Loading summary
Transcript69 lines
- [00:00]
A
Hello, friends, and welcome back to another episode of the Juice Box Podcast. In every episode of Bolus 4, 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 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 we will be thinking about it while we're talking. If you want to learn more, go to juiceboxpodcast.com Meal Bolt. But for now, we'll find out how to bolus. For today's subject, nothing you hear on the Juice Box Podcast should be considered advice, medical or otherwise. Always consult a physician before making any changes to your healthcare plan. Jennifer, how are you?
- [01:25]
B
I'm fine. How are you today?
- [01:26]
A
Good, thank you. We are going to talk about how to bolus for Ben and Jerry's chocolate chip cookie dough ice cream.
- [01:34]
B
Oh, okay.
- [01:35]
A
It's very specific.
- [01:36]
B
Have you ever been to Ben and Jerry's?
- [01:38]
A
I have been there once. Yes. I visited Vermont one time and we did the Ben and Jerry's tour.
- [01:44]
B
We did too.
- [01:45]
A
Yeah. It was a nice little day. And then a little ice cream outside and then we were on our way.
- [01:50]
B
Do you remember what kind did you get? Was it cookie dough?
- [01:53]
A
Probably, but I don't know. Actually, the one I like right now is. It's the one with. Oh, God, there's a late night talk show host on the front of it. Oh, hold on a second. Is it Colbert? Maybe. But it's the mix. I like the caramel. Yes. It's called American Dream. Maybe we should do this one. There's pieces of cone in it with caramel. Oh, and I do, I do enjoy that. So if I have ice cream, that is the one I get. I pick chocolate chip cookie dough because I think it's a fan favorite.
- [02:28]
B
I'm assuming it probably is with the cookies inside of it and everything.
- [02:34]
A
Yeah, it used to be better. I'm not going to lie to you. I've had it in the past and I've had it, you know, in the last Year. It's not as good as it used to be, but that's like everything else, I think. So the ingredients in this, it's interesting because I think people think Ben and Jerry's and they probably think like, oh, that's more simple. But it's not.
- [02:51]
B
Which is why I asked if you had ever been because you've ever been to their actual like place in Vermont. Yeah, it is very homey. Like unless it has. I mean I was there years ago so it might be changed now, but it is very like you'd expect only real cream to be in there and like real hundred percent madagascar vanilla extract and like, like all the things.
- [03:12]
A
Right. I think it's important you bring that up because imagine that if we dug into it, that was probably how the company started. It's been sold off since then, but they still hold onto it for marketing reasons. Is there a world where you look at Ben and Jerry's and you think, well that's a more healthy ice cream. But you know, I don't know that that's the case. Exactly. All right, so what do we have here in the Ben and Jerry's? We're going to take a look first for. So we're going to have to measure the meal first. Right. We're going to look at the carbs, the fat, the protein. What do you think the glycemic impact is going to be? So now what do you think they're calling a serving?
- [03:47]
B
What did I say to pay attention to? Go ahead from glycemic index. What did I say to pay attention to? Not just carb but what?
- [03:53]
A
Just sugars. Total sugars.
- [03:54]
B
Total sugars, yeah. So what's the comparison there?
- [03:57]
A
Well, do we want to use the, the serving size which any self respecting person eating ice cream isn't going to have 2/3 of a cup of it, are they?
- [04:06]
B
Well, I was going to ask what the serving size is because some labels list ice cream as a half a cup. But more recently it has increased to 2/3 of a cup.
- [04:16]
A
This one says 2/3 which means that the, the container contains three servings in total. So if you have one serving or a third of the container, you are getting 34 grams of sugar. It also says includes additional sugar, 28 grams which makes. Wow, hold on a second. And the carbs are 43 and wow, there's a hundred milligrams of sodium in it. The fat in 2/3 of a cup. Any guess?
- [04:46]
B
22 grams?
- [04:48]
A
20?
- [04:49]
B
Yeah, 20. That's pretty close.
- [04:51]
A
That's not bad. So if you eat that, what is that, a pint? It comes in. If you eat that whole thing, you're getting 60 grams of fat, 240 milligrams of cholesterol, 300 milligrams of sodium, 40, 80, 120, 100 and like 130 some carbs. And then what they're calling like about a hundred total sugars, including added sugars of 28 grams. Okay, so there's 34 total sugars, but of that, 28 of them are added sugars.
- [05:24]
B
Meaning it's not just the natural sugar that comes in, the cream, the milk, the, you know, that kind of natural sugar that would come in. And if there's cookie dough chunks that. What's cookie dough made from? It's made from flour.
- [05:38]
A
I don't think it's the cookie dough. I'm looking at the ingredients. And do people know ingredients are listed by volume? Yes, by volume for most, the least. So cream is the number one ingredient, followed by skim milk. And you're like, okay, I'm doing it. Now the next one is called liquid sugar, sugar, water.
