#77 Think Like a Pancreas Chapter 5: The Basal/Bolus Approach with Heather

Who's ready to think like a pancreas?! This is the fifth episode in our 10 week, Think Like a Pancreas Book Club Series and today I am covering chapter FIVE called, The Basal/Bolus Approach. My guest for this one is another amazing T1D mom, Heather. This chapter gives a great overview of the different insulin programs to choose from as well as a great pro and con list to being on an insulin pump.

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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Transcript

Katie: 0:00

This episode of the sugar mamas podcast is sponsored by sugar medical, the very best place to get all your diabetes supply cases and accessories. You're listening to episode 77 of the sugar mama's podcast. And today I'm going over chapter five of the book, think like a pancreas by Gary Scheiner with fellow T one D mama Heather chapter five is called the basal bolus approach. And it gives a great overview of the different insulin programs to choose from as well as pros and cons to being on an insulin pump. Remember it is not too late to get a copy of the book and follow along with us. I will definitely 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, you can head on over to his company's website, integrated diabetes.com. Integrated diabetes services is also a great place to find help that you may need in achieving better control in your diabetes management, regardless of which insulin or pump. Or injections you are on. They have a whole team of highly qualified, certified diabetes care and education specialists that are ready and willing to help you check them out. One last note, not sure what was going on with the audio in today's episode, but there are a few times where there is some artifact noise in the background. It doesn't last long, but I just wanted you to be aware. Sometimes producing a podcast can be a lot like diabetes management, anything can happen. And sometimes you just can't waste your time, trying to figure it 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 fantastic sponsor sugar, medical, sugar medical is the place to get all your diabetes supply cases and diabetes accessories, like decorative decals and silicone sleeves to keep your essentials safe and stylish. If you're living life with diabetes. You know, that it always pays to plan ahead and be prepared for anything and everything at any point in time, that's why sugar medical has designed their products to keep your diabetes must haves, organized, and portable at all times. You never know when the opportunity for adventure is going to pop up, but with sugar medical, you can be ready to explore and enjoy life. When. And wherever head on over to sugar, medical.com to take a look at all their super sweet styles. 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 in the show notes to the sugar medical website, along with offer code details. Thanks. All right, everybody. I am here with Heather today and we are going over chapter five of think like a pancreas for the book club series, chapter five is called the basal bolus approach. And I was just saying, making a comment that it's one of the shorter chapters I feel like. But it's, again, chock full of lots of good information, also chock full of lots of good graphs and charts. So I'm gonna say it again. If you don't have a copy of the book, highly recommend getting a copy, cuz you are definitely wanna want to be able to go back and reference all of these charts and graphs that he lays out so nicely for his readers. But Heather, go ahead and introduce yourself and tell the listeners what your connection is to type one diabetes.

Heather: 4:16

Hi. Thank you. Thank you so much for having me on first it's I really I'm very excited about this. My name is Heather. My son Ellis was diagnosed at 17 months in 2019. He's now four, obviously that's math. We know math yeah, we do. Or we think we do sometimes we do sometimes. Yeah. But he was diagnosed at, at 17 months and he is my only son and he's my, so he is my first and my only, and he is, has type one diabetes and it was when we, when he was diagnosed you know, I actually it's this it's the, it's the classic, you know, the symptoms and it boggles my mind. I can go on a tangent for a long time about, you know, how people miss it and how it's possible that the doctor doesn't just, you know, you call your doctor and you say, my son is drinking and peeing lot. And he says, you know, it's August. And you know, doesn't even think twice. I don't wanna get too. I get, I get worked up about it, but it is intense that, you know, it's the typical symptoms. He was peeing a lot. Looking back at pictures, he definitely lost weight, but I didn't see it at the time. And then, you know, like week after he told me that it was, you know, August, it's a heat wave. He I look, I'm looking at him and he looks like, you know, off and tired. And we get in, he asked me for a Starbucks, he was very verbal. He was O he came out of me speaking and he told me he wanted a Starbucks muffin. I said, okay, let's go. And we get in the car and I'm sitting there and I hear him breathing. Like, I could hear it. Like I didn't start the car and I hear heavy breathing. And I'm like, that doesn't sound right. So I rushed over like a crazy woman to, cause I did a little Googling and interestingly, something I found when I Googled was that. I don't know what page I was on. Cause it's not valid information, but only 1% of children this age could be type one. And I, maybe I saw that and I kept that as you know, I tried to block. I said, oh no, no, no, it's not that. But in my heart, I was nervous. And I ran over the doctor. He threw up in the office and they did a test and he, you know, I remember the doctor said to me, he looked white. He goes, you have to go to the emergency room. Your son has diabetes. And I went, where do we go? Like, I just went into it. I, I kind of knew my whole family took a deep breath. My mom was with me and my and hit Ellis's dad. And I said, where do we go? It went into action. I kind of had that feeling that it was coming, but I didn't at the same time, you don't snow it coming. But I, I, oh, I've been reliving that where I've been reading, I was reading all of those things and Googling, but putting it away anyway, it was, I, well, I didn't know, but so we go over to the hospital and. we just, they throw you in. went in, I went in to go,

Katie: 6:50

Yeah. I was kind of the same way I knew in the back of my mind that it could be diabetes or something more serious, but I wanted to pretend like it wasn't. And then but yeah, I kind of went into like, you know, mom robot mode too. Sarah immediately broke down and was crying and screaming, so I was trying to hold it together for her, you

Heather: 7:09

She's when was she? She's older. I mean, Ellis was a baby. He had no clue. He just was like, get off me. How old was Sarah?

Katie: 7:15

She was eight. Yeah.

Heather: 7:16

It's tough.

Katie: 7:17

Oh my gosh. Yeah. So tough.

Heather: 7:19

Everyone. Every age group, you know, I have, we have a big, obviously, you know, there's a big support group online and everyone that you talk to, you know, you think, I, I always said, this is the hard being a toddler. He's only for, it's a, it's a very difficult, but every age group being, you know, a. They have, there's a different set of challenges. And I can't imagine a girl having a daughter at eight that's must have been really tough

Katie: 7:41

there's not a good age. I think infants would be extremely hard toddlers then, you know, you know, tween or wherever my daughter is. And then. Teenage years I think would be awful.

Heather: 7:50

Yeah,

Katie: 7:51

there's there's pros, I guess you could say there's pros and cons to each, but yeah. There's that, like you said, it perfectly there's challenges to each age. Well, okay. Tell us something that's not related to diabetes. I've I I've kind of realized like listening back to my episodes. I'm like, gosh, this is, this is a lot about diabetes. it's a podcast for type one diabetes, but I also like to know, you know, a little, a little extra about my guests. I think it's fun for listeners too. So just tell us maybe like a couple fun facts about you or Ellis or your family. Like what's some stuff we need to know about

Heather: 8:24

Yeah. S is so funny. I mean, he is my world right now, of course. And. It's a little sad, but a little, I think everybody gets it is LS is my world right now. I was a graphic designer. I stopped working actually before he was diagnosed and, and then I really put it all on pause when he was, but I, I am a graphic designer. I've been actually just starting to kind of get back into it. Cause I, I did lose a little, I don't wanna say I lost a little bit of myself, but you do kind of, but in this, in the ha like in PO in a positive note, I love my baby so much. He's so that's like my world. It really is my world right now. But I enjoy it my little he's so funny when you said tell something funny. I know, I know. It's like, wow, I really don't have a life right now. but I love it. I love it. I, love being with him. We're like, we're like Harold and mod. I always say. But like before all of it, and then it, you know, he was diagnosed and then we went into COVID. So I did, this is a little, this sounds a little Debbie downer here, but I did like, you know, forgot a little bit, but at the same time, I can't wait to travel with him. You know, you asked, I saw, you asked a question about where traveling and I can't wait to travel again, and he has this globe and we're gonna travel the world when, when we get it together.

Katie: 9:37

Well, he's still so young. I mean, I, we didn't really start traveling, traveling, traveling with our kids until our youngest was five, because it's like, what's the point? Really? Why are you gonna spend all this money? And you know, you're not gonna exactly appreciate it or remember it. So we would go on like little small family vacations every year, but we didn't start like venturing out into the stuff until they were older. So no worries. You got some time you got time? I actually had talked to Ellis briefly yesterday cuz we kind of jumped on for a second just to make sure all the technology was working and Ellis was there and she, she, he is such a cutie and he, he made me call him Peter Parker cuz he was in his Spiderman costume and I called at one point and he was like, it's Peter Parker.

