#1682 Bolus 4 - Ice Cream
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Jenny and Scott talk about bolusing for ice cream.
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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, how are you? I'm fine. How are you today? Good. Thank you. We are going to talk about how to Bolus for Ben and Jerry's, chocolate chip cookie dough, ice cream. Okay, it's very specific. Have you ever been to Ben and Jerry's? I have been there once. Yes, I visited Vermont one time, and we did the Ben and Jerry's tour we did too. Yeah, it was, though it was a nice little day, and then a little ice cream outside, and then we were on our
Jennifer Smith, CDE 1:49
way. Do you remember? What kind did you get? Was it cookie dough, probably,
Scott Benner 1:53
but I don't know. Actually, the one I like right now is, it's the one with, oh god, there's a late night talk show host on the front of it. Oh, hold on a second. Is it Colbert, maybe? But it's the mix. I like the caramel. Yes, it's called American dream. Maybe we should do this one. There's pieces of cone in it with caramel. Oh, and I do, I do enjoy that. So if I have ice cream, that is the one I get, I pick chocolate chip cookie dough because I think it's a fan favorite.
Jennifer Smith, CDE 2:28
I'm assuming it probably is with the cookies inside of it and everything.
Scott Benner 2:33
Yeah, it used to be better. I'm not gonna lie to you, I've had it in the past, and I've had it, you know, in the last year. It's not as good as it used to be, but that's like everything else, I think, to the ingredients in this. It's interesting because I think people think Ben and Jerry's, and they probably think like, oh, that's more simple, but it's not,
Jennifer Smith, CDE 2:51
which is why I asked if you had ever been, because you've ever been to their actual like place in Vermont. Yeah, it is very homey, like, unless it has. I mean, I was there years ago, so it might be changed now, but it is very like, you'd expect only real cream to be in there, and, like, real 100% Madagascar vanilla extract, and like, like,
Scott Benner 3:11
all the things, right? I think it's important you bring that up, because I imagine that if we dug into it, that was probably how the company started. It's been sold off since then, but they still hold on to it for marketing reasons. Is there a world where you look at Ben and Jerry's and you think, well, that's a more healthy ice cream, but, you know, I don't know that that's the case exactly. All right, so what do we have here in the Ben and Jerry's? We're going to take a look first for so we're gonna have to measure the meal first, right? We're gonna look at the carbs, the fat, the protein. What do you think the glycemic impact is going to be? So now, what do you think they're calling a
Jennifer Smith, CDE 3:46
survey to pay attention to good from glycemic index. What did I say to pay attention to not just carb, but what the sugars? Total sugars, total sugars. Yeah. So what's the what's the comparison there? Well, do
Scott Benner 3:57
we want to use the the serving size, which any self respecting person eating ice cream isn't going to have two thirds of a cup of it. Are they? Well, I was
Jennifer Smith, CDE 4:06
going to ask what the serving size is, because some labels list ice cream as a half a cup. But more recently, it has increased to
Scott Benner 4:14
two thirds of a cup. This one says two thirds, which means that the the container contains three servings in total. So if you have one serving or a third of the container, you are getting 34 grams of sugar. It also says includes additional sugar, 28 grams, which makes Wow, hold on a second. And the carbs are 43 and wow, there's 100 milligrams of sodium in it. The fat in two thirds of a
Jennifer Smith, CDE 4:44
cup. Any guess? 22?
Scott Benner 4:47
Grams, 20, yeah, 20. So it's pretty close. That's not bad. So if you eat that, what is that? A pint? It comes in. If you eat that whole thing, you're getting 60 grams of fat. 240, Milligrams of cholesterol, 300 milligrams of sodium, 4080, 120 like 130 some carbs, and then what they're calling like about 100 total sugars, including added sugars of 28 grams. Okay, so there's 34 total sugars, but of that, 28 of them are added
Jennifer Smith, CDE 5:23
sugars, meaning it's not just the natural sugar that comes in, the cream, the milk, the you know, that kind of natural sugar that would come in. And if there's cookie dough chunks that what's cookie dough made from? It's made from flour.
