I was like, she likes Skittles and it makes it easy math for me. And the nurse was like, well, we really need to think about a healthier option. Like what about strawberries? And I was like, listen, lady,

Samantha:

you obviously don't

Katie:

get it. I'm like, strawberries are a healthy choice. And she will have plenty of those in her actual lunch. But if we need to get her blood sugar up quickly, she's gonna be eating candy or drinking a juice box, cuz I'm not gonna play around with that while she's at school. So I actually

Samantha:

got the tension in high school for eating candy when I was low and not having something healthy. She wrote me up for an detention. The nurse did.

Katie:

Are you serious? Did you

Samantha:

get out of it? Swear to God. Yeah, no. I walked down to the office and the principal who like knew my mom was like, why are you here, Sam? I had never gotten attention in. And I was like I ate candy instead of fruit. When I was low, he ripped up the paper and play of me and put it in his trashcan. He's like, go back to class. I was like, okay. Gosh,

Katie:

geez, Louise. That's ridiculous. I mean, I can see that I can see it happening, but oh my gosh, that's annoying.

Samantha:

God people don't really get it. It's like, it's such so, so frustrating. And it will be for like our kids. Like, it's so frustrating because unless you love someone with IVs or have it yourself, you do not get it. Yeah. It's. Stressful.

Katie:

I know. I know. And, and I, but it's also annoying to have to explain it to everybody. You know, I, I feel like I've just kind of adopted the mindset of like, whatever they don't understand. They never will. Like, why am I gonna try to explain, you know what I mean? Like why waste my breath? Which yeah. Maybe that maybe that's not, I mean, education is important, but you know, I feel like you gotta learn. You gotta learn when is the proper time to educate and when you just need to be like smile and nod, just smile and nod. Thank you. Thanks so much. Yeah. so do you, yeah. What do you guys use to treat Lowe's

Samantha:

so, so ridiculous. We are huge on tropical punch Kool-Aid. It is so stink and sweet. So I literally, if we're, if we're coming down, we, we have these like little tiny, you know, the glasses that come with like your normal glasses, but like the little short guys. Yes. Mm-hmm one of them is like, Solve the problem every time. So Amelia always wants to like add a Snickers in there, but I'm like, let's just try Kool-Aid first. Like let's just try a drink. Cause it's like too much.

Katie:

right. We'll we'll add that Snickers to your dinner later today. yes. Yeah. She's a mess. Coolaid forever. I love that. So do you, are you just like old school? Mixing it up with the powder and the water in a picture? Oh, cool girl.

Samantha:

Two packets, two puffs of sugar. It's always in my fridge.

Katie:

I'm gonna buy some just to try it. I love it.

Samantha:

If you gotta, you gotta

Katie:

man. I could crush some grape Koolaid when I was a kid. That was my favorite.

Samantha:

Yes, same. So we have learned that I, I, this could just be us. I don't know the it's the red dye. I don't know what it is, but the tropical punch has like somehow some better effect with treating lows. We got the orange and I like chugged one, one day and it like did nothing for my blood sugar. And I'm like, what is happening? It could be in my brain. I don't know what it is, but tropical punch hits it every time.

Katie:

Okay. All right. Tropical. But now that is a fun science experiment for your daughter to do. I'm like, I know which flavor of Koolaid will bring my blood sugar back up. The quickest, when I'm having a low, the blue raspberry

Samantha:

lemonade, like sends like does too much, like she could have like a shot glass, a blue raspberry lemonade, Koolaid. And she would just, it would just knock her on her butt. So we're like never changing the flavor. My husband's always like, can we try something else? I'm like, no, it has to be this.

Katie:

Denied not happening.

Samantha:

Denied. That's what we're doing. No change.

Katie:

okay. I'm gonna try it. I'm gonna let you know how it goes. I can't wait. I can't. Okay. okay. The author does throw in a quick blurp about overtreating your loaves, because we've all been there, right. Either whether we're panicking and we're just shoving candy and juice in our kids' faces or our faces. Or you're just, cuz I, I don't know. Cause I don't have type one, but I've heard that when you have a low you're like extra hungry, which my daughter actually, yeah. My daughter actually verbalized that for the first time. The other day she's like, mommy, I just feel so hungry when I'm low. And I'm like, oh, okay. This is the first time I heard you say that. So it's easy to treat overtreat lows. The author just suggests that if you do, like if you recognize that you have overtreated your low, once your blood sugar comes up to like a reasonable level, like it's re recovered, you go ahead and dose for the You know, to cover the carbs that you overtreated with which is a bold move, you know, if you just recovered from a low, but do you guys, you know, what, what's your kind of experience been with overtreating low's. So with

Samantha:

Amelia, it's kind of, we're very careful with her while she's at school, because to have that rebound, like where you were already low and then over did it. And she's like trying to learn and stuff in school, that's just like too much for her. So we're super careful with her mm-hmm but before, before the decks come before I could like really see what was going on. I did, I would like eat like a whole stinking bag of gummy bears or something like when I was low, because it is so true. It's like, you're super hungry, but you're you also feel like it doesn't even feel like hunger to me, it used to feel. Almost like you were medicating something like, it almost felt like you were taking more and more and more and more until you felt right. Mm-hmm like, not like until you felt full. Cause you never feel full. Like you could just eat forever. Mm. But it was almost like until you didn't feel low anymore, but then by that time you were far past the amount of carbohydrates you had eaten. Mm-hmm and I had done that for literally ever. And if Amelia was, if it was up to Amelia, she would do, she would do the same, but I'm always like, Hey, Hey, Hey, Hey, Hey, Hey. Cause the one time she crushed a bag of gummy bears and I'm like meals, what are you doing? You're so to have five. And she was like, oh, they were just really good. But I know what was really happening was like, she just like didn't realize how many she was eating or she was just. Feeling well and needing to eat. And, but, so she was like, they tasted really good. I got them for her like a week later. And she was like, E these are gross. Why'd you buy them? I'm like, okay. Yeah. That solidifies what just

Katie:

happened. Yep. Yep. Exactly. Yeah. I, I had to, I had to send Sarah to school with something that she likes well enough to eat, to treat her lows, but not to where she likes so much that she will just like overeat. Like I was for a while there, I was sending her with Gatorade and I would like mark the bottle with like, okay. Oh my God. Like, if you have a low, I want you to drink to this line and then I'll let you know if you need to drink some more. Well, she would just like start drinking the Gatorade and not stop. And I'm like, okay, we need to not send you with Gatorade anymore.

Samantha:

That's diabetes, like turns off your self control. I don't

Katie:

understand it. Yeah. Well, I mean, let's be honest, self control is hard enough as it is without diabetes. Yeah, I know. Yes. I can see where that would be. Definitely even just with the anxiety of treating it low, like you just kind of are, are maybe a little panicked and you're like, I need to drink the whole jug. I just have to drink the whole thing.

