#1632 Bolus 4 - Cinnamon Toast Crunch
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Jenny and Scott talk about bolusing for CTC.
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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 four, 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.
Summertime is right around the corner, and Omnipod five is the only tube free automated insulin delivery system in the United States, because it's tube free, it's also waterproof, and it goes wherever you go. Learn more at my link, omnipod.com/juicebox That's right. Omnipod is sponsoring this episode of the podcast, and at my link, you can get a free starter kit. Terms and Conditions apply. Eligibility may vary. Full terms and conditions can be found at omnipod.com/juicebox Jenny, I have a list in front of me here that says this is the top 10 Best Selling cereals by boxes sold. Okay, be a lot of words here. You don't know Cheerios, Frosted Flakes, Honey Nut Cheerios, Honey Bunches of Oats, cinnamon toast, crunch, Fruit Loops, Lucky Charms, frosted Mini Wheats, life and my favorite from when I was a child, Fruity Pebbles. Now,
Unknown Speaker 2:29
you know a fruity pebble? I know what they look like. Yes,
Scott Benner 2:32
they're nothing like those bastardized Cocoa Pebbles, which are just garbage. I don't even know. I've never had them. Are they the same maker? One's chocolate and one's fruit. I bet you it's not chocolate or fruit, by the way. I just want to say
Jennifer Smith, CDE 2:47
that I'm quite sure not. So
Scott Benner 2:49
let's pick one of these, and Bolus for it. You want to go, Okay, how about Cinnamon Toast Crunch? Oh my gosh, sure. Sure. You think it has cinnamon in it. It might, hold on a second. It might toast. I'm
Jennifer Smith, CDE 3:02
sure that it has cinnamon, either that or the side of it says cinnamon flavoring. Well,
Scott Benner 3:08
you can get a mega box of it for $6.21 what a deal. Let's see here, Cinnamon Toast Crunch. I am looking at its label. All right, Jenny, let's see. What
Jennifer Smith, CDE 3:26
is this? Serving size, three quarters of a cup.
Scott Benner 3:28
Oh, interesting. The serving size is one cup. Oh, one cup. Actually, I got thrown off a little bit because this label is in English and Spanish, and I kept going like, this doesn't seem like a word, I know. Sorry. So it's one cup total carbohydrates, 33 what is 33 like the magic number, or something like that? 33 grams of carbs, dietary fiber. Three grams. People are gonna be like, are you subtracting the are you not subtracting fiber? Yeah, right. No, you don't subtract by total sugar 12. This is exactly the same as, like we did. How is that? That's crazy. But this isn't gonna hit like the oats. This is gonna hit like a truck. So also milk, right? So we have to, like, a cup of milk. We're gonna have to do a cup of milk on this, do a standard one cup of milk. Okay, hold on a second. And now, is there anybody that only eats a cup of cereal? That's the question. Just made Jenny,
Jennifer Smith, CDE 4:32
I'm just referring back to the big the big vats on the wall in a cafeteria at college that like it's got the poor nozzle that you just pull it down it cranks it all out into your bowl. And I remember watching people fill their bowls at school with, like, the Jethro bowl of cereal.
Scott Benner 4:55
What's the Jethro bowl? What did you just say? Gigantic, gigantic. Okay.
Speaker 1 4:59
Oh. Whole bowl. Really, it was probably half of a box of cereal
Jennifer Smith, CDE 5:03
in a bowl, as though they'd sit down
Scott Benner 5:05
to eat. Hold on a second, food. Label, milk, whole milk. What do you drink? Oh, we don't drink milk. Sorry, I'm just gonna
Jennifer Smith, CDE 5:18
the dairy industry is gonna be like, Damn, that girl, she doesn't drink
Scott Benner 5:21
milk, cup of whole milk. It was hilarious. 12 carbs and no fiber, 12 grams of sugar, sugar and milk. Why is everything 12? Oh,
Jennifer Smith, CDE 5:37
1212, grams. That's because the carbohydrate is the same as the sugars,
Scott Benner 5:41
right? Yeah, but it's not, like, added, right? They're not added, no. That's all just protect me. I was like, they're not adding sugar to milk. Are they?
