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Episode 32- Q+A!!!
324 Plays1 year ago
Raquel and Amanda go through as many questions as they can from all of YOU! We frequently have question and answer boxes on Instagram, but it's challenging to get to all of them! So this episode is dedicated to having in depth conversations for all of your questions. Which pump should I choose? How do I manage oral health? Elaborate explanation of splitting doses? How do you deal with diabetes being forever? AND SO MUCH MORE!
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Transcript
Introduction to Podcast
00:00:00
Speaker
Hello, and welcome to the 108 podcast. I'm Amanda. And I'm Raquel. And we're the Type 1 Together girls. We are stripping down life with Type 1 diabetes from two people who live different versions of it every single day. Please remember, Type 1 Together does not give medical advice. We are only sharing from personal experience.
00:00:19
Speaker
Hey, Amanda. Hi. Sorry, I started that weird, but I thought to myself, man, we need a fun intro, some music, or just something like different. We're working on it. So my brain just went to like, change your cadence. Oh, you're like, hello. I'm pretty sure the last three times we've done intros, we've been laughing about that. So clearly we gotta do something about it soon. But how is
Amanda's San Francisco Trip
00:00:46
Speaker
life? How are things going?
00:00:48
Speaker
things are going well and also not well. Things are totally fine. So we're recording this on a Thursday. This past weekend I went up to San Francisco just for 48 hours because my best friend is up there for a clerkship and I love going up to the Bay Area. It's so much fun. I had
00:01:11
Speaker
the best time, brain was all the way turned off, had one too many my ties, you know, just had like an awesome, super fun weekend. And there was one point, of course, poor Danny, whenever I'm out like that, if there's ever like a tough low or stubborn highs, he's immediately texting me like I'm on it. And then he'll say,
00:01:34
Speaker
you know, like, oh, I'm so sorry, I didn't want you to have to deal with this. I really want you to turn your brain off. And I'm like, I hope you know that my brain is all the way turned off. Like, I barely pay attention to the, to any of the alarms or
Managing Diabetes Remotely
00:01:50
Speaker
anything. Like the only time I would want to hear from you is if like there is a significant low
00:02:00
Speaker
And I would just want like a I see it and I'm on it so that I don't have to sit there and wonder if you are waking up to the 45 alarm or whatever, you know, but yeah, that was funny.
Hattie's Blood Sugar Fluctuations
00:02:14
Speaker
And then I.
00:02:15
Speaker
got home like right in time for the Super Bowl. And then just during the Super Bowl, Hattie, okay. So Hattie's had kind of strained sugars lately. Her time and range is still the same, but we're just kind of like all over the place. And we recently started vitamin D supplements for her. And I can't remember if we brought this up on the podcast already. I have yet to make videos on it.
00:02:42
Speaker
But I am planning on making multiple videos discussing the importance of vitamin D for all people, but especially for people with type 1 diabetes. Basically, it can increase the efficacy of insulin, the potency of insulin, like it makes it
00:03:00
Speaker
easier for your body to uptake that insulin. So we are noticing that she's a lot more insulin sensitive than she's ever been. So we're seeing her like start to rise slightly and then what we used to do would give her a micro bolus like a 0.15 units just to like slow it down before it got out of hand. And
00:03:22
Speaker
And that all of a sudden will drop her from 180 to 150 to 120 to 118 to 110. So it's this weird immediate reaction, but then she kind of levels out. And anyway, so this was happening during the Super Bowl to the point where we
00:03:41
Speaker
a dose of fresh insulin mixed with her playing with my brothers, her uncles, and running around and having so much fun was kind of tanking her. And then she was super hungry. She had two bagels. She ate almost half of a rotisserie chicken herself. She had vegetables. She had fruit. She had an entire avocado. And this was over the period of like
00:04:05
Speaker
five or six hours, that's a lot of food for a little kid, a lot.
Vitamin D and Insulin Sensitivity
00:04:09
Speaker
And there was a point where we just like stopped giving her insulin because she just kept crashing and we were planning on doing the whole let's dose after the fact and see how
00:04:22
Speaker
how this food is affecting her because the activity is just making it tough. Well, she was like super flat 110 to 130 all through the Superbowl for like the hour and a half after we got home and then she fell asleep at like nine, nine 30.
00:04:40
Speaker
and that girl just skyrocketed. It was like straight up to 350 and she just sat at 350 and Dani and I were giving her bolus after bolus after bolus and we were so nervous because all day even the small bolus says we're tanking her so we would start with a smaller amount because we don't want to tank her and wake her up right after she's fallen asleep and had an exhausting day like she needs the rest.
00:05:09
Speaker
and it was just so dang stubborn and so we like gosh I think he stayed up until 11 or midnight and then I woke up and I was like oh my gosh babe go to sleep I've got it and then I stayed up till 2 30 just like dosing getting her down and then
00:05:34
Speaker
I heard Dani wake up again at 430 because after like five plus units, we finally got her down in range. I felt safe enough to fall asleep when she was at like 170, kind of slowly trending down and she just halted at like 165, went right back up. So he was up at 430 dozing her.
00:05:54
Speaker
It was just a mess. So all that was happening. And it was like, that was Sunday, Monday, Tuesday. And it's just all over the place. We're super frustrated. Not with her, but just with diabetes in general. And then last night we dose her
00:06:15
Speaker
appropriately and it's later at night. Typically, she's very insulin resistant at night. She was high. She was above 250. She starts coming down. She falls asleep and I'm thinking, okay, this is good. She has a lot of insulin on board. She's falling asleep and when she falls asleep, she usually does that whole like skyrocket back up from growth hormone.
00:06:40
Speaker
and no nothing happened she just freaking went down into the low 40s and it was so scary and so sad and you know she was fine like she really was fine there was one point where danny went in two times in a row like eight minutes apart
00:06:57
Speaker
And the second time she was like, can you guys hurry up? A little four-year-old with so much attitude, hilarious. And you know, then this morning she was in a great mood but definitely tired, just kind of like laying on the couch while breakfast was being made instead of playing.
00:07:15
Speaker
And yeah, that's just where we've been a lot of times. I don't have anything to say when you're like, oh, how's life? And this time I had a lot of diabetes life to talk about. That's how it goes. It's like periods of nothing. Yes. And then that. Yes. And then that is tiring. It's so, I'm tired, man. It's really, really exhausting. I know.
