#76 Think Like a Pancreas Chapter 4: The Three Keys to Better Control with Suzanne

Who's ready to think like a pancreas?! This is the fourth episode in our 10 week, Think Like a Pancreas Book Club Series and today I am covering chapter FOUR called, The Three Keys to Better Control. My guest for this one is another amazing T1D mom, Suzanne.

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

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OTHER INFO MENTIONED IN THE SHOW
Episode #18: Identifying Trends in Your CGM Data and Blood Glucose Values with Ariel Warren
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Transcript

Katie: 0:00

This episode of the sugar mama's podcast is sponsored by sugar medical. The very best place to get all your diabetes supply cases in accessories. You're listening to episode 76 of the sugar mamas podcast. And today I'm going over chapter four of the book. Think like a pancreas by Gary Scheiner with T one D mom, Suzanne chapter four is called the three keys to better control. It's not too late for you to get your copy of the book and follow along with us. I will put a link in the show notes to where you can buy it either on Amazon, or if you want an extra special signed copy from the author himself. Head on over to his company's website, integrated diabetes.com. Integrated diabetes.com is also a great place to find the help that you may need in achieving better control with your diabetes management. They have a whole team of highly qualified, certified diabetes care and education specialists that are ready and willing to help you check'em out. Okay. Without further ado, let's get started. You're listening to the sugar mamas podcast, a show designed for moms and caregivers of type one diabetics here. You'll find a community of like-minded people who are striving daily to keep their kids safe, happy, and healthy in the ever-changing world of type one. I'm your host and fellow T one D mom, Katie Roseboro. Before we get started. I need you to know that nothing you hear on the sugar mamas podcast should be considered medical advice. Please be safe, be smart, and always consult your physician before making changes to the way you manage type one diabetes. Thanks. Before we start the show. I wanna take a minute to tell you about our wonderful sponsor sugar medical. I have a question for you. How are you toting around all of your diabetes stuff? Is it haphazardly thrown at the bottom of your purse, backpack or suitcase? My husband has lovingly nicknamed my purse, the black hole, Because once things go into it, they have a tendency to disappear into the dark abyss, true story. That's why within days of my daughter's type one diagnosis. It became very clear, very quickly that no ordinary purse or bag was gonna cut it. When it came to carrying around this mountain of must-haves that's when sugar medical stepped in to save the day, their huge selection of travel bags, backpacks and insulated cases are expertly designed to keep all of your supplies, tidy and easily accessible while on the go Stop scavenging for supplies at the bottom of your bag, like a Savage and start savoring the sweet piece of having them organized and ready to move at all times. Do yourself a favor and head on over to sugared.com to take a look at all their super sweet products. Plus get 10% off all. One time purchases using code sugar, mama that's S U G a R M a M a for 10% off. You'll find a link to the sugar medical website, along with the offer code details in the show notes. Thanks. Everybody, I am here with Suzanne today and Suzanne, I'm really excited to talk to you because it is chapter four of think like a pancreas. And this chapter is called the three keys to better control. I was just telling Suzanne that I was thinking this was gonna be one of like the easier shorter chapters to read through, but it, it was, it was, it was a great chapter, but it was definitely chock full of just as much information as, as the other chapters. But I there's a lot of good talking points in this one. So, before we get started, Suzanne, tell the listeners just a little bit about who you are and what your connection to type one diabetes is.

Suzanne: 4:02

I have. Twin daughters, Kai and Rowan. They are seven. They actually just turned seven on Saturday. And Kai is. our type one. I stay home. Mostly. I say, I say, I'm a stay at home. Mom-ish because I have a couple things that I do for my mental health, like working at a clothing boutique and I have an antiaging wellness business. My connection to type one is obviously I said, has type one. And she was diagnosed about three weeks after she turned two.

Katie: 4:38

Hmm. So she was too first of all, I just wanna say I follow Suzanne on Facebook. We follow each other personally, and I did not know your girls were twins until you posted about their birthday last weekend. I cuz they're fraternal right? Yeah, but although they do look very, very similar in my opinion. But yeah, I just, I guess I just thought they were really close in age, you know, like Irish twins or something like that, so have you, I'm just curious to know, have you gotten Rowan checked for the antibodies?

Suzanne: 5:04

had, we had her screened once and she didn't have any of the markers. And I, I believe that maybe it's not as easily accessible anymore or I'm not really sure. However, I honestly don't think, I wanna know if she has the markers. Like, I just don't want that looming over me. They did. She a, she has a higher chance of developing it. they were identical, they said 50% chance, but they're not. So if they said still a good chance.

Katie: 5:35

Yep.

Suzanne: 5:36

Yes.

Katie: 5:36

I have two boys I've tested them both. They, neither of them had markers which I was very grateful for, but apparently I've been told that that doesn't necessarily mean they won't ever develop type one, super, super fun. Like, I, I kind of wish I never found out, but I actually just did finger pricks last weekend because they were both like my oldest son actually asked. He's like, I've been having to go to the bathroom lot. Mom, will you check me? And I did. And his sugar was fine. And then, and then my youngest one is just goes to the bathroom all the time anyway. So I feel like I'm always, I've always got my eyes on him, but anyway, super fun times. Well, you wanna give us a, a little, a brief diagnosis story of, of Kai when she was just a little, a little older than.

Suzanne: 6:16

So she hadn't actually turned two yet, but because I stayed home, I was very. I stayed home full time. Then I didn't have any little side things that I was doing, but because I was home all the time, I was very in tune with just my daughters and their behavior. And so she had her symptoms for maybe two weeks before we ended up taking her in. She was, she had the classic symptoms. She was, I say, slamming sippy cups of water soaking through her diapers. By the end of the day, she would just be throwing herself on the floor in fits of anger, which was totally out of character for her. And so I say, ironically, I don't know that that's right. But we ended up going to an Easter egg hunt the day before she was diagnosed and they had all the candy and, you know, probably like two or three packages of fruit snacks. Then she was really thirsty. So she had some pink lemonade. And when we got home, I pulled her out of her car seat and she just started throwing up. And we had had like concerns prior to her throwing up. But that was like, okay, something is wrong. And then they weren't too yet. So we're like, well, you guys really need naps. We do need to take you to the doctor, but you need a nap more than that. So we had them take naps, sounds horrible. The next day we brought them in and brought her in. And I gave her a dumb, dumb on the ride to the doctor because I'm like, that will keep you happy. You're a toddler. And the doctor, the doctor was like, why does she have. Dumb dumb in her mouth. And I was like kind of offended that she was questioning me. But anyway, so they checked her blood sugar I don't know it was high. They didn't tell me what it was. So they sent us home for two hours and had us come back and then they sent us straight to the ER. And I remember them saying that she had type one and I was definitely in denial. Had no idea what it was, but I'm like, Nope, it's gotta be wrong. That's what she has. the next day we went through the hour crash course. on how to keep her alive.

