A (3:50)

Do you remember back, I know you're a particular eater. I don't mean that in a finicky way. I just mean you do a good job with your intake. So I imagine your sliding scale for your food worked pretty well, am I right?

B (4:03)

It did. And because my parents, especially my mom was kind of the controller of the food until I went to college, everything was weighed and measured. And like, we had a bouncy scale that sat in the kitchen table and everything got measured, everything got weighed. And it was thankful that I had really good educators, too. That made it. It made it workable in my brain at that age, too. Like, this is just the way that it works. And look, with all the activity, I mean, I danced, I was in volleyball, I was a cheerleader, I biked with my dad. I did a lot of things. And so with those variables, I saw that if I just stuck with the schedule that I was given, it worked out pretty well. Now, what happened in between finger sticks, I don't know. There was no CGM to say, gosh, this dose really is the right one for you.

A (4:54)

But is it fair to say that most. See, I don't think this is true because I talked to so many people who are on a sliding scale right now. Like, it happens. It happens to Canadians a lot, depending on what province they live in. And I am surprised more and more about Americans that I hear who are like, oh, no, I'm on a sliding scale. I'm like, how's that possible? It's like hearing somebody uses a fax machine. You're like, what? Right, But. But is that still pretty common?

B (5:20)

It can be. You know, we. Especially what I do with the clients that I am able to work with. Yeah, I see a lot of people who have access, really, I think is what this speaks to. It's access to technology. It's access to a clinical service that has encouraged you to be able to be better because they're providing you the ability to have technology. And many people don't have that. So sliding scale is what it is. You're told to have a dose of insulin. And what I've come to see too, with some sliding scale people that I've worked with, is they're not even given as much detail as I was given when I was using sliding scale. Right. It's eat breakfast, take three units of insulin. There's not as much detailed. Your meal has to consist of this much food because we're expecting three units to cover your food.

A (6:17)

Okay.

B (6:18)

Right.

A (6:19)

If you met somebody today who had access to insurance and they could get what they needed and they were on a sliding scale, would you tell them, I think you shouldn't be doing that, or would you say, I mean, is it different now that there are CGMs? Are there people out there on sliding scale? We're in a CGM probably. Right.

B (6:37)

I would say that it defines sliding scale in a little bit of a different way then. So those people are MDI still. Right. They may have a cgm, which gives them more access to information about what their doses that are set doses provide in control. I would even say that there are some people that might be using their pump as sliding scale instead of carb counting. They may actually just be dialing in a manual dose of insulin. And then potentially they might have a correction factor put into their pump so the pump then automatically gives correction. That could be another way of navigating sliding scale with a little more precision. But in general, sliding scale is usually multiple daily injections with a set amount of insulin and then a corrective factor that's a set dose based on blood sugar value.

A (7:34)

You think there's a lot of yo yoing that goes on for people who are managing like this?

B (7:38)

Very likely. Unless they're willing to get. You know, I have a couple of friends who use MDI and do very well with it, but theirs is a precision. They've learned how to look at their CGMs, they've learned how their insulin works for them. They've learned the timing of their dosing. Even though they are using kind of a sliding scale, most of them have also found that their most common foods, they've just figured out the dose for it. They don't necessarily have an insulin to carb ratio. They've just been able to say, well, gosh, my bowl of cottage cheese with pineapple Always takes four units. I'll take four units if my blood sugar's high. I add a little bit more to this.

A (8:20)

Right? Okay. I've never had cottage cheese in my life.

B (8:23)

You've never had cottage cheese.

A (8:25)

And as you're talking about it, it makes me feel icky. I just wanted to say that.

B (8:27)

Well, that's okay. It's not. I. Yeah, it's all good. I don't know why it even came to mind. I was just trying to think of, like.

A (8:33)

It was nice. I just. I was like, oh, I've never had that. There you go.

B (8:36)

I did make you eat a tomato, though.

A (8:38)

I did. I did have a tomato. Where was I? I was a. I was. We were on vacation and tomato came out and I was like, all right, I'll eat it. And I did. And I sent Jenny a picture of it.

B (8:46)

I said, look, yes, I ate the tomato.

A (8:48)

I don't know if that episode's out yet or if people have context for that yet or not. So sliding scale is like. Like, put it, like, real black and white for me. Take all the. The nuts and bolts out of it. Like, I'm at the doctor and they're just gonna say, hey, put in this much insulin at this time, eat at this time, eat this much food. If your blood sugar is 150 to 199, I want you to do this much. If it's 200 to 250, I want you to do a little this much. That's it. That's a slide, and that's it.

B (9:14)

And there's basal insulin behind it. So usually the basal insulin is also once a day at this point. Right. And then meal times are covered with a sliding scale, which tends to work a little bit better at this point because many people, not everybody, but most people are using rapid. They're not using the older R insulin, which took longer.

A (9:34)

I was gonna say, are there. I don't want to muddy the two. So let's just say we're done talking about that now. But, like, are there places in the world where people are still using, like, regular and mph?

B (9:43)

Oh, absolutely.

A (9:44)

Really?

B (9:44)

Yeah, absolutely, yes.

A (9:46)

Well, and then they're on a. Like an old school sliding scale at that point.

B (9:50)

And then they're on very old school sliding scale, kind of similar to mine. It was just very structured. There was not. There was not deviation from timeframes or where snacks were gonna happen or anything unless there was exercise. In the picture that you.

A (10:04)

I remember Mike always. He kind of paused for a minute when he was drawing up his Insulin. And I did ask him one day, what are you thinking about? He's like, I'm trying to figure out how active we're gonna be today. And that was kind of the end of it. Like, it was in the morning and he was just. It was weird to watch him. He'd, like, pull on that and he'd be like, you know, meanwhile, it wasn't. Obviously his outcome was terrible, so it wasn't working for him. But that was, I think, the extent of his training. I'm making. I'm making air quotes.

B (10:30)

I mean, you know, the old school stuff again with even the intermediate acting cloudy insulin, the N and the R, whatever. Like, I had a very different snack in the afternoon depending on whether I was headed to a sport right after school or not. So snack for sport was this type of intake so that I wouldn't drop because I was on the tail end of my intermediate acting insulin and it would encourage me to have a low.

A (11:04)

And I did all those things that.

B (11:06)

You kind of figure out as you go.

A (11:08)

Okay, thank you. I appreciate it.

B (11:09)

Sure.

A (11:17)

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