Samantha:

yeah. That's meals a hundred percent me. I'm like the other day I was 41 when I woke up and my husband saw my alarm and he was like, I'll go eat something to eat. And I was like, Ugh, no, I've gotta probably actually eat something, not just the Snickers. And he, I had to put down our baby and go and eat something. And he was like, Sam 41. How'd that happen? And what's really happened is my basal is like all messed up from the baby yet. And I would take, I took Lant and I had adjusted it like five extra units. Well, that was too many. Like mm-hmm so I was low that whole. No

Katie:

back. Oh, no. How old's your baby? He is four months yesterday. Oh my gosh. You like just had a baby. I'm sorry. I

Samantha:

did just have a baby. I literally just went back to work like a month ago.

Katie:

oh my gosh. Well, congratulations. When you said you had a baby and your insulin was all outta whack. I was like, well, I, I just assumed it was like a couple years ago, but you like a new one? No, he's a new guy.

Samantha:

He's a new guy.

Katie:

Oh my gosh. You're amazing. You. Oh, you, you have a type one daughter. You have type one yourself. You just had a newborn and you just went back to work. Oh my gosh. You're amazing. Yes.

Samantha:

Yeah. And he was an IVF baby on top of all of that, so, oh yeah. He was

Katie:

working baby. Yes. Yep. You worked for that one. Okay. all right. The author that's for sure. yes. Yeah. The author transitions into treatment of severe lows, which hopefully, hopefully, no, you know, hopefully we don't have to experience those or at least not many of those in our life, but he just kind of gives some tips for, for that. He says, definitely do not like if somebody is having a seizure or has like blacked out, do not put food or drink in their mouth because they could choke on it or it could go into their lungs, which is not good. Definitely don't stick your fingers in their mouth because if they're having a seizure, they could chomp down on your fingers and do some major damage. This should be number one on the list, but call for emergency help. Right. And then administer the glucagon. And he actually on page 2 67 and 2 68 of the book, he like. Bullet points out the steps to treating a severe low using those traditional red glucagon kits. And because he's like the instructions for those things are not written in a language that anyone can understand. It's so confusing. And then of course, if you're in a pink mode trying to treat a low, a severe low, like you're not gonna take the time to read those instructions. So he, right. Like writes them out in plain English for you, which is very nice to have. And then he says, you know, the person should come to in like 10 to 20 minutes. You know, hopefully by that time, if you've called 9 1, 1, the paramedics have arrived also. But he also makes a note that like, if you are sick or your child is sick and they cannot keep anything down, but they're having a low blood sugar, you can actually use those emergency red glucagon kits to micro dose, the glucagon. And just to like bump their blood sugar up. If they can't, you know, if they're, if they're vomiting and they can't keep anything down. Right. And then he Al he, he says, and we actually do not, we need to get one. Sarah does not wear one, but he says you should always be wearing a medical ID. Bracelet or have something in your wallet like a wallet card or wear a necklace that has your medical ID. Because first responders are trained to look for those things first. So bracelet, necklace, or wallet. And I think tattoos actually are pretty popular too. Like have it tattooed on your wrist? Yeah. Yeah. So have you or your daughter ever experienced an extreme low? Uh,

Samantha:

Honestly there was only one time where I was super low and it was because again, during the whole IVF business, we were, I had, I was stuck at 400 for like hours and my doctor had like really pushed hard on. you know, we were doing this anger retrieval and you know, my blood sugars had to be perfect. Perfect, perfect. Blah, blah, blah. And again, this was not an endocrinologist who doesn't really get it, but still that stuck in my brain. Mm-hmm and I was stuck at like 400 for like five hours. So I was stacking on stack and on stacking didn't have a pump. Didn't really remember how much insulin I took. And when all came, crashing down. Oh my goodness. It was so bad. We like, I was like walking into CVS and I, we were like picking something up. I think I remember like leaning on my husband's shoulder and he was like, what's going on? And I'm like, I think something's wrong. And he like, got my phone outta my purse. It was like low, double arrows down. Cause I like, didn't see it coming. And he was like, oh my, well, thank God we knew the pharmacist. He like found one of my prescriptions with the glucagon on it. We just did it right there in CVS. And I like, oh my gosh, the, see they say 10 to 20 minutes, but for me, like, I felt better instantly. Like I put it in and I was like instantly better. Really? Okay. Which is insane. Right? Yeah. Cause it's like, and it obviously wasn't. Passed out or like near death or anything, but I was like, not doing well and I like took it and I was like standing straight up, ready to party. The husband was like, what just happened that crazy? I don't even know. I know madness, but it like does kind of calm your nerves with the whole, like if got your forbid, you know, I mean, it was the, one of the girls were super low, you know, that it, it's not like you're not sitting there standing over there then for 10 minutes being like, okay, like, yeah, start working

Katie:

now. Or, you know, yeah. I've, well, I've heard several moms who have had to do that to their kids. Like they, most of them have said that like, of course they called, you know, for emergency services. But like, by the time they got there, their kid was really fine cuz they had administered the glucagon and like, and they, some, a lot of times they don't didn't even end up having to go to the hospital. I'm just curious, like, do you remember what your blood sugar went up to after you used the glucagon? I've always just, I just, and I'm sure everybody's different, but yeah. I wanna know like how high is it gonna take you.

Samantha:

So I was unrecognizable high on the Dexcom and I was four 90, I think, on

Katie:

my meter. Okay. So it's gonna take you up and I felt like, Ooh, garbage. Mm, yeah, after that low. So it's high save your life, but yeah. It's you pay for it? Oh my gosh. Yeah. I mean like, who really cares what you're gonna go up to? Like, let's just get it in. Exactly. Exactly. It's, I'm just, I've always wanted to know, like,

Samantha:

it's one of those things, like if you're taking a glucagon, like you almost wanna take insulin with it as you're taking it, because it's like, you are gonna pay for this for sure.

Katie:

Hmm. Interesting. I, I almost, when I had the de I wore a Dexcom for 10 days, a couple a month or two ago, and I was like, so tempted to, cause my daughter has all these nasal spray Basim oh. And and like, some of them are like on the verge of being expired and I'm like, I'm just so tempted to like, do try this just cuz I wanna see what, how a normal pancreas would handle this. Like if it would, I of course I did not. I just feel like that's not, that's not the right thing to do, but I was just thinking about like, I'm like I'm, I'm just curious. I wonder how this would affect like a normal fire a little bit. Yeah, exactly. Okay. Interesting. All right. I think that's all I wanted to say from that section. Oh, do you guys wear medical ID, bracelets or necklaces or anything?

Samantha:

No, we don't. We probably should, but she's so we're still, we're newly in this place. We're like, we're very observant of like what people think of us. Well, Amelia is mm-hmm so we're, we're working through that where she's very, really worried about like people knowing she's low or seeing that she's eating and they're not allowed to eat in school. So yeah. Everyone knows she's diabetic. I read to her class and, and any other scenario, I'm always with her so far. So until she's a little bit older and I'm not really around as much, I'm kinda letting that one fly.