00:07:41
Speaker
I feel bad for her because she's got to be tired feeling so up and down and dealing with lower lows than usual. Our lows are typically not lower than 62. We really catch it in the 60s most of the time.
00:07:57
Speaker
her highs don't really get that far above to 10 to 20. So it's like, keep her in a decent range and let her live her life. But whew, that swing to 350 and down to 40, that does not feel good, I'm sure. So how about you? What's, what are your sugars like or just your life?
Raquel's Blood Sugar Management
00:08:20
Speaker
Yeah, I've been feeling pretty good. I have been feeling happier, I think, like I kind of talked about distressing and stuff. So that's been paying off. I've been walking a lot more like throughout my day and it's been helping my blood sugars on my overall energy and mood. And there's just been a lot of fun things happening between like Super Bowl and Valentine's Day. I'm really sorry. My boyfriend's working from home today. He's not even in the room, but his computer keeps making noise. I hope you all can't hear it.
00:08:54
Speaker
But I always feel weird talking about like my cycle and stuff on here, but at the same time it's such a normal thing. So yeah, like right before I usually get it, I'm super stubbornly high and that was happening earlier in this week. And I had like a pretty big spike after breakfast and I've been eating the same thing for breakfast all week. I've been making like a little English muffin with cream cheese and
00:09:19
Speaker
smoked salmon. It's like a kind of bagel like thing, but not bagel because that really spikes me in the morning with my coffee. And it's been interesting to see like how differently I've had to dose for that meal every single day. I had it today actually, and I've been sitting at like between 85 and 110.
00:09:37
Speaker
But then two days ago before I had gotten my period, I needed literally so much insulin. I had such a big spike. Um, so anyways, that's always frustrating, but it's really cool that I'm finally getting in tune with that pattern and figuring out how to make it work. And then I was telling you that yesterday for Valentine's day, Kevin took me to a really good Italian restaurant and I ate all the carbs, all the bread and pasta and delicious things. And.
00:10:04
Speaker
I had just gotten my period. And so I get really low and that happens. Like I didn't actually drop low yesterday, but I was just in range and it's like, I don't even have to put an effort and it just works. And I gave insulin throughout the meal. I definitely split it up in different ways and I was just kind of watching it and the whole meal, I didn't even go over like 130. I spiked once I went to bed to about 170 and came right back down. And so it was kind of like a, not a day without diabetes, but it just feels easier. Yeah.
00:10:35
Speaker
And it really just has come down to being such an intuitive thing of like when to dose more, when to dose less and getting in tune with your body's patterns, which I know is harder for parents, but it feels cool when you can kind of recognize those patterns and know deep down what you should
Listener Q&A
00:10:50
Speaker
be doing. So that was good. I mean, yeah, it's okay. This is very funny. You know, I've talked about how we're pretty synced up in lots of ways. Yeah.
00:11:03
Speaker
Well, apparently you and Hattie and your blood sugars are fairly synced up because you started the week, both of you pretty insulin resistant with a lot of highs and you're kind of
00:11:14
Speaker
taken, taken on some blows at the end of the week. That's so true. You know what else? I did start taking my vitamin D regularly ever since you were telling me about it last week. And so like I took it like last year and then I just kind of got out of the habit. And so I'm really curious now to see if that actually has an impact. We saw a significant, a significant impact, literally just like
00:11:38
Speaker
four days after she started taking it. And that's because her vitamin D was on the lower end. I think who knows if like adding supplements, if you already have a sufficient amount of diet, vitamin D like helps. But I know a lot of type one diabetics are
00:11:56
Speaker
either lacking in vitamin D or just on the lower end of normal. So I don't know, more information on that to come, but basically it helps reduce inflammation. And when your body does not have inflammation, it works the way it's supposed to, like being able to take up the insulin that's introduced into it. That's so cool.
00:12:18
Speaker
I know it is so cool. Okay, so today we're going to do Q&A's. We put some Q&A boxes up over the last week or two, and we're going to go through about eight
Sponsor Talk: Transcend
00:12:31
Speaker
questions. But before we get into that, we have Transcend to thank for sponsoring this episode of the 108 podcast. So, okay, you guys, Transcend is just the coolest.
00:12:47
Speaker
Do you need to raise low blood sugar fast? Transcend gels and shots contain 15 grams of pure glucose to raise blood sugar quickly. And the best part, thanks to durable packaging and shelf stability, you'll be stashing them everywhere in your pocket glove box backpack and have peace of mind for those scary lows. For real, those things are scattered all over our house, all over our cars,
00:13:12
Speaker
and all over Hattie's classroom. Plus, their easy to use products taste great and provide a precisely formulated alternative to sugary sodas, candies, and juices. They are on a mission to make living with diabetes easier and that means raise your lows on the go conveniently at any time, any place. Yeah, I am so thankful for Transcend because
00:13:40
Speaker
I'm the worst about getting like granola bars and messy things and always having them in my bag. And then they'll like make my bags crummy or the car crummy, or they'll just get so smushed that after a couple of months of being in that bag, I just throw it away because it's like unedible, I feel like. But these are so nice and easy to carry around and clean and lightweight. They're even waterproof, which is cool. Like I've heard people go like taking them on a boat or like scuba diving if you were to do that.
00:14:06
Speaker
And then they're so great for super fast acting sugar. So like if your child is super active or, you know, whatever's going on, you just know you have enough to bring them very high. Yes. Well, not very high in a bad way, but like it'll work quick. It's funny that this episode just happened to be, I didn't plan this, that it happened to be one of the episodes we're talking about transcend because
00:14:34
Speaker
Last night when Hattie went low and she was at 40, like I think the, we got an LOW reading at one point, but the lowest finger prick we saw was like 46 or something like that. And we gave her a transcend gel pack and it brought her up to 130 and then she slowly coasted. She like got up, didn't spike past that.
00:15:01
Speaker
And then she slowly coasted down as the pump took care of that, trying to get her to her goal blood sugar of 110. And then she slept the rest of the night between like 75 and 110 blood sugar, which is just so perfect. So I think that contributed to her waking up feeling tired, but not like she got hit by a truck, you know? Cause at least she got restorative sleep with good blood sugars from
00:15:27
Speaker
you know, 11 PM onward. And that, that's a special thing that only transcend gels have been able to do for us seriously. And they get them down really fast. Yeah. They were kind enough to give our audience a codes. You can use code type one together for 25% off your order on their website. Pretty awesome. We'll make sure to link that in the show notes as well. Thank you, transcend. Thank you. All right. Let's dive into our first question.
