#1692 Bolus 4 - Thanksgiving
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Scott and Jenny talk about bolusing for Thanksgiving dinner.
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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 to the Juicebox podcast. I hope your Thanksgiving is calm and your boluses were spot on
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 while you're listening, please remember 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 health care plan or becoming bold with insulin. Today's episode of The Juicebox podcast is sponsored by the contour next gen blood glucose meter. This is the meter that my daughter has on her person right now. It is incredibly accurate and waiting for you at contour next.com/juicebox I drug Jenny onto the podcast when she wasn't supposed to record today. Hi, Jenny. Hi. How are you? I'm good. Thank you. My lack of planning made me two weeks before Thanksgiving say, oh, shouldn't we have done something for Bolus for for Thanksgiving? That would have been smart. That's fun. Yeah. So I went out to the to the peeps, and I said, like, you know, tell me some of the things that you guys are going to eat on Thanksgiving. I got, like, a little comprehensive list. I'm going to roll through it with you just very quickly. Okay, people eat roast turkey or ham. They seem to have stuffing in a couple of different ways, corn bread, stuffing, regular bread, stuffing, sausage and oyster, stuffing, four separate ones. Oh, mashed potatoes. They have gravy. They have sweet potato casserole. Many of them appear to put marshmallows on top of it, yes. Green bean casserole, cranberry sauce, mac and cheese is was a big one. Dinner Rolls, roasted Brussels sprouts, roasted root vegetables, carrots. You know, that's that thing you might know more about. People have salads. Apparently, I would never eat a salad on Thanksgiving, not when all those other food that's fine. I mean, what am I gonna waste time with salad? Them? Pumpkin, Apple, pecan, sweet potato, cherry pie and cheesecake. These are the things that were given to me as as a list. Great. I tried to break them down into context for myself. Like, I basically said, like, what's a what do you think the carbs are in a serving of and I kind of have a list in front of me, and I'm interested to see, I'm interested to see if it matches how you would think of it off the top of your head. And then when I walk them through how to Bolus for the whole day.
Okay, makes sense? Sure. Okay, Turkey does not have carbs in it. You agree?
Jennifer Smith, CDE 3:38
Turkey does not have carbs in it unless it was cooked a specific way to have carbs in it. Okay? Yes, it doesn't have
Scott Benner 3:45
carbs. I roast the turkey, I'm not going to see carbs, a little bit of fat, maybe. It says maybe four grams for a typical serving,
bread stuffing, 40 grams of carbs for a cup. What would you say? You said bread pudding, no
bread stuffing, just regular stuffing. You know what stuffing is. Would you eat stuffing? I
Jennifer Smith, CDE 4:03
hate stuffing. Okay, like you said, all the stuffing options, I was like, nothing there would ever enter, like I wouldn't even pick the spoon up my eyeballs. Bypass that, because wet bread is disgusting.
Scott Benner 4:14
I knew you were gonna say wet bread, by the way.
Jennifer Smith, CDE 4:18
Yeah, I'm so sorry all the people who love stuffing. I mean, my parents like stuffing. My mom still makes stuffing. If I'm eat carbs, I may eat something that I want and I don't like stuffing, but yes, that sounds approximately correct for a serving of stuffing.
Scott Benner 4:33
Okay? And now we do know that, and I'm going to bring this up a couple times today, just make sure if you make stuffing. The way I make stuffing, so, Jenny, the way I make it is, I will bake bread this week. I'll make some wheat, I'll make some white I'll make a number of different loaves of bread, a little rye, and then I will cut it up into little cubes and spread it out into big trays and let it get a little stiff. Right? Yeah. Yeah, then I throw it into the oven to crisp them up. I make stuffing like that. In that stuffing goes turkey stock from the morning of. I make my stuffing on the morning of, I take the neck and the heart and the liver, and I boil it in water with butter and seasoning, and then I use that water to flavor the stuffing. Right? That stuffing will have a different impact on blood sugar than stove top out of a box, right? Because of the process nature of it. Yes, yes. Correct, it will same thing if I make scalped potatoes out of potatoes, or if I make scalped potatoes out of a box, we're going to see the stuff coming out of a box being a little more difficult. Correct, okay, I just want to keep that in people's minds, okay,
Jennifer Smith, CDE 5:41
well, I think also a little bit more little bit more difficult, because the box stuff, again, as we've gone over this before, has a lot more processed or packaging, type of preservatives in that can have an impact in one way or another, whereas Scalloped Potatoes, that you Do all yourself, and you know all the ingredients, because you know all the ingredients. I think there's something to seeing what you put into an item that makes you also understand better how to navigate coverage. When we're talking about something like insulin and managing and timing and all that kind of stuff, there just is, yep. So I
Scott Benner 6:19
just want people to keep that in mind. If you're making these things fresh, it's going to be, you know, maybe one impact. And if you're making them from Box stuff, they might be a little more difficult because of the process nature of the box food. So stuffing, you're okay with about 40 carbs. Now that's for a cup. How about sides? I've got 35 for a cup of mashed potatoes. That sound about right,
Jennifer Smith, CDE 6:39
that's about right. And easy eyeball is, you know, again, nobody gets out unless you're my mother. When I was little and had all the serving spoons that were taken wherever we went for holidays, it is what it is. I'm alive today because of my
Speaker 1 6:54
mother. I'm imagining your mom just like, you know, like when in one of those, one of those movies where someone shows up to, like, shoot somebody from a distance, like, I imagine your mom, like, unfurling her tools in the kitchen. Yeah, entirely, yes.
