#412 Turkey Tutorial

November 25, 2020Scott Benner

Bold With Thanksgiving

Thanksgiving Pep Talk

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Scott Benner 0:09
Hello, everyone, and welcome to Episode 412 of the Juicebox Podcast. Think of today as a pep talk for Thanksgiving. Today we're just going to talk about how Arden's going to manage on Thanksgiving Day, which, if I'm being honest, really is about how we manage every other day, just that people seem to get very nervous around these holiday situations. And I understand why there's probably more grazing and snacking. There's also a lot of variables and what you're eating. We'll break it all down. Talk about how I'm going to attack it. See if you can find some good ideas in here for yourself. Please remember while you're listening that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making changes to your health care plan. Becoming bold with insulin, or stuffing your turkey and that's not some weird euphemism. actually think when you stuff the turkey. You can like mess it up and cause a problem is it trickin gnosis botulism botulism that sounds like something to do with a can. Alright, so before we get to everything else, let's just figure out what undercooked poultry does to

hold on

Scott Benner 1:26
cooking you're stuffing in the turkey they're calling that a mistake to avoid I can tell you personally, I used to put my stuffing in the turkey but it slows the cooking time way down. It doesn't allow an even heat to go through the bird and I don't do it anymore. I prepare my stuffing I actually make it by hand I bake the bread I tear it up days in advance let it become stale almost and then combine it with a whole bunch of different stuff not the point I make my own stuff I make the stuffing and I put it in a pan and bake it because I found what I put it the stuffing in the bird took too long to cook and I wasn't getting a cook through the way I wanted so now I'm drying the outside of the turkey to cook the internal portion what Hold on a second. On cooked I know we'll get to the rest of it. Just give me a second turkey causes Wow. Raw and undercooked meat and poultry can make you sick. Most raw poultry contains wow can't be low backer can't be low backer needs a better name. It also may contain salmonella, Clostridium perfringens and other bacteria. raw meat may contain salmonella, e. e stands for you in this situation. How long does it take to get I'm falling down a rabbit hole here? How long does it take to get food poisoning from Turkey? 12 to 72 hours to symptoms usually lasts around four to seven days about cook your turkey. You know, poultry has to be cooked to 165 degrees, right? Hold on Turkey. Done. 100%. Right. Yes, 165 degrees. A whole Turkey is safe when cooked to a minimum internal temperature of 165 degrees Fahrenheit as measured with a food thermometer. Check the internal temperature in the innermost part of the thigh and wing and the thickest part of the breast. Alright, there's our little turkey tutorial. Oh, I just found the name of the episode by mistake turkey tutorial. That'll be fun. All right, I'll do that. Let's talk about some other stuff. Everyone freaks out around holidays. Oh my god, we're gonna be snacking all day. There's food in the house. There's bowls of food on the cabinet. There's grazing. I hear you. Maybe this COVID Thanksgiving might not be exactly the same as most But still, it's here, right? You're gonna get up have a breakfast, there's gonna be a big launch or a big dinner. grazing in between pie. I'm assuming cookies. gluttonous extravaganza. Here's how I think about a meal with insulin. First, I wonder how long does it take for the insulin to start working? How long till it effects the blood sugar? And how long will it last in the body? It's my first thing. How does the insulin work in order? First thing to consider. Second thing? What is ardan? eating carbs? How many? Yeah, that's easy, right? You count the carbs. Everybody's like no, no, it's not easy, Scott. Because stuffing it's pretty easy. You don't I'm saying pan full of stuffing ish is probably a piece of bread and a half something you gotta you got to wing it a little bit. Just I didn't mean to wing it because of the turkey. You got to just kind of like roll with it. You got to look and guess be kind of aggressive. But still, the most important thing here is Pre-Bolus. Getting your insulin in and working so that it can time itself up with the impact of the food. So what we're talking about here is timing. So the insulin kind of comes online at the same time that the food comes online meaning while the food is pulling up on your blood sugar, you want the insulin to be pulling down you want them to get involved in a tug of war that no one wins. That's how you keep a stable line. You know, when you see people's lines are super stable on their graphs, but they have food. And then they're like, Yeah, but you can't find the bagel. You know, people do that. Hold on. Sorry, I've been sick. How do you not see the bagel on the line is because that as the food impact is trying to push the blood sugar up, the action of the insulin is trying to pull it down. And so it just creates this stability. No side is winning the fight. So you have to Pre-Bolus your food, you can't let the carbs get ahead of the insulin. To understand Pre-Bolus thing better, you can check out Episode 217 diabetes pro tip Pre-Bolus. Now the next thing to consider is the impact that the food or the drink you're having, is going to have on the system.

