#1619 Bolus 4 Oatmeal
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Jenny and Scott talk about bolusing for Oatmeal
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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.
Scott Benner 0:00
Hello friends and welcome back to another episode of The Juicebox podcast.
In every episode of Bolus for Jenny Smith and I are going to take a few minutes to talk through how to Bolus for a single item of food. Jenny and I are going to follow a little bit of a road map called meal bolt. Measure the meal, evaluate yourself. Add the base units, layer a correction. Build the Bolus shape, offset the timing. Look at the CGM tweak for next time. Having said that these episodes are going to be very conversational and not incredibly technical. We want you to hear how we think about it, but we also would like you to know that this is kind of the pathway we're considering while we're talking about it. So while you might not hear us say every letter of meal bolt in every episode, we will be thinking about it while we're talking. If you want to learn more, go to Juicebox podcast.com. Forward slash meal, dash bolt. But for now, we'll find out how to Bolus for today's subject, please don't forget that nothing you hear on the Juicebox podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin.
This episode of The Juicebox podcast is sponsored by Medtronic diabetes and their mini med 780 G system designed to help ease the burden of diabetes management, imagine fewer worries about Miss boluses or miscalculated carbs thanks to meal detection technology and automatic correction doses. Learn more and get started today at Medtronic diabetes.com/juicebox All right, guys, listen to Jenny and I fumble through figuring out how to tell you to Bolus for a specific item. And you'll know, this was the first one we recorded, because it's probably going to sound like it. But Jenny, my idea is, is to create, like a food library of basic, simple foods. And then once we feel like we have that library, kind of like completed, I want to go to menu items like, I want to start like, oh, I want to go online and be like, I have like, examples from people, they've already sent, like, one, you have no idea how many people want to know how to Bolus for the roles at Texas Roadhouse, like, something simple like that. So, like, we're going to start, and you won't know. So we're gonna, it's gonna
Unknown Speaker 2:34
be very like, I should ever been to Texas
Scott Benner 2:37
Roadhouse, Roadhouse, but I think that'll be interesting, because what we can do is just pull up the menu, pull up the nutritional information, and just take, try to apply as much science to the random known information, yeah, and then, like, release people out into the world and see what they do. So
Jennifer Smith, CDE 2:55
no, it's kind of a progressive build. Then really the idea of taking single items like an orange, and then saying, Okay, now that you've got all the simple single food and the potential way to work them, now let's build in something that's more of a complete meal. Is the idea, right?
Scott Benner 3:16
I somehow oddly believe that these small episodes will teach people to swag better in the end? Great, yeah, I think, because, I think that's the most reasonable way, long term, to have type one and have to manage food, right? You can't. I mean, in the beginning, you know that you see the people like, I got a scale. I got this is there an app that you can take a picture of something, it'll tell you how much it weighs. Like, you know, like that. Mania hits you in the beginning, but at some point years into it, you're like, ah, it looks like 45 grams. So I'm interested to see if this helps people. Okay, all right, so let's start with something simple. How about oatmeal?
Unknown Speaker 3:53
Oatmeal? Yeah, okay, never have an oatmeal.
Unknown Speaker 3:57
Yes, okay,
Jennifer Smith, CDE 3:58
and I think we need to define oatmeal. I know. Are we defining quick oats, like the little bags of Apple Cinnamon, not real apple, and probably lots of sugar and not much cinnamon? Or are we defining old fashioned, thick, rolled oats? Or what are we defining here? Because there's a difference.
Scott Benner 4:18
Let's go with what people probably eat and Yeah, how about Quaker? Like, instant oatmeal, Chinese. Like, I don't know what it is, but I got it here. Okay, you ready? So there's a box you can buy on Amazon. It has four different flavors. It has maple and brown sugar, cinnamon and spice, apples and cinnamon, peaches and cream. So let's just like, let's say we chose the maple and brown sugar. Serving size is one packet. Okay? There is half a gram of saturated fat, no trans fat, half a gram of polyunsaturated fat. There's 260 milligrams of sodium, 33 grams of carbs
Unknown Speaker 4:58
in a single. Packet, right? Packet, 33.