Jennifer Smith, CDE 7:07
An easier one is a female fist, or a smaller size, like, even, like a teen sized or, you know, a woman's fist is about a one cup portion, so it's a really nice thing that you're carrying around with you. You don't have to get the serving spoons, yeah.
Scott Benner 7:23
So a fist of mashed potatoes. About 35 cars, 35 grams. A fist of corn stuffing, or stuffing, about 40. About 40, okay, sweet potato casserole, I have between 55 and 60 grams for a cup. And an indicator here that there's going to be a big, like, glycemic hit right
away, a lot of sugar,
Jennifer Smith, CDE 7:45
a lot of sugar, both from the way that the sweet potatoes were cooked to begin with, as well as the marshmallows. There's usually extra, whether it's maple syrup or brown sugar that's added to it. I mean, it's like, sugar on top of sugar on
Scott Benner 7:58
sugar. Yeah, and then yeah, green bean casserole, a cup, 12 grams, approximately any,
Jennifer Smith, CDE 8:04
any 12 grams. I mean, again, that differs in making
Scott Benner 8:10
the recipe I had here had, like it was used a soup mix and onion. So there's some hidden carbs in the onions in the soup mix,
Jennifer Smith, CDE 8:15
yeah. But on average, I usually say that's an easy one, a fist again, is like 15, okay, it's probably easiest,
Scott Benner 8:22
okay, cranberry sauce has a quarter of a cup of canned cranberry sauce. Oh, it's 22 grams of carbs, which is of that is 21 grams of sugar. It's all sugar,
Jennifer Smith, CDE 8:32
huh? It's all it's all sugar. I mean, cranberries themselves, they really are nothing. They're really tart, yeah, but it's all the I mean, there's nothing cranberry in it, except for the flavor and the juice that came out. And then you just put sugar in it and make it into like jelly.
Scott Benner 8:48
So before we get to the mac and cheese, which I didn't realize was such a big thing for people, although my son said to me, like, Is there gonna be macaroni and cheese at Thanksgiving this year?
Jennifer Smith, CDE 8:56
We've never had mac and cheese. Never been a Thanksgiving, ever. I didn't think of that
Scott Benner 9:00
either, but it was a big thing that people brought up. But wrote up. But I'm just want to
point out that we've got the turkey
so far. We've got the potatoes. We haven't even said gravy yet. So potatoes, sweet potato casserole, green beans, cranberry sauce, we're not even to the macaroni and cheese yet. If you had a serving of each of these, you're looking at 3590 100 105 my gosh, dead, 120 plus the turkey, like you're already up at like, 130 carbs, right, right for for this stuff on your plate. And I don't think this is crazy to think that people might put a cup of potatoes and this and that, even if it was half like, think about it like, even if you went half a cup of potatoes, half a cup of this, half a cup of that, you're still, you know, 6070, 80 carbs, right? And
Jennifer Smith, CDE 9:51
you didn't even get into, you know, sometimes it's the meal, I know which you said I'd never have salad for Thanksgiving, but you add, maybe that's the beginning of the meal. Before the other major entrees and what often comes with a salad are some type of roll, or cornbread rolls, or something like that, that also adds into, well, now I'm actually sitting down for the meal. Yeah,
Scott Benner 10:12
it's a good point. Cornbread roll, 26 grams for a square down, about right?
Jennifer Smith, CDE 10:17
They're pretty yes, they're, they're, in fact, a little bit more carby than like, those tinier rolls that are more often served at a gathering like this, like just bread rolls, they're more like 20. They're like 20. Yeah.