- [05:58]
B
And this should tell you 100% of the hit that this is going to have. Right?
- [06:03]
A
You're gonna get smacked by this one also, by the way. Liquid sugar, sugar, water, and then the next one is water. So going back down to the label, 34 grams of sugar, including 28 grams of added sugar. And then the daily value tells you how much of the nutrient in the serving of food contributes to your daily diet. 2000 calories a day is used for general nutritional advice. This is 56% of that, just the sugars. So then after, after that, wheat flour, then sugar, then brown sugar then.
- [06:37]
B
Because how do you make chocolate chip cookies? Sugar and brown sugar.
- [06:40]
A
Of the first seven ingredients, liquid sugar, sugar and brown sugar are three of them. Egg yolks, butter, which is cream and salt, expeller, pressed soybean oil, eggs, coconut oil, chocolate liqueur, cocoa, cocoa, molasses. That sounds like sugar. Guar gum, salt, vanilla extract, natural flavor, natural fl. Cocoa butter, invert, sugar. There's more sugar, milk fat, tapioca flour, soy, lecithin, other extracts, turmeric extract and milk.
- [07:17]
B
So what's interesting is that, so you said, you know, turmeric extract. It's interesting because that would be used as a color.
- [07:27]
A
Yep.
- [07:28]
B
And turmeric is a natural. I mean, it's a root. So the interesting thing is that they don't have yellow, blue, red dye. They're actually using a plant based coloring, which is actually pretty nice.
- [07:40]
A
We like that.
- [07:41]
B
On the scale of all the other things that's in it, Jenny's looking for.
- [07:44]
A
The, for the high side of this. She's like, at least there's no coloring in it. Yeah. Actually it looks like they use that and annatto extract.
- [07:53]
B
Annatto.
- [07:54]
A
Annatto.
- [07:55]
B
Yeah. It's commonly also used. Annatto is often used in cheese, cheddar cheese. It's the reason it's yellow. Oh really? Otherwise that's the reason you can get white and golden cheddar cheese. The white stuff doesn't have the annatto added to it.
- [08:08]
A
So they make that ice cream a little browner to give you the feeling of like chocolate chip cookies. But that's. Yeah. All right, well there you go. All right, let's bolus for it.
- [08:18]
B
Maybe they want people to not have inflammation after. Maybe that's the reason for the turmeric. I don't know.
- [08:24]
A
Yeah. Again you're high setting. So now we're going to evaluate like where you are before we make this bolus. Right. We know what the carbs are, we know there's going to be a big fat hit, there's going to be a big sugar hit. So that glycemic impact is going to happen fast. But when do people eat ice cream? End of the day.
- [08:39]
B
Right, End of the day. Dinner, bedtime is a common evening time snack after dinner. Either that or common to have it after a meal, especially when on vacation.
- [08:52]
A
Yeah, that's what I'm thinking is the thing that gets dropped on top of your other. It's almost a la mode in your belly.
- [08:59]
B
Yes.
- [09:01]
A
So there's a meal in there already that you've hopefully bolused well for. And then on your way to drop this slow, this spike from the sugar and the slowing from the fat right on top of it.
- [09:12]
B
Right.
- [09:13]
A
All right. So I mean, depending on where you are.
- [09:17]
B
Yeah. I mean you kind of have two environments of consideration for bolus there. If you are eating it in the aftermath of a meal, there's likely a bolus strategy for that. It would be different than, let's say it's middle of the afternoon, you're done at the pool, you had lunch three hours ago. And now you and the kids, everybody, whoever it is, your dog, you all want ice cream. Great. So you're going to go for ice cream. At that point it really is covering the ice cream and nothing else.
- [09:45]
A
Yeah, yeah. And maybe even in that scenario there's a little running around. Maybe that fat might be helpful in that situation. But again, if it's 8:30 at night, and you're, you know, you're already standing in front of the freezer thinking to yourself, like, I shouldn't be doing this. And you're, you know, boy, that looks good. Yeah. But I am gonna do it. And so maybe you're gonna need to be more aggressive. You figure out your insulin to carb ratio. Get that all going, too. But how are you going to layer this over? Like, is this going to be. Do you expect to see continued hits from ice cream along the way?
- [10:17]
B
Especially with the fat content, like you said, who is typically going to eat two thirds of a cup, which is way more. When I was growing up, it was a half a cup. Was a serving size on the label, but 2/3 of a cup. Nowadays we definitely overeat. Two thirds of a cup should be enough, but many people will have more than that. And so the hit effect builds because of the fat increasing as you take more.