Heather: 10:20

he's very funny. He is entertaining and he's alive, but he's, he's, he's funny. And yeah, he is definitely Spider-Man now. Yeah.

Katie: 10:27

Yes, love it. Love it. Okay. So let's jump into the chapter, the basal approach. What do you think in your opinion was the author's purpose in writing

Heather: 10:37

So this book, I'll just say, say briefly that this book is, I remember when I first picked it up a few months after Alice was diagnosed, maybe three months when I was catching my breath and everybody says this, I kind of said, I read it all in one night and I said, okay, clicks. And I wanted to send a copy to all of my friends and family. And they're like, okay, it's great, but okay, you really, you know, you're pushing it. But I mean, they did, I did send it out to a bunch of people, but it's the thing that is amazing about this book is that it's so readable. It gives you so much information, but it's so readable. And it's a lot of important information and there's a lot of chapters that are more that, you know, the three keys that got me the other day, the three important, you know, keys to control there, there's aspect of it that are, that are handle like your emotional, there's a lot of emotions. And then there's a lot of super technical, real deal stuff that you're dealing with the human body. And when you're first diagnosed or even, you know, two years later, you read it again and you're like things click. you know, or they don't, or they do it depends on the day, but yeah, but I think with this chapter, I think the whole book is important. This chapter in particular, the more, you know, and the more you understand about what it is that you're doing, the better that you can do it, that's obvious. And it goes with, you know, that's a life, a general statement about many things, but in particular, how it works, what you can do. And then, you know, he also offers information that I, that I remember my endo telling me as well. And, and you talked about it on your live session, too. About how I think Sarah you know, at her, in her age, The chart and it will get into the charts that he, that he offers too. They're amazing. But in her age group, you know, insulin tends to be higher at night. Insulin needs tend to be higher at night, so higher, but anyway, there's info that it's, it's the basics, but it, it gives you a good look at what you're doing in a readable way. And I think basically the goal is just, you know, know to understand what basil is, what the difference is. And the more, you know, the more you just, the better you can ha you know, make, make decisions. And that's the whole book really,

Katie: 12:47

this chapter was really kind of honed in on like the difference between basal insulin and Bo insulin. It kind of gave another brief overview of the different brands and types of basil and bolus. And then it, what it really focused on like how to choose a program that incorporated both basal and bolus insulin, cuz there's several options, right. That you could pick, so kind of how to choose the one that's right for you. And then I, I like how, at the end of the chapter, he kind of spent some time going over the pros and cons of insulin pumps and then the DIY like hybrid closed loop systems or not necessarily DIY there is DIY. But you know, just the hybrid closed loop systems that are out there, like the, the tandem pump with the control IQ. And then the new Omnipod five, that's getting ready to be released to a wider market. So we'll go over that of course. But, but yeah, it was a, it was a great chapter. I, you know, I, I think I wanna make a small note. He talks a lot in this chapter about insulin peaks. And I just feel like it's important to kinda talk about what that means. It basically just means that when the insulin is like working the strongest, like when it's working, you know, at its strongest. So a lot of times, you know, if when your insulin is peaking if food has already digested or hasn't started digesting, cuz there's a lot of fat in the meal you might see like low blood sugars or hypoglycemia during a, a point at which insulin is peaking. But I don't know. I, I feel like that's not something that people naturally know when you say like, oh, when your insulin peak it's like, well, what is that even? So I just, I just wanted to say that before we even yeah.

Heather: 14:22

the, in the beginning. I mean, I, I keep in the beginning, you know, sometimes I say, you know, BD before diabetes or ad, but yeah, all of this information, these might have just been, I didn't, I definitely didn't understand it really fully understand it, but it was a good, it was a good intro. And now I, you know, I'm reading it and yeah, this, this does make sense, but you know, in Ellis is actually, we'll get into it as well. But Ellis is on tandem now and he has control IQ. So, and I actually, I have some questions for you about peaking. We're all still learning so much as we go, but insulin peaking, I don't wanna jump ahead, but we don't peak with our basil, but we do with our BOS and we can talk, we'll talk about that, but yeah, it's a, it's a great, it is a good chapter.

Katie: 15:09

Yeah. I feel like the insulin peak as far as basil goes is more when you're on injections, you know, what's more for those long insulins, not all of them, some of them don't really peak at all, but there are a few that have a peak and then, you know, you gotta look out for it cuz that's typically when people see like overnight lows, you know, while their kids sleeping and stuff like that. But all right, well, let's start with the, kind of the difference between the two basal insulin. We'll start there. And then we'll move on to bolus, but so basal insulin, you can think of it as like background insulin. So the insulin that's always running in the background. So if you are on injections or MDI, this is like something that you inject. Most people, I feel like do it in the evening at some point in time. Some people choose to do their basal long acting injection in the morning. And then there are certain types of long acting insulins where you can actually split the dose. So you can do a little bit in the morning and a little bit in the evening, I, the way I understand it is only Levemir is the one that can do that, but I might, I might be wrong on that. Anybody's welcome to prove me wrong. But I, when Sarah was diagnosed, I just was, I just remember being so confused about why do we even need basal insulin? Like, why do we have these two insulins? And you know, basal is important because of the liver, which plays a huge role in our blood sugars. And I think it's something we don't always think about all the time, but the liver is constantly putting out glucose. And that is because number one, there's certain organs in our body that just need glucose for fuel, like our brain and our nerves, and then our muscles, while we're exercising, they will only use glucose to get fuel. So the liver in order for those organs not to shut down is constantly like putting out a small amount of, of glucose. And then we have all these hormones, like stress, hormones, growth, hormones, sex hormones adrenaline, no epinephrine. The list goes on and on that when they are released into the bloodstream, they actually trigger the liver to release even more of its stored up glucose. So then of course you would. So without basal insulin in your system, whether you're getting that through a basal rate on a pump or an injectable long-acting insulin, without it, you would just see, see this steady creep in blood sugar numbers. Something happened to Sarah's pump the other night right around midnight where the insulin got suspended. I don't, I can't even, I could, I heard this why I don't even know.

Heather: 17:28

I know I was, I was gonna point out a bunch of times when this happened and, and you don't know, but you see it, you see her, you watch the DCOM and you see it, you know, when it's something wrong with the pump, you don't maybe know exactly what happened. You might there. I'm sure there are times when you, you will be determined to figure this out and you will be on the phone with them. And sometimes you go, I don't know, but you're gonna change that pod. Cause her BA she's not getting any background insulin and yeah, you see it creep up right away. You know it, you learn it that you see it just go up.

Katie: 17:58

Yeah, yeah, absolutely. And you can, you know, especially if you're on a pump, you can look and see if they have any insulin on board. And if don't, it's like, well, why in the world are they going up? So for us it's yeah. It's cuz her basil, but it's, it was amazing. I mean, okay. So she, when her insulin got suspended, it, she was around a hundred and it was around, you know midnight. And then when I got woken up and looked at her. CGM, that was like four hours later and she was at two 70. So it doesn't take long for your blood sugar to grow up. If you don't have any of that basal insulin running in the background. Now I'm a horrible mom, cause I happen to have my high alarm high alarm off that night.

Heather: 18:34

You're not a horrible mom, please.

Katie: 18:36

yeah, I know we all do it.

Heather: 18:38

I just, I will tell you that mine is also now set to about 300 be and it used to be, I mean, it depends. I do lower it, you know, but sometimes you're not, don't say that because you need that sometimes. But yeah, it does. It does really happen really quick. I saw it with LS, I don't mean to, to interrupt you too, but I'm thinking about all, all of a sudden, the background insulin, and my mom, when she talks about it and she still does, she's funny. She, she, she gets it, but she also is not totally immersed in it all the time, of course, but she does get it. She's my she's been my person that does, she understands and she's here and she's here for us. She calls it the drip, drip, drip, drip. And that's, you know, I mean, I laugh, but it actually is. It's true. The drip, drip, and you know, you think about our bodies and you look at all these graphs and you and the background insulin, and you think of all this and you and I who have working pancreas, pancreases, our bodies give us that bale. That just works. And there's just doesn't and it is true on the pumps. Yeah. You see it immediately going straight up and it's just, you change that. You change that pod, right?

Katie: 19:45

right away. Yeah. Yeah. Yeah. And we'll talk about that a little later. That's definitely the cons of being on an insulin pump is, is that yeah, I like that. The drip, drip, drip, drip. It reminds me of that song from Incanto right. Like. Drip drip, drip.

