Episode 15: Do As We Say, Not As We Do!

Welcome to Think Like a Pancreas, the podcast. Our goal is to keep you informed, inspired, and a little entertained on all things diabetes. The information contained in the program is based on the experience and opinions of the Integrated Diabetes Services Clinical Team. Since this is a very individualized condition, please check with your healthcare provider before implementing any of the weird stuff we may happen to share with you today.

I'm your host, Gary Scheiner, owner and clinical director of Integrated Diabetes Services. And today we've got something really fun to talk about, hacks, creative and odd things we do that are off the beaten path to better enhance our diabetes management or our quality of life. And I am delighted to be joined by our clinical team.

We may have a couple more people joining us, but I wanted to give everybody a chance just to introduce themselves quickly. Kathryn, why don't you go first since you love going first? Okay. My name is Kathryn, of course, and I am a clinical exercise physiologist, diabetes care and education specialist. And I use DIY loop for my personal management. And that's my favorite thing. Awesome. And Kathryn is recently wed. Yep. Enjoy. And she's got a doggy. Yep. Her name is gravy.

And I have two great cats, Theo and Gunther, and they're just the best things ever. Very nice. All right, Jenny. Give us your quick background. Sure. So I'm Jenny. I'm a registered dietitian and a certified diabetes care and education specialist. I've had type one for 36 years. I've used a lot of different pumps. I think I've used almost all the CGM's that have been on the market. I also am a DIY looper and yeah I work with a lot of clients through pregnancy preconception.

Women's health is really important to me because it's a sort of left out but it's also very left out in terms of diabetes management and what to expect and what to do. So yeah that's me. Yay! Yeah and the reason Jenny's bobbing up and down is because she literally walks the walk and talks the talk. She's on a standing treadmill right now. She uses that most of the time when you're working. How many hours a day do you spend on that? Well I'm at work.

all day, different hours of the day, obviously, and some clients all walk and some clients, you know, that I chat with, I won't. But yeah, I mean, I probably walk a good couple of hours a day, again, not at a terribly high pace. I mean, I'm not like 30 miles a day, I'm not getting, but it's certainly more than sitting, which is great. And Dana has one and Kathryn has one as well, although Kathryn's, I don't know, it blew up or something this morning, right?

I will say that the treadmill is my favorite hack. And it is the like the days that I am on this walking pad working, I probably get more steps than when I'm not working, which is like the best hack ever. Yeah, I get my hack, if you're not coordinated enough for a treadmill, because I'm not is I go wobble board. Yeah, my desk. But you get the core exercise without the actual movement, because I will fall over. I would probably fall over more with that than with the treadmill.

I think I actually did a pretty good job. We had us close our eyes before and I had them close while I was walking. I was amazed that I didn't fall off of it. So yay. So if we hear a loud thud, we know what happened. No, no, I had to sit down during meetings or you guys get to watch. It looks like there's an earthquake happening in my office the entire time. So patient calls and meetings, I have to get stationary. Dana, tell us about yourself and where you are.

I am a registered dietician and a diabetes care and education specialist as well. I am talking to you from Dallas, Texas, and I've got my two dogs next to my walking pad. And I think, yeah, I'll normally get maybe 25,000 steps or on a high day and a low day is like 18,000. So Um, yeah, for sure this is my favorite hack, but I also tell people make your workspace. If you're sitting all day long, try to figure out a way to be more active. You know, those chair peddlers are awesome dumbbells.

I can put walking like ankle weights on, um, just to sneak it in something you're already doing. I think that's the best hack ever. Dana's. I had to hire Dana, despite her being a Cowboys fan. That's tough. Okay. You gotta stop with the sports business. It's not personal. I don't mess with you and your Eagles. It just doesn't sit well It's fine for you, Gary. It's just fine. I will survive. The hack is somehow you'll find a way. Yeah. Somehow. It's all fine. It's all fine. It's all good.