00:15:55
Speaker
Yes, let's do it. Okay. It is.
Oral Health for Diabetic Children
00:15:59
Speaker
How do you manage oral health while treating night lows? Hmm. How serendipitous that this is our first question. I'm worried my toddler is going to have cavities. Raquel, I want to hear from you actually first what your experience was like growing up with oral health and having nighttime lows. And did your mom do anything special or different? Yeah.
00:16:22
Speaker
I think for the most part, I would just try to drink a little water after having juice or whatever it was, but I'm not gonna lie, it did not always happen.
00:16:31
Speaker
I definitely have had cavities before. And then I definitely put off going to the dentist for a while once I was an adult and moving and needed to find a new one and all that stuff. So it's hard to say. I've definitely blamed it on the fact that I've had to treat a lot of nighttime lows, especially when I was dancing all the time. It was very often and before Control IQ was a thing on the tandem pump.
00:16:55
Speaker
Yeah. I mean, I think it's really important to try to brush your teeth, but it's one of those things that as soon as you brush your teeth and you're ready for bed, you go low and it's the most annoying thing ever. And it takes so much willpower to get up and do it in that moment. Yeah. This is kind of like, to me, the same thing as being worried about having a cell phone so close to your child and like the potentially negative effects of like the radio waves or wifi waves or whatever. I don't know.
00:17:25
Speaker
about all that stuff, where it's kind of like there's nothing you can do about it. And the first priority is their safety and keeping them alive, which is giving the low sugar snack and keeping a phone near them so you have access to blood sugars, right?
00:17:45
Speaker
So I have definitely gone into like our oral health journey with Hattie sort of accepting that she might get cavities but doing everything in my power to help avoid if I can. So a lot of my parenting is like
00:18:01
Speaker
I do things where it's like I do all my research and I do everything I can in my power that is feasible so that if something were to go wrong, I could look myself in the mirror and be like, I did everything in my power that I knew to be true at that point. You know what I mean? And that means when there's a low snack and
00:18:25
Speaker
It's in the middle and I try really hard to do like the juice or the gels or applesauce first. So she's not chewing gummies, but there was like a period of six months where she would literally only have gummies and priority is getting that low blood sugar up.
00:18:40
Speaker
I'll deal with a cavity later. So I do try and do the more, yeah, like I said, like just liquid treatments. And then I also always offer her water. We have
00:18:56
Speaker
parents, you'll know what I'm talking about. We have those cups of water that have kind of like the suction at the top. It's like a little saucer and it looks like a disc and it's suction. So I will put it up to her lip and she'll just like take a swig. So I try and do that every time I give her a little snack and then we brush and floss. But honestly, like we have been to the dentist a few times already and the dentist tries to tell me like,
00:19:25
Speaker
You need to do better at brushing. You need to be better at flossing. She definitely develops plaque, especially on her bottom teeth, like in between her teeth in the front. And I just kind of look at her. Sometimes she knows that she's a type of diabetic. And I look at her, uh, Dennis sometimes and I'm like, there's really not much I can do about the fact that at the end of the day, I've got to save her life in the middle of the night. And you know,
00:19:55
Speaker
Yeah, so we also were told that we should go once every three months, but I don't do that to be honest. But I think that is an option if you truly are concerned. And with the liquid thing, that's a really good tip. And I also will buy juice boxes specifically for a night if your kid will eat them at the time, because then with a straw, you can try to put it kind of further back and it won't sit on your teeth as much as
00:20:21
Speaker
like when I get the juice jugs and I'm drinking from the bottles. So try to do what we can, but yeah. Okay.
Rheumatoid Arthritis and Diabetes
00:20:31
Speaker
Any knowledge on joint pain or potential diagnosis of rheumatoid arthritis? What an interesting question. It is very interesting. Do you know a bit about it?
00:20:45
Speaker
I don't, and I'm not gonna pretend like I do. A lot of, I think my grandmother and my mom have it. Maybe other family members have had it. I know it's autoimmune, so it can be more common in type ones, I believe, but I'm not gonna pretend to know anything about this. What about you?
00:21:02
Speaker
Yeah, so it is definitely an autoimmune inflammatory disease. And I do know that if you are prone to developing autoimmune diseases, like if you have one, you do have a higher risk of developing another, which is why a lot of people have celiac.
00:21:25
Speaker
with diabetes. And yeah, I don't know specifically, I'm not sure if you're asking like, hey, I have joint pain, is it possible I have rheumatoid arthritis? If that is your question,
00:21:39
Speaker
My answer is definitely going to be chat with the doc and bring it up. Don't be scared to bring it up. And if they immediately dismiss you, just to kind of hold your ground, I think, and be like, okay, that's great that you don't think it's that, but what should I be looking out for?
00:21:58
Speaker
What should I anticipate if it does develop into that? What are the stats of people with type 1 diabetes who then develop RA or vice versa? And is there any blood work that can be done?
00:22:14
Speaker
that would indicate this is happening because at the end of the day, if you ask those questions and really get your doc thinking, hopefully the endo or your primary care physician, whoever would be like, I guess I can order a blood test. What's the harm? And then you at least know. Yeah. And I think just being aware of the different autoimmune conditions in general is good because like we said, it's definitely more common if you have one, if you have type one to have other things.
00:22:44
Speaker
All right, number three is, can we get an elaborate explanation of splitting doses?
Split Insulin Dosing Techniques
00:22:52
Speaker
How long do you count all the carbs, et cetera, et cetera?
00:22:57
Speaker
Okay. This one has been asked a lot lately and I think it's cause we talk about it a lot. And before we get into nitty gritty things about it, I think from my perspective, I just want to say that there is absolutely not a one size fit all answer to this. The reason why I think splitting doses works well for me is because of the flexibility it gives and how much you can change around the different factors, whether that's timing or amount.
