Juicebox Podcast: Type 1 Diabetes

Bolus 4 - Pizza Hut Pizza (Episode #1674, Nov 8, 2025)

Host: Scott Benner
Guest: Jenny Smith

Episode Overview

This episode of the Juicebox Podcast's "Bolus 4" mini-series breaks down real-life strategies for bolusing insulin for one specific high-carb, high-fat food: Pizza Hut’s Pan Pepperoni Pizza. Scott Benner and diabetes educator Jenny Smith candidly share their approaches to estimating insulin for pizza and explain the “Meal Bolt” roadmap—an approach designed to help listeners systematically manage challenging meals. The discussion is lively but practical, emphasizing understanding food composition, extending boluses, and using experience to guide future tweaks.

Key Discussion Points & Insights

1. The Challenge of Bolusing for Pizza

• Bigger portions, bigger spikes: College-age and athletic populations often consume much larger pizza portions (e.g., 3–6 slices), leading to extremely high carbohydrate intake at a single meal.
  • Quote (Jenny, 01:43):
    “It’s not uncommon to have half of a pizza, three quarters of a pizza. And when you’re talking about...like 36 or 38 grams per slice...that’s a lot of carbohydrate, right?... And that’s the big reason that we have such extraordinarily high blood sugars.”
• “Hidden” fat overload: Most people do not consider the substantial fat content (17g per slice), which slows digestion and extends blood sugar impact.
  • Quote (Scott, 03:08):
    "Not only does a slice of this have 36 grams of carbs, but it has 17 grams of fat. And most people don't bolus for their fat.”
  • Quote (Jenny, 05:13):
    "Fat is hidden in the foods that we eat…unless we’re physically adding it…but when it’s already in the food…it’s hidden. You don’t visibly see it, so you don’t think, well this can’t be that bad.”

2. Food Analysis—Pizza Hut Pan Pepperoni Pizza

• Nutrition per slice: 36g carbs & 17g fat.
  • Three slices = ~108g carbs & 51g fat.
• Ingredient differences affect bolusing: Fast-food pizzas like Pizza Hut often use oil-rich dough, extra cheese, and processed additions (e.g., dough stabilizer DATEM), making them higher fat and slower to digest compared to thinner, homemade pizza.
  • Quote (Scott, 05:54):
    "You’re getting pre-made doughs that are probably made off-site…they have stuff in it called datum…versus a homemade pizza that’s probably just flour, water, yeast, salt, maybe some oil."

3. The “Meal Bolt” Roadmap for Bolusing (10:00, 16:29)

Explained at the start and wrap-up:

• Measure the Meal: Total carbohydrates, protein, fat, glycemic index/load.
• Evaluate yourself: Blood sugar, insulin on board, activity, stress/illness.
• Add the Base Units: Use your I:C ratio.
• Layer a Correction: Adjust for current blood sugar.
• Build the Bolus Shape: Decide between standard, combo, or extended bolus.
• Offset the Timing: Pre-bolus timing based on meal composition.
• Look at the CGM: Watch blood sugars post-meal.
• Tweak for Next Time: Adjust approach based on results.

4. Insulin Strategy for Pizza: The “Pizza Bolus”

• Use an extended/combo bolus (the “pizza bolus”): Due to carbs + high fat, insulin should not all go in at once.
  • Quote (Jenny, 07:00):
    "Really, pizza is the age-old reason that pumps even years ago first came out with the idea of an extended bolus. In fact, we call it the pizza bolus."
• Typical split: Start with 50% up front, 50% extended over 2–4 hours.
  • Quote (Jenny, 08:10):
    “You would usually use as a starting place a 50/50...[give] 50% of the carbs upfront, 50% extended out. Minimum of two hours. Could be as long as four or five hours after the meal.”
• Pre-bolus is critical, but careful not to go overboard: Too much upfront insulin risks early low before carbs digest.
  • Quote (Scott, 07:49):
    “I find there’s a need to pre-bolus for pizza, but not the entirety of the carbs. Because if you put too much up front, the digestion happens slowly. The insulin ends up crushing you long before you get the impact from the pizza.”
• Glycemic index: Pizza is moderate at best (55–70), not high like rice or watermelon, so digestion is slower.
• Evaluate the situation: Physical activity, excitement, or context (e.g., party after running around, car rides elevating glucose just before eating) all affect the required dose/timing.
  • Quote (Scott, 10:05):
    “Maybe the kids have been outside running around...your brain goes, oh no, pizza, a lot of carbs, put in a big bolus, and they were falling already and you didn’t realize it.”

