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- [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 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. While you're listening, please remember that 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 or. Or becoming bold with insulin. Jenny, I put up a post on the good old Internet and I asked people, what did I say? Let me see what I said. Very simple. What restaurant foods give you the most trouble when you're trying to bolus? Let's make a list. There's some vague stuff here, but there's also people are saying, like, absolutely, like, specific restaurants.
- [01:52]
B
That's why I was wondering if it was just items like French fries in general or if it was specific restaurants with specific items. Because.
- [02:00]
A
Well, yeah, I mean, there's one thing I've. I've learned about putting something on the Internet is that they don't know what you're thinking. So, you know, I thought somebody would. You know, I always assume people will just know what I'm thinking, but some people are just like, Chinese food, pancakes, pizza, that kind of stuff. And I'm like, oh, yeah, sure, we'll get to all that. Anyway, then some people got more specific. It's chow mein. I really. I really struggle with honey garlic chicken. But we've got some Panera, McDonald's, Taco Bell, specific Panda Express, Boba.
- [02:34]
B
You know, I have to tell you right now, I don't understand the whole boba tea thing.
- [02:38]
A
I don't either.
- [02:38]
B
I don't get it. I really don't. We have a. I mean, we've got multiple places here that have it. Oh, and then they're just to like. Look, I'm like, I don't understand the idea of drinking something that's got like jellified, weird looking bubbles at the. I don't get. I really just don't get.
- [02:52]
A
It has a fixation with it and I don't understand either.
- [02:56]
B
Okay, well, I'm not alone.
- [02:57]
A
Tater tots from Sonic. That's very specific. And Culver's. What's Culver's?
- [03:03]
B
Oh, Culver's. You've never. That's a. Yeah, Culver's. Culver's is custard. And then it's like a burger place, but.
- [03:12]
A
Oh, it's a Wisconsin thing. That's why you know about it.
- [03:14]
B
It's a Wisconsin thing.
- [03:15]
A
Burger chain, frozen custard, fried cheese curds. Fried cheese curds.
- [03:20]
B
You don't know what a cheese curd is?
- [03:21]
A
No, I'll learn the thing.
- [03:22]
B
Come on, you've got a brother that lives here in Wisconsin.
- [03:24]
A
You just do you know how Wisconsiny you just got when you said come? You're like, come on.
- [03:32]
B
Oh, entirely. Yeah.
- [03:33]
A
I'm going to keep making this podcast for 20 more years just so I can know you when you're like 60. That's what I want now. I can hear you.
- [03:40]
B
I will probably talk like my father when I'm 60. I don't know. He has her. He had, I should say, the ultimate very Wisconsin accent.
- [03:49]
A
Okay, well, I'll get you to do an impression one day. But first, I mean, let's pick one of these things. I want to start with the tater tots. What was that?
- [03:57]
B
Oh, Tater tots from Sonic. Oh, Sonic.
- [04:00]
A
Okay, okay, hold on a second. Sonic, Tater tots, nutrition. I'm going to type. I bet. Yeah. I'm the first person in the history of the world to type those words together. Okay, let's see.
- [04:13]
B
I've never been to a Sonic.
- [04:15]
A
By the way, I have not either. Okay. Now this is their website. Okay, I'll accept their cookies. 360 calories for the tots. Okay, nutritional information. Oh, there's small, medium, and large. I'm gonna go large because, I mean, I don't know how many is in a small and a medium and a large. Let's see, does it say. No, it just tells you small, medium or large. Which one do you want to do?
- [04:45]
B
Let's do a medium.
- [04:46]
A
A medium. We're shooting the middle protein in this. 3 grams carbohydrates. Jenny, any guesses? It's hard. You don't know how many are in there, but why not pick a number?
- [04:57]
B
Yeah. In a. So a medium serving. A medium serving. I'm gonna guess 45 or 50.
- [05:06]
A
Okay, 43. You're a savant. Total dietary fiber 4. I'm gonna ask you in a second why you thought that for medium fat. 19 grams saturated fat 3.5. They're very, very proud to tell you there's no cholesterol or trans fatty acid in it. Oh, sodium. Oh. 890 milligrams calories. From fat. 170. Calcium 19. Vitamin A7. Iron. 1.4. Vitamin C, 1.4. Okay, well, I don't know how to bullish to this already because they are definitely deep fried. Right? So there's going to be.
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B
Oh, 100% deep fried.
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A
Yeah. There's no way there, there's a baked option in this.
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B
I don't imagine they weren't terribly high in fat, right? Well, in the medium portion, maybe. In the small portion it wouldn't be terribly high, but small.
