Latest / The Healthy Diabetic / #388: Diabetes Tips & Tricks (Part 1) - Everything You Need To Know About Insulin

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#388: Diabetes Tips & Tricks (Part 1) - Everything You Need To Know About Insulin · The Healthy Diabetic

• 0:14
  SPEAKER_01: Welcome back.
• 0:15
  SPEAKER_01: This is episode number 388 of the Healthy Diabetic Podcast.
• 0:20
  SPEAKER_01: I'm Coach Ken.
• 0:21
  SPEAKER_01: If you don't know much about my story, I was diagnosed with type 1 diabetes at the age of 25 in 2007, and I'm the founder of Simplifying Life with Diabetes, a diabetes health coaching company that bridges the gap between your medical team and the daily complexities that you face every single day living with this condition.
• 0:37
  SPEAKER_01: I truly believe that every single one of us living or caring for someone with type 1 diabetes only has one job, and that's to figure out what's going to work for you.
• 0:47
  SPEAKER_01: If you're looking for new perspectives and new ideas on how to live with diabetes, you've come to the right place.
• 0:52
  SPEAKER_01: As always, before we get started, please remember that nothing that you hear on this podcast should be considered medical advice or otherwise.
• 0:58
  SPEAKER_01: Please always consult your medical team before making any changes to your diabetes management.
• 1:05
  SPEAKER_01: Okay.
• 1:06
  SPEAKER_01: Another episode, another solo episode.
• 1:08
  SPEAKER_01: It's Monday, October, what is it, 5th?
• 1:11
  SPEAKER_01: We got another episode coming out tomorrow, which actually it's this episode right now that's coming out tomorrow.
• 1:17
  SPEAKER_01: So it's I'm excited to announce a new series.
• 1:21
  SPEAKER_01: If you haven't listened to any of the other series that we got going on, right?
• 1:25
  SPEAKER_01: So we got the full podcast episodes, and then I'm I started another series called Diabetes Confessions, which has been super fun just to press record and just talk about like the things that have been on my mind with diabetes and you know the things that I you know questionably did over my diabetes journey and just other things that I want to get off my chest.
• 1:48
  SPEAKER_01: So that's that's diabetes confessions.
• 1:50
  SPEAKER_01: I think there's what three or four episodes out of that now.
• 1:53
  SPEAKER_01: And now today we're gonna start in a whole new series that I really hope that you're going to enjoy.
• 1:59
  SPEAKER_01: Hopefully these will be under 30 minutes, maybe even under 20 minutes.
• 2:02
  SPEAKER_01: It's talking about a specific topic and just trying to do a little bit of deep dive.
• 2:09
  SPEAKER_01: I might have some guests, some specific guests, endos, dietitians, whatever it is, come on and talk about some of these topics to dive into them a little bit deeper because I'm obviously not a doctor, but a lot of these topics are gonna be specific things based off of the five pillars of diabetes success and specific things that I know that you have challenges with and maybe having an issue navigating or you know using to manipulate your blood sugars.
• 2:34
  SPEAKER_01: And we're gonna call this series diabetes tips and tricks.
• 2:38
  SPEAKER_01: So for today, we're gonna talk about something that's really, really important.
• 2:43
  SPEAKER_01: And it's something that everyone thinks about when managing diabetes because it's the hormone insulin.
• 2:50
  SPEAKER_01: We need insulin when we're diagnosed with type 1 diabetes, whether you have a little bit of beta cell function when you're first diagnosed or not, eventually you'll get just like me, where you pretty much have zero.
• 3:02
  SPEAKER_01: You have zero beta cell function.
• 3:04
  SPEAKER_01: So you need synthetic insulin, or what I call synthetic insulin, to, you know, live, to, you know, keep yourself alive.
• 3:12
  SPEAKER_01: And it is crazy to me that, you know, we've got all this stuff.
• 3:16
  SPEAKER_01: I mean, I don't want to go too deep into the insurance biz or the political things that are getting in the way of us having being able to get affordable insulin.
• 3:28
  SPEAKER_01: So we're not gonna dive into that, but all that stuff is like, it's it's always on my mind.
• 3:32
  SPEAKER_01: I'm sure it's on your mind.
• 3:34
  SPEAKER_01: It's on my mind specifically right now because I lost my insurance, so I have zero insurance.
• 3:39
  SPEAKER_01: I've been lucky enough to be able to, you know, dive into you know, Nova Nordisk, uh, Eli Lilly, Afrez, everybody's like discounts that they have on specific, you know, if you don't have insurance for some reason.
• 3:55
  SPEAKER_01: And if you're in that spot and you don't really have insurance and you need help with insulin, most of these insulin companies now have what's called an assist patient assistance program or something like that.
• 4:05
  SPEAKER_01: I get I'm in the same thing with my DEXCOMs or with my DEXCOM, like I get 90-day supply of DEXCOM for$45 because I applied for this patient assistance program.
