#1695 Bolus 4 - Lettuce
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Scott and Jenny talk about how to bolus for lettuce.
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Scott Benner 0:00
Welcome back, friends. You are listening to 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? Jenny, I am on Hershey land.com where I am staring at the nutritional facts for Reese's milk chocolate peanut butter cups. Oh, it allows me to choose from all different counts. I'm just gonna pick the smallest one, 1.5 ounces.
Jennifer Smith, CDE 1:41
That must be the the one that's the original. I guess
Scott Benner 1:45
that's two little cups. Probably two little cups in a package. I mean, we could try to which I'd be curious.
Jennifer Smith, CDE 1:50
Does the package say one cup is a serving, or does it say both cups are the serving side?
Scott Benner 1:56
I'm gonna pull up the 1.5 to see. 1.5 is two cups, that's but is that the is it one cup the serving size? Good question. One package is going to be the serving size. So, one full package, okay, two, just like you were imagining in your head, 1.5 ounces for the whole thing. Total Fat in this one package, 12 grams, actually more saturated fat here, I guess that's probably the chocolate right. 4.5 grams. Cholesterol is not an issue. There's 135 milligrams sodium, 24 carbs. So I guess each cup is 12 carbs, 22 sugars, two dietary fiber. Apparently there's some iron calcium. There must be iron, calcium and potassium and everything. Because no matter what junky food comes up, it always has those three simple ingredients. It says milk chocolate, which is sugar, cocoa, butter, chocolate, skim milk, milk fat, lactose, lecithin and whatever PG, PR is, and then peanuts, sugar, dextro salt, TB, HQ and citric acid to maintain freshness. It says,
Jennifer Smith, CDE 3:03
so it doesn't get all hard as a rock in the package before you eat it 20 years from now, in your bunker.
Scott Benner 3:10
I just wanted to find out what PGP r is. So I don't know what that is either, polyglycerol, poly Rich onellate. It's a fat it's a food additive. The food GPR is a food additive, specifically an emulsifier used to improve the flow properties of chocolate and stabilize low fat margins. Sexy. That makes me want to eat it now. Okay, so Reese's, you know, it's funny. You hear people say all the time, like, and I wouldn't treat a low blood sugar with chocolate either, because, like you want, you know, fast acting simple sugars, but you'd be surprised how many people I see online who do treat their lows with chocolate like I think they don't know to go more simple sugar. But let's just say we're not treating with it. We are eating it, eating it yummy, right? All right. So we figured out what everything is, as far as the impacts, how are we going to handle this? Is this a snack? I mean, is there anybody out there eating a Reese's along with a meal? I can't imagine.
Jennifer Smith, CDE 4:15
Well, maybe at the end of a meal as a treat. I mean, for kiddos, you know, working with enough kids, many kids do want to sweet something. It's either a cookie or it's this time of the year, might be a popsicle or a fudgesicle. So I can see this being something at the end of a meal that's maybe your treat or your dessert. Let's call it. I think what's fair about considering a chocolate type of candy is also chocolate. As you said, it's not the greatest thing for low blood sugars because of the fat content. And if we look at this, my guess would be two of them. There's probably 10 to 12 grams of fat. I can't remember what you said before 12. Okay, so if you ate. Both of these calories, then are probably about 50% of the total comes from
Scott Benner 5:06
fat, okay? 210 calories for the pack, sure. So if you have
Jennifer Smith, CDE 5:10
12 grams of fat times nine is little more than 100 Okay, right? But I think that's valuable to understand, because when you're treating a low one of the first three ingredients on something to treat should be dextrose or glucose. It just should, because that's, it's the simplest form of glucose or sugar that there is. It doesn't take digestion. It gets in and it hits. So enjoy your Reese's, but don't use them as a treatment for a low the other piece that I think people would look at, besides just total carbs is in candy, there's total sugars too. And when you look at total sugars and you're talking about bolusing strategy, that's another piece that can be very valuable. When you talk about fat, kind of like potato chips, you might think, well, there's fat in here, so maybe they're going to be it's going to be slower. So maybe Pre-Bolus isn't as important. But when you look at this, you have to look at the label. I don't know how what's the total sugars compared to the total carb?
Scott Benner 6:07
22 sugars, 24 carbs, right?
Jennifer Smith, CDE 6:10
So this is all sugar. Yeah, there's really not. They say that there's peanuts, but
Scott Benner 6:17
I don't know how many peanuts you're saying. I
Jennifer Smith, CDE 6:19
don't know how many peanuts those total sugars are. That's like, it's a lot of added sugar. It's a heck of a lot of added sugar. And some labels even break it down further and tell you not only total but they'll tell you how much of that is actually been added as sugar. And sometimes you'll be surprised to see that total sugar might be this much, but maybe the added sugars aren't that considerable, and then your Pre-Bolus strategy might shift a little bit. But this, I would guess, is pretty close to 22 okay, if it's even there. So Pre-Bolus strategy that, yeah, go ahead. This is candy. You're eating it alone. Just like everything that we're trying to look at, you're eating it in a right now. This is it. Nothing else with it. You definitely need Pre-Bolus for this. If your blood sugar is in Target higher than you want it rising, definite Pre-Bolus. My estimate would be at least 20 minutes, 15 to 20 minutes for a Pre-Bolus for this, right in those circumstances, and if, again, blood sugar is high or rising, already longer.
