Latest / The Healthy Diabetic / #378: Diabetes Confessions (Part 2) - Why I Stopped Pre-Bolusing & What That Means For My Blood Sugar

Transcript

#378: Diabetes Confessions (Part 2) - Why I Stopped Pre-Bolusing & What That Means For My Blood Sugar · The Healthy Diabetic

0:14
SPEAKER_00: Welcome back.
0:15
SPEAKER_00: This is episode number 378 of the Healthy Diabetic Podcast.
0:20
SPEAKER_00: I'm your host, Coach Ken Kenniss.
0:22
SPEAKER_00: 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 of living with this condition every single day.
0:39
SPEAKER_00: I truly believe that every single one of us living with type 1 diabetes only has one job, and that's to figure out what's going to work for you.
0:46
SPEAKER_00: If you're looking for new perspectives and new ideas on how to live with diabetes, you've come to the right place.
0:53
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.
0:59
SPEAKER_00: Please always consult your medical team before making any changes to your diabetes management.
1:05
SPEAKER_00: Okay, no gram today, solo episode.
1:09
SPEAKER_00: And because it's a solo episode, we're gonna talk about diabetes confessions.
1:14
SPEAKER_00: This is part two of diabetes confessions, a new series that I'm starting on the show where I'm just going to press record and I'm gonna have a specific topic, specific confession that I want to make in diabetes, and we're gonna chat about it.
1:31
SPEAKER_00: I'm gonna give you some insight into how I used to live with these confessions and what I used to do, and if that has changed, if I still do that, or if I've kind of improved, I guess, the perspective of that different of that specific confession.
1:49
SPEAKER_00: Today, and this is an interesting one because I feel like so many people that I work with, so many, even myself, struggle with this.
1:57
SPEAKER_00: And not only struggle with this, just move past it.
2:01
SPEAKER_00: And don't maybe don't think that it's that big of a deal.
2:04
SPEAKER_00: And I would say it's probably in the top three most important things to keep your blood sugar stable and not go from a good stable blood sugar for me of 100 to 120 to 250, 300.
2:18
SPEAKER_00: That's me.
2:19
SPEAKER_00: That's a good stable blood sugar for me between 100 and 120, even really eight, 180 or 85 and 120, but I like 100 to 120.
2:29
SPEAKER_00: But this is something that so many people I think don't do in the we'll just say meal process, eating process.
2:38
SPEAKER_00: And that's pre-bolishing.
2:40
SPEAKER_00: And the reason this is a diabetes confession is because I used to think this was like, yeah, it's not a big deal.
2:48
SPEAKER_00: Especially during the time in my life, that three, four years at the beginning of my diagnosis when I was in depression and denial.
2:57
SPEAKER_00: I didn't pre-bolish.
2:59
SPEAKER_00: I hardly ever took enough insulin.
3:01
SPEAKER_00: I wasn't necessarily a hundred percent afraid of taking insulin, but I was a little bit because I had did have a couple scary lows at the beginning.
3:08
SPEAKER_00: But I never really pre-bolisted.
3:11
SPEAKER_00: At least not the whole entire time frame that I should have pre-bolic based off of the duration or that what I call the activation of the insulin that I was taking, which was new Novolog and Humologue at the time.
3:21
SPEAKER_00: And then we fast forward to today.
3:23
SPEAKER_00: Diabetes confessions, people, I still don't pre-bolish all the time.
3:28
SPEAKER_00: And then there's a reason why for that.
3:30
SPEAKER_00: Because I, as a as a diabetic of almost 19 years now, I understand and recognize that pre-bolicing, like I said at the beginning, is probably one of the top three most important things when you're consuming food and then dosing for insulin.
3:45
SPEAKER_00: So why is pre-bolishing so important?
3:48
SPEAKER_00: Maybe you're someone, I mean, I've literally talked to people on the podcast, and I've literally talked to people in coaching sessions that don't even really know what pre-bolishing is.
3:58
SPEAKER_00: They've heard the term before, but they don't really know what it is.
4:02
SPEAKER_00: And they've never really been educated on why it is so important.
4:07
SPEAKER_00: And again, it is probably fun.
4:10
SPEAKER_00: It's in the top three of most important things to prevent post-meal spikes.
4:17
SPEAKER_00: You're gonna spike a little bit, probably, depending on how many carbohydrates and sugar and protein and fat that you're consuming.
4:23
SPEAKER_00: You're gonna spike a little bit.
4:24
SPEAKER_00: But the difference is can we catch that spike?
4:26
SPEAKER_00: Can we get in front of that spike so it doesn't go to 200, 250, 300?
4:30
SPEAKER_00: So if you're someone who after you eat most times, you got this big spike over 200, then this episode is gonna be 100% for you.
4:41
SPEAKER_00: So let's talk about the reality situation insulin, right?
