July 22, 2025 • 38 mins
In Episode 44 of Think Like a Pancreas—The Podcast, Integrated Diabetes Services nutrition experts Dana Roseman and Jennifer Smith discuss how nutrition guidelines for diabetes have changed since they were both diagnosed almost 30 years ago.
They emphasize the importance of individualized nutrition plans that change as you change. This dynamic duo offers tips and insights on exercise, fasting, new food choices, and the importance of a comprehensive approach to diabetes management.
Meet Your HostsDana Roseman, MPH, CDCES, RDN, LDN, is the Director of Technology and Applied Research for Integrated Diabetes Services. She is a Certified Diabetes Care & Education Specialist and Registered Dietitian with a Master’s in Public Health from the University of Illinois at Chicago, a Bachelor’s in Science from the University of Texas at Austin, and clinical nutrition training from UT Southwestern Medical Center. Diagnosed with Type 1 Diabetes, she has spent nearly 20 years improving diabetes care through technology, research, and patient education—including expertise with insulin pumps, continuous glucose monitors, and hybrid closed-loop systems. Dana serves as Research Information Liaison for the Dallas JDRF, is active on nonprofit boards, and empowers people with diabetes to thrive physically and mentally, making her a leading voice in diabetes innovation.
Jennifer Smith, RD, LD, CDCES is the Director of Lifestyle and Nutrition for Integrated Diabetes Services. She is renowned for her expertise in nutrition, diabetes education, and athletic performance. With a Bachelor’s Degree in Human Nutrition and Biology from the University of Wisconsin, Jennifer is a Registered Dietitian, Licensed Dietitian, Certified Diabetes Care & Education Specialist, a certified trainer for insulin pumps and continuous glucose monitors, as well as a published author. Having lived with type 1 diabetes since childhood, Jennifer offers unique insight into day-to-day diabetes management, pregnancy, sports nutrition, and technology integration.
What you will learn:✔️Nutrition needs change as you age with diabetes.
✔️The value of the exchange system for eating with diabetes.
✔️Free foods still have nutrients.
✔️Your body’s response to nutrients is your own. No two people are the same.
✔️Your body changes over time and will not process nutrients in the same way as it once did.
✔️There is more to your diet than just the carbs that you eat.
✔️Food is fuel that must be effectively used.
✔️The importance of understanding the timing of your insulin.
Chapters00:11 Welcome and introduction.
0:34 Meet Integrated Diabetes Services Licensed and Registered Dietitians Jennifer and Dana.
01:24 How type 1 diabetes nutritional guidelines have changed over the past 30 years.
03:52 Most helpful piece of technology to battle your meals.
05:04 There are no “free” foods.
08:43 Your diabetes may vary.
10:42 Fuel your body. Don't follow a "diet"
14:51 Calories and Carbohydrates
17:53 The liberation of ratios
20:28 The three pillars of diabetes management
24:22 The value of Afrezza for those over 18
25:58 Fiber and net carbs
28:59 Eating for activity
35:52 What else to expect in upcoming episodes
Resources Mentionedhttps://integrateddiabetes.com/type-1-diabetes-what-nutrition-macros-should-i-follow/
Connect with Us
🔵Website: integrateddiabetes.com
🔵 Follow on Social Media: @integrated_diabetes_services and @ integrateddiabetesservices on Facebook
🔵To work with the Integrated Diabetes Services Team, visit https://integrateddiabetes.com/how-to-start-the-process/ , or email info@integrateddiabetes.com
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Also, leave a review to let us know what you think, and share this episode with others who will enjoy it as well!
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Gary Scheiner (00:11):
Welcome to Think Like a Pancreas, the podcast where our goal is
to keep you informed, inspired, and alittle entertained on all things diabetes.
The information contained in thisprogram is based on the experience
and opinions of the IntegratedDiabetes Services clinical team.
Please discuss any changes to yourtreatment plan with your personal
(00:31):
healthcare provider before implementing.
Jennifer Smith (00:33):
Hi everyone.
Uh, I'm Jennifer Smith, the registereddietician, certified Diabetes Care and
Education specialist with IntegratedDiabetes and the Director of Lifestyle
and Nutrition, and my colleague Dana, uh,and I are here to talk today all things
nutrition sort of unfiltered, right Dana?
Dana Roseman (00:53):
Yeah, I'm super excited to do this.
Jenny and I never get a chanceto just one-on-one, just kind of,
go deep on nutrition and diabetesand this is gonna be super fun.
Um, hopefully we'll get to do thisover and over with some new topics.
But today we're just gonna kindof get started on some basics.
Again, my name is Dana Roseman, aregistered dietician and certified
(01:14):
diabetes care and education specialist aswell, and I'm the Director of Technology
Unified Research for Integrated Diabetes.
Let's get into it, Jenny.
Jennifer Smith (01:22):
Yeah.
So, and you've, so I'vehad type one for 37 years.
I don't know how long have you?
Dana Roseman (01:29):
Not quite 30.
I'm right behind you at 28 and, uh,
Jennifer Smith (01:32):
28, so you've been rolling kind of long enough.
Did you ever start on the exchange diet?
Dana Roseman (01:39):
Absolutely.
I think everybody, um, yeah, who wasborn before 19, I don't know, 80?
Not to age us, right?
Was on the exchange diet and
Jennifer Smith (01:49):
Right.
Dana Roseman (01:49):
It's still so ingrained in my head.
I don't know about you, but everythingI do, I try to move away from that
15 increment, but I just, it, it tooka long time for me to move away from
15 grams and a piece of bread andjust, you know, calling it a day.
Jennifer Smith (02:06):
Yes.
And then there are a lot of thingsthat then have changed right?
Over the course of the years that we'vehad diabetes and the course of the
years that we've been other, helpingother people who have diabetes too, i've
always looked back on that as, okay,my lunch is no longer like two starches
and one fruit and two vegetables.
You know what I mean?
(02:26):
But I do think that it provides a reallygood base for where we are now with the
changes that have happened in, especiallytype one nutrition information, because
I think we've become really carb centric.
Dana Roseman (02:41):
Yeah.
Jennifer Smith (02:42):
Right?
And we are missing out on whatthat really emphasized was balance.
Dana Roseman (02:48):
Right.
And I think that when you talk aboutexchanges, I do think about these
very separate food groups that were,you know, they had a line dividing
everything and you were just countingwhat you could have for that meal.
And I think, just that word you couldhave, um, I remember my mom was like, oh,
you could have this, you could have that.
Well, now we've really movedaway to, you can have all of it.
(03:11):
There's not, you know, any parametersor limitations, but of course,
learning how to balance all ofthat to what you just said and
Jennifer Smith (03:19):
yeah, and I mean, today's information, thankfully, I
think has brought in what you're kind ofemphasizing is more flexibility, right?
Dana Roseman (03:27):
Absolutely.
Yeah.
Jennifer Smith (03:28):
It is no longer the, you can't have it or the no sugar at all.
Right?
Dana Roseman (03:34):
Right.
Jennifer Smith (03:34):
But it also, even with our technology, which I know we'll
talk about within this realm too,but with technology and everything,
we've got a lot more ability tohave flexibility and that's lovely.
Dana Roseman (03:47):
Absolutely.
I think technology has really movedthe ball for nutrition and widening
the menu, so to speak, and, um, andespecially continuous glucose monitors.
I think that if you were to pickone technology to help the most
in terms of meal time, insulindosing, you know, strategizing for
(04:07):
your meals, that CGM is above all.
Jennifer Smith (04:10):
Abso... I mean, if I, I, I can't remember, it was quite
a while ago, I was at a meetingwith other people with diabetes.
We were just started chattingabout technology, right?
And almost everybody said the same thing.
You know, if, if there was the zombieapocalypse that we all talk about and
worry about, and like hoard supplies,
Dana Roseman (04:28):
Hoard your diabetes supplies.
Absolutely.
Jennifer Smith (04:30):
Right?
I would a hundred percent try to makeit to the companies that make the
CGM supplies and like hoard those.
Dana Roseman (04:40):
Right, right.
And it just, those directional arrowsare such a game changer because we all,
you know, those of us who know, knowthe finger sticks just, you know, you
had a point snapshot in time and youwere just kind of hoping for the best.
Right?
But to have that prediction in termsof metabolism and how your blood sugars
are impacted from food in general?
(05:02):
It's just a total game changer.
Jennifer Smith (05:05):
It is.
And you know, again, going back tolike the exchange system, I'm sure you
were taught that vegetables are free.
Dana Roseman (05:12):
Right?
Oh my gosh.
That whole list.
Right?
And don't worry about protein and fatbecause who would bother with that?
Right?
Jennifer Smith (05:20):
Right.
Yeah.
I know my one wonderful aunt who,after I was diagnosed, she asked my
mom, she was always more so the hostof, family gatherings and holiday
kinds of events, and she asked mymom right away for that upcoming
Christmas, say, but what can Jenny have?
Right?
Dana Roseman (05:37):
Right, right.
Jennifer Smith (05:38):
And my mom was like, you can make a big plate of peeled cucumbers
because at the time I didn't really like,I didn't like the skin on the cucumber.
Dana Roseman (05:47):
Go big in Jenny!
Jennifer Smith (05:48):
My lovely aunt and uncle, they peeled, I don't even know how many
cucumbers because they were free now.
Dana Roseman (05:56):
Oh my gosh.
Jennifer Smith (05:57):
Right?
And so Jenny absolutely was sittingand eating a plate of cucumbers, which
I'm quite sure at some point, betweenthe finger sticks created a swing up in
my blood sugar that I didn't capture.
But it all keeps to work out.
Dana Roseman (06:11):
Absolutely right.
Absolutely, because there is nofree lunch, no free cucumbers.
And whether, you know, and that'swhat I think I love so much about
nutrition science in general, inaddition to diabetes management,
is just kind of the, the science innavigating all of that and learning
what your body does and how it responds.
(06:32):
Because I know your response tocucumbers is maybe gonna be different
from my response to cucumbers.
And so I think that's a part of, maybewhere people get stuck in terms of
nutrition and diabetes is that theythink it's one size fits all, and that,
you know, those chicken nuggets aregonna hit the same way that they're
supposed to time and time again.
And it's just, as you wellknow, just not the case.
Jennifer Smith (06:53):
It's not.
And I think that again, it bringsin the benefit of some type of
the technology that we have.
Dana Roseman (06:59):
Absolutely.
Jennifer Smith (07:00):
Especially the CGMs.
Because had I known eatingthe whole plate of cucumbers,
Dana Roseman (07:04):
Right.
Jennifer Smith (07:04):
Was... I would've very quickly gone back with my mom to the
doctor and said, cucumbers aren't free.
Right?
Like it would've brought twoand two together, you know,
like we can now see today.
And I think that's brought in especiallywith you know the macronutrients, right?
Dana Roseman (07:20):
Mm-hmm.
Jennifer Smith (07:20):
Being the carbs, the proteins, and the fats.
The ones that provide us the calories.
As I said, we're more carbcentric, but we're really learning.
I think even in the past five years,
Dana Roseman (07:30):
Agreed.
Jennifer Smith (07:30):
We're learning and talking more about the fats and the proteins and,
Dana Roseman (07:35):
But I would say people who have had diabetes for so long
are always shocked at, oh, this isgonna come into the conversation.