Katie: 8:16

Yeah, the one we all know. so well, oh my goodness. I'm sorry. I I've said it so many times on this podcast, but I just have so much respect for you parents. I know your girls were older now, but so much respect for you, parents that had or had type one toddlers cause. I was not a great toddler mom. I'm very happy that we're past that phase. And I just, I can't imagine. I feel like that has to be a very hard time to have a type one kid,

Suzanne: 8:44

it was,

Katie: 8:45

yeah. All right. Well, let's dive in chapter four. So I always like to ask the guests, what, what do you think the author's purpose for writing this particular chapter was

Suzanne: 8:55

Well, it was using your data you know, three ways to have better control and kind of giving us that information.

Katie: 9:05

yeah, I think he just wants to kinda like lay out the BA the, not the bare minimum, cuz it's, it's kind of a lot when you start reading through it all, but you know, the kind of the three things you really need to keep in mind, if you want to see better numbers, which I think all of us want to see better numbers. I think some of us aren't willing to put in the work to see better numbers, but we all right. Wanna see'em so he will dive into those in a second, but just to list them off real quickly, that the three keys to better control are the right tools the right self management skills and the right attitude, which arguably I'm gonna say that the right attitude might be the most important part of that whole of that whole thing. I mean, you have to have the tools too, but you know what I mean? Yeah. All right. So we're gonna talk first. Before we dive into the the three keys, just how the author defines what quality diabetes control is, which I found interesting. But he said that quality diabetes control means staying within your target glucose range, as much as possible without frequent or severe hypoglycemic events or without too much interference with your daily life. So in other words, like if managing your diabetes is getting in the way of you enjoying your life, then something needs to change. That doesn't mean you can throw it all out the window and ignore it. Obviously. If it's creating so much anxiety and anger and resentment and fear in your daily life, like something something's gotta change. And, and that probably is a good sign that you might need to seek out help from somebody other than just yourself. And we can talk about that more later, but so I, I just wanted to say, I was curious to know when I read that, I'm like, okay, well, what is frequent severe hypoglycemic events means like, how does he quantify that? And he says, frequent is like more than two or three a week, which. That actually seemed like kind of a low number to me. I mean, cuz we, I feel like we treat lows frequently now that's not to say we're chugging juice boxes left and right. But we're, you know, Hey, have a few Skittles, have it, like get, get your number above that 70 line. And then severe is a, lot more severe causing accidents, seizures or loss of consciousness. Thank goodness we have not yet experienced any of that. So I'm very grateful. What did you think about that definition of quality diabetes control?

Suzanne: 11:17

I would say that I don't disagree with it, however, which I feel like that's always the response, but I think that there are times that it's just, you can't control it and it's gonna get in the way. And I think that we deal with this, especially at school, it's like, well, this is, you know distracting and it's interrupting and I'm like, well, you know, she needs to take care of her low blood sugar or her high blood sugar, or she can't you know? So it's like, have to take care of it in order to live. And I, I agree that or three, when I read the two or three lows a week, I was like, oh, I mean, I feel like same as you said, were. nudging and bumping and

Katie: 11:59

mm-hmm

Suzanne: 11:59

doing all of those things to avoid lows, but sometimes you can do it all and still happens. But I think for the most part, we try to do, you know, kid first diabetes,

Katie: 12:10

mm-hmm

Suzanne: 12:10

as much as we can.

Katie: 12:11

Yeah. Yeah. I think everybody's threshold for what, you know, interfering with your daily life I'm sure that's different for everybody, right? Because it's, it's gonna interrupt our daily lives. Just like everything else is gonna interrupt our daily lives. Right? Like our car's gonna, something's gonna happen with our car and we have to stop and get it fixed, or else we won't be able to drive to work or, you know, somebody's gonna get sick and you have to take him to the doctor. I mean, you know, there's certainly things you can't ignore, but I think if it's just a constant, like if it's a 24, 7 pain in the rear and giving you. Certain amounts of anxiety and frustration, then that's when it definitely needs to the occasional frustrations are expected right. As with anything in life. But, but yeah, when it's all consuming is when it becomes a problem, I thought his definition and he goes on to talk about it. So we'll talk about it too, but it did not include any mention of the A1C as a measure of good quality control, which it's definitely, the A1C is important because higher A1C are correlated with like a higher risk for complications down the road, which we went over, all those complications in chapter two of the book. In case people don't know, an A1C represents the percentage of red blood cells or the cells in your body that carry oxygen that have glucose stuck to them. So an A1C between four and 6% is considered normal. And remember, we spend a long time in chapter two talking about how glucose is just so sticky. It can stick to everything, including your blood vessels and just really havoc in your body. So just makes sense. In a higher, a higher A1C means that more glucose is stuck to those red blood cells. So. But the, the author does mention it as a definition that time and range is really kind of the, the key factor to look at when you're determining whether or not you have good diabetes management. And there's actually, I saw something popped up on my Instagram feed or Facebook feed that there's a campaign being supported by Dexcom. It turns out it's not just Dexcom, but it's, it's Dexcom, it's beyond type one children with diabetes, college, diabetes network, JDRF international, and taking control of your diabetes. And of course, Nick Jonas, he's always gonna be in there somewhere. Right. And they, they are all advocating for glucose time and range to be the standard metric for diabetes management. So I'm kind of moving away from using that A1C as a standard metric and using time and range instead. So what is the target. Range, according to the American diabetes association and the advanced technologies and treatments for diabetes, Congress, it is defined as 70 to 180 milligrams per deciliter, or for the millimoles people. It is four to 10 millimoles per, per liter, Okay. So target range can change and vary depending on like the person, you know, a little kid might have a, a more, a wider range, you know, especially if they're unaware of their low blood sugars, if they don't really feel those symptoms whereas a pregnant person might have like a much tighter range, cuz they're trying to keep really tight control and have a healthy pregnancy and healthy, a healthy baby So the goal is to have a time and range of 70% or more of course, with. No more than 5% of your CGM time, your, your monitor time below your target range. We're gonna pull up the Dexcom clarity app in a little bit, but just keep that in mind. Okay, so let's jump into the three keys of better control. So the first key to better control is the right tools. Um, We're gonna breeze through this pretty quickly just because we covered a lot of this in chapters two and three. And, and then we'll kind of bump on over to the second key, but so the right tools, you obviously, you're gonna have to have some insulin. There are lots and lots of different types of insulin. It's a personal preference as to which one you choose. Well, it's a personal preference and it's which one your insurance will cover. Right? but some, some insulins work faster than others. If it's a rapid acting, some insulins like long acting insulin stay in the system longer. So it's really kind of up to what works best for you or your child. And what will be covered by your insurance. You obviously are also gonna need some sort of insulin delivery device. That can be anywhere from those disposable syringes to the prefilled insulin pins or the insulin pins where you switch out the reusable not reusable, but disposable insulin cartridges. There are injection ports like the Medtronic port, and if you wanna learn more about that, I did a whole episode on that it's episode and then of course there are full featured insulin pumps like Medtronic pumps and tandem. then there are patch pumps. Like the Omnipod, there are hybrid closed loop systems, which that can be right now on the market is tandems control IQ. And there's the loop app, which is actually not FDA approved, but it's out there and people love it. And then there's the new Omnipod five system, which is coming out very short. Choosing a pump is a matter of personal preference. The author did make a note that if, if you go to his website, which is integrated diabetes.com, there is a resources tab. And under the resources tab, they compare all the different pumps. So you can kind of, and they ha I went on there this morning. Actually they have like a whole every pump and then a list of pros and a list of cons. So you can kind of read through those and decide which one would be best for you. I mean, Sarah was hands down. I absolutely do not want a tube. And so the only pump for us was the Omnipod and it, and we love it. It's been, it's been wonderful, but you know, you have to take your kids' personal preference into account. Like, I don't think what what's Kai on.