• 4:15
  SPEAKER_01: And a lot of the companies have these patients assistant programs that you can, you know, sign up for.
• 4:21
  SPEAKER_01: So whatever insulin that you're using, look into that.
• 4:25
  SPEAKER_01: Because even if you have insurance, a lot of them you're able to use these discount codes, like a Fresza as an example.
• 4:33
  SPEAKER_01: I get 30 days worth of a Fresza for 35, 40 bucks.
• 4:38
  SPEAKER_01: And that discount code only works if you have insurance.
• 4:41
  SPEAKER_01: So I'm not that's why I'm not using a Fresa right now.
• 4:44
  SPEAKER_01: I'll wait till open enrollment starts, you know, in November and re-reenroll on my insurance, and hopefully it won't skyrocket and be twice as well.
• 4:53
  SPEAKER_01: I was paying for it.
• 4:54
  SPEAKER_01: So, anyways, let's go into insulin.
• 4:57
  SPEAKER_01: For the majority of this episode, I'm gonna pull up a infographic or this graphic that I made with, of course, AI's help, just kind of showing us three specific metrics of insulin, right?
• 5:11
  SPEAKER_01: So you've got your activation, you've got the peak, and you've got what I call the duration.
• 5:16
  SPEAKER_01: And there's other names for these.
• 5:18
  SPEAKER_01: This is this is just what I call it.
• 5:20
  SPEAKER_01: Right.
• 5:21
  SPEAKER_01: So the activation would be how fast does your insulin, again, whatever you're using, whether it's long acting, median, medium, rapid acting, fast, rapid acting, or rapid, rapid, fast acting.
• 5:33
  SPEAKER_01: Regardless of what insulin you're using, activation just means how long by the from the time that you take the insulin, how long does it take for that insulin to get into your bloodstream, connect to the cell, or get into the cell and start lowering your blood your blood sugar.
• 5:48
  SPEAKER_01: That's what activation means.
• 5:50
  SPEAKER_01: Okay, then you have your peak.
• 5:52
  SPEAKER_01: So the peak is when is the insulin gonna be the strongest?
• 5:56
  SPEAKER_01: What is the time frame of that of that strength?
• 5:59
  SPEAKER_01: You know, so as an example, Novolog and Humolog typically peaks around two hours.
• 6:05
  SPEAKER_01: And again, we're gonna go over this, but it it will peak around two hours, and that's when it's going to be the strongest.
• 6:11
  SPEAKER_01: Why is that important?
• 6:12
  SPEAKER_01: I'm gonna tell you here in a second when we get to that.
• 6:15
  SPEAKER_01: So you got the peak, and then you got the duration.
• 6:18
  SPEAKER_01: How long from the time that you take it to the time that it's really out of your system?
• 6:22
  SPEAKER_01: It's it's gone.
• 6:23
  SPEAKER_01: Your your body's gone through it.
• 6:25
  SPEAKER_01: What is what is that time frame?
• 6:27
  SPEAKER_01: The reason that is important is again, we'll go over it here in a second.
• 6:31
  SPEAKER_01: So uh just we're gonna go over those three components with with insulin.
• 6:36
  SPEAKER_01: And there's there's more different types of insulin than it's on this list.
• 6:40
  SPEAKER_01: I just came up with like two or three of you know, long acting, medium acting, short acting, and rapid acting.
• 6:49
  SPEAKER_01: I came up with like two or three of the main ones that most people just use.
• 6:54
  SPEAKER_01: So if the insulin that you're using isn't in this list, don't worry, like it's it's totally fine.
• 7:00
  SPEAKER_01: But it's important that you know what the activation peak and duration of your insulin is.
• 7:06
  SPEAKER_01: Okay, so I'm gonna pull up this infographic for those of you who are watching or listening on hopefully you're watching, on YouTube or Spotify.
• 7:15
  SPEAKER_01: The Spotify and YouTube is where we we push the videos out.
• 7:19
  SPEAKER_01: So the whole entire video should be on Spotify and YouTube.
• 7:23
  SPEAKER_01: If you're just listening on Apple Podcasts, that's fine.
• 7:26
  SPEAKER_01: I will also try to add the a PDF of this in the show notes as well.
• 7:32
  SPEAKER_01: So if you are listening on the audio format of this episode, you can kind of try to maybe follow along if you want to.
• 7:38
  SPEAKER_01: Um, but again, I'll I'll go through the list and you'll kind of understand what we're talking about.
• 7:42
  SPEAKER_01: Okay, so here's here's the list, right?
• 7:46
  SPEAKER_01: If you're on, again, if you're on Spotify or if you are on Apple Podcast, or I'm sorry, Spotify or YouTube, you should be able to see this list.
• 7:56
  SPEAKER_01: Okay, so the first thing that we're gonna start at the bottom.
• 8:00
  SPEAKER_01: We're gonna start with long-acting insulin.
