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- [00:00]
A
Welcome back, friends. You are listening to the Juice Box Podcast. In every episode of Bolas 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. Today's episode of the Juice Box Podcast is sponsored by the Contour Next Gen blood glucose meter. This is the meter that my daughter has on her person right now. It is incredibly accurate and waiting for you@contour next.com Juicebox Today's episode is also sponsored by Medtronic Diabetes, who is making life with diabetes easier with the MiniMed 780G system and their new sensor options, which include the Instinct sensor made by Abbott. Would you like to unleash the full potential of the mini med 780G system? You can do that at my link medtronicdiabetes.com juicebox I don't know what this means. All right, I'm hitting record now. Yes. Did you just say does this have anything to do with your weird text?
- [02:16]
B
I did. Okay, so I'm very odd text.
- [02:20]
A
Yeah, I'm starting the recording like this so people can hear that. A few minutes ago I texted Jennifer a link to a pot pie recipe and a list that says 110. It's number 110. Number 250. Number 3, 100. Number 4, default number 5. Current BG130. Number 6 rising arrow number 7. No insulin on board and in real time. I don't care how long it takes. We can chat. While you're doing it, I want you to Go to that recipe.
- [02:50]
B
Okay.
- [02:51]
A
And with those parameters, tell me how to bolus for one serving of the pot pie.
- [02:57]
B
Okay. So my. Can I guess then. So number one is the insulin to carb ratio.
- [03:02]
A
Yep.
- [03:04]
B
Number two, 50 is it's sensitivity. Oh, the sentence. I was going to guess either sensitivity or the amount of carbs per serving.
- [03:17]
A
No, I'm not telling you any of that. That's on you.
- [03:19]
B
You're not telling any of that. Okay, awesome.
- [03:21]
A
And I'm. It's just a link. You have to click on it. You're gonna have to pick through it, you're gonna have to look at the ingredients and you're gonna have to figure out how to bolus for it. And I want a fat and protein bolus out of you too. And there's a good reason for this. I'm not just torturing you on a Monday morning.
- [03:37]
B
Oh, okay. So I'm looking at the recipe. And so the recipe is. Looks like it's eight servings, which would be typical for like a pie based recipe. To cut it into 8 servings. It has a top and a bottom crust to it. I'm assuming the crust is also homemade.
- [04:03]
A
In the recipe, there's a ingredient.
- [04:05]
B
Homemade pie dough recipe. Okay. And.
- [04:15]
A
While you're thinking, I'm gonna read the ingredients to people.
- [04:18]
B
Okay.
- [04:19]
A
One recipe for homemade pie dough. One pound boneless, skinless chicken breast. A third of a cup of butter. A a half a cup of celery. A third a cup of an onion third cup all purpose flour. Half a teaspoon of salt. Quarter teaspoon of freshly ground black pepper. A quarter teaspoon of celery seed. Even though we use celery. Interesting. A half a teaspoon of garlic powder. 1 teaspoon chicken bouillon paste or more to taste. 1 cup of milk. 8 ounces of frozen vegetables, mixed carrots, peas, green beans and corn. One egg, One tablespoon of milk. So that's the entirety of what you need to make this concoction. And I'm going to use that word because I love that work. I also want to point out that I sent a complicated meal on purpose and the website is set up by a person who is just pushing ads on you. So it's difficult to navigate is my other point. Like there's pictures and there's, you know, make the pie crust. I highly recommend D blah, blah, blah, you know, and then photos and then ads are popping up like it's everyone who's done a recipe website. It's a busy website that's important later, just for context. So then there's cooking instructions, tells you how to cook it, notes about making it ahead of time, et cetera. And it does give nutritional facts at the bottom.
- [05:38]
B
Oh, well, I won't look at those.
- [05:39]
A
Good. Don't cheat.
- [05:40]
B
I'm not. Yeah, I didn't even go that far. I was just getting to the rest, to the ingredients, scrolling through. I was looking at the picture first, actually, as you saw, I went to the servings first because you always want to know how many servings a recipe might make so that you know what a single serving, not what the portion is that you put on your plate. What do you want first?
- [06:05]
A
I guess. Well, I guess tell me. Just tell me the bolus. Then we'll pick it apart and tell you and you can tell me why you got to it. So, you know, does it need an extended bolus? What's the total dose? What goes up front? How long would you stretch it out? Whole thing?
- [06:22]
B
Sure. I mean, if I'm looking at, from just a, like a protein standpoint, I'm looking at the ingredients right now, A pound is 16 ounces. That's typically about. Should be approximately four servings. Four or four ounce servings. Right. But this recipe says that it makes eight servings, which means that really you're only getting about in a cooked portion, 2 ounces at best. Of the chicken, there are other things in here that would have a little bit of protein, depending on the chicken bouillon that you're using. Vegetables have a little bit of protein. There's an egg in here. So my guess would be that this is not terribly high in protein. When we're talking about the bolus strategy and pre bolus, which ones are going to be more heavily impacting your blood sugar. Right. And in this recipe, I don't see it as being a terribly high protein meal if you eat one serving. Right. Fat again, I mean, for the most part, it really only has the fat from an egg, minimal. From the boneless, skinless chicken milk. It's got a little bit, I mean, a tablespoon of milk.
- [07:35]
A
No, no, no, there's more.
- [07:37]
B
Oh, is there more?
- [07:38]
A
Yep, there's. At the top, there's one cup. So you're getting a third of a cup of butter. A cup of milk.
- [07:46]
B
Yep.
- [07:46]
A
And then the homemade pie dough recipe.
- [07:48]
B
The homemade pie dough recipe, which is butter and flour.
- [07:51]
A
Flour and a double. And a crust on the bottom. And a crust on the top.
- [07:56]
B
Correct.
- [07:57]
A
So, you know, Jenny, between you and me, I don't know how many times you've had a pot pie in your life? That's a pretty thick crust.
- [08:02]
B
It's usually a very thick crust.
- [08:04]
A
Yeah.
- [08:04]
B
It was the one thing that I really did like meat in when I was younger. I loved chicken pot pie.