It's not as easy as saying this is 10 carbs, because 10 carbs of Hawaiian Punch will impact your blood sugar differently than 10 carbs of macadamia nuts. I don't know how many carbs are in macadamia nuts. But imagine you've eaten 10 carbs of them. The punch will hit you quickly and harsh, right your blood sugar will shoot straight up while the macadamia nuts which by the way, I've checked on and one cup of whole or halved macadamia nuts have 19 carbs. So if you have a half a cup of macadamia nuts, which is probably what like a handful, you've got 10 carbs, but they're not going to hit with the same exuberance that a simple sugar like a juice would. So keep that in mind for a second, you have 10 carbs worth of impact on your system. If it's something liquid, like the juice, or something sugary, it's gonna happen very quickly. So you need the insulin to be working. When the Hawaiian Punch goes on, I have no idea why I picked one punch. I've never drank one punch in my life. Nor do I know anybody that drinks it. But that's not the point. The point is, you may need a longer Pre-Bolus so that you can match the action of the insulin up to the impact of the Hawaiian Punch. Now for something like the nuts, you might be able to Bolus with the carbs, wait a couple minutes and start eating. Because as the insulin slowly comes online, and begins to work, the nuts are slowly coming online and trying to push your blood sugar up. Now the key around these bigger days, I think is understanding there's going to be a mix of foods a mix of impacts. Pumpkin Pie is sugar, and milk, right there's like, like milk in it, I think so there's some fat, but then you have the flour from the pie. So you have two different impacts, you have the sugary filling impact. And the carby flour impact. Same with a cherry pie, apple pie, sugary and carb at the same time. It's not dissimilar to Chinese food, where you'll get the slower carbon pack of rice, but the quicker sugary impact of some of the sauces. So imagine that for pumpkin pies and example, you'll need enough of a Pre-Bolus that you'll head off the sugary spike. But you still need enough insulin over the timeline that the pie is going to impact your system to keep down any slow risers. So there's two things in there, a more fast acting carb and a more slow acting carb. If you're pumping, you may use an extended Bolus, a bolus that would put in a portion upfront and drag the rest of it out over time. I'm also a big fan of manipulating basal insulin top line idea being that if your bazel is set to keep your basic body function stable, and now all of a sudden, you're adding a whole lot of carbs over many, many hours. It's reasonable to think that the basal insulin you're using on a normal day might not work as well, on a carb heavier day. To learn more about Temp Basal increases and decreases go to Episode 218, also part of the diabetes pro tip series for Temp Basal. While we're at it, you're going to want to look at Episode 263. It's about how fat and protein impacts your blood sugar. Two things that you don't think of as being impactful on your blood sugar, but they are fat slows down digestion. Slower digestion lengthens the time that the carbohydrates impact your system and protein. As your body breaks it down. Your body turns protein into anybody. glucose and glucose is anybody. Sugar and sugar makes your blood sugar go up. So all those proteins people like those are free carbs. Those are free carbs, huh? Are they diabetes pro tip Episode 263, fat and protein. Some people who aren't MDI multiple daily injections who are in injecting their basal insulin and not manipulating it with their pump. Find on days like Thanksgiving, but a little extra bazel might be the way to go. The idea being your basal insulin, again is only supposed to keep you stable at a number and stable. So if you're super stable all day without food and your blood sugar's 200, my opinion your base was not strong enough. But if you're super stable all day at 95, without food bazel is probably right on. But what if you put in a tiny bit extra,