00:23:23
Speaker
to make your current situation and all the variables going on in that moment work together. So for example, on Super Bowl Sunday, I was snacking a lot. And instead of just being like, oh, I'm guessing I'm going to have 45 carbs. Let me split it up into two or three doses. I was just like, a couple of units here, a couple of units there, watching the blood sugar. Am I going up? Am I going down? How much am I going up? How much should I give? And I was just kind of giving more. And I ended up staying completely in range
00:23:53
Speaker
And a lot of that just comes with practice. But then there's other times, like last night, even when I had the Valentine's Day pasta dinner where I gave, I knew I was going to have probably like 60 carbs and I gave
00:24:08
Speaker
what is likely to have been a third of the dose as soon as we put in the order, a third of the dose while we were eating, as soon as I got the food, and then a little bit more towards the end of the meal or when we were finishing. I think we were eating dessert and I gave more. So that was a little more calculated, but Amanda, you'll probably explain it much more specifically and better.
00:24:29
Speaker
No, I don't think so. No, I think that especially if you've never heard the term before or if you're new to the process or if you've just never done it, it kind of feels like this
00:24:44
Speaker
this secret that other type ones know the exact formula to and you don't and it's not, I promise it's not split. Split dosing literally just means like you're giving all the insulin that your body needs for a certain meal or a time frame, just not at one time, not with one single injection or one single push of a button.
00:25:08
Speaker
And a very simplified, like, stripped back example is, let's say your child is eating two pieces of pizza, which is going to amount to 60 grams of carbs. The simplest split bolus that we think of is splitting it in half, right?
00:25:28
Speaker
So because pizza is so fatty and it digests very slowly over time and you can often have a pizza spike well after you've finished eating, you want to attempt to time the peak efficacy of insulin with that delayed spike from the pizza.
00:25:57
Speaker
So if we have this situation for your child, what I would do and what I have done in the past is let's say Hattie is going to be eating 60 grams of pizza. I will dose 30 as soon as she takes her first bite because
00:26:16
Speaker
That insulin won't start working for 15 to 20 minutes. That gives her 15 to 20 minutes to eat pizza, which very slowly digests. So I'm not worried about her tanking before the pizza actually digests and hits her bloodstream. And then I might give the remaining dose and dose for that last 30 grams.
00:26:41
Speaker
20 minutes after she's done eating because I know from personal experience and trial and error that her pizza spike happens two and a half hours after she's done eating. So I do it then so that hopefully by the time that second dose of insulin is peaking and it's most efficient in the body is when the delayed pizza spike is happening. So you kind of keep it under control.
00:27:11
Speaker
So with that, if you, so it's not just about the spike, right? It's also about avoiding a drop. So let's say that you had given, so you gave her 30 carbs worth at first, and you're not afraid of her dropping, like you said, because it's going to.
00:27:26
Speaker
slow absorption of pizza, but if you had given her 60 from the beginning, what would have happened? If I gave her 60 from the beginning, that dose for all 60 grams would have peaked in 90 minutes
00:27:45
Speaker
right? So it would have been the most active, the strongest in the body about 90 minutes later. But from experience, I know that Hattie's blood sugars rise the most from pizza because it's finally hitting the bloodstream after three hours, right? And so when the insulin is at its strongest 90 minutes after I've given it,
00:28:10
Speaker
the pizza digestion is not at its strongest. It's still slowly trickling into the bloodstream. So then she drops and then I give her a low snack to recover and then that low snack is recovering her blood sugar right as the pizza is finally all the way digesting and it's super hitting her bloodstream and now she's skyrocketing and there's not enough strong insulin coursing through the body because we're at the tail end of the insulin's efficacy period.
00:28:40
Speaker
Exactly. So she would have tanked. A lot of people see this and they're confused. They're like, but pizza is so many carbs. Like you got to get it all. I think that also demonstrates the point a little bit that I talk about of if you give more insulin, it's going to act a little bit faster. I don't know how to explain this like scientifically, but it's that thing where like, if I don't have the ability to pre bolus.
00:29:06
Speaker
But then I up the bolus a little bit. A lot of times it can kind of, at least for me, balance it out. So if you're giving 60 carbs instead of 30, like I would guess.
00:29:17
Speaker
that the drop might happen a little faster. Do you see that? Yes. Yeah. Yeah. That's for sure. Like last night, an example, that's a good example last night when we dosed her for like, you know, she was going high and she was eating the rest of her dinner or whatever. And we dosed her for 15 grams of carbs because it was late at night.
00:29:40
Speaker
Her insulin carb ratio is super strong and her correction factor is super strong. So it, the pump suggested three and a half units. That's a lot of units of insulin for her size for one meal. But I went with it because we hadn't tried that before. Cause she typically doesn't eat after seven or seven 30 PM. So yeah, you know, it's kind of like a trial and error sort of thing. And that much insulin in her body all at one time,
00:30:10
Speaker
after she had already eaten some food really sent her tanking because there just wasn't enough sugars digesting in her system to meet that strong of an insulin dose when it was peaking.
00:30:28
Speaker
Yeah, that makes a lot of sense. And then the other time where this could be really useful besides just when you're having a high fat meal is just when you're a little nervous to dose a lot. Like when you're going out to eat and you don't want to give that full pre-dose splitting it up, even if you're only giving one out of four total units 10 minutes before, or when you place that order is going to help get some insulin in the body. So you're not seeing a crazy spike after, even if it's not a high fat meal. So there's kind of different ways you can play with it, but just in general,
00:30:57
Speaker
the flexibility of knowing that you don't have to just perfectly get the right amount from the get go, give one dose, especially when you're pumping and you're able to kind of be more flexible with it, that can be life changing. And sometimes I do a split dose without even realizing I'm going to need it. Like I'll give insulin for a meal, start eating 30 minutes later, I'm clearly going up, I should have given more, I'm giving more then. Like I kind of consider that a split dose because I should have given that insulin before, but I didn't realize it.
00:31:27
Speaker
It's just really being flexible with dosing, I would say. Yeah, it is. I will say we say all this and it sounds very nonchalant and it can be, especially for those of us who are pumping because you just type the number in and then your body gets the insulin. But if you still have a child who's on MDI, this might sound very,
00:31:53
Speaker
nauseating and panic inducing and just kind of like, oh my gosh, another poke. Don't do it. I never did split doses with Hattie when she was on MDI because she hated injections. She only ever accepted an extra injection if it meant she could have something super sweet.
