A (3:16)

I somehow oddly believe that these small episodes will teach people to swag better in the end.

B (3:22)

Great.

A (3:23)

Yeah. I think. Because I think that's the most reasonable way long term to have type one and have to manage food. Right. You can't. I mean, in the beginning, you know that you see the people, like, I gotta scale. I got this. Is there an app that you can take a picture of something that'll tell you how much it weighs? Like, you know, like that mania hits you in the beginning, but at some point, years into it, you're like, ah, it looks like 45G. So I'm interested to see if this helps people.

B (3:48)

Okay.

A (3:48)

All right, so let's start with something simple. How about oatmeal?

B (3:53)

Oatmeal?

A (3:53)

Yeah.

B (3:54)

Okay.

A (3:55)

You ever have an oatmeal?

B (3:57)

Yes.

A (3:57)

Okay.

B (3:58)

And I think we need to define oatmeal. Are we defining quick oats, like the little bags of apple, cinnamon, not real apple, and probably lots of sugar and not much cinnamon. Or are we defining old fashioned thick rolled oats? Or what are we defining here? Because there's a difference.

A (4:18)

Let's go with what people probably eat. And quick oats. Yeah. How about Quaker, like instant oatmeal? Jenny's like, I don't know what it is, but I got it here. Okay, you ready? So there's a box you can buy on Amazon that has four different flavors in it. It has maple and brown sugar, spice, cinnamon and spice, apples and cinnamon, peaches and cream. So let's just like. Let's say we chose the maple and brown sugar. Serving size is one packet.

B (4:45)

Okay.

A (4:46)

There is half a gram of saturated fat, no trans fat, half a gram of polyunsaturated fat. There's 260 milligrams of sodium, 33 grams.

B (4:57)

Of carbs in a single packet, right?

A (5:00)

Single packet, 33. Three grams of fiber, one soluble fiber. Sugar.

B (5:05)

You wanna guess fiber?

A (5:08)

Fiber? Dietary fiber, three grams.

B (5:11)

Oh, it's pretty good. Three. Look at that.

A (5:13)

He's like, Finally. But total sugars 12. There's protein in it. That's interesting. Four grams.

B (5:20)

Grains have protein and the more unprocessed they are, the more fiber as well as the more protein they retain. Okay, so.

A (5:28)

So this one's interesting. I've never. Wait, we're gonna really find out the foods I've never seen in my life. I've never had oatmeal in my life.

B (5:35)

Are you kidding me?

A (5:36)

No, I have no idea. Like it's really.

B (5:38)

You've never had oatmeal?

A (5:40)

Oatmeal looks like small pieces of cardboard in mush to me. Is that not what it is?

B (5:47)

I don't know. I'm sorry that that's what you think.

A (5:50)

They look like, but you would turn me onto like what? Like steel cut oats or something like that.

B (5:57)

If you dislike steel cut oats. I know that there is a world of people out there who love their steel cut oats. I do not like, I don't like the consistency of steel cut oats and I'm not really a texture person, honestly. But steel cut oats just are gross to me. I much prefer old fashioned thick rolled and then do kind of. I do like an overnight oat. So it's where you put the fluid in of whatever kind you're going to use. You let them sit overnight with the liquid in them so that it gets absorbed, they get soft and then you could technically cook them a little bit to heat them, but they're soft enough that you could eat them cold, which changes the glycemic nature of them.

A (6:44)

What tastes? I almost said what tastes like? What does it taste like? Describe it to me. Today's episode is sponsored by Medtronic Diabetes who is making life with diabetes easier with the mini Med 780G system. The MiniMed 780G automated insulin delivery system anticipates, adjusts and corrects every five minutes. Real world results show people achieving up to 80% time and range with recommended settings without increasing lows. But of course, individual results may vary. The 780G works around the clock so you can focus on what matters. Have you heard about Medtronic's extended infusion set? It's the first and only infusion set labeled for up to a seven day wear. This feature is repeatedly asked for and Medtronic has delivered. 97% of people using the 780G reported that they could manage their diabetes without major disruptions of sleep. They felt more free to eat what they wanted and and they felt less stress with fewer alarms and alerts you can't beat that. Learn more about how you can spend less time and effort managing your diabetes by visiting medtronicdiabetes.com juicebox Oats are pretty.