- [08:10]
A
Who doesn't love a pot pie, right? Yeah, yeah, yeah.
- [08:12]
B
But my estimate would be that the fat would be the higher part of this meal because of all the things that you just noted. Right. So I would expect to need an extended bolus for this because the real carbs in here that are the hit carbs are coming from the pie crust, which is high fat.
- [08:37]
A
Right. And the gravy, too. Right.
- [08:39]
B
And the sauce, which comes from the bullion, the chicken bouillon, and then the flour, which, again, there's not a heck of a lot of extra flour. It's only a third of a cup in the whole entire pie. But again, because the pie crust is high fat despite it having carbs. You know, even if I just estimated the carbs in this, a top and a bottom crust are usually top crust, about 10 to 12 grams of carb, bottom crust, about the same in an eighth of a pie. So that's what, 24 grams. And then there are some grams of carb coming from the celery, the onion, the mixed frozen vegetables, inclusive of peas and corn. A little carbier. So and the extra flour, I mean, I'm going to add in 10 extra grams. So let's call it 35 grams of carb per eight of a pie.
- [09:36]
A
Okay.
- [09:37]
B
That's just a rough after. That's just carbs. Right. But again, I think because the carbs are held by a higher fat type of food, what we're looking at is using an extended bolus for this meal.
- [09:54]
A
Can I tell you, in the recipe for the crust, you're using six tablespoons of cold unsalted butter and three quarters of a cup of vegetable shortening. Just so you know that that's. That's the crust recipe. Right?
- [10:06]
B
It's high fat. Yeah, yeah, entirely. I clicked on the.
- [10:09]
A
Oh, you did?
- [10:09]
B
Look, because I was like, what are they using for the fat?
- [10:13]
A
Yes.
- [10:13]
B
Yeah. Extended bolus. Yes, pre bolus. I'm gonna say if your blood sugar is stable and in target, your blood.
- [10:23]
A
Sugar in this breakdown is 130.
- [10:26]
B
Oh, that's right. You had it in the. That's right.
- [10:28]
A
Okay, it's 130. And the arrow.
- [10:30]
B
Rising.
- [10:30]
A
Arrow is rising.
- [10:32]
B
Yes. Okay, so rising arrows, regardless of where the current BG is, a rising arrow indicates that you are at Somewhat of a deficit of insulin to create a rise. Right. So in this, it's not necessarily the food that you're pre bolusing for, but it's the fact that you have a rising arrow and your current BG is already at the top of maybe where some people would want it to be, like 130. Right. And it's rising. A pre bolus would be beneficial here to at least get a. A plateau.
- [11:06]
A
Yeah.
- [11:07]
B
So that when you do start eating this slower digesting type of meal, you don't still have a rise going. Right. By how much? Probably 15 minutes is an estimate, but in this case, because of the content of the meal, I'd say just do a pre bolus and wait for the arrow to stabilize.
- [11:27]
A
Okay.
- [11:28]
B
That would be my recommendation.
- [11:30]
A
Can you contextualize the. The fat protein units in this, like just looking at it, or is that a thing that you need like a calculator for or something like that?
- [11:38]
B
Probably you would definitely need a calculator if you're going by like the Warsaw method of FPUs. To get an idea. If I estimated again, I think I gave a pretty good estimate amount of protein, I'd guess around 20 grams per servings, maybe a little bit less. Maybe it's like 17 grams. But again, nice round numbers are a little easier. So maybe per eighth of a pie here, 20 grams of protein. And then FPUs usually use somewhere around 40 to 50% of the amount. And then the potential of extending that in some way, shape or form in the aftermath of the meal. And using is the number one here, the 10. Is that the insulin to carb ratio?
- [12:25]
A
That's your insulin to carb ratio. 1 to 10. The 50 is insulin sensitivity. 100 is the target blood sugar.
- [12:30]
B
The target blood sugar, yeah. So then fat, like I said, that's the one that, I mean, it would really do. It would need a little bit of addition of all of the pieces of fat that go into this in an eighth of a pie, I'd guess somewhere maybe slightly under 30 grams per slice.
- [12:53]
A
For fat.
- [12:54]
B
For fat.
- [12:55]
A
Go ahead. Carbs, you said What? I forget.
- [12:57]
B
30, around 35 would be my estimate. And protein somewhere around 20.
- [13:04]
A
Okay.
- [13:04]
B
At the most.
- [13:05]
A
Honestly, I wish people could see me smiling. Keep going.
- [13:08]
B
And then the fat, I think 30 might be a little high, but it, I don't think it's too far off given all the fat in the crust and what you're adding. And the milk I'm expecting would be whole milk and the egg, you've got a fair amount of fat Here. So let's call it 30 grams of fat. And again, in FPUs, the calculation for additional fat gram counting goes in and then the Warsaw method takes into calculation what are the calorie units that kind of come out of what you're adding in in order to come up with the amount to you is along with your insulin to carb ratio of 1 to 10, and that gives you your FPU, but it doesn't unless you add in and you've got the facts here. You've got a correction or an ISF of 50, you've got your target blood sugar of 100. Right. So if you have a calculator that takes into consideration what you would need for corrective insulin, then that would also go up front along with just the carbs. Right. So if we just factored in, let's say this is 35 grams of carb. If it is, that's 3.5 units at a 1 to 10 ratio. Correct. And then we'd have to do a little bit of the math again to be able to say, okay, we've got a target of 100. Current blood sugar is 130 and rising. If it's an angled arrow up. That angled arrow is usually a rise rate of about 2 milligrams per deciliter per minute. So if you did nothing about this rise effect, 2 milligrams per minute in the next 30 minutes is what, how much higher could your blood sugar be if you do nothing about the rise.
- [14:55]
A
In blood sugar 2 per minute for 30 minutes? Could be 60 points higher.
- [14:58]
B
Could be 60 points higher.
- [14:59]
A
Okay.
- [15:00]
B
Right. So if it is, you could be sitting at a 190 if you did nothing. Again, I'm just adding in a little bit of layering to this to get the perspective on. We have to do something about the rise.
