#1674 Bolus 4 - Pizza Hut Pizza
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Jenny and Scott talk about bolusing for all kinds of Pizza Hut.
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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 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,
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. Jennifer, we are back talking about bolusing for food today. Yay. Want to do Pizza Hut. Oh, fun. Okay, so tell me what you said a minute ago about when you're trying to help college age people and the problems that they have.
Jennifer Smith, CDE 1:43
The problem is that there is a large appetite, especially in the gentlemen that I work with of the college age, or even the older teen into the college years, right? And I was mentioning that, well, you made a comment, after looking at some of the nutrition facts for just a slice of pizza. You're like, wow, that's that's a lot of carbohydrate, right? And I said, Yes, that's the big reason that we have such extraordinarily high blood sugars, without consideration of why a lot of my college students I work with, many of them, eat just big portions, right? Especially the athletes. And it's not uncommon to have half of a pizza, three quarters of a pizza. And when you're talking about what was the slice, it was like 36 or 38 grams per slice. For a Pizza Hut slice,
Scott Benner 2:29
I chose pepperoni, large, original pan slice. Okay, that's what we're going to talk about today, but it has 36 carbs in a slice, right
Jennifer Smith, CDE 2:38
in a slice. And if I'm looking at a pizza, and you're having half of a pizza, you can guarantee they're at least four, maybe six slices in a half of a pizza, and when you're putting in 70 grams of carb for half, clearly that's the reason that your blood sugar is really high and then stuck high for hours later With the other nutrients that we would have to consider.
Scott Benner 3:03
I mean, as I'm looking at this, let's go through it, right? Let's measure the meal. Look at the carbs, the fat, yep, glycemic index, etc. So not only does a slice of this have 36 grams of carbs, but it has 17 grams of fat. And you know, most people don't Bolus for their fat. No, if you sit down, you're saying it would not be crazy for somebody's teenager to eat three slices of this. Absolutely not. Okay, so 3060, 90, 100 and jeez, that's a lot, right? Like, so we're looking at 3060, 90, 102 like 100 Well, it's like, it's like 110 115 carbs.
Jennifer Smith, CDE 3:44
Well, 90 plus another, 3090, plus another. What? 24 grams? Yeah, right.
Scott Benner 3:51
And then 17 times three slices of pizza. Oh my gosh, Jenny, we have to take a half a break for two seconds. I'm gonna be back in 30 seconds. I'll explain why when I get back, yay.
Speaker 1 4:03
Oh, there's your puppy. Oh, my gosh, he's so cute. Did he need to go
Scott Benner 4:10
potty? No, he he doesn't like to be by himself for too long. Oh, you can hang with me while I make the Friday. His name is Friday. His name is Friday. Yes, oh, Mike, is that because you got him on a Friday? No, no. It was an exhaustive search for a name. So, Arden. Arden. He is. He is very cute. Arden is recovering from a tonsillectomy, yeah. And so she's loaded up on the perks right now, and it's sleeping. So I thought I could get away with him being downstairs. But he just, he was downstairs, like, maybe Rob can leave enough of it in while you were talking so that people could hear it. But he was just like, Oh no, no, come get me. Oh,
Jennifer Smith, CDE 4:52
I couldn't, I could not hear any of it, so I just
Scott Benner 4:55
didn't want him down there, like, freaking out the whole time. So anyway. 17 grams of fat. So, 1020, 3044, 45 4050, there's, like, over 50 grams of fat in there. Most of you don't Bolus for your fat. So and
Jennifer Smith, CDE 5:13
why? I think the reason to bring up there, it's even less visible than protein. Sure, right? Fat is hidden in the foods that we eat, unless we're physically adding it, like sour cream on top of something heavy cream in something butter on top of something else. You know that that's fat, right, salad dressing, all that kind of stuff. But when it actually is already in the food, not only the crust with making probably has got oil in it, and then you've got the cheese and the pepperoni, which have natural fats in them. It's not like there's been added to it, but it's hidden. You don't visibly see it, so you don't think, well, this can't be that
Scott Benner 5:53
bad, right? Right? And the breakdown of what's in this Pizza Hut pizza, I think of Pizza Hut as like fast food pizza, but in a lot of the country, you don't have mom and pop, hand tossed pizza places everywhere, like, you know, where I live, you do. You're getting pre made doughs that are probably made off site or something. They have stuff in it called datum, D, A, T, E, M, enzymes and stabilizers to keep the dough uniformed and extend shelf life in storage or transportation, you know, versus a homemade pizza that's probably just flour, water, yeast, salt, maybe some oil, maybe not even. Obviously, there's ingredients differences, but the fat difference is insane, like I make pizza here. I don't know that. I even Bolus it differently for Arden than any other food. Really. We just count the carbs and eat it and but it's thinner crust. It doesn't have like, an inch of cheese on it, you know, it doesn't have whatever datum is.