B (7:57)

They're pretty. I don't know, they're a little bit. They're a little bit not sweeter, but I don't know. They're more breakfast foodie tasting than something like plain rice that has not been flavored with anything as well. And if you have cooked them or soaked them the right way, they're pretty soft. So they're not like the cardboard that you're envisioning.

A (8:19)

I just realized I'm gonna sound like an alien while we're talking about this, so why do I eat them? It's not for flavor, is it for.

B (8:27)

Well, if you eat again, that's the difference. That's why I asked, what are we talking about? Quick cook versus old fashioned and especially the old fashioned thick roll. The difference being that the quick cook are really. They're processed like they're. They're broken down. They're more ground up. It's the reason cook really, really quickly. And they are like. You're talking about. They're more like mush, but with enough.

A (8:49)

Sugar on them that I'm like, okay, I can do this.

B (8:53)

You could do it. Yes.

A (8:54)

That's why there's four different flavors in one package, correct?

B (8:57)

Yes.

A (8:58)

All right, well, let's assume that some people must throw these together, like in the morning because it's quick and. Right. And so we're going to do. For all these, we're going to keep it. One unit covers 10 carbs. One unit moves you 100 points. And. Okay, that way, like, we can kind of keep the math simple. So if there's 18 carbs here, then what? It's one 1.8 units. And then there's.

B (9:26)

There are. There are only 18 carbs in that little packet. Really?

A (9:29)

Oh, no. 33. What was I saying? Sorry. So 3.3. 3.3 units. I saw the. I was looking at the wrong number. And then. And 12 of that is sugar. Like, how does that sugar impact that bolus in your mind? Because you know what I mean? Like, the oats themselves are probably a very slow breakdown. Is that not right?

B (9:48)

Yeah, correct. And with the sugar added now you've added in. What is that? If you do the math, it's about a third of the grams of total carb actually come from sugar, and that's added sugar. And so what we're looking at is a much heavier glycemic impact. And for definition, as I mentioned, to begin with, we look at quick cook versus old fashioned and they're both in the moderate glycemic index kind of number line. I think one is somewhere in the 50s and that's probably, that's the older old fashioned oats. And then the more quick cook flavored tend to be somewhere in the 60s. So they're not terrible, terribly different, but it's what you end up doing to them that can make the difference. And as we're talking about bolus strategizing along with now adding in sugars, flavors, that kind of thing to it, you're adding in a third of the weight of this product is sugar doesn't seem.

A (10:49)

Like a good idea.

B (10:51)

Right. Well, right. And.

A (10:53)

But it feels like in my mind it feels like you're getting a slow digestion material with a quick spike. So I'm gonna.

B (11:00)

And when are we usually eating?

A (11:02)

When I'm already having trouble bolusing for things because for a number of different reasons, feet on the floor, maybe adrenaline about the day, maybe you have a lower basal rate overnight that helps you not to get low overnights. You wake up, you have more resistance, less insulin. Then you throw in something that's gonna take forever to digest and hit it hard with sugar right away. So that's where you get a 320 blood sugar that lasts for three hours. Right.

B (11:27)

Okay, right, exactly. So you know, when you think through the strategy as you've defined, a 1 to 10 ratio, a 1 to 100 correction factor, so we're giving some points of reference and if we also say, okay, you've come into this meal, this breakfast at a stable in target blood sugar to just simplify the whole piece. Right. You're not rising already, you're not low or having dropped or treated a low, blah, blah, blah, you're coming in nice and stable. Let's say a blood sugar of 100, making it even easier. What would you anticipate, knowing what we've just talked about in terms of the glycemic nature of this particular food, I'm.

A (12:09)

Anticipating a quick rise. I'd want a long, pretty aggressive pre bolus. Right. I would be. I used to talk about this more, but I'd be looking for like an 80 diagonal down on my, on a CGM before the oatmeal hit. Because I think the oatmeal is going to hit you really quickly. Like the sugar. It's going to hit you really quickly. Yeah. So.

B (12:33)

And we're also placing in, we're not Placing anything else addition to it. We're not saying eat eggs first, we're not saying add a load of butter to the dish or whatever this is. You're just cooking these quick oats and you're going to eat them. That's it.