it would be holding your blood sugar down a little farther. But if you're planning on grazing all day, and eating that may again be necessary. All we're talking about is manipulating the insulin to put it where you need it. My goals during the day are really simple. Yours should be to, I'm trying to maintain the steadiest blood sugar, so as I possibly can, and I want to avoid spikes and significant lows. After food, I don't want hardens blood sugar to go over 140. And in a perfect situation, I'd like Arden's blood sugar not to go below 70. But you know, it hits 65 for a second. Not the worst thing in the world. My opinion, I follow a few rules around this. First one is, it is far easier to stop a low or falling blood sugar than it is to return a high blood sugar to a safe range. Right? So stop a fall with a little juice, get it leveled out, start over again, or have a 300 blood sugar that you're fighting with all day. Which scenario would you rather be in? For me? I'd always rather be on the other side. But don't get me wrong. I'm not trying to make a low blood sugar. I'm saying that they're easier to fix without a rebound. How do you stop a high blood sugar from happening if you've messed up the bolus? Well, I'd look into bumping and nudging a little bit. That's going to be an episode 225 diabetes pro tip, bump and nudge. Basically, the idea is this I think of type one management as driving, there's lines on either side of the lane, and I'm trying not to leave the lines. That's why I have my daughter's dexcom CGM set at a high alarm of 120. A low alarm of 70. If she should drift under 70, we bump it back up with a little bit of juice. The idea being the less you use in carbs, the less likely you are to overcorrect up. So I'd like to know sooner so that I can kind of bump it back up. Same thing with a high blood sugar getting over 120 nudge it back down again. Again, the idea being the amount of insulin that it takes to turn on 120 that's rising into a 90 that stable is far less insulin than it would take to turn a 200 into a 90. And you know, once you start getting up 151 8200, you start using more and more insulin, which eventually causes a low later. And then should you miss address the low now you're on the roller coaster and you're up and down. So I like keeping what feels like tighter tolerances, so that you can just make small adjustments to stay in your lane. Over time, that turns into better bolusing better correcting, you just get better at it in general, before you know it, you don't really leave the 70 or 120 or whatever range you set. That's been my finding. If you're interested in learning more about the dexcom g six continuous glucose monitor, go to dexcom.com Ford slash juice box. There are links right there in the show notes of your podcast player. And that Juicebox podcast.com. Now I think it's important to remember to Bolus for what you're eating. But all of that infers that your settings are good to begin with. And for many of you, this might end up being your Achilles heel. What do I mean? Well, many people I find have bazel insulin that is not well dialed in. So either your blood sugar's are always on the higher side. And you're making these very aggressive bonuses at meals because you don't realize it but when your bazel is off, well then your meal boss is off to Here's what I mean real quickly. Let's say that your basal insulin should be one unit per hour, but you have it at a half unit per hour. That means that every two hours of the day, you're missing out on a unit of insulin. So if you're at a half, and you're really a one, you're 12 units deficient over a 24 hour period. So you're trying to make that insulin up somewhere, you're very likely mixing it up with your meal insulin. So if you're not using enough bazel you probably think you need more for your meals than you actually do. Meaning if you had more bazel which would hold your blood sugar lower and more stable. You would need less insulin mealtime and vice versa. If you're a Basil's too heavy. You're probably one of those people who's like oh, I barely use any insulin at meals because you have so much basal insulin going throughout the day. You're basically feeding the bazel to stop you from getting low Does that make sense. And if that does make sense to you, but you'd like to learn more, check out Episode 237, diabetes, pro tip, setting basal insulin. So back to my original thought here, you need to put insulin in for the food you're eating. If you eat something at 9am, and then 10am 11:30am, and then again at 11:45am, these things all need to be covered by insulin.

Now, if your settings are right, then put what you put in at 9am is for that food, what you put in a 10 is for the next food, etc, and so on. But if you're too aggressive with your meal, insulin, meaning your settings are way off, maybe what you put in at 9am, and 10am was too much for that. So you're thinking, Oh, but the thing is, you know, 1130, that's free.