Heather: 19:59

I didn't see it. Yeah. Everyone. Did you see it? We're still like in love with Luca, but I will see it. I didn't see it.

Katie: 20:05

Okay. Well, there's a song and you'll know when you hear it and then reminds me of that.

Heather: 20:09

There's a lot of funny songs and not to digress, but there's a lot of funny songs that pop into my head at different moments, like get low, low. The, my friend does that yeah.

Katie: 20:18

Diabetes and musical.

Heather: 20:19

Yes. That's a great idea.

Katie: 20:21

Well, I did it. I did an episode on

Heather: 20:23

I miss that. I need to just,

Katie: 20:25

whole playlist on Spotify called type one diabetes, the musical. So,

Heather: 20:30

you are so funny by the way, like, I laugh out loud at a lot of your, your posts, like out loud and I return to them. The one gets me every time, but you arm, you crack me up. I'm writing down diabetes, find the musical, find it. You'll send it to me of,

Katie: 20:47

when we were doing our test yesterday, I had to stop and tell Alexa something. I had a timer going for something for Sarah. And I was like,

Heather: 20:54

of our kid. Ellis is little and he's like, Alexa said a timer when I could eat in 12 minutes. Like Alexa's amazing too. There's pros and cons of Alexa that, that we should do another episode on that.

Katie: 21:06

yes, that's

Heather: 21:07

Yeah, that's great.

Katie: 21:08

a

Heather: 21:09

Yeah,

Katie: 21:10

note.

Heather: 21:10

yeah,

Katie: 21:11

So on MDI. So those injectable insulins, the different types and brands of basils and long actings are NPH, which honestly, I feel like hardly anybody, at least there's not a whole lot of children using NPH insulin right now. That was kind of like something that was more popular in the seventies and eighties. There is Deir slash Levemir, which is the same thing. There is glaring. I, I don't know if I'm saying that correctly, but glaring slash LAN. Basaglar which is Lantis and Basaglar are, are the same thing, basically. And then there's Deek, which this is brand named Triva and then there's concentrated glaring, which is the brand named TJA. And I've heard that I've heard of TJA and Triva called the fancy insulins because they are like ultra long acting and they will stay in your system for like 24 to 48 hours, as opposed to like 18 to 24, like some of the other ones. And then if you are not on inject, if you're not doing injections, if you're using a pump you, that long-acting insulin goes away, you don't take that anymore. Instead, your pump gives you what is called a basal rate, which we've already talked about, but it's, it's, it's the drip, drip, drip. So your pump is constantly dripping and infusing a tiny amount of rapid acting insulin. So most people are on like Humalog Novalog or FIAs. And it's just a continual drip all day throughout the day of that rapid acting insulin. And so that becomes your, your basal or background insulin when you're on a pump. So some common basal needs in. Just people in general. Surprisingly there's not a big difference between men and women, which I find kind of shocking, but, but there is a big difference in different age groups. So for the most part, like people that are younger than 21, which is called the growth years, their basal needs tend to be higher throughout the night. And then kind of drop in the morning hours and then gradually increase from noon to midday. Um, I have a note to make about that. But people who are 21 and older kind of it changes basal needs are higher in the early morning. So that can also be called Dawn phenomenon and then they'll drop off until midday and a low level in the afternoon and then a gradual increase in the evening. So I find that, and then ki kind of just as you get older, your basal needs go down in general because there's just not as many hormones being produced and those yeah,

Heather: 23:29

I that's what I was gonna say. Our, their bodies, these little bodies are changing so fast and growing, and it's very intense. We know this as parents, without children with type one diabetes, but we get to see it in a different way. I always say that someone asked me why, you know, Ellis was didn't. I stopped using the baby monitor after a while. I said, well, I don't really need it. I can see what he's doing on his D comp you know, he's, he's still he's okay. I mean, that's not fully true, but we do get to see inside and their bodies are changing so much. And that's something I actually will talk about this too. But with when you change the basal rates on the pump, sometimes especially Ellis is only four. It's like a two day period and like, well, something switched. Is he growing? Is he, you know, his foot got bigger, so something's going on in there and you change. And it's a lot of changes. That's a pro for pump,

Katie: 24:18

No. I love that too. I love yeah. Cuz with the long acting you it's one dose, right. You know, you're getting certain, certain amount of units one time a day. Yeah. I love that too. With the pump you can go in and you can fine tune it to where, you know, from 12, midnight to 7:00 AM, they can get one basal rate and then their insulin needs might go up and then you can increase the basal rate for the next couple hours. It's great. But I, it's also very frustrating cuz the, I feel like the basal rates change fairly frequently. Not only like going up or going down, but they change throughout the day like, oh, I used to need more basal in the morning and now it seems like I need more basal in the afternoon and it it's just a, it's a comp constant game of adjusting and tweaking.

Heather: 25:03

And there's a lot of variables. I mean, it's basil, we rely on basil. I, I mentioned to you, we, that I sometimes over I over basil him. Ellis because there's very, I'm not sure if he's going, this is a little, it's confusing, but I didn't just make this decision. My doctor and you know, my diabetes educator, we, we give him a little bit more basil to cover some of the food. And sometimes I'll UN it's an art, it's a science and an art and you know, it's never perfect, but there's so many variables in talking about changing those basal rates, just jumping back because you look at it and yeah, you might say Sarah needs more basal in the afternoon, but also was she at a birthday party on a bouncy? Well, that's where my world is in a bouncy house at that time, because you gotta wait. There's, that's part of the pattern management too. There's so many variables. You look at the basal, is it the basal, do I wanna change the basal? I start with the basal, do you tend to do that as well?

Katie: 25:57

I oh, yeah, for

Heather: 25:58

That's where I go.

Katie: 25:59

with basil. Unless we're just seeing like crazy spikes in the morning, which is usually the only time we see super, super crazy spikes that breakfast meal, then I'll mess with the insulin decarb ratio too. And that helps sometimes, but I like how you turned the word basil into a verb there. I'm not sure if you noticed it, but you, you said I oftentimes over basal him, which I'm.

Heather: 26:21

yeah, that's like in my, I didn't even realize that I do that. That's yeah. We're we, we over basil. Yeah, we do. We, that's funny, actually. I didn't even realize that that that's just part of my repertoire, but we do, we, we use BAS basil, the basil. I love the basil. Well now he's on control AQ and that is all about the basal that's a song we could write too.

Katie: 26:39

About the baseline.

Heather: 26:41

but yeah, it's I forgot my, where I would, where I was going.

Katie: 26:46

Well, I'll say something and then maybe it'll come back to you. What I was like with somebody at his age you know, he he's four, so he's probably, I'm guessing, like, not the, maybe a little picky. Maybe doesn't always finish the whole meal that you've bowled for him. So I feel like, you know, overcompensating with basil, maybe isn't such a bad idea because that is what can be adjusted, right? Like once you put that BOLO insulin into him for a meal, you it's in there and you can't take it out, but if the Basil's up and you start to see, oh, he's dropping low, then you can go into the pump and adjust it and kind of either suspended or, or just turn it down. So I, I, I think.

Heather: 27:23

Yeah. That is, that is it. Thank you. That is exactly what I was thinking because could the control IQ right now is constantly adjusting his basil. I, I miss it all the time. It'll just increase it by a little bit when it sees, you know, it's, it can as. For anyone who doesn't know, but it connects via Bluetooth to his monitor and his, his CGM. And it washes those trend arrows on the Dexcom. And it'll, you know, 30 minutes in advance will start adjusting that basal by micro, like teeny little bit, you know, his basals now 0.1 or so at certain points, it change wise. We said it changes throughout the day, but it'll just bump it up to 0.1 0.12, and then it'll, you know, it'll turn it off. So I was doing this when we were on Omnipod. I'm sure you were to it until you just recently did went DIY, I believe.

Katie: 28:14

still on Omnipod, but we are using the DIY app to control the pump.

Heather: 28:20

yeah,

Katie: 28:21

Okay. So Heather just said that Ellis, his like average ish basal rate is like 0.1. Heather, take a guess at what Sarah's basal was running at yesterday. When in the wave of hormones that she was experiencing

Heather: 28:34

How old is she again there? So she was diagnosed at eight. And how old is she now?

Katie: 28:37

10 she's 10. Yeah.

Heather: 28:40

I'm gonna just go wild and say 0.7.