4:45
SPEAKER_00: We know that our body secretes insulin, our pancreas secretes insulin, the T cells talk to the beta cells, the beta cells, you know, communicate to the other hormones, you know, every all the all the things that go on.
4:58
SPEAKER_00: Okay, and our body makes insulin.
5:01
SPEAKER_00: Our liver, our pancreas communicates to our liver, and it drops sugar into our bloodstream at different points of the day, i.e., why we have a problem in the morning with highs, maybe, or you got a problem when your blood when you wake up and your blood sugar shoots to whatever it does, it spikes a little bit.
5:18
SPEAKER_00: That's because of Don phenomenon.
5:21
SPEAKER_00: Part of it is because of the liver dropping sugar into your bloodstream.
5:26
SPEAKER_00: The pancreas cannot communicate.
5:28
SPEAKER_00: The cells and the pancreas cannot communicate to the liver to say, do not do that.
5:32
SPEAKER_00: We don't need you to drop sugar into the bloodstream.
5:35
SPEAKER_00: Okay, so the reason that this is important, because when we talk about pre-bolusing, our body obviously doesn't make insulin, and we're taking synthetic, what I call synthetic insulin.
5:48
SPEAKER_00: Insulin that's not that is foreign to our body, that it's manufactured.
5:53
SPEAKER_00: It is manufactured insulin, and it has what I call an activation, duration, and a peak, that specific insulin.
6:02
SPEAKER_00: And all insulins aren't created equal, right?
6:04
SPEAKER_00: There's different types of insulin.
6:07
SPEAKER_00: There's you know, slow-acting insulin, which is our you know, basal insulin if you're on MDI.
6:13
SPEAKER_00: There's also like what I call medium or moderate insulin, which is gonna work slower than fast acting, but faster than slow hectin or basal.
6:25
SPEAKER_00: And then we've got fast-acting insulin, right?
6:27
SPEAKER_00: Insulin that's gonna work really fast, that's going to try to mimic what our beta cells and our insulin and a pancreas and all that stuff that's working prop when it works properly, it's trying to mimic that process.
6:41
SPEAKER_00: And the reason, if you don't know this, the reason that it's so fast in our body is because the communication pathways happen so fast.
6:48
SPEAKER_00: You know, you eat something, and as you consume this food, there's a process that can or uh there's signals to your brain, and then the brain signals to the rest of your body or the rest of the hormones and in your body and to the pancreas.
7:04
SPEAKER_00: Hey, we've got this coming in.
7:06
SPEAKER_00: We need to make sure that we have insulin to take care of a blood sugar spike.
7:10
SPEAKER_00: And you might spike a little bit, especially if you're eating like pancakes, or if you're eating pizza, or if you're eating something that's gonna hit you really, really fast, right?
7:19
SPEAKER_00: You might spike, but you're gonna come right back down, and then your body can regulate glucagon, which is gonna help bring you back up, right?
7:28
SPEAKER_00: So our body one can't regulate glucagon, and our body can't regulate insulin.
7:33
SPEAKER_00: So we've got those two things that are like kind of compacting together all the time.
7:38
SPEAKER_00: So that's that's why we have diabetes.
7:41
SPEAKER_00: So that process happens and it's instantaneous with synthetic insulin.
7:46
SPEAKER_00: And if you've been in diabetic for however long, 20, 30 plus years, you know that the old insulins, the first generations or second or third generations of insulin, they were really slow.
7:57
SPEAKER_00: They were really, really slow.
7:59
SPEAKER_00: And you could only eat specific things at specific times of the day.
8:04
SPEAKER_00: People, we live in the golden age of type 1 diabetes.
8:08
SPEAKER_00: The golden age.
8:09
SPEAKER_00: If you think about the CGMs that we have, the insulin pumps, the type of insulins that we have.
8:15
SPEAKER_00: Like we live in the golden age.
8:18
SPEAKER_00: Like I feel like sometimes when I get pissed off at diabetes because it's not working the way I want it to, I just think about that all the time.
8:25
SPEAKER_00: It's like, man, there's never been a better time to be a diabetic right now.
8:30
SPEAKER_00: It's insane.
8:31
SPEAKER_00: It's insane when you really think about it.
8:33
SPEAKER_00: But yeah, diabetes is still hard.
8:35
SPEAKER_00: Even though it's a great time to be a diabetic, it's still who wants to be type 1 diabetic?
8:41
SPEAKER_00: So when when we think about the concept of pre-bolishing, right?
8:47
SPEAKER_00: I'm gonna talk, I'm gonna give you a couple examples of why that this is important, right?
8:52
SPEAKER_00: So let's just take Novolog and Humolog, because that's what pretty much so many people, so many people are on those two insulins because they're like the insulin that you get when you're first diagnosed, and a lot of people don't know that there's even other options, and there are.
9:09
SPEAKER_00: The last time I checked, both of those insulins, okay, there's a duration, a peak, or I'm sorry, there's an activation, what I call an activation, a peak, and a duration.