• 8:02
  SPEAKER_01: Okay, and again, we're looking at activation, peak, and duration.
• 8:07
  SPEAKER_01: So there's two basic long-acting insulins that most people are on, right?
• 8:12
  SPEAKER_01: So you might not be on either one of these, but this is what most people are on.
• 8:16
  SPEAKER_01: And this is pretty much long-acting insulin is your basal insulin, right?
• 8:21
  SPEAKER_01: And we're gonna also go over basal in this series as well, like because basil is a really important thing to think about.
• 8:28
  SPEAKER_01: If you're on an insulin pump now with the closed loop systems, there really isn't really basil involved because your system is taking over the functionality of what basil actually does.
• 8:39
  SPEAKER_01: Okay, so just in a nutshell, basil is your long-acting insulin.
• 8:45
  SPEAKER_01: Basil is not, hear me, not designed to lower your blood sugar.
• 8:50
  SPEAKER_01: So if you're taking basal insulin, if you're on MDI and you're taking basal insulin and you constantly go low, maybe at night or whatever, it is that's a that's a prime red flag that your basal is too high, right?
• 9:05
  SPEAKER_01: So think about that as you're kind of navigating that that process.
• 9:10
  SPEAKER_01: But anyways, okay, so there's two main long-acting insulins or basal insulins.
• 9:15
  SPEAKER_01: Okay, we'll we'll talk about lantis first, right?
• 9:18
  SPEAKER_01: So lantis, the activation of lantis, and I thought this was a really interesting piece between the two.
• 9:24
  SPEAKER_01: So lantis and traceba, which is traceba is the one I use.
• 9:28
  SPEAKER_01: So lantis, the the activation, right?
• 9:31
  SPEAKER_01: So the activation again is how long does this insulin take to get into the bloodstream, attach to the cell, get into the cell, and start, you know, doing what it's supposed to do.
• 9:42
  SPEAKER_01: Okay, and it's about an hour to two hours.
• 9:45
  SPEAKER_01: There is no peak with long-acting insulin because it's it's basically just a think about like when you're on an insulin pump and this is before control IQ, this is before automated systems, before closed loop, and you just had basal rates in your pump, well, you could you could basically you're you and your doctor would configure or set specific basal rates depending on when you needed insulin throughout the day.
• 10:11
  SPEAKER_01: Right.
• 10:11
  SPEAKER_01: As an example, before I really started using closed loop systems when I was on insulin pump, when I was really on the tandem pump, this I really use utilized this when I was a tandem pump, I would because I wanted like a drip, right?
• 10:26
  SPEAKER_01: So think about basil as like it's a it's a drip of insulin throughout the entire day.
• 10:30
  SPEAKER_01: I wanted that drip all the time and I needed it.
• 10:32
  SPEAKER_01: So I would set a new basal rate, I think it was like 0.8 units every three to four hours.
• 10:40
  SPEAKER_01: Sometimes it would be three hours, and I and I actually think I actually got to four, right?
• 10:45
  SPEAKER_01: So I think I had like six different, six different times of the day where I got 0.8 units, and that really worked for me for where I was in my life, even exercising every day, training every day.
• 10:57
  SPEAKER_01: It was perfect.
• 10:58
  SPEAKER_01: So I would I would kind of flip-flop between 0.8 to maybe 1.1, 1.2.
• 11:05
  SPEAKER_01: Maybe I sometimes I went down to like 1.7 or 1.6, but I was kind of always flip-flopping or or adjusting as needed from that perspective.
• 11:14
  SPEAKER_01: Right.
• 11:15
  SPEAKER_01: So that's kind of what that long-acting insulin is.
• 11:18
  SPEAKER_01: It's I think about it like as a drip that you're getting all day long.
• 11:22
  SPEAKER_01: Right.
• 11:23
  SPEAKER_01: So Lantis is about an hour to two hours.
• 11:27
  SPEAKER_01: There's no peak again, and it lasts between 18 and 24 hours.
• 11:32
  SPEAKER_01: Okay.
• 11:33
  SPEAKER_01: Now, here's the really interesting piece between Lantis and what I'm taking, Traceba.
• 11:39
  SPEAKER_01: And this is why I really, really love Treceba.
• 11:42
  SPEAKER_01: So, like we said, the activation of Lantis is one to two hours.
• 11:47
  SPEAKER_01: Traceba's activation is 30 to 90 minutes.
• 11:50
  SPEAKER_01: So you're gonna you're gonna get some effectiveness, I would say, out of that insulin within 30 to 90 minutes, which I mean, okay, cool.
• 11:59
  SPEAKER_01: Again, no peak, but this is the really cool thing.
• 12:01
  SPEAKER_01: The duration of treceba is up to 42 hours, which is insane.
• 12:09
  SPEAKER_01: I originally thought it was 30 hours, and then let me let me just triple check this because I got this from Claude, and you know how AI sometimes is messed up.
