Latest / The Healthy Diabetic / #385: The Four Things That Fix Almost Every Diabetes Problem

Transcript

#385: The Four Things That Fix Almost Every Diabetes Problem · The Healthy Diabetic

• 0:15
  SPEAKER_00: Welcome back.
• 0:16
  SPEAKER_00: This is episode number three hundred and eighty-five of the Healthy Diabetic Podcast.
• 0:22
  SPEAKER_00: As always, I'm Coach Ken.
• 0:24
  SPEAKER_00: I'm joined by Graham, my good diabetes partner in crime.
• 0:28
  SPEAKER_00: If you don't know much about me and Graham's story, we are two type ones with almost 50, or I think over 50 years of lived diabetes experience.
• 0:37
  SPEAKER_00: Really hope that we inspire you on these conversations with me and Graham to think differently about what you or how you are managing your diabetes.
• 0:46
  SPEAKER_00: As always, before we get started, please remember that nothing that you hear on this podcast should be considered medical advice or otherwise.
• 0:52
  SPEAKER_00: Please always consult your medical team before making any changes to your diabetes management.
• 0:57
  SPEAKER_00: Graham, what's up?
• 0:58
  SPEAKER_00: What's up, man?
• 0:59
  SPEAKER_00: How you doing?
• 1:00
  SPEAKER_00: How's everything going?
• 1:01
  SPEAKER_00: How's the weekend?
• 1:02
  SPEAKER_00: It is Monday, the 20th or wow, October, September 28th.
• 1:07
  SPEAKER_00: How you feeling?
• 1:08
  SPEAKER_01: Good, bro.
• 1:09
  SPEAKER_01: Good, good.
• 1:10
  SPEAKER_01: Feeling feeling like it's Monday.
• 1:12
  SPEAKER_01: It was a busy, made made it a busy Monday, and nobody else made it a busy Monday.
• 1:16
  SPEAKER_01: I had a bunch of no shows to a bunch of bunch of things.
• 1:19
  SPEAKER_00: So that's always good.
• 1:21
  SPEAKER_00: I love when that happens.
• 1:22
  SPEAKER_01: Isn't it annoying when, you know, and even if it's happenstance and it's unintentional, you know, you're ready, you're rocked, you're locked.
• 1:31
  SPEAKER_01: And how often does that happen to you as a trainer?
• 1:34
  SPEAKER_00: Where it's a no-show or a late cancel.
• 1:37
  SPEAKER_00: What's well, what's worse?
• 1:39
  SPEAKER_00: Probably a no show because I'm expecting the person to be there.
• 1:43
  SPEAKER_00: If it's a late cancel, I know ahead of time.
• 1:46
  SPEAKER_00: Whether it's an hour ahead or a day or so ahead, like I'd say a no show is probably the worst.
• 1:53
  SPEAKER_01: Now, does that throw you off or can you stick and move?
• 1:56
  SPEAKER_00: No, I stick and move because I just go in the back and start working, or I go jump on the treadmill, or go pick up some heavy things and just start working out.
• 2:05
  SPEAKER_00: Right.
• 2:06
  SPEAKER_00: So it's it's easy to adjust, but it's still a pain in the butt because now I have to decide like should this actually be a late cancel?
• 2:12
  SPEAKER_00: You know, is this was this person supposed to show up and they just forgot that's a late cancel, like you're still getting charged for that.
• 2:19
  SPEAKER_00: So it's just kind of then determining that piece of the appointment.
• 2:24
  SPEAKER_01: Yeah.
• 2:24
  SPEAKER_01: Yeah.
• 2:25
  SPEAKER_01: What about uh what about your weekend?
• 2:28
  SPEAKER_01: Everything good?
• 2:29
  SPEAKER_01: Everything everything the week starting a while?
• 2:32
  SPEAKER_00: Yeah.
• 2:32
  SPEAKER_00: Week weekend was really good.
• 2:34
  SPEAKER_00: I got a lot done on Saturday.
• 2:36
  SPEAKER_00: I think I was I went in at I went into the gym because I was covering for one of my colleagues because he he was out.
• 2:43
  SPEAKER_00: And me and him are the only ones that are there on Saturday mornings.
• 2:46
  SPEAKER_00: So let's see, I covered all his classes.
• 2:48
  SPEAKER_00: So I think I started at s got there at 7 and didn't leave till 5 30, 6 o'clock.
• 2:54
  SPEAKER_00: Which is not usual for me.
• 2:55
  SPEAKER_00: Usually I'm out of there by 10 30, 11.
• 2:58
  SPEAKER_00: But because I was covering some of his stuff and then no one was in the gym, so I was like, oh, I'm gonna work for the next four hours.
• 3:04
  SPEAKER_00: And so turn on some music, put some headphones in, and just buckled down and got a bunch of work done.
• 3:10
  SPEAKER_01: What about the world of diabetes?
• 3:12
  SPEAKER_01: What's up?
• 3:13
  SPEAKER_01: What's up from your from your vantage point?
• 3:16
  SPEAKER_01: How are you looking at things?
• 3:17
  SPEAKER_01: What are uh is anything anything is anything new peaking its way into your your world?
• 3:24
  SPEAKER_01: I know you see things a lot differently than I do.
• 3:28
  SPEAKER_00: Nothing's nothing new necessarily is peeking into my world.
• 3:31
  SPEAKER_00: Um I'm just as I get deeper and deeper into coaching, like I've you know, I've been fortunate enough now to over the last couple months to have coaching ramp up a little bit, which has been really nice and really good.
• 3:43
  SPEAKER_00: But just talking to different people and listening to the challenges that they're having and listening to the challenges that the people, you know, that I'm talking with or interacting with on social media are having, it's it's be it's starting to become, I don't want to say, it's starting to become very what's the word to describe this?
• 4:03
  SPEAKER_00: It's starting to become very I can see a little bit more on like let me give you some context.
• 4:12
  SPEAKER_00: So as I've been a diabetic over the past almost 20 years, as I've been getting into coaching over the last four or five years of of strictly diabetes, there's been a there's been so many things that I've seen in terms of challenges, in terms of things that are people are having issues with.
• 4:29
  SPEAKER_00: But when you boil it all down, I I really feel like it's starting to become really only three or four things.
• 4:36
  SPEAKER_00: And if you do these specific three or four things, like most of your problems are going to start alleviating itself, and you're gonna actually start seeing like really cool outcomes with your blood sugars.
• 4:49
  SPEAKER_00: And it just goes back to you know, the five pillars, it goes back to the spin specific things that we always talk about on this show, and I'm always talking about in general.
• 4:58
  SPEAKER_00: You know, the first thing is can you get to a place where you just trust your decisions?
• 5:04
  SPEAKER_00: Because we make so many decisions a day.
• 5:06
  SPEAKER_00: Everyone makes more, you know, we we've we've talked in lengths on this show about the 180 plus decisions, and is it real?
• 5:14
  SPEAKER_00: Is it not real?
• 5:15
  SPEAKER_00: Do you really make that many decisions?
• 5:16
  SPEAKER_00: But at the end of the day, you're still making diabetes decisions, you're still making life decisions with your diabetes, regardless of what it is.
• 5:24
  SPEAKER_00: Like you're still making decisions.
• 5:25
  SPEAKER_00: So do you feel confident with those decisions?
• 5:29
  SPEAKER_00: I would say, outside of the actual managing of your blood sugars, once I see someone start really feeling confident and believing that the decisions that they are making are the right decisions for them, regardless of the outcome, so many things start getting better and so many things just fix themselves.
• 5:51
  SPEAKER_00: I would say the second thing is I am I've always been a big pre-bolus person, even though I don't necessarily always practice it.
• 6:01
  SPEAKER_00: Right over the weekend, I did not practice pre-bolishing.
• 6:03
  SPEAKER_00: I was up and down.
• 6:04
  SPEAKER_00: And sometimes we get, I think we get burnt out or we get fatigued, get diabetes fatigued with having to pre-bolus, having to go out with friends and sit down and wait 20 minutes after we, or you know, once our food gets there, or maybe you have a really good strategy and you can time it up if you're out to a restaurant or whatever it might be.
• 6:23
  SPEAKER_00: Like just it sucks to have to wait 15, 20 plus minutes, or even 10 plus minutes.
• 6:30
  SPEAKER_00: It just that it sucks.
• 6:31
  SPEAKER_00: So the more I am understanding blood sugar regulation, the more I'm even seeing it myself, like it it just becomes so obvious that this is a real thing.