9:22
SPEAKER_00: What do I mean by those three concepts or those three terms?
9:25
SPEAKER_00: So activation, let's talk about activation.
9:27
SPEAKER_00: Activation is how long that insulin, once you take your, take a shot if you're on MDI, once you actually tell your insulin pump how much insulin to actually give you, there's a time frame that it takes for that insulin to get through the skin, to get through the tissue, to get into the bloodstream, and then connect into the cells, into your into your cells to actually bring your blood sugar down.
9:52
SPEAKER_00: And the 15 minutes that we're told by our doctor, that's the standard, right?
9:57
SPEAKER_00: If you didn't have tons of insulin resistance, if you didn't have a crazy influx of insulin sensitivity where your body's really sensitive to insulin, the normal time frame, which I call activation, is about 15 minutes for Novolog and Humologue, and for a lot of other insulins too.
10:16
SPEAKER_00: But for Novolog and Humologue specifically as of what we're talking about, it's 15 minutes, right?
10:23
SPEAKER_00: So what does that 15 minutes actually represent?
10:25
SPEAKER_00: Right?
10:26
SPEAKER_00: Well, that 15 minutes represents when you start eating food, if you don't give that insulin time to get in front of a blood sugar spike, that's why you're high after an hour, half hour, 45 minutes, hour, two hours after you eat.
10:41
SPEAKER_00: Because you didn't give the insulin time to get in front of a blood sugar spike.
10:46
SPEAKER_00: That's why the 15 minutes is so important.
10:49
SPEAKER_00: It is very, very important.
10:51
SPEAKER_00: If you do that, even if you just stay on the standard of 15 minutes, which I don't agree that it's always 15 minutes because there's other factors involved.
11:01
SPEAKER_00: We're not gonna get into that right now, but we do get into that in coaching.
11:05
SPEAKER_00: There's other factors that are involved in this pre-bolishing time frame in this 15 minutes.
11:11
SPEAKER_00: There's gonna be factors that are gonna say, like, hey, I actually need to be take more pre-bolus, a longer pre-bolus than 15 minutes, or there's gonna be, and there's gonna be other factors that are gonna say, hey, I actually don't need to take 15 minutes.
11:25
SPEAKER_00: I'm gonna take like 10 or 12 minutes, or I'm gonna take less than that, or whatever it is.
11:29
SPEAKER_00: There's tons of factors that are involved in these decisions.
11:33
SPEAKER_00: But 15 minutes is the starting point, right?
11:36
SPEAKER_00: That's the it's where the baseline is, it's where we start from when we are making these decisions on how long our prebolus actually should be.
11:43
SPEAKER_00: Okay, so that's activation.
11:45
SPEAKER_00: I think the I I think the research actually says 15 to 20, but again, it just depends on how insulin resistant you are, how insulin sensitive you are, and all the factors.
11:55
SPEAKER_00: Okay, done.
11:56
SPEAKER_00: Activation.
11:57
SPEAKER_00: Then you have a peak of your insulin.
12:00
SPEAKER_00: What does that mean?
12:01
SPEAKER_00: It's typically between an hour and a half to I want to say maybe an hour and a half to two hours, depending on the insulin.
12:12
SPEAKER_00: Again, it depends on the insulin.
12:13
SPEAKER_00: And that's when your insulin is gonna be the strongest.
12:16
SPEAKER_00: So if one, if you don't give yourself time for that insulin to get in front of the blood sugar in front of a glucose spike, okay, you're losing the battle right there.
12:26
SPEAKER_00: Right?
12:27
SPEAKER_00: That's the beginning of you've you're losing part of the battle.
12:32
SPEAKER_00: And then the peak, right?
12:34
SPEAKER_00: It's probably when you don't pre-bolus and you see this big blood sugar spike over the next hour, hour and a half, you're gonna have the most impact.
12:45
SPEAKER_00: The insulin's gonna have the most impact on your blood sugar about bringing it down.
12:50
SPEAKER_00: Okay, so that's your peak.
12:51
SPEAKER_00: Then we have the duration.
12:53
SPEAKER_00: How long does it take for this insulin to get out of your system?
12:56
SPEAKER_00: And when I get to a freza in a second, you'll understand why this is important.
13:00
SPEAKER_00: How long does it take for this insulin to get out of your system?
13:03
SPEAKER_00: Because if you're still hovering at 200 and it hasn't, and your blood sugar hasn't come down yet into your target range or close to your target blood sugar, still sitting there at 200 plus, at three hours, almost three and a half hours, you're probably going to need more insulin because the duration of at least novel humolog, the last time I checked, it's between three and a half to four hours that it's out of your system.
13:31
SPEAKER_00: So you your insulin's not working anymore.
13:34
SPEAKER_00: Right?