I thought I could eat as much protein andfat as I wanted to and have no problems.
But when you really start having thatconversation about, no, do you realize
that delayed rise that you're having,you know, two, three hours later?
(07:56):
And it all makes sense topeople when you start bringing
in those other macronutrients.
Jennifer Smith (08:00):
Abso, and then it's a, again, as you said, it's the understanding
of how does this food hit me?
You know?
Dana Roseman (08:06):
Right.
Jennifer Smith (08:07):
With the online community that we now have today, which all of
us I think are very grateful for, Ithink that is where the exchange of
information gets a little bit muddiedin, well, you know, my child or I
Dana Roseman (08:22):
Right.
Jennifer Smith (08:22):
You know, can eat this and I always see this happen,
but my friend doesn't see that happen.
Why?
Am I doing something wrong and
Dana Roseman (08:30):
right.
Jennifer Smith (08:30):
It is where the individual nature of paying attention to what
happens to for you, um, comes beneficial.
Dana Roseman (08:39):
Yeah.
And I would take that a step furtherand what worked for me, I don't know
if you feel the same way, but whatworked for me 10 years ago or 15
years ago sure is not the same today.
My metabolism is changing withage and perhaps with some folks if
they're starting new medicationsor a GLP-1, that really changes
metabolism and digestion timing, andof course that impacts insulin timing.
Jennifer Smith (09:01):
Mm-hmm.
Dana Roseman (09:01):
And then one thing I would also say that always surprises folks is,
um, you know, weight management and ifthere's uh, weight loss, you know, insulin
is weight-based, and so then we go and tryto adjust, you know, mealtime adjustments
and, and basal adjustments and so,
Jennifer Smith (09:17):
right.
Dana Roseman (09:18):
Yeah.
I do think that people get very focusedon carbohydrates and that is just
such a small part of the picture.
Jennifer Smith (09:25):
It is.
And you know what, I think a, a biggerpiece, as you were kind of just hinting at
in what you said about like insulin dosesand the amounts and as they shift up as we
grow or we change through a stage of life,whether you're pregnancy preparation.
Dana Roseman (09:40):
Mm-hmm.
Jennifer Smith (09:40):
Or your perimenopausal or your testosterone levels are changing
as a man, as you get whatever it is.
Right?
Dana Roseman (09:46):
Right.
Jennifer Smith (09:47):
We have to expect that our insulin needs are not flat
Dana Roseman (09:52):
No.
Jennifer Smith (09:52):
Through our life, and thus, as we age and change,
we should expect that thingsaround nutrition will shift too.
Even our interests in foodmight shift and change.
Dana Roseman (10:04):
Absolutely.
Jennifer Smith (10:05):
Um, and especially with all the discussion online,
Dana Roseman (10:07):
right.
Jennifer Smith (10:08):
You know, about this diet or have you tried that one?
And it's, it's a reason I hate diet,
Dana Roseman (10:13):
right.
Jennifer Smith (10:13):
Because I don't know about you, but honestly the word diet to me
indicates almost a time framed parameter.
Dana Roseman (10:21):
Absolutely.
A short term try to, to dosomething quick and short.
Jennifer Smith (10:26):
Yeah.
Yeah.
Instead of I like fueling plan better.
Dana Roseman (10:29):
Mm-hmm.
Mm-hmm.
Jennifer Smith (10:30):
Um, because it makes me think of, especially having worked
with athletes who are more endurance.
Dana Roseman (10:34):
Yeah.
Jennifer Smith (10:34):
We talk about fueling over the course of
this long duration something.
And I think fueling your body ismore a lifelong understanding then.
Dana Roseman (10:43):
Right.
Jennifer Smith (10:43):
And what you find works.
Yes, it may evolve and your insulinneeds might shift and change.
Technology can help you see theshifts and the changes and how
you can cover it better with,you know, your pumping system or
Dana Roseman (10:55):
Right.
Jennifer Smith (10:55):
Whatever you're using.
Um,
Dana Roseman (10:57):
right.
Jennifer Smith (10:58):
But, yeah,
Dana Roseman (10:58):
but I think if you consider food fuel, you know, I, I use a lot of
car analogies when I'm talking to people.
So it's the gasolinefor your engine, right?
Jennifer Smith (11:07):
Yeah.
Dana Roseman (11:07):
And it, it does shift it.
It's not a quick fix.
It's not a quick burst.
It's it's fuel that you wannause and use effectively.
Jennifer Smith (11:14):
Yeah.
And I think that, you know, if Iwas ever restarting career wise, I,
I definitely really love the trackI started with nutrition, right?
Biology really with morehuman nutrition emphasis.
Dana Roseman (11:26):
Mm-hmm.
Jennifer Smith (11:27):
But I think I do a track of trying to figure out how to program
nutrition education, nutrition healtheducation from kindergarten through
high school, for example, so that eachyear you get a build on of, okay, these
are the food groups in kindergarten.
Dana Roseman (11:46):
Right.
Jennifer Smith (11:47):
You know, by the time you get to high school, most,
most teens are interested in sometype of sport or extracurriculars.
Something that requires their bodiesto be completely fueled the right way.
And if they knew more,they would fuel better.
Dana Roseman (12:03):
Right.
Jennifer Smith (12:03):
And then if they have diabetes, they would understand more
about why they're seeing things happen.
Dana Roseman (12:09):
Right.
And of course I think, you know,both of us would probably agree
that a lot of providers don't haveadequate nutrition education as well.
Um, no, I agree.
I think that people, you know,diabetes is such a food focused
disease, and unless your team hasa real dedication to learning and
implementing nutrition education, yeah,it's definitely something that people,
(12:33):
unfortunately, you don't have enough of.
Jennifer Smith (12:35):
Yeah, I mean, even around the fat and protein topic, you
know, we understand carbohydrates havecalorie value, and I think most people
with diabetes understand there's anallotment of carbohydrates you might need.
Hopefully I'm, I'm hopeful therein that people have an idea, right?
Dana Roseman (12:52):
Right.
Jennifer Smith (12:52):
That 500 a day is probably not what you need.
Dana Roseman (12:55):
Right.
Jennifer Smith (12:55):
But I think it gets missed, especially with the concept
that's still around about fat and protein.
Dana Roseman (13:01):
Mm-hmm.
Jennifer Smith (13:02):
The concept that it doesn't really require
you to pay attention to it.
So it's almost like afreebie like my cucumbers
Dana Roseman (13:09):
Absolutely right.
Your cucumber story is gonnasit with me the rest of the day.
So, but I think a lotof people all combine.
No, it, it's just gonna, I'm gonna thinkabout poor little Jenny with cucumbers.
Um, but I think so many folks, you know,come in and, and talk to us and they are
so focused on just looking for proteinand fat and eliminating so many quality
(13:31):
carbohydrates that their body needs and
Jennifer Smith (13:33):
Right.
Dana Roseman (13:33):
You know, eliminating a whole class of fiber or
micronutrients with all the colorof fruits and vegetables and you
know, they're eating a pretty.
Bland, you know, for lack, lack ofcolor or white diet of, you know,
protein and fat, and thinking that'sthe only way that they can do it.
And I, I don't know if the ketogenicdiet, um, you know, for dieting has
(13:54):
really impacted that, but it, it's,it's definitely not the only way.
Right?
Jennifer Smith (13:59):
Right.
And it, it, and it might again, Imean, we are, as we work with people,
as dieticians and educators, we arenot tied into any one particular.
Fueling plan.
Dana Roseman (14:10):
Right.
Jennifer Smith (14:11):
You understand what you wanna do.
Great.
We'll help you to getit to work out, but in,
Dana Roseman (14:15):
mm-hmm.
Jennifer Smith (14:15):
In the realm of even caloric intake with fats and
proteins, there's a missing pieceof information there because it
doesn't hit like a carb does.
Dana Roseman (14:25):
Right.
Jennifer Smith (14:25):
And so the concept of portion containment, it becomes
kind of a gray area, even addingextra calories in between meals.
Let's say you found that eating.
You know, two cheese sticks and a, aprotein chew in the middle of the day,
Dana Roseman (14:43):
which would always be that free food, the cheese sticks.
Right?
Jennifer Smith (14:46):
Right.
Absolutely.
They're, they're a free food,but they're not free calorically.
Dana Roseman (14:50):
No.
Jennifer Smith (14:50):
So if you are already meeting your needs with your main
meals and you're freebies still havecalories, and just because you, maybe
you can get away with not covering them.
Dana Roseman (15:00):
Mm-hmm.
Jennifer Smith (15:00):
Maybe your system is so well set that you can do that.
It doesn't necessarilymean you need the calories.
Dana Roseman (15:06):
Right.
Jennifer Smith (15:07):
So, yeah, I don't, it's a, it's a missing piece in
education, I think, especially oncewe get to adulthood, and I definitely
know that it's missed for thosewho are diagnosed more as an adult.
Dana Roseman (15:18):
Right, right.
Jennifer Smith (15:19):
Unfortunately.
Dana Roseman (15:19):
Well, I find those folks who are diagnosed as an adult when they get
that, maybe it's a misdiagnosis of typetwo diabetes, or maybe it's a confusing
diagnosis of LADA and they're not reallysure what that means, but, I think that
the majority of folks leave that initialdiagnosis visit and say, watch your carbs.
(15:39):
Right?
Jennifer Smith (15:40):
Right.
Dana Roseman (15:40):
And then of course people are like, well, I'm gonna watch them.
I don't
really know what to do about that.
Yes.
Jennifer Smith (15:47):
Boy, they look nice on my plate.
Dana Roseman (15:49):
Right, right.
They, I'm gonna watchother people eat them.
Right?
Jennifer Smith (15:52):
Yes.
I mean, it brings back in the technology,you know, maybe some of those people
diagnosed again more as an adulthave actually been prescribed a CGM.
Dana Roseman (16:04):
Right.
Jennifer Smith (16:04):
Or have been told a more, a, a better strategic way to use
finger sticks to get some information.
Right.
But if they are just told to watch carbs.
Well, what, what, what realmshould your blood sugar be?
Dana Roseman (16:18):
Then what?
Jennifer Smith (16:19):
Where should it be?
What should I get outta the CGMinformation that can help me understand
better how to maneuver within what I'mtrying to do with the food that I eat?
Dana Roseman (16:28):
Right, and I think so now, now to your point, most people, especially
little ones, you know at initialdiagnosis, they do leave the hospital
with a continuous glucose monitor.
And when you watch the carbs, sureyou watch little Johnny's blood
sugar soar after that milkshake or
Jennifer Smith (16:45):
right
Dana Roseman (16:45):
something, you know, the Cheerios or whatever it is, but you
don't necessarily have the understandingof the insulin timing, which I think
is the beginning and the end ofeither, you know, and it doesn't even
matter how you're taking your insulin.
It could be injections, could be, youknow, technology that's automated.
The insulin stays the same and thetiming of that insulin stays the same.
(17:06):
And so learning how to time thatwith the food spikes is...I don't, I
don't know if that's touched upon in
Jennifer Smith (17:13):
I don't
Dana Roseman (17:13):
initial diagnosis.
Jennifer Smith (17:14):
I don't think it is.
I think it's more what I see, youknow, I think we all see as educators
is this startup of getting you toa place mentally of feeling like
this is something you can live with.
That you can navigate with yourchild and they're still gonna be
a child and then comes in the,they can eat anything they want.