Scott Benner 7:20
What if I can't Pre-Bolus? We haven't talked about this in a while, but if then we just make so I'll just tell you what I would do. Yeah, if Arden wanted that, I don't even know she likes these. I don't think she does, actually, but if she wanted these, and she's like, I'm having them right now, I can't Pre-Bolus, I would do the Bolus for everything that's on the label. And then I would imagine there's going to be a spike. And I would try to, basically, I would try to, yeah, I'd try to Pre-Bolus the spike. So you're not Pre-Bolus in the food now you're bolusing for the food. Pre bolusing the spike, because the spike hopefully isn't going to come for 20 minutes or so. So I would over, you know, there's episodes called over bolusing, and there's Bolus and strategies in the Pro Tip series and everywhere else, I would make a more aggressive Bolus than the label called for if there was no Pre-Bolus. Absolutely.
Jennifer Smith, CDE 8:10
It's actually a concept by John Walsh. He calls it the super Bolus. We've talked about that before, right? It's if you can't Pre-Bolus, then give an overage right now, you're still going to get more spike than if you had Pre-Bolus, but it's not going to be as high, right as if you don't give extra
Scott Benner 8:25
right now, yeah, no, yes. So I would definitely do that. So you're saying 20 minutes. If you're a person who can say, I'm going to have Reese's Peanut Butter Cups, I can wait 20 minutes, then go ahead and
Jennifer Smith, CDE 8:35
if you can, if it's right after Halloween trick or treating, and your bucket is full of these, because that's what was given out in your neighborhood, then you probably have a child. Who is I want the Reese's now, you know, dad or mom or whatever.
Scott Benner 8:47
And, yeah, I would say, like, because we went over it earlier, like, if you're 70 and falling, don't reach for chocolate. But if you were out trick or treating and you're 120 diagonal down, this is a perfect time for a Reese's.
Jennifer Smith, CDE 9:00
There you go. And maybe not Pre-Bolus or Bolus at all. You could probably just keep walking
Scott Benner 9:05
exactly like so there's just ways to think about, you know, in the end, Jenny, like, I probably don't say this enough, and I've probably said it too much, but everything about diabetes is timing and amount. I mean that about the insulin, and I mean that about the food. You know, I've said it before. I'll say it again. Like, we spend so much time thinking about how the insulin impacts the food, we don't often think about how the food impacts the insulin, or how the food impacts the number. And I think those are important ideas too. So yes, anyway, this is how you would Bolus for a Reese's Peanut Butter Cup one and a half ounces. Don't forget that you also may be getting in your Reese's Peanut Butter Cup artificial flavors that we didn't notice before, and this recipe may also include bio engineered ingredients. I'm sure it probably does according to all bulk foods.com Yeah. So good luck. Everybody. Enjoy. Way, Jenny, what would you do here chocolate? And the only way I eat chocolate is there's a chocolate chip that I like, and we keep, like, a little dish of them in the house, like covered and so if I have a chocolate idea, I grab a few chips. That's where I get my chocolate fixed. When I need it. It doesn't happen completely often, but they're always available, because I find that otherwise I do end up with, like, not going to out anybody's company, but like, you know, chocolate that comes in a wrapper that often I eat it, and I think this doesn't really taste good. No, I'm not
Jennifer Smith, CDE 10:36
really a milk chocolate person. Personally, I have a piece of chocolate every day so but my chocolate is usually the 90% at least 85% 90% it's the dark chocolate chocolate, and it's because me, personally, my taste buds are much more satisfied with the richness, okay, of That dark chocolate, and it's not such a sweet overload. I think that's what ends up having people come back more and more and more to like they can easily eat the whole Hershey bar. They could easily eat both of the peanut butter cups, because it's that combination of those ingredients that companies have figured out. Again, it's sugar, salt, fat, and they combine them in such a way that it hits your tongue, which goes right to your brain and says, more. That's awesome. I want more.
Scott Benner 11:28
I'm gonna I'll share. I use the is it jardinelli chips? Oh, Ghirardelli. Oh, you know what? It's problem. Yeah, I probably confusing that with somebody I know gerardelli chips. I just said somebody's last name. Anyway, hi everybody, if you hear that, and I do very similarly, like, I'll buy a bag of milk chocolate, a bag of dark chocolate chips, and actually just throw them in the bowl, and I mix them up so that when you grab it, you get, like, and I think when you grab it you end up with, like, I don't know, seriously, like, eight chips, maybe. And then you're like, tablespoon, yeah. And they're like, Okay, there, that was that. And then you're kind of on your way again. Anyway, okay, well, I appreciate you doing this with me. Thank you, of
Jennifer Smith, CDE 12:06
course, no, that's great. Thanks.
Scott Benner 12:16
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 offset 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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