- [05:53]
A
I'll give it to you. 20 grams small fat. 13. Medium fat. 19 large fat. 31. Oh, yeah. I want to read this little thing from their website. It says crispy tots fried to a golden brown and lightly seasoned with salt. Does 890 milligrams of sodium sound like lightly seasoned with salty? That's a lot, isn't it?
- [06:15]
B
1900 milligrams. This is a lot.
- [06:17]
A
890 milligrams.
- [06:19]
B
Oh, 800. That's still almost half of what you should have in an entire day.
- [06:23]
A
That's what I'm saying. But, but they, that's. The marketing people said lightly, lightly seasoned.
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B
Yes.
- [06:29]
A
Just kind of sprinkle on it. You're gonna love it. Anyway, these things are probably awesome. I just want to say that they probably, they probably taste like heaven. I don't know. Where do we start here? Let's say that we roll up on a Sonic and we're not going to get a full meal. We're just going to have our tots and get on our way. And our blood sugar is nice and stable at 120. Let's say that. So 120. We're going to want to measure the meal. 43 carbs. I think you've got to really consider the fat here. And this is going to be the first time I think we talk about it. So to this level, evaluate yourself. We have a little bit of a, a higher blood sugar. 120. I'd love to see that come down to 80. So there'll be a bolus in there for that. And we'll do some calculations here. So you know what I mean? We're gonna do the old. One unit covers ten for carbs and one unit moves us. How have we been doing this? One unit moves us. Why don't we say 50 for this one?
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B
50 for this one?
- [07:27]
A
Yeah, let's say one unit moves us.
- [07:28]
B
Make it nice and easy.
- [07:29]
A
Yeah, let's make it easy for us. So about a unit for the, for the 120 in my mind. And then your ratio is going to tell you what, like 4.3 for, for the carbs, which is a 5.3. But the, the pre bolus here would have to be. This is interesting, right? Because this place is, it's not at your house. You're gonna have to drive to it. And truth be told, you're either going to bolus while you're driving or you're going to bolus and sit in the parking lot before you order. There's no way around it, right?
- [08:01]
B
I mean, unless you are going inside to actually sit down. But all right. I mean most many people are doing a drive through type of thing for a fast meal or something.
- [08:11]
A
If I'm just grabbing the tots, I would think it's an in and out situation for me and Jenny. Like, honestly speaking, like how many people do you think are saying to themselves, hey, I'm 20 minutes out from the Sonic, I'm definitely getting tater tots. I'm gonna bolus now.
- [08:25]
B
Like not many.
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A
I don't have type one. Like would you make a big bolus while you were driving?
- [08:29]
B
Depends where my blood sugar was and how is it, how is it starting? You know, if I'm. I always have something with me and would I bolus for all of it? No, I would likely almost 100% certain that I would bolus for something of it. And then once I actually had it in hand, see what's happening with my blood sugar again. This is where that evaluate your blood sugar and kind of the trend happening and go ahead and bolus for the rest of it at that point or maybe see where it's going even once I get in line to make the order now that I'm there. Going to have it in hand in the next five minutes.
- [09:03]
A
Yeah.
- [09:04]
B
What happened with that five or ten gram bolus that I gave on the way here just to start tipping me in the direction of insulin working before I take that first bite?
- [09:16]
A
I think your safety is the most important Thing, obviously. And I would tell you that in 19 years of having type 1 diabetes, we have one time bolus in the car and it had. And it didn't work out.
- [09:27]
B
Sure.
- [09:27]
A
And it was. I know I've told the story on the podcast before, but it was harrowing for a minute. You know, but mostly speaking, I think this is a pretty honest thing to say if I'm thinking about it. Then we bolus in the car on the way.
- [09:42]
B
Correct.
- [09:42]
A
If I don't bring it up to Arden. She's not going to.
- [09:45]
B
She's not going to.
- [09:45]
A
No, she's not going to remember that. But, you know, for the sake of talking about how to successfully bolus for these sonic tater tots, I think an accurate bolus with a, you know, a significant pre bolus is gonna be the only way to get ahead of these.
- [09:58]
B
Right, right. Because again, they're fatty, but they aren't excessive in this portion. You're gonna get hit by the carb part of this sooner than the potential for what will likely be still a lingering effect, maybe after you eat it. Because these are processed potatoes.
- [10:17]
A
Yeah.
- [10:18]
B
Right. They are broken down, they're smashed up, they're precooked before they get fried. So their glycemic impact is absolutely be a heavier, quicker hit. I think what confuses people often is that they know that this is a fried food. So they may expect it to have a slower impact on their blood sugar when really that slow impact is coming, but it's not the immediate of what they're going to see happen to their blood sugar.