Suzanne: 17:34

She's on. the

Katie: 17:35

Yeah.

Suzanne: 17:36

we did injections for her first six months, which for us, it was really, really hard. You know, there were times we would have to hold her down and chase her down

Katie: 17:45

Hmm.

Suzanne: 17:45

she didn't wanna shut. But her first pump, we got six months after she was diagnosed, it was a pump that's no longer available. It was the animus pain and it did have tubing. And I know a lot of people are like, very don't want the tubing and I get it, never had problems with it. It worked well for us,

Katie: 18:03

Yeah.

Suzanne: 18:03

we love the Omni.

Katie: 18:04

I actually got my hands on a infusion set, like a tandem, like a dummy pump and an infusion set just to kind of like, hold it and see it. And Sarah could hold it and see it. And I put the infusion set on and I didn't, I did not have a problem with the tubing. It's so tiny and you can just kind of tuck it away, but Sarah was still, she would not even put that thing on. And I'm like, I listen all U tandem users out there. I know it's a fantastic piece of technology. But she just can't get past the tubes. So for now we're, we're Omnipod users and we're very happy with it. All right. Other tools that you may. Or that you will need is you, you might need other medications, which for our kiddos type one, kiddos, this doesn't necessarily apply to them. Cuz many of them are not approved for children. We talked about this in the last chapter and I think I'm gonna do a whole separate episode actually on this. Maybe I'll throw it in there somewhere in the middle of the think like a pancreas book club series or I'll stick it at the end. But I think it's interesting. It's just a lot to talk about with all the other things that there are to talk about. All right, you're going to need a kick butt glucose monitoring system. And the author makes a pretty bold statement. He says everyone, that's a pretty, all inclusive word who takes insulin should use a CGM on a regular basis, which, Hey, I totally agree with, but I also know that some people just don't have access to. A CGM. So if you can get your hands on a CGM, then yes. I would say everyone who can get their hands on a CGM should use one on a regular basis. Even if you have a CGM though, you're gonna need to have a, a gluer and a land set to, you know, for times where your CGM is failed or it's warming up. And he makes a point several times in this chapter to talk about needles. Like whether it's a syringe or your land set, like always look at the gauge you want the biggest gauge you can find cuz a bigger gauge means a thinner needle or land set. So it's the opposite there. Okay. Another tool you're gonna need is a way to download and analyze your data, which at the back of the book in chapter 10, there's a list of different programs that you can use to do this. Because typically when you go to your endocrinologist, they, or you're, if you're working with a certified diabetes care and education specialist, they're gonna wanna see. That data. So you need a way to download it. Okay. This is the part I wanna spend a little bit more time on, but a supportive healthcare team is another tool that you're gonna need which that goes without saying, right? And I think our mind always jumps to endocrinologists, but he lists out several members of you know, the medical pro world that you could really use to your benefit. this could include a diabetes educator, which I think most of us were probably put in touch with those. When we were diagnosed in the hospital, these are typically dieticians or nurses that have advanced training in diabetes care. And of course my naive brain, when we got diagnosed, I was thinking that they only do and know type one, but diabetes educators know all types of diabetes. So some specialize of course, in, in one more than the other, but they, they know. Anything that has to do with diabetes. They, they can help you with it. A registered dietician is on the list. These are the nutrition experts. My sister is a registered dietician, so I can bounce questions off of her, which is always helpful. A mental health counselor. you know, if you, again, this kind of goes back to what Suzanne and I were talking at the beginning of you know, if diabetes is just taking over your life with anxiety and resentment, it's time to seek some help. So this could be a psychologist, a psychiatrist, or a social worker. But they, you know, the author makes a point of saying, you really cannot handle diabetes management. Well, if you're dealing with debilitating stress, anxiety, depression, eating disorders, sleep disturbances, obsessive, or compulsive behaviors, relationship difficulties, financial hardships, and or job discrimination. So if that description speaks to anybody out there listening, then definitely consider getting some help. I feel like the stigma of mental health is. Getting less, I guess like more, it, it, people are definitely talking about it more openly, but I certainly don't want anybody to feel shame over. We we've, we've gone to a mentor. We've gone to a counselor. Have you guys

Suzanne: 22:10

Not with Kai

Katie: 22:12

yeah. Mm-hmm mm-hmm mm-hmm yeah. We we've gone to, we've gone to the counselor at our endocrinology office and, you know, she's just kind of, they're just so helpful because they bring up ways to think about your situation in ways that you didn't even, that didn't even cross your mind. And I don't know, I just found that her questions were really insightful and it's just nice to talk about it. You know, it's just nice to

Suzanne: 22:44

specifically, but, and there are times where diabetes.

Katie: 22:45

out there. And feel like even just talking about it, just releases this whole weight about it. on the list of medical professionals is also an exercise specialist. So this might be good if like you have a, you know, a really athletic kid or you have somebody who's going to college to play a sport. They might need extra help kind of determining what their insulin needs are surrounding their sport or their activity. And then other specialists are also on the list. So this could be like a podiatrist, a foot doctor, an ophthalmologist, or an eye doctor, a dentist, a nephrologist, which is a kidney doctor, a neurologist, and a cardiologist, which is a heart doctor. So you, you, you may need those people. We see an eye doctor and the dentist. Those are the two that I, that we see regularly. All right. We're gonna talk about physicians because they're also on the list and Typically in with type one, it's usually an endocrinologist, but not always. I just wanna talk a little bit about when it might be time to get a new endocrinologist or physician. So the author makes a point to say that if your physician fails to answer your questions to your satisfaction or does not support your pursuit of new technologies management approaches or other healthcare specialists or if they just are passing a lot of judgment and you leave every single appointment feeling like, you know, totally judged and, and guilty for whatever management strategies you're attempting. Then yeah, it might be, it might be time to get a new, it might be time to get a new endocrinologist or physician Suzanne. Have you guys ever experienced anything like that

Suzanne: 24:16

we've been with the same endocrinologist since she was diagnosed and he's wonderful and super supportive our diabetes educator that we had for the first. Three years had type one herself and became a very good friend of ours and just, it was almost enjoyable to go to the appointments.