13:34
SPEAKER_00: And if you're on a pump, typically it'll give you a little bit more understanding of how much insulin's on board because it'll tell you like you have this much insulin on board, it's gonna last for this much longer, which is why pumps are a really cool device and really cool technology.
13:47
SPEAKER_00: But it's important to understand that because again, if I'm sitting at 250 and it's been three and a half, almost four hours, I know that that insulin's almost gone.
13:57
SPEAKER_00: It's either gone or almost gone.
13:59
SPEAKER_00: So I'm probably gonna need another dose.
14:01
SPEAKER_00: This is where the art of managing your diabetes comes into play and the trust in the decisions that you're making.
14:08
SPEAKER_00: And any decision that you do make that involves insulin, here's the disclaimer always, always have low treatment available in case you mess up, in case you take too much.
14:20
SPEAKER_00: That's happened, that happens.
14:23
SPEAKER_00: But for me, I would rather take a chance to come back to my target blood sugar and get back in range if I'm over 200 than stay at 200 and fear taking more insulin because I just took insulin three, four hours ago.
14:38
SPEAKER_00: But because I understand the duration of my insulin, I know I can take a couple more units.
14:44
SPEAKER_00: At that point, now I'm taking a correction, not just a bolus, I'm taking a correction.
14:50
SPEAKER_00: Because either I didn't take enough insulin or I didn't, or I didn't give it a good enough pre-bolus, or, and it could be a combination of all three, I'm very insulin resistant, so I actually need did need more insulin.
15:03
SPEAKER_00: So, gosh, there's so many factors.
15:06
SPEAKER_00: And I and I know if you're listening to this and this is all new information to you, you're probably thinking, like, this is too much.
15:12
SPEAKER_00: It is.
15:14
SPEAKER_00: But once you understand it on a deep level, and once you start experimenting with different foods, once you start experimenting with using other tools like walking or like exercise or doing squats, or those tools are gonna help you.
15:29
SPEAKER_00: It's gonna help you manage the craziness.
15:33
SPEAKER_00: It seems crazy now because you don't have all these tools in place.
15:38
SPEAKER_00: No one's taught you the fine details of all this stuff.
15:43
unknown: Right?
15:43
SPEAKER_00: That's why it's confusing, that's why it feels overwhelming.
15:47
SPEAKER_00: So when you learn the fine details, you'll have more confidence in your decisions.
15:52
SPEAKER_00: And that's that is what's going to push you to thrive with this condition is having confidence.
15:57
SPEAKER_00: Okay.
15:58
SPEAKER_00: So we talked about activation, talked about the peak, and we talked about the duration.
16:03
SPEAKER_00: Okay.
16:04
SPEAKER_00: Now, let me give you another insulin example, and then I want to talk about me specifically on why I don't pre-bolish that much, but I'm gonna have to go back to pre-bolishing all the time.
16:17
SPEAKER_00: So here's another insulin situation or scenario for you.
16:23
SPEAKER_00: The reason that I even today really don't really pre-bolus that much is because I was utilizing a secondary insulin in a fresa.
16:36
SPEAKER_00: And if you don't know anything about a fresa, it is an inhaled insulin, right?
16:40
SPEAKER_00: So the novolog, humolog, all those insulins, they're going to pump, or you you had to take a shot with a pen or a syringe, throw a vial.
16:49
SPEAKER_00: And they they work the way we just talked about with the activation, 15 to 20 minutes, the duration or the peak in the duration, right?
16:57
SPEAKER_00: A Fresa is completely different because it works way faster, right?
17:00
SPEAKER_00: So the the activation of a Fresza is between, this is what the research said, this was what at least what I heard when I started a Fresa, is between 60 seconds and three minutes.
17:14
SPEAKER_00: I give it a little bit of a minute buffer.
17:16
SPEAKER_00: Really, they say 60 seconds.
17:18
SPEAKER_00: I don't know if that's 100% true because I don't feel it sometimes.
17:21
SPEAKER_00: I feel like it doesn't work within the activation part of it, doesn't work within 60 seconds.
17:27
SPEAKER_00: So I give it a little bit of a buffer.
17:29
SPEAKER_00: I say between one to three minutes.
17:31
SPEAKER_00: It's getting into the cell, it's getting close to getting into the cells and allowing your blood sugar to come down.
17:38
SPEAKER_00: Right?
17:38
SPEAKER_00: So I can take a small inhale, a four unit, which is actually two units, if we're quantifying synthetic versus a fresa.
17:48
SPEAKER_00: So it comes in a fresa comes in four unit cartridges, eight unit cartridges, and twelve unit cartridges, divide them in half, and you'll get the actual units from if you were just taking regular insulin, synthetic insulin.
17:59
SPEAKER_00: Okay, just so you guys know that.
18:00
SPEAKER_00: That's at least how I think about it.
18:03
SPEAKER_00: So back to the affresa piece.
18:07
SPEAKER_00: So the activation of a fresa is way faster.