Jennifer Smith, CDE 5:48
Nope, milk sugar, essentially, it's in there naturally, yep. All
Scott Benner 5:52
right, I'll accept that. So we have now we got to figure out what an actual serving size is. I mean, it's, I bet she's three cups. I would say the
Jennifer Smith, CDE 6:03
majority of people eat two cups, two okay, let's, I would say two cups. So it is. And I'm, I'm thinking, kiddos,
Scott Benner 6:11
okay, right? I think that's the biggest problem is that people just look on the back like, Oh, it's 33 carbs, and then they just fill the bowl up with it. And, right,
Jennifer Smith, CDE 6:19
yeah. So what's, Yep, exactly. So what's the first step? Measure?
Scott Benner 6:23
Yes. So first step M measure. So we're going to measure and say we're having two cups, which is now 66 carbs. And does that mean we end up with two cups of milk? Or you think it's still one cup? I would still say one cup of milk. All right, we'll be generous and say one cup of milk. 66 carbs from the Cinnamon Toast Crunch and 12 from the milk is 78 total carbs. Okay, now we're gonna evaluate ourselves, right again? Yes, it's morning time. Are you a person who has wait? I wonder how many people are gonna realize they do or don't have trouble bolusing in the morning. That it's more about the food and the lack of Pre-Bolus than their scenario. But you want to check your blood sugar. If you have a CGM. Take a look at it. If you don't, please check with the meter. Do you have any insulin on board? What kind of a day is this going to be? Is it going to be a stressful day? Is going to be an active day that might impact how you Bolus? Probably not for Cinnamon Toast Crunch, however. So we're going to calculate our food. Bolus, Jenny, we have 78 carbs. And you guys, I wish this is not. This should just be video so you can just see Jenny going like, you know, in a day? Is that a week? I don't understand, but 78 carbs. And so that's 7.8 units of insulin using our standardized one to 10 carb ratio, which we're doing for all of our examples. So now we have 7.8 units of insulin that we need. I mean, let's say the kids wakes up at 130 I think you'd a lot of you'd be thrilled if your kid woke up 130 right? But we're also one unit moves you 100 points. So let's add another unit, another point three to it. Let's just call it eight for fun. Now we got to take a look at what we're going to do. We're going to build this Bolus up like, what are we going to do with it? Pre-Bolus, four in the morning. Jenny, when do you put it? I'm sure I've written blogs about it. I'm sure I've talked about on the podcast that you know. Arden, actually, after it, we left an end to appointment one day, asked me back when we just didn't know what we were doing and everything was upside down, or a 1c was in, like, the mid eights. Is there anything I can do to help you with this? Like a little kid standing in a parking lot said to me, and I said, you could stop eating cereal for a little while till I can figure this out. Yeah, but I did get back to it, and you know, she doesn't eat cereal anymore, but I did figure out a Bolus for it, and I'm gonna tell you that the answer is an aggressive Pre-Bolus, an aggressive amount of insulin, and you need momentum on your side when that cereal kicks like there has to be such a pull from that insulin when that cereal kicks that you can keep your stability. I mean, I don't know, what do you think for you're gonna say a half an hour, right? Today's episode is brought to you by Omnipod. It might sound crazy to say, but Summertime is right around the corner. That means more swimming, sports activities, vacations. And you know what's a great feeling, being able to stay connected to automated in some delivery while doing it all. Omnipod five is the only tube free automated insulin delivery system in the US. And because it's tube free and waterproof, it goes everywhere you do in the pool, in the ocean or on the soccer field. Unlike traditional insulin pumps, you never have to disconnect from Omnipod five for daily activities, which means you never have to take a break from automated insulin delivery ready to go tube free. Request your free Omnipod five starter kit today@omnipod.com slash. Juicebox Terms and Conditions apply. Eligibility may vary. Full terms and conditions can be found at omnipod.com/juicebox type that link into your browser, or go to Juicebox podcast.com and click on the image of Omnipod right at the bottom. There's also a link right in the show notes of your podcast player.