Scott Benner 10:29
Okay. Now, if you're gonna go crazy and have vegetables on top of that, don't forget something like Brussels sprouts, 12 grams for a cup cream corn, 15 grams for a half a cup. Glazed carrots, 18 grams for a half a cup. Does that sound right? Jenny's not gonna eat cream corn anytime soon. But am I right about that? Yeah, okay.
Unknown Speaker 10:48
No, no cream corn. To
Scott Benner 10:50
take all this stuff together and say, These Bolus four episodes have been great because we've been breaking down like, Hey, here's, you know, one food like, you're at the mall, you have a Cinnabon. Here's how you Bolus for a Cinnabon. But what we're talking about here is between four and eight different foods all mixed up in your gullet at the same time. Do they all have different impacts, or does it just turn into one big impact that we like? Is it really just like are we really thinking about the foods individually, or are we thinking about them together? The contour next gen blood glucose meter is sponsoring this episode of The Juicebox podcast, and it's entirely possible that it is less expensive in cash than you're paying right now for your meter through your insurance company. That's right if you go to my link, contour next.com/juicebox you're going to find links to Walmart, Amazon, Walgreens, CVS, Rite, aid, Kroger and Meijer. You could be paying more right now through your insurance for your test strips in meter than you would pay through my link for the contour next gen and contour next test strips in cash. What am I saying? My link may be cheaper out of your pocket than you're paying right now, even with your insurance, and I don't know what meter you have right now. I can't say that, but what I can say for sure is that the contour next gen meter is accurate. It is reliable, and it is the meter that we've been using for years. Contour next.com/juicebox and if you already have a contour meter and you're buying test strips, doing so through the Juicebox podcast link will help to support the show
Jennifer Smith, CDE 12:35
at a meal like this, you would have to think about their impact together, because I think about the way that one of my uncles, when we had meals together, especially Thanksgiving, he would take, you know, like a roll, and he'd put Turkey in it. Sometimes he'd like, dip it in his mashed potatoes and gravy, and, like, take a bite full of it. And all of the observations of a child, think back to the funny things that you watched happen at a dinner table, right? But if I think about it that way, all of that is going into as you funny, funny said the gullet, right? They're all going down at one time, and they all have a different impact. The bun is high glycemic because it's so just a processed thing. And then you've got turkey, which is all protein, pretty low fat, depending on how you cooked it, or what's on it, right, the gravy, which is depending, again, how you made it a lower impact, and then you throw into it mashed potatoes, and maybe the cranberry sauce went on the roll before the right, you Do. It's a great i It's a great question, because you would want to think about all of them individually, as we often do, but a meal like this that is often also a very drawn out meal. You're eating a little bit of this, a little bit of that, maybe you're forking it all together and putting it in so we really have to consider it as a full effect meal,
Scott Benner 14:01
yeah, so it's gonna hit fast and long, correct, right? Yes, no matter what you do, like, I'm actually while you're talking, and if people are like, it'd be nice if you were prepared before you started, Scott, but I'm putting together. I'm basically putting a plate together right now of this stuff, right? I'm gonna put a dinner roll in there, and I'm going to put some vegetables in there. Watch what I do here. I'm going to do, let's see, let's do glaze carrots. And people love putting sugar on carrots. Okay, so I'm going to say, give me a total for all carbs. So I put in glazed carrots, I put in a roll, I put in mac and cheese in the way we just talked about it. I put in green beans, sweet potatoes, gravy, mashed potatoes, stuffing and Turkey, okay? And I gave it all of its carb and all of its. That and everything else, right? So the total carbs for that plate, the way we broke it down, right? You want to guess. I'll give you a range to guess. Inside of
Jennifer Smith, CDE 15:09
my guess would be somewhere between 150 and 202
Scott Benner 15:14
it says 218, to 236 that is the maximum, okay?
Jennifer Smith, CDE 15:18
And it really missed something that was on that plate?
Scott Benner 15:21
Well, it was roast turkey, three ounces bread, stuffing at 40 carbs, mashed potatoes at 35 I have six grams for the gravy at a quarter a cup of gravy, which, by the way, a quarter a cup of gravy, please. And then I have sweet potato casserole between 55 and 60 for a cup. Green bean casserole, 12, mac and cheese, 32 to 45 dinner roll, 20. Glazed carrots, 18, right? Yeah, I think it was the glazed
Jennifer Smith, CDE 15:47
carrots that I didn't I didn't add in all the other ones I was adding in my head.