• 6:41
  SPEAKER_00: And if you can one trust your decisions, actually get a real pre-bolus, not a five-minute pre-bolus, not a seven-minute pre-bolus, but as close to 15 to 20 minutes as possible, depending on the insulin that you're on you're using.
• 6:54
  SPEAKER_00: So many things are going just it just alleviates so many different things, mentally and physically.
• 7:01
  SPEAKER_00: And then I've really started to like thinking more and more and more about microbolicing and not just microbolising, because I've talked about microbolicing before on the show, and I used to always talk about it with microbolicing with a fresa, right?
• 7:15
  SPEAKER_00: So I'd take, you know, most of the most of the insulin that I would need for a meal with a fresa, and then I would microbolish with lemjev.
• 7:23
  SPEAKER_00: Well, now I'm doing the opposite.
• 7:25
  SPEAKER_00: Now I'm taking most of my insulin with uh Lemjev, fast acting, and then micro bolusing with either more Lemjev 45 minutes to an hour later, or I'm micro bolusing with a fresza.
• 7:43
  SPEAKER_00: So it it's just it's really become a really interesting thing with the microbolicing because for me, it's allowed me to not feel like I have to take all this insulin at one time, whether it's I'm correcting for a high and I gotta also dose for a meal, or whether it's just, hey, I'm gonna eat 40, 50, 60 grams of carbs and I need, you know, six, seven, eight, nine units, whatever it might be.
• 8:05
  SPEAKER_00: So I can take that, still have a good pre-bolus, microbolus it, and I it's crazy to think that it comes out way, it just comes out differently sometimes.
• 8:16
  SPEAKER_00: From if I'm taking a lot of insulin versus subtracting that, like let's say as an example, I gotta take six or seven units, which is an it, which is like a moderately high dose for me.
• 8:30
  SPEAKER_00: Typically, my doses are anywhere from three to maybe four units.
• 8:34
  SPEAKER_00: That's what most of my dosing is.
• 8:36
  SPEAKER_00: Now, if I have if if I'm eating a little bit higher carbohydrate meal and I gotta take, you know, six, seven, eight units, as in like for pizza as an example, like it I have to microbolus it.
• 8:48
  SPEAKER_00: And then the fourth thing it would be that I'm really recognizing because I'm increasing the amount of this macronutrient so much, is that trying to micro bolus microbolus later for protein and fat, really for protein.
• 9:06
  SPEAKER_00: That is, I if I don't do that, especially at night, even if I'm following all of my rules and not eating a bunch of food and a bunch of high carbohydrate uh foods in the evenings, I'm following my rule of not of not having to fight digestion when I'm going to bed.
• 9:25
  SPEAKER_00: So this means I'm eating dinner like around six, seven o'clock.
• 9:29
  SPEAKER_00: Even if I'm doing that piece, the protein and fat, because I'm eating a crap load of protein, it hits me at a 10, really 11, 12 o'clock when I'm sleeping.
• 9:42
  SPEAKER_00: So then I wake up at one o'clock, two o'clock in the morning to this alarm that says, oh, you're 250, or oh, you're 200.
• 9:49
  SPEAKER_00: When I should be microbolicing that, I should be taking another two to four units before I go to bed, which is hard sometimes because sometimes I'll go to bed at like 85, 100, 110, like perfectly where I want to be for the night.
• 10:03
  SPEAKER_00: But if I would take that extra unit to two units, maybe three units, depending on how much protein I'm having, I know that I wouldn't be waking up at 200, 250.
• 10:12
  SPEAKER_01: Now, let me throw a real quick scenario.
• 10:14
  SPEAKER_01: Let's say I love and respect you like I currently love and respect you, but I came to you for training and I said, I disagree with all those things.
• 10:23
  SPEAKER_01: Will you still train me?
• 10:25
  SPEAKER_00: Of course.
• 10:26
  SPEAKER_01: Okay.
• 10:27
  SPEAKER_01: Okay, okay.
• 10:28
  SPEAKER_00: But when you start having challenges with your blood sugars, I'm gonna show you and we're gonna come back to those four components because those four components are huge.
• 10:39
  SPEAKER_01: Well, I'll just pick one and be like, all right, there's one of the four that I disagree with entirely, so I'm just not gonna do that, but we're still gonna work well together.
• 10:46
  SPEAKER_01: Do you think the answer is yes?
• 10:48
  SPEAKER_00: Yeah.
• 10:49
  SPEAKER_00: I'll work with I it's not it's not about the concepts of what I'm talking about.
• 10:54
  SPEAKER_00: It's about how I'm going to interact and and engage with the individual.
• 11:01
  SPEAKER_02: Okay.
• 11:01
  SPEAKER_00: Right?
• 11:01
  SPEAKER_00: So even if someone's listening to even if you're listening to this right now and you're like, Ken, I disagree with everything you're saying right now because I don't pre-bolish, I don't microbolish, I don't I eat late, I eat snacks, but I still don't have crazy problems with my blood sugars.
• 11:17
  SPEAKER_00: That's awesome.
• 11:18
  SPEAKER_00: Good for you.
• 11:19
  SPEAKER_00: But I would also argue that there's times that you probably do have issues with your blood sugars, and it's one or all of one or multiple or all of those pro all of those things.
• 11:30
  SPEAKER_01: Do you think anybody train?
• 11:32
  SPEAKER_01: I've never asked you this.
• 11:33
  SPEAKER_01: Do you think anybody do you think there is anybody who just trains with you just because it's, you know, it's good to be in good, it's good to be in company with another type one diabetic where they're like absolutely almost not really looking for all that advice and stuff, they're just looking to be trained by another type one.
• 11:48
  SPEAKER_00: I have a I have a basic.
• 11:50
  SPEAKER_01: Wait, wait, what's the answer?
• 11:51
  SPEAKER_01: I didn't hear you.
• 11:52
  SPEAKER_00: No, yes, 100%.
• 11:53
  SPEAKER_00: So here's the example.
• 11:54
  SPEAKER_01: Okay, so I'm not I'm not like alone in that thought.
• 11:56
  SPEAKER_00: No, no, here's the example, right?
• 11:58
  SPEAKER_00: And this is why I love coaching because and I don't want to talk too much about coaching right now when we talk about diabetes, but this is why I love coaching because coaching is all about being a guide.
• 12:09
  SPEAKER_00: I don't care who it doesn't matter if it's a sport coach, it doesn't matter if it's a health coach, it doesn't matter if it's a fitness coach, a nutrition coach, it doesn't matter.
• 12:17
  SPEAKER_00: As a coach, our job is to be a guide for that individual in whatever way that might be.
• 12:23
  SPEAKER_00: Some people need a lot of help.
• 12:25
  SPEAKER_00: That's why I love the five pillars.
• 12:27
  SPEAKER_00: Some people need a lot of help in one of them, and other people need help in all of them because they're lost.
• 12:34
  SPEAKER_00: I literally have a baseball player right now, high school baseball player.
• 12:38
  SPEAKER_00: He his A1C is better than mine.
• 12:40
  SPEAKER_00: We'll just call it a call it a spade a spade.
• 12:43
  SPEAKER_00: Like his A1C is better than mine, his blood sugars are really good, but he doesn't know the terminologies.
• 12:48
  SPEAKER_00: There's things that are happening on the back end, like eating too late or like not pre-bolishing enough.
• 12:55
  SPEAKER_00: There's little things on the back end that he's not doing that now that he's having conversations with me, he's understanding.
• 13:01
  SPEAKER_00: Like he didn't even know what Don, he didn't know what Don phenomenon was.
• 13:05
  SPEAKER_00: And we talked about it and we went through it and we came up with a strategy for it.
• 13:09
  SPEAKER_00: That's what coaching is about.
• 13:11
  SPEAKER_00: That's what being a guide for someone is about.
• 13:14
  SPEAKER_00: It's not about me being the smartest person in the room because I'm not.
• 13:18
  SPEAKER_00: I'm not the smartest person in the room at all.
• 13:21
  SPEAKER_00: It's about me being a guide and being able to guide the person that I'm in front of or people that I'm in front of to an outcome that's going to work for them.
• 13:31
  SPEAKER_00: Not work for everyone else.
• 13:32
  SPEAKER_00: An outcome that's going to work for them.
• 13:35
  SPEAKER_01: And this is just going with the conversation, not an argument.
• 13:39
  SPEAKER_01: I just when I hear that, I'm surprised that that guy's doctor, if if that's one of his big issues, that the doctor wouldn't talk to him about Don.
• 13:48
  SPEAKER_01: Like I first heard about that from my doctor because my issue was, you know, was that exact issue in the morning.
• 13:54
  SPEAKER_01: And I I talked about those things.