00:32:12
Speaker
But if it was like, Hey, I'm going to force you to endure another injection because we're having pizza at a party. Like, nah, I just, in that case would weigh my options and choose one time to give the bolus that made the most sense, which for pizza specifically was going to be dosing her halfway through her meal. Or as soon as she took that last bite.
00:32:39
Speaker
You know, in an effort to at least mitigate such a strong spike and then just like accept that it might not go perfectly. And that's okay. But at least she has the insulin in her body that she needs. Yeah. Yeah. We do talk about it like it's whatever, but I think it's just with time it's gotten to that point. And like you said with pumping, it's made more possible, but it's definitely not for everyone. No, it's definitely not for everyone. And sometimes you try and it doesn't work. I tried with hot chocolate a few weeks ago.
00:33:09
Speaker
And it was like, I gave a dose for 10 grams and then 10 grams and then 10 grams all the way up until it was like, I had dosed for 60 grams and she still went high and it was just a mess. And I was like, okay, none of this timing worked. I didn't think through any of it. I just sort of threw insulin at her and like slowed the spike and it wasn't, it wasn't great. And I won't do that again.
00:33:37
Speaker
Like that type of split dosing didn't work for us. So, all right, next one.
Managing UTIs with Diabetes
00:33:43
Speaker
T1D and UTIs. Let's talk about it. I feel like you probably have a little bit more on UTIs because didn't you experience that in the beginning or no? Or were you told like, oh, it's probably UTI, but it wasn't?
00:33:57
Speaker
we did not experience UTIs. They thought she was having UTI and that is why she was peeing and that is why she was sick. They thought she was, had a really severe UTI. So they were like trying to force us to do a clean like sterile urine catheterization because she wasn't potty trained yet.
00:34:19
Speaker
And then one doctor finally relented to letting me try to put her on the potty. Cause I was just like, I refuse to stick a tube up her when she's awake. She's two that's so traumatizing prick her fricking finger. So yeah, but I do know that having UTIs as a type one diabetic is, um, yeah, more common. So.
00:34:46
Speaker
It's because you have higher blood sugar, your defenses are down, your inflammation can be up. So what about you? Have you experienced that? I haven't really had them. I don't think maybe I did a little bit growing up. I know it is common with type ones. I do want to mention with this though, that yeast infections are also really common. That is something I experienced a lot, especially as a dancer.
00:35:13
Speaker
because I was always in like tight leotards and stuff like that. But I think that I got it more so because of my blood sugars, like definitely being higher a lot of the time or going up and down. And so just another thing to be aware of, it's so crazy how much
00:35:27
Speaker
an imbalance of blood sugar can throw off so many other things in the body. Yeah. Like it's tough. Okay.
Choosing the Right Diabetes Pump
00:35:36
Speaker
Next question is how to know which pump to pick. This is a good question and one that we get a lot of. Do you have any insight Raquel?
00:35:50
Speaker
Yeah, so first of all, I want to say that the pumps available right now are all really amazing. And I actually believe that completely. It has not always been that way. And most of the pumps out there now offer some sort of, what's it called, automated system where it's doing some of the changing in basal rates or dosing for you. It won't do everything for you, but it does something.
00:36:14
Speaker
I mean, first things first, insurance won't always cover whatever pump you want. So that's one way to easily determine which one you can get. From there, there's just differences in not only the look and feel of the pump and how you wear it, but also the algorithm. So I think it's important to just look into every little bit. For me, I was not afraid of tubes. Well, sorry, that's not true. There was no such thing as tubeless options when I was diagnosed or when I got a pump. So I chose whatever tube, tubed pump.
00:36:44
Speaker
that I don't even know why we got the one I got. It's not even available on the market anymore. But at this point I would say obviously like a lot of parents choose Omnipod because it's tubeless and they steer away from T-Slim because it's tubed. I can give my reasons why I love T-Slim if you want and then you can give the reasons why you love Omnipod maybe and then I can talk a little bit about the Medtronic pump as well.
00:37:06
Speaker
There's also a beta bionics pump right now, but we both don't use that or know a ton about it. From what I've heard, it is not super aggressive. It's more for people that have very high, like definitely higher A1C, or maybe like you have a child that is a teenager and super burnt out and just not doing anything. And so it's kind of low effort, but it's not going to get you necessarily the same results as the tandem metronic or omnipods.
00:37:33
Speaker
Okay, why I love my T-Slim because number one, it has one of the more aggressive algorithms out there. It will actually automatically dose you if you're going high within different limitations. It won't dose you more than once an hour and it'll only give you 60% of that dose, but it will do some of that for you if you're just not able to look at your pump.
00:37:55
Speaker
And then it will raise and lower your basal rates. I love how it has different profile settings. You can kind of like have different things set up for different areas of life like school versus home or weekend versus weekday. I love that I can wear it discreetly. I can wear it in my pocket.
00:38:13
Speaker
or even like in the side of my bra or something like that and no one really knows that it's there. I can tuck the tubing in. Personally, tubing is not an issue for me. I tuck the tubing into my pocket or into a pouch however I'm wearing it and it rarely gets caught on anything and even when it does, I can't even
00:38:29
Speaker
think of one time that it's actually pulled out the site. That being said, fully aware, it's harder with kids. But I do know a lot of little kids that wear T-Slim and they love it. And they also just, a lot of them will wear it in a spy belt or like a fanny pack kind of thing on the back of their body. And so they like turn it away from them and they just tuck the tubing into the zipper pouch and then it really doesn't get caught on anything.
00:38:52
Speaker
And then I also love the fact that you can disconnect it. So that is on one hand with Omnipod, it's awesome because you always have the insulin even when you're swimming or in the shower. But on the other hand, I really love the ability to take it off, especially when I was dancing or when I work out.
00:39:07
Speaker
and not having something bulky still on my body. And for me, when I'm swimming, I tend to drop anyways because of all the activity, so that's not a huge issue. So yeah, I think those are the main reasons why I love it. Oh, something else to consider is that the Medtronic and T-Slim right now have multiple site options. So for me, I use True Steel, which is a steel cannula, and there's a lot of reasons why I love that. I won't go into all of it right now.