18:10
SPEAKER_00: So I can get away with taking a four or even an eight, depending on how many carbohydrates and sugar and protein and fat I'm consuming.
18:21
SPEAKER_00: I can get away with taking an eight and then take a little bit of insulin on the back end.
18:27
SPEAKER_00: Whether that's taking a not like maybe I'm cutting it in half my dose.
18:34
SPEAKER_00: Maybe I'm doing a microdose, which just means I'm taking more insulin later.
18:38
SPEAKER_00: I'm going to set a timer for like 45 minutes, maybe an hour later, and take more insulin.
18:43
SPEAKER_00: I really enjoy microdosing on a fresza, and here's the reason why.
18:47
SPEAKER_00: I enjoy microdosing on a freza because a freza gets out so fast.
18:52
SPEAKER_00: We talked about the duration of synthetic insulin like an ovalog and a humolog.
18:56
SPEAKER_00: It's around three to four hours.
18:58
SPEAKER_00: It's probably more three, three and a half to four hours.
19:01
SPEAKER_00: But a fresza, depending on the on the cartridge, because they're all a little bit different.
19:06
SPEAKER_00: Fours are typically out of your system in 60 minutes, typically, from what I've read.
19:13
SPEAKER_00: The eights is closer to hour and 15 minutes, hour and a half, and the 12s are closer to maybe hour and a half to two hours.
19:23
SPEAKER_00: Right?
19:23
SPEAKER_00: So if I'm taking fours, which is the ones I take the most, fours and eights, I know the fours are out of my system within an hour.
19:33
SPEAKER_00: That's not enough time to have insulin on board to cover any protein or fat, because fat and protein we know are going to break down way slower.
19:41
SPEAKER_00: That might hit us two hours, three hours out.
19:44
SPEAKER_00: So I have to understand that, which is why microdosing comes in, right?
19:48
SPEAKER_00: So if I take a microdose of insulin of my, I'm take, I take Lemjev instead of Novolog and Humlog, but my fast-acting insulin that I still use, if I take a little bit of insulin an hour out, that's gonna cover me from when that protein and fat are starting to, you know, make my blood sugar rise, depending on how much I have.
20:13
SPEAKER_00: I might not need to cover for it.
20:15
SPEAKER_00: But for me, I'm like a carnivore.
20:18
SPEAKER_00: I eat a lot of protein and fat.
20:20
SPEAKER_00: So I need extra support from insulin because a fresa is going to be out too fast to deal with that.
20:27
SPEAKER_00: Right.
20:28
SPEAKER_00: So this again, this is the it's the art of how you manage your own unique diabetes because your diabetes is unique to you.
20:39
SPEAKER_00: That's it.
20:40
SPEAKER_00: I know other people that are on a fresa who just specifically use a fresa and don't really microdose, don't use any other insulin for whatever reason, whether it's because they're on low-carb diets or whether because they're not eating that many carbs, or because they've just figured it out.
20:55
SPEAKER_00: I I could not do that.
20:56
SPEAKER_00: For the amount of food that I consume, I had to get to a place where I was microdosing or I was using both in some capacity.
21:08
SPEAKER_00: So that's why I like a fresza.
21:10
SPEAKER_00: Now, going back to the pre-bolus, okay, so that's why I start that's why I didn't, I stopped pre-bolishing.
21:17
SPEAKER_00: And I've been doing that for almost two and a half years, two, two and a half years using a fresa and not having to pre-bolis as much.
21:25
SPEAKER_00: Still have to pre-bolish a little bit, but not having to pre-bolis as much.
21:29
SPEAKER_00: I don't have to wait a full 15, 20, 30 minutes like sometimes you do on normal insulin because of whatever reason.
21:37
SPEAKER_00: Now, here's the caveat to this, and this is actually the first time I've actually been talking about this on the podcast.
21:44
SPEAKER_00: I recently lost my insurance, which means that I'm not going to be able to take a Fresa anymore because a Fresa is too expensive to get without insurance.
21:55
SPEAKER_00: So I had a discount code specifically from a Fresa, which was super cool.
22:00
SPEAKER_00: I could get 30 days of supplies for a Fresa for$35 because there's a discount code, but they only give you that discount code, or you're only allowed to use that discount code if you have active insurance, because the insurance pays part of the premium, and then a Fresa handles part of the premium for you.
22:19
SPEAKER_00: But because I don't have insurance now, I got to wait till 2027 starts an open enrollment at the end of this year.
22:26
SPEAKER_00: I can't, I'm not going to be able to utilize a Fresa.
22:29
SPEAKER_00: I have tons of 12s left.
22:30
SPEAKER_00: I'll still use it periodically when I need to, when I have really high glycemic meals that I'm consuming, I'll use it.
22:36
SPEAKER_00: But or dealing with really, really annoying highs.
22:40
SPEAKER_00: I like to use a Fresa for really annoying highs, but I'm not going to be able to use it.
