#1634 Bolus 4 - Pancakes
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Jenny and Scott talk about bolusing for Pancakes.
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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 roadmap 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.
A huge thanks to my longest sponsor, Omnipod. Check out the Omnipod five now with my link, omnipod.com/juicebox you may be eligible for a free starter kit, a free Omnipod five starter kit at my link, go check it out. Omnipod.com/juicebox Terms and Conditions apply. Full terms and conditions can be found at omnipod.com/juicebox Jenny, we are going to do pancakes. Oh, pancakes. Now we have two different pancakes sitting here. We have the ones for those of you who are in the grocery store buying the Betty Crocker Bisquick, shake and pour pancakes. And don't put your heads down. Stay proud. I know you'd buy them out there. Jenny, do you even know what this is? It's a plastic bottle that you pour water in and then you shake, shake, shake, shake, shake it up, and you have pancake mix when it's over. You don't know this. They
Jennifer Smith, CDE 2:25
didn't know that they made them that way. I thought you still had the powdery stuff that you had to mix in a real bowl at home. I did not
Scott Benner 2:32
know you can buy it like that too. This is, like, this is next level, I'm not gonna say lazy, but this is next level, easy, okay. Like, it's a plastic jug. You pour cold water and you shake it up, you have mix. I have tried to Bolus for them, and it ain't easy. So, like, I could do it, but it's not easy. It takes pre bolusing. It takes extended boluses. It takes increased basal over top of like eating and Arden does not use syrup with sugar in it. As a matter of fact, she oddly eats pancakes dry. Sometimes she won't even put butter on them. Sometimes. Now I have those. We're going to look at those. But then I also have a very simple to make on your own pancake recipe that has been on my blog for years that does not cause any consternation the way these the mixes do. But let us start with the mix nonetheless, and that's
Jennifer Smith, CDE 3:26
interesting. I would expect what I'd expect from both of them in the extended nature of insulin need after has is not the upfront, but it's the long term. Would be the because of the way that you cook them.
Scott Benner 3:41
Okay? Yeah, I'm not sure. I don't know why, but, like, all I know is simple ingredients that are real seem to be I'm not, listen, they're still pancakes. It's not like bolusing for you know
Jennifer Smith, CDE 3:53
what I would expect? Your recipe is real flour, right? It doesn't have all of the added preservatives. It
Scott Benner 4:01
doesn't. And I do spend a little extra money when I buy flour in the house. It's a little better, but it's still it's got butter. You'll see. You'll hear it when you hear it. But let's start with, let's, let me turn to a new, clean page on my shaking bottle. Let's start with the Benner cake. This quick shake and pour buttermilk pancake mix, 10.6 ounces a serving size is a this is hilarious. A half a cup of mix is a serving size, and they're calling that three pancakes.
Jennifer Smith, CDE 4:29
And is that dry mix before you've mixed it with the liquid ingredients, that's the next question.
Scott Benner 4:36
I think if it's three, I don't know, I don't know what they're saying. So let's look on the it's 10.6 ounces.
Jennifer Smith, CDE 4:44
That would be my consideration. It's that you've got a half a cup of dry mix, and what you add to it, liquid wise, it sounds like it's just water. You don't have to add milk or other nutrient containing foods. So if it's just water. So the whole container, I would expect, takes a certain amount. So if you break it down to a half a cup of the dry mix, how much water goes in? That probably makes three. Does it give a diameter? To
Scott Benner 5:13
be honest, I think it might mean the mix with the liquid in it. Oh, yeah, because it's saying there's five. I'm trying to think of, I have used this before, so five servings of a half a cup? Yeah, I bet you there's about two and a half cups of liquid in there. Yeah, I'm gonna go ahead and say that this means a half a cup of the actual mixed is there some tiny pancakes? Man? Well, that was my point. Is that this is where they're three pancakes. It's got to be like three inches Exactly. They got to be the tiniest goddamn pancakes you've ever seen in your life, is my point. So again, this is where they're going to mess you up, because no one's making a pancake that's two and a half inches across. No, no. So anyway, a grain of salt on the on the serving size. But let's just say, why don't we just say that you eat half of the container? That makes sense. Okay, so, so let's call it servings in the container. Yeah, there's five servings in the canner you're gonna have. Let's just say you're gonna have two of them. You're gonna have two servings. So this is six grams of fat. It is. Where are the car? Oh, it's 9090, carbs. 45 for a serving. 