Katie: 28:43

Three units.

Heather: 28:45

No,

Katie: 28:46

yes. For four hours straight DIY loop had her running at three units per hour and it w she could not get under one 50. Like it was still trying to creep up even at three units per hour. And that's with her bowl insulin for her meals. I was, I was almost just laying in the floor in the heap, just crying. Cause I'm like what? In the world?

Heather: 29:06

imagine this is also a little, just a tan. I don't wanna turn into a tangent, but re imagine in the beginning when that, you know, I don't know what her basal rates were in the beginning, and I'm sure you started on MDI, but that would freak me out to be that high. And now you look at it and you say, She needs more insulin and it's, that's a whole, that's also another episode about, you know, the fear of insulin in the beginning when you're diagnosed or sometimes, you know, just it's insulin is a wonderful thing and it that's what, just what she needs, but that's sounds so high. She needs

Katie: 29:38

It is scary to me cuz when we started out on the pump, which was really only like a little over a year ago, her base rate was like 0.35. That was where we started. So that's a huge, what I don't even can't even do the math, whatever. It's a lot of increase. It's a lot of

Heather: 29:53

lot. I can't, yeah, we're good at math, but sometimes it's like Alexa, Alexa,

Katie: 29:59

Yeah, exactly.

Heather: 30:01

a lot, but she needs it. It's what insulin. Yeah. It's just, that's what their bodies need. So you just roll with it. Yeah.

Katie: 30:08

So let's, let's travel back in time and think about the MDI days for just a second. Did you, what long acting insulin were you on before the pump? Do you remember?

Heather: 30:17

was Landis. And Basir, it was it's funny when, when you were talking about all, what, what I use, it's a, I didn't know this at the time, of course, but it, I use now what my insurance changes to every month or if it doesn't and as long as I'm okay to it with it, that's another conversation, but it's all, when he was diagnosed with his basilar Orlan, that's what we still actually have. We have the pens, the, the quick pens. But in terms of it changing all the time, I'm actually his rapid insulin does between hemolog Nolo AMO log Lispro.

Katie: 30:47

mm-hmm

Heather: 30:49

It's all, it's all. They're all pretty much. We don't venture into the, like you said, the NPH. Nobody does that FIAs. No, just the there's like those, those four general ones.

Katie: 30:59

right. Yeah. Yeah, yeah. Yeah, we were on uh, basic R first and that was burning. Like when we had injected it would, Sarah would complain that it really, really burned. So I talked to the doctor about it and then she put us on truce, which was a fabulous, long acting insulin. I'm curious to know. Did you ever, do you remember ever missing a dose of your long acting insulin?

Heather: 31:19

we were only doing injections for a few weeks,

Katie: 31:23

Oh, really?

Heather: 31:23

yes, we were. I was blessed. My funny stories in the hospital are funny. Now I'm walking around going, we need a pump and we need a Dexcom. We're not leaving until we have Dexcom. What is a Dexcom but we did. We, we, I, my endo was amazing. And, you know, since he was so young, they pushed to get him on the, on Omnipod really quick. So I did not ever miss a dose. I was really intense and all my notes, and I looked back at all my notes and I thankfully, I mean, it happened, I did make some other. Some other mistakes, you know, 0.3, five instead of 3.0, gave him three units instead of 0.3, five, that happened. That was terrifying. But no, I never miss. I do think about since I was only giving him shots for so short and I want to go back for a while. You know, I was like, we're out. I'm not doing it. That seems crazy. It was too intense. I do think about, like I said, it's, there was a fear I do wanted to go back now. You know, when we first got on the pump, it was life changing because I'm chasing him. He was very little and I didn't have to stop and we didn't have a food schedule and he could eat whatever he wants. And it's like, Chi change I'm you can't see me, but I'm using anyway. Yeah. Just say, like chasing him around. But I do think about, you know, at times I don't want to, I'm not ready to fully go back at because he's four now we, we maybe would be able to, but we have to talk about it and plan for it because he's not much gonna be like, Hey, today we're doing shots. He, he doesn't really get that cuz we didn't for, so for, he just knows diabetes as a pump, he doesn't remember. But I think about what would happen. And this is like an interesting concept and you come up with all these, I call it, they're like hacks. They're not really hacks. It's called planning, but what would happen if you know. I'm not just gonna switch over. So let's say, you know, his pod fails and I go to put one on and it does. And it doesn't, you know, insert. So I'm left without a pot or I'm out, you know, somewhere and I'm like, all right, I gotta give him the shot. It's fine. You you'd give him the long number one. I wouldn't even remember at this point what the dose was and how, you know, said, thankfully, you know, I'd call on as I was making these notes, I said, oh, add this is the emergency book. You know, just remember what to do in that moment. But anyway, so I, you, I would give him the sh it's say, I would give him the shot. He doesn't have a pump. I would give him the long acting, you know, basilar. And then if I wanted to, if I got home and wanted to put a pump on what would the scenario be? You know, cause I'm not ready to just go jump him, you know, dive right back into giving. And I, we could, but it's more emotional for him anyway. So do I put the pod back on or now his tandem? I don't know how that would work. Haven't gotten there. I will. And then you turn off the, you know, do you turn off his, his basal rate so that I don't. So then that you have that long acting, you know, the shot, the injection that you gave, that's working for 1824 hours, but I want the pod still on. So, but I can't, you know, you can't have your basal rate on and that, that, you know, that insulin working in his body. So you turn off the basil on his pod. Boless regularly. I, it would be, it would look completely different because you wouldn't have those segments. And I don't remember, and it would, it would be different now anyway, but I don't remember how that insulin is gonna be working in his body, like, you know, talking about peaks. So I have these scenarios in my head. I'm like, okay, that's what I would do. I don't know if that would be perfect, but you have to plan for these things. So.

Katie: 34:36

Yeah. Well, and I mean, you know, I think in every situation it's like, you, you have the decks come right in front of you, so you can watch what numbers are doing. I mean, if you have to give them 10 juice boxes and you have to give'em 10 juice boxes, but but actually Sarah actually dropped her PDM in the pool last summer, which the PDM is the little remote that controls the Omnipod pump. And those are not waterproof. The, the pump is waterproof, but not the PDM. So we were out a pump for a good, I think it was 72 hours before they shipped us another one. So we did have to go back to shots, but yeah, I just, I did exactly that. I, I put the I put the, I gave her an injection of TBA and I just kind of guessed, like I knew her basal needs had gone up. So I think I gave her like one more unit. That she was on when we had stopped with CEVA before, you know, like before we got on a pump it ended up, ended up not being enough. So the next night I, I did another, I increased it by another unit. The tricky part was though when the PDM finally came in the mail and we put the pod back on her I just turned it on and started running her basal rates. But you know, like the next night, cuz you know, like it had been a whole 24 hours since I had given her, her last long acting dose. But but with Truva it can stay in your system for up to 48 hours that, yeah, the next day I was noticing like with her basal rate on her pump running, she was just super like, we could not keep her up. Like she was super low. So I did eventually just turn off the, just kept turning off the basal for a little while.

Heather: 36:00

You watch the Dexcom and as it goes, you're like off. Do you, can I ask you a question? I, a lot of questions as an old, you know, but we all do, but do you. My endo always told me this and I don't always see it, but that when you change the basal rate, it takes an hour. I think, you know, it takes a little bit of time cause that basal from the hour before or currently is still, is still going. It's still working, but it takes an hour. You know, if you're, if you know, you know, Sarah's gonna go swimming and she goes low and she's swimming, you set that, you change that basal. Or I turn him on exercise mode now in tandem, which is another conversation too. There's so much, but it takes one hour for that basal change to, to kick in.

Katie: 36:43

yeah, yeah. That's yeah, I do. Yeah, I mean, obviously, you know, we have a pool in our backyard, so it's not always like, I'm gonna get one hour mommy, you know, like I'm getting the pool. So I'll just, I'll just shut it off or do a super big. Temp basal decrease. You know, with DIY loop. Now I have a swimming override, which again, there's like a million conversations coming out of our one

Heather: 37:06

I know, sorry. I knew that would happen. I tend to do that, but I, you know, it's exciting and there's so much to

Katie: 37:11

I know there is. But I like so, but if I'm noticing a change in her basal needs during the day, like let's say at four o'clock every day I notice she starts dropping, then I would go, I wouldn't go in and change the basal rate at four. I would go in and change it at

Heather: 37:26

Right. Great. Yeah, that, that makes sense. And we do, when you're doing pattern management, that does make sense. But I, you know, I was, I was thinking more on the fly because you know, you turn off that basal sometimes. And it, it, I don't know. I tend to see that sometimes it it's faster. Sometimes it's not, I don't know. I haven't been sold on that hour, but I guess it does make it's true because when you're doing pattern management, you do set it for before. So there we go. We found it's.