00:39:34
Speaker
There are some people that the plastic cannula just don't work for and with the omni-pod, that's the only option as of now. So I just want to throw that out as a variable too. What about you? So I've actually had the unique opportunity to feel what it's like to have an omni-pod on and feel the insertion of the needle and the cap that are left behind and a T-some slight.
00:40:01
Speaker
And I had that opportunity at the Friends for Life conference last summer. And it's funny because I stand by Omnipod through and through. It is the only pump we know.
00:40:17
Speaker
It absolutely was and continues to be the right choice for my child, but I will say that if I was an adult and I was choosing between pumps, I personally would have a really hard time right now deciding.
00:40:33
Speaker
because of the ability to detach the tubing because what I did when I had the opportunity to wear the T-Slims light was they gave me tubing too. So I just wore the tubing for three full days because I really wanted to experience it as close as I could.
00:40:56
Speaker
Yeah. And I would like take it off to shower and then I would like, you know, tuck it in my pants or whatever when we were walking around and it really wasn't bad and I didn't notice it. When we were making the decision on what pump for Patty, going into it, my very first thing was I really want the auto because like her, just her needs change what feels like hour to hour.
00:41:24
Speaker
And I was super burnt out. My husband was super burnt out. She was not feeling great because the control was not there. So I went into like the, you know, pump class that was held by the hospital being like, I want OmniPod 5 because it had just come out on the market, like literally a week before. And.
00:41:46
Speaker
they told me at that point, cause it still had not been FDA approved for kids under six. Oh, she won't qualify for that. So I went into that being like, Oh my gosh, perfect. There's no tubes and there's no super breakable like pump cassette, you know, it's like the plastic Omni pod and it's an auto system. And then when they told me that she was not going to be able to be on the five,
00:42:14
Speaker
I was devastated because it just felt like, well, why even freaking go on a pump then? Because I know my two-year-old and I know her abilities and more importantly, I know what she's just not going to be able to handle. And my two-year-old personally would not have handled two being well. She would have tugged at it. She would have pulled at it. She would have tried to take it off.
00:42:37
Speaker
She would have played with it. She would have kinked it. The fact that it was attached to a very expensive, relatively heavy for a two year old's body pump, like the actual cassette that you work with, that thing would have been dropped. It would have slammed into corners. It would have been, you know, it would have fallen down the slide at the playground.
00:43:01
Speaker
And I personally didn't want her to have to wear a spy belt or a fanny pack every single day, all day long. And I was super concerned about tubing when she was sleeping because she was the kind of sleeper that would roll off her bed all the time. Or like her head would be down by where her feet are supposed to be at two in the morning. Like we just have a very wild and crazy child. And so,
00:43:31
Speaker
It was a non-starter, but I really thought long and hard about it when they told me I could not go on Epod 5 or that she couldn't. And then I fought tooth and nail and found out that you can actually have the endocrinologist write. What's that called? Do you know what I'm talking about? Yeah, like something of like they need this statement. Yeah, exactly. Yeah, it's basically like
00:43:55
Speaker
an order where the insurance company has to approve it. Anyway, but that is, we ended up getting on the OmniPod 5. It was a two month process between when I said I want to go on the pump and I was like, get us on it yesterday and then two more months of just struggling through while I fought everyone tooth and nail.
00:44:16
Speaker
Yeah, those are my main reasons. It was basically all about my child and how wild she is, just won't handle tubing. Yeah.
00:44:30
Speaker
The new Moby tandem pump is like you can wear it on your arm or leg with a very short tubing. So it wouldn't be like a long tubing hanging off or on your stomach. There's like a little adhesive you can put down and slip it into. So that's something that's coming out soon to look out for. No one's really tried it yet. So we'll see how that goes, but there's no screen on the actual
00:44:54
Speaker
device, which is kind of nice because then that's a really good point that you brought up about just like throwing it around. And yeah, I hadn't really thought about that. I did crack my screen once when I was dancing, but it's only happened once.
00:45:05
Speaker
But yeah, no, I mean, the Omnipod, I have heard seriously such incredible things and I would go on it too. I think it's an awesome pump. And then the other one, the Medtronic system, it's important to note, does not connect with the Dexcom. They have their own sensor, which could be a good or bad thing depending on if the Dexcom works for you. Like I know so many different people that prefer different CGMs. The T-Slim does also integrate with Freestyle Libre now. Does the Omnipod?
00:45:33
Speaker
I don't know. No, not yet. But they will eventually. But with the electronic one, it's their own sensor and they have their own follow app. But with that, when you have the sensor with the pump, they have the lowest target number on the entire market, which is 100. That's the first time that the FDA has approved that. So it has a little bit more of an aggressive algorithm. It does like five minutes. I forgot the wording they use, but it's like
00:46:03
Speaker
every five minute auto corrections, whether that's like suspending, giving a little more and things like that. And they also now have a site that has a seven day wear out there, which is really cool. Um, and I've heard people really love that. So full transparency. I had a really awful experience with Medtronic years ago, and now I have heard nothing but amazing things about that pump. So I wouldn't rule it out altogether, but yeah, I think we answered the question. Yeah.
00:46:33
Speaker
The other thing I will say is I was worried about how bulky the Omnipod is. When I wore it, I specifically put it on the outside of my arm because I'm a side sleeper and I wanted every opportunity to feel the full amount of discomfort that I could. Wow. I'm really sorry, everyone. It's okay. You want new Mickey Mouse Clubhouse in the living room?
00:47:01
Speaker
Okay, can you give me one second to finish my thought please? Do you want to say hi into the microphone? No? Okay. That's our two-year-old everybody, so you got a little bit of squeaky in that. But I specifically put it on the outside of my arm so that I would constantly be pressed up against it because I wanted to feel
00:47:25
Speaker
the most amount of discomfort I could and I like did not notice it. And then more often than not, when we ask how do you wait, where's your pump? Where's your pump? She has to search her body because she forgets where it is. So that's a helpful.
00:47:42
Speaker
I agree. Yeah, I also put it on my arm that same day and I was really surprised that I didn't notice it because that was one of my biggest things with Omnipod 2. It really was super light. I still feel like for an adult, I don't like the way it looks on me bulky wise, but like how it feels, it was nothing.
00:48:03
Speaker
Alright, next question.
Adjusting Insulin Ratios
00:48:05
Speaker
How to know when it's time to change correction factor or your insulin-to-carb ratio? Amanda, I know you have a good answer for this.