• 13:56
  SPEAKER_01: And, you know, we don't talk about this enough where I I wonder if if if you just grabbed every type one off the street right now and be like, all right, you're gonna sit down with a doctor, tell him tell them your three to five issues that you're having.
• 14:09
  SPEAKER_01: Like, I don't know that everybody has that waiting for them.
• 14:12
  SPEAKER_01: I don't know if they completely grasp that that that that's a thing.
• 14:16
  SPEAKER_01: So I think that's great.
• 14:18
  SPEAKER_01: I think that's great.
• 14:19
  SPEAKER_01: But the other thing that you said, and I find it a little bit just not confusing, but it's like we gotta pick what we're gonna we gotta pick our measurement here.
• 14:28
  SPEAKER_01: Like every we all talked about moving away from A1C to time and range, and now it's like, well, he's got me beat on A1C.
• 14:36
  SPEAKER_00: So but that is one metric.
• 14:37
  SPEAKER_00: That's one metric, and it's still a good metric, it's still a good metric to look at.
• 14:41
  SPEAKER_00: But it again, it's not telling the whole story.
• 14:44
  SPEAKER_00: I'm just using that as an example because everyone can relate to that measurement.
• 14:47
  SPEAKER_01: Yeah, yeah.
• 14:48
  SPEAKER_01: Hold on, but I guess my point would be that like maybe in his case the time and range would be better because say he was having those morning spikes, that you know, that would yeah, and and again, hold on, that would show you versus just being like cool, A1C's cool, move on.
• 15:04
  SPEAKER_01: It's like, oh well, you know, you might have a great A1C, but you might feel shitty, shitty, shitty waking up in the mornings into the into the morning because you're spiking with coffee or getting going or whatever it is.
• 15:17
  SPEAKER_00: All right, so let me clarify this.
• 15:19
  SPEAKER_00: I used A1C as an example.
• 15:21
  SPEAKER_00: His time and range is his time and range is good.
• 15:25
  SPEAKER_00: He wakes up and he wakes up in range.
• 15:28
  SPEAKER_00: His range is 100 to 130.
• 15:31
  SPEAKER_00: That's where we want him to start the day.
• 15:33
  SPEAKER_00: Most of the time he's in that range.
• 15:36
  SPEAKER_00: It's the other things that he didn't know about, like a Don phenomenon, like feet to the floor, the things that spike your blood sugar in the morning, the things that spike your blood sugar in the evening or in the night when you're trying to go to bed.
• 15:48
  SPEAKER_00: He eats late because he has lifting every pretty much every single day, and he doesn't get home till later.
• 15:54
  SPEAKER_00: Right?
• 15:54
  SPEAKER_00: So there's there's there's aspects of this that are important to understand, not just the A1C.
• 16:00
  SPEAKER_00: And you're absolutely correct.
• 16:02
  SPEAKER_00: When you say like we want to get away from A1C, we do, but it's still a metric that's that's engulfed in our brains that we should still look at.
• 16:09
  SPEAKER_00: It's just not the ultimate measurement that we hang our hat on.
• 16:13
  SPEAKER_02: Yeah.
• 16:14
  SPEAKER_00: But it is an important measurement.
• 16:15
  SPEAKER_00: Okay.
• 16:16
  SPEAKER_00: So here's the other thing that I want you to that I want everyone to understand.
• 16:21
  SPEAKER_00: Okay.
• 16:21
  SPEAKER_00: I'm gonna pull everybody that's listening on audio, we're gonna pull up a I'm gonna pull up this screenshot real quick.
• 16:28
  SPEAKER_00: Yeah.
• 16:28
  SPEAKER_00: So everyone can see it.
• 16:30
  SPEAKER_00: And hopefully when we see this screenshot, we'll get a little bit better understanding of why I think this is so important when we talk about managing our blood sugar outside of the doctor's office.
• 16:42
  SPEAKER_00: Okay, and how how why okay, so why this is important, okay?
• 16:47
  SPEAKER_00: So here's this is a presentation and I'm gonna just blow it up.
• 16:51
  SPEAKER_00: You can see this, right, Graham?
• 16:53
  SPEAKER_01: Mm-hmm.
• 16:53
  SPEAKER_01: That's awesome.
• 16:54
  SPEAKER_01: Looks good.
• 16:54
  SPEAKER_00: Okay.
• 16:55
  SPEAKER_00: So this is a thing that we have to understand.
• 16:58
  SPEAKER_00: Okay.
• 16:58
  SPEAKER_00: And if again, if you're listening to this on audio, this is on Spotify, the video will be on Spotify, and the video is also on YouTube.
• 17:06
  SPEAKER_00: So if you want to see this screenshot, you can see it.
• 17:09
  SPEAKER_00: But I'm gonna talk through it so hopefully you'll understand what this is, right?
• 17:12
  SPEAKER_00: So when we think about how much time, think about the time that you actually have with your doctor.
• 17:20
  SPEAKER_00: It's not that much time, right?
• 17:22
  SPEAKER_00: If we think about the standard, right?
• 17:24
  SPEAKER_00: And and some doctors spend more time with us.
• 17:26
  SPEAKER_00: Like Graham, you've talked about your doctor sometimes will spend 45 minutes with you.
• 17:31
  SPEAKER_00: My doctor spends 45 minutes with me if I have questions, but some people don't.
• 17:35
  SPEAKER_00: And on the average, we get 15 to 20 minutes every three to four months, depending on the person, right?
• 17:41
  SPEAKER_00: I'm going only twice a year now because my doctor says, like, I don't need to see you every three to four months.
• 17:47
  SPEAKER_00: Stop paying me money that you don't need to spend.
• 17:50
  SPEAKER_00: It's like, okay, cool.
• 17:51
  SPEAKER_00: So for the most part, every we get 15 to 20 minutes every three to four months.
• 17:58
  SPEAKER_00: Okay.
• 17:59
  SPEAKER_00: If that is the case, that's about 60 minutes a year that you get with your providers, with your endocrinologist.
• 18:07
  SPEAKER_00: 60 minutes a year.
• 18:08
  SPEAKER_00: Okay, now if you're brand new to this game, if you're brand new to buy a diabetes, you're probably getting more than that because you're seeing your endo, you might be seeing the your you know, your diabetes educator to get more education, you might be seeing a dietitian.
• 18:22
  SPEAKER_00: That's awesome.
• 18:23
  SPEAKER_00: But for the most part, with your endocrinologist, you get about 60 minutes a year.
• 18:28
  SPEAKER_00: Does everybody know?
• 18:29
  SPEAKER_00: I mean, it's right here on the screen.
• 18:30
  SPEAKER_00: Does everybody know, for those of you who are listening on audio, do you know how many minutes there are in a year?
• 18:36
  SPEAKER_00: There's 525,600 minutes in a year.
• 18:41
  SPEAKER_00: If you take out that 60 minutes that we get with our providers, okay, get with our endos, that leaves 5,200 or 525,540 minutes that you have to manage this on your own.
• 18:58
  SPEAKER_00: Whether you're managing it as a young kid and your parents are helping you, or whether you're managing it as an adult.
• 19:04
  SPEAKER_00: That's an important distinction.
• 19:06
  SPEAKER_00: It's a very important distinction.
• 19:08
  SPEAKER_00: Okay.
• 19:09
  SPEAKER_00: And we're going to go back to, yeah, we're back to the to me and Graham now.
• 19:13
  SPEAKER_00: But it's an important distinction because we can't think that the doctor is going to save us and allow us to, you know, figure out how to manage this thing.
• 19:23
  SPEAKER_00: We have always said we need them.
• 19:26
  SPEAKER_00: We need them to prescribe medications.
• 19:28
  SPEAKER_00: They can help us with some with some questions and stuff like that, but 15 to 20 minutes is not enough every three to four months for you to learn what it takes to manage diabetes.
• 19:39
  SPEAKER_00: And that's why amazing individuals like myself, CDEs that are doing this on their own, dietitians, psychologists, that's why we're out here.
• 19:48
  SPEAKER_00: Because you can't learn everything in 15 to 20 minutes.
• 19:52
  SPEAKER_00: And if you were trying to, you're probably throwing your hands in the air because it's gonna, it's taking you years and years to do that.
• 19:59
  SPEAKER_00: There's a lot that goes into this condition.
• 20:02
  SPEAKER_00: The 42 plus factors, the, you know, all the variables, the 180 plus decisions that we make every day.
• 20:09
  SPEAKER_00: I still think it's BS, but whatever.
• 20:11
  SPEAKER_00: Like, there's so many things that you have to think about.
• 20:14
  SPEAKER_00: And for most people, that is daunting.