- [10:46]
A
Okay. So I'm using a fat and protein bolus calculator.
- [10:50]
B
Yeah.
- [10:51]
A
That is on my website. It's not medical advice and use it at your own risk. I just wanna say that I have.
- [10:58]
B
One on my phone as well.
- [10:59]
A
There you go. It asks me for grams of fat, grams of protein, grams for insulin to carb ratio, grams for one unit. So I tell it 10 and it tells me the carbohydrate equivalent of the fat is 18 grams. That seem about right to you? Yeah, 19. 19 grams of fat. So it's saying that if you're 1 to 10, an extra dose would be 1.83. Yeah.
- [11:32]
B
And it should usually. I don't know if your app is the same as mine, but it'll give. For those who want dosing idea or timing of dosing it, you should give how long to.
- [11:40]
A
It's recommended put that bolus over an extended bolus of four hours.
- [11:44]
B
Okay.
- [11:44]
A
Right. So I think that's significant. For people to hear. Because, you know, we said at our 1 to 10 ratio, these tater tots are 4.8 units of, of insulin. Right. Or 4.3, whatever it was. 4.3, two more units is like 40% more like it's a lot more insulin. And that, I think that not understanding that piece is the spot where you get into the, like, I don't know what happened. I just had tater tots. They seem like benign, like, right. There's probably a handful of them. Hour, two hours later, my blood sugar's super high, my kid's blood sugar's super high. It won't come down. You know, I don't understand. All my settings usually work, et cetera, so on. Especially with these, you know, with the automated systems that are going to believe you that you put in the right amount of insulin and take away your basil and so you're going to float up, stay up, and then how would you. If you didn't understand the impacts of the fat, I believe it would be difficult to assume a 40 or 50% need over top of the original bolus. Like that would seem, I think, significant to people who don't understand the rest of it.
- [12:49]
B
Right. And where I think bringing in another piece to this consideration, a sonic meal or any fast food, many times they come in in a setting where you will also likely be sedentary after eating, such as you're on a road trip and you're stopping quick to grab a bite along the way, right. And you're getting back in the car and now you're going to sit for another hour or two hours. A lot of the kids that I work with are on travel athletic teams. They're going somewhere, they eat on the way, they may play a sport, they're hungry. After they stop, it's another hour to get home. They're sitting in the car. So that can have an impact. And in terms of bringing up the fat, like we're discussing, Absolutely, you may control the initial rise pretty well with the bolus just for carbs, but later on, you may never really see that curve back down. You may also see a little bit more of a nudge up in your blood sugar than you'd expect.
- [13:47]
A
I'd ask people to keep this in mind too. And I'm going to say a couple of things very quickly. If you didn't, if you just got the tots, then I go ahead and bolus for, you know, about the way we talked about. But if you add a crispy tenders five piece to it, you'd be adding 27 carbs and 20 more grams of fat. If you added the crispy chicken sandwich to it, you'd be adding 52 carbs and. Yeah, well, listen, you'd be adding 52 carbs, 10 sugar, 24 fat, and by the way, another 1500 in sodium.
- [14:21]
B
Yeah.
- [14:22]
A
And that's the chicken sandwich, which you're gonna definitely think like chicken. Awesome. Chicken's good for you.
- [14:27]
B
Must be better, right?
- [14:28]
A
Let's just go to the burgers for a second. I'm just gonna go. Plain Sonic cheeseburger, 48 carbs, 8 sugars, 35 fat. Right. If you get the Double Sonic Smasher, it has pickles on Jenny.
- [14:42]
B
It has pickles like, oh, you remember.
- [14:44]
A
I like a lot of healthy for you and that. Don't worry, carbon.
- [14:47]
B
Just ask for a side of the pickles.
- [14:51]
A
Carbs, 30 sugars, 8 fat, 37, 1500 sodium, like, so there's a lot here that there is when you start mixing it together, especially, I think, the chicken, because I think in people's minds, the chicken is, like, free. It's chicken. They don't think about the breading or the fat or et cetera. But just, I mean, keep in mind, if you take five piece tenders, 27 carbs, and then add it to the medium tots, that's 40, 50, 60, 70 carbs. It's 2040, you know, 39 fat. That's a significant bolus. And once that meal gets ahead of you, it's going to stay ahead of you.
- [15:37]
B
And this is entirely. I think it's the best example of why teaching about only carbohydrates is false information.
- [15:48]
A
It is.
- [15:48]
B
You're taught to just cover the carbohydrates that you're eating. Here. I looked at the label. This is what it told me. My ratio is this. I figured it out.