Scott Benner 5:01
Grams of fiber, one soluble fiber, sugar. You want to guess, fiber, fiber, dietary fiber, three grams. Oh, it's pretty good. Three, look at that. He's like, Finally, but total sugars, 12, there's protein in it. That's interesting. Four grams
Jennifer Smith, CDE 5:20
grains have protein, and the more unprocessed they are, the more fiber as well as the more protein they retain.
Scott Benner 5:26
Okay, so, so this one's interesting. I've never wait. We're gonna really find out that the foods I've never seen in my life, I've never had oatmeal in my life. Are you kidding me? No, I've no idea like it really you've never had oatmeal. Oatmeal looks like small pieces of cardboard in mush. To me. Is that not what it
Unknown Speaker 5:49
is? Sorry, that that's what you think they look like.
Scott Benner 5:52
But you would turn me onto like, what like steel cut oats or something like that. If you were telling
Jennifer Smith, CDE 5:58
me dislike steel cut oats, I know that there is a world of people out there who love their steel cut oats. I do not like, I don't like the consistency of steel cut oats. And I'm not really a texture person, honestly, but steel cut oats just are gross to me. I much prefer old fashioned, thick, rolled and then do kind of I do like an overnight Oat. So it's where you put the fluid in of whatever kind you're going to use. You let them sit overnight with the liquid in them so that they get it gets absorbed, they get soft. And then you could technically cook them a little bit to heat them, but, but they're soft enough that you could eat them cold, which changes the glycemic nature of them.
Scott Benner 6:43
What taste was it? What I almost said, What tastes like? What does it taste like like? Describe it to me. Today's episode is sponsored by Medtronic diabetes, who is making life with diabetes easier with the mini med 780 G system, the mini med 780 G automated insulin delivery system anticipates, adjusts and corrects every five minutes. Real world results show people achieving up to 80% time and range with recommended settings, without increasing lows. But of course, Individual results may vary. The 780 G works around the clock, so you can focus on what matters. Have you heard about Medtronic, extended infusion set? It's the first and only infusion set labeled for up to a seven day wear. This feature is repeatedly asked for, and Medtronic has delivered. 97% of people using the 780 G reported that they could manage their diabetes without major disruptions of sleep. They felt more free to eat what they wanted, and they felt less stress with fewer alarms and alerts you can't beat that. Learn more about how you can spend less time and effort managing your diabetes by visiting Medtronic diabetes.com/juicebox
Jennifer Smith, CDE 7:56
oats are pretty, they're pretty, I don't know. They're a little bits. They're a little bit not sweeter, but I don't know. They're more breakfast foodie tasting than something like plain rice that has not been flavored with anything as well. And if you have cooked them or soaked them the right way, they're pretty soft, so they're not like the cardboard that you're envisioning. I just realized
Scott Benner 8:20
I'm gonna sound like an alien while we're talking about this. So why do I eat them? It's not for flavor. Is it for Well,
Jennifer Smith, CDE 8:27
if you eat again, that's the difference. That's why I asked, What are we talking about? Quick cook versus old fashioned, and especially the old fashioned thick roll. The difference being that the quick cook are really they're processed like they're they're broken down, they're more ground up. It's the reason that they cook really, really quickly, and they are like you're talking about, they're more like mush,
Scott Benner 8:48
but with enough sugar on them that I'm like, okay, I can do this. You could do it, yes, exactly, different flavors in one package, correct? All right. Well, let's assume that some people must throw these together, like in the morning, because it's quick and right? And so we're going to do for all these, we're going to keep it one unit covers 10 carbs. One unit moves you 100 points. Okay, that way, like, we can kind of keep the math simple. So if there's 18 carbs here, then what? It's one 1.8 units. And then there's,
Jennifer Smith, CDE 9:26
there are only 18 carbs in that little packet, really. Oh,
Scott Benner 9:29
no, 33 what was I saying? Sorry, 3.3 3.3 units. I saw the I was looking at the wrong number. And then and 12 of that is sugar. Like, how does that sugar impact that Bolus in your mind, because you know what I mean, like the oats themselves are probably a very slow breakdown. Is that not right?