Jennifer Smith, CDE 10:19
Well, one thing I would say is, if you have an idea of what you've mastered with another type of meal that isn't cereal, yeah, this is 12 minutes, yeah, let's say you've mastered something that you love to eat is 12 minutes. It has a different hit than cereal does for high glycemic like this, my strategy is double that as a starting place.
Scott Benner 10:47
Okay? So if right, 12 works for you, for most things, you're going to 24 minutes, yeah, or
Jennifer Smith, CDE 10:52
25 to round it out, just make it nice and even say, okay, 25 minutes. This is a hard hitting now we've doubled the the serving size on the package, right? It's not just one cup. We're eating two cups of it, and we're now eating 24 grams of added sugar. You know, how many teaspoons of sugar that is? Do you
Scott Benner 11:13
know 24 grams of sugar is, how many teaspoons of sugar?
Jennifer Smith, CDE 11:17
Yeah, how many grams of carb is in one teaspoon?
Scott Benner 11:22
Ah, did I stump? Scott, look, I know. Is it two? No, a teaspoon, like a level, a teaspoon, like a measuring teaspoon, four. Wait, there's four carbs in a measuring teaspoon of sugar. So not like the teaspoon that you use to put in your coffee, which is probably five teaspoons. So what does that mean? Put that contextualize that for
Jennifer Smith, CDE 11:43
Yeah. So now we have 12 grams in a cup. We're eating two cups of the cereal. That's 24 grams of sugar. 24 divided by four is how many teaspoons.
Scott Benner 11:53
Six. There you go. Wow, really? So I,
Jennifer Smith, CDE 11:59
and I bring this in not this is, again, this is not a judgment. This is a teaching piece, but it's teaching in the fact of we're considering the glycemic impact of this food. We're not just eating one serving now we're eating two, so you're increasing the load effect of a high glycemic food.
Scott Benner 12:16
Yeah. Also, let me read the ingredients for you from Cinnamon Toast Crunch, whole grain wheat, sugar. Also, I don't know if people know this, the order they're in is their amounts. So there's, it's mostly whole grain wheat. It is second, mostly sugar. Third, rice flour, canola and or sunflower oil. Can they not make up their minds? What does end or mean? So whatever they got laying around, it's whatever they it's a mix. There you go. What do we got today? Throw it in there. 1234, we are now five things deep. The next item that is most prevalent in Cinnamon Toast Crunch is fructose, then maltodextrin, dextrose, which I think sounds like another way to say sugar it is. We've just said sugar three times in a row, right? Sugar, fructose, dextrose, sugar, sugar, sugar, am I? Am I right about that 100% okay, all right. Salt, wow, cinnamon. We got the cinnamon pretty early. Oh, and it's not cinnamon flavor. It's real salt. It's real cinnamon. It's probably in there to mask whatever tri sodium phosphate is, soy, less is thin, less than, less than caramel color, Rosemary extract. Oh, a little the nature. BH, two added to preserve freshness. Vitamins and minerals, calcium carbonate, vitamin C, iron, zinc, they list them all here, A, B,
Jennifer Smith, CDE 13:37
what are? What are those? Therefore they're enriched or fortified, right? Enriched or fortified because all of that whole grain weed at the first ingredient that's been stripped, yeah, of all the beneficial vitamins,
Scott Benner 13:50
right? Oddly enough, like percentage of your daily value for the vitamins, it's between 10 and 20% for all those. So, yes, yeah, they've given you a vitamin in there. You could have took it on your own, though, we're gonna Pre-Bolus this meal. You know, double of what you find to be working with a food item that you're good at bolusing for. Again, I'll tell you, like on something this aggressively glycemic. I mean, there's a load here and an impact, right? The load from the processed food, the impact from the sugar. I think if you Bolus for this even super aggressively, and you're on an algorithm, and that algorithm is going to go, here's the insulin, if you I don't like this word, but if you mess up that Pre-Bolus and don't get the insulin ahead of the spike that's coming, that algorithm is going to sit for hours and not give you basal. There's no way you're not going to be 400 if you mess up the pre vault. Potentially, yeah, no way. There's a way. But like, yeah, potentially, and at least on a regular pump, your basal still churning, and might get in the way of it a little bit. So now, if this all works, I. Know this is going to sound crazy to people. Wait, somebody online is going to call me a insulin pusher. I can keep a steady line. Yes, with with cereal, it's a lot of insulin and a lot of timing, and you can do it. Would I do this every day? Even if I could? I would not. I'm just being honest with you. I've seen my daughter eat a bowl of cereal once in the last year and a half so, and I she was sick, and she's like, You know what I want? And I was like, What do you want? Just like, and she says, yeah. Like, I was like, all right, but could I do it? I could. I don't think it's the greatest decision you're ever gonna make in your life. But if this is your sitch, what am I 10? If this is your situation, I want you to Bolus, well for the cereal that's all like, I mean, you're gonna, I just don't want you having high blood sugars, which, by the way, are gonna, at some point, those big spikes are gonna turn to, like, a crashing low at some point in the future, too.