Unknown Speaker 15:44
Yeah, it may be,

Scott Benner 15:46
but it'd be better to just get your bonuses down better. So that you can continue to Bolus for the things that you eat, that becomes very important on days like today, while grazings in line. Because what happens is you start thinking, Oh, I have enough insulin for that, then you don't, then you're 100 blood sugar turns into 150. Like, it'll come back down. And then it doesn't, you have the bolus for what you're eating. My opinion is to stay aggressive with the foods that you're eating, keep after them with insulin, and if you do cause a low later, well, Lucky you. It's the most food horrific day of the year, there's something to eat. Again, I'd rather be on the lower side than the higher side. And you might be thinking, Scott, that's stalking, my doctor told me never to stack insulin. To that, I would say it's only stalking, if you don't need it. If you do need it, that's called bolusing. If things do go wrong, please do not throw yourself into a tizzy. Don't start yelling about diabetes being unfair, and you always knew this was gonna happen and falling into the drama. Because the drama stops you from learning the lessons. Because everything that happened is right there in front of you. You can see I bolused here, then this happened, I wanted that to happen next time, I should boast a little more or a little less or a little sooner or a little later. You don't want to give up the lessons. They're hard fought right. And you don't want to keep having to have them over and over again just to learn them. So get rid of the drama. Try to figure it out. You can do it. You can absolutely do it. Make your best guesses about carbs. Keep in mind that potatoes are going to hit a little more substantially. Then I don't know green beans, right green beans, thought cars. Um, I think green beans, carbs. I don't really eat green beans. Hold on a second. Yeah, green beans have carbs. A couple of green beans has seven carbs. I don't really count carbs. Actually, I just sort of guesstimate the plate. And you probably can too. If you have enough. If you have enough, you know time in the simulator and you really been able to figure it out. He just sort of looked down you go. I'll tell you right now here's how I do a plate I go potatoes. 30 piece of bread 20. Turkey. Yeah. 10. Beans, 10. We got here cranberry sauce, I don't know, a little bit of it five. I just roll like that was it Bang, bang, bang, bang, bang, insulin goes in good Pre-Bolus get a good fight set up between the food and the carbs. And then correct on the backside. If you have to. You may have to correct with insulin. And you may have to correct with food. I'm not sure. But sitting around and waiting and crossing your fingers. It's not a good plan. I would much rather punch first. That's sort of how I think about bolusing. Because when it this is a sports metaphor. So I'm sorry if you don't get it right off the bat. But you need to dictate the pace. Right? You come out swinging Anyway, you want to think about it. You act first. So that the next thing that happens is because of you because at least that you can measure. Right when you cover your face. And you're kind of hiding and you're just hoping not to get knocked out. You don't know what's happening to you. You don't know why your blood sugar is doing what it's doing. But at least you can say, You know what? I had an Eclair. I thought it was 35 carbs. My blood sugar went to 200 and later I had to correct with another unit. So next time I'm gonna get that unit into the original Bolus. I'm gonna say I guess that he Claire, maybe it is 35 carbs, but it punches like it's 45 carbs, or whatever. You know, your numbers may vary, but the idea is there. I learn from that and move on and the next time I have an Eclair I do a better Bolus job. That's it. Get out be aggressive. Don't be scared. Do your best test if especially if you don't have a Dexcom CGM test use your meter my daughter loves the Contour Next One meter and you can learn more about it at Contour Next one.com forward slash juicebox. But that's how we roll Arden pumps. I should have said that up front Arden has an omni pod. She's had not a pod since she was For, and she is 16. Now, as a matter of fact, if you'd like to learn more about Omni pod, you go to my on the pod.com Ford slash juice box and on the pod would be delighted to send you a free, no obligation demo pump, you can actually try it in your home, see if you like it. But that's beside the point, I digress. You have to do what you have to do. Whether you're on MDI, and you're going to be a little more aggressive with bazel for Thanksgiving, or you're on a pump. And you think yourself Yeah, this is the second day of my Omni pod, but my site starting to get a little funky. So I'm gonna change my insulin pump the night before Thanksgiving, so I have a nice fresh infusion going on Thanksgiving Day, those are the kind of little things you can do to prepare. From there,

