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Happy MealLarge fryQuarter PounderJenny's pickScott's pickStripsBreakfastSaucesLarge shakeKid's meal
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Bolus 4 · Episode 1754

McDonald's

Somewhere between two and a half and three million Happy Meals are sold in the US every day, so Scott took Jenny to McDonald's — on their website, which lists everything. A Happy Meal, a large fry, a Quarter Pounder, the meals they'd each actually order, breakfast, the sauces, a large shake, and a kid's nugget meal, every one run through the estimator. This is the episode where Scott first made the estimator public.

Scott Benner and Jenny Smith, RD, CDCES, LD
Open the Bolus 4 estimator
Carb ratio1:10
Sensitivity50
Target90
Fat + protein100%

Scott's settings on the recording: one unit covers 10, sensitivity 50, target 90, blood sugar 100, nothing on board, stable arrow. Every reading on the tape matches a 100% fat-protein factor, so that's what this page uses. From the Filet-O-Fish on, Scott says “80” — the readings match a target of 80 with the blood sugar still at 100, which adds 0.4 of correction to each up-front dose. The trend arrows he mentions don't change the math. 6:03

01 · Bolus 4 · Episode 1754

A Happy Meal, and a large fry

The hamburger Happy Meal: the burger, a small fry, apple slices and a milk. Jenny guessed the pieces. Then Scott asked for just a large fry.

3:42

Hamburger Happy Meal

60carb22protein16fat
6.20u up front2.32u over 4h8.52u total
Burger, small fry, apple slices, milk — 475 calories, as listed on McDonald's website. On the tape: “start with a 6.2,” then 2.3 over about four hours. “Total dose, eight and a half units.” The 0.2 is the correction from 100 down to 90.

Large fry

65carb7protein23fat
6.70u up front2.35u over 4h9.05u total
Zero sugar, zero added sugar — which isn't zero carbohydrate. On the tape: 6.7 up front and 2.35 over four hours. Basically the same bolus as the whole Happy Meal.
McDonald's website · 1:10 · 50 · target 90 · blood sugar 100  ·  Click any item to hear that moment
Jenny's guess, piece by piece7:03
30g · the bun
Her estimate for the burger.
30g · small fry
About the same again.
10–15g · apple slices
Depending on how many are in the package.
12g · milk
A carton. Her pieces added up to more than the 60 on the website, so she figured the fry serving must be smaller.
02 · Bolus 4 · Episode 1754

A Quarter Pounder with Cheese

Just the burger. Then Scott deleted the carbs to see what the fat and protein ask for on their own.

10:57

Quarter Pounder with Cheese

42carb30protein26fat
4.40u up front3.54u over 5h7.94u total
On the tape: 4.4 up front, 3.54 over five hours. Jenny would have guessed at least four hours — everyone's digestion is a little different.

Same burger, carbs deleted

0carb30protein26fat
0.20u up front3.54u over 5h3.74u total
Just the protein and fat. The 0.2 up front is only the correction to target; the 3.54 over five hours doesn't move.
1:10 · 50 · target 90 · blood sugar 100  ·  Click any item to hear that moment
Why the numbers surprise people12:09

“I was only ever taught to count the carbohydrates.”

Jenny, on what she sees in people's faces when she works with them one on one. Fat and protein coverage has been around for years, and people still under-cover it — mostly out of worry that they can't possibly need that much more insulin. When they start using it, their control improves.

Where fat and protein start to matter16:02

Scott asked whether some people just don't need a bolus for fat.

  1. More than about 20 grams of fat in a sittingThat's high fat, Jenny says — with a good chance of an impact in the later hours after the meal.
  2. More than about 20 to 25 grams of proteinThe same thing: a potential drift up later, nothing to do with the carbs you counted so carefully.
  3. “I never need a bolus for fat”Her blanket answer: something behind the scenes, like basal, was probably tested with that usual fat in the picture — so it's making up for it.
  4. Very low carb eatersKeto, paleo, high-protein or very high-fat eating is often covered already by the insulin they use, which hits slowly over the time they need it.
03 · Bolus 4 · Episode 1754

Jenny's pick: the Filet-O-Fish meal

Scott made her order something. She took the fish. With a medium Sprite and a medium fry, because that's how the website lists the meal.