Scott Benner 15:52
You're also, you're really awesome at this, by the way, people should know. I don't give Jenny any help while we're making this at all. I don't let her see anything she doesn't know the numbers I'm talking about. I'm turning her into your avatar. It's what I'm trying to do while we're talking Yeah, so I've got that, and then I'm just gonna say to it this, right? Watch this. I'm gonna tell it to go to Juicebox podcast.com/meal,
bolt, meal dash, bolt, and apply that to this meal,
Speaker 1 16:25
because you guys could do this too. Is my point. I'm just gonna let chat G P to do that while i i fill some people in on another thing that chat G P, T and other large language models like, I don't care which one of these algorithms or which one of these, my God, why can't I think of
Scott Benner 16:40
the word all of a sudden? What it's gonna really ruin the world? Jenny, what's going to ruin the world?
All right, so watch this. All right. No matter which one of these models you use, I'm just going to type in algorithm, yes. Sweet potato recipe with Marshmallow, because I don't have one, I'm just going to grab one from the interwebs. I have never made that. I'm going to use the one from candied sweet potatoes from all recipes I'm going to click on, I'm going to click on print so I can just do a drag up on the ingredients. Four pounds of sweet potatoes quartered, three cups of miniature marshmallows divided a cup and a half of butter, a cup and a quarter of brown sugar. Got a cup and a half of butter. I'm just telling you, when I break, hold on a second. I'm gonna put that in here, and I'm gonna say to it this, please give me a nutritional breakdown. Okay, and so it's gonna, it's going to take those, you know, quarter cup of this, cup of that, whatever it is, it's gonna tell you there's this many carbs in this much sugar in it, blah, blah, blah. Because you guys like, I mean, this is pretty I don't know how many people are gonna do this. I think you could probably just go from a cheat sheet that says, which, by the way, I'm gonna put the cheat sheet up. Look for the cheat sheet on the Facebook group and on the on the website today for Thanksgiving, if you're listening to this on Thanksgiving. But I want you to know that you could head out to one of these and have it break it down for you, and it'll give you some pretty, pretty reasonable places to start, right. So the so the Thanksgiving bolt formula that came back, it said, right. If your BG is 90 to 120 when it starts, it'd like to see a Pre-Bolus 20 minutes, dosing about 60 to 70% up front and doing extended or split drag, the remaining 30 to 40% over the next two to three hours. Does that sound reasonable? Too? Sounds reasonable? Okay, it should, because we're the ones that made the meal bowl. Yes. If your BG is rising, you can try before the meal. Pre-Bolus a little longer, 25 to 30 minutes for and maybe add 10 to 20% to the total dose. So if you're Rising before the meal, get ahead of it a little further. Try to stop it from going up before you eat, or
Jennifer Smith, CDE 18:52
within that just a secondary would be at a corrective without any food consideration, so that you actually get that to turn around, especially if you're at a meal where you're not quite sure exactly what you're going to sit down to and what you're going to eat first, then just correct what's going on. Perfect. If your
Scott Benner 19:10
blood sugar is falling before the meal, you could start eating sooner or only give 50% up front, deliver the rest over maybe two hours. Use the natural fall that you're experiencing if you are experiencing one as part of your Pre-Bolus. Now it says, if you're grazing for hours, increase your basal by 10 to 20% you do do a basal increase for Thanksgiving
Jennifer Smith, CDE 19:31
when pre current algorithm that I use, and actually with the algorithm, just called something different, right? My Thanksgiving and we celebrate Christmas. So my Christmas, when we were getting together, family, lots of stuff, my day was coded by 25% okay, so I did a basal increase of 25% and that helped me navigate. Because what we're also i. Kind of hinting around here, while you can do a good job of looking things up with today's technology, thankfully, when I was there, there wasn't as much information to be able to look up, and it was a lot more imprecise estimation. And even today, I think a lot more people end up doing, oh, it looks about like this, right? So I found that that 25% increase not only helped because of the grazing nature and the long duration of intake, but it was because I was absolutely not weighing and measuring things. It was all an estimated guess, and it looks like 30 grams. Looks like 20 grams,
Scott Benner 20:37
a little more, a little I always say, go heavier, but that's me. What about people who say that? Like, I try to give myself more insulin, but I always end up low later. What do you think is happening to them? Like, colloquially, like, I obviously we're not with them, but what are you doing if you're ending up low later in the day?
Jennifer Smith, CDE 20:53
Depends on when later, right? It could be that one, the amount of extra you gave was just too much, or you were more in the category of over over, calculating the amount of insulin, not the amount of insulin, but the number of carbs, and so then you were getting more insulin that you needed. The other consideration in it could be that maybe you are also the one hosting the gathering, and you're on your feet and you're busy and you're moving and you're lifting things and, you know, in and out, and whatever it might be, it could be that what you've experienced in the past, not hosting now you're on your feet, and you didn't need as much, right? So, I mean, it could be a bunch of variables, but in general, if you're getting low, there's too much insulin and there wasn't enough food to cover it. I mean, that's the base.