don't get behind, because when you start chasing blood sugars, it takes a special kind of ninja level to crush a high, bring it down and get it stable again. So as corny as it sounds, you'll never get high. If you don't get high. Make sure your base was right. Learn your Pre-Bolus times understand the differences in different glycemic loads and glycemic indexes of foods. ie how hard and how fast they hit you and go for it. Test when you need to test. Be ready. But don't let it ruin your day. I'm saying you can have a good day too. And if you're catching this one the day before Thanksgiving, you're like, well, this would have been helpful last month, the podcast is always here for you will get it go let's get together for Christmas dinner. Right? doable. It's very, very, very, very doable. perspective. My daughter is a one season between five two and six two for almost seven years. She has no diet restrictions. Her blood sugar's are very stable. Her time and range is excellent. She has the consistency that you want. And the only thing I know how to do is use insulin. Everything else is extra. There's a ton of variables Don't get me wrong, a lot more than what we spoke about here today. As a matter of fact, in Episode 231 diabetes, proto variables, we talked about a lot of them. We talked about a ton of stuff, how exercise impacts things, and there's no doubt that it will take time for you to understand all the variables in a way that's actionable in the moment. But it is incredibly doable. So if this is your first time hearing the podcast, I hope you jump into those pro tip episodes and see what you can figure out they're all available at diabetes pro tip comm or right here in your podcast player. And if you're a longtime listener, you're just looking for that pep talk for Thanksgiving, go get at it, you can do it. Oh, you know what I should say? If you're gonna have time around family and friends who don't understand diabetes, and you wish they understood it better. Episode 371 explains Type One Diabetes to an outsider. Maybe then mom will understand why you're a little agitated. Because all the different pies are coming and nobody told you how many carbs are in them and etc, etc. All right. I really enjoyed this. I hope you have the happiest of Thanksgivings. I know you can do this. And if you need help, check out the private Facebook page for listeners to the podcast Juicebox Podcast type one diabetes. There are over 7000 people in there talking about management. If you have a quick question I can't think of a better place to ask. I want to thank the sponsors even though there were really sponsors On this episode, but I slipped them in you know I'm saying the Omni pod tubeless insulin pump you can get a free no obligation demo of the Omni pod sent directly to your home by going to my Omni pod.com Ford slash juice box. You can learn more about the dexcom g six continuous glucose monitor@dexcom.com forward slash juice box. You can also get yourself a Contour Next One blood glucose meter which is the easiest to use and most accurate blood glucose meter that I've ever used for my daughter. Contour Next one.com forward slash juice box. Add your voice the Type One Diabetes Research with the T one D exchange T one d exchange.org forward slash juicebox. That's for us residents only.

You know I cook every year Thanksgiving. The one thing I can't figure out is how to make gravy myself. I am bad at it. And it has something to do with the drippings and flour. There's whisking involved, but I just can't do it. I don't know what your plan is. This year. I'm gonna actually smoke a turkey a smaller one and a pellet grill and make a smaller one in the oven bacon tubers. I'm trying to cook two burns with two ovens that didn't work. trying something new but didn't want to mess up and have to be like Oh great. This sucks. So I'm gonna double up on the birds this year and see which one flies that was a terrible joke. mashed potatoes, I'm great at maybe some yams, beans, vegetables, cauliflower, making some fresh bread. Like I said earlier, I make this stuffing myself. Order for my grandma. Hope you have a great day too. No matter what your tradition is. I think you can do this. I swear you can. Let me just leave you with this. If you told me I could, in two sentences explain diabetes on Thanksgiving to you, I'd say get ahead and stay ahead. And then if you didn't cut me off right away, I'd say you have to get your basal rates, right, you need to learn how to Pre-Bolus and please understand the different impacts of different foods. That's really the basis of this. That's enough to get you through tomorrow. And those pro tip episodes, they'll teach you the rest. Thank you so much for listening. Have a Happy Thanksgiving. There's a lot more coming on the show between now and the end of the year. actually have a doctor coming on next week who is so well versed in treating thyroid issues I just recorded with her today. It's a it's an absolute joy, the treat you're gonna love. And you know what I'm asked to say here, all the sponsors are back in 2021. And I'd like to thank them Dexcom Omni pod Contour Next One touched by type one, g vo type O pen. T one D exchange. Their support allows the podcast to get produced the way it does. I'm sitting in front of a microphone the day before Thanksgiving recording this for you. Because this is my job. And I get to have this amazing job because you guys support the show. And your support leads to add support and add support pays my bills and then I get to sit here and do this. So it's a circle of life kind of a situation for everyone except the turkey.