Jennifer Smith, CDE 9:47
Yeah, correct. And with the sugar added now you've added in, what is that? If you do the math, it's about a third of the grams of total carb actually come from sugar, and that's. Added sugar. And so what we're looking at is a much heavier glycemic impact. And for definition, as I mentioned to begin with, we look at quick cook versus old fashioned, and they're both in the moderate glycemic index kind of number line. I think one is somewhere in the 50s, and that's probably that's the older old fashioned oats, and then the more quick cook flavored tend to be somewhere in the 60s. So they're not terribly different, but it's what you end up doing to them that can make the difference. And as we're talking about, Bolus strategizing, along with now adding in sugars, flavors, that kind of thing to it. You're adding in a third of the weight of this product is
Scott Benner 10:47
sugar. Doesn't seem like a good idea,
Unknown Speaker 10:50
right? Well, right? And, but it
Scott Benner 10:53
feels like, in my mind, it feels like you're getting a slow digestion material with a quick spike. So I'm gonna and when are we usually eating morning, when I'm already having trouble bolusing for things because for a number of different reasons, feet on the floor, maybe adrenaline about the day. Maybe you have a lower basal rate overnight that helps you not to get low. Overnights, you wake up, you have more resistance less insulin. Then you throw in something that's gonna take forever to digest, and hit it hard with sugar right away. So that's where you get a 320 blood sugar that lasts for three hours. Right? Okay, right, exactly.
Jennifer Smith, CDE 11:30
So you know, when you think through the strategy as you've defined a one to 10 ratio, a one to 100 correction factor. So we're giving some points of reference, and if we also say, okay, you've come into this meal, this breakfast at a stable in Target blood sugar. To just simplify the whole piece, right? You're not rising already. You're not low or having dropped or treated a low blah, blah, blah, or coming in nice and stable, let's say a blood sugar of 100 making it even easier. What would you anticipate, knowing what we've just talked about, in terms of the glycemic nature of this particular food,
Scott Benner 12:08
I'm anticipating a quick rise. I'd want a long, pretty aggressive Pre-Bolus, right? I would be, yeah, I used to talk about this more, but I'd be looking for like, an 80 diagonal down on my on a CGM before the oatmeal hit, because I'm thinking the oatmeal is going to hit you really quickly, like, the sugar that's going to hit you really quickly. Yeah, so, and
Jennifer Smith, CDE 12:34
we're also placing in we're not placing anything else addition to it. We're not saying, eat eggs first. We're not saying eat a add a load of butter to the dish, or whatever this is. You're just cooking these quick oats, and you're going to eat
Scott Benner 12:47
them. That's working these down, and you're leaving the house. And so, right, exactly.
Jennifer Smith, CDE 12:52
So the goal would be, if you know you're eating this, you're getting up in the morning, you've got this amount of time frame to leave the house, or get your kids out of the house, etc, that Bolus goes in almost as soon as you are getting out of bed, if you are the quick eat person in the morning, Bolus do your morning get ready thing. My previous experience in college with quick oats, because that was what they served in the cafeteria, until I started doing my own thing was like a 30 minute to get ahead of that, to get ahead of what was going
Scott Benner 13:27
to happen. I'm gonna I'm making notes for myself about other things to talk about, because I don't want to derail these but you're making me think of other stories that people have told me. Oh, great. So in case people aren't like following along yet, we did measure the meal. Evaluate yourself, add the base units, calculate the food, Bolus, carbs, etc, and now we're to the l layer a correction. So if we, you know, Jenny said, like you know, if you were, let's assume you're at 100 but if you weren't, if you were at 120 or 150 or whatever, that Pre-Bolus would include a correction to move that number to your target number, right? And now we got to decide, like, is this like, you know, we've talked, I think a big, long Pre-Bolus. Do you think it needs any extension, or extended Bolus, or a follow up? Bolus afterwards, or not, if you hit it hard enough up
Jennifer Smith, CDE 14:15
front, right? Not, if you do not, if you're really on top of the Pre-Bolus and that timing upfront. There's nothing sticky that doesn't have a lot of fiber in it. There's really nothing that's going to hold this food for a long time. It truly is a more carbohydrate type of food, which has an in and out clearance that mimic or goes along with, why we use rapid acting insulin, right? Rapid insulins have an in and out, and if there's nothing else in the picture to linger well beyond that three hours, like fats and proteins, your timing of that meal should coincide with the way that the insulin is supposed to
Scott Benner 14:52
work. If this didn't have sugar on it, you would Bolus differently for it. If this didn't have
Jennifer Smith, CDE 14:58
the added sugar. Factors too, if it was just truly plain, quick cook, quick cook. Oh, it's definitely less time, especially starting with all the factors that we defined already right, blood sugar, stable in Target, et cetera. But still at least a 15 minute, probably even 20 minute Pre-Bolus time.