18:35

Filet-O-Fish meal · medium fry · medium Sprite

145carb21protein34fat
14.90u up front3.90u over 5h18.80u total
950 calories. Jenny guessed 150 carbs. On the tape: 14.9 up front, 3.9 over five hours, “a total of 18.8.” Target 80 from here on.
1:10 · 50 · target 80 · blood sugar 100  ·  Click any item to hear that moment
The number that stopped her21:29

Fourteen units up front.

Jenny uses about 26 units in a whole day. One Filet-O-Fish meal is more than half of that — for lunch.

04 · Bolus 4 · Episode 1754

Scott's pick: the Double Quarter Pounder with Cheese meal

Picked from the photos as “the one that looks like it's trying its hardest.” 1,330 calories, with a medium Coca-Cola.

22:10

Double Quarter Pounder with Cheese meal · medium Coke

80g of that is sugar
156carb53protein57fat
16.00u up front7.25u over 8h23.25u total
On the tape: “sixteen units up front, 7.25 over eight hours.”
1:10 · 50 · target 80 · blood sugar 100  ·  Click any item to hear that moment
Eight hours?23:38

Jenny: absolutely.

The teenage guys she works with often need a considerable extended bolus — or some compensation in whatever system they use — for eight to twelve hours after they finish eating.

Jenny's one ask24:15

Eat the food. Drink water.

Don't put liquid sugar on top of it. Scott hopes most listeners wouldn't order a regular Coke with this — but McDonald's lists the meal with one, which says what most people do.

What the estimator is for27:30

Scott's settings page comes first — this one believes the settings you give it.

  1. Check your settings firstjuiceboxpodcast.com/settings takes your weight in pounds and gives you a starting spot. Not perfect, not a rule — see your endocrinologist — but it can show you that your settings may be off.
  2. Then feed it the mealJenny: if your settings are mostly true, this is the next step up — not only how much insulin, but how long this meal is going to hit you.
  3. It's a toolNot a replacement for your doctor or your common sense. None of it is a blanket statement for anybody.
05 · Bolus 4 · Episode 1754

McCrispy Strips, four piece

For everyone saying they don't eat the burgers, they have the chicken. No oven involved.

30:30

McCrispy Strips — 4 piece

24carb40protein23fat
2.80u up front3.67u over 5h6.47u total
Just the strips, nothing else. On the tape: 2.8 up front, 3.67 over five hours.
1:10 · 50 · target 80 · blood sugar 100  ·  Click any item to hear that moment
Jenny31:19

The carbs need less insulin than the fat and protein.

That's where people miss it, get frustrated, and decide the carb count must be wrong. Everybody's tolerance is different: at some amount you just bolus for the carbs, pre-bolus the right way, and it works out. But there's likely a tipping point.

06 · Bolus 4 · Episode 1754

Breakfast: the Sausage, Egg & Cheese McGriddle meal

It comes with a hash brown and a coffee. Nothing to count in the coffee — that's your own experience with caffeine. Then Scott put in Arden's settings from before her GLP.

32:47

McGriddle meal · 1:10 · 50

63carb21protein41fat
6.70u up front4.53u over 8h11.23u total
On the tape: 6.7 up front, 4.53 over eight hours.

Same meal · Arden's 1:4.5 · 36

63carb21protein41fat
14.56u up front10.07u over 8h24.62u total
Arden's carb ratio and sensitivity without a GLP. Scott read it as 14.5 up front and 10.07 over eight hours — the tool's up front is 14.56. About 24 units for a breakfast sandwich meal.
Target 80 · blood sugar 100  ·  Click any item to hear that moment
If the number scares you34:33

Suppose it says 24 and you're only comfortable with 12.

  1. The rest of the day goes highNot just the next couple of hours — this meal's impact could run eight hours because of the fat and protein.
  2. You nickel and dime itA unit. It goes down, it goes back up. Two. Nobody looks at a high and thinks, I probably need 14 more units.
  3. It usually costs as much anywayJenny: add up what went in to correct the stuck high, and it's likely at or above what the system told them to give in the first place.
07 · Bolus 4 · Episode 1754

Sauces, and a McCafé drink

The website lists everything, down to the packets.