- [15:14]
A
Yes.
- [15:15]
B
Even though this meal may upfront, if you were flat at 100, you probably wouldn't need a pre bolus for this.
- [15:21]
A
Okay. Because it's going to hit you a little slower, but with the rise and the rise.
- [15:28]
B
But if we, you know, take current blood sugar 130 as it is minus your target, it gives you 30. And then you divide that by your Correction Factor of 50, an additional 0.6 units of insulin is going to be needed on top of the 3.5 units of actual carb. Now, that's just the upfront.
- [15:50]
A
Yep. What does that put us at? Total upfront? Unlike other systems that will wait until your blood sugar is 180 before delivering corrections, the MiniMed 780G system is the only system with meal detection technology that automatically detects rising sugar levels and delivers more insulin as needed to help keep your sugar levels in range even if you're not a perfect carb counter. Today's episode of the Juice Box Podcast is sponsored by Medtronic diabetes and their MiniMed 780G system, which gives you real choices because the MiniMed 780G system works with the Instinct sensor made by Abbott as well as the Simplera Sync and Guardian 4 sensors giving you options. The Instinct sensor is the longest wear Sensor yet, lasting 15 days and designed exclusively for the Mini Med 780G. And don't forget Medtronic Diabetes makes technology accessible for you with comprehensive insurance support programs to help you with your out of pocket costs. We're switching from other pump and and CGM systems. Learn more and get started today with my link medtronicdiabetes.com juicebox contour next.com juicebox that's the link you'll use to find out more about the Contour Next Gen blood glucose meter. When you get there, there's a little bit at the top you can click right on. Blood glucose monitoring. I'll do it with you. Go to meters, click on any of the meters, I'll click on the Next gen and you're going to get more information. It's easy to use and highly accurate. Smart Light provides a simple understanding of your blood glucose levels. And of course with Second Chance sampling technology, you can save money with fewer wasted test strips. As if all that wasn't enough, the Contour Next Gen also has a compatible app for an easy way to share and see your blood glucose results. Contornext.com juicebox and if you scroll down at that link, you're going to see things like a buy now button. You could register your meter after you purchase it or what is this? Download a coupon? Oh, receive a free Contour Next Gen blood glucose meter? Do tell contour next.com juicebox head over there. Now get the same accurate and reliable meter that we use. Yep. What does that put us at? Total up front 4.14 okay, go ahead.
- [18:16]
B
And then what we're looking at is again more math calculation for the FPU units and then the extended nature of it. My expectation for whatever the total dose would be using the Warsaw for calculating the fat and protein units. My expectation is that it would I'd expect it to tell you to extend that bolus for the fat and protein somewhere around four to five hours. That would be my guess of this meal.
- [18:48]
A
And what's the extended amount? The extended amount? The total insulin over the four or five hours.
- [18:54]
B
God, I'd have to do the math.
- [18:56]
A
Would you please? Because in a second, Jenny, someone's going to crown you the king of diabetes. That's going to be me. So go ahead and do that. Okay.
- [19:03]
B
Okay.
- [19:05]
A
So I. I'm. While Jenny's doing that, I want to. I want to reiterate. It is Monday morning. It is 29th December. We are between Christmas and New Year. Most y' all aren't even working. Jenny and I are recording. I texted her once again five seconds before we got on a link to something called the best chicken pot pie.
- [19:25]
B
Which looked like you were texting me like, this is where the gold is hidden under this. I'm like, what are these numbers? I don't know what he said.
- [19:31]
A
Underneath of it, it just says 1. So everything's numbered. 1 is 10, 2 is 50, 3 is 100. 4 is default. 5 is current. By the way, default is the 50% for the FPU calculation in Warsaw. Default is for protein. Yeah, yeah, yeah. You know, it uses the. Like you can go heavier or lighter.
- [19:50]
B
You can. And the default for fat is 10.
- [19:53]
A
I'm not sure. 5 is current. BG136 is rising. Hour 7 is no insulin on board. I just texted her that. And then you guys also heard. Actually, let me tease something here. Jenny and I shared with each other what our middle names were before we started recording. And then. So Jenny knows now, if you want to know my middle name, I know.
- [20:13]
B
Something that nobody will ever know.
- [20:15]
A
I told her, I will burn her house down if anybody finds out. I hit the recording just where you heard it start and we started talking about this. She has no context for any of this. Okay? None. No context at all. Okay, Give me the FPU bolus and then I move on.
- [20:32]
B
I am calculating.
- [20:33]
A
Oh, sorry. A little quicker. Come on.
- [20:35]
B
It's okay. No, I was, you know, I was talking along with. It's along with you. So if. If my. What was my estimate with for protein was 20. So if we take 50% of that. Yeah, right. 50% of 20 grams is about 10 units or 10. 10 grams. Except. Excuse me. 10 grams of protein times 4 calories per gram is 40 calories from protein.
- [21:01]
A
Okay.
- [21:02]
B
Because FPUs essentially in the Warsaw get transitioned. An FPU is a hundred one. FPU is a hundred calories of added fat and protein.
- [21:15]
A
Okay.
- [21:16]
B
Okay. So if we expect protein to be 10 grams, that's about 40 calories and then fat is heavier in calories. And if you. That's what I was. I was trying to make sure that I'm not using my calculator, my own software.
- [21:33]
A
No, I'm. What? You're doing this in your head.
- [21:35]
B
I'm doing this in my head entirely. I'm not using my calculator. I love my calculator. I actually tell my. My children not to use their calculator.
- [21:45]
A
You can use it if you want to, if it'll. It'll get you to it.
- [21:48]
B
Let's go here.
- [21:50]
A
Because my point is going to be. I think, like, everyone. Hang on.
- [21:54]
B
My calculations are okay.