Scott Benner 5:37
I don't think it's the cookie dough. I'm looking at the ingredients. And do people know ingredients are listed by volume? Yes, by volume, for most the least. So cream is the number one ingredient, followed by skim milk. And you're like, Okay, I'm doing it now. The next one is called liquid sugar, sugar water,
Jennifer Smith, CDE 5:58
and this should tell you 100% of the hit that this is going to have, right? You're
Scott Benner 6:03
gonna get smacked by this one, also by, by the way, liquid sugar, sugar water, and then the next one is water. So going back down to the label, 34 grams of sugar, including 28 grams of added sugar. And then the daily value tells you how much of the nutrient in the serving of food can contribute to your daily diet. 2000 calories a day is used for general nutritional advice. This is 56% of that just the sugars and so then after, after that, wheat flour, then sugar, then brown sugar,
Jennifer Smith, CDE 6:36
then because, how do you make chocolate chip cookies? Sugar and brown sugar
Scott Benner 6:40
of the first seven ingredients, liquid sugar, sugar and brown sugar are three of them, egg yolks, butter, which is cream and salt, expeller pressed soybean oil, eggs, coconut oil, chocolate liqueur, cocoa, cocoa, molasses, that sounds like sugar, guar gum, salt, vanilla extract, natural flavor, natural flavor, cocoa butter, invert sugar, there's more sugar, milk fat, tapioca flour, soy lecithin, other extracts, turmeric extract and milk.
Jennifer Smith, CDE 7:16
So what's interesting is that so turmeric extract. It's interesting because that would be used as a color. Yep, and turmeric is a natural I mean, it's a root. So the interesting thing is that they don't have yellow, blue, red dye. They're actually using a plant based coloring, which is actually pretty nice on the scale of all the other things Jenny's
Scott Benner 7:43
looking for the for the high side of this, she's like, at least there's no coloring in it. Yeah. Actually, it looks like they use that and Anna toe extract.
Jennifer Smith, CDE 7:52
Anato, anato, yeah, it's commonly also used. Annatto is often used in cheese, CHED cheese. It's the reason it's yellow. Oh, really. Otherwise, it's the reason you can get white and golden cheddar cheese. The white stuff doesn't have the annatto added to
Scott Benner 8:07
it. So they make that ice cream a little browner to give you the feeling of like chocolate chip cookies. But that's, yeah, all right, here you go. All right, let's Bolus for
Jennifer Smith, CDE 8:17
it. Maybe they want people to not have inflammation after maybe that's the reason for the turmeric, I don't
Scott Benner 8:23
know. Again, you're high setting. So now we're going to evaluate like, where you are before we make this Bolus right? We know what the carbs are. We know there's going to be a big fat hit. There's going to be a big sugar hit, so that glycemic impact is going to happen fast. But when do people eat ice cream? End of the day, right?
Jennifer Smith, CDE 8:39
End of the day, dinner. Bedtime is a common evening time snack after dinner, either that or common to have it after a meal, especially when on vacation.
Scott Benner 8:51
Yeah, what I'm thinking is the thing that gets dropped on top of your other it's almost a la mode in your belly, so you're, there's a meal in there already that you've hopefully bolused Well for, and then on your way to drop this slow, this spike from the sugar and the slowing from the fat right on top of it, right? All right. So, I mean, depending on where you
Jennifer Smith, CDE 9:15
are, yeah. I mean, you kind of have two environments of consideration for Bolus there, if you are eating it in the aftermath of a meal, there's likely a Bolus strategy for that. It would be different than, let's say it's middle of the afternoon, you're done at the pool. You had lunch three hours ago, and now you and the kids, everybody, whoever it is, your dog, you all want ice cream. Great. So you're going to go for ice cream at that point, it really is covering the ice cream and nothing else. Yeah, yeah.
Scott Benner 9:45
And maybe even in that scenario, there's a little running around. Maybe that fat might be helpful in that situation. But again, if it's 830 at night and you're, you know, you're already standing in front of the freezer thinking to yourself, like, I shouldn't be doing this, and you're. You know, that looks good, but I am going to do it. And so maybe you're going to need to be more aggressive. You figure out your insulin to carb ratio. Get that all going too. But how are you going to layer this over? Like is this going to be you expect to see continued hits from ice cream along the way,
Jennifer Smith, CDE 10:16
especially with the fat content. Like you said, you know, who is typically going to eat two thirds of a cup, which is way more. When I was growing up, it was a half a cup was a serving size on the label, but two thirds of a cup nowadays, we definitely overeat. Two thirds of a cup should be enough, but many people will have more than that, and so the hit effect builds because of the fat increasing as you take more.