• 12:18
  SPEAKER_00: I'm just gonna ask Claude again, is Traceba 30 hour duration or up to 42?
• 12:32
  SPEAKER_01: Because I originally thought it was 30 hours, but they it might have changed.
• 12:37
  SPEAKER_01: FDA label states beyond 42 hours.
• 12:41
  SPEAKER_01: So it's it's the the actual so in practice, most people experience 36 to 42.
• 12:48
  SPEAKER_01: Okay, cool.
• 12:48
  SPEAKER_01: Perfect.
• 12:49
  SPEAKER_01: So 36, we'll just call it 36 to 42 hours.
• 12:54
  SPEAKER_01: Now, this is why this is really cool, right?
• 12:56
  SPEAKER_01: Have you if if you're on MDI, if you've ever been on MDI, I'm sure all every single one of us has been on MDI, which is just manual daily injections at some point in our lives.
• 13:07
  SPEAKER_01: So the really cool thing about this is Lantis is 18 to 24 hours.
• 13:12
  SPEAKER_01: So I would say probably around 22 hours, you're you're not really getting much effectiveness out of that insulin.
• 13:21
  SPEAKER_01: So if there's been times, and and I actually do this all the time, I'm an idiot.
• 13:26
  SPEAKER_01: I'm an idiot.
• 13:27
  SPEAKER_01: Here's my diabetes confessions.
• 13:29
  SPEAKER_01: I sometimes forget to take my traceba shot.
• 13:34
  SPEAKER_01: And this is one of the, because sometimes I forget, one of the, it's one of the this is one of the reasons why, because I forget is one of the reasons why I split my dose.
• 13:46
  SPEAKER_01: Right?
• 13:46
  SPEAKER_01: So I take 24 units of treceba a day.
• 13:51
  SPEAKER_01: That's the that's my baseline is 24.
• 13:55
  SPEAKER_01: If I'm more insulin sensitive for some reason, I might take 20 or or 18 or 19.
• 14:01
  SPEAKER_01: If I'm more insulin resistant, I might bump it down a little bit and or bump it, yeah, bump it down a little bit and take a little bit more.
• 14:08
  SPEAKER_01: But for the most part, I'm taking 24 units and I'm splitting that thing half and half.
• 14:12
  SPEAKER_01: So I take half of it, so I take 12 units at night and 12 units in the morning.
• 14:17
  SPEAKER_01: So because this insulin lasts for 42 hours, almost two straight days, if for some reason I forget in the morning or forget at night, I'm still covered.
• 14:29
  SPEAKER_01: I don't have to worry about it.
• 14:30
  SPEAKER_01: I still have active insulin.
• 14:33
  SPEAKER_01: I'm not it there, I've never had an issue.
• 14:36
  SPEAKER_01: And remember, your basal insulin, okay, and and this is also for your pump as well, even if you're on control IQ.
• 14:44
  SPEAKER_01: If it's dripping, it's you know, your control, the reason not control IQ, but but closed loop systems, because control IQ is just tandem.
• 14:52
  SPEAKER_01: So on controlled control, my God, I'm getting can like my words mixed up.
• 14:57
  SPEAKER_01: On closed loop systems, think about every single time that your pump thinks you're gonna rise a little bit, it gives you a little bit of a drip.
• 15:08
  SPEAKER_01: A little bit.
• 15:08
  SPEAKER_01: Just gives you a little bit of a drip, right?
• 15:10
  SPEAKER_01: And it's supposed to keep you steady.
• 15:13
  SPEAKER_01: You might increase or decrease a little bit, like you know, maybe 10 milligrams per deciliter, but that's about it.
• 15:20
  SPEAKER_01: You shouldn't decrease by 30 milligrams per deciliter on you know, using basal insulin or on MDI, using Tristba or Lantis.
• 15:30
  SPEAKER_01: That means you just probably have too much.
• 15:33
  SPEAKER_01: It's too strong in that moment.
• 15:35
  SPEAKER_01: So I just think this is really cool, and this is why I love trisbo, because I can split those doses and they last so much longer.
• 15:44
  SPEAKER_01: So I'm getting, I'm almost like getting double of what I actually need, which also allows me to take a little bit less dose.
• 15:54
  SPEAKER_01: Because if I'm taking, if I'm if I'm splitting this up and the peak is 30, 30 to 9, I mean not that well, actually, no, I'm sorry, there is no peak.
• 16:03
  SPEAKER_01: If I'm splitting this up and and the duration is 42 hours, that means like I'm getting more and more insulin every basically every 12 hours.
• 16:14
  SPEAKER_01: I'm getting more and more insulin that's getting put in.
• 16:17
  SPEAKER_01: So like it's it's just it's an interesting thing when I think about the basil, because I don't I like I'm never worried about not having basal insulin on board.
• 16:29
  SPEAKER_01: And basal insulin is one of the num not the number one, but one of the number one things that you have to get right.