Dana Roseman (17:34):
Right.
Jennifer Smith (17:35):
We can have the flexibility that we want.
Dana Roseman (17:36):
Which is so different from where we started with diabetes management.
Jennifer Smith (17:40):
It is.
Dana Roseman (17:40):
I mean, that was not in the exchange
Jennifer Smith (17:42):
no
Dana Roseman (17:42):
program.
Jennifer Smith (17:43):
Not at all.
No, it, it was not.
In fact it was, I remember the day thatI went in to visit my, um, my diabetes
educator and then she had an RD uh, withher and the visits were always together.
And the dietician at that meetingwas teaching me to read labels.
Dana Roseman (18:01):
Oh yeah.
Jennifer Smith (18:01):
For carbohydrates.
So it was rolling into, outta thatexchange system into, you can count
your carbs and now you can start to takeinsulin for what you want to eat as long
as you're trying to meet these needsbecause you're still a growing child.
Right?
Dana Roseman (18:16):
Right.
Jennifer Smith (18:16):
This is how much you need to eat, but this
is how to cover it better.
She taught me.
I will never forget.
She'll taught me how to read alabel because she asked me, what
would you really like to eatthat you haven't been able to?
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Jennifer Smith (19:07):
And I said, I'd like a Hershey bar with almonds.
I, I don't know why, but thatwas just something that like,
Dana Roseman (19:15):
Do you still hold that as like a favorite food?
Jennifer Smith (19:18):
You know, it's kind of funny.
I, I don't really, um, I stillreally, I really like chocolate.
Dana Roseman (19:25):
Yeah.
Jennifer Smith (19:25):
Yeah.
It doesn't have to havealmonds in it normally.
A gigantic... but it was the readingof the label and understanding
those nutrients that went into it.
And again, a focus still on carbohydrates,but the understanding that if I wanted
the whole bar, this ratio would allowme to eat it and then my blood sugar
would do what I wanted it to do and itwas really a-- it was really profound.
Dana Roseman (19:48):
Um, yeah, no, I think that the ratios, the, this beginning of your
carb ratio, your insulin sensitivitycorrection factor was empowering.
Jennifer Smith (19:58):
It is.
Dana Roseman (19:58):
Because all of a sudden you can navigate going out to eat differently
or, you know, traveling differently.
Um,
Jennifer Smith (20:05):
yeah,
Dana Roseman (20:06):
and it really changed kind of how to expect
your blood sugars to respond.
Jennifer Smith (20:09):
And that expectation goes along with what you were, you
know, talking about before my Hersheybar story, was really the timing.
You know, we talk about diabetes, Ialways still in my mind think about
the three, like the three points ofdiabetes management being insulin,
food and movement or activity.
Dana Roseman (20:28):
Mm-hmm.
Jennifer Smith (20:29):
Right?
Dana Roseman (20:29):
Right.
Jennifer Smith (20:29):
And I think of the three of those, while we think a lot about food.
And not as much as,
Dana Roseman (20:36):
'cause you gotta do it, you gotta eat.
Jennifer Smith (20:37):
Because you have to do it.
We have to eat right.
We don't think as much aswe should about activity.
Dana Roseman (20:41):
No.
Jennifer Smith (20:41):
But the one that I think really gets missed is, okay,
I know I need to take insulin.
So I take my insulin.
But now with the technology, wehave the understanding of, as you
said, the timing of the insulin.
Dana Roseman (20:53):
Mm-hmm.
Jennifer Smith (20:54):
Like when should I take my insulin to cover that Hershey bar
so that I do get the response that Iwant and then on the on the back end,
I can still enjoy having had it andI'm not fighting a 250 blood sugar?
Dana Roseman (21:07):
Right, right.
And I mean, I think there's a coupleof things I think will be written
on my tombstone one day and one ofthem is, nothing is spontaneous in
diabetes management and that just isstrides for, meal planning, right?
Jennifer Smith (21:21):
Yeah.
Dana Roseman (21:21):
And not just the food you're gonna eat, but the timing of that insulin.
Jennifer Smith (21:25):
Yes.
Dana Roseman (21:25):
If you don't plan ahead, you can expect to have a spike.
And it doesn't matter how fancy ouralgorithms are, our pumps are, our
CGMs, or how much we spent for it,you know, the insulin hasn't changed.
Jennifer Smith (21:39):
No.
Dana Roseman (21:40):
It really hasn't.
Jennifer Smith (21:41):
In a long time.
I can't even remember when.
So my first change of insulin fromR, which, I mean, I was pre bolusing
by, yeah, 45 minutes at least.
I remember I was working in collegeat a, at a plasma donation center.
Dana Roseman (21:59):
Oh,
Jennifer Smith (22:00):
and, which was really fascinating.
It was, it was a super cool job.
But I remember my, my lunch, mybreaks were only 30 minutes for
my meal and for my insulin, right?
And I was using R insulin.
Dana Roseman (22:13):
Right.
Jennifer Smith (22:13):
And I remember reading about Humalog and I went to my doctor at
my next visit and I said, you're gonnawrite me a prescription for this because
I only have 30 minutes to take insulinand finish my meal and get back out on
the floor and my R insulin isn't working.
He was like,
Dana Roseman (22:32):
right.
Jennifer Smith (22:33):
He kind of like, I was very upfront with this.
Dana Roseman (22:36):
Yeah.
Jennifer Smith (22:36):
He was like, okay, we can do this.
So, but it was, it was a changingpoint and an understanding and I didn't
Dana Roseman (22:45):
Absolutely.
Jennifer Smith (22:45):
I didn't have a CGM at that point.
I just had a billion test stripsto be able to finger stick more
often than I was ever told to.
Dana Roseman (22:52):
Right.
Jennifer Smith (22:53):
Um, but it was the information about starting,
especially in college, understanding,gosh, the food that I eat,
this is the choice that I have.
Dana Roseman (23:02):
Right.
And I always try to remember andremind people, you know, the insulin
we're using for that bowl of cerealthat you know is gonna spike your
blood sugar pretty quickly is the sameinsulin that when your blood sugar's
300, we have to wait an hour and ahalf for you to start seeing a change.
I mean, that is the same insulin.
And so it makes sense that we wouldhave to take our insulin ahead of time.
Jennifer Smith (23:23):
Yeah.
Dana Roseman (23:23):
Because we call it fast acting insulin, but it isn't that fast.
Jennifer Smith (23:27):
It isn't.
I always think that Rapid issuch a misnomer, honestly.
Dana Roseman (23:30):
Oh my gosh.
I wish they called it slow asmolasses insulin and then everyone
would really appreciate it.
Jennifer Smith (23:36):
Right, right.
I know.
Well, and even that, youknow, we have Rapid and now we
have a little bit more rapid.
Right.
Dana Roseman (23:43):
Right.
Jennifer Smith (23:43):
With the Fisp and the looms and that.
Dana Roseman (23:45):
Yep.
Jennifer Smith (23:45):
The ultra Rapid.
Dana Roseman (23:46):
Mm-hmm.
Jennifer Smith (23:46):
The ultra.
But there is still a place, and I'mvery grateful that they still do make R
insulin because there is a place for somepeople who've decided on a fueling plan
for their life to be able to use that.
But again, what's itboiled down to for them?
They've figured out theirbolus timing for that.
Dana Roseman (24:04):
Or maybe just have a more regulated schedule and not, you
know, a college student kind of, youknow, juggling three jobs and school.
Jennifer Smith (24:12):
Right.
Yes.
Dana Roseman (24:14):
Because we've all been there.
Jennifer Smith (24:16):
We've all been there.
Yeah, exactly.
Well, I think, you know, well,talking about insulin, we've also
not really mentioned because it can'tbe used under the age of 18, right,
afrezza.
So
Dana Roseman (24:28):
on label, we should say.
Jennifer Smith (24:31):
Right on label.
Correct.
And so I think it begs a bit inthe discussion around nutrition.
Because there are times, as youjust said, college days where you
are really, really busy and you canbarely get to the, to the mess hall
and grab something and then head out.
Or if, I've worked with a numberof, you know, executive level
(24:53):
business people who, on meals out,they don't have the time between
conversation that's business specificto actually get their timing down.
So, you know, Afrezza is... I don'tthink it's-- I think it's underutilized.
Dana Roseman (25:09):
Absolutely.
I'm just thinking of really anyonewho has just crazy, busy schedules
and they're like, hurry, hurry, hurry.
Okay.
Eat.
Right?
I mean, diabetes just doesn't lenditself for that kind of schedule and
Jennifer Smith (25:19):
No.
Dana Roseman (25:19):
Um, but I, I do agree.
I think Afrezza, when I've personallyused it, I notice that action time is
really fast and lovely for when I need it.
I don't use it often.
Jennifer Smith (25:31):
Mm-hmm.
Dana Roseman (25:32):
But when I do, I do appreciate having it on
hand, it it as another tool.
Jennifer Smith (25:36):
Yeah, no, it's a great, it's a great one in the whole realm
of specifics, I think to nutrition and
Dana Roseman (25:42):
mm-hmm.
Jennifer Smith (25:43):
The way that we now live our lives.
Dana Roseman (25:47):
Right.
Jennifer Smith (25:47):
Work well.
Dana Roseman (25:47):
Right.
Jennifer Smith (25:48):
I guess, you know, another thing that I often think of
that gets discussed, maybe inaccuratelywithin food is-- and especially with
the newer food on the market we havetoday, the low carb kind of trend
to using much higher fiber content.
Dana Roseman (26:07):
Right.
And having net carbs.
Yeah.
Jennifer Smith (26:10):
Yeah.
So what you was
Dana Roseman (26:11):
I was just thinking when you, you were telling.. Well,
when you were talking about your,um, your Hershey's bar with the
almonds and learning the label, Iwas thinking, I wonder if she was
even taught about the fiber thatmaybe the almonds were putting in.
Right?
I mean, I don't think that that wassomething that we really started
talking about until maybe 10 years ago.
Jennifer Smith (26:31):
Um, I would agree and may... I don't even know,
maybe a little bit ahead of that.
'cause I do remember.
I do remember visiting with adiabetes educator before I was an
educator, and she was talking aboutfiber, and the idea at that point
wasn't as in depth as we usually get.
(26:54):
It was more to the, more tothe, more aligned with, if
there's fiber, just take it out.
Like, just don't count it.
Dana Roseman (27:01):
Right.
And it didn't matter if itwas insoluble or soluble.
And I know we've had this debate,you know, amongst our Integrated
Diabetes Providers, and I do thinkthat fiber hits people differently.
Jennifer Smith (27:12):
It does.
Dana Roseman (27:12):
Um, you know, some people will subtract all
of it out and do just fine.
As I've gotten older, that does notwork so well for me, and it means
that I have a, a longer metabolismor a longer digestion time, but
it certainly doesn't mean I'meliminating a good amount of insulin.
Jennifer Smith (27:30):
Right.
No, I've actually, it's, it's kindof funny, I've found the same thing.
In fact, you know, some of the,the lower carb varieties of if and
when I'm not-- I like making bread.
I know you like to make bread too.
Dana Roseman (27:42):
I make sourdough regularly.
I actually have one that'sgonna go out of the oven soon.
Jennifer Smith (27:48):
Yay.
I made your sourdough your sour... Ithink I told you I made your sourdough.