Scott Benner 21:39
So I'm gonna go back here to this sweet potato breakdown. First of all, the breakdown is extensive. You don't obviously need this much information that it gives back. But if you really wanted to understand nutritionally, what's in that sweet potato thing, my goodness, it like really, it really gave me a return here it tells me the sweet potatoes, the net carbs for the sweet potatoes, glycemic index, glycemic impact for the marshmallows, the brown sugar, the butter, the whole thing tells you the total estimated glycemic load for the whole pan for serving. It's really, really lovely for the whole pan. If you ate the whole pan of sweet potatoes from that recipe, you'd have a glycemic load of 463 Oh, there's 12 servings in the pan per serving. It's 39 glycemic load per serving, which is, you know, so and that is high glycemic load, very high. That is, I mean, the context, low is under 10. Medium is 11 to 19. High is above 20. Now keep in mind, like Jenny knows this because she went to school for it, and she's smart. I don't know any of this. I just typed it into the machine, and it's giving it right back to me, like so it's it's valuable, and I
Jennifer Smith, CDE 22:49
know that we did define glycemic load versus glycemic index, right? This nice little chat thing is giving you a little bit of both. It's a high glycemic index, but when you break it down and you say, Okay, it's high glycemic index. But, Gosh, I really just want to taste it. Maybe I'll have a tablespoon of this. Then the glycemic load is absolutely much lower than over 20.
Scott Benner 23:15
It's also telling me here that, like, if you were going to eat this by yourself, like, just have the sweet potato thing. You'd need a maybe up to a 30 minute Pre-Bolus for this. So now, absolutely right. So now, all of a sudden, if that's mixed in with the rest of your meal, the 10 to 20 minute Pre-Bolus for food isn't really going to help. And by the way, you all know what's about to happen. You're going to be running around putting stuff on the table, and as you're walking towards the table, one of you is going to yell across the room, Billy, did you give yourself insulin too late? It's already too late. Everything's a bum puzzle at that point. Now you're a half an hour late. If you're going to have the sweet potatoes, and then the Spike's going to happen, you're going to go crazy trying to knock the spike back down, or you're going to live with it. It's going to ruin your day. It's going to you're going to be upset. I'm telling you. For me, it's funny, Jenny and I talked about this, we're like, are we going to talk about it with numbers? Or I think of this, I think you get up in the morning, you get ahead, and you stay ahead, right? You use increased temp basal, you make sure to Pre-Bolus the first couple things that you're eating, and then after that, you just cover stuff as you're eating it. And you should have the insulin the way I think of it, like on your side, on the momentum side for you. And then you just got to have the kind of wherewithal to realize when to shut that basal off and not make yourself low afterwards. And if you're going to have a dessert later in the day, it's going to be high glycemic index. You need a nice, long Pre-Bolus for it. That's it, I mean. And then don't go to bed and sleep too sound. Turn all your turn all your alarms
Jennifer Smith, CDE 24:46
up. And it may be a night that you turn your alarms up in terms of the low alert, right? You have your low alert set for 65 or 70, and you're not quite sure exactly what the lingering effects of this meal are going to. Look like. Then set your low alarm much higher, so you can catch it faster, right? Or the high alarms. Set your high alarm a little bit lower so you can catch it and you can again, catching something on a rise, versus waking up with a 200 plus blood sugar. Because your alarm was set for 200 it saves you time to navigate adding more insulin when it's needed sooner than later.
Scott Benner 25:25
Yeah. So I'm gonna point out, before I move on from this, that doing that chat, GPT breakdown of that recipe per serving. It assumes 12 servings, right? But you're getting 433, kcals, calories from it, 64 carbs from a serving, five grams of fiber, 39 grams of sugar, net carbs, 59 protein, three and a half fat, 19.5 saturated fat, 12 mono saturated five, polyunsaturated point seven. Cholesterol, 51 milligrams sodium, 220 milligrams potassium, 750 calcium, 77 iron, 1.2 that is from taking that recipe, dropping it in there, and going, Hey, break this down for me. Nutrition this, right? So when you're find yourself listening to these other Bolus for episodes, and you're like, Oh, this is interesting, because I'm getting a lot of good feedback from them. People are interested in, like, that's chatting through, like, how to Bolus for something. Just realize, like, there's way more impact from this stuff than you think. Now we picked, I picked, you know, something with a ton of sugar the
Jennifer Smith, CDE 26:22
hardest. Yeah, right. And actually, it makes me think of going back even in just a bit ago, you know, like Billy, or whatever his name was, Bolus, and he's already sitting in like the meal is coming, right. Well, what could you do if Billy is so willing to do it? Start with the turkey. Then right start with the so you can give the Bolus. You can let Billy decide what he wants on the table. Start with the turkey, or the proteins, if it's ham, or whatever your protein source might be, because that's going to have a very low glycemic hit. And you then at least build in a little bit of time that the insulin is going to have to get moving before you have your sweet potatoes with marshmallow.