• 16:36
  SPEAKER_01: You need to make sure your settings and your pump are accurate because basil can really help you stay level, especially in those times, like it let's say you're an athlete and you got all this adrenaline going.
• 16:50
  SPEAKER_01: Like I've worked with so many young kids, and it was just changing their basil rates up a little bit, and we completely avoided that the crazy adrenaline spike.
• 17:01
  SPEAKER_01: So basil can help you in all different ways.
• 17:04
  SPEAKER_01: When when I was on when I was on an insulin pump, I used to get like smacked in the face in the morning from Don phenomena.
• 17:14
  SPEAKER_01: Just smacked in the face.
• 17:17
  SPEAKER_01: And I just I ended up adding a specific basal rate two hours before I would always it would always smack me in the face.
• 17:25
  SPEAKER_01: I would just always add an extra basal rate in the morning.
• 17:30
  SPEAKER_01: And it completely changed it all.
• 17:32
  SPEAKER_01: I didn't have to worry about anything else.
• 17:35
  SPEAKER_01: So there's specific things that we can do with basal and long-acting insulin that can really have a really crazy impact on our blood sugars.
• 17:45
  SPEAKER_01: Okay, so that's long-acting insulin, our basil.
• 17:47
  SPEAKER_01: Then we're gonna go up to the yellow here.
• 17:50
  SPEAKER_01: This is medium or intermediate acting insulin.
• 17:54
  SPEAKER_01: This is just NPH.
• 17:56
  SPEAKER_01: You got humilin and novolin.
• 17:59
  SPEAKER_01: I honestly don't know much about either of these.
• 18:02
  SPEAKER_01: Um, I'm gonna go over the activation peak and duration in case you are on one of these.
• 18:07
  SPEAKER_01: I've never been on NPH, so it, I just never, I don't, I don't have a lot of experience in using these insulins because I've I've just always been on an insulin pump, which you just use rapid acting insulin, or I've always been on MDI, which I just have rapid acting and long acting.
• 18:25
  SPEAKER_01: So I've never really utilized it.
• 18:27
  SPEAKER_01: But I do know some people, I've talked to some people on the podcast, which who use NPH along with long-acting traceba, along with rapid-acting insulin, and along with a fresa.
• 18:39
  SPEAKER_01: So I do know people that utilize all four different types of insulin, which I thought was really cool.
• 18:46
  SPEAKER_01: But okay, let's go over this.
• 18:48
  SPEAKER_01: They're they're basically the same.
• 18:50
  SPEAKER_01: The the activation peak and duration for humilin and novelin in pH are exactly the same.
• 18:56
  SPEAKER_01: One to three hours is the activation, the peak is four to twelve, and then the duration is twelve to eighteen, which is crazy when I think about this.
• 19:07
  SPEAKER_00: So depending on the person, you could be on the the high end of this peak at twelve hours.
• 19:18
  SPEAKER_00: Yeah, I don't know.
• 19:19
  SPEAKER_00: This is so crazy.
• 19:19
  SPEAKER_00: Four to twelve and twelve to eighteen.
• 19:21
  SPEAKER_01: That's crazy.
• 19:22
  SPEAKER_01: That's that's it's a big gap, too.
• 19:24
  SPEAKER_01: It's a big, huge gap.
• 19:25
  SPEAKER_01: And remember, here here's the other thing with all these insulins.
• 19:29
  SPEAKER_01: Okay, and which is why they give you these big gaps sometimes, you know, because every person's different.
• 19:35
  SPEAKER_01: And insulin sensitivity versus insulin resistance will determine how effective or how fast your blood sugar is getting into your system and getting into your cells.
• 19:46
  SPEAKER_01: It will affect what the peak is and it'll affect the duration.
• 19:50
  SPEAKER_01: So just think about that as we're going through that, through this.
• 19:54
  SPEAKER_01: So that's medium and intermediate acting insulins.
• 19:59
  SPEAKER_01: Okay, let's go to rapid acting insulin or what we call bolus insulin.
• 20:03
  SPEAKER_01: Okay, rapid acting insulin.
• 20:05
  SPEAKER_01: This, I just put two in here.
• 20:07
  SPEAKER_01: There's other ones, but these are the two that basically when you're first diagnosed, you get put on one of these, depending on what your insurance will take, which is novolog and humolog.
• 20:16
  SPEAKER_01: Again, they're both exactly the same.
• 20:19
  SPEAKER_01: Well, no, let me rephrase that.
• 20:21
  SPEAKER_01: They're almost exactly the same.
• 20:24
  SPEAKER_01: Novalog, its activation is 10 to 20 minutes, and humolog, its activation is 10 to 30 minutes, right?
• 20:31
  SPEAKER_01: So humolog could be 30 minutes longer.
• 20:35
  SPEAKER_01: Now, I want to talk about this for one second.