Yeah. Alicia, your background. I am Alicia Downs with the RN registered nurse Master's of science of nursing in. education, certified diabetes care and education specialist, board certified in advanced diabetes management. My pronouns are she/they I'm gender ambivalent. I am yeah, I'm a nurse. So my specialties are medical complexity.

So folks that have maybe their medical world is impacting their diabetes world or their diabetes world impacting their medical world or they're not sure what in the world is going on. And also behavioral mental health. I have a extensive psych background in nursing. And so the two worlds go together quite a lot. And I am unlike a lot of us here. I'm a tandem user. I'm I'm our I'm our I don't know if Tavia's are you tandem? Are you tubing it these days?

Are you say I am DIY looping it but I have my tandem I'm the lone tuber hold out here mostly because I am also probably our reigning auto-immune queen. My skin cannot tolerate pods. I will be mobile being after I get back from the ADA meeting. I will be jealous because I want to be so that I might not let it go. You think you'll find some some hacks with Moby? I don't know what kind of hacks you're gonna find but I'm I already have a Moby hack. I haven't even gotten to use it yet.

And I already have one. Me too. Hold that thought. Hold that thought. And Alicia's in the Philly suburbs way. Yep. So I am currently 30 feet from Gary. So I'm here in our Philly office. I live about 45 minutes way out. He like it's not like in buggy country. I'm like the last step to stop on the line. Like, just because I just because I can't bike into the office doesn't mean I'm like in the boonies.

Gary just acts like I did in in Philly like if you can't walk to a good cheese steak that but you live in in no man's land but I'm the office nerd. I'm the one with all the nerdy toys in office. here, here and at home. Cool. All right, Tavia. I'm Tavia Vital. I'm a registered nurse and certified diabetes care and education specialist. I've lived with type one for about a million years. So I've got the, I own the crown. You are so old.

Longest living person on our team or not long, longest time lived with type one diabetes so far on our team. How about that? How many years is it? A million. A million. A million. I mean, a million is a whole lot. 43 this year. Oh man. And I have not been. Fourty years. I was going to say it because then you know, I'm at least older than, right? Like, oh well. Tavia, have you had diabetes since you were like negative six years old? Like yes. Thank you, Alicia.

Yes. Like you were an ovum with diabetes. How does that calculate? I like, I like Alicia. She's my favorite today. I work with a variety of different people. across the lifespan with type 1 diabetes. So little babies, toddlers, young children, and their parents, of course. Several adolescents at any given time and their parents, usually.

Young adults, older adults, people who are working on trying to become pregnant or who are pregnant and working through healthy pregnancy management with their diabetes. I also am bilingual in Spanish, so I work with many of our Spanish -speaking clients. I'm in eastern Iowa. I think I didn't say that part. Eastern Iowa. That's right. Corn is high as the eye can see. Only if I go a couple of blocks that way. I can't see any corn from my office. All right. A couple blocks.

Corn's probably growing really well this year. We've had a lot of rain. Yes. Rain and heat. Corn's happy. Corn is happy. Now, if you take diabetes and remove the EDEs, you have DAP, and that's Paula. Paula, tell us about your blog. My name is Paula. I am a family physician and diatologist and a registered or certified diabetes education specialist. I spend some of my day working with the IDS team online.

Some of my day is seeing patients mainly with type 2 diabetes, but still almost all on insulin. I also treat obesity, and I don't hold a grudge against Gary or Dana because they actually support baseball teams, not cricket teams, and football teams, not rugby teams. You can't have it all. You got to tell the folks at home where you're from. Say again, sorry? You got to tell the folks at home where you're from. I'm from South Africa. Did I miss that out? Sorry. You didn't say that. Oh, sorry.

I'm from Durban in South Africa, and it's currently winter, so it's dark here already. It's six o 'clock in the evening. And I actually have a blanket wrapped over me because it's quite cold this evening. Oh, my gosh. Everybody is sweating in the United States. I just want to point out that it's hotter in Pennsylvania that it is in Florida. So Yeah, rub it in. Yeah, we don't want people to think you were from like Tennessee or Boston or something, Paul. We wouldn't want that now.