- [21:56]
A
They're not just okay, first of all, you're a treasure. And secondly, seriously. And. And secondly, when you're all in your doctor's offices and they go, I don't know what happened, it's because they don't understand it like this. But bigger picture, Jenny, I don't understand it like this. And I want to be clear that most of what you just did, that if you spent 10 years teaching it to me, I would not retain it. Okay? Like, my brain does not work the way yours does. I've interviewed people about fat and protein. I've had the Waltzing the Dragon lady on. What was her name? Oh, gosh. To talk all about the Warsaw Method. You and I have talked about it. I. I just. I can't wait to tell everybody the rest of it. I just want to be clear that right now that if you asked me to do this the way you just did it, I would go dir. And then that would be the end of it. I would do my thing. I'd start going like, there's a lot of fat in that and it's a rising blood sugar. So let's maybe cut this arrow off, get it coming down a little bit before you start eating. I don't know, pre bolus, you know, 12, 15 minutes, like somewhere in there. And then I'm going to want to extend this out more hours than you think, because this thing's going to hit again. It might hit twice. Right? It might hit in 90 minutes a second time. And it could. It could roll on me again if I. If I'm not on top of it with all the gravy and thing. That's how I think about it. The math and everything else you talked about. I promise you, with a gun to my head, I wouldn't be able to figure out. I want to promise you that. Okay. And I'll tell you why I'm telling that after you Tell me how much you want a bowl is for the fat extended over the four or five hours.
- [23:37]
B
Yes. So to break it down again, if we do total FPU units, you'd essentially take all the fat and all the protein, because the calculator essentially could do it for you. Right. And again, an FPU is based on calories, with a hundred calories being like 10 grams of carb. So if you take all the calories that I'm adding here together. Right. 20ish grams of protein in total. So that's 80 calories. And then we've got. I estimated 30 grams of fat. Right. 30 times nine is another 270 calories. Okay, so if we take 270 plus the 80. I'm making you do math in the morning.
- [24:21]
A
Two hundred and seventy plus 80. It's 350.
- [24:24]
B
Yeah, 350. And then again, that's 350 calories. And then if you take that into consideration of the 100 calories is equal to 10 grams, it kind of works out to be about the same number of units as the carbs.
- [24:40]
A
I'm gonna cry. Go ahead, say you're not.
- [24:42]
B
Because we had 35 grams of carb. But if we take 350 calories, it becomes per 10 grams and a 1 to 10 ratio, 3.5 units.
- [24:51]
A
Okay, so.
- [24:52]
B
And then my expectation would be to extend it over somewhere around four to five hours would be my expectation. I think that the Warsaw Method often extends.
- [25:03]
A
You think it goes a little longer than you two things?
- [25:05]
B
I think it often goes a little bit longer, but I also think it in many people ends up being a little heavier. And that's why there is that math ability to say, well, I only need to count 30% of fat and maybe I only need to count this much of protein or whatever it is. And there's some wiggle room that you end up figuring out for your own personal needs. But the general math of how it's done is based on all in total. And then the calculator gets you to how much and how far to extend it.
- [25:36]
A
Awesome. So I'm going to go over this with you one more time. Your carbs, you calculate it as about.
- [25:40]
B
I estimated about 35.
- [25:43]
A
35. I'm writing this down. The fat. You said 30.
- [25:47]
B
I said about 30.
- [25:48]
A
Yes, about 30. The protein.
- [25:50]
B
About 20.
- [25:51]
A
About 20. You had the. It's funny, you had the bolus at what? And then you had a correction on top of it. You.
- [25:59]
B
Yes. So the bolus would have been for 35 estimated grams of carb just at a 1 to 10 ratio is 3.5 units.
- [26:05]
A
Yep. And you had.
- [26:06]
B
And then the correction. If you take current blood sugar 130 minus target blood sugar of 100, you get 30. You divide that by the correction factor of 50 and you get 0.6. That's the correction amount. Then you add 3.5 from the carbs to the 0.6 from the correction, you get 4.1.
- [26:24]
A
Yeah. And the extended.
- [26:26]
B
And the extended for The FPUS was 3.5.
- [26:29]
A
Okay. All right. I'm going to go slow because I'm excited.
- [26:36]
B
Okay.
- [26:37]
A
So the reason I explained to you all that I don't understand all this, like mathematically is because I've been doing something over the past couple of months. The haters out there, just hold on a second, okay? Because I think this is going to prove it out for you. I don't understand the Warsaw Method technically. I understand it theoretically. Sure I am. You know, I'm okay with breaking down boluses and, you know, by, you know, correction factor and, and by your carb ratio. I can do that. It does not come natural to me. I don't think about it that way.
- [27:08]
B
I think theoretical is a great way to describe because I know years ago when we had a fun little discussion about looping, when you started looping, like, like Jenny, I think I need to start doing carb counting.
- [27:24]
A
We might need to understand a little bit about what's going into this thing.
- [27:27]
B
This isn't working. But I think theoretical is because you've figured out by eyeballing, yes, a plate and being able to say in a general way, I know the ingredients that go into this. And I can estimate because I have historical information about what happens to my daughter's blood sugar after things like this. I can say I know how much I've touched up with and what has happened. So you have a. You have a base for that eyeballing.
- [27:58]
A
Okay. So. So yes, I for the last couple of months have been doing a thing. I've taken the deep research model from Google, Gemini and ChatGPT and I've been dumping your and my conversations into it. Okay. And so I told it to learn about how you and I think about bolusing by giving it a ton of the Bolas four episodes. I gave it the pro tip series and the bold beginning series and told it like, these are my theories and Jenny's theories about, like, how to handle diabetes. I gave it the episode where I spoke to the woman about the Warsaw Method and I said like, this is the Warsaw Method. Make sure you completely understand the Warsaw Method. And after you've understood all the, you know, all of it, I'm going to start asking you some questions. So I started asking it questions, and I asked it to build an AI prompt. So it's not a. It's not code or it's nothing. It's. It's. It's in English. It's pretty specific. Okay. But I've been hammering through it, using it, trying again, saying, oh, look, you didn't do this, you didn't do that. Fix it again. And I have a prompt now that I like pretty well. Nice. So when you and I started today, I dropped that prompt into Google Gemini. I wanted you to know I'm using that.
- [29:16]
B
All the fancy tools that you're using.