Jennifer Smith, CDE 15:51
So good if you don't figure out your strategy. And that's where the end of our acronym, your acronym, right? It comes in. It's evaluate. Watch that one hour, three hours, five hours. How did this meal filter out for you? What do you have to tweak for next time? And I, you know, I'd go back to a friend of mine, who I've known had for a long, long time. She also has type one almost as long as I do, and I don't know that she still does it. But years ago, before all of the aid assisted types of systems on the market. She wanted cereal once a year for her birthday. Yeah, that's what she wanted. And she did. She didn't have your acronym, but she figured it out. She tested it out, and what she found works. This is not medical advice, not encouraging you to do this.
Scott Benner 16:42
None of this is medical advice. I've been doing this for a long time.
Jennifer Smith, CDE 16:46
Was it was a timing thing. So she had to get the initial step of insulin added the right way. And what she found worked was doubling the dose of insulin that she would normally take for cereal, and on the back end, she suspended her pump. Okay, so at the Bolus time, she suspended her pump for hours after and over Bolus, the hell out of the cereal. Over Bolus up front to get ahead of getting too high. And on the back end, she balanced it out because she took away the basal, which is a slower drip, drip, drip, and she could take it away easily. So that
Scott Benner 17:26
might work on an A I D as well. It could potentially, yeah, what people have to understand about the algorithms, like at a basic level, is you tell it, these are your settings, and this is how much I ate. It believes you right? It is not going to adjust, because your blood sugar, like, shot up out of nowhere. It goes, no, no. They told us how much we did and we did the right amount, like, we're going to keep doing the thing we're doing now. Some of them will, you know, start pushing back as something rises and rises, but that pushback is not going to be aggressive enough to overcome a major Miss in the amount of insulin or the amount of timing that you choose. Okay, all right, like, I know it's not food you ate, but do you think you could sit down right now eat two cups of Cinnamon Toast Crunch and Bolus for it? Yes, yes. If I get you to do that on video one day,
Jennifer Smith, CDE 18:14
that'd be do it. I could do it. I probably wouldn't pick Cinnamon Toast Crunch, but something else that I'd
Scott Benner 18:20
prefer I take my hall pass on that one. All right, I appreciate it. We covered it, right? We're
Jennifer Smith, CDE 18:27
good. No, it's great, perfect. Thank you.
Scott Benner 18:37
Summertime is right around the corner, and Omnipod five is the only tube free automated insulin delivery system in the United States, because it's tube free, it's also waterproof, and it goes wherever you go. Learn more at my link, omnipod.com/juicebox, that's right. Omnipod is sponsoring this episode of the podcast, and at my link, you can get a free starter kit. Terms and Conditions apply. Eligibility may vary. Full terms and conditions can be found at omnipod.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 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, correct. Direction, 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. For 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, wrong wayrecording.com.
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