00:48:16
Speaker
There's lots of complications when you go into your meal times or your snack times with a high blood sugar and you're adding a correction factor to your carb ratio. So the reality there is you can't really know, unfortunately, when you're evaluating meal times. So when we were on,
00:48:42
Speaker
MDI and this works for pump therapy too. The way I learned how to differentiate was I waited until she was high and needed a correction and there was going to be no food around, you know, at least for the next couple hours. So when we were on MDI, that most often looked like giving her correction injections through her pajamas, honestly, when she was sleeping.
00:49:12
Speaker
She got very used to, she hated them, but she got very used to shots pretty quickly and she wouldn't wake up for corrections. And once I realized that I could give her corrections in the middle of the night with shots, then I started doing that because I was so anxious watching her sit at 250 or 300 all night long, even though I swore she would be fine. And so that's how I learned how to adjust corrections is
00:49:41
Speaker
I would think to myself about the timeline of fast-acting insulin, when it should start working, when it peaks, and how long it is supposed to last in the body. It starts working after 15 to 20 minutes for your basic heme log, no vlog. It peaks in efficiency or efficacy.
00:50:02
Speaker
at 90-ish minutes, and then it's in the body for three, four, up to six hours. Some people, you know, the fast acting can work up to six hours. For my daughter, it really shows that it's no longer working after three to four hours, and I could tell that, right? So let's say she had high blood sugar and it was 10 p.m., and I knew she needed a correction,
00:50:32
Speaker
I would go in and give the correction dose that they told me to give from the doctor's office. I would wait for 15 minutes. And if by 15, 20 minutes, there was literally no movement in that high blood sugar, I knew that that was an incorrect dose and she needed more. And so I would like slightly adjust from there. And then with meal times, if you're trying to figure out
00:51:01
Speaker
if it's a carb ratio thing, your best bet is to pay very close attention to whatever meal you're going into where your child's blood sugar is flat with a right arrow. And if you know your carb ratio is right, if you pre-bolus, you count your carbs accurately,
00:51:28
Speaker
your child fully eats all of the carbs that you have dosed for.
00:51:33
Speaker
you see a normal little spike in the blood sugar and then it returns to its baseline. Whatever blood sugar it was before the meal started, it returns around there. And this is a really complicated process. I mean, we have a freaking coaching program dedicated to explaining it because there are so many other factors. But if all the other factors pretend aren't contributing to the blood sugars,
00:52:02
Speaker
that in its most basic form is how you know the carb ratio is right. If the blood sugar goes low after a couple hours, it's probably too strong of a ratio. If the blood sugar goes high and stays high and never returns back to that originating or the original blood sugar, then you probably need a stronger carb ratio. Did that make sense?
00:52:24
Speaker
Yes, I think you said it all. The only thing I'm going to add is that knowing when to adjust these things can also a little bit depend on what system you're on now that we do have the automated system. So like in the T-Slim workshop that we did, and we're going to do again soon, we talked specifically about what things with the T-Slim, if you're using control IQ, are helpful to change
00:52:45
Speaker
at what points and how you know somewhat. And I think in the Omnipod class, you also dove into more specifics there. So I just want to throw that out that like, if you're really struggling with that, maybe, and you're not on MDI, it could also have to do with like other things that are happening with the pump and fully understanding it can be really helpful. Like the background amount of insulin, the insulin that's already on board from previous. Yeah. How long the, the basil has been paused for. Yeah. There's a lot of other factors.
00:53:14
Speaker
But I feel like going back to the roots of starting a blood sugar, you should see a little rise and a return to the starting blood sugar. That's helpful as a starter. Definitely. Okay.
Endocrinologist Visit Frequency
00:53:27
Speaker
Next question is how often are you supposed to see your endo? We currently see ours every three months.
00:53:35
Speaker
Okay, so we did some polls about this on Instagram a few weeks ago because a lot of people were very interested and it seemed that everyone had kind of different answers actually. Generally speaking, most people are told to see them every three months, but whether you're seeing the endo or just a nurse practitioner varies based on where you are. Does your office actually have enough endos? There's a big shortage of endos in the world, which is pretty unfortunate.
00:54:00
Speaker
But it also, I mean, honestly, I saw my endo or nurse, it was usually two times nurse, one time endo, like every single three month period growing up. And then like last year when I, or maybe the year before, when I really got my A1C down and my endo felt comfortable, she was like, you should just come every six months. So.
00:54:25
Speaker
I think it's just whatever works for you. For me, I mostly go at this point to get prescriptions, but in the past it was necessary for me to see them every three months for sure. I think that every three months is the gold standard, our hospital system.
00:54:41
Speaker
has a switch off between the nurse practitioner and the endocrinologist every other visit. So we see our endo every six months. And we've been going every three months since diagnosis. I will say we weren't seen again until like six or seven weeks after she was just discharged, which is, that's wild to me, like wild.
00:55:06
Speaker
I don't get that. I feel like they should be discharged and then set you up with an appointment the next afternoon. Like let you go home, sleep, catch your breath and then like, I don't know. But yeah, I actually recently just asked our endocrinologist if I can start seeing her every six months because I just don't feel like I need the support
00:55:31
Speaker
Alright, next question.
Managing Diabetes in Kindergarten
00:55:33
Speaker
What is your plan for Hattie going to kindergarten? So we actually in California, San Diego specifically have this newer thing called transition kindergarten and she qualifies for that this fall of 2024. So I've already signed her up for that. I'm waiting to hear back if we actually got in, but I was assured that we would.
00:55:57
Speaker
I've already established communication with the school nurse there and I met the health tech that is there more often in person and we reviewed everything. They agreed to follow Dexcom on their phones and my plan is to
00:56:18
Speaker
go in and meet with the health tech and the school nurse the week before, create our 504 plan together. I already got a printout of the basic medical care plan that our endocrinologist office provides, and I will be going through that.
00:56:34
Speaker
with a magnifying glass and making it work for us and basically just like revamping it, having our doctors sign off on it so that essentially the medical care plan says that Danny and I have the right and the authority to
00:56:54
Speaker
change carb ratios and correction factors and anything and to give guidance. And that that's a doctor's order because the nurses at the public schools have to follow the doctor's orders. So that's how we're going to get around that. And then I also plan on getting a sugar pixel actually for her classroom.