- [29:18]
A
No, no, no. I did it to show, and I did it like this because I believed in you and I wanted. And I wanted to prove out your knowledge, and at the same time, I wanted to prove out this thing. Okay.
- [29:31]
B
That must mean that my math teachers would be maybe proud of me.
- [29:35]
A
I think the whole world's about to be proud of you. Okay. So after I put this through, what I noticed was it split the pie into six pieces.
- [29:45]
B
Oh, interesting.
- [29:46]
A
So I said to it, hey, make the serving 1/8 of the pie and reevaluate. That's the only change I've made. Okay.
- [29:53]
B
Okay.
- [29:53]
A
You ready?
- [29:54]
B
Yes.
- [29:55]
A
Based on the adjusted serving size of 18 of a pie, ingredients break down for an eighth of a serving. Double pie crust, 28 carbs, 17 and a half fat, 3 protein. You said crust, 12 and 12. Okay. Chicken breast, 1.9 ounces, half of 4, just like you said. Fat, 2 protein, 13. Butter in the sauce, 7.5 fat. Flour is the thickener. 4 carbs.08 protein. Peas and carrots, quarter of a cup. 5 carbs, 0.8 protein. Whole milk, 0.8 carbs, 0.8 fat, 0.8 protein. Ready? Jenny said carb. Estimate 35. This says 38. Jenny said protein. Estimate 20. This says 18.5. Jenny said fat. Estimate 28. This said 30. Look how I'm going to curse. Look how close you were on all that. That's amazing. Hold up. Immediate bolus.
- [30:55]
B
It's just breaking down. Food rest. It's just breaking down.
- [30:58]
A
I know it's easy for you, but I. It's a magic trick to me. Okay? And sure, there are people out there that think like you, but they also don't have time to do this. No. Okay. This is a specific situation where two lunatics on 29 December are talking about pot pie. Okay. All right. Right. I don't know which one of us is crazier at the moment. It doesn't really matter. Okay. You said 3.5 for the bolus, 0.6 for the correction total 4.1. This has it as 4.4. Look how close. Okay. It has 3.8. Only because it had three more carbs than you did. Three point. The only reason it's a little off. Right. Extended bolus. It has the FPUS at 3.26. It wants an extended wave bolus of 3.25 units. Total dose 7.65. Your total dose was 4, 5, 6 7. Yours was 7.6. This total dose is 7.65.
- [31:58]
B
And again, I was a little bit over in protein and fat. Just slightly. Right. So that would make the difference too.
- [32:05]
A
Okay. And here's everything else you said. Timing, execution. This says pump settings dual or square wave bolus over five hours. You said four or five. This will probably be heavier. Pre bullets time. It says 13 minutes before eating. Constraint, logic, duration change. The FPU dropped the 3.26. This falls safely into the five hour bracket. This is because at. At. And this is important. I'm going to go back to this. When it was cutting the pie into sixth, it was a lot more insulin.
- [32:32]
B
Sure.
- [32:33]
A
Right. Just for that tiny bit more to your point about servings earlier. Okay. And it had the extended bolus out longer. And now this will be interesting. Watch points to tweak for next time. Do you know why it's saying that? Because of the meal bolt breakdown. Because I taught it that. And then. And that's what I've been building the prompt. Anyway. Listen, I might not be smart smart, but I'm smart.
- [32:54]
B
You are?
- [32:54]
A
Yeah.
- [32:55]
B
Everybody's got smarts in one way or another.
- [32:57]
A
It says T plus in 3 plus 3 hours. Check for a drop. The FPU is on the lower end of the five hour bracket. 3.2. If you tend to run low, you could manually shorten this to four hours. Look at this. But the standard work haul protocol suggests 5. Tweak for next time. Since the duration is now shorter, check BG here to ensure the tail of the fat protein digestion didn't outlast the insulin. What is my point? Hire Jenny if you can. If your brain works that way, God bless you. You might understand all this like this one day. But if you can't, if you're a big dummy like me, just ask the thing. Jenny, don't Lose track of the fact that I didn't tell it the ingredients.
- [33:41]
B
I gave it a link to a.
- [33:43]
A
Recipe, a link to a recipe, and it went. And God damn, I'm so proud of this. I can't begin to tell you.
- [33:51]
B
You should be. I think the other thing that is of value is you should always second check though the ingredient, what it is using. Because like you found, I looked right at the first part of the recipe. I'm always looking at servings that a recipe makes right. To know whether feeding my family with two hungry boys who eat everything, I'm like, yeah, I totally need to like triple this resume.
- [34:16]
A
It missed that because it missed that. It did.
- [34:18]
B
That's my point.
- [34:19]
A
The prompt missed it because the serving size. It says serving eight right there.
- [34:24]
B
Yep.
- [34:26]
A
So just because people might contextually be interested when the serving size was broken down as a sixth instead of an eight. Listen to this. Carbs total went to 50. Fat total went to 36 and a half. Protein to 24 and a half. The bolus goes up to 5.6 and the FPU bolus goes to 4.2. It's 9.8 now. Total insulin.
- [34:48]
B
A lot more insulin.
- [34:49]
A
Yeah. So if you just think of that pie and cut it into eight pieces, then the insulin is 7.65. You cut that same pie into six pieces, it goes up by over, like, over two units.
- [35:04]
B
And that was my point in making sure that you have fed it something that it's got the right serving size, especially in this kind of context, because let's say somebody didn't catch that it was doing this based on 6 servings instead of 8. They put in all the insulin. They wondering, why am I going low? When I did what I thought that I probably should do. I've given it all the right information. It's a really, really important piece.
- [35:31]
A
Yeah. I think that you should understand your diabetes. I think it is somewhat generally preposterous to think that you're gonna break down every meal the way Jenny just did. I think that it's a little preposterous to think that you might just be in the situation where I am, where I go, fat, protein, lot this extend like I. Some people's minds aren't going to work that way. This is a great example of why so many people struggle bolusing for this stuff. Like. Like it's just. And Popeyes, you know?
- [36:01]
B
Well, and I will say in a. I always try to think what's usable.