So Christy, just just join. Christy, tell tell everybody a little bit about yourself. Hi, yeah, um, my name is Christy Pagio, and I am located in Grand Rapids, Michigan. I am a therapist. I'm a mental skills specialist. I do coaching and therapy for people with diabetes across the lifespan. And I've worked in the endocrinology field for 15 years before going into private practice. The average age ranges that I work with are mostly adults, but I do have some kiddos that I work with with type one.

I'm really picky about that. And older adults as well, living with diabetes. I myself have lived with type one for, I just had my 24 year anniversary with it. This month, I'm a looper and I'm also, I'm involved with other diabetes communities too, around the country, but integrated is one of the favorites. Yeah, and Christie provides therapy and coaching services for people with emotional and mental health concerns. And our other clinician, Anna Sabino couldn't be here today.

She was looking forward to this. And she shared with me some of her favorite hacks. We have time, I'll share those with everybody. Hacks are interesting. And I think the reasons we need hacks in diabetes is number one, the people who design the devices that we use are usually a bunch of engineers who don't have diabetes, and they don't get what it's like living and using these devices.

And if by some miracle, they actually develop something that really does work well, then the FDA won't approve it because somebody might hurt themselves, stub their toe or something, and we don't get to use them. So we have to get creative, living with this disease day in, day out, year after year, we can come up with some creative solutions to some of the common challenges that we all face. Now I do have a special pride, and you can see it back here.

41 pounds of glucose tablets goes to whichever clinician provides them. Yeah, we've got a lot of glucose tablets here in the office. Not because we're going low that much, but. We just like giving these away. I was just going to say, maybe you have that because we don't go that low that much. That's right. We prepared. No one uses. That's right. We have had those for years. They don't spoil these things. They'll survive the next ice age. They don't get mold. The sugar crystals start.

Color of it. Yeah. It's like whatever the, the not ice burn, you know, the freezer burn. It's like a glucose burn. They get like little poke. They're like polka dots, like the artificial color and kind of like. Does the thing. Thousand years from now the earth's going to be covered with two things, cockroaches and glucose tablet tubes. That's all that's going to be left. That's all. No, and lancet. Oh, yeah, lancet. And they'll all still be sterile and ready to use because we never ever.

Nobody's used them ever. Does anybody have a hack related to low blood sugar or hypoglycemia in some way? I do. What do you got? So mine's around physical activity and the heat. So if you're going to be outside mowing the lawn doing some gardening, I always used to get stuck midway through and then start going low and then my low brain would rationalize. I'll just finish this thing and then I'll go in, which then by the time you treat, it's so low.

So my hack is to, if you know you're going to be outside working on a project, bring your stuff with you. Bring whatever you treat, Gatorade, glucose tablets, glucose gel. If it's had out, try to have liquid with glucose or sugar in it. And then you don't have to stop working. You can chug and mow at the same time if you need to. A beer hat with Gatorade in it. Whatever works. I would mess up my sand, but sure.

Speaking of Gatorade, I didn't even realize how great it was until I started sharing it with people and it just was like the best thing I've ever told them. So if you go on Amazon, you can get like little mason jar things and put a cap on it and get Gatorade powder, scoop the Gatorade powder and put it in so you can get highly concentrated Gatorade with a very small amount of water.

So it's not sloshing around in your stomach and it tastes still a lot better than glucose tabs, glucose gels, especially for runners. Great option. The additional hack to that would be if you are like me and you grew up with a mother who saved all the possible packaging that could be reused and repurposed for something else. You can save the glucose tablet containers, put in the powder, and then you've got your container already. and it's identified as a glucose, a low glucose treatment for you.

So you don't even have to label it. And then they're pretty easy to obviously put water into. Shot and shake and down you go. That's what I do. The other- Well, if you're a runner, those mini little bottles that you put on your belt, those are the perfect size for glucose or for sugar water, yeah. Yeah. It actually goes along with a hack that I had for lows, which is liquid tends to, for most people, get absorbed faster or better for lows than chewable or edible types of things.