45 for a serving. So 90 for two servings, you get 90 carbs. You're getting six grams of fat, a lot of a lot of sodium, by the way, you're gonna see we're eight, almost 1000 milligrams of sodium. Wow, 480 per serving. Five or a gram for a serving. So two grams sugars, including nine grams of added sugars. You're getting, you're getting 10 grams of sugar in a serving. So 20 grams of sugar in that because there is at, I mean, most of it's added. Actually, they are adding a lot of sugar to it. Protein six, so you're getting 12 protein total. Okay, don't worry, there's calcium and iron in them. You're gonna live forever. The ingredients are enriched flour, bleached wheat flour, malted barley flour, niacin, iron, thiamin, mono nitrate, riboflavin, folic acid, sugar, Defatted soy flour. I don't know what that means. Leavening agents like baking sodium, sodium, sodium aluminum phosphate and mono calcium phosphate. There's also palm oil, dextrose, buttermilk, salt, something that's called da temp, but it's all in caps. That scares me, for some reason. I'm gonna look that up later. Contains wheat, soy and milk ingredients. Okay, well, let us go to our breakdown list. We have measured our meal. Our meal is 90 grams of carbs. We are one unit for 10. So that's going to be nine units of insulin. We're going to evaluate ourself again, this is the morning, I would have to say another evaluation here is, I mean, how many people are making pancakes and not putting bacon or some sort of, like a breakfast meat with it, which is, I know that's not what we're talking about right now, but like, you know, like, that's going to hold up the whole, the whole thing well,
Jennifer Smith, CDE 8:24
and I think in the realm of, again, your listening body, a lot of people are all actually trying to do that. They may not have before, but they may be trying to do that to mitigate the impact of what they expect the pancakes to do?
Scott Benner 8:41
Yeah, I'm saying the only the issue there is, like, you're trying to add protein with it. So in the morning, protein might mean bacon, and then bacon is going to mean fat, and then you're going to have, you know, you're going to get the lift from the fat later too, right? Okay, calculate our food. Bolus, we've done that. We have nine units. What do you think? Jenny, you want to you wake up in the morning, it's Saturday morning, you are having the experience that Arden has been having lately. A hot shower is shooting her blood sugar up. Never used to happen. All of a sudden, hot showers, boom, like she's
Jennifer Smith, CDE 9:12
going and it's not just her CGM that's being weird. It's actual, by finger six, she's rising too.
Scott Benner 9:17
She's jumping up in hot showers lately. Okay, so you get out of the shower, you come downstairs, Mom, it's Saturday. What are we doing? Oh, you're lucky. I'm a great parent. I've bought you a bottle of pancakes, and again, I've made them so you know, if there's shade, it's for everybody. There you go. And my blood sugar is 150 Oh, now I need a half a unit to move the blood sugar, probably more. Your blood
Jennifer Smith, CDE 9:40
sugar still rising according to the CGM trend, or is it stable at 150 let's
Scott Benner 9:44
call it stable, just to make those okay. Okay, so I need a correction for my one unit moves us 10 carbs. One unit moves us 100 points. That's for our examples. So now I'm looking at a nine and a half unit meal, uh, meal, Bolus. Do you. And what I hear from people all the time is like, oh, big Bolus to scare me. So I think that they can, often people look at them go, that's a lot like, you know, I don't know if I'm gonna put all that in there. I would say, you know, I think your rule of thumb here for double whatever you find works for you. So if you found, like Jenny used in other examples, if 12 minutes is a good Pre-Bolus for you, for something like this, you're going to need 25 minutes. This episode is brought to you by Omnipod. Would you ever buy a car without test driving it first? That's a big risk to take on a pretty large investment. You wouldn't do that, right? So why would you do it? When it comes to choosing an insulin pump, most pumps come with a four year lock in period through the DME channel, and you don't even get to try it first. But not Omnipod five. Omnipod five is available exclusively through the pharmacy, which means it doesn't come with a typical four year DME lock in period. Plus you can get started with a free 30 day trial to be sure it's the right choice for you or your family. My daughter has been wearing an Omnipod every day for 17 years. Are you ready to give Omnipod five a try? Request your free Starter Kit today at my link, omnipod.com/juicebox Terms and Conditions apply. Eligibility may vary. Full terms and conditions can be found at omnipod.com/juicebox find my link in the show notes of this podcast player, or at Juicebox podcast.com
Jennifer Smith, CDE 11:30
and the Bolus size really does scare you. A stepping stone to getting there, if you really love this product, would really be do that 25 minute Pre-Bolus with half of what the Bolus recommended is, if it's nine units, take four and a half. Take that with the Pre-Bolus, and then as soon as you start eating, take the other because we all know the insulin action time is not right here and now, as it's delivered, still takes a little build up time to get it working. So that's it's this strategy that, while it may not be beneficial for keeping your blood sugar under 180 at least you're getting the whole Bolus without as much fear. Is truly what's in the picture?