Katie:

Yeah. That's true. Sarah doesn't wear one either and we're kind of in the same boat. Like Sarah does not as little as humanly possible, like do not call her out or make her feel, even if that means wearing like a pretty silver bracelet. She's like, Nope, Nope. I don't wanna do that. Like, cuz she nice too. Yep. Yeah,

Samantha:

yeah. It's I feel so bad for them, but

Katie:

I do too. I mean, I get it. I'm not that doesn't bother. I mean, it bothers me. It makes me sad to think. They're so self-conscious about it, but it, you know, I get it. I, I can, yeah, I can sympathize with that. All right. The author goes through, kind of gives a, a good list of just tips for preventing lows in the first place. I'm just gonna kind of quickly read through these. And some Sam, you can let me know kind of what has helped you and like what you've just found to be helpful off of this list. Sure. But using a CGM properly, which sounds like a no brainer, but you know, you need to turn on your alerts and you need to make sure they are set at a point. A threshold above the point of hypoglycemia. Cuz if you have it said at like 60 it might be a little bit too late if you, you know, if your kid is 60 double arrow down, like you want it to alert you before that. So you have a little bit more time to recover gracefully from the low. So set your alerts at a reasonable level. I think Sarah as just said it like I have it set differently on a few different apps, but I wanna say it's somewhere between 70 and and 80. The apps that I have. I like it to be set a little higher, cuz I, you know, at 80 I feel like we can catch it before it gets to be a scary, a scary low. Yeah.

Samantha:

We're at a hard 80 on

Katie:

everything. Okay. Okay. He said author suggests use a hybrid closed loop system, such as tandem control IQ, Omnipod five or DIY loop. Those are the systems that adjust your basal rates. So if it predicts that you're gonna go too low, it will like shut off your basal. Which is pretty cool. They are great especially if you wanna sleep through the night, but they are so are frustrating cuz like Sam and I already discussed. If you're a control freak, they can be they can be frustrating. Like sometimes you don't want it to shut off the basal. Okay. Author also suggests matching your insulin to your needs, which, you know, makes sense. Don't have more insulin than you need. That obviously takes a lot of trial and error to kind of figure out how much you or your kid needs. And at different times of the day he suggests using a rapid acting insulin rather than like regular insulin, because rapid acting clears the system in like three to four hours. So it offers less risk of blood glucose levels declining, even after food has digested regular insulin takes a lot longer to get cleared from the system. You wanna dose properly and precisely if possible. So if you can get your hands on like syringes or you know, prefilled, insulin cartridge, or pins, insulin pins that have like half unit measure measurements. So you can be more precise in your dosing. You wanna give your insulin time to work, which, so, in other words, you don't wanna stack your insulin. Bolus of rapid acting insulin can take three to four hours and sometimes more to stop working. So don't stack it now. I will say that we do not follow this rule all the time, because I just feel like yes, the longer time goes on, I do feel like you just kind of learn to know your kid's body and you just kind of know, okay. I just need to give this some time. So let me be patient and wait it out. Or, okay. This is just not gonna bring her down anytime soon and I need to get more insulin. So I, I don't know. I just feel like you kind of figure that out as time goes on. Okay. You wanna time your bolus this properly? So for this one, like if you're eating a really heavy meal or a meal with a lot of fat and protein you probably don't wanna give your insulin. Ahead of time. You might wanna wait until like you're eating the meal or maybe right until you finish the meal. Just because you don't want your insulin to like peak or be working its strongest before your food even has a chance to digest, cuz all that fat slows down digestion and your carbs, those carbs don't get into the system for quite some time. You wanna set appropriate targets. So the lower, lower the target the greater, the chances of hypoglycemia because like target. Targets of 80 or 90, they don't leave a whole lot of room for error. So he suggests aiming for a target of a hundred or more, which I think that's in our, all of our calculations in our pump settings. That's our target is a hundred at the moment. If you are coming off a day where you had a low or your numbers were just super erratic and crazy, or maybe you like exercise really, really heavily, the author suggests consider making your target higher for the next 24 to 48 hours. If you usually have it at like 90 or a hundred, you know, the next day or two, you might wanna have it at like one 20 or something that's gonna keep you a little safer. And then he says to time meals and snacks appropriately, which. We don't, we don't do this. I'm just gonna say we just kind of eat. I mean, I guess we kind of eat at the same time, lunch, lunch. No, let me start over breakfast, lunch and dinner around the same time. But anyway, he just makes it a big, like, apparently if you're using NPH, which I feel like not many people are using that at this time, but if you are, yeah, you like really have to be scheduled about when you eat. And even as little as a half an hour, being off schedule can make a huge difference and cause you to have low blood sugars. But then even if you're on a long acting insulin, like some of the more commonly used ones, like he mentions glaring, BAS Glar or Deir. If you're off by like a few hours with your meals and snacks, it can cause significant drops in blood sugar, which I did not know. We're almost done with the list. He says you also wanna deduct fiber. So fiber is included in the carb count, unlike all the prepackaged labels nutrition, facts, and whatnot, but fiber does not get converted into glucose during digestion. So he suggests that you subtract the grams of fiber from the total carbohydrate count. He also says you need to adjust for exercise in daily activity, which we are we've discussed at length in previous episodes. That was. A lot of what chapter seven and eight was about. So you can go back and review that. But he says, if you are using a hybrid closed loop system and you're like exercising or doing a lot of activity, you definitely wanna raise the target blood glucose at least an hour before exercising, which I know the Omnipod five that your daughter's on has like the exercise mode or I forget what the connectivity mode. Yeah. Yeah. And isn't the target like one 50. Yeah.

Samantha:

Okay. It's super cool. I haven't used it yet. I think it only works for when you're in automatic mode, which we have not trusted yet, but I'm looking forward to the day that I do. I love it.

Katie:

Oh my God. You're like, we're not doing it. We're not yeah. Yeah. Self okay.

Samantha:

Self control.

Katie:

Yeah, the DIY loop has they call 'em overrides, but it's the same thing you can like tell it what you want. The. Target to be at. And at first I was just turning them on the overrides on like right before Sarah would go to dance class or right before she'd get in the pool. And then I realized like, oh, I need to like, turn this on an hour or two before if I actually want it to be effective. So yeah. We're big 10

Samantha:

basal

Katie:

girls in that scenario. I know I do miss 10 basals and extended BOS. Those are nonexistent with the DIY loop system. Yeah. Oh no, I know. All right. He also last two things. He says you wanna adjust for alcohol to prevent low blood sugars, cuz alcohol, go back and listen to episode 60. That's the, the episode on how alcohol affects somebody with type one diabetes, but long story short, it can cause your numbers to drop. So after you've been drinking you wanna make sure you lower your basal level or you need to consume some extra carbohydrates and then he ends with you just need to check, check, check, and evaluate, look for patterns of lows in your CGM data or your logbooks. If you've been keeping those and then just really talk it through with your healthcare team on how you can kind of prevent those lows in the future, if you're seeing those patterns. All right. So Sam, what, on that long list of tips to prevent lows kind of stuck out to you? Like, you know, what have you struggled with, or maybe what have you been really successful with? Any of the above

