Juicebox Podcast: Type 1 Diabetes
Episode #1695 Bolus 4 – Lettuce (November 30, 2025)
Host: Scott Benner
Guest: Jenny Smith
Episode Overview
In this episode of the Bolus 4 mini-series, Scott Benner and diabetes educator Jenny Smith break down strategies for bolusing (dosing insulin) when eating lettuce. Continuing their conversational, real-world approach, the hosts use salads and lettuce-based dishes as a springboard to discuss how to analyze and dose for low- and high-carb meals, especially when dining out. The core message: Lettuce itself is rarely the problem in blood sugar management—it's all the extra ingredients that ride along with it.
Key Discussion Points & Insights
1. Lettuce as a Common Food – Context & Carb Content
- Lettuce is the #4 most consumed vegetable in the US.
- “I thought this was gonna be number one because of how many people I see eating salad.” (A, 00:16)
- It’s not just salads—lettuce is everywhere: sandwiches, wraps, etc.
- Most common varieties: Romaine and iceberg.
2. Measuring Lettuce: Portion Size & Carb Counting
- How do you count the carbs in lettuce? Cups? Fist size?
- “A fist is a cup. A cup of greens… is primarily, like… fibrous structure, really.” (B, 02:32)
- Carb estimate: 1 to 1.5 grams per cup (fist-sized portion).
- “It’s like one or maybe one and a half grams per fist size portion. It’s really not… countable in the grand scheme of things.” (B, 02:46)
- Practical takeaway: Unless you’re eating several cups, lettuce carbs are negligible.
- “Should you be adding… ‘Oh, added three lettuce leaves to my burger today’? Really?” (B, 03:09)
3. The Real Culprits in Salads: Toppings, Dressings, & Restaurant Portions
- Salads at restaurants contain significant carbs, fat, and sodium.
- Example: Red Robin Caesar Salad
- 230 calories, 21g fat, 4g carbs (side salad)
- Other menu salads can have 25–60g carbs
- Crispy Chicken Tender Salad: 60g carbs
- Southwest Salad: 910 calories, 61g fat, 1850mg sodium, 47g carbs
- Example: Red Robin Caesar Salad
- Where do the carbs and calories come from?
- “It’s not from the iceberg lettuce.” (A, 04:50)
- “It’s going to be the breading on the chicken… and the dressing, that’s pretty carby.” (A & B, 04:50–05:22)
- Restaurant salads can have as many or more carbs/calories than ‘unhealthy’ options.
- “There are items on this menu that you would think of as not healthy for you and some of them aren’t better for you than the Southwest salad, I’m sure.” (A, 06:13)
4. Lettuce as a “Delivery System” – Don’t Blame the Greens!
- Key takeaway: Lettuce itself doesn’t make blood sugar go out of range.
- “If you have eaten something like this… and you really go off the rails blood sugar wise after the meal. You shouldn’t be blaming, not counting the lettuce.” (B, 06:38)
- “Your lettuce is a delivery system for something else. That’s it.” (A, 06:48)
- It’s everything that’s ADDED to the lettuce—proteins (with breading), fatty dressings, fried toppings, etc.—that spikes blood sugar.
5. Dining Out: Carb Counting Challenges
- Restaurant portions, prep, and hidden sugars make carb counting tricky.
- “At home you know all the ingredients… at restaurants, portions are double, sauces have more sugar… Did you eat the bread before the meal?” (B, 08:05)
- Small misestimations add up: Missing 40–50 grams of carbs is easy in a restaurant meal.
- “You’re nickel and diming it with like, ‘I’ll give them another half a unit’… You missed by 40, 50 carbs here.” (A, 09:27)
- Shocking calorie/carb counts: chocolate shakes, kids’ menus, etc.
- “The monster size [shake] has 160 carbs in it and the kid size has 83.” (A, 09:00)
6. Bolusing Framework: “Meal Bolt” Formula (Recap)
- Step-by-step pathway:
- M: Measure the meal (carbs, protein, fat, GI/GL)
- E: Evaluate yourself (current BG, insulin on board, activity, stress, illness)
- A: Add base units (carb/insulin ratio)
- L: Layer a correction (adjust for BG)
- B: Build the bolus shape (all at once vs. extended/dual wave)
- O: Offset the timing (pre-bolus, timing meals)
- L: Look at the CGM
- T: Tweak for next time
- “We're going to follow a little bit of a roadmap called Meal Bolt… we want you to hear how we think about it…” (A, 00:07; 10:32–11:52)
Notable Quotes & Memorable Moments
-
“Should you be adding… ‘Oh, added three lettuce leaves to my burger today’? Really?”
—Jenny (B), 03:09 -
“Your lettuce is a delivery system for something else. That’s it.”
—Scott (A), 06:48 -
“If you have eaten something like this… and you really go off the rails blood sugar wise after the meal. You shouldn’t be blaming, not counting the lettuce.”
—Jenny (B), 06:38 -
“You missed by 40, 50 carbs here… This is gonna be all day. And then people are like, ‘I don’t know. It wasn’t from the missed lettuce.’”
—Scott (A), 09:27 -
“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.”
—Scott (A), 11:38
Key Takeaways for Listeners
- Don’t overthink the lettuce: For home meals, the tiny carbs from lettuce are insignificant unless eaten in huge amounts (multiple cups).
- Scrutinize the rest: In salads, most carbs and calories come from proteins (especially breaded/fried), dressings, cheese, croutons, and other toppings—not the lettuce.
- Restaurant food: Expect larger hidden carbs/fats and less control. Use rough estimates and know perfection is nearly impossible.
- Bolus logic: Focus your calculations and insulin on the whole meal, especially the high-impact, high-carb/fat sources—not just the “healthy” bits like lettuce.
Timestamps for Key Segments
- Lettuce overview and why it matters: 00:00–01:45
- How to measure/count lettuce carbs: 01:46–03:31
- Case example: Restaurant salads and their macro breakdown: 03:42–06:26
- Why salads can spike blood sugar: 06:26–07:38
- Realistic dining out bolus advice: 07:58–10:32
- Recap of the “Meal Bolt” process: 10:32–11:52
This episode is a reminder that, when it comes to diabetes management, it’s the hidden ingredients—not the greens—that often have the largest impact on blood sugar. Think beyond lettuce for effective bolusing!