Juicebox Podcast: Type 1 Diabetes

Episode #1754 – Bolus 4: McDonald's

Host: Scott Benner
Guest: Jenny Smith
Date: January 30, 2026

Episode Overview

This episode dives into real-world bolusing strategies for eating at McDonald’s—focusing on how to properly cover high-carb, high-fat, high-protein fast food with insulin for people with type 1 diabetes. Scott and Jenny lean into the philosophy of “living well with diabetes.” They use the new Bolus Calculator (developed by Scott and available at juiceboxpodcast.com/bolus4) to model how much insulin is needed for various McDonald’s meals, providing numbers, methods, and some lighthearted banter around nutrition, judgment, and the realities of eating fast food with T1D.

Key Discussion Points

1. Intentionality and No Judgment

• Scott frames the conversation as practical and non-judgmental: “Everybody's thing you put in your body, it's entirely your choice. I certainly just want you to cover it the right way, which is obviously the intent for Bolus 4 to begin with.” (02:37, Jenny)
• Emphasis on the approach: not technical, but about “how we think about it,” to help listeners understand the process, not just the math.

2. The “Meal Bolt” Methodology

• The show follows the “Meal Bolt” protocol:
  • Measure the meal
  • Evaluate yourself
  • Add the base units
  • Layer a correction
  • Build the bolus shape
  • Offset the timing
  • Look at CGM, tweak for next time
• Although not explicitly broken down at each step, the hosts keep this structure in mind while analyzing meals.

3. Staggering Fast Food Numbers

• The discussion kicks off with shock over just how many Happy Meals are sold daily in the US: “Two and a half to three million a day.” (04:03, Scott)
• Both hosts marvel at how much fast food is culturally normal, reinforcing the practical need for this episode.

4. Exploring the Numbers: McDonald’s Meal Calculations

Using Scott’s new calculator, they model several different McDonald’s meals to show:

A. Cheeseburger Happy Meal (06:03)

• 60g carbs, 16g fat, 22g protein, 475 calories
• Insulin-to-carb ratio: 10
• Sensitivity factor: 50
• Target BG: 90
• Blood sugar: 100, stable arrow
• Calculator result:
  • 6.2u up front, 2.3u extended over 4 hours (Total: 8.5u)
  • “Total dose, eight and a half units.” (08:47, Jenny)

B. Large Fries (09:08)

• 65g carbs, 23g fat, 7g protein
• Calculator result:
  • 6.77u up front, 2.35u extended over 4 hours
• “Hamburger Happy Meal and the large fry. Basically the same bolus as far as it goes.” (10:14, Scott)

C. Quarter Pounder with Cheese (11:04)

• 42g carbs, 26g fat, 30g protein
• Calculator result:
  • 4.4u meal bolus, 3.54u extended over 5 hours
• Jenny notes, “Everybody’s digestion…is a little bit different. So it’s one of those experimental [things]…” (11:53, Jenny)

D. Filet-O-Fish Meal (with Sprite and Fries) (20:26)

• 145g carbs, 34g fat, 21g protein
• Blood sugar: 80, falling arrow
• Calculator result:
  • 14.9u up front, 3.9u extended over 5 hours (18.8u total)
• Jenny: “I only use about 26 units a day, total. … That’s like, half my insulin for lunch.” (21:58, Jenny)

E. Double Quarter Pounder Meal (w/Coke) (22:17)

• 156g carbs, 57g fat, 53g protein, 1330 calories
• BG: 80, falling arrow
• Calculator result:
  • 16u up front, 7.25u over 8 hours (23:38)
• "You're not getting out front of this fat all day." (23:29, Scott)
• Jenny: “It's absolutely [possible]. The teenage guys that I work with many times need ... compensation for sometimes 8 to 12 hours after they're done eating.” (23:58, Jenny)

F. Four Piece McCrispy Chicken Strips (31:10)

• 24g carbs, 23g fat, 40g protein
• Calculator result:
  • 2.8u up front, 3.67u over 5 hours
• “The carbs actually require less than the fat and protein.” (31:18, Jenny)

G. Sausage, Egg & Cheese McGriddle Meal (w/hash brown, coffee) (32:42)

• 63g carbs, 41g fat, 21g protein, 1050 calories
• Calculator (average settings):
  • 6.7u up front, 4.53u over 8 hours
• As insulin sensitivity lowers (i.e., more insulin resistant):
  • “That same meal … in a more insulin-resistant person goes from 6.7 up front ... to 14.5 up front, 10.07 over 8 hours… If that person … was really only comfortable with 12 [units], you are going to spend the rest of your day with a high blood sugar.” (33:55, Scott)

H. Large Vanilla Shake (39:01)

• 133g carbs, 19g fat, 17g protein
• “If it was a 4.5 [insulin:c] ratio, 36 [sensitivity]: 29.5 up front, 5.3 over 4 hours—34.87 units.” (41:17, Scott)
• “85 total sugars ... 21 teaspoons of sugar” (41:54, Jenny)

I. Chicken Nuggets + Small Fries + Apple Slices for Kids (43:58)

• Carbs: 45; Fat: 21; Protein: 12
• Ratio 10, Sensitivity 50:
  • 4.5u up front, 2.37u over 4 hours
• “[No one] is extending these things. I think that's where they're seeing the rises later.” (46:17, Scott)

5. Understanding Fat & Protein Bolusing

• Many people under-bolus for fat and protein because they were “only ever taught to count the carbohydrates.” (12:29, Jenny)
• “Once I start using it, you see improved glycemic control…” (12:29, Jenny)
• The “Warsaw Method” is referenced for calculating fat/protein dosing, and links/resources are available at juiceboxpodcast.com.