Katie: 37:48

I mean, with swimming, I feel like we're always having to treat Lowe's when Sarah swims, it doesn't matter if her Basil's on or off, it's just swimming just sucks. The glucose right on out of her.

Heather: 37:59

Alice is not into the really super into the pool and I like that. And I also, as of just a mother, I know I have to, not like that. I want him to be swimming of course. But we don't have, we're not there yet. He gets in the pool, but it doesn't affect us as much. Yeah.

Katie: 38:11

All right. We're gonna move on to bolus insulin, but I do wanna make a note I've referenced this chart, I think in every episode, up until this point, except for maybe with chapter two, but on PA on, in chapter three. So going back a little bit on pages, 51 and 52 table three, three gives you all the insulin action profiles for both the Boless insulin, like rapid acting insulin and long acting insulin. So it tells you like When it starts to work when it will peak and then about how long it lasts in the system. I think that's, this is a fantastic chart for anybody to go back and look and to see, what the insulin you've been prescribed is how it's working in your, your kid's body or, or your body, if you're the one with type one. Alright, so Blu insulin is you can think of it as bunches. And that is the insulin that we take when we eat or when we have, have to do a correction for high blood sugar. So I feel like most people I know are with kids with type one are using either Novalog Humalog or fast, which FIAs is a little bit faster acting insulin. But you know, again, everything, every carbohydrate we eat except for fiber gets broken down into glucose. Most carbs take about 10 to 20 minutes to start raising your blood sugar. And then most carbs take about two to four hours to finish digesting, so to get outta your system completely. And then of course, you know, if there's a lot of fat in the meal, then that can kind of pro prolong that, that slows down digestion. So that can kind of pro prolong that time. But, and then of course I already said, we have to take rapid acting insulin. If, if our blood sugar is, is very high and we need to correct for it. Let's see. So brands on the market for rapid acting insulin are a PRA Humalog and Novalog or Novo rapid. And then there's the ultra rapid acting FIAs. Then there's inhaled insulin, which I think is only improved for people that are 18 years and older. So it definitely wouldn't be our kids. I've heard amazing things about Afreza like, I've, I've heard that if you've already taken your Boless insulin and then you like have a really nasty peak, you can actually. Like take Afreza even after your BOIC insulin and it'll kind of safely bring you back down. Don't quote me on that. I'm expert on that insulin. But I just heard really great things about it's like a, it doesn't necessarily replace your BOIC insulin, but it's like a good sidekick, all right. So now we're jumping to the part in this chapter where the author is now to the point where we're putting basil and bolus together in like a whole insulin program. Pretty much everybody that has type one diabetes is going to eventually end up taking. Basal and Blu insulin. I know a lot of people at the beginning who go through a pretty strong honeymoon phase might only have to take Boles insulin or only have to take basal insulin. So that, but I feel like as it progresses, everybody pretty much ends up on both. And then even some people with type two diabetes eventually end up taking, you know, if it can progress to the point of really being out of control, then you might end up also taking basil and bolus insulin. So there's lots of different ways that you can combine combine basil and bolus insulin, and we're gonna go over those different options. Right now I'm not gonna go into great detail cuz again, there's a really great chart in the book. I believe it is table five, one on page 1 36 that kind of summarizes and goes over each one of the pros and cons of these basal bowls programs. So I'm gonna briefly list them and then we'll, we'll go into a little bit more depth when. Kind of get to the ones that most people are using. But basil Blu option. Number one is using a pre-mixed insulin twice a day, which this was again, very popular back in the seventies and eighties, pretty much nobody, at least no children that I know used this method. But it's actually a combination of NPH and rapid acting, acting insulin in the same syringe. And then Basline bolus option. Number two is taking a morning dose of NPH and some bolus insulin for breakfast, and then taking an evening bolus for dinner and some bedtime NPH. the author says there's really not much of a difference between option two and option one. Neither of them are really great. Both of them are kind of like older, older school ways of, of managing diabetes basal and bolus option. Number three is taking a bedtime dose of NPH plus just injections throughout the day of bolus. Bowl of insulin. NPH, I think is good for like people that experience the Dawn phenomenon when their blood sugars shoot up in the morning, because if you take it at night NPH kind of peaks right around when you would be waking up in those early morning hours. so that can be helpful for some people. Again, I do not know any children that are using that. Basal involve option. Number four is using a long acting insulin that's injectable plus MDI or injections, and then, or a basic mechanical pump. So you can actually, you know, you were kind of talking it through earlier, but, and I actually considered doing this when we were on the Omnipod in the beginning, but you can actually turn the Baal rate down to as low as it'll possibly go. The pump usually does not let you turn it off altogether. I mean, it will, but it's only for a short amount of time. Like there's a time limit that the pump will let you totally suspend insulin. But you can like on the Omnipod, you could turn it down to as low as 0.05, which for Ellis, that's like half of his basal rate anyway, so that probably wouldn't work, but, but you can turn it down super, super low, like for Sarah that's that wouldn't even

Heather: 43:38

be, that would be off for her, but you know what, there's also at call these hacks. They're not really hacks you just, they are, you learn that as a month. I used to temp basil. think you could temp basil down to zero, so you're turning it off, but then you have to, I don't remember which setting turns it back on automatically. I think that does, if you temp basil, not temp basal down, but to spend, I forgot already. I, I forgot which way.

Katie: 44:00

so temp basal will come. You can turn it off for like two hours or something or an

Heather: 44:05

And then it automatically comes with,

Katie: 44:07

on. If you suspend it, it will not

Heather: 44:09

way I hated that because then if you fall asleep, that's one of those things you fall asleep. Didn't set your alarm. Um, No, but I used, I used to do that where I would temp BA let down to zero for whatever, however long it would let me set in a reminder and do it again. There's a lot, you, you control like you human control. Like you.

Katie: 44:27

in control IQ. Right. Love it. Oh, all right. And then there's basil and Blu option number five, which is long acting insulin and bedtime in NPH. Plus MDI. I, again, I know anybody on that. And I think there's certain people that it would be appropriate for certainly. I mean,

Heather: 44:43

Yeah. I didn't mean to just know it cuz you know, of course I've, that's the thing with all of these, you pick a program, everybody's everybody, every human body is different and, and you know, you find what works for you

Katie: 44:54

yeah,

Heather: 44:54

and it's probably trial it's trial and error until you, you find and it changes. So yeah, I'm not yucking anybody's programs. Of course I disagree with you that no, I haven't heard of in real life besides this book, I haven't heard anyone yet, but we may, we may meet them.

Katie: 45:10

Yeah, well, and this book was written for people of all ages and people who are both type one and type two, but are just insulin dependent. It's written for people who are insulin dependent at all ages. So All right. Then let's see. And Bo basal and bolus option number six is a full feature insulin pump. So this is like your Omnipod pump or tandem you know, without the control IQ or a Medtronic pump. again, you're no longer taking a dose, an injection of long-acting insulin, you're getting your long-acting basal through a basal rate. And then just bolusing for meals and high blood sugars accordingly. And then there's basal and bolus option number seven. This is the last one in case anybody's wondering how long I'm gonna keep reaching this which is hybrid closed loop system. So there are hybrid closed loop systems that are FDA approved, and that is the tandem control IQ. And I apologize, Medtronic has a system and I. I don't know anything about it and shame on me, but I just don't feel like I can talk about it cuz I don't know a whole lot about it. But the one I hear most about is tandem control IQ and then the FDA just approved the, the Omnipod five system, which again, should be coming, should be released to a wider market later in 2022.

Heather: 46:23

cannot wait to hear about it. Like when people start really using that, because it, it was, you know, The release, the release that it was, you know, that it was approved, came out maybe three days after we switched to tan. There were other reasons why we switched. but you know, my end class, like, Ooh, I'm sorry. I said, no, we're happy. We're still, I'm still, there were, you know, there were Ellis, didn't like his pods, but that's another episode. We'll talk about it. but it's I cannot wait to hear how it works because it just was hype for so long. I'm sure. You're yeah, yeah,

Katie: 46:52

I, yeah, I'm super excited about it. I think we. For sure. Try it. I don't know if we'll stick with, I mean, we're definitely sticking with Omnipod. Sarah really likes her pod pump. But I don't know. It's too, obviously too soon to say whether or not I'll stick with the DIY loop or that uses Omnipod or transition over to the Omnipod five system. But I definitely wanna try it out.