• 20:39
  SPEAKER_01: When we talk about the activation, especially for rapid-acting insulin, the insulin that I am using predominantly for bolusing for meals, there's one specific thing that makes this very, very important, knowing what the activation actually is, and that's pre-bolicing.
• 20:56
  SPEAKER_01: Because if you are not pre-bolicing for at least the bottom part or to the mid part of what the activation is, right?
• 21:07
  SPEAKER_01: So as an example, Novolog.
• 21:09
  SPEAKER_01: If you are not pre-bolicing 10 to 15 minutes, you're missing the boat.
• 21:14
  SPEAKER_01: Humolog.
• 21:15
  SPEAKER_01: If you're if you are not pre-bolassing for 10 to probably I would say 20 minutes, you're missing the boat.
• 21:23
  SPEAKER_01: This is where you're gonna really come be fighting with postmeal blood sugars.
• 21:28
  SPEAKER_01: Okay, so make sure that you understand Novalog, humolog 10 to 20, or I'm sorry, Novalog 10 to 20, humologue is 10 to 30.
• 21:37
  SPEAKER_01: Now the peak on both of these is exactly the same, one to three hours, which I have seen, excuse me, I have seen most in myself and in a lot of the research articles and conversations with doctors.
• 21:52
  SPEAKER_01: Both of these, for most people, it's between one and a half and two hours, is the peak of what.
• 22:00
  SPEAKER_01: This insulin is the most effective, but it does give you a one to three hour ratio there.
• 22:07
  SPEAKER_01: And then the duration is three to five minutes for both.
• 22:11
  SPEAKER_01: Okay.
• 22:12
  SPEAKER_01: Or I'm sorry, three to five hours for both.
• 22:14
  SPEAKER_01: Three to five hours for both.
• 22:15
  SPEAKER_01: So that means at the three to five hour mark, that insulin's gone.
• 22:20
  SPEAKER_01: And I would say from I just feel like for me personally, when I get to three, man, that it I can tell that it's it's not working as as well as it used to be.
• 22:33
  SPEAKER_01: Okay.
• 22:34
  SPEAKER_01: When I get to four, definitely probably gone out of my system in four.
• 22:38
  SPEAKER_01: But again, it just it's all based off of how insulin resistant you are and insulin sensitive you are.
• 22:44
  SPEAKER_01: Okay, so we got long acting, we got medium intermediate acting.
• 22:48
  SPEAKER_01: We just talked about rapid acting.
• 22:49
  SPEAKER_01: Now let's talk about ultra-rapid acting.
• 22:52
  SPEAKER_01: This is this is really cool because for the longest time we've only had rapid acting.
• 22:59
  SPEAKER_01: We've only had that 10 to 20 minute pre-balls, 10 to 30 minute pre-balls with Novolog Humulog.
• 23:05
  SPEAKER_01: Now we have two insulins that work way, way faster.
• 23:11
  SPEAKER_01: Okay.
• 23:11
  SPEAKER_01: Fias is the fastest, and Lemjev is the second fastest.
• 23:19
  SPEAKER_01: And then you have Afresa, which is really interesting that it says right here, which I'll have to confirm with with Claude and with Afresa's website.
• 23:30
  SPEAKER_01: But Afresa says it's 12 to 15 minutes, which I think it's actually way shorter than that.
• 23:35
  SPEAKER_01: So we'll have to double check that.
• 23:37
  SPEAKER_01: But anyway, Fias and Lemjev.
• 23:40
  SPEAKER_01: Fias' activation is at 2 to 5 minutes, which is just think about that.
• 23:45
  SPEAKER_01: So within five minutes, it's starting to work.
• 23:48
  SPEAKER_01: I would say that you probably still should be pre-bolusing 10 to 15 minutes, but you don't have to really push the 15 minutes.
• 23:55
  SPEAKER_01: Where Novolog and Humolog, you really should push the 15 to 20 and in probably 20 to 30 minute pre-boluses with Novolog and Humolog.
• 24:05
  SPEAKER_01: With FIOS, you I mean, 10 minutes is probably, I would say 15 minutes are probably the max uh with fios, again, depending on insulin resistance versus insulin sensitive.
• 24:18
  SPEAKER_01: But I I always liked fios.
• 24:20
  SPEAKER_01: Sometimes for me, I couldn't take it because it burned when it was when it went in, but Lemjev does some that's as well sometimes.
• 24:28
  SPEAKER_01: But fias's activation is two to five minutes, peak is one hour to one and a half hours, and the duration is three to five.
• 24:36
  SPEAKER_01: So the duration is basically the same as no vlog humanoid.
• 24:39
  SPEAKER_01: Then you have Lemjev, which is a little bit slower or a little bit a little bit slower, but not to buy that much.
• 24:45
  SPEAKER_01: So Lemjev is five to fifteen minutes, right?
• 24:48
  SPEAKER_01: So they give a huge, they give a 10-minute, right?