Samantha:

Half to half units was huge like that. I feel like with them trying to figure like regulate everything and all that. I think half units were just, if we weren't able to do half units during the night and stuff like that, she'd be crashing left and right. And she'd be high. It's just half units really changed the world. But the, it really helped us both having like the IOB, like, so we were able to see how many to prevent stacking, because I feel like that was such a huge thing before, if you were MDI and you like, weren't have, you didn't have a pump on you that was showing you how many insulin units you took or, you know, you just kept taking it like that. And it wasn't really something that like your endocrinologist talked about. Like, they were never, like, they were like, oh, you took insulin two hours ago. And like, that's fine. Like, you should keep in mind. You don't take more insulin until two hours. Well, in reality, it's like. Four for us. Do you know what I mean? Like mm-hmm, it's four hours until it's completely out of Amelia system. So it's like, mm-hmm Oh gosh. So that really changed everything. Having the insulin on board to check, to see how much we took. Yeah. The half units and honestly like the 10 basal function. That is huge for us. Mm-hmm cause she is so much like for her, I'm not there when she's at school. If I know she's gonna be in gym. If I know if she's going to recess, I can call her, I see her kind of trending down and I'm like, Hey babe, turn your BAS off. And that almost always saves the day mm-hmm

Katie:

Yeah. I know. I agree. I mean, usually if you can catch it quick enough, it can, you know, prevent them, prevent you from having to treat the low with food, which I think is great. Yeah. You know? Yeah. Huge. Yeah, definitely. Cuz you know, as fun as it sounds to eat candy all day long, it really does get old. I think according to my daughter it does it does. Yeah. Frustrating. Yeah. And I did wanna say and I'm sure you, I'm sure you've heard of this too, but like for. For listeners that are on MDI. Like if you want to have access to those kind of like pump features of being able to see insulin on board and keeping track of all of that, the Medtronic in pin, which this is not an ad and it's, this is not sponsored by Medtronic, but like the Medtronic in pin has Bluetooth technology where you actually connect it. You connect your insulin pin to an app on your, on your, your phone or your kid's phone. Whoever's the type one. And it keeps track of all that dosing information for you. So you can flip, open the app and see, oh, I have this much insulin on board. Maybe instead of giving more insulin, I just need to get up and move around a little bit or whatever the case may be. So I did an interview with a girl. This was like towards the beginning of the podcast episodes, but she uses the in pin and she said is it's like really helped her with rage, boing and. And not stacking her insulin.

Samantha:

I love that phrase. I love that phrase. I rage bulls so much. It's not even funny.

Katie:

I know I do too. And, and, but again, I feel like I've learned when I need to rage, bolus, and when I need to not rage bolus. So

Samantha:

it's so funny that you mentioned the pen too, because I actually I'm a nurse and work for a, an insurance company and mm-hmm I I'm, I work in a pharmacy, so I review different meds and all that stuff. And I create I create the question set for like prior authorizations. So like all the people that are out there that are like, Oh, my gosh, I submitted this for prior and I'm waiting on this insurance company forever. Like, hi, it's me. yeah, it's me. You're waiting on. like, so I just got the I pen policy up today and I was like, oh my gosh, this sounds so cool.

Katie:

It is cool. We actually own two I pens, which I don't even know how that happened. To be quite honest, they did not send me one. I purchased one through our insurance and for whatever reason, Picked it up at the pharmacy. And then like two weeks later, another one came in the mail. So I don't know what happened, but wow. We have two and we have not used them yet. Cuz my daughter hasn't wanted to take a pump break recently, but when she does or if she does we will definitely try it out cuz I think they're awesome. I can't wait to hear about it. Yeah. All right. Let's talk about dealing with the post meal spikes. So that was first part of the chapter was all about the lows. Now we're gonna move on to talking about those high blood sugars a fancy word for a post meal like after you've eaten is post prandial. So you might hear some endocrinologist say that. And some researchers, I know that I did an interview with a guy once that he said that word. 20 times and I had to Google it cause I had no idea what he was talking about. But post prandial, that means after me, I'm not gonna use it, but I just want people to know. Okay. So I just look like real quick. I just wanna give listeners a review of what happens in a, like a normal functioning pancreas system, somebody without type one diabetes. This just helps me to remember that like it's real hard to be a pancreas because our systems are so efficient and when they're working, it's just amazing what they can do. And to try to like mimic that as a human, with like outside medications, it's just, it's not, it's just not easy. So when somebody without type one, diabetes starts eating the pancreas, like immediately releases insulin and it starts to produce amylin. which is another hormone both insulin and amylin come from the beta cells. So those are the cells that get destroyed in type one diabetes. And the insulin that our body makes in our pancreas, it starts working like literally immediately and it finishes it, the whole job that it was set out to do in a matter of minutes. And then there's amylin, which is also, it's a hormone that keeps food from reaching the intestines too quickly. So basically it slows down digestion. So the reason why blood sugars spike so much after meals in someone with type one diabetes is because number one, food digests much faster because we don't have that, you know, you don't have that Amlin working. And then the insulin that you get out of a cartridge or a vial works much, much slower than. What the insulin that the pancreas makes. And so I just, I don't know. I just think that's important to remember, to, to keep everybody's mind and perspective of this is really a hard job and we're doing the best that we can. But the author says that significant post-meal spikes have been shown to produce earlier onset of kidney disease and accelerate the progression of already existing eye problems. So just keep that in mind. You know, they're gonna happen, but let's try to keep 'em from happening all the time. Glucose variability, which is like the standard deviation number that you see on your CGM data that is associated like the higher, that number is the more likely you are to have long term cognitive impairment and increases your risk for dementia, which Ooh, who wants to think about that? I think that's in pretty severe cases, but. Yeah, just wanted to throw that out there. But then in the short term you know, your quality of life can suffer with these giant spikes and blood sugar. They make you have low energy, poor brain function, your moods can be altered and your physical and athletic ability becomes diminished, which you, you mentioned that after you had to treat that low and you had that giant spike and I'm sure you've you've, you know, probably experienced it other times, but you just feel crummy, right? Yeah. Awful. Yeah. Um, Interestingly enough, I never really heard the time behind it, but apparently most post meal spikes happen about an hour and 15 minutes after the start of a meal, which I was thinking about us eating breakfast, which is usually when we see our biggest spikes. And that's pretty spot on like an hour and 15, maybe an hour and a half after breakfast is when, if she's gonna spike. That's when we that's, when we see the spike and then table nine, three in the book just gives a really sweet summary of. After meal blood glucose targets kind of based on age. So usually a little bit more conservative for the younger, for the younger kids. And then the author jumps right on into how to better control. Post meal spikes. So I'll, again, Sam, I'll read down the list and you can kind of just tell me what stuck out to you and like, okay, what you've used and what you've been successful with with you or your daughter. But he says you wanna choose the right insulin. So again, NPH uh, regular or regular insulin is not great, cuz it takes forever to start working. you know, if possible you really wanna choose like a Humalog or a Novalog that works, you know, a rapid acting insulin that works faster. And then there's FIAs, which is an ultra rapid acting insulin that, that works about five or 10 minutes faster than Novalog or Humalog. And it gets cleared outta the system faster, maybe like an hour faster or so, and then Afreza which is the inhalable insulin. I've I it's, Sarah's not old enough to use it. I think you have to be 18 to use Afreza but I've heard great things. So if your kid or you are over the age of 18, may might wanna look into that. um, Author suggests using a pre bolus for most meals. A pre bolus is when you give insulin 15 to 20 minutes before eating, since it can take that long for insulin to even start working again, you would not want to do this with like a really heavy fatty meal. Like a good example is pizza or fettuccini Alfredo or anything that has like a really rich creamy sauce to it. Lots of cheese, stuff like that. Okay. He also says You know, avoiding the post meal spikes you might wanna consider using, like he calls it the super bowls technique, which I think is a term that was coined by the guy that wrote the sugar surfing book. I think don't quote me on that, but this is a technique where if you're on a pump, unfortunately only pump users can use this technique, but you would turn off your basal rate for a few hours, like maybe three hours. So, but you're missing three hours worth of basal. So instead you would actually take that insulin up front. So if you have your basal rate set at like one unit an hour and you turn it off for three hours, you would actually take those three units of insulin that you would be missing up front. And this would be for like a higher GI meal. That's gonna hit your system, like really hard and really fast. So a good example would be like breakfast cereal because you might need all that insulin up front to kinda combine combat that after meal spike. We've tried that a few times with breakfast cereal and I would say like three quarters of the time it worked really great. And then of course, there's just those other times where diabetes doesn't play by the roles in. It did not cereal and breakfast