Heather: 47:12

it's impressive. You're amazing because I remember hearing people that didn't wanna wait and I just didn't have the MI I, I was afraid and I know you're you posted some links and, and help because it's, it's overwhelming, but it's, it takes a lot. You gotta really dig in there and I'm, I wanna hear more about how I was afraid. I didn't, I felt like I didn't have the mental bandwidth to create this DIY. I mean, I know people are doing it, but it's intense and you are, that's really great that you, that you jumped in and you're doing it. You don't wanna wait people don't you don't wanna wait. It's a lot of waiting.

Katie: 47:41

a lot of waiting. We're very, we're a very impatient generation, unfortunately. I felt the exact same way, super intimidated by it did not have the mental space to even think about it. And then all of a sudden we had like two really horrific diabetes weeks with all. It's like all of a sudden Sarah's hormones were like, okay, we're here now. We're here for the party. Which is normal, cuz I guess we're kind of approaching that time in her life when she's probably gonna start her period soon and, or at least in the next year or two. But anyway, I just got so frustrated that I was like, I'm done. Like I'm not waiting anymore. I'm gonna sign up for an automated or I'm gonna learn how to build this automated system. And yeah, I'll have to do another episode or 40 on that, but it's.

Heather: 48:21

It

Katie: 48:22

great, but also a huge learning curve. But but yeah, so hybrid closed loop systems. If people are like, I don't even know what that is. Could you please explain it? So hybrid closed loops involve a CGM, a pump, and then Bluetooth technology to, to allow the pump and the CGM to communicate with each other. And then based on what the pump is seeing, that's what, what, you know, based on what the pump is seeing happening in the CGM graph and data it will automatically, so without you having to do anything, it will automatically adjust insulin accordingly. So if it sees that you're dropping or your kid is dropping, it'll adjust basal rates the way it does it is through basal rates. So they'll, they'll make the basal rate higher or lower depending on what they're seeing in your CGM data. So it's, it is great, everybody, you know, and I think a lot of people think like, oh, that's amazing. I could just be totally hands off. If I have that,

Heather: 49:16

No, no, no, no,

Katie: 49:17

that's not true. Cause you still have to correct for high blood sugars. You still have to correct for lows. You know, the way the author actually described a hybrid closed loop system is that it's a very small rudder steering, a very large ship. So, you know, you can't go and eat a slushie from the seven 11 down the street and expect your hybrid closed loop system to keep you in range. The

Heather: 49:38

Just handle it. Thanks. Bye. What, what I, when we first, you know, a couple weeks in, I was needed a break. It, it is immensely helpful with those adjustments, but you have to learn how to work together with the system. You know, I remember thinking I don't wanna step we're stepping on each other's toes. Like for example, he'll eat something. I was used to giving him uncovered carbs. If you know, I knew he was gonna exercise this technology control. I call her, she, her and she, I you'll hear me that just cuz she felt like a backup buddy that I didn't have before. And it's true. That's it ISS extra help, but you can't completely let it go. So if I give him some, I was used to giving him uncovered carbs Omnipod. We would do that. I would see his blood sugar go up and it would say it would either go too high or stay where I wanted it. Trial and error, but she being control IQ would see though that watch his sex come. He would, you know, Ellis would start going up and say, Ooh, I wonder what that is. Give an automatic correction, which was maybe more or less than we needed or just, I that's not, what would I wanted? So then he would drop low again. So it defeated the uncovered carbs. So I would was learning and I'm still learning that. So now I'll go in and I'll trick her. You can't trick her. You know, it is, it's a little trick. I'll give him, you know, let's say I want him to have a couple uncovered carbs for, you know, the playground I'll bowl list one or two, just a tiny bit. So she knows that he ate that way it doesn't see you. Can you learn the system? And it doesn't see this rise assume that he's, that it's, you know, a natural rise. You kind of just, you had to figure it out.

Katie: 51:14

that auto correction feature you just mentioned is what I was trying to say. When I said auto bolus feature

Heather: 51:20

Oh, yes, yes, yes, yes, yes. Yep. But I do again and I don't wanna go crazy thinking about it. I wrote a note to think to, to look it up, but there is a scheduled meal time or missed meal, but it is it's auto. Correct? So it, it watches, if you go above the target, you start to go above the target and you know this cuz yeah. D you're doing the, the, the close loop too. It'll start. It'll give you a micro correction. It doesn't give you full correction if you did the actual, you know, manually, but it does do that, which is great. And then you have to make sure you have to keep looking at it to make sure that if he had a correction and you're like, why he's still higher than you, you know, Ellis is still higher than I want him. And he's kind of stuck and you rule out all the things is he's still digesting. Does he need it? If you, again, step on each other's toes, you gotta watch. Let's say I'm about to, you know, give him extra, you know, give him a correction. Not that I make it up. Sometimes I'm just like, I know his body, like 0.1 is not gonna work or, you know, I'll just say, I wanna give a half a unit. You're not really supposed to do that on this pump or that's what my D and no, my diabetes educator said you're not supposed to, but, and I'm not, and she's amazing by the way another convo. But you know, you're not, don't lose that mindset of, I'm gonna give him a half a unit because this pump is using very specific numbers. So if you, it gives the correction and then I correct too, without seeing that we're double do we're overdoing it. So it's all about, you know, watching and learning and not stepping on each other's toes.

Katie: 52:45

Yes. I had a A guest on a couple months ago, telling her her daughter was in the clinical research trial for the Omnipod five system. And I asked her at the time, like, so I, I said, you know, I feel like a system with a system like this that's automatically adjusting things for you. You could be a little bit more aggressive with the amount of insulin you're giving your kid and the system will catch it for you. Well, lemme just tell y'all that having been on the DIY system now for a couple weeks, at least with DIY loop, that is not true.

Heather: 53:15

No, then you're just gonna feed your, you know, it does. It's not true. It, you, I had that sense of it. You can, no, you definitely don't wanna give more insulin, but it's the program you have to still figure out and you're constantly changing the program, but you do have a, you know, I find that I have a little bit of backup cuz it does catch lows. I'm obvi you know, 0.1 is when we talk about his basil being 0.1, it's not always that I actually just made that adjustment back down because I saw him dropping the kid's like you're filling my belly with juice. The dentist is saying, can we not let the gummies because you have two cavities already. Of course. Yeah, there's a lot. But I said, you know, you have you, you, you still make adjustments. But it does catch the lows a little bit better for us. There's that safety.

Katie: 54:01

It catches the lows for us too pretty well, but not if I've overdone it

Heather: 54:05

Right. You know, you see that arrow turn and you, and you know, I, we know our kids, we see one, if he's 180 4 and I see the arrow turn straight down, I'm like, and I don't, you know, I VE I don't know what he's doing. I could feel what he's doing somewhere in class or whatever he's done. Like he's jumping and this is gonna be, and then the next one is 1 54 double down, and it's not gonna catch those. It can't it can't.

Katie: 54:25

right. Yeah, no, I definitely can't. All right. Let's let's end with the I do wanna say real quick, just in case anybody's curious, I'll leave a link in the show notes. If you're interested in learning more about the DIY loop situation it's also called a couple other things. There's open APS. There's Android APS. I'll leave a link in the show notes to these. It's gonna take like weeks of reading on your part to really learn

Heather: 54:48

It

Katie: 54:49

what,

Heather: 54:50

make sense at first, but when, when it clicks, it starts to click. Actually, I didn't click for me fully until I started using it

Katie: 54:56

right, right.

Heather: 54:57

yeah. But it's interesting. It's very cool.

Katie: 54:59

I agree. You really just gotta, if you're gonna commit, you gotta commit and jump in with both feet and you'll figure it out as you go. Cuz there's no amount of reading or learning that you can do ahead of time

Heather: 55:07

something general just general is that if something's not working, you have to make a change. That's a very good, that's a nice thing to put on. If you word it. If I figure out the exact words, I would, you know, an affirmation, something isn't working make a change, but it is scary.