- [15:58]
A
I.
- [15:58]
B
Why is this happening? And unless somebody really steps in and says, hey, this meal contained 50 grams of fat, this is the reason this is happening. And then proceeds to also teach you how to navigate that you're forever going to be frustrated by only counting carbohydrates.
- [16:17]
A
Yeah. By the way, they also offer a variety of dipping sauces, as does every. I'm not picking on Sonic. But, like, there's a signature sauce, a ranch, a honey mustard, a buffalo, a barbecue. You know, those things. I find people don't think about that at all. But ketchup, I think ketchup's one that, you know, people are like, oh, I have a burger and ketchup. And you Know, there's a tablespoon or 2 tablespoons of ketchup later, and you're probably looking at.
- [16:40]
B
Or a quarter cup of it if you're. I mean, honestly, Come on.
- [16:44]
A
Seriously, right?
- [16:44]
B
You think, oh, most people eat a lot of ketchup at a time. I mean, I think ketchup, the fries, or whatever they're eating with it are just a loading place to get the ketchup in for some people. And ketchup is full of sugar.
- [16:59]
A
The fries are the delivery system for the ketchup.
- [17:01]
B
Yes. Thank you.
- [17:02]
A
Yes. Yeah, yeah. I've made fun of somebody in my life one time. Like, I think that baked potato is just a way for you to eat butter. Okay. I think. Is that good for this one, do you think?
- [17:12]
B
I think it is. I think it highlights a lot of the things that need to be considered. You know, we started with the tater tots, obviously, which I don't.
- [17:19]
A
I don't even.
- [17:19]
B
I think I was in, like, middle school last time I had a tater tots.
- [17:22]
A
Listen, I think it's one of those things, like, I think it tugs at your young heartstrings. Like, I mean, tater tots at. I mean, did you not have pizza and tater tot day at school?
- [17:32]
B
Oh, 100% rectangle pizza. It was the one day that when my mom looked at the calendar after I was diagnosed, it was the one day that we'd look at it to be like, okay, I won't pack your. I won't pack your lunch today. You can have the pizza. Right?
- [17:45]
A
The pizza. Which, by the way, makes an Elio's pizza look like gourmet. And you were still excited about it, right?
- [17:51]
B
100%. It was great.
- [17:53]
A
What piece of cardboard with, like, half ketchup on it and a handful of tater tots? And you were like, my life is all. And then people are like, it was exciting. It was. Oh, my God. It was the best part of your life.
- [18:02]
B
You know, I think. Was this the best part for you, too? Like, the rectangle pizza slices. We had those plastic. Plastic school trays that we went through the line. And it was always exciting to me, visually, that the pizza slice fit perfectly in the rectangle. That hat that was on the plastic tray, like, that was very exciting to me that it fit perfect in that little rectangle. Now people are gonna think that I'm weird.
- [18:26]
A
Don't tell people stuff like that. Hey, let me tell you something here. The original cold brew iced coffee. At Sonic, there are four sizes. Small, medium, large, and something called RT44. What could RT44 stand for? Not the point. The RT44 size has 82 carbs in it. 58.
- [18:48]
B
Is it 44 ounces, is it? I don't know. I'm just asking. There's a number there. So I'm curious if that's the size. I'm looking kind of like the slushies at 7:11 that are like gigantic.
- [19:01]
A
I don't know. It has 82 carbs, 58. 58 grams of sugar. God, there's 460 milligrams of salt in that. That's crazy. Is that not crazy? How many calories are you supposed to have a day? Like 2000.
- [19:17]
B
It depends on your activity level, your age, all that kind of stuff. But in general, this is again, a big reason that drinking your calories in general shouldn't be done. All of the drinks from any of the national brands, they're not a way to take in calories because they're not ones that register with your brain.
- [19:36]
A
Small has 28 carbs, 20 sugars in it. 5. Fat. There's fat in coffee?
- [19:42]
B
Well, probably, because if it's mixed, it's probably got half and half.
- [19:46]
A
Yeah, I don't know. I don't drink coffee anyway, just want you to know that because it's listed as the. The. The breakfast coffee. I don't know, in my mind, makes it sound like it's, you know, healthy. It's for breakfast.
- [19:59]
B
Healthy, right. It's your breakfast coffee. Maybe it's got some good protein or something in it.
- [20:03]
A
I don't know. All right, I'll see you.
- [20:05]
B
Thanks.
- [20:14]
A
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&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 a 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 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 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. The Juice Box podcast is edited by Wrong Way Recording wrongwayrecording. Com. If you'd like your podcast to sound as good as mine, check out rob@wrestwayrecording.com.