Dana Roseman (27:52):
Oh yeah.
Jennifer Smith (27:52):
Discard scones.
They were, yeah, they are good.
They good.
They don't have a lot of fiber.
Dana Roseman (27:58):
No.
Jennifer Smith (27:59):
A lot of butter.
I don't think I've added that muchbutter to anything in a really long...
Dana Roseman (28:02):
yes, yes, yes, yes, yes, it is,
it is well worth the effort.
They're good.
Jennifer Smith (28:07):
It is, but on the lower carb front, on a more day-to-day basis,
you know, I'm not low carb, but I reallypay attention to the kinds of carbs
that I bring into, you know, my body.
And if I ever do have like lowercarb breads, there's one variety
that I really like, but I've foundthe same thing in that if I discount
the fiber, it does not work.
Dana Roseman (28:29):
No, no.
Jennifer Smith (28:30):
If I cover it all, thankful for the AID system that I use
because I can tell the system to deliverinsulin I need over a time period, which
is very helpful, but I can't, I can't
Dana Roseman (28:42):
That's exactly what I was gonna say.
Yeah.
Yeah.
Jennifer Smith (28:44):
But I can't discount it.
Dana Roseman (28:45):
No, I can't discount it as much, but it's the time of digestion
that I absolutely pay attention to.
Jennifer Smith (28:53):
Yeah.
Dana Roseman (28:53):
Not subtracting out insulin.
Jennifer Smith (28:55):
Right.
Dana Roseman (28:55):
That's what I found as well.
Jennifer Smith (28:56):
Yeah.
Yeah.
Dana Roseman (28:57):
And then I think, um, you know, just along with that, a lot
of times, I hear a lot of discussionabout nutrition before activity and if
people should eat and what they shouldeat, and avoiding low blood sugars.
And a lot of times I find that peopleare carb loading to increase their
(29:17):
blood sugars to be a high level,but their automated system is just
Jennifer Smith (29:22):
hits it,
Dana Roseman (29:22):
dumping insulin and so then they end up with a
low and they think it's the food.
They need to more have more food,more food, more carbohydrates.
But that's not where theproblem is coming from.
Jennifer Smith (29:32):
No, and it, I mean, it also brings in the idea of,
are you fueling your body becauseyour body needs it as an athlete?
Dana Roseman (29:41):
Right.
Jennifer Smith (29:41):
Or, and it was a really hard concept that I used
to work a lot more with athletes.
Again, especially endurance.
It was a really hard concept forthose with type one to understand.
You have to think about fuelingyourself and athletics first, right?
Dana Roseman (29:57):
Right.
Jennifer Smith (29:57):
And then you have to understand how to work that
in for blood sugar management.
And it's almost the opposite formost people with diabetes as you're
kinda speaking to, it's like, no, no,I have to make sure my blood sugar
doesn't get too low, so I have toeat all of this extra food, but does
that really serve your performance?
Dana Roseman (30:14):
Right.
Jennifer Smith (30:15):
Most likely not.
Dana Roseman (30:16):
No, and then you're sluggish and you're not doing your
fastest activity, whatever that may be.
Jennifer Smith (30:22):
Right.
Dana Roseman (30:22):
And, um, I don't know about you, but I really prefer to eliminate
that and work out on a fasted state.
I've got less,
I do too.
Jennifer Smith (30:30):
Variables.
Um, less insulin for sure.
That might be a whole otherdiscussion that we have in terms
of fueling for performance.
Yeah.
No, but it's, I, I think it'sa valuable one to bring in, in
terms of just the nutrition realm.
Understand your needs.
As I said in the background, kidsusually get a visit with dieticians
(30:51):
within diagnosis just to make surewhere are they on their growth chart?
Are they meeting it?
This is what you need to make surethat they're eating every day.
But we lose that as we diagnose...or as you get diagnosed older and
older, you kind of lose that piece.
And so we have to have an understandingof our base need and then if you are
an athlete, what to add on top ofthis just from that exercise piece.
Dana Roseman (31:15):
Mm-hmm.
Jennifer Smith (31:16):
And as we grow our needs change.
Dana Roseman (31:18):
Right.
Absolutely.
Jennifer Smith (31:20):
Um, so you can't eat, keep eating
Dana Roseman (31:21):
Needs do change
Jennifer Smith (31:22):
And yeah.
Dana Roseman (31:23):
Gosh, I wonder if there's been a study, and I don't know this for
sure, on, um, date or or age of diagnosis.
And then how you approach your diabetesmanagement from a nutrition standpoint.
And I don't know, maybeyou and I should do that.
Jennifer Smith (31:38):
That would be, that would be a really interesting thing to study
because i've, and I'm sure you know,we all have run across enough people
who started kind of where we did with
Dana Roseman (31:48):
mm-hmm.
Jennifer Smith (31:48):
This age old exchange diet.
Dana Roseman (31:50):
Absolutely.
Jennifer Smith (31:51):
And how you've moved forward, uh, I, in remembering it.
Dana Roseman (31:54):
And you really had to have carbohydrates, right?
Jennifer Smith (31:57):
Oh, yes.
Dana Roseman (31:57):
'Cause you had a huge dose of basal insulin that you were kind of
fighting against the rest of the day,and you couldn't take it out of you.
And so once it was delivered, that wasjust kind of it, and now that's, that's
not the case we've got, if you're onan automated system that can suspend,
you don't have to, you know, kind offorce yourself to eat certain things.
Jennifer Smith (32:18):
Right.
I, and that's actually, that's actuallya really valid point to make, in
that our older insulins, like I usedL or what was called Lente insulin.
Dana Roseman (32:27):
Yeah.
Jennifer Smith (32:27):
R insulin.
Right?
Dana Roseman (32:29):
Absolutely.
Jennifer Smith (32:29):
And so I took it, I mixed it up in a syringe.
Cloudy first.
Dana Roseman (32:34):
Yes.
Or actually it wasn'tshake, you know, roll.
Jennifer Smith (32:38):
Roll it exactly.
But you know, it was twice a day.
Dana Roseman (32:40):
Yeah.
Jennifer Smith (32:41):
It was take it in the morning and then the L
insulin peaked around lunch, somy lunch had to be very timely.
Dana Roseman (32:47):
Right.
Jennifer Smith (32:47):
And it had to be the same con-- content in those
different, you know, food groups.
And then dinner time again, Itook the same, you know, different
dose, but the same mix of insulins.
And that covered me.
I always had to have a bedtimesnack 'cause the peak in
that was gonna hit over.
Dana Roseman (33:02):
Right.
Jennifer Smith (33:02):
I mean, there was a very strategic, and so in talking to
other people who've had that pattern.
I think to this day, I can't sleeplater than like six o'clock in
the morning because that was whenI took my dose of insulin and
Dana Roseman (33:17):
Right.
Jennifer Smith (33:18):
I always got up, even in my teen years where I was gonna
sleep later, I still got up to take myinsulin and then I'd go back to bed.
Dana Roseman (33:28):
Right.
I mean, thank goodness for new insulinand new technology and new formulation.
Jennifer Smith (33:33):
Yeah.
Dana Roseman (33:33):
But I do think a lot of people have the very strong belief that
they must have a nighttime snack toavoid low blood sugars, even if they're
on automated systems and, um, even ifthey, they really don't need it at all.
They are, that is so ingrained.
Jennifer Smith (33:51):
It is.
And it's a hard, it's a hardtrain of thought to break when
you grew up with that as the idea.
Dana Roseman (33:57):
And there's a lot of fear involved with not having that.
Jennifer Smith (34:00):
Yeah, and it, it, it also kind of goes back to, which
I definitely, another conversationabout fasted, like exercise or fasting
Dana Roseman (34:07):
mm-hmm.
Jennifer Smith (34:08):
Especially from, I mean all over health,
but especially female health.
There's some good value to it,but with our systems today,
we should be able to fast.
I even say that with our, with our newerlong-acting insulins today, even if
you're using multiple daily injections
Dana Roseman (34:26):
agreed.
Yeah.
Jennifer Smith (34:27):
There should be enough flexibility in the way
that that has stability in action.
Dana Roseman (34:33):
Right.
Jennifer Smith (34:33):
To fast if you wanted to, or skip a meal if you wanted to and
Dana Roseman (34:39):
agreed.
Jennifer Smith (34:39):
Again, it's a really hard brain flip to kind of make.
Dana Roseman (34:42):
Yeah, right.
Yeah.
I mean, they're just flatter in deliveryand hopefully not... I mean, the new ones,
you're right, they don't have the peaksthat we kind of grew up with, you know?
Jennifer Smith (34:51):
Right.
Dana Roseman (34:52):
And, and so hopefully people test that and recognize that
they could fast all day becausethat's really the beginning and the
end of the, the other, uh, insulindeliveries that they're getting.
Jennifer Smith (35:03):
Yeah.
And the AID systems of any variety,it really does boil down to having
those settings tested, especially yourbaseline basal if you are the variable
schedule type of person who sometimes,gosh, you work through your lunch
break, well, if your system is set upwell you should be able to do that.
Dana Roseman (35:22):
That's okay.
Jennifer Smith (35:22):
Right.
That's okay.
Yeah.
Dana Roseman (35:24):
I always ask people upfront, you know, do you feel like you
could go the whole day without eating?
Not that, of course, as a registereddietician, we want that or would promote
it, but could you, and I mean, most timespeople are like, well, no, I, I couldn't.
Jennifer Smith (35:38):
Right.
And then you say, well, yes, youshould be able to, and then, and
then we're... let's get to work.
Let's examine what we needto do to get you there.
You know?
Dana Roseman (35:48):
Yeah, exactly.
Jennifer Smith (35:49):
We can probably go on for another like two hours.
I know.
Dana Roseman (35:52):
Absolutely.
Absolutely.
But I think just from what our,we've kind of talked about today,
just that, you know, this is such abad pun, but there's no food off the
table for people living with diabetes.
We just need to strategize for it andlearn how we're gonna approach that.
And so I don't think either one ofus would approach talking to people
(36:12):
and say, you know, you have to followlow carb or you have to have this.
We would just really work and design
Jennifer Smith (36:19):
yeah.
Dana Roseman (36:19):
That individual's nutrition plan for fueling their body to the
Jennifer Smith (36:24):
right
Dana Roseman (36:24):
best of their health.
Jennifer Smith (36:25):
And I think the value in doing that with a dietician
too, is that we have worked withmany other health conditions, right?
And the fact that if you also have...you know, heart disease or you have
absolutely something else in the picture.
Dana Roseman (36:40):
Yeah.
Celiac disease or
Jennifer Smith (36:43):
yeah.
Dana Roseman (36:43):
I mean there's just so much that we also would take
into consideration for the wholeperson, not just the diabetes.
Jennifer Smith (36:49):
Yeah.
I think that would be another one.
I mean, even just aroundthe gluten-free realm.
Dana Roseman (36:53):
Absolutely.
Jennifer Smith (36:54):
Another whole topic of discussion.
Dana Roseman (36:56):
Yes.
Jennifer Smith (36:56):
Because, because it just has so many different little rabbit holes.
Dana Roseman (37:01):
Yeah.
Yeah.
Jennifer Smith (37:02):
To talk about, so..
Dana Roseman (37:03):
Absolutely.
Absolutely.
Yeah.