• 20:18
  SPEAKER_00: All the things that they have to think about, all the things that they have to keep in mind, the frustration of having to deal with insurance.
• 20:25
  SPEAKER_00: Your doctor can't help you with that stuff.
• 20:27
  SPEAKER_00: I mean, hell, I can't even really help you with that stuff.
• 20:29
  SPEAKER_00: All I can do is like, hey, maybe ask these questions.
• 20:32
  SPEAKER_00: There's so much to deal with.
• 20:34
  SPEAKER_00: And when you when you understand that all of these things that you have to deal with comes down to one thing, one thing that's going to save you and allow you to be able to thrive with this condition.
• 20:48
  SPEAKER_00: And that's the trust that you have in yourself and making decisions.
• 20:53
  SPEAKER_00: That's why for me, that is the number one thing.
• 20:56
  SPEAKER_00: All the other stuff is really important.
• 20:58
  SPEAKER_00: And you can thrive for a long, long time on knowing how on pre-bolicing, no getting enough insulin in, eating the right foods.
• 21:07
  SPEAKER_00: You can thrive for a long, long time, but that's not going to be sustainable forever if you don't trust yourself.
• 21:13
  SPEAKER_00: And that's why for me, like the that piece has become so apparent with all the people that I'm working with right now.
• 21:21
  SPEAKER_00: The people that are thriving and can continue that consistency and that progress.
• 21:27
  SPEAKER_00: They're thriving because they're they're starting, or they do trust themselves.
• 21:34
  SPEAKER_01: How often are you recommending to people to take insulin, have a meal, and then exercise, like go for a walk or something like that to kind of engage the insulin?
• 21:47
  SPEAKER_00: It depends on the person.
• 21:48
  SPEAKER_00: It really does depend on the person.
• 21:50
  SPEAKER_00: It depends on the situation, right?
• 21:51
  SPEAKER_00: Because sometimes you just don't have that ability to do it.
• 21:54
  SPEAKER_01: So so I I asked that because I'm wondering about like your microbolicine for protein, like You know, wouldn't it wouldn't it be a pretty good piece of advice to tell someone like, you know, for dinner, you know, you have a f a full, you know, all-out protein meal, take a very small amount of whatever it is, and then you go exercise.
• 22:14
  SPEAKER_01: Like, wouldn't that make a lot of sense like just for like nighttime, just for night the sake of like, isn't that kind of like a double whammy?
• 22:20
  SPEAKER_01: Like you're avoiding a carb, you're hitting the proteins, you're also getting the exercise on top of it.
• 22:25
  SPEAKER_01: Is you know, that seems to me like a pretty almost, you know, like how the cave, you know, it's like it's like that's like the best piece of advice, right?
• 22:33
  SPEAKER_01: How did the cavemen do it?
• 22:34
  SPEAKER_01: Like primitive, almost like a primitive way.
• 22:36
  SPEAKER_01: Like, go, you get my question, go ahead.
• 22:38
  SPEAKER_00: Yeah.
• 22:39
  SPEAKER_00: So I think there's a there's a couple things to this.
• 22:42
  SPEAKER_00: The first thing is if you're not eating a bunch of carbs, then you don't have to take that much insulin anyway.
• 22:48
  SPEAKER_00: But the thing that you have to recognize is by the time that protein, because it's very slow digested, okay, by the time that protein is really hitting its peak to actually maybe blow raise your blood sugar, and it also depends on the on the the quantity of protein that you're consuming, how much protein you're consuming.
• 23:06
  SPEAKER_00: If it's 20 grams, no, I'm not gonna dose for that.
• 23:10
  SPEAKER_00: That for me personally.
• 23:11
  SPEAKER_00: But if it's 40, 60 grams, well shit, yeah, I'm probably gonna have to dose for that at some point.
• 23:16
  SPEAKER_00: But the problem is, is the duration of your insulin and when it's peaking and when it's like not as strong, is this is because it's not like this every single time, is the insulin that you're taking now for that protein, okay, if I if I take insulin now and I'm eating my food and I'm eating basically just protein, is that protein gonna fully digest within the life cycle of that unit, two units, whatever you're taking of insulin?
• 23:44
  SPEAKER_00: That's the that's the first thing.
• 23:45
  SPEAKER_00: The second thing is if you're super sensitive to insulin, the protein might not be raising your blood sugar to even call on or to even prevent like you going hypoglycemia.
• 23:58
  SPEAKER_00: That's the other problem, that's the other, like not problem, but thing, thing and maybe issue with this.
• 24:03
  SPEAKER_00: Again, it's different for everyone.
• 24:05
  SPEAKER_00: I've done it, I've done it both ways.
• 24:07
  SPEAKER_00: I've had I've covered for some protein at the very beginning of my meal and had it gone both ways, where it's like, okay, I still rise because the insulin's probably gone and not super effective by the time the protein is like fully going through digestion, or by the time that protein is like done with digestion, whatever it might be, and I've gone up.
• 24:28
  SPEAKER_00: And then I've also done it the other way, where I'm eating some protein with some carbohydrates, but then I still plumb it out because it's too much.
• 24:38
  SPEAKER_00: Right?
• 24:38
  SPEAKER_00: I took enough insulin for the carbohydrates that are work that's working right now in my system or digesting right now and raising my blood sugar, but the protein hasn't raised my blood sugar yet.
• 24:46
  SPEAKER_00: So therefore it's too much protein in the moment.
• 24:48
  SPEAKER_00: That's why microbolusing is like becoming such an interesting thing for me, because I can I can take and microbolus for the protein later, whether it's 45 minutes later, hour, two hours later, whatever it might be, and know that I'm not gonna go low.
• 25:05
  SPEAKER_01: How often are you yourself pairing insulin with exercise?
• 25:11
  SPEAKER_01: Or just not is that not a practice for you?
• 25:13
  SPEAKER_00: I don't really practice that.
• 25:15
  SPEAKER_00: The only time I'll practice that is if I'm high.
• 25:17
  SPEAKER_00: Like today, I'm gonna go play basketball for three hours tonight.
• 25:20
  SPEAKER_00: And the goal is to be around 120 to 130.
• 25:25
  SPEAKER_00: That's where I want to start at with is with little to no insulin on board.
• 25:29
  SPEAKER_00: Because I know that act that activity is going to drop me a little bit over time.
• 25:35
  SPEAKER_00: And if I can go into that with hardly any or no insulin on board, I know I'm not gonna bottom out.
• 25:43
  SPEAKER_00: Because if I do have insulin on board and I'm going to play basketball, I'm throwing double the gasoline on the fire.
• 25:50
  SPEAKER_01: So you're actually doing the opposite, which is something I do too, yeah.
• 25:53
  SPEAKER_01: Like you're positioning it, you're positioning it around not having any insulin.
• 25:59
  SPEAKER_00: Yeah, I'm trying to, yes.
• 26:00
  SPEAKER_00: Sometimes it doesn't work.
• 26:01
  SPEAKER_00: Like I've gone before and I'm like 225 for some reason, and I'm like, oh man, I gotta dose for this because I'm not gonna.
• 26:09
  SPEAKER_00: So I'll take like a unit, maybe two units for that, and then I'm gonna and then I end up bottoming out.
• 26:14
  SPEAKER_01: Man, you just hit on such a niche, niche, niche thing that I have always battled, and you said it so perfectly because the number always happens to be, yeah, like 220, just like right right there.
• 26:29
  SPEAKER_01: But do you take insulin before it?
• 26:32
  SPEAKER_01: And I have always been of like, you know, like I didn't learn this until Jay Cutler was in the NFL.
• 26:37
  SPEAKER_01: If anybody remembers Jay Cutler was a type one, he he's still known.
• 26:41
  SPEAKER_01: He he married like a celebrity, or he did, and he's been all over the place even when he was not in the NFL, but he's a type one diabetic.
• 26:49
  SPEAKER_01: And you know, they'd have these articles about how the breakdown was and what it looked like and the care.
• 26:54
  SPEAKER_01: And I've seen other athletes, but I'm just like, nah, I just um I'd rather unplug and not have to think about it and come back and attack it later.
• 27:02
  SPEAKER_02: Yeah.
• 27:03
  SPEAKER_01: That's kind of always worked for me.
• 27:04
  SPEAKER_01: It's also not like I'm an athlete, like I'm not doing it all the time, you know.
• 27:09
  SPEAKER_00: But I don't know.
• 27:10
  SPEAKER_01: That's always a hard, that's a hard, hard one, man.
• 27:12
  SPEAKER_01: Like, yeah.
• 27:13
  SPEAKER_00: And here's a here's another example with this.