Katie: 24:35

Yeah, that's great. We, we have a good endocrinologist. We, we live in a very big town, but surprisingly there's really only one option for pediatric endocrinologists. It's in a big specialty children's hospital, but so, you know, I read this and I think like, oh yeah, if you're not happy, you can just find another one. But I mean, we would have to drive two hours to get to the next endocrinologist, which is in Gainesville, Florida. So it's not always as easy as you might think to just up and find a new, new physician. Ours is great too. The only thing we run into problems with is when we wanna try like a new insulin or a new piece of technology, she's usually willing, but I have to really. Explain to her, why we wanna do this. And because there, it it's like pulling teeth to get people to fill out paperwork which I know it's a pain in the butt. Right. So if, if I'm not really committed to it, I can see why she would be guessing it.

Suzanne: 25:25

We're

Katie: 25:25

that, that has been a little frustrating just when we wanna try something new, especially if I know my insurance will cover it. I'm like, can't we just try it. Have you guys ever worked with anyone other than like an endocrinologist? Do you guys work closely

Suzanne: 25:36

the ones living

Katie: 25:37

sort of eye diabetes care and education specialists?

Suzanne: 25:40

with it every day. we don't.

Katie: 25:41

we do not either. I mean, I consider reading this book, work, working closely with a certified diabetes care and education specialist. I mean, I'll call if I really need to, but I don't call very often, but there's again,

Suzanne: 25:52

Yeah.

Katie: 25:53

in calling if you really need the help for sure. Okay. I love the last member of the healthcare team, cuz it's. that you wouldn't really consider on your healthcare team, but that's just your supporters. So this is your village, like your friends, your family, your teacher, your kids' teachers, caregivers, babysitters. I know that I, we are extremely fortunate. We have a lot of family in town. They're always willing to help out if we need childcare. They're willing to deal with diabetes even though, you know, it's not usually fun for them. And I, I do feel bad, but they're, they're very, very willing to help if we need it. And I'm fortunate because my kids are getting older, so I can, I don't always have to call on a babysitter. Like I can leave them at home for short periods of time while I run to the grocery store or so I can get those little kind of mental breaks here and there. But how do y'all handle childcare?

Suzanne: 26:40

asked my husband this last night as I was looking things over. And he is like, we don't. And I was like, well, that's not really true.

Katie: 26:46

Mm

Suzanne: 26:46

is here right now. She. Has been just the biggest blessing to us. She actually lived in Austin, Texas when Kai was diagnosed. And one of the many reasons that she moved back was to help us. And I mean, she takes overnight knowing that she's not gonna get a great night's sleep. But I would just say, you know, we don't really ask anybody to help us. We have people who want to help and who offer to help, but it's just so much. And because Kai's younger, she doesn't, I've always kind of given her the option. Like, do you want to be more involved in this or do you want mommy to take care of it? And you know, she's wants me to take care of it and I'm like, you have your whole life. I am happy to do it all. So for someone else to take care of her, they have to. Be able to do everything and that's a lot. So I would say, you know, we've gone to like art camps and things that are, you know, maybe a couple hours long where I'm leaving her aside from school and I'll just give like a brief list of like, you know, she needs insulin before she eats. If you wanna do that, I can give you a little tutorial if you don't, I can come and do it. You know, I'll text you if she needs to have a couple Skittles, that kind of thing. But I mean, my mother-in-law's and the school nurse are literally the only people that know how

Katie: 28:05

mm-hmm yeah. Okay. I was gonna ask you about school. Like who's, who's helping at school, the nurse

Suzanne: 28:11

yeah, the school nurse, she's amazing.

Katie: 28:13

yeah, I, that that's really nice that you, you know, at least have that To ha to lean back on and that you can trust while she's away at school. I'm gonna do a whole separate episode on childcare and just babysitters, cuz I feel like that's something that really weighs on a lot of people's minds. I guess I would just encourage people to. Especially like a military family. For example, if you're living in a town where you literally have no family and you might not even have any friends because you might have just moved there and you're just getting settled, I would just encourage you to just try to find somebody that you can trust or that you can train to you out. Cuz we all need a break. Sometimes I feel like even, you know, and it doesn't have to be a weekend getaway to wherever it can, you know, it can be an hour here, a couple hours there to run some errands or go for a walk or you know, go out for a dinner with your spouse or, or a friend. whatever you need to do to find somebody who can help you out every now and then. And I, I, you know, and in that same breath, like people can be trained. Like I know we think like nobody else can do this and I can't trust anybody with my child, but before your kid was diagnosed or before my kid was diagnosed, at least I knew. Almost next to nothing about type one diabetes. And I had to learn it all, just like we all did in the hospital in a matter of like 24 or 48 hours. So if I can do it and if you can do it, and if all the other parents out there listening can do it, then you can find a babysitter who can do it, you know, I'm

Suzanne: 29:40

Mm-hmm.

Katie: 29:41

So don't please don't throw your hands up and say, I'm, I just can't find anybody like, no, no, no, you, you can, you just might have to take the time to kind of walk them through the basics of type one. And we, with technology these days, most of us have a way that we can check in on their numbers pretty much constantly. So if there's an emergency, it's nothing that a phone call couldn't handle, you know, it's easier said than done, but that's just. Words of encouragement to parents. All right. We're gonna move on to the second key to better control, which is strong self management skills. So a lot of this is gonna be covered in the next three chapters, like about adjusting insulin on your own, like making those everyday decisions that you have to make constantly throughout the day to adjust insulin. That's gonna be the next three chapters, but the tools he lists first are the self-management skills. Excuse me, are the first one is self-monitoring so wearing a CGM. Okay. And if you're not wearing a CGM, then you need to be doing frequent finger sticks, at least, you know, before and after meals and, you know, surrounding physical activity and things like that. You know, and. As best you can, if you are wearing a CGM, try not to become obsessive with it, you know, try to kind of set limits. I was curious to know, Suzanne, do you guys have any certain boundaries or limits? She's shaking her head? No.

Suzanne: 31:01

I was thinking about this yesterday too, and talking to my best friend. And I was like, I look hundreds of times a day. Like it.

Katie: 31:07

yeah.

Suzanne: 31:08

It's bad, but I feel like I do, I do when I'm away and when she's at school and I'm at work, those are times that I try to take advantage of not having to check all the time, but I'm definitely like

Katie: 31:20

Yeah.

Suzanne: 31:20

always glancing.