Scott Benner 10:46
Yeah, I do a little thing. There's a sorbet in my freezer. Usually that's just for me. It's like a mango thing. Oh, and I used to, like, scoop it out and put it into a dish, but then I'd find like that when I was filling the dish, I'd end up putting more in than I wanted. So now it's just kind of understood, like, it's mine. Don't eat out of it, because I'm eating right out of the container now, because I take a little scoop and I go, Oh, that was good. And maybe I do it again, and I'm like, Yeah, I'm done now, yeah. And that was it. And I get all the like, all the good feeling that I wanted from the from the sorbet, enjoyed the like, the maybe kind of the freshness of it, or the palate cleanse, or whatever it ends up being, for me, and then I don't feel compelled to eat the rest of it, because I took it out. I'm like, Oh, I just put it back. Now, I guess that might lead some people to eat the entire thing, like, too. I don't know, but it works for me that way. Okay, so we build the correction, put it on. Do you think this is a an extended Bolus? I
Jennifer Smith, CDE 11:39
think this needs, for the most part, a good Pre-Bolus because of the sugar content, but it definitely needs something to cover the behind, right? And this is where a little experimentation comes in for something like this. Maybe an extended Bolus works for you, where you do 5060, 70% of it up front, and you do it with a good Pre-Bolus time, and then you extend the back end of it maybe over two or three hours. Given the fat content in a single serving is 20 grams, maybe that's enough, right? The other consideration would be, maybe you see a pretty quick hit, so you're going to cover it completely, and you're also going to Pre-Bolus to dull down the rise. But on the back end, you end up never really coming to target, or you just hover high, and then you go up a little bit more two or three hours later, you might cover the back end with a temporary basal increase, if you have access to something like that on a pump. Yeah, you know other algorithms you might not have to worry at all with a single serving, 20 grams. It's not low fat, but you might have an algorithm that takes care of that, because it's a little more aggressive.
Scott Benner 12:54
You have to kind of just do the looking at your CGM an hour, two hours, three hours afterwards, figure out how this went, and then just tweak it for next time and try to try to try to figure out how to manage it
Jennifer Smith, CDE 13:03
best. And you know, for those people who are using MDI and have decided that that's just what they like to do, right, it works the best for them in all scenarios you may actually be able to utilize in what I really think is an underused insulin in a scenario like this, that would be r right. Let's say you covered the impact really well with your rapid acting insulin. But you know from previous experience that two hours later it starts to go up, and rather than you having to give a little nibble and a little nibble and a little nibble of extra rapid insulin, you may be able to cover the back end hit with a small amount of our insulin, because it's got such a slow kind of accumulation of getting to its effective amount. And it might hit well for a couple of hours after the meal. Would
Scott Benner 13:56
this be a good place for a frizer too, potentially, yeah. Like, if you get the rise, you can kind of just boom, like, drop it down.
Jennifer Smith, CDE 14:04
You could drop it down absolutely again, another one that's underutilized, I think some of it's age specific or written off label, and whether somebody is willing to do it, but yeah, you could control the quick hit the back end. Again, depends on what you see happening, but that's variables.
Scott Benner 14:24
It's in my head, because I just interviewed Pete Zendo about the afreza being available for younger people now. Kind of made the point that he's like, I'm not sure that people are going to manage their diabetes just with like, basal insulin afreza. But he's like, I can see it being a toolbox thing that you have in the house. And, you know, every once in a while you think, Oh, this didn't work out. Let me just like, you know, kill this fat rise that I've got going on for two hours that I can't get rid of, or something like
Jennifer Smith, CDE 14:52
that. Yeah, no, afreza is definitely, in fact, there was just a really good study that was put out studying afreza in pregnancy, which. As you know, I'm very fond of things in pregnancy. It's usually not, it hasn't been recommended well enough, but it's been being used by some good clinicians, and in cases like, you know, some eating something like this. And you really don't want that quick hit, but you want it to be gone pretty quickly.
Scott Benner 15:19
It's great. Might be it. Yeah, it's not for here. But I keep wondering if it's gonna break through like that or not. But, well, yeah, this was fun. Thank you. Everybody enjoy their ice cream. I'm not, I'm certainly not bagging on you. This looks I'm just looking at the picture. It looks good. So you're gonna eat your mango. I will just have a clear that's exactly what I'll do. I'll just go like, I'll take like, a little, like, scraping off the top and I'll be like, That's enough. I'm good. Anyway, thanks, Jenny Sure.
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. 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. 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, wrongway recording.com,
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