A (12:48)

These down and you're leaving the house and so.

B (12:51)

Right, exactly. So the goal would be if you know, you're eating this, you're getting up in the morning, you've got this amount of timeframe to leave the house or get your kids out of the house, et cetera, that bolus goes in almost as soon as you are getting out of bed. If you are the quick eat person in the morning bolus, do your morning get ready thing. My previous experience in college with quick oats because that was what they served in the cafeteria until I started doing own thing was like a 30 minute.

A (13:23)

Yeah. To get ahead of that.

B (13:25)

To get ahead of what was going to happen.

A (13:27)

Yeah, I'm going to, I'm making notes for myself about other things to talk about because I don't want to derail these. But you're making me think of other stories that people have told me.

B (13:34)

Oh great.

A (13:35)

So, so in case people aren't like following along yet, we did measure the meal, evaluate yourself, add the base units, calculate the food, bolus, carbs, et cetera. And now we're to the L layer a correction. So if we, you know, Jenny said like you know, if you were, let's assume you're at 100, but if you weren't, if you were at 120 or 150 or whatever, that pre bolus would include a correction to move that number to your target number.

B (14:02)

Right.

A (14:03)

And now we got to decide like is this like, you know, we've talked, I think a big long pre bullet. Do you think it needs any extension or extended bolus or a follow up bolus afterwards or not if you hit it hard enough up front. Right.

B (14:15)

Not if you do. Not if you're really on top of the pre bolus. And that timing up front, there's nothing sticky that doesn't have a lot of fiber in it. There's really nothing that's going to hold this food for a long time. It truly is a more carbohydrate type of food which has an in and out clearance that mimic or goes along with why we use rapid acting insulin. Right. Rapid insulins have an in and out and if there's nothing else in the picture to linger well beyond that three hours like fats and proteins, your timing of that Meal should coincide with the way that the insulin is supposed to work.

A (14:52)

If this didn't have sugar on it, you would bolus differently for it.

B (14:56)

If this didn't have the added sugars to if it was just truly plain quick cook oats, definitely less time, especially starting with all the factors that we defined already. Right. Blood sugar stable in target, et cetera, but still at least a 15 minute, probably even 20 minute pre bolus time.

A (15:18)

Yeah. So shorter pre bolus still not just five minutes.

B (15:22)

Right.

A (15:23)

And because this stuff is going to get in there and start hitting hard, it's just going to hit a lot harder if there's sugar on top of it. Okay. And then we wanted to look at the CGM maybe an hour later, see where we're at, and then just kind of spot check an hour, you know, three hours later, whatever you're comfortable with, and then take some notes for yourself and tweak it for next time. See, see if you got the outcome you wanted. Adjust your ratios, you know, adjust your pre bolus time, maybe a little longer, a little shorter, and give it another whirl. I Somebody said something online the other day that I love. They somebody was trying to figure out how to eat ice cream.

B (15:59)

Oh.

A (16:00)

And this person said, my strategy for ice cream is I keep going back and eating ice cream until I figure it out.

B (16:06)

That's exactly what we're talking about here. Yes.

A (16:09)

So try your oatmeal again. All right. Awesome. This was great. Thank you.

B (16:13)

Cool.

A (16:21)

Thanks for tuning in today and thanks to Medtronic Diabetes for sponsoring this episode. We've been Talking about Medtronic's MiniMed 780G system today, an automated insulin delivery system that helps make diabetes management easier day and night. Whether it's their meal detection technology or the Medtronic extended infusion set, it all comes together to simplify life with diabetes. Go find out more at my link medtronicdiabetes.com juicebox 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 Juice Box Podcast. In each episode of the Bolus four series, Jenny Smith and I are going to pick one food and talk through the bolusing 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@juiceboxpodcast.com meal bolt but here's what it is step one. M, 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's on board, and what kind of activity are you going to be involved in or not involved in? Do 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, 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 gonna talk about in every episode of Bolus 4. 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 gonna be that confusing and we're not gonna ask you to remember all of that stuff, but that's the pathway that Jenny and I are gonna use to speak about each bolus. And the episode you just heard was professionally edited by Wrong Way Recording wrongwayrecording. Com.