Katie: 31:21

Yeah, I know. I mean, it's, it's definitely hard. I wear it on my wrist, which I feel like is a huge help to me cuz when she goes low or high, it just buzzes and I can feel the vibration on my wrist. So I'm not always having to pull out my phone it and that helps too because you know how it is. Like when you have your phone out, you're not just gonna be looking at the Dex com app you're gonna getting on Instagram gonna be checking your email and you're gonna be seeing what's for sale at old Navy. You know, it's just like a never it's like a never ending spiral. So the less I can pull my phone out during the day, the better for me. And I find it very ironic that as I'm literally, as I'm saying that sentence, I'm getting a low alarm for Sarah. So let me text her real quick and tell her to eat some skitles But yeah, my, my watch has. I mean, it's a, it's not like anything fancy, it's a Fitbit and there's a watch face called the glance watch face that you have to download. And it shows me her numbers and that's been a huge godsend for just kind of keeping me out of that obsessive spiral of looking out the Dexcom all the time. All right. Another self-management skill you need is record keeping. I'm just gonna go ahead and admit that I am extremely bad about this. And I'm gonna blame Dexcom because Dexcom a fabulous job of keeping all this information me, the Dexcom clarity app, like has all those amazing graphs and stuff that you can look at. So I, I don't always feel like I need to write everything down, but he's kind of saying like, you know, really detailed record keeping is not something that we need to do all the time. It may, you know, most of us did it at the beginning. And then if you're going through a period where blood sugars are just really outta whack, like just all of a sudden things seem to be going haywire, like maybe puberty or pregnancy or stressful situation that you're going through. Like, it might be a good idea to kind of take the time to keep a more detailed log so you can figure out how to get things back under control. So he says, if you are gonna keep records, it should include the amount of insulin you're taking. Any, any other diabetes medications, the food you consume and any special notes about like where you consumed it? Like, are, are you, were you at a birthday party? Were you out at a restaurant? Was it Thanksgiving? Things like that physical activity throughout the day records might include stress that would affect blood sugars. And then if you are a pump user, like when your infusion set changes take place and then many of these things can actually be logged like right in the apps that we already own itself. Like the, the Dexcom app, for instance do you keep records like this ever.

Suzanne: 33:53

I, we use sugar meat, so we have that as a record. And that's nice because you can go back and look. But I do have like a couple notes in my phone where I keep track of. Breakfast is a difficult, probably the most difficult meal of the day for us. And so I have like a note where like, okay, when she has waffles, the insulin to carb ratio, isn't you know, which she needs this much more insulin than what the carb ratio is, that type of thing. And then I have one that's more related to like protein rises and stuff, and how to address those for the different five meals that she'll eat.

Katie: 34:32

picky eater. I mean, maybe that's a blessing though, right? It's less mental burden on you. Yeah.

Suzanne: 34:43

Yes.

Katie: 34:43

Yeah. I don't sometimes I'm like, oh, I wish, know, my, these friends are telling me about like, my son will only eat macaroni and cheese and peanut butter and jelly. And I do a little bit roll my eyeballs at that, because like, I feel like, you know, you can always like try, try and try again, but it is nice to think like, well, that makes it easy. Right. You know, you know what you're getting them. you know what you're giving them. I bet you'd be an ex. I bet you're an expert at dosing. Those five meals, Suzanne

Suzanne: 35:09

Well, I'm not, but I mean, I have a good general idea of what's gonna happen and what to do.

Katie: 35:17

Yeah. All right next on the list of self management skills is data analysis. So it's worthless to keep rec records of your data. If you're never going to even look at them or analyze them. Let's see. I have a note here to read the highlighted paragraph on page 1 0 3. I don't even remember what that is, even though I was just looking at it yesterday.

Suzanne: 35:42

Eliminate low blood sugars before addressing highs

Katie: 35:48

yes. So I think the point there was, if you're gonna be analyzing your data, the thing you wanna start with first is addressing the lows. Cause yeah, usually a lot of us have a tendency to overtreat lows. Which can then lead to highs. So if you address those lows first and how to avoid'em in the first place, then you can kind of take away all the other things you're dealing with at the same time, which I think is good advice. Okay. Thank you. All right. Let's see. So good questions to ask yourself while you're looking at the graph or the data. And I also wanna just throw out there is a good episode that I already did about this it's episode 18, which is titled identifying trends in your CGM data and blood glucose readings. was with Ariel Warren. She's a diabetes educator, but that was a good one. If you got you guys wanna go back and take a listen. But so good questions to ask yourself, are the patterns different on certain days of the. Is physical activity, having an immediate or delayed effect. Do certain types of foods always seem to make your blood sugar rise or fall? Are you always high after experiencing a low or do lows tend to repeat themselves? Are you often low or still a bit high after taking extra insulin to correct elevated readings? So like maybe are you rage, boing, maybe are emotional situations affecting your control and then does your glucose level vary based on how long you have used an insulin pin, a vial, an insulin vial, or a pump infusion set. So maybe the insulin is kind of on its last leg about to expire. Same with the infusion set. I, what are, what are some of the trends that you've noticed recently or in the past with your daughter's graph that you guys have had to make adjustments for?

Suzanne: 37:24

Well right now she's sick. So she definitely is needing a lot more insulin

Katie: 37:30

Hm.

Suzanne: 37:30

she But some other, when she's not sick, like at school, things are definitely different. I think for her, she deals with some anxiety and stress when she's at school, which causes her numbers for us to be a little bit higher than what we see at

Katie: 37:47

Mm-hmm

Suzanne: 37:47

and then I think we kind of see like when our pump is on the last day,

Katie: 37:51

yeah,

Suzanne: 37:51

maybe experience some, some issues, but.

Katie: 37:55

yeah, We have the same experience with school and stress levels. She seems to run higher at school, especially on testing days. I'm trying to find that sweet spot of what works best to get, you know, give her better control during those days. We're having a lot of trouble with the evening right now, too. I've been analyzing those evening graphs quite a bit. She just seems to. Go high at dinner, but then drop like low right before bed. And so I'm J. So it's, it's, it's interesting though, because evening seems to be her most physically active time. Like she's usually, you know, after general she'll, she'll go out and she'll roll her blade or she'll be messing around with her brothers and they'll be running around the house or so I feel like we like really had dinner time down and then all of a sudden something changed and now I'm having to analyze that data all the time to see and I have a personal rule of, I only change one thing at a time. Like I'm like, okay, well let's, let's change the maybe the basal rate around this time and see if that helps. And I, and I only change things by 10% at a time too, which like a turtle speed. But I, I have found that if I change things more than 10% of the time, it usually does not go very well. so, that's my rule. So first I'll change basal rate 10%. If, if that, you know, from there, maybe I'll change the insulin to carb ratio by 10%. I'll always give it like two or maybe three days in between to kind of see, well, did that change help before I go and change something else? Do you have any rules like that, that you kind of follow your own rules? Yeah,

Suzanne: 39:20

I mean, I think I try to do one thing at a time because you can't identify, what's working if you do a bunch of different things. But I wouldn't say, I think I'm a rule follower, but I also think I'm not. So