Scott Benner 15:18
Yeah, so shorter Pre-Bolus, still not just five minutes, right? And because this stuff is gonna get in there and start hitting hard, it's just gonna hit a lot harder if there's sugar on top, okay? And then we wanted to look at the CGM maybe an hour later, see where we're at, and then just kind of spot check an hour, you know, three hours later, whatever you're comfortable with, and then take some notes for yourself and tweak it for next time. See, see if you got the outcome you wanted. Adjust your ratios, you know, adjust your Pre-Bolus time, maybe a little longer, a little shorter, and give it another whirl. I somebody said something online the other day that I love they somebody was trying to figure out how to eat ice cream. Oh, and this person said, My strategy for ice cream is I keep going back and eating ice cream until I figure it out.
Jennifer Smith, CDE 16:06
That's exactly what we're talking about here. Yes,
Scott Benner 16:10
try your oatmeal again. All right. Awesome. This was great. Thank you. Cool.
Thanks for tuning in today, and thanks to Medtronic diabetes for sponsoring this episode. We've been talking about Medtronic mini med 780 G system today, an automated insulin delivery system that helps make diabetes management easier day and night, whether it's their meal detection technology or the Medtronic extended infusion set, it all comes together to simplify life with diabetes. Go find out more at my link, Medtronic diabetes.com/juicebox. Hey, thanks for listening all the way to the end. I really appreciate your loyalty and listenership. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox podcast. You foreign.
In each episode of The Bolus four series, Jenny Smith and I are going to pick one food and talk through the bolusing for that food. We hope you find it valuable. Generally speaking, we're going to follow a bit of a formula, the meal bolt. Formula, M, E, A, l, B, O, L, T. You can learn more about it at Juicebox podcast.com, forward, slash, meal, dash, bolt. But here's what it is, step 1m. Measure the meal E, evaluate yourself. A, add the base units, l, layer, a, correction, B, build the Bolus shape, O, offset the timing, l, look at the CGM and T, tweak for next time. In a nutshell, we measure our meal, total carbohydrates, protein, fat. Consider the glycemic index and the glycemic load, and then we evaluate yourself. What's your current blood sugar, how much insulin is on board, and what kind of activity are you going to be involved in or not involved in? You have any stress hormones, illness, what's going on with you? Then a we add the base units your carbs divided by insulin to carb ratio. Just a simple Bolus l layer, a correction, right? Do you have to add or subtract insulin based on your current blood sugar? Build the Bolus shape. Are we going to give it all up front, 100% for a fast digesting meal, or is there going to be like a combo or a square wave Bolus? Does it have to be extended? I'll set the timing. This is about pre bolusing. Does it take a couple of minutes this meal, or maybe 20 minutes? Are we going to have to again, consider combo square wave boluses and meals, figure out the timing of that meal, and then l look at the CGM. An hour later, was there a fast spike? Three hours later, was there a delayed rise five hours later? Is there any lingering effect from fat and protein? Tweak, tweak for next time? T What did you eat? How much insulin and when? What did your blood sugar curve look like? What would you do next time? This is what we're going to talk about in every episode of Bolus four. Measure the meal, evaluate yourself, add the base units, layer a correction, build the Bolus shape, offset the timing, look at the CGM tweak for next time. But it's not going to be that confusing, and we're not going to ask you to remember all of that stuff, but that's the pathway that Jenny and I are going to use to speak about each Bolus the episode you just heard was professionally edited by wrong way recording, wrongway recording.com,
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