Scott Benner 12:13
Yeah, I'm gonna say, you know, just from a person who's, you know, raised a kid with type one diabetes, I like Carrie's sugar free syrup. Of all the ones that we've tried over the years, that one seems to taste the most like syrup carries, yeah, S, C, A, R, y, s, do you have one that you tell people about?
Jennifer Smith, CDE 12:31
You know, there are two that I think have quality flavor, which I've heard from a couple of people. They really don't like one of them, the LE conto brand. I don't have an issue with the flavor of it. The other one is the RX sugar. That one has a really nice maple sugar. It's all yellows, sort of non sugar alternative, kind of in it. So those tend to work well, I've never seen an issue with the RX sugar. I while there are, again, on all of these alternative sugars, carb counts on them, probably like the carries. I don't know if Arden has to count any of the carb grams on there, but I don't for the RX sugar. But I'm also not eating, like a half a cup of it.
Scott Benner 13:17
I don't see the carries doesn't add rocket fuel to pancakes for her. So okay, I take that as a way that she probably doesn't need to cover it. Now, listen, I happen to know because during covid, I went on an extensive research to find out why the waffles at a local diner were so good. I was really bored during covid, and I found out what syrup they were using. So I'm going to tell you that the one you get in a diner that you probably think of is tasting good has a serving size of two tablespoons, which no person in the history of the world has ever used on pancakes. But let's just say two tablespoons, not only are you going to get 100 calories from that, but you are going to get 26 grams of carbs from two tablespoons of this, if you're doing 90 grams worth of pancakes and a quarter of a cup of syrup, which I'm still being generous for people, but let's say that. Let's say it's, it's another 52 grams, yes, yes. It's another 52 grams of insulin of carbs, which is now putting your, I'm gonna have to do some math here. That's 142 but that is that 14 plus the correction, that's just about 15 units for that. Then if you're gonna put, yeah, Jenny's like, I haven't taken 15 years, and it's less than three days, that's not true, but not all at once. Oh, my God. My point is, is that you can't, you can't come online all the time and tell me I don't know how to Bolus for pancakes if you're not addressing them for what they really are, that's all like, you're gonna have to come at it for what it really is. You can't say, oh, that number seems too big, or I've never Bolus that much before, like this is what it is.
Jennifer Smith, CDE 14:53
And I think a valuable piece to point out too is, you know, you brought up a waffle house for. Waffle right? Let's say you have figured out your pancakes at home. You know the portion size. You know exactly what goes into them. When you go to your local pancake place, it will be different. Is it a little easier to swag the pancakes you're eating? Sure, because you have something that you've figured out to work, but also your pancakes at home might be four inches, and this pancake that comes out to you now is the whole, the whole plate, right? And so then you end up, let's say you swag it pretty good in terms of the grams of carb, but now in terms of worry about that amount of insulin, you put that in your pump and you're like, my gosh, 14 units of insulin. I usually take five for what I eat at home. Yeah, what you need is what you need, right? Based on how much you're eating and how much you're calculating. So as long as your insulin to carb ratio is the same, sure, you might use five units at home, but you may very well need the 14 units because of the difference in portion.