Katie: 39:35

similar. I think we're very similar. I like to pretend I'm a rule follow up or deep down. I really don't wanna follow the rules. Yeah, exactly. All right. So reading the Dexcom clarity app, we'll try to, and I just wanna apologize to all the Libre people out there. I'm not discriminating against Libre. I'm sure it's a wonderful thing. And, but I just don't know anything about it or much about it because we use Dexcom and that's all we've ever used, but I have a feeling that the things I'm about to mention I bet they're similar within the Libre system. But I'm gonna open up the clarity app real quick. So if you op, if people open up their clarity apps and you'll see the screen. At the very top, there's like the days. So you can do like what's going on in the two day, the past two days, the past seven days, and then the there's the past 14, 30 and 90 days. So you see that average glucose first. And that's just, you know, the average of all the glucose data points that the CGM has measured over the past. However many days you've chosen at the top. And below that is the standard deviation, which This is a really important number because it kind of gives a it reflects the amount of like variability in your readings. So lower is better. That's kind of the general rule. If the standard deviation is more than half of your average glucose, that means you're probably having too many extreme highs and extreme lows or extreme highs and lows. So kind of the goal to shoot for is to have a standard deviation that's less than one third of your average. So if you, if you have a standard Devi deviation that is one third or less of your average glucose, then that means your readings are fairly consistent. And then you see that little number next to standard deviation, the percentage, which is GMI, which that stands for glucose management indicator. So this number is kind of a good predictor for what your A1C is gonna be at your next endo appointment. They just can't call it an A1C because they actually didn't do a blood draw to figure out the number it's just calculated based on the CGM data. I find I'm interested to know what you guys find, but I find like right now, our 90 day GMI says 6.5%. But I have found that every time we go into the endo, ours is like half a point less than what it says. So we went to the endo not too long ago and it said same thing. The predictor was 6.5% for the GMI, but that then the A1C was actually six. So I don't. Do you guys find yours is different or is it pretty.

Suzanne: 42:06

always different and ours is always higher. Like our GMI right now. For 90 days is 6.2. A lot of times I feel like it'll be around 5.9 and we've never been in the fives. Like I'm like the day that we're in that we hit 5.9 I'm G

Katie: 42:27

Yeah.

Suzanne: 42:30

but Yeah. our GMI is always, we've pretty consistently, it's always lower than what our actual A1C is.

Katie: 42:37

Yeah. Okay. All right. That's interesting. You, we have the opposite experience. I wonder what that means. Hmm

Suzanne: 42:44

I know I was trying to.

Katie: 42:46

yeah.

Suzanne: 42:48

Yeah.

Katie: 42:48

I just changed. So we're gonna jump down to time and range now, which is the next little section with this colorful green and yellow and red and orange GRA or bar thing, looking thing. I just changed our range in our, in like the actual You know, app to be, instead of being from 70 to 180, now it's 70 to one 50 and I'm really upset cuz now our time and range percentage isn't as good I'm like, dang it. I might switch it back. Huh?

Suzanne: 43:16

did you make only

Katie: 43:19

I that's the problem. I don't think I did. I think I did more than that, Suzanne. I broke my own rule. All right. I know I'm like, but like the 90 day one I'm like, oh no, let's not look that, but the seven day one looks nice. Let's let's pay attention to that one. So time and range is yeah, time and range is just like we talked about at the beginning, just a percentage of glucose readings that fall within your target range. So whatever you have set as your target range, it's a percentage of readings that fall within it. And I already mentioned like the goal is to be at 70% in range or more. And then with less than 5% of your readings be in the low And definitely try to avoid the very low You wanna let's move on to carb counting. That is the other, we'll kind of breeze through this because I feel like carb counting is diabetes 1 0 1. And also I did do an episode on carb counting in the newly diagnosed series. And I thought I made a note of that, but I didn't, I'll say it at the end of the episode. But 29. Okay, awesome. Thank you. It is all right. You're you're better at reading my own notes. I was always the girl in college where people would be like, Hey Katie, can I borrow your notes? And I'd be like, yeah, sure. And I'd give it to'em and they'd. Like after two minutes, they'd be like nevermind, thanks. Like I'm the girl that has notes, like in the corner and along the margin and like arrows, like that kind of person all right. Carb counting. There are a few interesting things here though. Like, first of all, I would highly recommend getting a food scale for everybody out there. Do you have a food scale, Suzanne? Yeah. He recommends measuring everything in grams because that's the most accurate, I did not know that. I feel like I switched back and forth between grams and ounces. Fiber. I wanna mention fiber because fiber is a carbohydrate worth noting because fiber is not digested and is broken and is not broken down into glucose. Thus, it will. Raise your blood sugar. So he even recommends kind of like if you're, if you're eating a meal that has 20 grams of carbs, but five of them are fi fiber. The but's five grams of fiber to subtract that from the, the 20 grams before you dose, before you figure out the insulin dosage for it. I actually don't do this ever, but I was just thinking the other day when I was reading this chapter, like, I really need to do this, especially for, with breakfast. Or really just with all meals and see if it makes a difference. But I don't know. Do you do that?

Suzanne: 45:38

fiber.

Katie: 45:39

Yeah. we're Gary. We're so sorry. We're we're we're we're gonna do better. We promise. Okay. So subtract. I I'm gonna, I'm gonna start paying attention to it. Maybe I'll even keep a log book who knows this could be my week to turn it all around. Let's see, he talks about reading food labels. Won't go into detail on that. Oh yeah, there it is. Episode 29. So that's the other episode I did on carb counting. Okay. I had never heard of this, but the author mentions carb factors for extra precise carb calculations, which a carb factor is the percentage of a food's weight in grams. That is carbohydrates. So for he gives the example of an apple has a carb factor of 0.13. So if you weigh your apple and let's just say for easy math, it's a hundred grams. You would multiply that by 0.13 to figure out how many grams of carbs would. Would be in that particular food. So that would be 13 grams, right? Did I do that math? Right? I have never used carb factors. I find that very interesting. I might give it a try, but if you go to www.carbfactors.com, it will list all of the carb factors for different foods on there. Yeah. All right. So the author does make a note about dietary discipline, which his advice is that spacing meals and snacks out at least three hours apart will help you to maximize the time you spend in your target blood sugar range. He doesn't say you have to do that. He just says it will help you to maximize the time you spend in your target range. So what are your thoughts on that?

Suzanne: 47:12

mean, it sounds good, but kids wanna eat and spacing your meals. I don't even, I think I eat more than every three hours like that? I was doing the math. I was like, so if you have breakfast at seven and then you have a snack at 10,

Katie: 47:26

Mm-hmm

Suzanne: 47:26

like that's three hours apart, and then you have your lunch at one and like, you're gonna be up a bit later than you probably wanna be.

Katie: 47:32

yeah.

Suzanne: 47:32

like, I just don't think, you know, we don't graze. We definitely are more like scheduled in our eating. And

Katie: 47:39

yeah.

Suzanne: 47:40

I think that. That's maybe my mind is able to understand that better. Just, you know, having more scheduled times to eat, not just grazing all day long.