Jennifer Smith, CDE 6:49
And datum, that's a new one. I haven't heard of that one.
Scott Benner 6:54
Figure out what datum is. So how do we Bolus for this? Right? Like, I mean that the why we're here, really?
Jennifer Smith, CDE 7:01
Pizza is the age old reason that pumps, even years ago, first came out with the idea of an extended Bolus, right? It's, in fact, we call it the pizza Bolus, really. Instead of even extended Bolus, we just refer to it as a pizza Bolus, but it encompasses all foods that could have similar nutrient content to Pizza being pretty high in fat carbs, not low, but often high, along with the high fat content where you're going to need you know, if we build our meal Bolus, right with the lovely acronym that you came up with,
Scott Benner 7:39
meal bolt. Meal bolt. Juicebox podcast.com/meal-bolt, now if you want to learn more about it, sorry, I have a website. Oh, yay. You measure the meal out, the carbs, the fat. Now, glycemic impact, right? There's an interesting one, because I find there's a need to Pre-Bolus for pizza, but not the entirety of the carbs, because if you put too much up front, the digestion happens slowly. The insulin ends up crushing you long before you get the impact from the pizza. So correct talk about how to stretch it out.
Jennifer Smith, CDE 8:10
So in general, most pizza probably falls somewhere more moderate glycemic. It's not high glycemic, like sitting down to just white sticky rice or watermelon or anything like that, and the higher the fat and higher the protein content, would lower the glycemic impact, potentially even further, but somewhere around 55 to 6070 maybe at the most, in terms of glycemic index, which means that that extended Bolus idea is relevant, yeah, and you would usually use as a starting place a 5050, right? And as you definitely said, we still need a Pre-Bolus
Speaker 1 8:50
for it, yeah, something's got to start happening, correct?
Jennifer Smith, CDE 8:55
Especially again, you know another thing to evaluate is the next step. Evaluate, right? What's what's happening on your CGM? What's the trend looking like? Are you sitting flat at 100 Are you rising from 120 and you've been going up already? All those things to evaluate might tell you a little bit more about the Pre-Bolus time. Yeah, but not necessarily. What you need to do to cover the meal in the aftermath is still going to be a starting place of like a 5050, 50% of the carbs up front, 50% extended out, it could be a minimum of two hours. Maybe you have a child who really eats two pieces of pizza. Well, in this case, 17 grams per slice is 34 grams of fat that that child is eating and along with maybe something else, maybe they had a salad that had salad dressing on top of it, or whatever bread sticks
Scott Benner 9:48
that went along with the meal, french fries, stuff like that, right? Yeah, the
Jennifer Smith, CDE 9:51
other stuff. So again, building that idea of extending your Bolus could be a limit, a minimum of two hours. HOURS could be as long as four or five hours after the meal.
Scott Benner 10:04
Yeah. So to talk about it the way we would probably talk about it more in like the Pro Tip series, the impact of your insulin needs to be lined up with where the carbs are are trying to make your blood sugar go up. So if you take a slice of pizza and start eating heavy dough, it doesn't get broken down right away. It's not a lot of simple sugar. It's gonna, you know, get absorbed through your cheeks or, like, hit you real quickly. There's not a high glycemic index. You're not gonna, like, start flying up right away. If you go say to yourself, like, I'm gonna eat three slices of pizza. I'm gonna Bolus for, you know, 36 carbs, three different times right now that insulin is going to crush you long before that pizza impacts your blood sugar, so but you do have to get some in. I still want you to what Jenny just said, like it occurred to me, like some of you are putting your kids in a car and driving to a pizza place. Sometimes just getting in a car makes people's blood sugar go up, right? They sit still, they start going up. Many of you might be ordering pizza for a party, and then maybe the kids have been outside running around like crazy, and then you bring them in, you go, hey, here pizza. Then your brain goes, Oh, no, pizza. A lot of carbs. Put in a big Bolus, and they were falling already, and you didn't realize it. I mean, that stuff's all you're gonna have to figure that out, like from situation to situation, right? But stretching out that Bolus with an extended Bolus. Or, if you can't do an extended Bolus, making, you know your own, you know boluses along little boluses along the way to kind of put make sure that this insulin is in you and active while the carbs are kind of coming online, being digested and still hitting. The reason the fat so important in all of this, the way I try to think of it is just that the fat kind of slows down digestion. It holds those carbs in your stomach longer, and it extends the impact time that the food's going to have.