• 24:52
  SPEAKER_01: Yeah, a 10-minute gap here, where Fias only has a three-minute gap, which is crazy.
• 24:59
  SPEAKER_01: Lemjev peaks faster, right?
• 25:02
  SPEAKER_01: So Lemjev is going to peak between 30 and 90 minutes, and then it's out of your system within four to six.
• 25:09
  SPEAKER_01: So it lasts a little bit longer in the system.
• 25:12
  SPEAKER_01: Then we've got a Fresa.
• 25:14
  SPEAKER_01: Again, the last thing that I saw about a Fresa, it was at activated the activation, or it started work, it started getting into the cell within 60 seconds, and then it was anywhere from three to seven minutes was the activation of the last thing I heard about a Fresa.
• 25:30
  SPEAKER_01: But this this chart says 12 to 15 minutes.
• 25:32
  SPEAKER_01: Again, I got this from Claude.
• 25:34
  SPEAKER_01: The peak is 35 to 55 minutes, which is pretty consistent.
• 25:39
  SPEAKER_01: I've even seen 90 minutes.
• 25:41
  SPEAKER_01: So the thing with a Fresa that you have to remember is a Fresa only comes in three different cartridges, right?
• 25:47
  SPEAKER_01: You can only take uh four units, eight units, and twelve units.
• 25:53
  SPEAKER_01: Now, that is not an actual one-to-one ratio to synthetic insulin, which would be Novlog, Humolog, Lemjeb, and Fias.
• 26:01
  SPEAKER_01: Right?
• 26:02
  SPEAKER_01: You basically divide that by two, and that's the conversion.
• 26:07
  SPEAKER_01: That's basically the conversion, right?
• 26:09
  SPEAKER_01: So a Fresa, the it comes in three cartridges, four, eight, or four, eight, and twelve.
• 26:14
  SPEAKER_01: So a four-unit cartridge is really like taking two units, an eight unit cartridge is like taking four units, and a 12-unit cartridge is like say taking six units.
• 26:24
  SPEAKER_01: So the different cartridges, they'll peak.
• 26:27
  SPEAKER_01: It doesn't say here, but it will peak at different times.
• 26:31
  SPEAKER_01: So the first one, the four units, is probably more to, or I'm sorry, the each cartridge, the duration and how fast it works or when it's out of your system is different, right?
• 26:45
  SPEAKER_01: So the four units is the four unit cartridge is just about sixty minutes, is what I've heard, maybe 75 minutes, depending on insulin resistance versus insulin sensitive sensitivity.
• 26:57
  SPEAKER_01: The eight, the eight cartridge or the eight unit cartridge is around that 60 to 90 minutes, and then the 12 unit cartridge is that two to is around two to three hours when it's out of your system, right?
• 27:12
  SPEAKER_01: So the more insulin you're taking, the longer it's gonna stay in your system.
• 27:16
  SPEAKER_01: Okay, yeah, that's the chart.
• 27:18
  SPEAKER_01: That's insulin.
• 27:20
  SPEAKER_01: I hope this helped with kind of understanding insulin and kind of understanding the different types of insulin that you could do or use.
• 27:30
  SPEAKER_01: Think about like how you utilize insulin.
• 27:35
  SPEAKER_01: If you are on a pump, which most I just think a lot of people are, maybe not.
• 27:41
  SPEAKER_01: I'm just I'd be curious about that.
• 27:43
  SPEAKER_01: I would be curious what the stats are.
• 27:46
  SPEAKER_01: I have to ask Claude if maybe if Claude knows or if Claude, I don't know, I don't know if AI can figure this out.
• 27:53
  SPEAKER_01: Approximately, how many people, including adolescents, are on insulin pumps, and how many people are on shots or a fresa or you know, not using insulin pumps?
• 28:08
  SPEAKER_01: That'd be an interesting stat to look at.
• 28:11
  SPEAKER_01: I'll have to kind of look into that.
• 28:13
  SPEAKER_01: Hmm.
• 28:14
  SPEAKER_01: But anyways, so think about how you utilize your insulin.
• 28:19
  SPEAKER_01: If it's an insulin pump, how are you utilizing it?
• 28:22
  SPEAKER_01: In an insulin pump, you're using one specific type of insulin.
• 28:25
  SPEAKER_01: It's most likely Novolog, Humolog, or Lemjev or Fias.
• 28:30
  SPEAKER_01: Most people aren't using FIAS in their insulin pump.
• 28:33
  SPEAKER_01: Most people are using humolog and novolog in their insulin pump.
• 28:37
  SPEAKER_01: I was using Lemjev, which I absolutely loved using Lemjev.
• 28:41
  SPEAKER_01: I still use Lemjev as an insulin pen.
• 28:44
  SPEAKER_01: So that's my ultra rapid acting outside of a fresa.
• 28:48
  SPEAKER_01: So for me, I'm using Lemjevresa and Traceba as my insulins of choice.