Katie: 55:22

yeah, no, I, I, it is scary. It's and it's overwhelming and you're already tired and stuff, but. And I just do wanna say again that the DIY loop and the open APS and Android APS, those are not FDA approved. That's like something you do on your own. You build the app on your computer. There's no tech sport. If things fail, although there is some extremely amazing and genius level Facebook groups that are there to help you, if things fail,

Heather: 55:48

These people, there's so many amazing people out there and smart and you learn so much. And sometimes instead of calling my end or just writing an email, I'm like, I'll post something on there and you get, people are so smart. It's and it's so wonderful. And how, but there's a lot of info.

Katie: 56:02

Alright, let's end with just some pros and cons of pumps, which you can, I'm just gonna read the pros and cons of pumps list, and you can kind of flip this around to kind of interpret what the pros and cons of like MDI would be obviously injections, MDI. You do not have to wear an extra device, which is a huge pro but pros and cons of pumps. So a huge pro is that they have a built in bolus calculator, which means you have to do less math. So you just, if it's, if it's hybrid closed loop, The pump knows what your blood sugar is, and you just enter the amount of carbs you're going to eat, and it will figure out how much insulin you need, which is amazing. And then if it's not, if it's just a, a full featured pump, you enter in blood sugar and you enter in carbs and it will tell you how much insulin to give amazing. Pumps will actually deduct like insulin on board. If you already have a lot of insulin in the system, they will deduct some of that to prevent stacking of insulin and then potential like low blood sugars later. The pump keeps a record of insulin dosing both basal and bolus. So you can go back and analyze. You can download that information and take it to your endocrinologist when you have your appointments. I think that's an amazing feature.

Heather: 57:10

that is the worst, but

Katie: 57:11

yeah, I use that. I would use that all the time and there would be even be some days where, you know, Sarah would come home from school and she had been running high all day and I would, you know, kind of go behind her back and be like, did she even give herself insulin for lunch? And, you know, I could see, like there was a couple days where she didn't like, maybe she thought she did and she never hit that final button

Heather: 57:31

yeah. Yeah.

Katie: 57:31

or she gave her, or she gave herself less than what I was telling her. So

Heather: 57:37

life

Katie: 57:37

yeah. I wouldn't like ho about it, but it was good for me to see like, oh, this is why, you know, rather than like blaming hormones or something like

Heather: 57:46

Yeah. It's, that's, that's one of the most amazing things. And, and when you do pattern management, I can't imagine not technology has is. So the technology is just so incredible because you don't have that it's diabetes is already confusing and there's so many, I use this word a million times variables, but you can look back and do this pattern management, look at the data. We imagine not having that though, you know, and.

Katie: 58:09

Or imagine a finger prick a million times a day to get it. Like, no, it wouldn't be happening here. I can tell you that. I love pumps because you can use temporary basal rates to, you know, you can set a basal rate that's higher or lower to kind of fight off things like stress, hormones, or menstrual cycles or increased activities. Higher fat meals, illnesses, travel pregnancy, all that sort of stuff. With a pump you're only having to do one stick every two or three days, right? When you change your pump set or your infusion set compared to like six or eight pokes a day with injections with a pump insulin can be delivered just with the push of a button, which was, is honestly my, one of my favorite things as a parent. Cuz if I have to change something while Sarah is asleep I can just tiptoe in there and push a few buttons and I do not have to wake her up unless of course she's gotta eat something cuz she has a low blood sugar. It's really virtually impossible. I at least I can say from, from the perspective of Omnipod, it's really virtually impossible to deliver accidental insulin. Which was something I worried about, you know, and people have asked me about that. Like, don't you just worry that the pump is just gonna all of a sudden give her all this insulin. I don't, that that's almost impossible to happen with Omnipod at least. What about tandem? Hmm.

Heather: 59:23

Oh, well, tandem is a touch. I tandem is a touch screen. So I do worry about that. You have to make sure I lock it. That's a, that's an interesting thing that you say you don't worry. I didn't worry for a long time about the, you know, the random technology taking over. I'm like, no, what do you, I have a friend who was diagnosed and he, he was diagnosed at 18. Now he's my age. We're 37. This was a while. And he, it took him a long time to get on a pump. And he has a, he has a very real Val, I didn't understand it. Cuz when I jumped on the pump, Alice was low. I said, this is amazing. I can't imagine doing this the other way. Why wouldn't you want it? He had a very real, very valid and he deals with it. Still fear of this technology that he, you know, he doesn't, it could, it's like, it's like, you know, Alexa sitting next to me, it's not, is it really gonna take over? I don't, I don't know, but he has a, it's a, I, I don't, you know, it's very real and he, you know, it's a panic. I, I don't necessarily fear that. It's just gonna randomly accidentally Boless, but there are mistakes that you can make as humans when you're using the, the technology. Like I said, you know, Tandem's a touchscreen, Ellis has just been dabbling, you know, he knows how to do it, but I, you know, I, I set, I lock him out and change the pin every once in a while so that he doesn't just play around. But, you know, we do it together, you know, and this morning he actually, we were doing walking through the screens and I said, give yourself, you know, 10 carbs, whatever it was. And then I saw him make a little error and go, oh no, wait, let me go back. And he's very savvy. Like he's on these kids, this on the phone. He knows how to do it very fast, but I said, but let, let me see qu, and he just quickly went through the check check, check. There's a bunch of checks on. Both of them actually Omnipod and 10, but I said, LS, you have to show me and you have to, it's very important that you take your time and we do it together. So there's just human error. On Omnipod, I used to, you know, lock it. So, you know, I, I would have a fear of my finger just going quickly. And instead of seven, I give 70. So you set that so you can set the max bolus. I didn't know that at first, but yeah. I think there's human error involved with it. And you don't know. I don't know. I don't sit again. I don't sit and think that my pump is gonna take over my house. It's technology. It's not it's, there's always stuff that can go wrong. You said the other night, you didn't know what happened to, you know, her PDM or her pod and it's techno, so things just do can go wrong.

Katie: 1:01:39

You always have to be vigilant. You can't just expect it to do everything for you for sure. Pumps definitely allow for some very precise dosing, which is really great, especially for the little itty bitty kiddos, because they just need those tiny amounts of insulin. So you can give like very precise doses. And then there's been many studies that show that people on pumps just tend to have better A1, CS and tiny range, which is huge. some cons of the pump are, you know, cost. Most insurance companies will cover a pump, but then there's of course there's copays and deductibles that have to be met. There is a humongous learning curve. I've said it several times on the podcast, but do not think that getting on an insulin pump is a magic wand that is gonna fix everything. There is a very steep learning curve. You have to know what you're doing. You have to enter your settings incorrectly. So it's great and it's wonderful and convenient. It makes life a lot easier, but it there's still a lot to learn. So technical difficulties. They can fail. Pumps can fail. Infusion sets, can fail. Cannulas can get kinked. Something can happen to where your insulin delivery is being interrupted. So that's a big con and that kind of leads to like the most major con of being on an insulin pump. Is that when you, when a pump does fail or if the cannula or tubing that's delivering the insulin gets kinked or knocked outta place or whatever it may be, you are not getting any insulin. So, you know, when you're on injections or MDI, you have that basal insulin dose running in the background. So you always have some amount of insulin in your system, which usually will prevent you from going into DKA. If you're on injections and you like skip a dose or forget to Boze for a meal or whatever, but on a pump, if insulin gets interrupted, you are no longer getting any insulin whatsoever. So you, there's definitely a higher risk for developing DKA and then there's skin problems, you know, and not everybody handles the adhesives well, For CGMs and then with a pump you're adding of course, another adhesive into the picture. And then some people, especially some children just don't tolerate infusion infusion set changes very well, cuz they can be uncomfortable. And if you have to do'em in public, that can be inconvenient and whatnot. But let's see, we already did. Hold on, let me look through my notes real quick. Yeah, we already did that, but yeah, that's kind of the ProCon list that the author gives and the book of insulin pumps. Definitely you can take advantage of the tent basal and extended bolus, which a lot of the hybrid closed loop systems do not have the extended bolus feature. I know tandem has it, but there's a limit. You can only do two hours right. Of an extended bolus.

Heather: 1:04:08

extended, we we, I, I think there is a limit cause it, I haven't really, we don't really extend as much now, which is very interesting, but we, again, we use BA basil, basil, basil. We use a, to cover a lot of our carbs, but I think that there is a, is a limit. It's set to, to it's automatically set to two. I'm not sure, but we, we don't really use it that much now, but the extended bullets went Omni PADD we, I loved it. I'm finding it's just a different system now, but I loved extending it was, it saved us. And then you could cancel it too. If, if you know, if Ellis. Decided that he didn't like what he was eating. We would just stop it. Yeah, it's a great feature.