Katie: 47:49

yeah, We try to, we try, we, we definitely don't follow this, this rule, like hard and fast. This is not a black and white situation for us for sure. But we, you know, I try to space amount because I think that's just healthy overall, like for self control, you know? this is something that I've even had to work on in my own life. Like I used to be a Grazer and I've tried to like, You know, spread it out a little bit more, but but like you said, like try telling that to a toddler or, a growing teenage boy or growing, growing teenage girl, just sometimes people are hungry and there's nothing wrong. Like Trying to space him out as much as possible is ideal. Cause I do think that would help you to in range as much as possible. But you know, you also have to like the first, very first part of the chapter said, you can't let diabetes management interfere with your, your life and your overall mental and emotional wellbeing to a certain point. So um, and you know, there's just times where you have dinner and then it's like, you know what, let's have some dessert and you know, you feel like a dessert or if you're at a birthday party and you know, you thought the food was over and then all of a sudden they bring out a pinata and so you gotta, you got a dose for the ring pop that your kid is going to eat. So great advice, not always easy to follow, but always, definitely good to keep in mind. All right, we're gonna quickly talk about protein and fat. We mentioned him in the last. Chapter. I just think it's fascinating. So protein only affects blood sugar in the absence of carbs or when carbs are very low. So what is very low? It's less than 20. If a meal has less than 10 to 20 grams of carbs, that is when it's considered low. So if that is the case, like if you have a really co low carb meal with protein you wanna count up the grams of protein. So measure the protein, measure it in grams and assume that 50% of it will be converted to glucose. So if you weigh your chicken and it weighs 20 grams I don't even know if that's reasonable, but let's say it weighs 20 grams. Then you can assume if you have a low carb meal that. 10 of those grams, you can count them as carbs in a way. Um, We usually eat some pretty high, higher carb meals. So this is not usually an issue for us. When it also is an issue he says is when there's a huge amount of protein, like 60 grams or more of protein. So maybe like a giant dinner with steak and potatoes. Then he says, if it's 60 grams or more just to tack on it, extra 20 grams of carbs when you're figuring out your calculations. But if you don't wanna think about one more thing, which is understandable, you wanna have to think about protein, just make sure your meals have at least 15 to 20 grams of carbs in it. And then you won't have to worry about it. Let's see. Fat we've we've discussed fat a little bit too, but fat is. A hum a home wrecker when it comes to blood glucose levels it has the potential to slow down digestion enough that rapid acting insulin may peak. So it may be at its strongest before the food actually has a chance to digest. So that usually leads to like low blood sugar. And then of course you're gonna treat that low blood sugar. And then after you treat that low blood sugar your digestive system is actually gonna have a chance to start digesting those carbs, which is you're gonna see an additional blood sugar rise. And that could be a few hours later after eating. So he says, consider delaying the Boless insulin in the case of high fat foods. So giving it like right as you start eating and. Or even maybe after a meal or both depending, depending on the situation fat in your diet can also increase insulin resistance, which forces the liver to dump more glucose into your bloodstream more than normal. And then just too much fat, just isn't good for you. So just keep that in mind. I mean, we all love pizza and we all love all those fatty foods, but everything in moderation cuz high fat, high fat diets can lead to other problems like cardiovascular disease, heart disease, weight gain. Right. We don't need any of that. Have you ever guys ever experienced those effects from fat or protein rise?

Suzanne: 51:41

Like one of her five meals that she'll eat is nuggets and French fries from McDonald's. And we have discovered over time that there's really no pre BOS required for that meal, because it's so slow to kind of affect her blood sugars. But then also, you know peanut butter and honey sandwich is one of the things that she'll eat. And so there's always a protein rise,

Katie: 52:03

mm-hmm

Suzanne: 52:04

you know, a couple hours after in that I have all that information saved in my handy Dany notes in my phone. So I kind of have an idea of correction, how much of a correction she needs when she has her peanut butter and honey sandwich and that type of thing. But for sure, we notice those things.

Katie: 52:22

Yeah.

Suzanne: 52:22

And if, if you're not aware of them, it's very frustrating. Like if you don't know that those things cause your blood sugar to rise or change, like infuriating.

Katie: 52:33

Yeah. It really, really is. I have a, I have another rule. I ha I try to make a mental note when we have a really big meal like that. Like some of our you know, the main culprits are of course pizza, but usually it's pizza, like out at a restaurant or fettuccini Alfredo is, is a, my, daughter loves pasta. So fettuccini Alfredo is a big one. Chick-fil-A, stuff like that. So we, we usually have to do a pre bolus and I, for us, I know everybody's different for us. I think it's because of where Sarah wears her pod. Like she wears it on her thigh and that's not a great place for in absorption. I think. I think it just takes that long for her body to really like absorb the insulin. And I, I feel like she's just not very sensitive to insulin or she's insulin resistant. I don't know. J just just seem to take longer for her we run out of no, Novalog I wanna try FIAs, but that's the ultra rapid acting insulin. But, but yeah, I always just try to my, so my rule is I make a mental note and then like starting around two or three hours after the meal, I'll just kind of start glancing a little bit more often at the Dexcom. if I start to see a rise, I'll just go ahead and give her like a unit, which for us that would be 10 carbs to cover. So if I'm wrong, then she ha just has to eat 10 carbs, which is easy to do. And then if I'm right, it usually will stop that rise. And then of course, there's always times where I have to go in and give more insulin, cuz that that one unit wasn't enough. All right. The next little section we're just we're is, is insulin self adjustment. So that is a huge skill that you need to, to get good at in order to manage your diabetes well, and have good control. The next three chapters are gonna talk all about that. So that's really the meat of the book on how to adjust your insulin and all these different circumstances and scenarios, all these different types of foods and whatnot. So we are not going to go into detail about that right now, the last key to better control. And like I said, arguably, the most important is a good attitude. So he kind of gives you a little list of things to kind of do a little self check. Like how are you doing in the areas of determination, problem solving, persistence, discipline, and acceptance. So determination. He, you know, he just kind of asks you like rank where your diabetes management falls. In your priorities, like it should not be consuming your life with all the things, but it should also be a priority, right? Not an obsession, but a priority. Because if you, I think his, his argument is that if you make it a priority and you, you make it a point to kind of really study yourself and learn what works for you or your kid just everything is gonna be so much easier. And then you can live your life the way you wanna live your life with a little bit more, you know, positive outlook just feeling better overall, like physically and mentally and emotionally. And just more, just more peace because you, you know what you're gonna do, you know what to expect and when things go wrong, cause they always do. You can calmly decide how you're gonna handle it. So problem solving. That was another thing he said, do a little self check he's. He just says, just don't don't just throw your hands up. Right. I'm never gonna get it. Or everything always goes wrong for me. Like, don't, don't be a problem. You know, don't throw your hands up or you try to be a problem solver. Like we have had to deal with this with insurance issues. We are still trying to get approved to be on the Omnipod dash. It has been over a year now and currently we've written several appeals, nothing. They've all gotten denied. We're, we're approved for the classic Omnipod, but now we've taken it to the level of my husband who he's, you know, we get our insurance through his employer. He has gone to HR and said, Hey, I don't understand this. They cover this, but they're not covering this. Like, I think a box just needs to be checked or unchecked, like, and I need you to figure this out for me. So they're, they're working on it. They've been working on it for about two months. Even the lady has written back to us a few times and been like, this is really taking a lot longer than I expected. And I'm like, yeah, tell me about it. like just don't. So we're waiting to hear, she said it should be very soon before we have an answer. So I'm hoping it's the answer I wanna hear. It's not even the dash that I it's, it's the new system that's coming out, which will be covered as a pharmacy benefit, similar to the dash. So anyway, we, you know, we're not throwing our hands up in that situation. If that doesn't get approved, I'll probably try to find some other way to come at it, I just don't wanna, that's not something that I wanna give up on. That's important to us. And then that goes right into persistence. So never give up right. Diabetes is a marathon, not a sprint. Every day presents a new opportunity to start over and start fresh. So are there any problems that you are trying to solve with persistence Suzanne, similar to the insurance one, I mentioned.