• 27:15
  SPEAKER_00: I played basketball, so I'm I'm I'm I'm excited that I get to play.
• 27:19
  SPEAKER_00: I'm playing basketball like two to three days a week, which is amazing because I it's my it's my hobby.
• 27:25
  SPEAKER_01: I love to do it.
• 27:27
  SPEAKER_00: So last Friday, I went in and played and didn't take any insulin, and that was 185.
• 27:34
  SPEAKER_02: Okay.
• 27:34
  SPEAKER_00: And I was like, I'm not gonna take insulin right now.
• 27:37
  SPEAKER_02: Yeah.
• 27:37
  SPEAKER_00: Two and a half hours later, like I'm leaving at 85.
• 27:41
  SPEAKER_00: Perfect.
• 27:42
  SPEAKER_02: Yeah.
• 27:42
  SPEAKER_02: Totally.
• 27:42
  SPEAKER_00: If I would have taken a unit for that, I would have plummeted it out, bottomed out.
• 27:47
  SPEAKER_01: You know what has always, always gotten me is swimming.
• 27:51
  SPEAKER_01: And I know this is the conclusion of the summer, but I also would remember as a kid going to camp and hearing that about other kids.
• 27:58
  SPEAKER_01: There is just something about I think when you're actually truly swimming, you're not touching the ground.
• 28:03
  SPEAKER_01: I mean, you're literally moving, even if you don't feel like it, you know, it's just constant movement.
• 28:07
  SPEAKER_01: There is something about swimming that always got me.
• 28:09
  SPEAKER_01: I think I am such a runner now that my body knows how to react to it and it knows when to react.
• 28:15
  SPEAKER_01: So it's always in the morning, and I think my body knows, all right, he's doing something, so it's gonna release.
• 28:22
  SPEAKER_01: But on the opposite, if I leave for a run at 225 and I take one unit of insulin, I'm guaranteed to crash.
• 28:29
  SPEAKER_01: Like, so there almost is not an option.
• 28:32
  SPEAKER_01: But then again, I'm running for 40 minutes, you know, 35, 40 minutes.
• 28:37
  SPEAKER_01: I'm gonna make four miles and I'll come back and take insulin.
• 28:39
  SPEAKER_00: So what's your what is your target for when you exercise?
• 28:43
  SPEAKER_00: Like what what hypothetically, what do you want your blood sugar to be at when you start your run?
• 28:47
  SPEAKER_01: Dear, I'm I'm being this is I'm being honest with you.
• 28:50
  SPEAKER_01: I'm being, I don't, I don't, it doesn't matter.
• 28:51
  SPEAKER_01: It doesn't, it doesn't, I'm not thinking about my blood sugar.
• 28:54
  SPEAKER_01: I'm not thinking about my blood sugar.
• 28:55
  SPEAKER_00: I'm thinking about like No, it's not that you're thinking about your blood sugar in the moment, Graham.
• 29:00
  SPEAKER_00: It's it's about the planning of like what do I for the for this run to be like the best, where I don't feel high, I don't feel low, I'm like cruising and bruising, man.
• 29:13
  SPEAKER_00: I'm amazing.
• 29:14
  SPEAKER_02: Yeah.
• 29:14
  SPEAKER_00: What does your blood sugar need to be?
• 29:16
  SPEAKER_00: Because you have to think about this.
• 29:18
  SPEAKER_00: Is how I think about the exercise piece and not having insulin on board.
• 29:22
  SPEAKER_00: Okay.
• 29:23
  SPEAKER_00: You know that, you know that type of exercise that you're doing, and if if it's going to raise you or drop you, right?
• 29:31
  SPEAKER_00: You pretty much know that if you're an avid epic exerciser.
• 29:35
  SPEAKER_00: Okay.
• 29:36
  SPEAKER_00: So thinking about that, you need to have your have a cushion, right?
• 29:40
  SPEAKER_00: So for me, regardless if I'm doing high intensity or if I'm doing resistance training, 130 is perfect for me.
• 29:48
  SPEAKER_00: That gives me a 30 milligram per deciliter gap, plus and minus.
• 29:55
  SPEAKER_00: So I've got to 160 and I've got to 130 or to 100, right?
• 30:01
  SPEAKER_00: That that gap is perfect.
• 30:03
  SPEAKER_00: I don't have insulin on board.
• 30:05
  SPEAKER_00: If I'm getting to, if I'm doing strength training and it rises me like it typically does, okay, then I know that okay, maybe I can put a little bit of insulin on board.
• 30:14
  SPEAKER_00: Or halfway through I'm gonna micro dose and do a little bit.
• 30:18
  SPEAKER_00: I know my insulin resist my insulin sensitivity is in it is getting heightened because I'm moving, because I'm exercising, my muscles are uptaking the insulin faster and the sugar and burning off the sugar faster.
• 30:31
  SPEAKER_00: So I think having the idea of a target is so important.
• 30:35
  SPEAKER_00: Just like we have the idea of a target for our blood sugars when we're not exercising.
• 30:40
  SPEAKER_00: What is the what is in a perfect world?
• 30:42
  SPEAKER_00: What do we want?
• 30:44
  SPEAKER_00: What where do we feel the most comfortable and and uh have the most trust in ourselves?
• 30:49
  SPEAKER_00: Some people it's 130, some people it's 150, some people it's 100, some people it's 90, right?
• 30:55
  SPEAKER_00: Some people it's 110, 115.
• 30:57
  SPEAKER_02: Yeah.
• 30:58
  SPEAKER_00: Right?
• 30:58
  SPEAKER_00: So understanding that, because for me, everyone looked, we talked about earlier about how we're trying to get away from A1C.
• 31:07
  SPEAKER_00: The world of diabetes has now gone pretty much to time and range, which is fine.
• 31:12
  SPEAKER_00: But again, time and range has its has its limitations.
• 31:16
  SPEAKER_00: For me, it's way it it is a way easier task, I would say, for myself to look at target blood sugar, average target blood sugar instead of time and range.
• 31:29
  SPEAKER_00: Because I know where I want to be, I want to where I feel the best, and that's the unicorn for me is 100.
• 31:36
  SPEAKER_00: I want to be a unicorn.
• 31:37
  SPEAKER_00: If if I could be a unicorn one 24-7, I would be a unicorn.
• 31:40
  SPEAKER_00: So every single decision I make, whether it's exercise-wise or I'm not even exercise wise, because it's a different target for exercise.
• 31:47
  SPEAKER_00: It every single decision I'm making outside of exercise is to get back to 100, not to get back into time and in range, right?
• 31:55
  SPEAKER_00: So if someone's 250, they'll make a decision, like, okay, I'm good, I'm back in range, but I'm at 175.
• 32:02
  SPEAKER_00: That's not a great number, right?
• 32:05
  SPEAKER_00: Make a different decision, right?
• 32:07
  SPEAKER_00: So it that for me, that's the biggest thing.
• 32:09
  SPEAKER_00: Like, what is your target that you that you're shooting for?
• 32:12
  SPEAKER_00: And all your decisions should be shot, should be made to get to that target.
• 32:16
  SPEAKER_00: And and let's be honest, I'm not 100 all the time.
• 32:19
  SPEAKER_00: No freaking way am I 100 all the time.
• 32:21
  SPEAKER_00: I'm more my average is I I looked this morning, my average is like 135 right now over the last three days on my DexCon is my average.
• 32:30
  SPEAKER_00: I got some work to do.
• 32:31
  SPEAKER_00: Like I'm trying to be as close to 100 as possible every single day.
• 32:37
  SPEAKER_00: That's the goal.
• 32:38
  SPEAKER_00: Doesn't mean it's gonna happen every single time, but that's the goal.
• 32:42
  SPEAKER_01: Yeah, so I guess for me, to be honest, that my my my answer would be it's something I need to work on too.
• 32:50
  SPEAKER_01: I see exercise as like a moment to escape.
• 32:54
  SPEAKER_01: You're doing something very good for your diabetes.
• 32:56
  SPEAKER_01: I don't I I I I have zero awareness really of my blood sugar as long as I know it's not.
• 33:03
  SPEAKER_01: I mean, for me, dude, if I was 120 and I'm gonna leave for a four-mile run, I'd probably eat something right there.
• 33:08
  SPEAKER_01: Yes.
• 33:09
  SPEAKER_01: Right, sure, for sure.
• 33:10
  SPEAKER_01: I probably would too.
• 33:11
  SPEAKER_01: I'm not gonna go north, I'm gonna go south, you know.
• 33:14
  SPEAKER_01: And it sounds like a funny thing to say.