6. Common Pitfalls and Practical Lessons

• Settings must be accurate for the calculator to work.
• Many people’s background settings (basal, carb ratio, sensitivity) may not be correct—there’s a tool for double-checking at juiceboxpodcast.com/settings.
• If you're not giving enough insulin, you'll be “nickel and diming it all day”—trying to chase highs for hours after a fatty, sugary meal (35:12, Scott).

7. Meal Customizations, Sauces, and Surprising Carbs

• Sauces can add significant (and often overlooked) carbs:
  • Sweet & sour: 11g
  • Honey mustard: 6g
  • Honey packet: 12g
• McDonald's website is praised for transparency of nutrition info: “This website is awesome. ... It is completely open and clear about what's in this stuff.” (37:03, Scott)

Noteworthy Quotes & Memorable Moments

• On honest nutrition advice:

  • Jenny: "Have I said that before? Like please don't eat this. Maybe I have...I just want you to cover it the right way.” (02:37, Jenny)

• On shocking insulin doses:

  • Scott: “If this was me, I'm probably gonna lose my mind here. And get the bacon Quarter pounder with cheese.” (22:16, Scott)
  • Jenny: “The only thing that actually made me pause was the amount of initial, like 14 units.” (21:30, Jenny)

• On “hidden” bolus needs:

  • Scott: “Nobody is extending these things. I think that's where they're seeing the rises later.” (46:17, Scott)

• On fast food’s hidden sugars:

  • “Can you imagine if I sat you at a table and I dumped 21 teaspoons of sugar, and I was like, get it in right now. Make it happen.” (42:11, Scott)

• On cultural eating habits:

  • “I've had to drive south a lot...You get below about North Carolina, you're lucky to find a diet soda in a refrigerator at a gas station anywhere.” (25:51, Scott)

• On practical reality:

  • “In the end, you're going to eat what you're going to eat. I'm not in charge. Jenny's not in charge. But … just please cover it with a proper amount of insulin.” (42:49, Scott)

Timestamps of Key Segments

| Topic/Quote | Timestamp | |---|---| | Bolus 4 method & setting up the episode | 00:00–03:11 | | Happy Meals—America’s love affair & mind-blowing stats | 03:27–04:10 | | Setting up the Bolus Calculator & first McDonald’s meal | 04:44–06:35 | | Cheeseburger Happy Meal: Numbers & calculator walkthrough | 06:35–08:47 | | Large fries analysis | 09:08–10:14 | | Quarter Pounder with Cheese walkthrough | 11:04–11:45 | | Importance of fat/protein bolusing (“Warsaw Method”) | 12:29–13:28 | | Filet-O-Fish meal, shocking insulin dose | 20:26–21:58 | | Double Quarter Pounder meal, soda, and extended bolus | 22:16–23:58 | | Chicken strips—fat/protein dominate bolus need | 31:10–31:33 | | McGriddle meal; How insulin need changes with settings | 33:06–35:12 | | Why people chase highs after fast food | 35:12–36:12 | | Dip sauces & hidden carbs | 36:30–36:34 | | Vanilla shake, teaspoons of sugar | 39:01–41:59 | | “No one is extending...” – kids’ McNuggets + fries example | 43:58–46:19 |

Final Insights & Takeaways

• No moralizing: The episode steers away from telling listeners what (not) to eat; instead, it prioritizes covering whatever food is eaten appropriately with enough insulin and the correct timing.
• High fat/protein = longer insulin duration: Many McDonald’s meals drive huge insulin needs and call for multi-hour extended boluses, which many may not realize.
• Calculator as a tool: The Juicebox Podcast Bolus Calculator can help approximate needs—but only if you know and input your true, up-to-date settings.
• Settings matter: Double-check your insulin-to-carb ratio and insulin sensitivity; many struggle because of “wonky” settings, not just poor carb estimates.
• Transparency is good: McDonald’s (and the hosts) are celebrated for putting all the numbers out there.

Closing Moments

• Jenny shares her “typical” healthy lunch for contrast: “Lunch today is cabbage…an avocado kind of dressing…and then a bowl of blueberries and some scrambled eggs.” (46:43)
• Both hosts express hope the episode is “fun but helpful,” and re-emphasize that knowledge and intentionality beat fear.
  • “I hope people had fun, but I actually think it was...helpful for people.” (46:35, Scott)
• Calculator and resources available at juiceboxpodcast.com/bolus4.
• The “Bolus 4” series and calculators are tools, not replacements for advice from your endocrinologist.

For more, explore the episode series, calculators, and resources at juiceboxpodcast.com. Bold With Insulin!