And an additional one to that, if you have access to some warm liquid, that can also get absorbed much faster. So even at home putting some honey in some warm water rather than just using jelly beans. that can actually bring the low up faster as well. So that's one of my, one of my hacks.

Milo hack is if you're, especially if you're like, if you're on an SGL or GOP one or you've got gastroparesis and things are like, or you're really stinking full, like you didn't time your insulin well, or you eat a whole lot and then you're really active and your gut kind of pauses and your insulin hits and you're crashing, anything that's going to make your gut not absorb your low treatment as fast as you would like.

You know, chew up your tabs, grab your gel, whatever, hold it in your mouth for a little bit, hold it on your tongue, hold it against your cheeks. You can actually start to absorb a little bit of that glucose through the buccal mucosa under your tongue, through your cheeks, straight into your bloodstream and get that little bit of glucose. That little bit of a bump can actually start to short circuit those symptoms.

Start to bring your blood glucose, just give you that little bit of an edge before you swallow it. Also going to warm it up just a little bit, make it absorb through your stomach. And that's a good trick for parents also, because you can rub jelly or honey in your little one's cheek. Same thing that you're just describing. Especially in the middle of the night. Somebody's asleep or they're starting to a little bit and you don't have the glucagon because shame on you.

You didn't do nothing that you're supposed to do because, you know, you can, yeah, you can powder, take a powder or gel and just rub it on the cheek. Someone doesn't have to physically swallow. Yeah. Don't, don't waterboard somebody with glucose gel, but you can smear it on the cheek and it will absorb while you're waiting for the EMTs to get there. It'd be a fun contest to see who can stuff the most glucose tabs in their cheeks. Really? We need to do that. You can start with it.

You start Gary. You start crooked. Right. And I also think, yeah, we have to mention. Redisting with glucagon is a great hack since that's not, you know, out in the open FDA approved But we all on the team have experimented with that and found really good success Yes, see if I have one of the Xeras violets While you can buy sterile vials Keep it by morning Amazon. Yeah best. Yeah Buy a sterile vial inject that pen into that sterile vial and then you can do it, right?

Or you can get the pre -filled syringe Well, that's the pre -filled yeah the vial comes in here Has 20 units basically of liquid glucagon And it's as drawn up in a u100 insulin syringe just to clarify syringe drop two to four units And it's it's pretty effective for preventing lows during exercise. I find it amazing before pickleball. I know that sounds crazy, but pickleball is like challenging for lows. So the little bit for me, it's three units. Perfect.

Yeah. And speaking of the syringes, one of my favorite hacks to teach patients, especially those who are on pumps, and you need backup because you never know where you could be where you get some kind of alarm and occlusion or your infusion site pulls out. These things happen. You need to have a way of giving yourself insulin until you're home and can do a proper pump change out.

So rather than carrying around a pen with insulin or a vial with insulin, because those go bad over time when you've got them at room temp, I teach people just to carry an empty syringe and even better get a syringe that's individually wrapped, I think, to room about who made these. I forgot what company. Well, can and distributed these. But having a syringe, you can draw insulin out of any pump.

You just have to put your needle in where you inject the insulin or into the cartridge itself and draw out. You can give yourself insulin every hour, just equal maybe to your basal rate, half a unit an hour, a unit an hour, and keep yourself going at least until you're home and can do a proper change out. That way you don't have to lug all this stuff with you for changing out your sites. Just having an empty syringe can save you from putting it into a lot of problems.

Here's my hack that I build on that. I carry a little more stuff because I don't know, because I have myself and my oldest son also as type one. So I've got my insulin vial and a little rubber wrapper thing. So if I drop it on the tile or the cement, it'll bounce probably. And I've got two empty syringes on a good day. Sometimes there's only one in there. And I have my low treatment of choice, which is Smarties that I buy in bulk, all in one handy, brightly colored, so I can find it to go bag.