- [10:47]
A
Yeah. I do a little thing. There's a sorbet in my freezer. Usually that's just for me. It's like a mango thing. Oh. And I used to, like, scoop it out and put it into a dish, but then I'd find, like, that when I was filling the dish, I'd end up putting more in than I wanted. So now it's just kind of understood, like, it's mine. Don't eat out of it. Because I'm eating right out of the container now. Yeah. Because I take a little scoop and I go, oh, that was good. And maybe I do it again, and I'm like, yeah, I'm done now. Yeah. And that was it. And I get all the, like, all the good feeling that I wanted from the. From the sorbet. Enjoyed the, like, the maybe kind of the. The freshness of it or the palate cleanse or whatever it ends up being for me. And then I don't feel compelled to eat the rest of it because I took it out. I'm like, oh, I just put it back now. I guess that might lead some people to eat the entire thing, like two. I don't know. But it works for me that way. Okay, so we build the correction. Put it on. Do you think this is an extended bolus?
- [11:39]
B
I think this needs, for the most part, a good pre bolus because of the sugar content.
- [11:45]
A
Yeah.
- [11:46]
B
But it definitely needs something to cover the behind. Right. And this is where a little experimentation comes in for something like this. Maybe an extended bolus works for you, where you do 50, 60, 70% of it up front, and you do it with a good pre bolus time and then you extend the back end of it maybe over two or three hours. Given the fat content in a single serving is 20 grams, maybe that's enough. Right. The other consideration would be maybe you see a pretty quick hit, so you're going to cover it completely and you're also going to pre bolus to dull down the rise. But on the back end, you end up never really coming to target or you just hover high and then you go up a little bit more. Two or three hours later, you might cover the back end with a temporary basal increase. If you have access to something like that on a pump. Other algorithms, you might not have to worry at all. With a single serving, 20 grams, it's not low fat, but you might have an algorithm that takes care of that because it's a little more aggressive.
- [12:54]
A
You have to kind of just do the looking at your CGM an hour, two hours, three hours afterwards, figure out how this went and then just tweak it for next time and try to, try to figure out how to manage it best.
- [13:04]
B
And you know, for those people who are using MDI and have decided that that's just what they like to do. Right. It works the best for them in all scenarios. You may actually be able to utilize in what I really think is an underused insulin. In a scenario like this, that would be R. Right. Let's say you covered the impact really well with your rapid acting insulin, but you know from previous experience that two hours later it starts to go up and rather than you having to give a little nibble and a little nibble and a little nibble of extra rapid insulin, you may be able to cover the back end hit with a small amount of our insulin because it's got such a slow kind of accumulation of getting to its effective amount and it might hit well for a couple of hours after the meal.
- [13:56]
A
Would this be a good place for a freza too?
- [14:00]
B
Potentially, yeah.
- [14:01]
A
Like if you get the rise, you can kind of just boom, like drop it down.
- [14:05]
B
You could drop it down. Absolutely. Again, another one that's underutilized. I think some of it's age specific or written off label and whether somebody's willing to do it. But yeah, you could control the quick hit the back end. Again, depends on what you see happening. But that's variables.
- [14:24]
A
It's in my head because I just interviewed Pete Zendo about the Afrezza being available for younger people now. Kind of made the point that he's like, I'm not Sure. That people are gonna manage their diabetes just with, like, basal insulin and Afrezza. But he's like, I can see it being a toolbox thing that you have in the house. And, you know, every once in a while you think, oh, this didn't work out. Let me just, like, you know, kill this fat rise that I've got going on for two hours that I can't get rid of, or something like that.
- [14:52]
B
Yeah, no, Afrezza is definitely. In fact, there was just a really good study that was put out studying Afrezza in pregnancy, which, as you know, I'm very fond of things in pregnancy. It's usually not. It hasn't been recommended well enough, but it's been being used by some good clinicians and in cases like, you know, some eating something like this and you really don't want that quick hit, but you want it to be gone pretty quickly. Brezza. It's great.
- [15:20]
A
Might be it. Yeah. It's not for here, but I. I keep wondering if it's gonna break through like that or not, but. Well, yeah, this was fun. Thank you. Everybody. Enjoy their ice cream. I'm not. I'm certainly not bagging on you. This looks. I'm just looking at the picture. It looks good.
- [15:34]
B
So you're gonna eat your mango.
- [15:36]
A
I will just have a kalea. That's exactly what I'll do. I'll just go like. I'll take, like, a little, like, scraping off the top and I'll be like, that's enough. I'm good anyway. Thanks, Jenny.
- [15:44]
B
Sure.
- [15:53]
A
In each episode of the Bolas 4 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 bulk 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 1. 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&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? 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? Offset the timing. This is about pre bolising. 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 going to 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 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 Juice Box Podcast. The episode you just heard was professionally edited by wrong way recording wrongwayrecording.com.