• 28:55
  SPEAKER_01: But think about think about like the different types of insulins that you're using or the the where how you can utilize maybe other insulins, even if you're on an insulin pump.
• 29:05
  SPEAKER_01: I will tell you that when I was on an insulin pump and I started using a fresa, it was really cool to see that work.
• 29:13
  SPEAKER_01: Now, the thing that I would say to that, which is one of the issues that I ran into when I was doing that, is making sure you're keeping track of insulin on board.
• 29:26
  SPEAKER_01: Because your pump will obviously tell you how much insulin is on board with the insulin that's in the pump, but you also have to take into account, if you're also using a fresa, how much insulin that you're using, are you using and what the duration of that insulin is going to be, right?
• 29:40
  SPEAKER_01: Are you using a four, an eight, or a twelve?
• 29:43
  SPEAKER_01: How long is it gonna take to approximately, right?
• 29:46
  SPEAKER_01: It doesn't have to be super exact, but approximately how long is it taking to get out of your system, right?
• 29:52
  SPEAKER_01: Because that's an important piece, right?
• 29:54
  SPEAKER_01: You don't want to be overdosing, like I just took a fresa, but for some reason I have sticky blood sugars.
• 30:00
  SPEAKER_01: Afresa still really hasn't kicked in yet.
• 30:02
  SPEAKER_01: And I also have insulin on board, but that insulin seems like it's not working very well.
• 30:06
  SPEAKER_01: So I take more insulin and then now an hour later I'm freaking plummeting, right?
• 30:10
  SPEAKER_01: Because I didn't give a fresa time to actually start working, right?
• 30:15
  SPEAKER_01: So I ran in, I've run into that issue before.
• 30:19
  SPEAKER_01: So a fresza was a really cool option to use on top of doing pumping, and it's been a really cool option to use on top of doing MDI, manual daily injections.
• 30:29
  SPEAKER_01: So I hope this helped everybody.
• 30:31
  SPEAKER_01: I'm gonna get off or stop sharing that that infographic.
• 30:37
  SPEAKER_01: But again, I will leave the PDF in the show notes if you want to look at that.
• 30:42
  SPEAKER_01: Again, and is any of this data on there?
• 30:44
  SPEAKER_01: Again, I got this from Claude, and I'm also using it for my own memory.
• 30:48
  SPEAKER_01: But if any of that data is incorrect, let me know.
• 30:52
  SPEAKER_01: Let me know, and I'll I'll update my chart because I also use that chart to when I'm talking to clients and we're navigating, you know, and troubleshooting things with their insulin.
• 31:05
  SPEAKER_01: Obviously, I'm not telling them how much insulin to take because that's out of my scope of practice, but we can talk about strategically how are you, how are you dosing for this?
• 31:13
  SPEAKER_01: How are you dosing for this?
• 31:14
  SPEAKER_01: You know, is this within your insulin to carb ratio?
• 31:17
  SPEAKER_01: Is this an op is this a place where maybe we should, you know, think about maybe increasing our insulin to carb ratio?
• 31:23
  SPEAKER_01: Do we need a little bit more insulin here?
• 31:25
  SPEAKER_01: Do we need less insulin here?
• 31:26
  SPEAKER_01: Like we know, so we can talk about those things.
• 31:29
  SPEAKER_01: And this chart has become really helpful when I work with people and even helpful for myself in understanding everything.
• 31:36
  SPEAKER_01: So yeah, understand your insulin, understand what the activation is.
• 31:41
  SPEAKER_01: That's probably the I mean, that's the number one piece of to this puzzle because it's gonna help you with your pre-bolus and navigating what should your pre-bolus actually be.
• 31:49
  SPEAKER_01: Do I need the full pre-bolus?
• 31:51
  SPEAKER_01: Do I need uh, you know, just maybe 10 to 12 minutes?
• 31:54
  SPEAKER_01: Remember, the pre-bolus is is, I would say, outside of like what your blood sugar is and like do you need to do correction or anything when you're eating food, I would say the pre-bolus is the number one piece to post-meal spikes.
• 32:10
  SPEAKER_01: Because, you know, there's obviously two different factors that are going to be at the top of the list, which is pre-bolishing and how much and are you taking enough insulin?
• 32:18
  SPEAKER_01: But for hypothetical reasons, hopefully you're taking enough insulin.
• 32:23
  SPEAKER_01: So if you constantly have post-meal spikes, it's it's probably because you don't you're not pre-bolishing.
• 32:28
  SPEAKER_01: And if you had just figured out the pre-bolus piece, man, everything could change.
• 32:33
  SPEAKER_01: Everything could change.
• 32:35
  SPEAKER_01: So yeah, I hope this helps.
• 32:37
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• 32:40
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• 32:48
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• 32:53
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• 32:58
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• 32:59
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• 33:05
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• 33:07
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• 33:17
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• 33:19
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