22:45
SPEAKER_00: So, which means that regular synthetic insulin, i.e.
22:50
SPEAKER_00: Lemjev, is going to have to be my primary source of bolus and correction.
22:58
SPEAKER_00: So now I now I'm going to have to pre-bolus again.
23:03
SPEAKER_00: 15 minutes.
23:05
SPEAKER_00: It's probably the max for me because Lemjev works faster than Novolog Humolog.
23:09
SPEAKER_00: So we've got Humilog or Novolog Humolog, which is kind of, I don't want to say the gold standard, but that's what everyone gets on.
23:16
SPEAKER_00: And then you have Lemjev and Fias, and there's a couple other ones, there's other ones too, but those are the four main ones I think that we that we use for synthetic insulin.
23:25
SPEAKER_00: So the fastest is Fias.
23:28
SPEAKER_00: I think it's three to five minutes, maybe, if I remember right.
23:33
SPEAKER_00: And then Lemjev is between seven to twelve minutes, where it goes through the activation process.
23:39
SPEAKER_00: It gets into the cell.
23:40
SPEAKER_00: So it's a little bit faster.
23:42
SPEAKER_00: But I have noticed sometimes, especially if I'm more insulin resistant, that I have to push a 15, 20 minute pre-bolus on Lemjev.
23:51
SPEAKER_00: I've noticed that.
23:52
SPEAKER_00: So again, the 15 minutes is a starting point.
23:56
SPEAKER_00: And you have to look at trends.
23:58
SPEAKER_00: You have to look at like, have you been more insulin resistant?
24:01
SPEAKER_00: Do you need to change your insulin to carb ratio?
24:04
SPEAKER_00: I do that all the time, right?
24:05
SPEAKER_00: My insulin to carb ratio is one to 10, but it's really one to 12.
24:09
SPEAKER_00: My baseline is one to 10.
24:11
SPEAKER_00: That's what most of the time I'm on.
24:13
SPEAKER_00: But if I'm sick, if I notice that I'm in more insulin resistant, I'll push it to one to eight.
24:18
SPEAKER_00: If I know I'm very insulin sensitive, I'm going to push it to one to twelve.
24:23
SPEAKER_00: And that, and and I'm always thinking about that.
24:26
SPEAKER_00: And I did that even on an insulin pump.
24:28
SPEAKER_00: It's a little harder on an insulin pump, I feel like, because you'd have to go in and like change your settings or just know the math in your head.
24:34
SPEAKER_00: But doing MDIs is super freaking easy.
24:36
SPEAKER_00: Okay, well, I need more insulin.
24:38
SPEAKER_00: Right now the math calls for three units, so I'm going to take four.
24:42
SPEAKER_00: Or I'm going to take five because I know I need more insulin right now.
24:46
SPEAKER_00: So it just it's again, it's the art of how you do this.
24:51
SPEAKER_00: But I remember where I was at now.
24:53
SPEAKER_00: Shoot.
24:54
SPEAKER_00: But anyways, diabetes confessions, pre-bulsing.
24:58
SPEAKER_00: It is really important.
25:01
SPEAKER_00: Outside of taking enough insulin and knowing what your blood sugar is and all the other, I mean, there's tons of factors, but there's tons of parts of there's tons of factors and tons of things that go into the decision.
25:13
SPEAKER_00: But out of all the things that you're trying to decide what to do, the decision doesn't just come down to how many carbs you're consuming and how much insulin you should take.
25:25
SPEAKER_00: It goes way deeper than that.
25:27
SPEAKER_00: Because the pre-bolus needs to be part of the top end of that decision, not the bottom part of the decision.
25:34
SPEAKER_00: It shouldn't be, okay, well, I need, I need five units of insulin for this meal that I'm about to eat.
25:40
SPEAKER_00: Okay, let me take it.
25:42
SPEAKER_00: Shoot on it, but I also got a pre-bolus.
25:44
SPEAKER_00: Like, no, it's like for me, it is it's it's three things.
25:48
SPEAKER_00: What is my blood sugar?
25:50
SPEAKER_00: Because that's going to dictate how much my pre-bolus actually needs.
25:53
SPEAKER_00: How much insulin do I have on board is another thing that I'm going to have that I have to kind of maybe recognize and understand.
25:59
SPEAKER_00: It's harder on MDI than it is on pumps.
26:02
SPEAKER_00: And so I got those two things.
26:03
SPEAKER_00: And then I go into what am I eating and how long do I need my pre-bolus to be?
26:09
SPEAKER_00: If I'm eating just a chicken salad, I'm probably not going to pre-bolle us that much.
26:13
SPEAKER_00: Let's just be honest.
26:15
SPEAKER_00: But if I'm 150 and taking a slight correction to come back down to 100, which is my target, I'm going to give myself some pre-bowls.
26:24
SPEAKER_00: I'm going to give myself a little bit of time.