Samantha:

is a beast to handle no matter what I feel. Yes.

Katie:

Yep. I agree. It really is. You know, we've gotten better, but there's still some days and it's certain cereals, like I've noticed that any cereal that involves cinnamon, which is ironic, right. Because yeah. Random people like people tell you to eat it. yeah. People tell you that cinnamon work, cure diabetes, but I have found that any cereal that, you know, even like a quote unquote, healthy cereal with cinnamon, I don't know what it is, but it's, it's like always the worst. So but yeah, breakfast cereal is for sure a beast. Okay. I'm like quickly checking in on Sarah and she's at camp and her Dexcom says 92 straight arrow down, but the dots suggest otherwise. So I'm gonna give it a minute. And I also just told her to eat some Smarties. So I feel like she's gonna start coming back up. Sorry had to take a brief pause there. That's okay. Yeah.

Samantha:

I thought I was low before we started, so I was like inhaling a plum and Arine just going hard in it. And I'm two 30 now. So I was wrong. Not should I oh

Katie:

no. Oh man. No, I'm sorry. So no

Samantha:

guessing people

Katie:

I, no, I couldn't tell you how many carbs were in a plum. That's not usually a fruit. I, I buy, but I'll have to look it up when we're done. Um, Okay. This is interesting, but if you apparently, if you inject rapid acting insulin into a muscle it can bring your number down in about like half the time. I have not experimented on this with Sarah, cuz I just feel like that's not my, I don't know. I don't wanna, that feels like I'm messing with fire. So I'm just, I'll let her try that when she's an adult, when she makes up her own mind to do that. But but anyway, he said that this can also cause bruising and you might need to use a little bit longer. Syringe or pin needle, because you gotta go a little deeper to get into the muscle. He suggests you could warm the site before you eat, which I mean, who really has time to do that, but you could kind of like put a warm compress over the area that you're gonna inject the insulin into in that makes the insulin go get absorbed faster. Um, He suggests that you get moving so 10 to 15 minutes of mild activity after you eat, like immediately after you eat, typically does the job. And he says the key is just to avoid sitting for long periods of time after eating, which if you've ever gone to the movie theater with your type one diabetic and they've eaten movie theater snacks and have sat through a movie, you will figure that out really quickly. yes. A hundred percent. It's like the worst. Yes. So get moving. And then don't smoke or vape because that constricts your blood vessels and your insulin cannot move around properly and get absorbed if you are If your blood fus are shrunk, so don't smoke or vape. All right. So Sam, what on that list of tips to prevent after meal blood sugar spikes stuck out to you the most? So we are

Samantha:

huge, huge pre bowlers. I mean, mm-hmm if we don't, we see like, almost instantly that it was a mistake, especially because Amelia is a big Duncan donuts fan mm-hmm I dunno how huge Duncan is in Florida, but it is everywhere here and she is a glazed chocolate donut theme. So typically it's like, oh, can we stop? And she takes like eight units for 10 chocolate munchkins, which would be fine if she was taking it, you know, a half an hour before she ate. But oh my goodness. Do we usually pay for that? I'm like, oh man, like, come on, we made that mistake. But yeah, so we actually tried also, cuz we kept on having that issue. So we tried to get the. How do you say it? The Thias the, the FIAs. Yeah. Yeah. Yeah. But they told us that my endocrinologist said that they it's a non-preferred drug in our, with our insurance plan and that they didn't see like great success with it. So we're still no blog girls forever.

Katie:

Okay. I know. I have toed around with the idea of trying FIAs too, because it's covered by our insurance. I don't know if my doctor would prescribe it, but it is covered. Yeah. But I'm like, I, I don't know. I've heard mixed reviews. Like it really doesn't work that much faster and like not worth the change. Right. I don't know. Maybe one day we'll give it a try, but we haven't yet stay tune. Stay tuned. Um, And I just wanted to confirm that dunking donuts is a big deal here in Florida. and we actually, this was a tradition that started before diabetes, but I was like, we are not giving that up. I don't care about diabetes. Right. But we're not,

Samantha:

I think that how I feel this morning.

Katie:

Yeah. There you go. But we, the last Friday of every month, so 12 times a year, we swing through Duncan and get a donut, so

Samantha:

12 times a year. So yeah, we definitely hit up Duncan much more than that.