- [36:05]
A
Right.
- [36:05]
B
What's going to give you the most bang. And if you're going to use something like this. I can see two specific reasons that you would use this tool. One would be for a restaurant meal.
- [36:19]
A
Yep.
- [36:20]
B
Right. That even at least lists all the ingredients. You may not have the recipe, but you may have the ingredients that you could tell it, and it could give you a better base to start with. But the other one that actually goes farther is, let's say there's a family who has chicken pot pie every single Friday night, and they've yet to figure it out. After eight weeks of trying, they're like, I don't know, they're just gonna put insulin in tonight and figure out how much more we end up having to nudge it with. Right. But that's not fun, because I think that takes some of the joy of eating really, out of just sitting and enjoying the food that you like. So if you have meals that you make over and over and over again, but you have yet to figure them out, these are the meals to go in and put the recipe in, see what this could actually give you. And then, like I did years ago, something using a carb factor. Carb factor is an easy way to figure out by weight how much just carb is in a made recipe. And then you can weigh a portion and you can multiply it by its carb factor, and then you get a better carb count for that portion. But this goes even the next level, it takes into consideration fats and proteins and extending a bolus and all of that kind of stuff. But put sticky markers or notes in the sides of your recipes that say, this is exactly how to do this meal. Is it going to be 100% every time? No, because the variables coming into or after a meal like this, they're very likely going to be different.
- [38:02]
A
Yeah.
- [38:02]
B
But at least you have a really solid foundation to start with.
- [38:06]
A
Right? Right.
- [38:07]
B
And it could clean up if this. Again, if you do this for 20 meals that you guys favor over and over, you're probably going to hit, you know, a good 80% of your management, especially after dinnertime meals.
- [38:21]
A
So the way I see it is that it should be like an app on your phone or something like that, because I don't expect people to do this all the time. Like, that's not my. Although while you were talking, I just typed in, now do this for salmon, green beans, and mashed potatoes with a dinner roll. Same parameters. I literally didn't tell it anything about it. Right. Atlantic salmon, 6 ounces, 18 fat, 34 protein. Mashed potatoes, 1 cup, 35 carbs, 9 fat, 4, protein. Dinner Rol. 1 roll, 16 carbs, 2 fat, 3 protein. Green beans, 1 cup, 7 carbs, 4, 4 fat, 2 protein. It must be how it, like, so it went out on the Internet. Like, it didn't. It didn't. And it still broke it down. And so I don't, I don't know if this is right or not because I didn't tell it like, make the green beans this way, the rolls like that. But it's an estimate. I mean, does this, the estimate sound far off for you? Couple mashed potatoes, 35?
- [39:14]
B
No, not at all.
- [39:15]
A
Right.
- [39:15]
B
It's about right.
- [39:16]
A
It gives a bolus and extended weight. My thought here is, and listen, I'm gonna have to like throw 97 disclaimers on this. And I don't even know if I'm gonna make it available for people. Like, but like, I taught it to do that. Like, it wasn't five minutes. It was sometimes sitting on my sofa for three hours to my laptop going like, no, you forgot this. No, you did that. Like, I had to like, it wasn't.
- [39:40]
B
Like to teach it what to look at and then what to compute.
- [39:43]
A
It wasn't a sci fi movie. I didn't say, jarvis, I need you to like, make a prompt that does this. And it was like, here it is. It's perfect. It was not perfect, but I told it like, I want to consider fat and protein in every bolus. I want to, I want a good breakdown. It wasn't easy. Like, what I basically did was I took my like, non scientific, non mathematical, chatty brain and I chatted with the AI until it gave me back a prompt. Right. The prompt is not. It is. It is. It's not small. It's not like a, it's not a. How do I want to put this? It's, it's not like a paragraph. It's right.
- [40:24]
B
It's a, it's lengthy.
- [40:25]
A
It's about three pages in a document. Right there. It is like, you could take that prompt, add to it, this is my carb ratio, this is my insulin sensitivity factor, but please still ask me if my, where my arrow is, what my current blood sugar is. Like that kind of question. You could drop that prompt in with a link, hit enter, it would say, what's your current blood sugar? What's blah, blah, blah? You could pop that in, push a button. I'm telling you, it takes about 25 seconds and it kicks, it kicks all this back. Verified by Jennifer. Seriously, are you not amazed of yourself right now? I know you're not. Because it's just a thing you do.
- [41:06]
B
I'm more pleased that it actually is verifiable. What I know how to mentally compute. Yes.
- [41:15]
A
Can you imagine if it was. They. They were both like wildly different. Be like, Jenny, we're not going to use this episode.
- [41:22]
B
The interesting thing is, what I would love to see is the different. Is how it plays out in comparison to some of our newer algorithms, right. Specifically the open source algorithms like Trio. Because Trio allows you to enter all the macros, carbs, fats and proteins. Right. And into the algorithm and the calculation, it has these pieces factored in so it has an outward watch. For gosh. He told me that there are 30 grams of fat in this meal, there are 18 grams of protein in this meal, along with 50 grams of fat or carbohydrate. So I'd like to see how it would actually dole out the insulin compared to just this very flat application dose that you're putting in, in a fashion of drip. Drip from a pump that can do an extended bolus.
- [42:27]
A
So, right. If you had, if you had Trio as an example, where you'd actually be able to see what it was doing the whole time, right. So you could do this and then put these. So basically what we're doing here is like you're talking about the algorithm, what the algorithm does when you tell it. This is how many carbs, this is how much protein, this is how much fat I'm eating. This is taking that same kind of brain and saying, make sure I'm correct about the fat, the protein and the carbs.
- [42:51]
B
Correct.
- [42:51]
A
And now, you know, here's that information, go do something with it. And of course, variables, you know, how old is your infusion set? Like there's, you know, are you hormonal? Like, there's still a lot of other impacts, but based on this, you know, just these two ideas, it takes a lot of the variability out of it. If you're right about what you're telling the thing, and the thing is right about how it's handling that information. I just think that.