26:26
SPEAKER_00: But if I'm 100 and I'm coming down a little bit, and I know I still have like 0.2 or whatever it is, like if you're on a pump, like you still have a little bit of insulin on board.
26:36
SPEAKER_00: Okay, you probably don't, you probably shouldn't do 15 minutes.
26:39
SPEAKER_00: Maybe you're doing 10.
26:41
SPEAKER_00: So like these are the these are the the ways that you kind of think about how do you dose.
26:46
SPEAKER_00: It's not just 15 minutes and go.
26:48
SPEAKER_00: It's not just I take my insulin and go.
26:50
SPEAKER_00: There's so many other things that have to, you you gotta think about.
26:54
SPEAKER_00: You gotta think about.
26:55
SPEAKER_00: Do you do you do you pre-bolis and take the amount of insulin that you're supposed to if you're about to go on a on a long 60-minute walk where there's gonna be hills, where you're gonna be like, you know, I don't know.
27:08
SPEAKER_00: It depends on how your body responds to that.
27:12
SPEAKER_00: And unfortunately, you're not gonna know until you do it multiple times.
27:19
SPEAKER_00: And then it's almost like taking the averages.
27:22
SPEAKER_00: I thought I think about diabetes of like you t you're always making decisions based off of the experiences that you have of the and the average trends that you see, right?
27:30
SPEAKER_00: If I see the same trends over and over and over again, I'm gonna make a decision based off of that trend.
27:37
SPEAKER_00: But if I'm making a decision based off of something I've never seen before, I can't let's not beat ourselves up about that because you're still learning how to make that decision.
27:47
SPEAKER_00: You you can't possibly we you can't possibly like fault yourself for making a decision that you've never made before.
27:57
SPEAKER_00: Like, or that you've made like a handful of times.
28:01
SPEAKER_00: And every single one of those times there was a different result.
28:04
SPEAKER_00: Like, come on, give yourself grace here.
28:06
SPEAKER_00: This is like it's crazy when I hear this.
28:08
SPEAKER_00: Like, oh, I can't do this or I can't do that.
28:10
SPEAKER_00: Well, how many times have you done that?
28:12
SPEAKER_00: Only like a handful.
28:13
SPEAKER_00: Oh my gosh, okay, stop.
28:16
SPEAKER_00: It's okay.
28:17
SPEAKER_00: It's okay.
28:19
SPEAKER_00: That's why you can correct, and that's why you have always have low treatment with you.
28:25
SPEAKER_00: Both both ends of the spectrum, highs and lows, you know how to deal with them.
28:29
SPEAKER_00: Unfortunately, highs are probably a little bit more challenging, I would say, to deal with, because it takes, it's gonna take, depending on where your number is, it'll probably take you 45 minutes at least, maybe even more, for that thing to come back down.
28:44
SPEAKER_00: That's I mean, just the highs are a pain in the butt.
28:47
SPEAKER_00: And then if you're more insulin resistant, you probably need more insulin than what the math is telling you.
28:52
SPEAKER_00: And then you turn around and do lows.
28:54
SPEAKER_00: I know people, I get it.
28:55
SPEAKER_00: Lows are really scary, they're hard, they don't feel we don't feel good.
29:00
SPEAKER_00: No, excuse me.
29:01
SPEAKER_00: We don't feel good on them 100%.
29:04
SPEAKER_00: They're awful.
29:05
SPEAKER_00: They are freaking awful.
29:06
SPEAKER_00: But once you recognize the trends of what you're doing, and once you recognize that there's really two different lows, not one specific, not just lows, there's two different lows.
29:18
SPEAKER_00: And you understand how to deal with both of those.
29:21
SPEAKER_00: It's another thing that we just we I hammer during coaching.
29:25
SPEAKER_00: So people don't have to deal with lows anymore, physically and mentally.
29:31
SPEAKER_00: I'm not gonna sit here and tell you that you'll never have a low ever again because that's not realistic and that's not that's not what diabetes is.
29:38
SPEAKER_00: Diabetes comes with having lows, but it's about how you react to that low and how you deal with that low, emotionally and physically.
29:48
SPEAKER_00: That's it.
29:49
SPEAKER_00: That's it.
29:51
SPEAKER_00: I hate lows just as much as you.
29:52
SPEAKER_00: I swear I do.
29:53
SPEAKER_00: I hate them.
29:54
SPEAKER_00: I can't stand them.
29:55
SPEAKER_00: I had some I had some lows yesterday.
29:59
SPEAKER_00: And I always know because I feel depression coming on.
30:03
SPEAKER_00: I feel like I feel like like, oh my god, why is this happening?
30:07
SPEAKER_00: Oh my god, what I'm so bad.
30:09
SPEAKER_00: I'm so terrible.
30:10
SPEAKER_00: I'm so negative.
30:12
SPEAKER_00: I am so negative towards myself when I go low.