• 33:17
  SPEAKER_01: Like it's my job to come home alive.
• 33:19
  SPEAKER_01: Like in a way, I think about that, you know, especially because I run outside and I go out, you know, into the open.
• 33:25
  SPEAKER_01: Like, I'm thinking more just like, you know, I need to be safe, you know, I I need to get home.
• 33:29
  SPEAKER_01: And it's not, it's nobody else's job to find me like having like a you know, having an episode on the side of the road.
• 33:36
  SPEAKER_01: And I I don't know.
• 33:36
  SPEAKER_01: I guess to me, I just always viewed exercise as that as like this is your chance to get it in.
• 33:41
  SPEAKER_01: Don't have an excuse to not get it in.
• 33:44
  SPEAKER_01: But optimal, man, like optimal blood, like gosh, can you imagine having like the care of like an NFL team and just being like Yeah, always trying to get to optimal man?
• 33:53
  SPEAKER_01: It's almost something I've never even thought about, to be honest with you.
• 33:56
  SPEAKER_00: So And it's not even that, and again, it's not that you are are going to be there all the time.
• 34:01
  SPEAKER_02: Uh-huh.
• 34:02
  SPEAKER_00: It just changes your decision-making process.
• 34:05
  SPEAKER_00: It it completely changes your decision-making process.
• 34:09
  SPEAKER_02: Yeah.
• 34:09
  SPEAKER_00: Because maybe you take uh an extra unit to get yourself to push yourself an extra 20 milligrams per deciliter closer to your target.
• 34:20
  unknown: Right?
• 34:20
  SPEAKER_00: Whether it's exercise or for or just you know, not non-exercise.
• 34:25
  SPEAKER_00: The one thing that I would say for you, Graham, that you just said that I think is really important, is what what's what's easier to manage?
• 34:33
  SPEAKER_00: We've we've always talked about that we feel like lows are not severe low, but lows are easier to manage than highs.
• 34:42
  SPEAKER_00: They just are.
• 34:43
  SPEAKER_00: To me, they are.
• 34:44
  SPEAKER_02: Sure, sure, sure.
• 34:45
  SPEAKER_00: It's the same thing when you're exercising.
• 34:48
  SPEAKER_00: What's easier to manage?
• 34:49
  SPEAKER_00: You taking a little bit of uh food to bring your blood sugar closer to your target for exercise, or you having to deal with a low during exercise.
• 34:59
  SPEAKER_02: Sure, sure, sure, sure.
• 35:01
  SPEAKER_00: 100%.
• 35:02
  SPEAKER_00: Take a little bit, push yourself a little bit, right?
• 35:05
  SPEAKER_00: I I've talked to people that exercise all the time that are like, well, like, you know, I didn't go as hard, or I was scared because I didn't want to eat anything, or I didn't want to take any insulin because I didn't want to go low, or I didn't want to push myself to like 160.
• 35:20
  SPEAKER_00: I'm like, okay, so what's what's harder for your training session?
• 35:24
  SPEAKER_00: You dealing with a low blood sugar, or are you going to 150-160?
• 35:28
  SPEAKER_00: Do you want the low blood sugar?
• 35:30
  SPEAKER_00: Because at 150, 160, you can still go.
• 35:33
  SPEAKER_00: You can still work out.
• 35:34
  SPEAKER_00: You can still you still have energy to work out.
• 35:36
  SPEAKER_00: And most likely, if you do go to 150, 160, that exercise, the exercise of that, you'll get the post exercise drop as well, which is a real thing.
• 35:48
  SPEAKER_02: Yeah.
• 35:49
  SPEAKER_00: So it it's it for me, it's just it really is about the decision making process of how you're trying to get to the outcome that you want to get to.
• 35:59
  SPEAKER_01: You know, another qu uh another question I had for you.
• 36:03
  SPEAKER_01: Do you think you're talking about trusting your trusting your decisions and being confident?
• 36:09
  unknown: Yeah.
• 36:09
  SPEAKER_00: And that comes in multiple ways, yeah.
• 36:11
  SPEAKER_01: Do you think that you think learning to trust your decisions over and over and over again breeds confidence?
• 36:20
  SPEAKER_01: Or do you think you are confident and then you need to learn to trust your decisions?
• 36:26
  SPEAKER_00: Like is it say it again?
• 36:27
  SPEAKER_00: Say that, say it again.
• 36:29
  SPEAKER_01: So like like like do you think that the confidence comes before or after the trusting your decisions?
• 36:35
  SPEAKER_01: As in, like, are you a confident person who now has diabetes and you need to learn and you've now learned to take that confidence and make you know, it might not it might people say like I didn't realize I could do this without my doctor's permission, like, and then you slowly start to learn how to trust.
• 36:55
  SPEAKER_01: Or is it you're kind of like like me, like you know, you're having a you know, there's things coming at you from every angle, blah blah blah blah blah at all times, and slowly but surely you build that confidence in one thing being like the diabetes, where like like I I see I don't think I I feel like I'm a confident person in certain things.
• 37:18
  SPEAKER_01: Like I don't, you know, I think people are overall confident in everything they do.
• 37:22
  SPEAKER_01: I I uh diabetes is almost a point of pride for me.
• 37:26
  SPEAKER_01: Like I I I've I have I have done what exactly what you said, number one, to to a T.
• 37:32
  SPEAKER_01: But the confidence came in many, many, many years of experience and things like that.
• 37:37
  SPEAKER_01: So do you think there's a distinction?
• 37:38
  SPEAKER_00: Do you think it's not like uh it's hard because I could see it both ways.
• 37:44
  SPEAKER_00: Right?
• 37:45
  SPEAKER_00: I could see someone saying, Oh, you have to be confident before you can trust, or you build confidence and then you have trust.
• 37:51
  SPEAKER_00: And then I could see it the other way where you're trusting your decision and that you're trusting the decisions that you're making and that builds confidence.
• 37:59
  SPEAKER_00: I kind of think about it in kind of the middle.
• 38:01
  SPEAKER_00: As you're building confidence, you're trust you are also trusting and learning to trust what you're the decisions that you're making.
• 38:09
  SPEAKER_00: So I feel like they're almost kind of hand in hand.
• 38:12
  SPEAKER_00: Okay, you you can't you can't have trust without confidence.
• 38:16
  SPEAKER_00: And you can't be confident without starting to believe and trust in yourself.
• 38:22
  SPEAKER_00: Right?
• 38:22
  SPEAKER_00: So it's it's it's like uh it's like the thought process of like we all these things happen, all these things are happening like in a domino effect in a positive manner, and you're building more confidence as things are happening.
• 38:34
  SPEAKER_00: Every single time that you make a d make a decision, right?
• 38:37
  SPEAKER_00: You might not trust that the decision is gonna come out the way you want it to be, you want it to, but it does end up coming out the way you want it to, and that builds confidence, but then you start just trusting in that specific decision, i.e., I'm gonna pre-bolle us for 15 minutes, or I'm gonna drop my pre-bolus right now because of all these factors that are in front of me.
• 38:56
  SPEAKER_00: So I don't need to pre-bolish because I already have insulin on board and I'm going to exercise.
• 39:01
  SPEAKER_00: So I'm not gonna really pre-bolle.
• 39:03
  SPEAKER_00: And when that works out, now you start trusting in that decision and you're gaining confidence and being able to make those specific decisions on the fly.
• 39:12
  SPEAKER_00: So I I I kind of feel like they're go hand to hand.
• 39:17
  SPEAKER_00: I'm sure one supersedes the other, but in in my head, I feel like they kind of they kind of go hand in hand if that answers your question.
• 39:25
  SPEAKER_01: Do you do you do you talk like the people that you talk to, do like if they made a change in their insulin, would they call their doctor?
• 39:32
  SPEAKER_00: Yeah, we always talk about that, right?
• 39:34
  SPEAKER_00: So it's my school of practice is not to tell someone, go, you need to take two more units here.
• 39:40
  SPEAKER_00: But what I can say, because we can see it on a graph and we can see it from and and understand it from the conversation, we can come up with ideas and theories on what to do.
• 39:52
  SPEAKER_00: Oh, well, you're dropping here, and here's all the things that you're telling me that are in place.
• 39:56
  SPEAKER_00: Maybe you just had too much insulin.
• 39:59
  SPEAKER_00: Right?
• 39:59
  SPEAKER_00: Maybe this was the time that you didn't need to take your entire insulin to carb ratio.
• 40:04
  SPEAKER_00: Maybe this is the time you use the gap concept of your insulin to carb ratio, and you've got like a two to three milligram per deciliter, or not milligram per deciliter, but uh insulin, yeah, insulin to carb ratio drop or rise, right?