Katie:

I mean, I'm not gonna say those are the only times we hit up Duncan, but I'm just saying those are the scheduled times. Yes. Those are the scheduled times. yeah, but we have to give it Sarah likes the strawberry frosted donut with sprinkles and yeah, we ideally like. A 20 or 30 minute pre bolus is best for that, but yes, for us at least. But yeah, but we don't, you can't always, you can't always make that that's. I mean, you know, cause a lot of times we're swinging through dunking after I pick him up from school. So she might only get like a 10 or 15 minute pre bolus by the time we yep. Pull in the direct, our thing

Samantha:

is the way that the route to school is set up. I always say, she'll be like, why should I take my insulin? I'm like, take eight units when you're by burger king, she'll call me and be like, Hey, I'm at burger king. Should I take that insulin? but she's really 10 minutes away from dunking Uhhuh. Oh

Katie:

my gosh. So things that we suggest I know. Right, exactly. I don't know. It's nice that our kids are a little older though. Cause they can like, I know do that on their own sort of. Thank God. I know. Thank God. all right. I'm gonna quickly go through this next section. It is on. So that was. You know a list of how to prevent the after meal spikes. And then this is like a tips on how to get food to digest more slowly, which could also help to prevent the after meal spikes. But he basically says you wanna try to eat lower GI foods. Those are, you know, things that have a lot of fiber um, and GI stands for glycemic index. If listeners don't know that, but table nine, four in the book in this chapter provides ways to substitute high GI foods for low GI foods. So you might wanna take a look at that. We just don't really do that. I mean, we try to eat healthy most of the time, but I'm not like. Spending all my days, trying to figure out ways to substitute high GI foods for low GI foods. But that's just me. Amen. Yes. Yeah. I did not know this. I think this is really interesting if apparently if you add some acidity to your food, like vinegar it slows down the rate of digestion, like Hmm. By a lot. So the, apparently this is why sourdough bread is much lower on the glycemic index than regular, like just regular white bread. And research has shown that adding acidity in the form of vinegar. So either just taking like a shot of vinegar straight or using a salad dressing that has vinegar can reduce one hour post meal, blood sugar rise by as much as 50%. Wow. I'm like so tempted to have Sarah take a shot of apple cider vinegar after she eats breakfast cereal and see what happens.

Samantha:

I know, I wish I could get Amelia to do that. Maybe

Katie:

if I offer some Robux. Yeah. Or pickles. Sarah loves pickle or yeah. Yeah. Oh too. Yeah. Maybe like here have some pickles with your toast breakfast

Samantha:

with your breakfast. Can you imagine?

Katie:

Yeah, I know I could not. So I don't know. Fun fact did not know that he suggests splitting your meal, so eat some up front, save some for later sequence properly. So eat your meals in a sequence, like try to eat your protein first proteins and veggies first, and then save like the carbs for later in the meal use an add-on medication Simin, which is also called pre Alatoid. That's the like hormone replacement for amylin that hormone that I was talking about a little while ago and then GLP one receptor agonist also slow down digestion. I'm not gonna say anything else about those other than that, cuz. That's probably beyond the scope of me. Mm-hmm but he also says get moving, which is, was in the last section, but not only, you know, muscle activity, you know, it, it's kind of like free insulin cuz you don't when your muscles are exercising, they can take in glucose without insulin, but also when your muscles are exercising, it diverts blood flow away from your intestines and from digestion. So it slows down digestion. So good to keep in mind and let's see. Oh, this was super interesting to me because I think we were actually seeing this sometimes in the morning with Sarah. But apparently when you have a low blood sugar, one of the many responses that your body has includes accelerated gastric emptying, which means that food digests and raises blood sugar even more quickly than usual following a low blood sugar. So that would be great for somebody that's having a low blood sugar. Right. But when it occurs soon before eating a meal, it can contribute to excessive post meal spikes. So in the mornings. especially with cereal, I was doing like a 30 minute pre bolus for before Sarah would eat her cereal. But sometimes that would cause her to go low before she actually ate the cereal mm-hmm And then we would see these really big spikes. And I was kind of attributing that to like a rebound high from like the adrenaline that's being dumped into our system. And then mm-hmm, that's causing the high blood sugar, but I feel like it also might have been. You know, partly attributed to this, like the accelerated gastric emptying, which means like, not only are we dealing with a rebound high and breakfast cereal, but now we're dealing with this like super fast digestion that's causing her blood sugar to go even higher. So then I start, this has worked really well for us, but I'll give her, like, I call it an Appetiser. I'm like, here's your Appetiser and I'll I'll give her like, just a little tiny handful of cereal or like a couple grapes or just something that's gonna like bump her up a tiny bit to keep her from crashing before she actually eats her breakfast. Yeah. So what, what on that list stuck out to you the most to when it comes to getting carbs, to digest more.

Samantha:

We're a huge on taking a walk. Like if we just ate and took a ton of insulin, taking it, if it wasn't on the list, but we take walks or I have her like hop right in the shower. Dinner can sometimes be hard for us, like right before bed and too much insulin lingering before she gets asleep. So I'm like get in the shower. So everything and love loud before you go to bed.

Katie:

Oh yeah. We used to shower in the bath all the time. That's like one of Sarah's favorite go-tos I'm just gonna get in the bath too. Perfect. Yeah.

Samantha:

Yeah. How can see you later? We like prop up iPad. Give her a movie. We're like just sit in there for a little bit.

Katie:

Yeah, exactly. I love it. What if she dropped it? Is it waterproof at the

Samantha:

iPad? No. Yeah, no, no. So we have this little stool it's designated for the iPad. It's like this Amelia stool that we have in her room. We grab it on like grab your iPad stool. We put it by the tub.

Katie:

Okay. She's not like holding it over the tub. You have it like God, no.

Samantha:

we saw her like 10th iPads. So definitely no

Katie:

yes. Yeah. Okay. Okay. Gotcha. All right. Well, let's see. All right. Troubleshooting routine highs. We are kind of wrapping up the chapter here, but you know, sometimes you just high blood sugars just seem like unexplainable, right? Like you've tried to figure it out and you just can't it's like your blood sugar's just high for seemingly no reason. The author does give a good review, however, of like things that can cause high blood sugars on pages 2 82 and 2 83. And then a lot of that was described in chapter eight. So if if you know, I, I won't, I, I'm not gonna list all those things here, so you can go back and listen to the chapter eight episode or look through chapter eight yourself. But then he does offer some questions to ask yourself when the highs truly seem to be unex explainin. So he says, ask yourself, is the insulin spoiled? I feel like that doesn't happen as much as people seem to make. You wanna think it happens, but agree. So, yeah. So has the insulin gone bad? Maybe you forgot to take your insulin. Maybe you forgot to take your basal insulin or your bolus insulin. You know, that can happen is the insulin absorbing properly. So author gives some really great examples of how to, you know, properly rotate your injection sites and your pump sites to avoid like having those fatty deposits filled up, which can prevent insulin from being absorbed AB absorbed that's on page 2 86. And then he says, ask yourself, was there a gap in insulin coverage? Like maybe. Like, maybe again, you didn't take your basal insulin kind of like at your scheduled time or you forgot to take it all together, or maybe you suspended insulin. Like if you got in the pool and you were swimming and so your basal insulin, wasn't running for two hours. I know for Sarah, whenever I suspend her insulin before she gets in the pool, like as soon as she gets out of the pool, I have to turn her insulin back on and give her a bolus for what she missed. Yeah. So like, if she, like right now, her basil rate is right at like about a unit, a little higher than that actually, which I think is really high for a 10 year old girl, but whatever. So if she's in the pool for two hours and I've suspended her insulin, like when she gets outta the pool, I have to Bo list for that. Like I have to give her two units of insulin right away, even if she's sitting at like 70, because I have seen pattern over and over again that she will immediately start to shoot up. Yeah, after she gets outta the pool. Uh, And then, oh, really. Yeah. Yeah, it's crazy. Isn't it?