And that just comes with me, whether I'm using my normal purse, or if we're going to go hiking, I'll throw it in my hiking bag. I sneeze, have what I need in a little bit. Yeah. Good thing with the syringes though, you can keep it in your car. They don't go bad in the heat. So, you know, they always say never leave insulin in the car. Even a free -oh pouch on a hot day is not going to protect that well. These empty syringes, they still stand up to all kinds of temperatures.

So keep one in your car, keep it in your briefcase, your desk at work, you know, backpack, you know, keep that empty syringe handy. Never know when you might need one. I tell patients when you, even if you've never been on syringes, like a lot of people were diagnosed and they started right on pens, they never used a syringe. Get a box of syringes. You don't have to have a prescription in every state. Some states you do. Get your doctor, write you a script.

Say just write me a script for syringes. Get one box and squirrel them away everywhere. Keep one at a friend's house. Keep one where you work. Like you said, where you work, where you play, where you worship, just squirrel them all over your world. And that way, wherever you are, when your world goes sideways, you've got one at a time. I actually, I keep, my load treatment of choice is like fruit snacks.

So I keep a fruit snack pack and a syringe taped together, and then I just squirrel them around my world. So high or low, I can fix it. I find that very useful, Alicia, regards to keeping pens in all different places, is I say to people, most of my patients are on a basil bowlers. They don't really use pumps. So I say keep your breakfast and dinner pen. You can use the same one at home, and then have a separate pen that you have at work that you use to inject yourself at lunchtime.

So you're not moving pens backwards and forwards all the time. You've got some at work, some at home, some at a friend's house. I know it doesn't hurt stability and temperature by doing that too. Right. Moving all over the place. Less, fewer bubbles since you're not carrying it around, shaking it up. People are more likely to take their insulin if it's convenient, if it's right there. Yep. Any glucose monitoring hacks?

I have one of the products that you get that the little test tube, or the little tubes that your test strips come in. I, for years, used to use the freestyle light meters. And so I saved a lot of the little vials, because they're really great for bringing along on travel. Aspirin, ibuprofen, Tums fit perfectly into them, like a stack of Tums. So they're great for a little bit. of things. And then I just with a Sharpie marker on the top, write what is inside.

And it's a lot easier than packing that big old bottle of something. So for my prescription meds, when I travel, I've got old life scanned vials that I test trip files that I use. We used to use like film canisters with old cameras. And now we all choose test strips that we don't use as much of anymore either. Film canisters. Wow. Uh huh. I know that's a throwback. Do you have a Polaroid at some point also? I have a Polaroid now.

Yeah, those are in again. Yeah, expensive. Yes. Well, you were asking about CGM hacking. And for the G7, I don't even know if this should be a hack. It's just kind of standard of care. As soon as my grace period starts with those 12 hours, I 100% put my new one on and let it marinate under my skin. Because otherwise I was getting so many false lows. And this helps tremendously. And it eliminates the warm up time.

You know, when you don't cancel your old sensor until your new one has been on for a while, and then it works immediately, no time without data. Yeah. They used to call that the wedding time. I remember with old CGM's it used to be what we were told to do that. I don't know why it stopped telling us to do that. So, yeah, well I think, yeah, now with the size that everything's so much smaller people don't mind wearing to CGM's along with their pump site but it used to be so much more cumbersome.

Yeah, yeah. Remember when we used to do finger sticks a few times a day and it would be like six hours between knowing what our blood sugar was. Now 30 minutes is too long, we can't go that long. I never did that remember when your fingers want this color. Yeah, like, oh my gosh, I still don't have normal fingerprints. When you get fingerprinted for identification, I still have spots that don't. And they'll like, but the colors right.

My hat and this is an old hack it may not apply much anymore, but for years the companies that made glucose meters. We're trying to build an all in one system, where you had the meter, the Lansing device and the test strips all built into a unit, and sometimes they got big and cumbersome. One company made one that had a little vacuum inside that would suck the drop from your finger when it pricked it. It was just such a lot of work and a lot of effort.