- [43:16]
B
No, it's great. Yeah, I think it's.
- [43:18]
A
I don't know where this is like yet, but this is a. You should all be paying attention to what we just talked about for the last half an hour here. The future is now is what I'm saying. This is not. I think I paid 20amonth for Gemini. I. I don't, I don't have some super.
- [43:33]
B
It's probably similar to Chat GPT, I think.
- [43:36]
A
Yeah. I don't know.
- [43:36]
B
Same.
- [43:37]
A
Right. What I've learned about the. Those two models, and I haven't dug into any others, I like a little more about the way Chat GPT writes. I think it writes. I think it actually writes a little more in my voice. So you guys want some insight? I train Chat gp. I gave it my book and my website, and I was like, this is about how I sound. So every once in a while, if I get like, if I get. If I get hosed up and I'm like, I need to, like, put something up and I don't have time, I can just. I can say, hey, listen, I want to, you know, I want people to listen to this episode because blah, blah, blah, please write it in my voice. Then I go back and I edit it. But it gives me a. It cuts 20 minutes out of that, right?
- [44:15]
B
Sure it does.
- [44:15]
A
It's amazing. But I like the Google Gemini better for code writing and more technical stuff. Oh, because I've been. May I at the end here. Sure. Can I. Can I bore you for a second? I've been messing with a lot of different things. Jenny's like, you're not boring me. Is that what you're going to say? You're going to be polite and say that. Look at you, so Midwestern, so lovely.
- [44:41]
B
Like, oh, my mom would be proud.
- [44:43]
A
Yeah, she. She was. She was like, no, you're not boring. Sure you are, Scott. Hold on a second. I'm logging into something and I'm.
- [44:50]
B
Those are the things, you know, parents tell you when you're having to sit and listen to grandpa's stories.
- [44:55]
A
My.
- [44:55]
B
My grandfather was a World War vet, and she always drilled it into my brother. And I, like, grandpa starts talking, you will pay attention.
- [45:06]
A
Yeah.
- [45:06]
B
You will sit there. You will not close your eyes. You will wait until grandpa's done talking about his stuff.
- [45:13]
A
So I've been using what I've learned. Like, and again, I want to be real clear. I don't understand coding at all. Like, I mean, I do not. Basically, I teach the algorithm deep research on conversations. And then, by the way, after it's done, completely, like, going over the podcast, I tell it, like, now everything you've learned, go access the Internet and fact check everything. Like, just don't take it because maybe you and I misspoke. Or, like, maybe it misunderstood. Like, so I'm doing a little as much redundancy as I can. Then I'm saying, all right, now give me code that I can put on my. My website. So this is not public right now. And I don't know that it ever would be. But I have a few things I've been working on. There's a something that's right now just called a strategy engine. So you can take your insulin to carb ratio, pop it in 10. Insulin sensitivity 50. Target blood sugar, let's call it 90. It gives you a max bolus limit to put in. It will allow you to enable reverse corrections if you want. You tell with the carbs. Hold on a second. Let's use what we just did here. This would be a good test for this then. So the carbs were 38. Right? The fat was 28.
- [46:30]
B
Were the carbs protein? Oh yeah, that's right. I guess 35.
- [46:35]
A
Yeah, yeah, the protein. I'm just going with this. The protein was 18.5. Current BG was 130. Insulin on board, zero trend arrow up. Generate a strategy. Boom, it's up already. 4.6 initial bolus, 3.26 for the FPUs, 7.86 combined. It says execution strategy. Pump setting, dual wave square 3.26 over five hours. Wait 13 minutes to pre bolus. Here's some safety precautions. Insulin on board, safety correction only. Subtraction. It's using the Medtronic model. I don't even know what that means. I want to be clear. Ambiguity guard, 10 to 70 range checked Warsaw method. Less than 1 FPO discarded. So it said do 4.60 and 3.26, 7.86. What we got with the prompt was 4.40, 3.25, 7.65. I'm going to tell you the same damn thing. Like, right, like it's a. It's. It's off by point. They Disagree by point 2, which is.
- [47:36]
B
Negligible for most people.
- [47:38]
A
That's embeddable on a website. Okay, here's some other stuff I've been working through. Basal math. Work through, enter a weight, 130 pounds. Am I a standard high? Am I high sensitive, standard resistant or highly resistant? Do it with me. 130. We're going to figure out somebody's basal insulin journey. 130 pound person, standard. Okay, tell me what their daily total basal insulin should be.
- [48:09]
B
They're 130 pounds.
- [48:11]
A
Yep.
- [48:13]
B
15. Just a rough.
- [48:16]
A
Yep. 16.25. Pump setting, 0.68 an hour. There's a fine tuning slider on it, right? I can say little less, little more like. And it tells you who fits. High sensitivity athletes, active kids, lean T1D standard. Most adults, preteen children, resistant, sedentary adults, Illness high Stress, high resistant puberty, teens, steroids, growth hormones. This is a embeddable app that it's hidden on my, my website right now. You guys can't see it. I, I'm the only one that knows where it's at. And it's password protected. You can't get to it. But that is code written from. I, I hope this blows your mind. The math behind basal insulin conversation we had. Right? And I said, read that, learn everything about it, fact check it. Build me an app. Boom. Insulin sensitivity calculator. Total daily dose. Let's make Somebody's total daily dose 50. Using the standard 1800, your estimated insulin sensitivity is. Do you want to do it or.
- [49:18]
B
You want to let it somewhere around 30, 35, 36. 36, 36.
- [49:24]
A
Yep. And there's a little tester on it. You want to test it. Make your current BG130. Make your target 90. Use 1.1 units. It says that's just to test the theory out. That's another app made from the math behind insulin sensitivity.
- [49:39]
B
And that's some of the math also that goes into your, your pumps if you're using that type of. Right. Yeah, it's just doing basic math for you. Otherwise you have to do the calculation and then manually enter the bolus. But today's pumps and for quite a long time have been. You tell it what your insulin to carb ratio, your ISF is during the day, what a target blood sugar that you're aiming for. And it does that all behind the scenes. And that's how it gives you the suggestion for the bolus. This.