00:57:13
Speaker
And I'm really hoping that whatever teacher is assigned to her is cool with that. I'm assuming they will be because I feel like if you're a teacher to very young children, you want to keep them safe, right? And if that teacher gives me any help, I will be requesting a different teacher. I've already set my mind up for that. I'm not playing games.
00:57:38
Speaker
And I just think that that will be helpful where I'll be like, you're not in charge of managing the blood sugars, but I would like for you to be aware that if you see a number below 70, she needs something. She needs a sugar packet. Like she needs a glucose, you know, whatever, yeah.
00:57:55
Speaker
And that way that will just feel better to me than like having to text the health tech, knowing that like I have to wait for her to respond to me and then walk to the classroom and then get, I'd so much rather the teacher just like hand her a transcend gel pack because she sees that how do you 65 and everything's just covered. So that's my plan TBD if it works and I'll be taking you guys through our journey. Yeah. Okay. Last question.
Coping with Lifelong Diabetes
00:58:25
Speaker
How do you deal with diabetes being forever? It's the hardest thing for me.
00:58:32
Speaker
Yeah. Um, like I don't think about the fact that it's forever too often because I think it does kind of make me spiral and it makes me really sad. Like thinking of myself as like an old person with diabetes. But then I realize there's no, not even a point in thinking about it because what I think of diabetes as now is probably going to be so different by that time. And things are going to be so much better, hopefully with the way things are already going. I think it's true.
00:59:03
Speaker
But so my personal Instagram account where I share about like young adult life with diabetes is type one day because like of the idea of taking things one day at a time. And I really try to live by that. It helps so much. Like there's just no reason to try to think about it forever, even though I know it's impossible not to. It's just sad, but at the same time, like we can do it. And I believe in myself and I always think I've done it for this many years.
00:59:28
Speaker
I can do it for that many more years. You know, like there's no reason why I can't keep doing it. And if anything, it's getting easier over time because I just learned myself better over time. You all are learning your kids better over time. And obviously I can't relate to it in the way that you all feel because I know that my mom obviously.
00:59:48
Speaker
feels more similar to you about all of it. Like that's gotta be so hard to watch your kid go through forever, but I hope that me at least sharing that it's really not that bad. And I mean that, I don't know, so many mixed feelings on how to like express it, but like,
01:00:03
Speaker
It's not as bad as it used to be. It's challenging, it sucks, and there's really, really hard moments, but it doesn't feel like it's my life. It's something I deal with in the background most days now, and yeah, I just take it one day at a time.
01:00:22
Speaker
I often think to myself, I remember spiraling a lot in the early days, like, this can't be forever. It's not worth it. Life definitely feels like it's over. Like, just all the things that feel fun and exciting are just done. And now my type one is coming in. Hang on one second. It's one of those days. Sorry, you guys.
01:00:49
Speaker
So Raquel and I had recorded this the first half earlier and then all of a sudden we're just out of time. It was so crazy. And so now we're trying to record the last few questions when the kids are home and no one else is here. So good old TV, I know. So now they're here. Anyway, the thing that I think
01:01:16
Speaker
now is for me personally, so I can't speak to everyone, but I hope that this helps ease some of the burden, pain, anxiety.
01:01:29
Speaker
When we were on Dexcom, even though it was 48 hours in and some people go way longer doing just finger pricks, that was an immediate relief. It was like, oh my gosh, I don't have to poke her finger 18 times a day and hold her down and it's awful and scary. Okay, sorry. Pause again, everyone. But basically once we got the Dexcom, it was such a relief knowing, okay, I don't have to poke her fingers 24 seven.
01:01:57
Speaker
And that eased it just a little bit, you know, and comparatively to what it could have been if I had to poke her finger all the time. And then when we finally got on the pump, I was like, Oh my gosh, we can, we're going to actually have three full days where she doesn't feel the sting of a needle in order to eat. And eating is a normal function of human life just to stay alive, you know? So that was super relieving for me.
01:02:27
Speaker
And yes, both things can be true where I was equal parts relieved and sad that I have to see these devices on my child's body, but I chose to like lean into the relief of it all. And from there I have like gained control. So I see her feeling better and doing better and I'm not scared of dosing for any and all foods and all these things. So life has really opened back up.
01:02:54
Speaker
And if all of those moments of clarity and like, oh my gosh, this is so much easier and how wonderful is it, I tell myself and others all the time, technology is the worst it'll ever be right now, today.
01:03:11
Speaker
you know not not truly but like today compared to the future today is the worst it'll be compared to the future so it's gonna get better stronger less painful smaller easier more in tune like and even if a cure never comes and
01:03:31
Speaker
you know, they can't put stem cells right smack dab in the middle of your pancreas and la de dee, like everything's going to get easier and better. So that's how I deal with it. I love it. I agree. I mean, there's nothing else we can do. We don't have a choice. We're in this. So try to be positive about it where we can. Exactly. All righty. Roll call.
01:03:54
Speaker
Roll call. I'm 137. Hattie's 160. I do want to say one thing before we head out. We are in the middle of enrolling for our grandparent course again, which starts on March 5th. It's six weeks of live calls and almost every single call we're going to have a guest speaker. So I'm leading the course as a whole, but then either Amanda will be
01:04:17
Speaker
On a couple different calls, diabetes educator Anna will be on a call, and we'll have Meg, who is our nutritionist, also on a call. And we'll be talking through all the diabetes things, but also family dynamics, setting boundaries.
01:04:35
Speaker
mental health like diabetes language how grandparents are talking to the grandkids about diabetes all the things that are super challenging to figure out and we already have the course almost half full we just open enrollment couple days ago but
01:04:52
Speaker
we'll be enrolling pretty much up until the start date, as long as we still have space and we're going to have about 10 to 12 total spots. So if you're interested, we'll put that in the show notes. It's one of the most fun, fulfilling courses I think that we do because it's just such a unique part of the family and they just want to be involved. They want to help. They want to give back. And they also want to give back to you as parents. And so giving them that opportunity to learn how to care for type one kids is so special.
01:05:22
Speaker
So yeah, that's really cool. Awesome. All right, guys. Links will be in the show notes and thanks for tuning in. We'll see you next week. Bye. Bye.