Jennifer Smith (37:05):
Well, we have a lot to talk about then in future episodes.
Dana Roseman (37:07):
I know, I'm excited.
Jennifer Smith (37:09):
Yeah.
Um, lots and lots of things whichwe'll hopefully be able to bring in
more around kind of the CGMs and thetechnology and how to use them around
food, um, and what else to explore, so
Dana Roseman (37:20):
Yeah, and I'd love to hear people's comments of what
they would like us to discuss also.
I think that would be fun.
Jennifer Smith (37:25):
Yeah.
Dana Roseman (37:25):
To hear from people watching.
Jennifer Smith (37:26):
It would be.
Yeah.
That would be great.
Well, thanks Dana.
Dana Roseman (37:28):
Or listening.
Yeah, it was good to chat with you today.
Jennifer Smith (37:30):
This was fun.
Gary Scheiner (37:30):
Thanks for tuning in to Think Like a Pancreas, the podcast.
If you enjoyed today's episode, don'tforget to like, follow or subscribe
on your favorite podcast app.
Think like a Pancreas-- the podcastis brought to you by Integrated
Diabetes Services, where experiencemeets expertise, passion meets
compassion, and diabetes care ispersonal because we live it too.
(37:54):
Our team of clinicians, all livingwith type one diabetes understands
the challenges firsthand.
We're here to help no matter where youare in the world in glucose management,
the self-care strategies, the latest tech,sports, and exercise, weight loss, type
one pregnancy, and emotional wellbeing.
We've got you covered.
(38:14):
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Visit integrateddiabetes.com oremail info@integrateddiabetes.com
to schedule a consultation.
On behalf of Think Like a Pancreas--the podcast, I'm Gary Scheiner,
wishing you a fantastic week ahead.
(38:36):
And don't forget to think like a pancreas!
Welcome to Think Like a Pancreas, the podcast where our goal is
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The information contained in thisprogram is based on the experience
and opinions of the IntegratedDiabetes Services clinical team.
Please discuss any changes to yourtreatment plan with your personal
(00:31):
healthcare provider before implementing.
Jennifer Smith (00:33):
Hi everyone.
Uh, I'm Jennifer Smith, the registereddietician, certified Diabetes Care and
Education specialist with IntegratedDiabetes and the Director of Lifestyle
and Nutrition, and my colleague Dana, uh,and I are here to talk today all things
nutrition sort of unfiltered, right Dana?
Dana Roseman (00:53):
Yeah, I'm super excited to do this.
Jenny and I never get a chanceto just one-on-one, just kind of,
go deep on nutrition and diabetesand this is gonna be super fun.
Um, hopefully we'll get to do thisover and over with some new topics.
But today we're just gonna kindof get started on some basics.
Again, my name is Dana Roseman, aregistered dietician and certified
(01:14):
diabetes care and education specialist aswell, and I'm the Director of Technology
Unified Research for Integrated Diabetes.
Let's get into it, Jenny.
Jennifer Smith (01:22):
Yeah.
So, and you've, so I'vehad type one for 37 years.
I don't know how long have you?
Dana Roseman (01:29):
Not quite 30.
I'm right behind you at 28 and, uh,
Jennifer Smith (01:32):
28, so you've been rolling kind of long enough.
Did you ever start on the exchange diet?
Dana Roseman (01:39):
Absolutely.
I think everybody, um, yeah, who wasborn before 19, I don't know, 80?
Not to age us, right?
Was on the exchange diet and
Jennifer Smith (01:49):
Right.
Dana Roseman (01:49):
It's still so ingrained in my head.
I don't know about you, but everythingI do, I try to move away from that
15 increment, but I just, it, it tooka long time for me to move away from
15 grams and a piece of bread andjust, you know, calling it a day.
Jennifer Smith (02:06):
Yes.
And then there are a lot of thingsthat then have changed right?
Over the course of the years that we'vehad diabetes and the course of the
years that we've been other, helpingother people who have diabetes too, i've
always looked back on that as, okay,my lunch is no longer like two starches
and one fruit and two vegetables.
You know what I mean?
(02:26):
But I do think that it provides a reallygood base for where we are now with the
changes that have happened in, especiallytype one nutrition information, because
I think we've become really carb centric.
Dana Roseman (02:41):
Yeah.
Jennifer Smith (02:42):
Right?
And we are missing out on whatthat really emphasized was balance.
Dana Roseman (02:48):
Right.
And I think that when you talk aboutexchanges, I do think about these
very separate food groups that were,you know, they had a line dividing
everything and you were just countingwhat you could have for that meal.
And I think, just that word you couldhave, um, I remember my mom was like, oh,
you could have this, you could have that.
Well, now we've really movedaway to, you can have all of it.
(03:11):
There's not, you know, any parametersor limitations, but of course,
learning how to balance all ofthat to what you just said and
Jennifer Smith (03:19):
yeah, and I mean, today's information, thankfully, I
think has brought in what you're kind ofemphasizing is more flexibility, right?
Dana Roseman (03:27):
Absolutely.
Yeah.
Jennifer Smith (03:28):
It is no longer the, you can't have it or the no sugar at all.
Right?
Dana Roseman (03:34):
Right.
Jennifer Smith (03:34):
But it also, even with our technology, which I know we'll
talk about within this realm too,but with technology and everything,
we've got a lot more ability tohave flexibility and that's lovely.
Dana Roseman (03:47):
Absolutely.
I think technology has really movedthe ball for nutrition and widening
the menu, so to speak, and, um, andespecially continuous glucose monitors.
I think that if you were to pickone technology to help the most
in terms of meal time, insulindosing, you know, strategizing for
(04:07):
your meals, that CGM is above all.
Jennifer Smith (04:10):
Abso... I mean, if I, I, I can't remember, it was quite
a while ago, I was at a meetingwith other people with diabetes.
We were just started chattingabout technology, right?
And almost everybody said the same thing.
You know, if, if there was the zombieapocalypse that we all talk about and
worry about, and like hoard supplies,
Dana Roseman (04:28):
Hoard your diabetes supplies.
Absolutely.
Jennifer Smith (04:30):
Right?
I would a hundred percent try to makeit to the companies that make the
CGM supplies and like hoard those.
Dana Roseman (04:40):
Right, right.
And it just, those directional arrowsare such a game changer because we all,
you know, those of us who know, knowthe finger sticks just, you know, you
had a point snapshot in time and youwere just kind of hoping for the best.
Right?
But to have that prediction in termsof metabolism and how your blood sugars
are impacted from food in general?
(05:02):
It's just a total game changer.
Jennifer Smith (05:05):
It is.
And you know, again, going back tolike the exchange system, I'm sure you
were taught that vegetables are free.
Dana Roseman (05:12):
Right?
Oh my gosh.
That whole list.
Right?
And don't worry about protein and fatbecause who would bother with that?
Right?
Jennifer Smith (05:20):
Right.
Yeah.
I know my one wonderful aunt who,after I was diagnosed, she asked my
mom, she was always more so the hostof, family gatherings and holiday
kinds of events, and she asked mymom right away for that upcoming
Christmas, say, but what can Jenny have?
Right?
Dana Roseman (05:37):
Right, right.
Jennifer Smith (05:38):
And my mom was like, you can make a big plate of peeled cucumbers
because at the time I didn't really like,I didn't like the skin on the cucumber.
Dana Roseman (05:47):
Go big in Jenny!
Jennifer Smith (05:48):
My lovely aunt and uncle, they peeled, I don't even know how many
cucumbers because they were free now.
Dana Roseman (05:56):
Oh my gosh.
Jennifer Smith (05:57):
Right?
And so Jenny absolutely was sittingand eating a plate of cucumbers, which
I'm quite sure at some point, betweenthe finger sticks created a swing up in
my blood sugar that I didn't capture.
But it all keeps to work out.
Dana Roseman (06:11):
Absolutely right.
Absolutely, because there is nofree lunch, no free cucumbers.
And whether, you know, and that'swhat I think I love so much about
nutrition science in general, inaddition to diabetes management,
is just kind of the, the science innavigating all of that and learning
what your body does and how it responds.
(06:32):
Because I know your response tocucumbers is maybe gonna be different
from my response to cucumbers.
And so I think that's a part of, maybewhere people get stuck in terms of
nutrition and diabetes is that theythink it's one size fits all, and that,
you know, those chicken nuggets aregonna hit the same way that they're
supposed to time and time again.
And it's just, as you wellknow, just not the case.
Jennifer Smith (06:53):
It's not.
And I think that again, it bringsin the benefit of some type of
the technology that we have.
Dana Roseman (06:59):
Absolutely.
Jennifer Smith (07:00):
Especially the CGMs.
Because had I known eatingthe whole plate of cucumbers,
Dana Roseman (07:04):
Right.
Jennifer Smith (07:04):
Was... I would've very quickly gone back with my mom to the
doctor and said, cucumbers aren't free.
Right?
Like it would've brought twoand two together, you know,
like we can now see today.
And I think that's brought in especiallywith you know the macronutrients, right?
Dana Roseman (07:20):
Mm-hmm.
Jennifer Smith (07:20):
Being the carbs, the proteins, and the fats.
The ones that provide us the calories.
As I said, we're more carbcentric, but we're really learning.
I think even in the past five years,
Dana Roseman (07:30):
Agreed.
Jennifer Smith (07:30):
We're learning and talking more about the fats and the proteins and,
Dana Roseman (07:35):
But I would say people who have had diabetes for so long
are always shocked at, oh, this isgonna come into the conversation.
I thought I could eat as much protein andfat as I wanted to and have no problems.
But when you really start having thatconversation about, no, do you realize
that delayed rise that you're having,you know, two, three hours later?
(07:56):
And it all makes sense topeople when you start bringing
in those other macronutrients.
Jennifer Smith (08:00):
Abso, and then it's a, again, as you said, it's the understanding
of how does this food hit me?
You know?
Dana Roseman (08:06):
Right.
Jennifer Smith (08:07):
With the online community that we now have today, which all of
us I think are very grateful for, Ithink that is where the exchange of
information gets a little bit muddiedin, well, you know, my child or I
Dana Roseman (08:22):
Right.
Jennifer Smith (08:22):
You know, can eat this and I always see this happen,
but my friend doesn't see that happen.
Why?
Am I doing something wrong and
Dana Roseman (08:30):
right.
Jennifer Smith (08:30):
It is where the individual nature of paying attention to what
happens to for you, um, comes beneficial.
Dana Roseman (08:39):
Yeah.
And I would take that a step furtherand what worked for me, I don't know
if you feel the same way, but whatworked for me 10 years ago or 15
years ago sure is not the same today.
My metabolism is changing withage and perhaps with some folks if
they're starting new medicationsor a GLP-1, that really changes
metabolism and digestion timing, andof course that impacts insulin timing.
Jennifer Smith (09:01):
Mm-hmm.
Dana Roseman (09:01):
And then one thing I would also say that always surprises folks is,
um, you know, weight management and ifthere's uh, weight loss, you know, insulin
is weight-based, and so then we go and tryto adjust, you know, mealtime adjustments
and, and basal adjustments and so,
Jennifer Smith (09:17):
right.
Dana Roseman (09:18):
Yeah.
I do think that people get very focusedon carbohydrates and that is just
such a small part of the picture.
Jennifer Smith (09:25):
It is.