And I came up with the idea of using a rubber band, just wrapped in this stuff together. Now I have an all in one, I've got my meter, I got my strips, I got my Lansing device. There you go. I was thinking of marketing this. Diabetes written on the rubber band. Right. Here's the $17 for it. If you want today, I will include a second rubber band at no extra cost. Wow, two for one different color. I don't want the same colored rubber band.

Yeah. Has anyone had the experience of using a glucometer and taking the batteries out and putting them on your person at night when you have sub -zero temperatures? Because the glucometers don't, they're not licensed to use at sub -zero temperatures. I just don't think so. They'll go to sub -zero temperatures. Sub -zero temperatures. I don't think so. I think it's a sub -zero temperatures. But it's a cool thing. How do you keep yourself alive of sleeping in self -destruct?

But apparently, you could take the batteries out, and you just put the batteries on you. So you put the batteries on your person, and it keeps them warm overnight. So then when you want to taste your sugar, you could put them back in again. Another option that's kind of in that I've had a number of skiers or who are, and they do many times bring their glucometer along on the hills or hikers in the mountainous kinds of areas. And what I usually recommend doing is taking one of the mitten.

Like you put the warmers in your mittens in cold, cold weather. You just take one of those mitten warmers and you pop it into the little pouch for your glucometer and it doesn't overheat it, but it keeps it nice and warm instead of freezing. So then you don't even have to take that. You also love for that same hack, baby socks are like the perfect size for all of that. And everyone has like a stray baby sock that never has a match again and perfect.

Yeah, when I first started looping, you know, it wasn't workable with Omnipod. You had to use the old Medtronic, which many people still do, but I would like to wear my pump like in my bra, but then it's all sweaty and like, so I used a baby sock. Baby sock was perfect. Yeah, it was the perfect size. I do it with my tandem pump because you have to wear it screen side out. And that once made me Iron Man.

And I was at church talking to my pastor and it lit up low and it was mortifying because my pastor suddenly was, yeah. No, he was like, you were blessed. It all worked out for you. I was just talking to the man and couldn't understand why he couldn't take his eyes off my blouse. And then I looked down and realized, so now if I do have to wear my pump there, I put it in a black baby sock. So it keeps everything nice and... I like the Iron Man.

Not Iron Man. Anyone have a nutrition related app or a food, or not hack that they'd come up with? I have one when I'm eating out. So we all know like bolus timing and trying to pre -bolus and we try to get that, we try to zhuzh it and get that timing in right.

But we've all been at a restaurant where like we walk in and it's crowded and we're like, we have no idea when my food hits the table. I am not risking this. I know I need a 25 minute pre -bolus on this, but I am not risking it because I have no idea when my food's hitting the table. But... One of the hacks I'll do is I will identify the higher glycemic index items on my plate and eat them last.

Effectively having pre -bolist those items by an additional 15 or 20 minutes because I just haven't put them in my body yet. So I have pre -bolist a whole meal but I can pre -bolist those things. Right. Eat your protein first. Yeah. I mean, those are good hacks. The protein first is from the glucose goddess. That's one of... Well, but also for weight management too. We always tend to eat the protein if that's like the main event of our meal.

And so if you eat the protein first and you're trying to manage weight, that's a great way not to feel like you're finishing your plate for no... I always say for the pre -bolist for a restaurant or even an unknown timing at... a friend's house or a gathering around a holiday when you're not quite sure exactly, but you have a relative idea. Most people, and this even goes for kids or parents of kids, have an idea of about how much they're typically going to eat.

And I say, you know, if your typical meal at a restaurant is 50 grams of carb, even if you pre -bolus 5 to 10 of that, you've got something started. You've got something that's also if the meal is delayed and they break all your plates on the floor and have to start over, that's a pretty quick and easy coverage, rather than having to eat another meal and then not being hungry and having to bolus again for later. I call that the down payment approach. Yeah, nice. Yeah, adults can do that too.