30:15
SPEAKER_00: Like so negative that I have to walk away, that I have to like walk outside or go away, like get away from me.
30:21
SPEAKER_00: Don't don't talk to me because I'm so negative towards myself.
30:25
SPEAKER_00: It's it's so crazy.
30:26
SPEAKER_00: It's so crazy the things that we go through and how everybody's lows are different.
30:30
SPEAKER_00: It's so crazy.
30:31
SPEAKER_00: But, anyways, yeah, pre-bolishing.
30:35
SPEAKER_00: It's important, people.
30:36
SPEAKER_00: You gotta do it.
30:37
SPEAKER_00: You gotta, it's just, I promise, I promise, I promise, I promise.
30:42
SPEAKER_00: I've been doing this for a long time, talking about this stuff and dealing with it myself for a long time.
30:48
SPEAKER_00: When I had unbelievable success in my diabetes, there's two things that I would I was constantly doing.
30:57
SPEAKER_00: Well, it just, I mean, I would say that there's a bunch of things I'm constantly doing, but the five pillars of diabetes success: mental health, strategic decision making, consistency in routines, nutrition, and your physical well-being.
31:10
SPEAKER_00: If I have all five of those in alignment, my blood sugars are freaking fantastic all the freaking time.
31:16
SPEAKER_00: And that's exactly what coaching is about.
31:19
SPEAKER_00: It's about finding where you are in all three of those pillars and making adjustments where we need to so you can thrive.
31:27
SPEAKER_00: Because that's all we all we want to do.
31:30
SPEAKER_00: Feel confident, thrive, and just live our lives.
31:33
SPEAKER_00: Pre-bolishing is part of that.
31:35
SPEAKER_00: When we talk about pillar two, it is part of it's part of it.
31:39
SPEAKER_00: You have to pre-bolish.
31:40
SPEAKER_00: If you pre-bolus, you give your you give the insulin time to do its job.
31:45
SPEAKER_00: Unfortunately, we don't have insulin right now outside of what I believe a fresa is kind of.
31:51
SPEAKER_00: We don't have insulin right now that works right now when you take it.
31:56
SPEAKER_00: Because it has to go through the it has to get through the skin, it has to get through the tissue, it has to get in the bloodstream, and then it has to get to the cell.
32:02
SPEAKER_00: That process takes a little bit of time.
32:05
SPEAKER_00: But the great news is it's just gonna keep getting better and better and better.
32:09
SPEAKER_00: It will.
32:09
SPEAKER_00: It will just keep getting better and better and better, which is an awesome thing to think about.
32:15
SPEAKER_00: So, pre-bolishing.
32:17
SPEAKER_00: That's my diabetes confession for the day.
32:20
SPEAKER_00: If you have something to confess, confess, comment on this episode.
32:24
SPEAKER_00: It's gonna be on YouTube, Spotify, Apple Podcasts, and then all the other platforms.
32:30
SPEAKER_00: But you can comment on Spotify and YouTube, and I think Apple Podcasts too.
32:34
SPEAKER_00: If you haven't followed the show on any of the pick whatever platform that you listen to your podcasts on, and I hope that you listen to Diabetes Podcast because there's a bunch out there.
32:46
SPEAKER_00: There's so many great podcasts out there, not just this one.
32:49
SPEAKER_00: So listen to this one, but also broaden your horizons and listen to other ones because you're gonna see, you're gonna hear other things that you're not necessarily might not hear on this podcast.
33:00
SPEAKER_00: So that's an important piece for me.
33:02
SPEAKER_00: When I first started this, I listened to podcasts all the time and learned so much.
33:06
SPEAKER_00: So make sure you follow the podcast, comment on this episode, and yeah, keep thriving.
33:13
SPEAKER_00: Keep thriving, and you can do this.
33:16
SPEAKER_00: You can do this.
33:17
SPEAKER_00: If someone like me who is in depression and denial, had no idea what to do for three or four years, can do this.
33:24
SPEAKER_00: My God, this is what is your oyster.
33:27
SPEAKER_00: You can 100% do this.
33:29
SPEAKER_00: If you need support, don't hesitate to reach out.
33:33
SPEAKER_00: Don't wait.
33:35
SPEAKER_00: If you're struggling and you can't figure this out, like don't wait.
33:38
SPEAKER_00: Don't wait.
33:40
SPEAKER_00: Because you're just gonna keep compounding the same variables.
33:45
SPEAKER_00: You're just gonna keep running through the hamster wheel.
33:49
SPEAKER_00: And it might just be a couple adjustments that you haven't even thought about that's gonna make you thrive and make you feel amazing.
33:57
SPEAKER_00: So don't wait.
33:58
SPEAKER_00: That's it.
33:58
SPEAKER_00: Diabetes confessions, pre-bolus, make sure you're pre-bolishing.
34:02
SPEAKER_00: Thank you so much for listening, everybody, and I will see you guys next time.