And you know what, I think a, a biggerpiece, as you were kind of just hinting at
in what you said about like insulin dosesand the amounts and as they shift up as we
grow or we change through a stage of life,whether you're pregnancy preparation.
Dana Roseman (09:40):
Mm-hmm.
Jennifer Smith (09:40):
Or your perimenopausal or your testosterone levels are changing
as a man, as you get whatever it is.
Right?
Dana Roseman (09:46):
Right.
Jennifer Smith (09:47):
We have to expect that our insulin needs are not flat
Dana Roseman (09:52):
No.
Jennifer Smith (09:52):
Through our life, and thus, as we age and change,
we should expect that thingsaround nutrition will shift too.
Even our interests in foodmight shift and change.
Dana Roseman (10:04):
Absolutely.
Jennifer Smith (10:05):
Um, and especially with all the discussion online,
Dana Roseman (10:07):
right.
Jennifer Smith (10:08):
You know, about this diet or have you tried that one?
And it's, it's a reason I hate diet,
Dana Roseman (10:13):
right.
Jennifer Smith (10:13):
Because I don't know about you, but honestly the word diet to me
indicates almost a time framed parameter.
Dana Roseman (10:21):
Absolutely.
A short term try to, to dosomething quick and short.
Jennifer Smith (10:26):
Yeah.
Yeah.
Instead of I like fueling plan better.
Dana Roseman (10:29):
Mm-hmm.
Mm-hmm.
Jennifer Smith (10:30):
Um, because it makes me think of, especially having worked
with athletes who are more endurance.
Dana Roseman (10:34):
Yeah.
Jennifer Smith (10:34):
We talk about fueling over the course of
this long duration something.
And I think fueling your body ismore a lifelong understanding then.
Dana Roseman (10:43):
Right.
Jennifer Smith (10:43):
And what you find works.
Yes, it may evolve and your insulinneeds might shift and change.
Technology can help you see theshifts and the changes and how
you can cover it better with,you know, your pumping system or
Dana Roseman (10:55):
Right.
Jennifer Smith (10:55):
Whatever you're using.
Um,
Dana Roseman (10:57):
right.
Jennifer Smith (10:58):
But, yeah,
Dana Roseman (10:58):
but I think if you consider food fuel, you know, I, I use a lot of
car analogies when I'm talking to people.
So it's the gasolinefor your engine, right?
Jennifer Smith (11:07):
Yeah.
Dana Roseman (11:07):
And it, it does shift it.
It's not a quick fix.
It's not a quick burst.
It's it's fuel that you wannause and use effectively.
Jennifer Smith (11:14):
Yeah.
And I think that, you know, if Iwas ever restarting career wise, I,
I definitely really love the trackI started with nutrition, right?
Biology really with morehuman nutrition emphasis.
Dana Roseman (11:26):
Mm-hmm.
Jennifer Smith (11:27):
But I think I do a track of trying to figure out how to program
nutrition education, nutrition healtheducation from kindergarten through
high school, for example, so that eachyear you get a build on of, okay, these
are the food groups in kindergarten.
Dana Roseman (11:46):
Right.
Jennifer Smith (11:47):
You know, by the time you get to high school, most,
most teens are interested in sometype of sport or extracurriculars.
Something that requires their bodiesto be completely fueled the right way.
And if they knew more,they would fuel better.
Dana Roseman (12:03):
Right.
Jennifer Smith (12:03):
And then if they have diabetes, they would understand more
about why they're seeing things happen.
Dana Roseman (12:09):
Right.
And of course I think, you know,both of us would probably agree
that a lot of providers don't haveadequate nutrition education as well.
Um, no, I agree.
I think that people, you know,diabetes is such a food focused
disease, and unless your team hasa real dedication to learning and
implementing nutrition education, yeah,it's definitely something that people,
(12:33):
unfortunately, you don't have enough of.
Jennifer Smith (12:35):
Yeah, I mean, even around the fat and protein topic, you
know, we understand carbohydrates havecalorie value, and I think most people
with diabetes understand there's anallotment of carbohydrates you might need.
Hopefully I'm, I'm hopeful therein that people have an idea, right?
Dana Roseman (12:52):
Right.
Jennifer Smith (12:52):
That 500 a day is probably not what you need.
Dana Roseman (12:55):
Right.
Jennifer Smith (12:55):
But I think it gets missed, especially with the concept
that's still around about fat and protein.
Dana Roseman (13:01):
Mm-hmm.
Jennifer Smith (13:02):
The concept that it doesn't really require
you to pay attention to it.
So it's almost like afreebie like my cucumbers
Dana Roseman (13:09):
Absolutely right.
Your cucumber story is gonnasit with me the rest of the day.
So, but I think a lotof people all combine.
No, it, it's just gonna, I'm gonna thinkabout poor little Jenny with cucumbers.
Um, but I think so many folks, you know,come in and, and talk to us and they are
so focused on just looking for proteinand fat and eliminating so many quality
(13:31):
carbohydrates that their body needs and
Jennifer Smith (13:33):
Right.
Dana Roseman (13:33):
You know, eliminating a whole class of fiber or
micronutrients with all the colorof fruits and vegetables and you
know, they're eating a pretty.
Bland, you know, for lack, lack ofcolor or white diet of, you know,
protein and fat, and thinking that'sthe only way that they can do it.
And I, I don't know if the ketogenicdiet, um, you know, for dieting has
(13:54):
really impacted that, but it, it's,it's definitely not the only way.
Right?
Jennifer Smith (13:59):
Right.
And it, it, and it might again, Imean, we are, as we work with people,
as dieticians and educators, we arenot tied into any one particular.
Fueling plan.
Dana Roseman (14:10):
Right.
Jennifer Smith (14:11):
You understand what you wanna do.
Great.
We'll help you to getit to work out, but in,
Dana Roseman (14:15):
mm-hmm.
Jennifer Smith (14:15):
In the realm of even caloric intake with fats and
proteins, there's a missing pieceof information there because it
doesn't hit like a carb does.
Dana Roseman (14:25):
Right.
Jennifer Smith (14:25):
And so the concept of portion containment, it becomes
kind of a gray area, even addingextra calories in between meals.
Let's say you found that eating.
You know, two cheese sticks and a, aprotein chew in the middle of the day,
Dana Roseman (14:43):
which would always be that free food, the cheese sticks.
Right?
Jennifer Smith (14:46):
Right.
Absolutely.
They're, they're a free food,but they're not free calorically.
Dana Roseman (14:50):
No.
Jennifer Smith (14:50):
So if you are already meeting your needs with your main
meals and you're freebies still havecalories, and just because you, maybe
you can get away with not covering them.
Dana Roseman (15:00):
Mm-hmm.
Jennifer Smith (15:00):
Maybe your system is so well set that you can do that.
It doesn't necessarilymean you need the calories.
Dana Roseman (15:06):
Right.
Jennifer Smith (15:07):
So, yeah, I don't, it's a, it's a missing piece in
education, I think, especially oncewe get to adulthood, and I definitely
know that it's missed for thosewho are diagnosed more as an adult.
Dana Roseman (15:18):
Right, right.
Jennifer Smith (15:19):
Unfortunately.
Dana Roseman (15:19):
Well, I find those folks who are diagnosed as an adult when they get
that, maybe it's a misdiagnosis of typetwo diabetes, or maybe it's a confusing
diagnosis of LADA and they're not reallysure what that means, but, I think that
the majority of folks leave that initialdiagnosis visit and say, watch your carbs.
(15:39):
Right?
Jennifer Smith (15:40):
Right.
Dana Roseman (15:40):
And then of course people are like, well, I'm gonna watch them.
I don't
really know what to do about that.
Yes.
Jennifer Smith (15:47):
Boy, they look nice on my plate.
Dana Roseman (15:49):
Right, right.
They, I'm gonna watchother people eat them.
Right?
Jennifer Smith (15:52):
Yes.
I mean, it brings back in the technology,you know, maybe some of those people
diagnosed again more as an adulthave actually been prescribed a CGM.
Dana Roseman (16:04):
Right.
Jennifer Smith (16:04):
Or have been told a more, a, a better strategic way to use
finger sticks to get some information.
Right.
But if they are just told to watch carbs.
Well, what, what, what realmshould your blood sugar be?
Dana Roseman (16:18):
Then what?
Jennifer Smith (16:19):
Where should it be?
What should I get outta the CGMinformation that can help me understand
better how to maneuver within what I'mtrying to do with the food that I eat?
Dana Roseman (16:28):
Right, and I think so now, now to your point, most people, especially
little ones, you know at initialdiagnosis, they do leave the hospital
with a continuous glucose monitor.
And when you watch the carbs, sureyou watch little Johnny's blood
sugar soar after that milkshake or
Jennifer Smith (16:45):
right
Dana Roseman (16:45):
something, you know, the Cheerios or whatever it is, but you
don't necessarily have the understandingof the insulin timing, which I think
is the beginning and the end ofeither, you know, and it doesn't even
matter how you're taking your insulin.
It could be injections, could be, youknow, technology that's automated.
The insulin stays the same and thetiming of that insulin stays the same.
(17:06):
And so learning how to time thatwith the food spikes is...I don't, I
don't know if that's touched upon in
Jennifer Smith (17:13):
I don't
Dana Roseman (17:13):
initial diagnosis.
Jennifer Smith (17:14):
I don't think it is.
I think it's more what I see, youknow, I think we all see as educators
is this startup of getting you toa place mentally of feeling like
this is something you can live with.
That you can navigate with yourchild and they're still gonna be
a child and then comes in the,they can eat anything they want.
Dana Roseman (17:34):
Right.
Jennifer Smith (17:35):
We can have the flexibility that we want.
Dana Roseman (17:36):
Which is so different from where we started with diabetes management.
Jennifer Smith (17:40):
It is.
Dana Roseman (17:40):
I mean, that was not in the exchange
Jennifer Smith (17:42):
no
Dana Roseman (17:42):
program.
Jennifer Smith (17:43):
Not at all.
No, it, it was not.
In fact it was, I remember the day thatI went in to visit my, um, my diabetes
educator and then she had an RD uh, withher and the visits were always together.
And the dietician at that meetingwas teaching me to read labels.
Dana Roseman (18:01):
Oh yeah.
Jennifer Smith (18:01):
For carbohydrates.
So it was rolling into, outta thatexchange system into, you can count
your carbs and now you can start to takeinsulin for what you want to eat as long
as you're trying to meet these needsbecause you're still a growing child.
Right?
Dana Roseman (18:16):
Right.
Jennifer Smith (18:16):
This is how much you need to eat, but this
is how to cover it better.
She taught me.
I will never forget.
She'll taught me how to read alabel because she asked me, what
would you really like to eatthat you haven't been able to?
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Jennifer Smith (19:07):
And I said, I'd like a Hershey bar with almonds.
I, I don't know why, but thatwas just something that like,
Dana Roseman (19:15):
Do you still hold that as like a favorite food?
Jennifer Smith (19:18):
You know, it's kind of funny.
I, I don't really, um, I stillreally, I really like chocolate.
Dana Roseman (19:25):
Yeah.
Jennifer Smith (19:25):
Yeah.
It doesn't have to havealmonds in it normally.
A gigantic... but it was the readingof the label and understanding
those nutrients that went into it.