5. Managing Delayed and Prolonged Rises

• High fat = delayed digestion: Pizza may cause late post-meal spikes (2.5–3 hours post), so prolonged insulin coverage is essential.
  • Quote (Jenny, 11:52):
    "Fat sort of sits on your insulin and it makes it work less effectively...your hit point from fat comes in somewhere around two and a half to three hours."
• Automated insulin delivery (AID) system caveats: Some pumps (e.g., Omnipod 5) do not allow extended boluses in automated mode—may require switching to manual mode for pizza and keeping manual settings up to date.
  • Quote (Scott, 12:45):
    “If you’re in automated in Omnipod 5...maybe you want to go into manual for that...Keep on top of your program settings...if you do switch back into manual, they’re where they need to be.”

6. Learning from Experience and Adjusting

• No “failure,” just learning: Every pizza night is an experiment; use CGM data to tweak approach rather than get discouraged.
  • Quote (Jenny, 13:35):
    “When I work with families, I say, well, it was an experiment. There’s no beat yourself up about it. This is what happened. You’ve got information.”
• Different pizzas = different boluses: Domino’s has less carb per slice than Pizza Hut, homemade is often much lower. Know your pizza type and slice size (home, pan, thin, deep dish).
  • Thin crust: ~20g/slice
  • Pan/fast food: ~30–35g/slice
  • Deep dish: 50–60g/slice
  • Quote (Scott, 15:26):
    “You need to know which pizza you’re eating before you even ask that question.”

7. Common Pitfalls

• Undercounting fat, over-bolusing up front: Results in early lows, correction with juice, then massive highs as pizza finally digests.
  • Quote (Scott, 16:25):
    “They’ll pre-bolus their pizza with all this insulin, get super low, drink a bunch of juice to fix it, and now they’re shooting up from the juice...then they eat the pizza...and they’re like, I was 500 all day from pizza.”

Notable Quotes & Memorable Moments

• (On big portions, 01:43) Jenny:
  “There is a large appetite, especially in the gentlemen that I work with of college age or even older teen...many of them eat just big portions, right? Especially the athletes.”

• (On extended boluses, 07:00) Jenny:
  “We just refer to it as a pizza bolus...it encompasses all foods that could have similar nutrient content to pizza, being pretty high in fat.”

• (On evaluating next time, 13:35) Jenny:
  “When I work with families, I say...it was an experiment. There’s no beat yourself up about it.”

• (On pizza pitfalls, 16:25) Scott:
  “Pizza is probably the culprit of more low blood sugars for people who don’t know what they’re doing than anything I’ve seen online.”

Timestamps for Important Segments

• 00:00–01:28 – Episode intro, the “Meal Bolt” roadmap overview
• 01:33–03:03 – High carb and fat in Pizza Hut pizza, real-world eating scenarios (portions, college athletes)
• 03:08–05:54 – Nutrition breakdown, hidden fat, ingredient differences (Pizza Hut vs homemade)
• 07:00–08:10 – Invention of extended bolus; why pizza made insulin pumps adapt
• 08:10–09:49 – Glycemic index, insulin timing, how to split a bolus for pizza
• 10:05–11:52 – Real-life variables influencing glucose after pizza (car rides, exercise, excitement)
• 11:52–13:35 – Impact of fat on insulin resistance, timing of post-meal spikes, using AID/manual mode
• 13:35–15:20 – Using outcomes to refine boluses, importance of pizza type/size
• 15:20–16:25 – Danger of one-size-fits-all approach, why pizza is tricky
• 16:25–16:29 – Common mistakes, summary and encouragement to listeners

Natural Takeaways & Tone

• Empowering, realistic, and supportive: Scott and Jenny keep the mood light and humorous (e.g., the brief dog interruption and banter about dog names), but push listeners to be thoughtful and forgiving as they experiment with insulin strategies for complex foods like pizza.
• Emphasis on learning and personalization: There’s no magic formula—just careful measuring, honest evaluation, and a willingness to tweak strategies as you gather more data.
• Concrete, actionable, and focused on the food: The advice throughout centers directly on helping listeners react, record, and adjust for future pizza nights—and encourages self-compassion when perfection isn’t achieved the first time.

For more on Meal Bolt and additional Bolus 4 episodes, visit juiceboxpodcast.com/meal-bolt.