Scott Benner 27:06
Try to put the sugar at the back. If you can put the sugar at the
Unknown Speaker 27:09
back exactly, yes, I tell you
Scott Benner 27:12
that this is, I mean, there's part of me that wants to break each one of them down. I wish you guys could have heard us talking before we started. Like, there is a way to break down. Like mashed potatoes. Like, this is how I Bolus for mashed potatoes. But once you start mixing stuff together, in the end, it's a it's a lot about the impact. It's about how quick it's going to hit you and for how long it's going to hit you. It's about Pre-Bolus things staying ahead of it. And I, you know, for me, again, with the, you know, temp basal, which a lot of your algorithms, it's, it's kind of a catch 22 on Thanksgiving, right? Because everybody's going to be on their automated their automated systems, you can't just tell it to, like, more, yeah, it's not going to want to do that. I don't know, like, what I would do in that situation.
Jennifer Smith, CDE 27:52
Another piece to this too, would be, what do we follow up the main meal with? We follow it up with, you know, if we're going to break anything down, some type of a dessert or a sweet treat ends up coming in at the end of the meal. Now, what precedes this? A load of insulin is already there. You have maybe coated it with whether it's an extended Bolus or a temporary basal increase or some type of override that your system allows you to utilize. And now you may be coming into a dessert time thinking, well, that looked pretty sweet, like look at the great job that I did, but you still have a load of fat that's loading that food down from completely clearing through and having a completed impact before you eat your let's Call it pecan pie. Okay, so I think there's consideration for what do you do with the dessert at the end, right? And it does go back to where. Where are you sitting? What does it look like is happening to your blood sugar? What's the direction you nice and stable? Are you stable, but just starting to kind of edge up? Are you stable but starting to nose down? Are you low already from whatever you know was miscalculated, because it is what it is. So I think it's another place to consider how you distribute that dessert type of a Bolus and the timing around it. Yeah,
Scott Benner 29:14
pies are, I guess, a good example, right? Like, so there's filling, like, pumpkin like, I'm looking at a pumpkin pie here. I guess we could break one down to like to see what's in it, right? Hold on a
Jennifer Smith, CDE 29:25
second. I mean, the most common are what pumpkin and apple pie? Those are the ones that we've always had at mine, pecan pie. We've never had it my Thanksgiving. It's a huge Thanksgiving thing, but I don't even ever think I've ever had pecan pie in my life.
Scott Benner 29:42
My grandmother was Pennsylvania Dutch. They used to eat something called shoe fly pie. Which fly pie molasses, right? Yeah.
Speaker 2 29:49
Again, all sugar, yeah.
Scott Benner 29:52
Also, she had type two diabetes, I would just want to point out, so yeah, I'm looking back, and that might not have been so hard to figure out why that happened. Okay, so I have right now, there's not a lot in pie dough. I hope you're all making your own pie dough. I make mine. It's easy to make. It's not that hard, really. Okay, so I am. I've gotten a breakdown here for Oh, hold on a second. It'd be nice if the if the website didn't launch a video on me. What is that ridiculous? By the way, all these recipe websites are just scams to get you to ads. Oh, of course, that's, that's all it is. Like, it's so hard to find the actual recipe. It's almost insane. You like pick you have to hit the, by the way, you hit the print button. That's what I do. Okay, so here is the pumpkin pie filling. I gave it here. I'll give it to you. The recipe is three quarters of a cup of granulated sugar, a teaspoon of ground cinnamon, quarter teaspoon of salt, quarter teaspoon of ground ginger, half a quarter teaspoon of cloves, two eggs, 15 ounce can of pumpkin or fresh pump and puree, and 12 ounces of evaporated milk. It parsed down the this way, granulated sugar, 150 grams for three quarters a cup, there's negotiable in cinnamon, sodium, of course, ginger, cloves, blah, blah, 100 grams in the eggs. 425 grams in the puree. 354, grams in the evaporated milk. Makes an eight palm piece serving. So let's see whole batch per serving, per slice. 149 calories, 27 carbs, 20 Oh, that's light on the carb. 23 sugar. It doesn't include the crust.