Jennifer Smith, CDE 11:52
It does and the fat part of it, beyond extending the carb digestion, because digestion slows with all the fat is really the resistance factor that larger amounts of fat at a time add in, like we've said before, fat sort of sits on your insulin and it makes it work less effectively. So building into this potential picture of this kind of a food is not only the extended Bolus, which you may just end up with, 50, 5050, now, 50% over two maybe three hours at the longest. But you know your hit point from fat comes in somewhere around two and a half to three hours. Well, in that then you might bring in another piece, which could be use of a temp basal or an override or something else to allow the system to give a little bit more where the fat is actually hitting.
Scott Benner 12:45
Yeah. I mean, as an example, like a lot of people are using a ID systems now, some of them are going to be more adept at this than others, too, right? Because you could set an extended Bolus in tandem, right? But you couldn't in Omnipod five and automated. So maybe if you're an automated in Omnipod five, and you're having pizza and you're seeing this happen, maybe you want to go into manual for that. Yep, keeping in mind that you put in initial settings in Omnipod five that now the algorithm has changed and your manual settings might not be anywhere near correct. So there's another layer to this too. You have to keep on top of your program settings so that if when you do switch back into manual, they're where they need to be correct, and then, yeah, just keep looking like, you know, an hour later, if you're having pizza at an hour later, you're, you know, 200 and it's going up. I mean, right, you need more insulin.
Jennifer Smith, CDE 13:35
Something was missed. And so next week, next time, it's a way I work with families, I say, well, it was an experiment. There's no beat yourself up about it. It was, this is what happened. You've got information you can, you know, now tell little Johnny, gosh, we can have pizza again. Like, let's try it again, and this time we're going to put more in the picture, or at a different time or
Scott Benner 13:55
whatever. And yeah, so when you tweak it for next time, just think of it as another pizza night. That's awesome. But now keep in mind something simple here that I think gets past people that was Pizza Hut. If you go look at Domino's, Domino's Pizza doesn't have that as many carbs in a slice, actually lower by a fair amount. And so
Jennifer Smith, CDE 14:16
I'm curious if there's a difference in slice size, meaning the weight of each slice may be different
Scott Benner 14:22
enough. I mean, for my memory, Pizza Hut pizza is pretty heavy, okay, thicker, right? And Domino's might be a little thinner, but still more like fast foodie pizza, although I would I tell you that even a hand tossed like a slice that I would make here at the house, I still think for Arden, I'd go like 20, but I'm making, like, a Neapolitan, pretty thin, not a ton of cheese. Like, I'd go about 20 carbs for a slice for her, yeah.
Jennifer Smith, CDE 14:48
And in general, that's a that's pretty close to what I teach as just a a guesstimate in terms of pizza, you know, a slice the size of adult woman's kind of or a smaller hand. And right tip of finger to wrist, covering the whole hand for thin crust, is about 20 grams of slice. Sounds like what you're probably making at home. And then if you're looking at more of the typical pan style, like a pizza hut or a Domino's or whatever, usually that's about 30, maybe 35 grams. And then when you look at more Chicago style deep dish, I mean, you're looking at probably 50 to 60 grams per slice,
Scott Benner 15:26
yeah, some of those could be an inch or more thick, right? Yeah. I think pizza is a great example of like, people are like, we need to know how to Bolus for pizza. And I was like, You need to know which pizza you're eating before you even ask that question. And you need to understand fat and you need to understand extending boluses. And if you don't, it's just not as easy as, like, throw in this number and go for it. Like, pizza is probably the culprit of more low blood sugars for people who don't know what they're doing than anything I've seen online, right? Because they think big number. They get all that insulin, and they finally have decided, like, I know I need this insulin, and then digestion doesn't work the way they're expecting. And boom, now they're doing right. And you know, the other side of what happens Jenny is they'll Pre-Bolus their pizza with all this insulin, get super low, drink a bunch of juice to fix it, and now they're shooting up from the juice. Don't have any nerve to put in more insulin, because that seems crazy. And then they eat the pizza on top of it, and they're like, I was 500
Speaker 2 16:23
all day. Yeah, absolutely. All right, yeah. Good luck. Everybody. Enjoy your pizza. Yeah, bye
Scott Benner 16:39
in each episode of The Bolus for series, Jenny Smith and I are going to pick one food and talk through the Bolus thing 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, tea, 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. 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. The episode you just heard was professionally edited by wrong way recording, wrong way recording.com,
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