They can bolus for half of what they think they're going to eat ahead of time, even if they're not sure how much they're going to have. When I'm teaching carb counting and carb estimation, we teach a lot. My favorite hack is just using your own hand as a measuring tool. A slice of pizza the size of an adult's hand is usually pretty close to 30 grams.

Most adults' fists are about a one -cup portion, and you can convert a cup of anything into grams of carb and be reasonably close and find that works really nicely. My hack for pre -bolusing, especially for teenagers or kids that are just starting to learn about that aspect, is to focus on blood sugars. So your blood sugar is 180, drop the last number of that blood sugar, and then the pre -bolus time is 18 minutes.

And just to kind of start getting little ones and teenagers who maybe don't want to think through, you know, glycemic index and all of that, that to me is a great kind of game hack. I mean, it's not fun, but it's, you know, better than talking about the glycemic index of teenagers. It doesn't like a good sandwich. A long sandwich. You guys call them different things, different parts of the country. Here in Philly, they're hoagies. What do you call long sandwiches where you are?

Subs. Sub. No hero. I'll fill in for Anna and say Grind -a. Oh yeah. What do you guys call long sandwiches? Sub. Subs. Well, different names. Yeah. Grinders. But eight grams an inch. Quick and easy way to estimate the carbs in a hoagie hero sub grinder. Eight grams an inch. And another easy... That's sushi rolls too. That's what I was going to say. For both adults, between where your wrist is and the top of your tall middle finger is usually somewhere between about six to eight inches.

So if you put that on top of a roll or a big bun, it's a nice visual for that hack of about eight grams per inch. Good one. Yeah. Anna, speaking of her, she had an interesting hack she wanted me to share. And this is specific to pump users who are using tube pumps. She said that before she goes out anywhere, she puts a second infusion set on her skin just in case her sight fails or pulls out accidentally. She can just take her tube, connect it into the other one and she's ready to go.

Or at least have an extra one in your bag, right? What I'm guessing when Anna does that is when she's gonna go participate and her really, what's the word I'm looking for? Really intensive sporting activities, her physical workouts that she's doing. A tough mutter. Yeah, yeah. Just crossfit. Kristy, did you have... Well, that's kind of... Do you have any hacks?

I was just gonna say, if you're changing shorter then a hack for at least insurance coverage for supplies is that you tell your insurance company that you're changing your supplies every two days instead of three so that you have extra supplies to do that. Yeah. Great one. Yeah, for me, I love hearing everybody's little hacks. The one that stood out to me the most is the syringe piece.

So I recently attended a conference and thought after my busy working day before I traveled across the state for this conference that I had thrown a pump site in and had not. But because I had syringes everywhere, I was able to do the hack with the syringe to get me through the next 12 hours until I got home. So those are hugely helpful. Does that mean I win the 41 pounds of glucose tablets? They're all yours, Gary. Well, let me let the glucose... All yours.

I've been stuck with them all this time. What am I gonna do with all that stuff? All yours. For seven years, I don't think I've ever seen Gary eat a glucose tablet. I have, exactly. I think the last few glucose tablets I honestly had were the ones that were made by a company that no longer exists, the Glucolift ones. Because not only were the flavors great, they didn't contain a whole bunch of beneficial. colors and stuffs.

And then when they went out of business, I was like, well, gotta find something else. The only ones that the fruit punch flavor, the only ones I was going to say, I have, I was like, now, now that you held that up, I have heard that rattle rattle sound come from your office. Yeah. I mean, I keep it here for in case patients go low while they're here, but yeah, I need them sometimes too. It's usually pretzels. Pretzels are way over there.

Well, that's a good, it's a good quiz question on this hack in terms of glycemic impact. I know one of the questions on our carb, I think carb counting or was one of those advanced carb counting kind of things that we put out, it had a question of which one is going to hit your blood sugar the fastest based on glycemic index. And I think it was there's glucose tablet. No, and maybe it doesn't including glucose tablets. I think it was saltines, regular soda, chocolate and Juice.