Jennifer Smith, CDE 31:37
Oh, I was gonna say gosh, because that seems awfully light on the car.
Scott Benner 31:41
This is just the filling. Now, I'm gonna let it do the crust for you. Okay, it takes a second. I mean, here it comes. Well, technology is amazing. I don't know why we're all arguing about it. So what if it blows up the earth? I mean, look, quickly it broke this down. All right, so nutritional breakdown for the crust, which, by the way, was two and a half cups of all purpose flour, a half a tablespoon of sugar, salt, half a pound of cold on salted butter, some ice water. The entire concoction is looks like 300 for the flour, six for the sugar. And moving on here, let's see as far as, okay, hold on, total carbs for the entire pie crust, 219 per serving. 27 for the crust, net carbs, 26 protein, four. So yeah, it's basically 27 for the cross 26 for the filling. It's over 50 for a slice of pie?
Jennifer Smith, CDE 32:41
Yeah, I was gonna say the average is about 5050. Grams, if you're just wanting a nice round number, 50 grams for an eighth of a piece of pie.
Scott Benner 32:49
Could do all this, or just ask Jenny, and she would have told you, I want people to be able to go do it for themselves
Jennifer Smith, CDE 32:55
afterwards. Yeah, no, it's a fantastic way to be able to do it and get the direct information. If
Scott Benner 33:02
Jenny can't live in your pocket and jump out and go, that's pi 50.
Jenny in your pocket. Oh, there, there you go. Wait, we could sell that. Break your different pies down this way. Listen, is this exactly how your pie is going to be or how your potato it's not, but it should give you enough right of a jumping in space for the carb total and the sugar understanding should get you close, right, like that. That's my hope for you, is to be close again. Get ahead, stay ahead and be ready for a low later. That's pretty much my whole Thanksgiving theory,
Jennifer Smith, CDE 33:40
and this, as I brought it up, at the end of a long duration meal. That's a really heavy meal. This also brings in the consideration of not only the Bolus, but the timing of the delivery of the Bolus. It may be a time when you actually do despite it being pie, it's sitting on top of butter and gravy and creamy stuff and fat in a heavy meal. So you may actually use 100% extended Bolus for something like this, depending on where you're starting with your CGM value and the trend. Would you normally do this if you just sat down to a piece of pumpkin pie? No, in and of itself, by itself, absolutely, you would need Pre-Bolus, and you would write, but because of the end result of meal on top of this, in your belly,
Scott Benner 34:30
I say make a blanket of insulin over top of the timeline of the meal. That's kind of how I think about it. Like, seriously, like a weighted blanket for, you know, people with, you know, people like weighted blankets. I just put a blanket of like insulin over top of the series, pulling up some other things that people might find interesting. Regular Budweiser has 10 and a half grams.
Jennifer Smith, CDE 34:51
That's a great one to bring up. A lot of people don't cover drinks.
Scott Benner 34:56
And a Bud Light has 6.6 I just randomly picked up beer. I don't drink beer, so I didn't know what to do there. And please, you know, if you want this to be easier, don't drink sugared soda. Don't drink juice cider. I mean, do people do apple cider still I would expect so yes, you know what I mean, apple cider has got to be crazy.
Jennifer Smith, CDE 35:17
It's pretty high carb, usually, depending on the brand, it could for a cup somewhere between 30 to 40 grams of carb just for a cup of apple cider.
Scott Benner 35:27
Yeah? And, I mean, so I don't know, like, good luck, I guess, get out there and start
Speaker 3 35:33
swinging. Yeah. Have a great time. Thankful for all we have.
Scott Benner 35:37
Jenny, let me ask you one question, yeah, I'm sitting here now. It's not me and you. It's me and some newly diagnosed family, right? Sure, and they've never Bolus this much in their entire life. They're gonna sit there. I know what they're gonna do. I've done it, right? They're gonna err on the side of caution. The kid's gonna get high. They're gonna have a whole like, look what happened. We ruined Thanksgiving. How do you find the nerve to make a an 80 gram Bolus when you've never done that before. What do you you know what I mean, it's, it's a ballsy move. It really is. Is there a way to, like, go into it slowly? Can you,
Jennifer Smith, CDE 36:12
well, I think with technology being the way that it is, you add it up, you've done the math, and you look at it six times, and you're like, Gosh, 80 grams. Like, we never Bolus for this much. Like you said you could do a an extended Bolus, because then you're not getting the load of it, despite good counting that you know that this is how much it actually is do an extended Bolus, and when you see that it's been working, but now, gosh, my blood sugar clearly is going up. You can always cancel an extended Bolus and take that as a normal Bolus. So that's one step wise approach. Is it likely that your blood sugar might end up getting low later? It is. But again, with so much food around and so much quick carb this would be the time to drink the apple cider.