Katie: 1:04:45

Yeah. I love it. I'm I also love that feature on the Omnipod pump. I'm kind of bummed that it doesn't exist with our DIY loop situation. No, you can't. It's they use absorption times, which again, another episode, another topic for another episode, but it's kind of their way of extending bolus. It's. Been a total mind shift, mind, mind shift for me and then I, I do know that the new Omnipod five system does not have extended bolus unless they're changing that. But I, as far as I know, they don't, they don't have it. So, but is there anything else you, well, anything else you would add to like the ProCon list of, of pumps or MDI?

Heather: 1:05:20

I think, I think we covered it. A lot of it. I mean, it's tech. we got it that he covered it. He covered it.

Katie: 1:05:26

Yeah,

Heather: 1:05:27

of course, I mean, there's the stuff that we talked about. I don't wanna beat and now on the head here, but yeah, we, we it's technology. It's amazing. I remember when I was first, when we first got on the pump, I couldn't imagine. I also just haven't I haven't done given him shots in a long time. I do think that when Ellis was first diagnosed too, I would, you meet all these people and you're new and you, they say I take a pump break. Sometimes, and I would be like, why, or I said, why would you want the tubing when you can have an Omnipod? Like, and I think I'm looking forward to, I'm trying to encourage Ellis more, to be able to switch back and forth eventually what he wants. If he needs a pump break, we haven't needed him on. He, I mean, we have in a way, but he doesn't know what that means yet. And I wasn't necessarily emotionally or mentally ready to do that to be doing the switch. But I feel like I'm getting closer. And we talked about it. I think the flexibility in switching there's pros and cons to all of, to every different program and, or, you know, every different device pump or, you know, and shots. But I think that it's cool. I look forward to being able to switch back and forth on a fly when he is bigger. I'm sure Sarah, I don't, does Sarah have an interest in like, you know, going back and forth? Do you guys do that

Katie: 1:06:39

well, we were kind of forced to when she dropped her PDM in the pool last, but then during the month of December last year she just decided she wanted to take a pump break. And I think she was just tired of just tired of wearing an extra thing on her body. I mean, She loves the Omnipod. And now, now that she's taken that pump break for a month, cuz it was like a solid,

Heather: 1:07:00

Is a long time. That's a,

Katie: 1:07:01

it was a long time I was. And during Christmas I'm like girl all the times to be on an

Heather: 1:07:06

I know there's so many things. Yeah. There's always things. There's nothing.

Katie: 1:07:09

I know. but now that she's taken that insulin pump, now that she's taking that pump break and is back on the Omnipod pump, I think she sees just how really is. So she hasn't brought it up. Like I remember when she took that pump break back in December, she had said maybe I'll take another pump break over the summer. Well, we're four weeks away from summer and I haven't heard one word about her wanting to take a pump break. So we'll see. I mean, if she wants to, that's fine. I don't, it doesn't bother me switching back and forth. You know, there, there really are pros and cons to each. I, I do love MDI for the simplicity of

Heather: 1:07:42

Yes, you just don't there's so much less stuff to carry

Katie: 1:07:46

Yeah. There's less stuff.

Heather: 1:07:47

diaper, my baby's four. I still use this like the same diaper bag because you have to have double at the sets. And, I guess my friend by who I was talking about before, I remember he was just walking around. He didn't have a bag with all this stuff. I know it's different with our, with our kids too. We also, I have extra stuff, stuff, stuff, but he had in his pockets, his extra, his meter, his, his low treats, low treatments and his pen and, you know, maybe extra test strips and he just was regular, you know? So Matt.

Katie: 1:08:16

Yeah. I know. I, I, I think MDI is a lot simpler. Mentally for me, I'm sure not everybody feels that way, but for me it was just less of a. A mental burden, you know, you're not having to want, think about like, oh, do I need to set a tent basal or do I need to, you know, suspend it? Or should I extend this bolus or whatever? Like MDIs was a little simpler in that regard. But,

Heather: 1:08:36

But if you get used to the pump doing the auto, you know, figuring out your bolus, you kind of have to think back and say, what's my carb ratio at this. Do you even when you're, when you go back to MDI, do you even, yeah. You still have carb ratios during the day. What do you do? You carry that? I, you have that info on your phone. I forgot. You know

Katie: 1:08:53

yeah, I had to go, I had to go look it up in our pump settings, you know, is, I

Heather: 1:08:58

Right.

Katie: 1:08:58

don't even know. It all, it'll come back to you quick though. You know, it won't take more than 24 hours

Heather: 1:09:03

when we switched his hand and I said, am I gonna forget everything? What if I don't like it? And I wanna go back, am I gonna forget everything? You don't, you go back and you just. It's

Katie: 1:09:10

yeah.

Heather: 1:09:10

it riding a bike? I don't know. It's mentally exhausting, but you do it. We do it.

Katie: 1:09:14

right, right. I mean, I, I really do think that I, I think we all, as parents need to be at least willing to let our kids kind of choose within reason. I mean, I did tell Sarah like, Hey, we're not like you can take a pump break, but like, we're not gonna take a pump break for three days and then go back on the pump for three days and then take a pump. Like I need you to at least admit like,

Heather: 1:09:33

Yeah.

Katie: 1:09:33

you know, for a certain period of time. But I think we all need to be okay with our kids

Heather: 1:09:39

I'm I wanna encourage it because it's their bodies and their learning, and this is new to everybody and it's their bodies. They should be in control of it control is another topic for another time too. I just wanna point out one thing about this chapter in general, that as you know, we were, you were reading all of the programs and made a joke about it going on this book in general, but, and specifically this chapter just occurred to me like, you know, there's people that are diagnosed, that, that when they're first diagnosed, they don't have support as much. I feel very fortunate. I had amazing team AMA an amazing team that we're still with. And they gave me they, without overwhelming, they gave us information, you know, they're there for us. A lot of people don't have that support and don't know that there are so many options and don't know that you can look past, you know, the one thing that you were told in the hospital and having this information is very helpful because people, you know, are not fortunate to have, you know, teams that give them information. I've seen people on Facebook not being educated and read this book, know that there's, there's so many different options find what fits for you you know, ask questions, keep asking questions. Some people, I feel bad for some people that I've met. It's hard. It's hard, no matter what, but if you don't have support and you don't know that there's options,

Katie: 1:10:51

no, I, I think that's very true, like there's options. And I think it's important people for, for people to know too, that like, this is not a lifelong, I mean, diabetes is a lifelong commitment, but the basal BOS approach that you choose is not a long commitment. And the author points that out towards the end of the chapter. Like, don't feel like if you. This way of doing things now that you have to stick with that forever, like you can switch and you can go back and you can change your mind, like you don't. And if your endocrinologist has a problem with that, if they're giving you some pushback for wanting to change or, or switch back and forth, like you need to ask them why, you know, why they're uncomfortable with that. And you know, may maybe even consider finding a new endocrinologist cuz you know, there's really no reason. Unless your insurance is just refusing to pay for things for whatever reason. Like there's, there's no reason why you can't try other things and switch back and

Heather: 1:11:40

Yeah. There's definitely times where it's a, it's a challenge. And you said, mentioned insurance and there's hoops that you gotta go through, but there's time you have to it's your there's time to make the change. If something doesn't work, make the change, right? Yeah. Yeah.

Katie: 1:11:54

All right. I can hear. Okay. We gotta go. We're.

Heather: 1:11:56

and you have to fix your AC. Thank you. I'm I feel like we went on and on and I'm so sorry if I was rambling, but thank you for doing this. I'm like, thank you for having me on it. It was amazing.

Katie: 1:12:05

Heather you were fabulous. So thank you.

Heather: 1:12:07

me now from

Katie: 1:12:08

And, oh my gosh. I love it, mom. Where are you? Okay, bye. My lady.

Heather: 1:12:14

Thank you. Bye.

Katie: 1:12:16

All right. My friends, that is it for our show today. Join us next time. As we cover chapter six, called basal insulin dosing with my friend and T one D mom, Shannon. 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. 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 more information on DIY loop, which is a hybrid closed loop system. That you build yourself and a link to the diabetes. The musical episode that Heather and I talked about that episode is very silly. So if diabetes has you down today, that would be a good one to go check out. Okay. My friends, I will chat with you next week, but until then stay calm and Boless on.