I think those were the four. And the one with the highest glycemic index and most people get it wrong is saltine crackers. Right, but I don't want to treat Lowe's with saltines, but I mean, everyone who's ever been to like a fish restaurant, they have saltine crackers on the table. Yeah, you know, that's going to skyrocket your blood layers. I don't know if oyster crackers are as fast. They probably they are.

Because it all dissolves, like what Alicia was saying earlier, all dissolves in your mouth before it even hits your gut. All right, so we have hack hacks to bits. Anyone else have a really creative hack they want to want to share before we wrap up? I've got some like, seriously, not FDA approved hacks. Yeah, that's where those are the best ones. I've got that. Okay. Any and all representatives diabetes, please. It's hurting down the volume now. I will deny it to my great.

My favorite hacks are the ones that let me get away with just living my life and dealing with diabetes later. So my favorite ones when I am that person that drives until the fuel light comes on. And my new car actually tells me like you have 34 miles left until you run out of gas. I drove until it got down to three the other day.

I was very proud of myself. So my favorite is when my pump goes off. And it says you're out of insulin. The first my first hack is that if I go in and just tell it load and just go to the first screen, I don't have to do anything. But it shuts up. So now it stops beeping at me. So it's like four o 'clock in the morning. And I just go shut up. I just go to that first load screen and just let it sit there. Because I'm not going to go into DKA between now and 530 when my alarm goes off. I'm okay.

And I can go back to living my life and or sleeping for like a safe amount of time. And from there, my next favorite hack when I run out of insulin in my pump is that I inevitably will run out insulin when I get to a restaurant. Or I look down I've got like two units left and this is not a kind of restaurant. This is like I'm gonna hit some carbs kind of restaurant. But I know that there's still insulin in here.

And I happen to know that if I do a tubing fill insulin will just keep coming out of this sucker. There's usually somewhere in the order of like 20 units still still left in the thing. So the diabetes educator and me has to say hey I am not getting a precision dose out of this thing. But the person who uses a pretty large volume of insulin anyway and who survived the days when I didn't check my blood sugar on a regular basis and I practice some pretty swaggy diabetes management.

I know that I can then do a tubing fill and it'll. Show me that I'm getting roughly like six units of insulin. What you said is people on large doses. If you're taking less than say 50 units a day, it's dangerous. Cause this thing is your typical meal bowl is, is on the order of less than six units. That's not going to work for you. But if you're, if you're swinging like 10 units for a meal bowl list, desert Island, you got no insulin, nothing. Yeah, you can certainly do that.

So like Gary said, if you've got a syringe handy though, pull that insulin out of there. Now I can take half a unit with the pods. People often complain if their pod comes off or alarms and they can't use it, they lose all the insulin. You can put the syringe right in that injection hole, slowly, slowly draw it out. It's almost an opposite of the fill. If the pot is killing it, the pot up here and you kind of angle it down, but you can definitely fill easily.

I mean, I've gotten at least 80% of what I've filled the pod when it's died within 24 hours. Um, that's a great over insulin after three days. I would let it go in the trash, but for sure. If it's soon, it comes out like sudsy and like bubbly. I mean, flick it out. Let that syringe sit for a little while. It's all going to settle out, flick that air out and you're good to go.

My last little hack for, um, not, um, getting as much into, uh, I guess waste and, or using less space in your diabetes, throwaway red boxes is this whole thing does not have to go in that box, right? All you have to do is unscrew the cap, pull out the little needle and put that right into it lasts for a year. You can even get the little nippers and take up just the needle off. And that's all that has to go. red part.

Yeah for years my dad used to take my syringes and just snap the top off because it cracks off pretty easily and that's what used to go in my red disposables rather than the whole syringe. So all right so I hope everyone listening and got some useful tidbits of information and ideas just remember you didn't hear it from us. Okay here are people with diabetes right giving you what can work. Yeah take nothing of this as medical advice check with your medical caregiver.

Absolutely all right so I want to thank everyone for joining today.