Samantha:

Yeah. It's kind of weird, honestly. Yeah,

Katie:

I know. And then the last question is, has your pump failed or malfunctioned that can obviously cause gaps in your insulin coverage and can cause your blood sugar to go really high? Do you have any kind of like anecdotal advice or stories concerning any of those questions?

Samantha:

For us we're big on, like, I do agree, like take your basil when you, like, if you are MDI, definitely taking it. Like for me, I, I take it when I like first wake up, so I like, I have thyroid medicine that I take and I take that with my Aus in the morning. But for anyone else, I mean, I know they typically suggest that you take it at night, so maybe taking it, like, like they say, like when you brush your teeth or like prepare something, like always make sure you do it in a routine because that's something so easy to. Advice wise for that, but pump failures. Yeah. Oh gosh. That's like something huge for us because I do feel like, I don't know if it's just how rush she is because. Um, We have so many pod failures. I don't even know really what to say. A lot of the times for us, that's what it is. The pods failed. Like it either came the adhesive peeled off or we have that a lot.

Katie:

Yeah. We have only, I feel like we've only really had like maybe three or maybe four pod failures, like true pod failures. Or like truly like the cannula came out and I didn't realize it. Yeah. Or the cannulas totally bent. And I didn't realize it but other than that, I've realized that most of our high blood sugars are just user error.

Samantha:

like, oh my gosh, don't you love that one? You're like, oh, this pod definitely failed. And then they're like tanking 60 double errors down. And you're like, God tank it. Yeah. It's your body. It's not the pod.

Katie:

Yes. Or it was my poor treatment decision or whatever the case may be. Yeah. Like I. But I like, I do like to blame the pods sometimes even though it's usually not the pod, it's usually me or something else,

Samantha:

you know, I'm like, God dang these pods in reality, I like gave her way too much insulin for that, but whatever. Right,

Katie:

right. But I mean, the author kind of ends the chapter with like, if you are off of your insulin, for whatever reason, whether you've suspended it, cuz. You've gotten in the pool or whatever the case may be. Mm-hmm or your PO your pump has failed. Like you really need to get some insulin in the system as quickly as possible, because it it's crazy, but you DKA can really start to happen within like hours of not having your insulin. Which is insane to me. We actually saw this a couple weeks ago when we were in Arizona and Sarah got so sick, like just insane, but you know, DKA, diabetic ketoacidosis is when basically your body doesn't have access to insulin, and if it doesn't have access to insulin, it can't use glucose for fuel. So it has to start breaking down all the fat. And when fat gets broken down to be used for energy, it gives off all these byproducts, which are keytones and keytones are very acidic. So it can really mess with the pH balance of your blood and it can turn it. Really, really acidic really quickly. And then when it gets too high, your body just cannot get rid of it fast enough. Like you just can't flush it outta your system. So, you know, the author says he, he gives three steps to reversing. The problem if keytones are present. So not if you're in DKA, like if you, if you suspect that your child is in, or you are in DKA, which the signs for that are nausea and vomiting breathing may be very deep or in irreg, fruity odor on the breath, dry skin, dehydrated from excessive urination, intense thirst, dry mouth blurry, vision headache, and muscle aches and pains. Like if there's keytones and you suspect DKA, you just need to go straight to the hospital. Like don't even try to mess around with that. But if there's, you know, if it's early on and the keytones are present and they're like, Not causing any of those big symptoms. Like he gives three steps to try to reverse it. He says inject rapid acting insulin consi, consider doing it into a muscle to get the insulin moving quicker drink tons and tons of water to try to flush out the keytones. And then if you're on a pump, you wanna change the cartridge, the tubing the infusion set, or the pod, if you're on Omnipod and then use a fresh VI of insulin to try to get those keytones out of there, because failure to correct could, like I already said, put you into DKA pretty quickly. And this is a interesting fact, more than 80% of type one diabetic inpatient hospital admissions are due to DKA each year. So if diabetics are going to the hospital type one diabetics, it's usually cuz they're in DKA. So have you ever been, I mean, other than. At diagnosis. Have you ever been in DKA or your daughter ever been in DKA?

Samantha:

Only once when I had the flu, I was probably in high school and my mom was like, okay, like your blood sugar has been high for like two whole days. Like we should probably go to the hospital and I was like, okay, I'm just gonna run upstairs really quick and brush my teeth. Well, I guess I passed, I guess I passed out. My sister tells me I took 20 years off of her life all the time. She bet you went upstairs time. And I passed out by bathtub and I don't remember it happening of course, but they ended up like dragging me down the hallway and I woke up in the, the ICU oh my gosh. It's funny to us now because they just get so they're so like, if anyone tries to trivialize diabetes, they, my sisters go hard on the like. Okay. Well, you've never like drugged your sister down a flight of stairs to take her to the hospital. You obviously don't understand, like I put them through

Katie:

it. Oh my gosh. Yeah. Wait, sorry back. So you were in high school. So were you like going through a phase of just wanting to ignore your diabetes or what happened? Oh, a

Samantha:

hundred percent. A hundred percent. When I first got to high school, I went from a private school to a public school and I was on, I had the Medtronic pump and a kid who I'm like friends with now, but I was a freshman was like, are you wearing plastic underwear? Cause my pump tubing was taking outta my pants. Well, that was all I needed to not wanna wear my pump to school and oh yeah. Yeah. I hate it. Oh yeah. Did it, did myself dirty. So, and my sister. So now they're all like, if I look, if I take a long nap, if I look grouchy, if I'm tired, they're like, what's your sugar, are you okay? I'm like, oh my God, you guys. That was like 17 years ago.

Katie:

Oh, but that, isn't it. It's a little bit of that is sweet, right? That they're so concerned about you. Yeah, I know. I'm you scared 'em to death. That's what you traumatized by. I,

Samantha:

I did. That's what I like, they feel like they're gonna die young. We just worried about diabetes and they're not

Katie:

diabetic. I know. I feel like I need to have you back on sometime to just talk about that whole teen phase of you wanting to ignore your diabetes. Cuz I feel like a lot. That's like a lot of parents' fear is like it happens their kids. Yeah. I know it does. I'm just

Samantha:

like, cause kids are mean right? Like they just like say the wrong thing and then that just like totally changes your perception of yourself. Really?

Katie:

Yeah, I know. And in middle school and high school, it, like you said, it only takes one thing to. Set off and, yep. Okay. I'm gonna start praying now.

Samantha:

I know makes me panic. My, my daughter heard girls just wanna have fun for the first time. A couple months ago, I was like, mom, this is gonna be me. I swear to God. I had an instant panic attack. I was sweaty. I'm like, oh my God, I can't hear this. I cannot think that. Please don't wanna have fun. I need you to like, stay home and just live with me

Katie:

forever. I know right there will be no partying in drinking for you in college. Not absolutely not. No girls

Samantha:

having fun whatsoever.