Scott Benner 16:04
I would say that, you know, when we talk about, you know, looking at your CGM down the line an hour, three hours, and evaluating what happened, so you can tweak it for next time. If that amount of insulin scares you to the point where you're like, I can't, I just can't do all that. Like, I don't, not understand. But then when you're doing your valuation, and you end up having to make a correction. Look at that insulin. Like, the amount that you use to correct with, is that the amount you skipped in the initial Bolus? Like, is it close? Like, that'll help you get to the idea of what you actually need. I'm not saying run out there and make some like, super aggressive Bolus. Like, you might be the person who doesn't need it. Like, you know, like, you're gonna have to work into this. But this is the thought process for going through this and and I'll just say here at the end, if you go to Juicebox podcast.com and type pancake into the search bar, you'll get a simple recipe that I use when I make pancakes home. It's a cup of flour. It's all purpose flour. It has two tablespoons of sugar in it, and it has two teaspoons of baking powder, a teaspoon of baking soda, a pinch of salt, a cup of milk, one large egg, two tablespoons of melted butter and some vanilla extract. And is it like drinking water and bolusing? It's not. It's still like pancakes, but it's not like the packaged pancakes, the box pancakes that were there. So
Jennifer Smith, CDE 17:21
what is your since you know and you have had both, what do you see is your difference in strategy, knowing that who you're feeding it that she's still going to eat the same amount of pancakes either way, right? She's
Scott Benner 17:37
tough, because she'll like, she'll grab them and then start eating. And they go, can I give me another one of those? And some days she's like, give me some syrup. Or someday she's like, I'm just gonna eat them dry. Like, see, it's a little bit the syrup sugar free. But what I like is I take a couple of different strategies and I throw them together nice long Pre-Bolus. It's gotta be 20 minutes at least, right? I like to see a falling blood sugar when the food hits. And then I put a basal over top of the first hour, at least, right? Like, because my goal is not to leave 90, right. Like, especially on stuff like this. Like, I'm more aggressive on the things that, like, could possibly lead you to an afternoon of 350 blood sugars, right? I don't mind missing on something that goes to 160 and we have to fix it, like, whatever, like, but I don't want to get I don't want it to ruin the day. So I would lay a basal, like an attempt basal, over top of the Bolus. And, you know, Arden's using trio right now the do it yourself. App, it's very simple to do. I'd put the Bolus in 20 minutes before, you know, if she had a lower, stable blood sugar going in, if she came downstairs out of that hot shower, and she was 170 and she said, I want pancakes. The next words that would come out of my mouth are Bolus, like, before I even go to look to see if we add an egg in the refrigerator now, like, just now, you know. And it's momentum, like Jenny, it's timing and amount. Like, I know this is fun to break down like this, but like, it's the right amount of insulin at the right time for the situation. So and then I like that you can bail on the temp basal if you start getting too low. And then to me the L or the look at the CGM in meal bolt. I keep watching. If I see a drift up, I'm right back on. I smack its hand like it's trying to shoplift. You know what I mean, like right back at it again.
Jennifer Smith, CDE 19:22
And with trio, you've probably like me, I've been using trio for a year now, and honestly, what I've found is it's less likely to need to do that back end slapping, mainly because it does a good job of that additive. Depending on how you have your dials turned in, it does a pretty good job of hitting for you before you have to step in, which is nice, because you can kind of step away for a bit right in
Scott Benner 19:50
the end. It's in the podcast somewhere. Jenny and I've talked about it. I've said it over and over again, but I leave a over heavy carb situations, I lay a blanket of insulin over top of it. Like a weighted blanket so it can't stand up and
Jennifer Smith, CDE 20:02
and in this case, I think that weighted blanket effect, so to speak, is relative to, as I pointed out initially, both types of pancakes require cooking them in oil
Scott Benner 20:15
or butter, or I do butter on the pan, and very little like, I actually butter the pan, and then I wipe it off like so I just don't want it to stick. That's all I care about. But I do see you're not wrong. I've seen people look like they're deep frying their pancakes. Yeah, that's a more southern thing, too. I've noticed when I'm traveling sometimes too. Is that maybe what could be?
Jennifer Smith, CDE 20:34
Yeah, could definitely be. I think it's also restaurant style is definitely heavily cooked in some type of oil or butter on the surface,
Scott Benner 20:45
they're trying to kill you, for sure. Yes, actually, I guess what they're trying to do is give you enough butter that you're like, I'm coming back there one day. Yes, yeah, okay, all right, this is good. That's, that's, that's
Jennifer Smith, CDE 20:57
that long term effect. You're not only thinking about carbs, but you're thinking about that lingering, yeah.
Scott Benner 21:02
So, I mean, I'm gonna tell you this all changes. You add bacon to this, or we're from the Northeast pork roll to this, and now, yeah, right. And now my checking, like, isn't just one, two hours later, because if I get pancakes right, two hours later, I'm done. It's good, but you add bacon or some fatty meat to it, now it's three, three and four hours later, like you still have to be looking Sure. So okay, all right, I appreciate it. Awesome. Thanks. Thank
you. A huge thanks to my longest sponsor, Omnipod. Check out the Omnipod five now with my link, omnipod.com/juicebox you may be eligible for a free starter kit, a free Omnipod five starter kit at my link, go check it out. Omnipod.com/juicebox Terms and Conditions apply. Full terms and conditions can be found at omnipod.com/juicebox
Unknown Speaker 22:00
you in
Scott Benner 22:04
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. 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. I can't thank you enough for listening. Please make sure you're subscribed or following in your audio app. I'll be back tomorrow with another episode of The Juicebox podcast. The episode you just heard was professionally edited by wrong way recording, wrong wayrecording.com.
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