And again, a focus still on carbohydrates,but the understanding that if I wanted
the whole bar, this ratio would allowme to eat it and then my blood sugar
would do what I wanted it to do and itwas really a-- it was really profound.
Dana Roseman (19:48):
Um, yeah, no, I think that the ratios, the, this beginning of your
carb ratio, your insulin sensitivitycorrection factor was empowering.
Jennifer Smith (19:58):
It is.
Dana Roseman (19:58):
Because all of a sudden you can navigate going out to eat differently
or, you know, traveling differently.
Um,
Jennifer Smith (20:05):
yeah,
Dana Roseman (20:06):
and it really changed kind of how to expect
your blood sugars to respond.
Jennifer Smith (20:09):
And that expectation goes along with what you were, you
know, talking about before my Hersheybar story, was really the timing.
You know, we talk about diabetes, Ialways still in my mind think about
the three, like the three points ofdiabetes management being insulin,
food and movement or activity.
Dana Roseman (20:28):
Mm-hmm.
Jennifer Smith (20:29):
Right?
Dana Roseman (20:29):
Right.
Jennifer Smith (20:29):
And I think of the three of those, while we think a lot about food.
And not as much as,
Dana Roseman (20:36):
'cause you gotta do it, you gotta eat.
Jennifer Smith (20:37):
Because you have to do it.
We have to eat right.
We don't think as much aswe should about activity.
Dana Roseman (20:41):
No.
Jennifer Smith (20:41):
But the one that I think really gets missed is, okay,
I know I need to take insulin.
So I take my insulin.
But now with the technology, wehave the understanding of, as you
said, the timing of the insulin.
Dana Roseman (20:53):
Mm-hmm.
Jennifer Smith (20:54):
Like when should I take my insulin to cover that Hershey bar
so that I do get the response that Iwant and then on the on the back end,
I can still enjoy having had it andI'm not fighting a 250 blood sugar?
Dana Roseman (21:07):
Right, right.
And I mean, I think there's a coupleof things I think will be written
on my tombstone one day and one ofthem is, nothing is spontaneous in
diabetes management and that just isstrides for, meal planning, right?
Jennifer Smith (21:21):
Yeah.
Dana Roseman (21:21):
And not just the food you're gonna eat, but the timing of that insulin.
Jennifer Smith (21:25):
Yes.
Dana Roseman (21:25):
If you don't plan ahead, you can expect to have a spike.
And it doesn't matter how fancy ouralgorithms are, our pumps are, our
CGMs, or how much we spent for it,you know, the insulin hasn't changed.
Jennifer Smith (21:39):
No.
Dana Roseman (21:40):
It really hasn't.
Jennifer Smith (21:41):
In a long time.
I can't even remember when.
So my first change of insulin fromR, which, I mean, I was pre bolusing
by, yeah, 45 minutes at least.
I remember I was working in collegeat a, at a plasma donation center.
Dana Roseman (21:59):
Oh,
Jennifer Smith (22:00):
and, which was really fascinating.
It was, it was a super cool job.
But I remember my, my lunch, mybreaks were only 30 minutes for
my meal and for my insulin, right?
And I was using R insulin.
Dana Roseman (22:13):
Right.
Jennifer Smith (22:13):
And I remember reading about Humalog and I went to my doctor at
my next visit and I said, you're gonnawrite me a prescription for this because
I only have 30 minutes to take insulinand finish my meal and get back out on
the floor and my R insulin isn't working.
He was like,
Dana Roseman (22:32):
right.
Jennifer Smith (22:33):
He kind of like, I was very upfront with this.
Dana Roseman (22:36):
Yeah.
Jennifer Smith (22:36):
He was like, okay, we can do this.
So, but it was, it was a changingpoint and an understanding and I didn't
Dana Roseman (22:45):
Absolutely.
Jennifer Smith (22:45):
I didn't have a CGM at that point.
I just had a billion test stripsto be able to finger stick more
often than I was ever told to.
Dana Roseman (22:52):
Right.
Jennifer Smith (22:53):
Um, but it was the information about starting,
especially in college, understanding,gosh, the food that I eat,
this is the choice that I have.
Dana Roseman (23:02):
Right.
And I always try to remember andremind people, you know, the insulin
we're using for that bowl of cerealthat you know is gonna spike your
blood sugar pretty quickly is the sameinsulin that when your blood sugar's
300, we have to wait an hour and ahalf for you to start seeing a change.
I mean, that is the same insulin.
And so it makes sense that we wouldhave to take our insulin ahead of time.
Jennifer Smith (23:23):
Yeah.
Dana Roseman (23:23):
Because we call it fast acting insulin, but it isn't that fast.
Jennifer Smith (23:27):
It isn't.
I always think that Rapid issuch a misnomer, honestly.
Dana Roseman (23:30):
Oh my gosh.
I wish they called it slow asmolasses insulin and then everyone
would really appreciate it.
Jennifer Smith (23:36):
Right, right.
I know.
Well, and even that, youknow, we have Rapid and now we
have a little bit more rapid.
Right.
Dana Roseman (23:43):
Right.
Jennifer Smith (23:43):
With the Fisp and the looms and that.
Dana Roseman (23:45):
Yep.
Jennifer Smith (23:45):
The ultra Rapid.
Dana Roseman (23:46):
Mm-hmm.
Jennifer Smith (23:46):
The ultra.
But there is still a place, and I'mvery grateful that they still do make R
insulin because there is a place for somepeople who've decided on a fueling plan
for their life to be able to use that.
But again, what's itboiled down to for them?
They've figured out theirbolus timing for that.
Dana Roseman (24:04):
Or maybe just have a more regulated schedule and not, you
know, a college student kind of, youknow, juggling three jobs and school.
Jennifer Smith (24:12):
Right.
Yes.
Dana Roseman (24:14):
Because we've all been there.
Jennifer Smith (24:16):
We've all been there.
Yeah, exactly.
Well, I think, you know, well,talking about insulin, we've also
not really mentioned because it can'tbe used under the age of 18, right,
afrezza.
So
Dana Roseman (24:28):
on label, we should say.
Jennifer Smith (24:31):
Right on label.
Correct.
And so I think it begs a bit inthe discussion around nutrition.
Because there are times, as youjust said, college days where you
are really, really busy and you canbarely get to the, to the mess hall
and grab something and then head out.
Or if, I've worked with a numberof, you know, executive level
(24:53):
business people who, on meals out,they don't have the time between
conversation that's business specificto actually get their timing down.
So, you know, Afrezza is... I don'tthink it's-- I think it's underutilized.
Dana Roseman (25:09):
Absolutely.
I'm just thinking of really anyonewho has just crazy, busy schedules
and they're like, hurry, hurry, hurry.
Okay.
Eat.
Right?
I mean, diabetes just doesn't lenditself for that kind of schedule and
Jennifer Smith (25:19):
No.
Dana Roseman (25:19):
Um, but I, I do agree.
I think Afrezza, when I've personallyused it, I notice that action time is
really fast and lovely for when I need it.
I don't use it often.
Jennifer Smith (25:31):
Mm-hmm.
Dana Roseman (25:32):
But when I do, I do appreciate having it on
hand, it it as another tool.
Jennifer Smith (25:36):
Yeah, no, it's a great, it's a great one in the whole realm
of specifics, I think to nutrition and
Dana Roseman (25:42):
mm-hmm.
Jennifer Smith (25:43):
The way that we now live our lives.
Dana Roseman (25:47):
Right.
Jennifer Smith (25:47):
Work well.
Dana Roseman (25:47):
Right.
Jennifer Smith (25:48):
I guess, you know, another thing that I often think of
that gets discussed, maybe inaccuratelywithin food is-- and especially with
the newer food on the market we havetoday, the low carb kind of trend
to using much higher fiber content.
Dana Roseman (26:07):
Right.
And having net carbs.
Yeah.
Jennifer Smith (26:10):
Yeah.
So what you was
Dana Roseman (26:11):
I was just thinking when you, you were telling.. Well,
when you were talking about your,um, your Hershey's bar with the
almonds and learning the label, Iwas thinking, I wonder if she was
even taught about the fiber thatmaybe the almonds were putting in.
Right?
I mean, I don't think that that wassomething that we really started
talking about until maybe 10 years ago.
Jennifer Smith (26:31):
Um, I would agree and may... I don't even know,
maybe a little bit ahead of that.
'cause I do remember.
I do remember visiting with adiabetes educator before I was an
educator, and she was talking aboutfiber, and the idea at that point
wasn't as in depth as we usually get.
(26:54):
It was more to the, more tothe, more aligned with, if
there's fiber, just take it out.
Like, just don't count it.
Dana Roseman (27:01):
Right.
And it didn't matter if itwas insoluble or soluble.
And I know we've had this debate,you know, amongst our Integrated
Diabetes Providers, and I do thinkthat fiber hits people differently.
Jennifer Smith (27:12):
It does.
Dana Roseman (27:12):
Um, you know, some people will subtract all
of it out and do just fine.
As I've gotten older, that does notwork so well for me, and it means
that I have a, a longer metabolismor a longer digestion time, but
it certainly doesn't mean I'meliminating a good amount of insulin.
Jennifer Smith (27:30):
Right.
No, I've actually, it's, it's kindof funny, I've found the same thing.
In fact, you know, some of the,the lower carb varieties of if and
when I'm not-- I like making bread.
I know you like to make bread too.
Dana Roseman (27:42):
I make sourdough regularly.
I actually have one that'sgonna go out of the oven soon.
Jennifer Smith (27:48):
Yay.
I made your sourdough your sour... Ithink I told you I made your sourdough.
Dana Roseman (27:52):
Oh yeah.
Jennifer Smith (27:52):
Discard scones.
They were, yeah, they are good.
They good.
They don't have a lot of fiber.
Dana Roseman (27:58):
No.
Jennifer Smith (27:59):
A lot of butter.
I don't think I've added that muchbutter to anything in a really long...
Dana Roseman (28:02):
yes, yes, yes, yes, yes, it is,
it is well worth the effort.
They're good.
Jennifer Smith (28:07):
It is, but on the lower carb front, on a more day-to-day basis,
you know, I'm not low carb, but I reallypay attention to the kinds of carbs
that I bring into, you know, my body.
And if I ever do have like lowercarb breads, there's one variety
that I really like, but I've foundthe same thing in that if I discount
the fiber, it does not work.
Dana Roseman (28:29):
No, no.
Jennifer Smith (28:30):
If I cover it all, thankful for the AID system that I use
because I can tell the system to deliverinsulin I need over a time period, which
is very helpful, but I can't, I can't
Dana Roseman (28:42):
That's exactly what I was gonna say.
Yeah.
Yeah.
Jennifer Smith (28:44):
But I can't discount it.
Dana Roseman (28:45):
No, I can't discount it as much, but it's the time of digestion
that I absolutely pay attention to.
Jennifer Smith (28:53):
Yeah.
Dana Roseman (28:53):
Not subtracting out insulin.
Jennifer Smith (28:55):
Right.
Dana Roseman (28:55):
That's what I found as well.
Jennifer Smith (28:56):
Yeah.
Yeah.
Dana Roseman (28:57):
And then I think, um, you know, just along with that, a lot
of times, I hear a lot of discussionabout nutrition before activity and if
people should eat and what they shouldeat, and avoiding low blood sugars.