Katie:

Girls just wanna have low car snacks and take their insulin. That's what the song should say. Girls just

Samantha:

sit really calmly next to their mom until they're 80. Oh,

Katie:

well, I would love actually, I would not love that. Let's be honest. I'm ready. I'm like, when can, y'all get out of this house, but I, I it's. Yeah. I, I just, can my

Samantha:

husband think about it in the same way? He's like, Sam, she'll be fine. If she goes away for the day, let's go on a date. And that then there we are check him the Dexcom every five minutes, minutes waiting for the four to hit five. I'm like, oh God, come on.

Katie:

Yeah. Yeah. I know. I, I hear you. I know. All right. Well, Sam, thank you. I know that was a longer recording and I just really thank you for your time. And I loved hearing all of your little stories and your tips and tricks. I think, I just feel like you have like. You know, you have like double the amount of insight and wisdom since you've lived with this stuff for so long, and now you have a child with diabetes and I feel like you had a lot to offer, so thank you.

Samantha:

You are so welcome. It was so nice to be honest, honestly, so nice to like, I feel like a lot of people would do so much better. Like just talking to someone who's going through the same thing. Like it's, mm-hmm, it's, it's lonely when you don't have a kind of someone that understands cause no one does, unless you're doing exactly what they're doing, you, they don't get it.

Katie:

I know. I know, I agree. The bummer. I know. I know. That's why I've tried to surround myself with I've like forced people to be friends with me. I'm like, oh, your kid has diabetes. You will be friends

Samantha:

with me. we're like, oh my God, I saw you had, we had so many times we've like walked up to people and been like, Oh, my God. I saw your deck come. Oh my gosh. On the pod. And majority of the time they look at us like, go, like, I do not wanna be your friend. Cause we're like in Disney or on the beach, you know, like whatever. And we're like, OK, bye. Like I just wanted, saw diabetic in the wild and wanted to be your friend, but it's fine. It's totally okay.

Katie:

I know. I know you don't wanna exchange numbers? No. Okay. No, you wanna be

Samantha:

my friend forever. Okay. All right. That's fine. All right. See ya.

Katie:

oh, I know. I feel like I get most of the time. Those are the looks I get too. There was this one time I was sitting at a, I was watching my son's baseball game and Sarah was sitting on my lap in this, like, she must have been, I don't know, 30, maybe mid thirties. She like grown woman comes up to me and like flexes her arm in front of my face. And she had a Dexcom on her arm. Oh my God. And I was like, it like took me a second cuz like my eyes had to focus cuz it was that close to my face. And I was like, oh and I like turned around and she's like, I just wanted to come say hi, I'm a fellow diabetic. I was like, oh I would've loved her. See, I did love her. Like after the initial shock wore off, I was like, I'd like to be your best friend, but anyway, she had to go cause she had to go home or something like that, but I wanted

Samantha:

you to come home with me for dinner, but it was nice to meet

Katie:

you talk later. Right. Right. So I thought that was fun. I like when people do weird, crazy stuff like that, like be weird. Be awkward. I, I

Samantha:

appreciate it. It consult working in healthcare. I think you're you're are you a physical therapist? Yes. Physical therapist. Yeah. Yeah. Oh yeah. Yeah. So patients like make you wanna be weird and you just accept it for what it's oh.

Katie:

Patients are so weird. Like if you ever had a normal patient, I don't think I ever have

Samantha:

never, never. And I love them. I love the weird ones.

Katie:

I know I do too. Like the weirder, they. No, listen, I don't like the mean ones. I hate the mean ones. Dito. Those are so bad, but the weird ones, I'm like, I'm, I'm here for you.

Samantha:

Come over here to me and snuggle me. That's thought exactly how I feel. I'm like, give me these weirdo. I love them.

Katie:

I know. Which is why I think I'm gonna do really well when my kids are middle schoolers, cuz middle schoolers are just so weird and awkward Dito. But I

Samantha:

think I'm yeah, my daughter's friends think I'm like so funny and she thinks I'm the biggest loser. She's like, mom, stand up. I'm like, come on. I love it. Aw. Let's do something weird. And she's like, no. Oh my gosh, whatever.

Katie:

fine. They'll they'll well, they'll appreciate it. When they're older they can look back and yeah, come on. That's pretty cool. I

Samantha:

guess okay. You were a little funny. Yeah.

Katie:

all right. I'm gonna let you go. But Hey listen. When I hit stop, don't like give it like 30 seconds because it needs to upload real quick. Okay. Okay.

Samantha:

Okay.

Katie:

All right, guys, that is it for the show today. I have a few updates. First of all, I would like you all to know that both Samantha and I are now using the Omnipod five automated insulin delivery system. And Samantha has braved the automated mode and she is loving it. She wants everybody to know that she's now using auto mode. Most of the time and they're absolutely loving it. And that is the same for us. I have only flipped it into manual mode once or twice to do a bigger extended bolus for a heavier meal. And other than that, it's been an automatic mode or auto mode. What automated automated mode. that's what it's called. And we are absolutely loving it. I mean, our control has been, I would say. A great deal better than it was before. Our standard deviation has gone down and I'm excited to go to our next indoor appointment and see what our A1C is. Also probably more importantly than A1C our time and range has been pretty darn and good. I would say it's been Over 70%, usually closer to like 80, 85% on most days. So that's pretty awesome. In my opinion, I also wanna let you know that I just put tropical punch Koolaid on my Walmart order for my next Walmart pickup. And I was laughing when I listened to that part of the show when I was editing it. And I thought, oh, I forgot about that. I gotta add it. Grocery pickup. So I did that and I will let you know how it goes. It made me sad to talk about the red Lily emergency glucagon kits, because just recently we learned in the diabetes news world, that those kits are gonna be discontinued soon, so they will no longer be available. I think it's just because there's so many like autoinjectors now, like the GVO hypo pin and the basi nasal spray that those Lily red Lily old school glucagon kits just don't get used as much. Let's see. Last update. Samantha mentioned being a huge pre bolus family. We are also a huge pre bolus family. Our control is so much better. So, so much better when we pre bolus typically in the mornings for us, for breakfast, it's a 30 minute pre bolus and other meals of the day. It's more like a 15 or 20 minute pre Bowlus. And then we've become really good at learning which meals you, we do not pre bolus for. And I know everybody's different, so I'm not telling you what to do. I'm just telling you what works for us. But we recently learned that ribs, barbecue ribs is another meal that we cannot pre Boles for because Sarah goes crazy low before those ribs digest and the carbs that she had with her meal have a chance to get into her blood sugar and get into her system. So ribs, no pre bowls for us. Also see pizza and feta Alfredo. Okay. I mentioned several episodes in this episode. I mentioned the episode about reading the Dexcom dots and not the arrows. I'll put a link to that in the show notes. I mentioned the episode about alcohol and diabetes. I will put a link to that one in the show notes as well. And then I mentioned the episode about the Medtronic in pin, which is the smart insulin pin that has Bluetooth technology built into it. I will also put a link to that in the show notes, as well as a link to where you can buy your very own copy of think like a pancreas and follow along with us. All right, guys. I hope you have a fabulous week. I will chat with you soon, but until then stay calm and Boless on. Bye.