• 40:19
  SPEAKER_00: So like as an example, my insulin to carb ratio, my normal insulin carb ratio is one to ten.
• 40:24
  SPEAKER_00: I would say probably 80% of the time, that's the ratio that I'm going off of.
• 40:28
  SPEAKER_00: But there's other times when I'm more insulin sensitive and I know it.
• 40:32
  SPEAKER_00: I know that one to 10 is like too much, I'm gonna take it to one to 12.
• 40:36
  SPEAKER_00: And then the times that I'm maybe sick or I know that I'm insulin resistant, and I just I know that I need more insulin over the past, I've needed more insulin over the past 24, 48 hours, 72, whatever it is, I'm gonna go one to eight.
• 40:50
  SPEAKER_00: Right.
• 40:50
  SPEAKER_00: And that's how I'm making the decisions in the moment.
• 40:53
  SPEAKER_00: Or I'm just saying, like, yep, I don't need that much insulin right now because of all these other things.
• 40:58
  SPEAKER_00: I'm just gonna take it.
• 41:00
  SPEAKER_00: My pump says I should take five units, I'm only gonna take three and a half.
• 41:04
  SPEAKER_00: I'm only gonna take four.
• 41:05
  SPEAKER_00: Right?
• 41:06
  SPEAKER_00: That that is an art to managing diabetes.
• 41:10
  SPEAKER_00: And it's also hard because sometimes you just need that much insulin even though you got all these factors in front of you.
• 41:17
  SPEAKER_00: So, yeah, it I it is out of my school of practice.
• 41:20
  SPEAKER_00: I never tell someone you need this much more insulin.
• 41:24
  SPEAKER_00: Because that's not but I can say it seems like you have too much, or it seems like you don't have enough.
• 41:40
  SPEAKER_00: When you say changes, what do you mean?
• 41:42
  SPEAKER_01: Like if they're gonna make a a change to the amount of insulin they're taking, do they do they get approval for a I don't think so.
• 41:49
  SPEAKER_00: Because why would you have to do that every time you want to make a change?
• 41:53
  SPEAKER_01: Uh I don't I don't I'm asking that.
• 41:56
  SPEAKER_00: I I don't think so because we should have the freedom and flexibility to uptick, downtick our insulin.
• 42:01
  SPEAKER_01: You should ask, just out of curiosity, spend a couple days and just say, like, hey, we're if you made a change, would you like let your So here's the difference.
• 42:08
  SPEAKER_01: I just always thought that was like a big, that was like a big one that people always No, but here's the difference, right?
• 42:13
  SPEAKER_00: In the moment, in the moment, I need more or less, I'm gonna make that decision in the moment.
• 42:20
  SPEAKER_00: I think I need to increase or decrease my insulin to carb ratio or my correction factor.
• 42:27
  SPEAKER_00: 100%.
• 42:28
  SPEAKER_00: I'm messaging my doctor.
• 42:29
  SPEAKER_00: Hey, doc, these are the things that I'm seeing right now in my management.
• 42:33
  SPEAKER_00: I feel like I'm more insulin resistant here, like I'm dealing with, you know, you know, menstruation right here as a female.
• 42:40
  SPEAKER_00: I'm dealing with this, I'm dealing with this.
• 42:42
  SPEAKER_00: I think I need more insulin to hear and I'm going to raise my, I want to raise my insulin needs to X.
• 42:49
  SPEAKER_02: Sure.
• 42:50
  SPEAKER_00: Do you think that's a good idea?
• 42:52
  SPEAKER_00: Excuse me.
• 42:54
  SPEAKER_00: Right?
• 42:54
  SPEAKER_00: That that's the difference, right?
• 42:56
  SPEAKER_00: Because you're talking about, hey, I'm doing, I'm making this decision for like now and down the road versus I'm making a decision in the moment.
• 43:05
  SPEAKER_02: Uh-huh.
• 43:06
  SPEAKER_00: In the moment, what am I gonna do?
• 43:07
  SPEAKER_00: Yeah, I don't know if I should take five units here or four units here.
• 43:10
  SPEAKER_00: There's all these variables in place.
• 43:12
  SPEAKER_00: Like my pump is saying I should take five, but I really think I should take four.
• 43:16
  SPEAKER_00: Let me message my doctor right now, and I gotta wait 15, 20, 30 minutes, an hour, a couple hours for them to get back to the phone.
• 43:21
  SPEAKER_01: I know that sounds ridiculous, but it that's what keeps people out of trouble too.
• 43:24
  SPEAKER_01: And that's like a maybe like a rule that they set for themselves, you know.
• 43:27
  SPEAKER_00: So I I don't if someone wants to do that, fine.
• 43:31
  SPEAKER_00: Like 100%.
• 43:32
  SPEAKER_00: Like if someone wants to do that and they feel like they need to do that, 100% do that.
• 43:37
  SPEAKER_00: But I'm telling you right now, that's gonna get real tedious.
• 43:40
  SPEAKER_00: That's gonna get real tedious really fast.
• 43:43
  SPEAKER_00: You're gonna get pushed to diabetes fatigue really fast.
• 43:47
  SPEAKER_00: That's why I always talk about it's like it's on us to make a decision.
• 43:51
  SPEAKER_00: As soon as we start asking our doctor for every single little decision, it takes the power away from us to actually make a decision.
• 43:57
  SPEAKER_00: And what we talked about earlier, build confidence.
• 44:00
  SPEAKER_00: And trust in making those decisions.
• 44:02
  SPEAKER_00: Because I feel like that is the number one problem, is we just don't, we don't trust, we don't trust our decisions.
• 44:08
  SPEAKER_01: Well, yeah, I don't I don't know how it goes with malpractice and liability and things like that.
• 44:13
  SPEAKER_00: And you know, I, you know, well, but I I think that it's not malpractice if you're telling someone like, hey, think about if you need more insulin or less insulin.
• 44:23
  SPEAKER_00: This is what I would do, and this is why.
• 44:25
  SPEAKER_02: Yeah, I agree with you.
• 44:26
  SPEAKER_00: I'm not saying you should do this.
• 44:28
  SPEAKER_00: That's the conversations I have.
• 44:31
  SPEAKER_00: And I feel like it's not malpractice because I'm not telling them how much insulin to take.
• 44:35
  SPEAKER_00: I'm just telling them, this is what the data is showing us.
• 44:40
  SPEAKER_00: What do you think you should do?
• 44:42
  SPEAKER_00: I'm guiding them towards making a decision.
• 44:45
  SPEAKER_00: That's not telling them, this is what the data is showing us, you need to take more insulin, or we need to change your insulin to carb ratio, or your correction factor needs to be higher, or your basal rates need to change.
• 44:56
  SPEAKER_00: We're not saying that.
• 44:58
  SPEAKER_00: That's not what we're saying.
• 44:59
  SPEAKER_01: That's actually good.
• 45:00
  SPEAKER_01: That's actually a really good solution that they would have working with someone like you.
• 45:04
  SPEAKER_01: Is you could like, let's put it like, you know, I'll I'll put together exactly what you need to say to your doctor, type of thing, if you wanted to.
• 45:11
  SPEAKER_01: So that's good.
• 45:12
  SPEAKER_00: Yeah, someone someone was asking me, one of my clients was asking about a Fresza, and their doctor was pushing back on letting them have a Fresa or prescribing them a Fresa because the doctor didn't really know much about it.
• 45:25
  SPEAKER_00: We talked about it.
• 45:26
  SPEAKER_00: I gave them the information, I sent them an article link on a Fresa, and and then also sent them the three things that you're supposed to tell the insurance.
• 45:35
  SPEAKER_00: The doctor has to code for the insurance for you to even get approved.
• 45:39
  SPEAKER_00: And because I helped that client with that information, their doctor was more receptive to listening about Afresa.
• 45:47
  SPEAKER_02: Sure.
• 45:47
  SPEAKER_00: And now they're gonna probably start Afresa.
• 45:50
  SPEAKER_02: Yeah.
• 45:50
  SPEAKER_00: When the doctor at first was like, no way, this is I don't trust this medication.
• 45:55
  SPEAKER_00: So that's what I mean about being a guide.
• 45:58
  SPEAKER_00: And it's like we all do that for each other.
• 46:00
  SPEAKER_00: We all of us in the diabetes community, you see it in Facebook groups, you see it in groups, you see it in social media, people talking to each other in the comments of a different post.
• 46:09
  SPEAKER_00: Like, I hate social media, but it's a powerful tool.
• 46:13
  SPEAKER_02: Yeah.