Suzanne: 57:12

I do the majority of the management. And so I feel like I'm constantly trying to like, get my husband on the same page and just not even necessarily on the same page, but sometimes I just want him to do some of the thinking. So that, and then I don't know if this is going down to the next question, but it was something that I was thinking about when I was looking over the questions. I have kind of, and I think we've talked about this on Instagram before. I have a hard time letting Kai eat when she's high. And I'm trying to, I'm trying to not do that. Like I'm trying to allow her to eat when she's high, you know, if she's four, you know, maybe not, but also. I don't wanna restrict her and, you know, be telling her, you know, you're high, so you can't eat. Yes, you can. I just need to it. just need to handle it.

Katie: 58:01

yeah, no, that's, that's I battle with that too. I mean, I I have found though really, and truly like, we actually had this happen just this past week, Sarah was gonna go with somebody else and my family was gonna take her to dance cuz I wanted to go watch my boys play baseball and it was right in the middle of her Dexcom warm up. So I kind of purposefully let her run a little higher than she normally would because I was like, I don't wanna put that. Like she's not, you know, they, I don't want them to have to be doing, I don't want them to be worried basically. So, and then when she came online, when she came on, she was, it was, she was like pretty high. She was like two 70 or something. And. And so, you know, she, she did a, we told her to do a correction and she did the correction for that number. And then I had her do a temp basal increase. So I knew, okay. Like, okay, we're getting we're, we're doing things to get under control. Right. We're we're giving more insulin, we're doing temp basals and then she got, she got to the baseball field cuz that family member dropped her off with me. And it's time it's dinner time. It's seven o'clock. So, you know, she's ready to eat. And she was still at like, she was coming down, but she was still at like, I don't know, maybe somewhere around 200, maybe two 20 or something. And and so I gave her the insulin for what she wanted to get from the concession stand. And we waited the, I made her weight a little longer than I normally do, just because I did want it to start trending down a little bit more. But, but she was the point is she was still high when she started eating. But the good news is that she didn't go higher after that. She actually just kept trending down and then eventually leveled off. So. I feel like it can be done it, but it is, it is hard cuz you gotta get, you know, you, I mean even every time even I think like, oh this is just gonna go higher and higher, but if you're giving the insulin that they need it, usually it won't it'll it'll just keep going down. Yeah, and then he mentions discipline. So there's all, a million things that you can be disciplined with with your diabetes management, you know, exercising, eating healthy all those things we just talked about, not greasing as often analyzing your data, making sure you're going to your doctor's appointments, carb counting properly. I mean just the list goes on and on. And then acceptance. So this is the very last thing we'll chit chat about. The author makes a

Suzanne: 1:00:05

Okay.

Katie: 1:00:06

important note that no one attains perfection all the time, even those people with outstanding control and amazing numbers are still out of range on a semi-regular basis, which that definitely fits the description for our family. We, I feel like we have really pretty good control when you look at our numbers and our time and range and standard deviation, but we're still out of range, like quite frequently. So it's okay. and then he, he says you know, he says he is not an overly or religious person, but it might. Everybody to memorize the serenity prayer, which is God, grant me the serenity to accept the things. I cannot change the courage to change the things I can and the wisdom to know the difference. So, you know, accept, the things, I cannot change things like our child being diagnosed with type one right. And the, the courage to change the things I can, which we're gonna talk about that in the next three chapters, how we can make changes. And, and there are things we can control with diabetes. We just need to learn how to do them properly. And then the wisdom to know, know the difference. So is always power cuz it allows you to make rational and decisions in the face of You know, a stressful situation. anything else you wanna chime in about or add to that?

Suzanne: 1:01:23

I just wanted to say that when we were first diagnosed, I didn't connect with the type one community. I was very kind of against it. I was like, Nope, I'm not doing that. I think I was, you know, I. I was grieving and I was in denial, but five years later, it'll be kind fifth diversity in April. I can say that like connecting with other people who are walking the same walk that you're walking is like, I'm getting teary eyed, just thinking about it because it's 100%, one of the silver linings, and one of the things that is going to get you through this. And, you know, I think about how much we struggled with management our first year. And I just think if we, I had, you know, connected with people more, I think it would've, we would've gotten to where we are a little bit sooner, and it's just nice to be able to talk to someone who speaks the same language and someone that when you're just having a crappy day, you can let them know you're having a crappy day and they get it.

Katie: 1:02:25

yes. Oh my gosh. I couldn't agree more. I, I just don't know what I would do, honestly, without this type one community, because there's there's yeah, nobody gets, nobody gets it except for the, the other parents that are going through it. And And, you know, our grief is real grief and our problems are, are real problems. And you know, that doesn't mean that we should stay stuck on those things all the time, but like, we need to talk to somebody about them and, and I can't, just, yeah, I'm so grateful for people like you and, and just the type one community that's literally of held us up over the past and a half, or I don't know. I've lost track of time now. I don't know how long it's been. I think it's been a year and a half. About a year and a half. I'm so excited because our local JDRF is finally having their first family meet up since the pandemic. Cuz Sarah got diagnosed in, you know, middle of the pandemic. So we have met people on our own, but we have not been able to part in anything in person with like an organization like that. so

Suzanne: 1:03:26

Yeah,

Katie: 1:03:27

that's coming up in, not this weekend, but next actually.

Suzanne: 1:03:31

that

Katie: 1:03:31

Yeah, All right. Well, thank you. Thank you for helping me tackle another chapter of this book. I, really

Suzanne: 1:03:37

Yeah,

Katie: 1:03:38

it.

Suzanne: 1:03:39

It was, super fun.

Katie: 1:03:41

It was, you have a great day and, and you know, I'll be in touch That's it for our show today. Join us next time. As we cover chapter five called the basal bolus approach. Again, get your very own copy of think like a pancreas by Gary Scheiner today. So you can follow along. There will be links in the show notes for that as well as a link to Gary's company's website, integrated diabetes.com. There will also be a link in the show notes to the two episodes I mentioned. While I was chatting with Suzanne that's episode 18, which is identifying trends in your CGM data and episode 29. All about carb counting last, I will put a link to the website, carb factors.com in the show notes. If you'd like to learn more about carb factors, all right, I'll chat with you soon until then stay calm and Boless on.