36:24
One packet, as Scott read them36:40
11g · tangy barbecue
Jenny guessed up to 20 for a sweet and sour packet.
6g · honey mustard
Ask for more than one and a lot of places charge you.
12g · honey packet
The little one you get for your tea.
62g · caramel macchiato
A large McCafé, with 14 protein and 10 fat. Scott didn't run it.
Protein on top37:30

Protein foam on a coffee drink.

Jenny saw a national chain's ad for it — 12, 15, 18 grams of protein on top of a drink that already has plenty of calories. You got more protein. Whatever else was in the drink probably wasn't something you needed.

08 · Bolus 4 · Episode 1754

A large vanilla shake

Jenny kept saying Scott had to get a shake. Small is 80 carbs, medium 97, large 133. He ran the large with Arden's settings — on a GLP and before it.

38:52

Large shake · Arden on a GLP · 1:10 · 90

133carb17protein19fat
13.30u up front2.39u over 4h15.69u total
Blood sugar 80, target 80. On the tape: 13.3 up front, 2.39 over four hours, total 15.69.

Large shake · Arden before the GLP · 1:4.5 · 36

133carb17protein19fat
29.56u up front5.31u over 4h34.87u total
On the tape: 29.5 up front, 5.3 over four hours, 34.87 units. Over the estimator's 25-unit max bolus — Scott raised it to 40 to see the number.
Arden's settings, as Scott entered them  ·  Click any item to hear that moment
Vanilla shake, by size38:55
80g · small
480 calories · 10 protein · 13 fat.
97g · medium
570 calories · 12 protein · 15 fat. “That 97 carbs just hit me hard.”
133g · large
780 calories · 17 protein · 19 fat.
4.5 · 36not odd
Jenny: with insulin resistance, ratios of four, five or six with correction factors of 35, 40, 50 are not uncommon.
The sugar, in teaspoons41:45
The large shake has 85 grams of sugar, 67 of them added. How many teaspoons is that?
21
Jenny: divide by four — 21 teaspoons and a dash. Picture them dumped on the table in front of you.
09 · Bolus 4 · Episode 1754

A kid's nugget meal

There's no nugget meal on the value menu, and Jenny says there should be — a lot of the kids in this community love chicken nuggets. So Scott built one: four nuggets, then a small fry, then apple slices. Stable arrow, nothing on board.

43:01

4-piece nuggets

10carb9protein10fat
1.00u up front1.26u over 3h2.26u total
On the tape: “one unit upfront, 1.26 over three hours.”

+ small fry

41carb12protein21fat
4.10u up front2.37u over 4h6.47u total
On the tape: 4.1 now, 2.37 over four hours.

+ apple slices

45carb12protein21fat
4.50u up front2.37u over 4h6.87u total
Only the carbs change: 4.5 up front, 2.37 later.

Same meal · a small kid at 1:20 · 100

45carb12protein21fat
2.25u up front1.19u over 4h3.44u total
Scott doubled the settings for a small kid: 2.25 up front, 1.19 over time.
1:10 · 50 · no blood sugar entered · stable  ·  Click any item to hear that moment
Scott46:04

Nobody is extending these things.

That's where he thinks the later rises come from — or people count on the algorithm to get in front of it. Most algorithms bolus a percentage of the need, Scott says, not the need itself.

Take a picture of this one

Things to remember from this one

The numbers that transfer to the next one.

20gfat
More than about 20 grams of fat in a sitting, expect an impact hours later.
20–25gprotein
Same for protein: a potential drift up later.
8–12hours
How long some teenage guys need extended coverage after a big meal like this.
÷4sugar → tsp
Grams of sugar divided by four is teaspoons. 85 grams is 21 teaspoons.

“Like, just don't put the liquid sugar on it.”

Jenny Smith24:33

“It's a tool.”

Jenny Smith29:00

“But there's likely a tipping point.”

Jenny Smith32:42

“I don't care what you eat. Just please cover it with a proper amount of insulin.”

Scott Benner42:50
The tool

Bolus 4 Estimator

Every number on this page, with your own settings.

Open it →The method

Meal Bolt

The tutorial the whole series is built on.

Read it →The collection

Every Bolus 4 page

Tap the cart and pick a food. One page per episode, with Scott and Jenny.

Open the cart →
Everything on this page is a simulation for education, not medical advice. Nothing here should change your insulin dosing without your care team.
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