• 46:14
  SPEAKER_00: When you have a chronic condition.
• 46:16
  SPEAKER_00: I freaking hate it.
• 46:17
  SPEAKER_00: If I didn't, if I wasn't trying to run a business and trying to build credibility and get clients through organic traffic, which is social media, I would not be on social media.
• 46:30
  SPEAKER_01: Yeah.
• 46:31
  SPEAKER_01: I I'm laughing because I question whether or not I would tell this story, but I'll decide and I'll have to end on this.
• 46:37
  SPEAKER_01: Here we go.
• 46:38
  SPEAKER_01: I'm gonna have to end on this, though, but it's you know, not everybody has it as good as I got it, apparently.
• 46:44
  SPEAKER_01: But you know, I see it both ways.
• 46:46
  SPEAKER_01: You know, it's like I I and I always say like I very much enjoy having the relationship with a doctor because I feel like that is the 100% and I'll I'm gonna squeeze every moment I I can out of them.
• 46:57
  SPEAKER_01: But you know, I find, and maybe this might be advice to other people, like the the more open you are, the more you are out there, the more they will be receptive.
• 47:06
  SPEAKER_01: So I, you know, I had I I didn't even tell you I talked to my endo last week.
• 47:10
  SPEAKER_01: I saw my endo, and she had asked about like the Ozempic, right?
• 47:14
  SPEAKER_01: And I was like, well, because you've given me such like a half dose, like the thing is gonna end up lasting me for it's already been three months, and I have I've been using one thing.
• 47:24
  SPEAKER_01: It's gonna end up lasting me for like four or five months, right?
• 47:27
  SPEAKER_01: So she goes, Well, you know, you've been so blah with me and open and you're working with me.
• 47:34
  SPEAKER_01: She's like, Come back in when you're done, I'll give you another, I'll give you another sample.
• 47:38
  SPEAKER_02: Yeah.
• 47:39
  SPEAKER_01: So by the end of the year, I'll have you pretty much in a I'll use Ozembik for a year and I'll have never spent a single dime.
• 47:45
  SPEAKER_01: And I'll have all the benefits that are coming from it.
• 47:48
  SPEAKER_01: And it's all just having an open relationship with the doctor, and you know, I think things like that are very, very important.
• 47:54
  SPEAKER_01: And I mean, but let's be honest, if I had you as my coach and then her, she'd only be more impressed with me, too.
• 48:01
  SPEAKER_01: So, like, you know, adding you as a coach is just another level, it's not replacing one, in my opinion.
• 48:07
  SPEAKER_01: But then again, like let's be honest, being a doctor is what they call, like, you know, bedside manner.
• 48:14
  SPEAKER_01: Like it, you still are a human being.
• 48:16
  SPEAKER_01: You you might not you might be an asshole.
• 48:18
  SPEAKER_01: Like you just might not be good with people.
• 48:20
  SPEAKER_01: So it's, you know, I I have been knock on wood.
• 48:23
  SPEAKER_00: I've just had amazing endos, and so but also I think I I think the other thing that we have to recognize here, Graham, is like unfortunately, not everyone is as blessed with their providers as you and me.
• 48:39
  SPEAKER_00: We both have been open about our providers, how much we love them, how much time they spend with us, how much information they share with us, how much education they give us, how much like what how the conversations are.
• 48:53
  SPEAKER_00: But a lot of people aren't as blessed as us.
• 48:56
  SPEAKER_00: And that's why I firmly stand on the belief that your decisions have to be made in the moment with you, not from your doctor.
• 49:06
  SPEAKER_00: Because again, as soon as you start trying to take all this, all the decisions that you're making to your doctor, it's just it you're not learning to trust in yourself.
• 49:16
  SPEAKER_00: You're not building confidence in your in the decisions that you're making.
• 49:20
  SPEAKER_00: And those two things are going to that they're going to sustain you being able to thrive, regardless of what you're doing, dosing and sleeping and exercise and eating and nutrition and all the outside of all that stuff, if you trust in yourself and you have confidence in the things that you are doing in your diabetes management, that is a recipe for sustainability for the long haul, which is going to make your blood sugars work so much better because you're not dealing with cortisol, you're not dealing with stress, you're not dealing with high cortisol levels, you're not you're not constantly in fight or flight because you're constantly pissed off.
• 49:59
  SPEAKER_00: Right?
• 49:59
  SPEAKER_00: It's it's I just I just think it's it that is so important.
• 50:04
  SPEAKER_00: And Graham has a different relationship with his endo than I do, right?
• 50:08
  SPEAKER_00: I use my endo for one specific thing, shoot the shit with him because he's an awesome dude, but to give me prescriptions.
• 50:15
  SPEAKER_00: That's literally his job in my management style.
• 50:18
  SPEAKER_00: And as that is his only job, which is why he's told me now, only come to me six twice a month.
• 50:24
  SPEAKER_00: Or once really, it's once a year.
• 50:26
  SPEAKER_00: Twice a month.
• 50:27
  SPEAKER_00: Yeah, once a year.
• 50:29
  SPEAKER_00: Twice a year.
• 50:30
  SPEAKER_00: Every six months.
• 50:31
  SPEAKER_00: It's once a year I go see this dude.
• 50:34
  SPEAKER_00: Because I don't, I don't need his services.
• 50:37
  SPEAKER_00: I don't need I'm confident enough in myself, I trust myself enough.
• 50:42
  SPEAKER_00: And for all of you who are just like on the endocrinologist roller coaster every three to four months, I would ask yourself, do you need to see that person that often?
• 50:51
  SPEAKER_00: If you want to, great.
• 50:53
  SPEAKER_00: If my endo said to me is like, you know what, I don't really need to see you.
• 50:56
  SPEAKER_00: Just come and get labs and we'll touch base through through Zoom every once a year or when you need me, and that's it.
• 51:03
  SPEAKER_00: I'd be like, nah, man, I gotta have a conversation with you at least.
• 51:06
  SPEAKER_00: Right?
• 51:06
  SPEAKER_00: So it it's what do you want that and what do you want that relationship to be?
• 51:10
  SPEAKER_00: And going back to the very beginning, when I pulled up that screenshot, there's five hundred and twenty-five thousand six hundred minutes in a year, and you only get to see them most of the time for five hundred and twenty-five thousand and four hundred minutes.
• 51:26
  SPEAKER_00: Maybe if you're lucky.
• 51:28
  SPEAKER_00: What are you doing for the all that time?
• 51:31
  SPEAKER_00: Who's helping you?
• 51:32
  SPEAKER_00: Are you managing it yourself?
• 51:34
  SPEAKER_00: Who's helping you?
• 51:35
  SPEAKER_00: Who's guiding you?
• 51:36
  SPEAKER_00: Who's who's who can you lean on?
• 51:40
  SPEAKER_00: I hope you have that person or persons that you can lean on and talk to and like deal with the challenges, deal with the up and downs with.
• 51:49
  SPEAKER_00: And if you don't, keep listening to our podcast because that's what we're here for.
• 51:54
  SPEAKER_00: A sounding voice to be able to help you deal with the challenges and deal with really the mental capacity of this thing, because it's it's hard.
• 52:03
  SPEAKER_00: Diabetes is a hard thing to live with.
• 52:06
  SPEAKER_00: And if you need more support, if you feel like you're not getting enough support, and you don't trust yourself, you don't trust your your decisions, and you're not you don't feel super confident, please reach out to me.
• 52:17
  SPEAKER_00: This has been one hell of a ride for me to be able to learn how to guide people to the outcomes that they want.
• 52:24
  SPEAKER_00: So it's just been it's been so fun.
• 52:26
  SPEAKER_00: And it's why that this podcast is so fun for me.
• 52:30
  SPEAKER_00: Because it it allows me to just sit down, press record, and talk to Graham, and then argue with Graham.
• 52:36
  SPEAKER_00: That's always fun too.
• 52:37
  SPEAKER_00: Graham, final thoughts.
• 52:38
  SPEAKER_02: I gotta go.
• 52:39
  SPEAKER_02: Awesome.
• 52:40
  SPEAKER_00: That's Graham's final thoughts.
• 52:42
  SPEAKER_00: He's gotta go.
• 52:43
  SPEAKER_00: Thank you everybody for listening.
• 52:44
  SPEAKER_00: I hope this was an impactful conversation for you.
• 52:48
  SPEAKER_00: I looked at the clock earlier and we were at like 23 minutes, and I see it sounded like the conversation was gonna come to a close, and then we went for another 30 minutes.
• 52:56
  SPEAKER_00: So thank you so much, everybody, for listening, and we will see you guys next time.