And a lot of times I find that peopleare carb loading to increase their
(29:17):
blood sugars to be a high level,but their automated system is just
Jennifer Smith (29:22):
hits it,
Dana Roseman (29:22):
dumping insulin and so then they end up with a
low and they think it's the food.
They need to more have more food,more food, more carbohydrates.
But that's not where theproblem is coming from.
Jennifer Smith (29:32):
No, and it, I mean, it also brings in the idea of,
are you fueling your body becauseyour body needs it as an athlete?
Dana Roseman (29:41):
Right.
Jennifer Smith (29:41):
Or, and it was a really hard concept that I used
to work a lot more with athletes.
Again, especially endurance.
It was a really hard concept forthose with type one to understand.
You have to think about fuelingyourself and athletics first, right?
Dana Roseman (29:57):
Right.
Jennifer Smith (29:57):
And then you have to understand how to work that
in for blood sugar management.
And it's almost the opposite formost people with diabetes as you're
kinda speaking to, it's like, no, no,I have to make sure my blood sugar
doesn't get too low, so I have toeat all of this extra food, but does
that really serve your performance?
Dana Roseman (30:14):
Right.
Jennifer Smith (30:15):
Most likely not.
Dana Roseman (30:16):
No, and then you're sluggish and you're not doing your
fastest activity, whatever that may be.
Jennifer Smith (30:22):
Right.
Dana Roseman (30:22):
And, um, I don't know about you, but I really prefer to eliminate
that and work out on a fasted state.
I've got less,
I do too.
Jennifer Smith (30:30):
Variables.
Um, less insulin for sure.
That might be a whole otherdiscussion that we have in terms
of fueling for performance.
Yeah.
No, but it's, I, I think it'sa valuable one to bring in, in
terms of just the nutrition realm.
Understand your needs.
As I said in the background, kidsusually get a visit with dieticians
(30:51):
within diagnosis just to make surewhere are they on their growth chart?
Are they meeting it?
This is what you need to make surethat they're eating every day.
But we lose that as we diagnose...or as you get diagnosed older and
older, you kind of lose that piece.
And so we have to have an understandingof our base need and then if you are
an athlete, what to add on top ofthis just from that exercise piece.
Dana Roseman (31:15):
Mm-hmm.
Jennifer Smith (31:16):
And as we grow our needs change.
Dana Roseman (31:18):
Right.
Absolutely.
Jennifer Smith (31:20):
Um, so you can't eat, keep eating
Dana Roseman (31:21):
Needs do change
Jennifer Smith (31:22):
And yeah.
Dana Roseman (31:23):
Gosh, I wonder if there's been a study, and I don't know this for
sure, on, um, date or or age of diagnosis.
And then how you approach your diabetesmanagement from a nutrition standpoint.
And I don't know, maybeyou and I should do that.
Jennifer Smith (31:38):
That would be, that would be a really interesting thing to study
because i've, and I'm sure you know,we all have run across enough people
who started kind of where we did with
Dana Roseman (31:48):
mm-hmm.
Jennifer Smith (31:48):
This age old exchange diet.
Dana Roseman (31:50):
Absolutely.
Jennifer Smith (31:51):
And how you've moved forward, uh, I, in remembering it.
Dana Roseman (31:54):
And you really had to have carbohydrates, right?
Jennifer Smith (31:57):
Oh, yes.
Dana Roseman (31:57):
'Cause you had a huge dose of basal insulin that you were kind of
fighting against the rest of the day,and you couldn't take it out of you.
And so once it was delivered, that wasjust kind of it, and now that's, that's
not the case we've got, if you're onan automated system that can suspend,
you don't have to, you know, kind offorce yourself to eat certain things.
Jennifer Smith (32:18):
Right.
I, and that's actually, that's actuallya really valid point to make, in
that our older insulins, like I usedL or what was called Lente insulin.
Dana Roseman (32:27):
Yeah.
Jennifer Smith (32:27):
R insulin.
Right?
Dana Roseman (32:29):
Absolutely.
Jennifer Smith (32:29):
And so I took it, I mixed it up in a syringe.
Cloudy first.
Dana Roseman (32:34):
Yes.
Or actually it wasn'tshake, you know, roll.
Jennifer Smith (32:38):
Roll it exactly.
But you know, it was twice a day.
Dana Roseman (32:40):
Yeah.
Jennifer Smith (32:41):
It was take it in the morning and then the L
insulin peaked around lunch, somy lunch had to be very timely.
Dana Roseman (32:47):
Right.
Jennifer Smith (32:47):
And it had to be the same con-- content in those
different, you know, food groups.
And then dinner time again, Itook the same, you know, different
dose, but the same mix of insulins.
And that covered me.
I always had to have a bedtimesnack 'cause the peak in
that was gonna hit over.
Dana Roseman (33:02):
Right.
Jennifer Smith (33:02):
I mean, there was a very strategic, and so in talking to
other people who've had that pattern.
I think to this day, I can't sleeplater than like six o'clock in
the morning because that was whenI took my dose of insulin and
Dana Roseman (33:17):
Right.
Jennifer Smith (33:18):
I always got up, even in my teen years where I was gonna
sleep later, I still got up to take myinsulin and then I'd go back to bed.
Dana Roseman (33:28):
Right.
I mean, thank goodness for new insulinand new technology and new formulation.
Jennifer Smith (33:33):
Yeah.
Dana Roseman (33:33):
But I do think a lot of people have the very strong belief that
they must have a nighttime snack toavoid low blood sugars, even if they're
on automated systems and, um, even ifthey, they really don't need it at all.
They are, that is so ingrained.
Jennifer Smith (33:51):
It is.
And it's a hard, it's a hardtrain of thought to break when
you grew up with that as the idea.
Dana Roseman (33:57):
And there's a lot of fear involved with not having that.
Jennifer Smith (34:00):
Yeah, and it, it, it also kind of goes back to, which
I definitely, another conversationabout fasted, like exercise or fasting
Dana Roseman (34:07):
mm-hmm.
Jennifer Smith (34:08):
Especially from, I mean all over health,
but especially female health.
There's some good value to it,but with our systems today,
we should be able to fast.
I even say that with our, with our newerlong-acting insulins today, even if
you're using multiple daily injections
Dana Roseman (34:26):
agreed.
Yeah.
Jennifer Smith (34:27):
There should be enough flexibility in the way
that that has stability in action.
Dana Roseman (34:33):
Right.
Jennifer Smith (34:33):
To fast if you wanted to, or skip a meal if you wanted to and
Dana Roseman (34:39):
agreed.
Jennifer Smith (34:39):
Again, it's a really hard brain flip to kind of make.
Dana Roseman (34:42):
Yeah, right.
Yeah.
I mean, they're just flatter in deliveryand hopefully not... I mean, the new ones,
you're right, they don't have the peaksthat we kind of grew up with, you know?
Jennifer Smith (34:51):
Right.
Dana Roseman (34:52):
And, and so hopefully people test that and recognize that
they could fast all day becausethat's really the beginning and the
end of the, the other, uh, insulindeliveries that they're getting.
Jennifer Smith (35:03):
Yeah.
And the AID systems of any variety,it really does boil down to having
those settings tested, especially yourbaseline basal if you are the variable
schedule type of person who sometimes,gosh, you work through your lunch
break, well, if your system is set upwell you should be able to do that.
Dana Roseman (35:22):
That's okay.
Jennifer Smith (35:22):
Right.
That's okay.
Yeah.
Dana Roseman (35:24):
I always ask people upfront, you know, do you feel like you
could go the whole day without eating?
Not that, of course, as a registereddietician, we want that or would promote
it, but could you, and I mean, most timespeople are like, well, no, I, I couldn't.
Jennifer Smith (35:38):
Right.
And then you say, well, yes, youshould be able to, and then, and
then we're... let's get to work.
Let's examine what we needto do to get you there.
You know?
Dana Roseman (35:48):
Yeah, exactly.
Jennifer Smith (35:49):
We can probably go on for another like two hours.
I know.
Dana Roseman (35:52):
Absolutely.
Absolutely.
But I think just from what our,we've kind of talked about today,
just that, you know, this is such abad pun, but there's no food off the
table for people living with diabetes.
We just need to strategize for it andlearn how we're gonna approach that.
And so I don't think either one ofus would approach talking to people
(36:12):
and say, you know, you have to followlow carb or you have to have this.
We would just really work and design
Jennifer Smith (36:19):
yeah.
Dana Roseman (36:19):
That individual's nutrition plan for fueling their body to the
Jennifer Smith (36:24):
right
Dana Roseman (36:24):
best of their health.
Jennifer Smith (36:25):
And I think the value in doing that with a dietician
too, is that we have worked withmany other health conditions, right?
And the fact that if you also have...you know, heart disease or you have
absolutely something else in the picture.
Dana Roseman (36:40):
Yeah.
Celiac disease or
Jennifer Smith (36:43):
yeah.
Dana Roseman (36:43):
I mean there's just so much that we also would take
into consideration for the wholeperson, not just the diabetes.
Jennifer Smith (36:49):
Yeah.
I think that would be another one.
I mean, even just aroundthe gluten-free realm.
Dana Roseman (36:53):
Absolutely.
Jennifer Smith (36:54):
Another whole topic of discussion.
Dana Roseman (36:56):
Yes.
Jennifer Smith (36:56):
Because, because it just has so many different little rabbit holes.
Dana Roseman (37:01):
Yeah.
Yeah.
Jennifer Smith (37:02):
To talk about, so..
Dana Roseman (37:03):
Absolutely.
Absolutely.
Yeah.
Jennifer Smith (37:05):
Well, we have a lot to talk about then in future episodes.
Dana Roseman (37:07):
I know, I'm excited.
Jennifer Smith (37:09):
Yeah.
Um, lots and lots of things whichwe'll hopefully be able to bring in
more around kind of the CGMs and thetechnology and how to use them around
food, um, and what else to explore, so
Dana Roseman (37:20):
Yeah, and I'd love to hear people's comments of what
they would like us to discuss also.
I think that would be fun.
Jennifer Smith (37:25):
Yeah.
Dana Roseman (37:25):
To hear from people watching.
Jennifer Smith (37:26):
It would be.
Yeah.
That would be great.
Well, thanks Dana.
Dana Roseman (37:28):
Or listening.
Yeah, it was good to chat with you today.
Jennifer Smith (37:30):
This was fun.
Gary Scheiner (37:30):
Thanks for tuning in to Think Like a Pancreas, the podcast.
If you enjoyed today's episode, don'tforget to like, follow or subscribe
on your favorite podcast app.
Think like a Pancreas-- the podcastis brought to you by Integrated
Diabetes Services, where experiencemeets expertise, passion meets
compassion, and diabetes care ispersonal because we live it too.
(37:54):
Our team of clinicians, all livingwith type one diabetes understands
the challenges firsthand.
We're here to help no matter where youare in the world in glucose management,
the self-care strategies, the latest tech,sports, and exercise, weight loss, type
one pregnancy, and emotional wellbeing.
We've got you covered.
(38:14):
We offer consultations inEnglish and Spanish via phone,
video, chat, email and text.
Wanna learn more?
Visit integrateddiabetes.com oremail info@integrateddiabetes.com
to schedule a consultation.
On behalf of Think Like a Pancreas--the podcast, I'm Gary Scheiner,
wishing you a fantastic week ahead.
(38:36):
And don't forget to think like a pancreas!
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