Scott Benner 36:59
Yeah, right, right? I mean, the other high side of all this is, if you're too aggressive, there's 1000 ways to fix it, and it's all right there too, right? Yeah.
Jennifer Smith, CDE 37:08
But I think getting up the nerve it does depending on the type of person personality you have, and if it's yourself versus you navigating a child, I think they're very different considerations. Yeah,
Scott Benner 37:21
no, for sure, I'd like to also bring up to people, please, like, put the tiniest bit of effort into making sure that you're not in the last three hours of your CGM on Thanksgiving, or that this isn't the last six hours of your pump site, like, that kind of stuff. Like, I, I would love you not to have a brand new pump site and not an old pump site on Thanksgiving. I think that gives you a lot better chance, you know, just kind of be ahead of your tack a little
Jennifer Smith, CDE 37:43
bit. I would like to add a note as well to try to start your day with some exercise, because it can really help. Okay, Jenny, everybody, come on. Don't watch the parade. I haven't watched the parade in a long let
Scott Benner 38:01
me tell you how my wife ruins the holidays with her. She's got some old family tradition where they eat these. I'm sorry if she hears this, like these, these garbage II, like cinnamon icing, rolls, like Jenny, okay. Yeah. No, no. Hold on. So right away in the like, Do you know what I'm talking
Jennifer Smith, CDE 38:21
about? A can where you pop them open and they Yes, okay, I know you're talking
Scott Benner 38:25
about, you know what I'm talking about? Yeah, I had to learn. But also it helped me because, like, because for my wife, Christmas morning is like these, I'm not gonna say what I almost said, but she it started with these cinnamon rolls that were not, you know, they're not homemade, they're not from a they're not even from a bakery. They're, they're, you know, out of a can, processed, like, blah, blah, blah. And, you know, it's come downstairs make these things. You know, Arden is just awake and they're gonna eat cinnamon rolls. So, like, while everybody else is, like, running down the steps and, like, oh, it's Christmas. I'm like, Bolus, we need insulin. I'm Pre-Bolus, thing for the rolls, right? And so she, and that's a every holiday like that. They would do those in the morning. And I think people have all kinds of stuff like that, like so, you know, it's your other idea too. Is like, if you're getting up on Thanksgiving and you're going to be at your aunt and uncles to watch the melee at two, and you know, that's when lunch starts. I wouldn't start the day with a bowl of Captain Crunch, right? Give yourself a shot. Is what I think, what I'm saying, and just don't get behind. I know that this sounds overly simple, but get ahead. Stay Ahead is such a great idea for days like this. You know, I really find it is No, it's great. Okay, apple cider, yeah, 30 grams of sugar, 32 carbs for a cup hard apple cider. Don't forget that with alcohol in it can be there. Try not to drink your carbs, please. That'll help. Drink water, lots of water. That water is terrible. Get some sparkling water tastes like water. I think is the problem.
Jennifer Smith, CDE 39:56
Tastes like water, yeah, add some, I don't know, add some lemon. Juice to it, or some lime,
Scott Benner 40:01
or nice idea, yeah, some mixed berries in there. Something, right?
Jennifer Smith, CDE 40:06
You know, squeeze and squeeze a couple slices of orange into it. It's not going to add anything you have to Bolus for, but it adds a little flavor.
Scott Benner 40:13
Also, don't forget, when you do your leftovers after Thanksgiving, the cold potatoes will hit differently than the hot potatoes hit. That's
a good point. Yes, thank you. Look at us. We're like little fairies, just dripping,
dripping knowledge, knowledge every which way. Thank you for doing this. Jennifer, Happy Thanksgiving. You too. Thank you.
I'd like to thank the blood glucose meter that my daughter carries, the contour next gen blood glucose meter. Learn more and get started today at contour next.com/juicebox and don't forget, you may be paying more through your insurance right now for the meter you have than you would pay for the contour next gen in cash. There are links in the show notes of the audio app you're listening in right now, and links at Juicebox podcast.com, to contour and
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in each episode of The Bolus four 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 of 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 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. Have a podcast. Want it to sound fantastic. Wrongwayrecording.com.
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