- [50:05]
A
But when you start on day one, putting in your numbers, what have we learned through conversations? All in all, like a lot of doctors offices will under value your insulin needs. You start with bad settings and the pump struggles and then before you know it, it's 30 years later and you.
- [50:19]
B
Don'T understand it and it's all off.
- [50:20]
A
Yeah, Smart. Insulin to carb ratio calculator. Using the 500 rule. Total daily insulin 50, calculate ratio 1 to 10. So imagine you could just start with your weight and then get these three numbers, then put them into the machine and then go back and use the thing to break down and, and it tells you, hey, this is a, you know, you're going to do a meal wave bolus for this. It's blah, blah, blah. Your outcomes are going to be so much more predictable and probably accurate. Right. Because in the end these simple things, like I know that some people listening are like, yeah, duh, buddy, but I want you to know. Like, I only know this from talking to Jenny for all these years. Like when you and I started, I really was just a guy going like, Jenny, I think I see stuff that if I do it, this happens. And you have taught me over the.
- [51:15]
B
Years what it is that you're seeing.
- [51:16]
A
Yes, what it is I'm seeing. And we've been teaching other people, hopefully through those conversations. But now I woke up in a world two years ago and I was like, hey, you know, I type into a prompt and it's, you know, it's not great, but. And then over the last two years it's gotten so much better so quickly. I don't know that there's any reason to struggle. Like, I don't know that there can't just be a webpage that you go to where you check your settings real quick and then tell it, hey, what's the nutritional breakdown of this meal? And then that's my bolus and ta.
- [51:44]
B
Da would be lovely.
- [51:46]
A
Yeah, I got it right here. I just thought, I mean I got to talk to like, I don't know how many disclaimers I got to write all over it, you know, and that's.
- [51:53]
B
The hard thing, I think, and probably why I think it takes a certain type of brain to think through it the way that you have, which has been fantastic. That's where I get frustrated in the companies.
- [52:09]
A
Right? Yeah.
- [52:10]
B
Because there are many, many engineering minded people within the production, the technology companies for diabetes technology. And so this isn't rocket science.
- [52:24]
A
No, I'm an idiot.
- [52:25]
B
I want to be clear and you're not at all. But what I'm saying is that this isn't rocket science. So why, why can't we have exactly what you just said that comes along with each and every pump so that it can actually give you. Your pump has been prescribed, your doses have been approved by your, your clinician. Right. And this app just takes what you've been told to dose and actually makes it a heck of a lot safer for you to use the insulin because now you've got something telling you exactly where to put the dose and how to time it. Like it doesn't. That just makes. And most of the, most of the pumps now are app driven to some degree. So it's not like it's again, rocket science.
- [53:16]
A
Right.
- [53:16]
B
Connecting one communicating app to another community. Communicating app and letting it just give you better management.
- [53:24]
A
Yeah, I mean I don't, I, Jenny, I don't know how to code and I don't understand diabetes the way you Do. And I didn't go to college. And I just understand what. What I've learned over the years and what I've learned.
- [53:35]
B
People go to college who know nothing. So don't feel bad about that.
- [53:38]
A
You're very nice, but I'm just. I'm just trying to point out that, like, my baseline is guy trying to help his daughter. Right? Like. And I. I will take your, you know, your compliment. I. I think my brain works in a pretty interesting way. Like, that's fine, But. But I'm looking at this now. What I'm thinking about is all the people I've talked to and where their struggle points are, right? Like, if I give them all the steps you and I just laid out, people are going, I'm not doing all that. I'll just guess 40 carbs and I'll bolus again if I get high, you know, like. Like that guy. And I understand that, but I don't know that there's not a world where you can't just say, this is how much I weigh. And here's a link to what I'm eating. Let's go. I don't know enough about coding, but I don't know that you couldn't just combine all these little calculators together and put in a tiny bit of information. I actually, the one I've been working on would actually go out and get the link, but it's tough because you need an API. It's boring. But, like. Like, there's, you know, ChatGPT, Gemini. It's going out on the Internet, and it's figuring out based on databases like these, right? The stuff that's in this food. I actually toyed with the idea of, like, paying for the API, putting it behind a paywall, and just telling everybody, like, look, it's five bucks a month. That should cover the tokens and go ahead and use the damn thing. You know what I mean? Like, I'm trying to figure all that out right now. But again, I'm not a coder, so it's taking me a little more time. Time. But anyway, you all, like, I don't know, don't take my advice. I swear to God, I. I literally. I went to summer school in ninth grade because I. I failed algebra. I just want you all to know that.
- [55:12]
B
All good.
- [55:13]
A
All right. Thank you, Jenny. This was really awesome. You are awesome.
- [55:16]
B
Thank you.
- [55:17]
A
Yep.
- [55:17]
B
Thanks.
- [55:26]
A
Having an E. Easy to use. An accurate blood glucose meter is just one click away. Contour next.com juicebox that's right. Today's episode is sponsored by the Contour Next Gen Blood Glucose Meter. I'd like to remind you again about the MiniMed 780G automated insulin delivery system, which of course anticipates, adjusts and corrects every five minutes to 24 7. It works around the clock so you can focus on what matters. The Juicebox community knows the importance of using technology to simplify managing diabetes. To learn more about how you can spend less time and effort managing your diabetes, Visit my link MedtronicDiabetes.com Juicebox okay, well here we are at the end of the episode. You're still with me. Thank you. Really do appreciate that. What else could you do for me? Why don't you tell a friend about the show or leave a five star review? Maybe you could make sure you're following or subscribed in your podcast app. Go to YouTube and follow me. Or Instagram TikTok oh gosh, here's one. Make sure you're following the podcast in the private Facebook group as well as the public Facebook page. You don't want to miss please do you not know about the private group? You have to join the private group. As of this recording, it has 74,000 members. They're active, talking about diabetes. Whatever you need to know. There's a conversation happening in there right now and I'm there all the time. Tag me. I'll say hi. If you'd like to hear about diabetes management in easy to take in bits, check out the Small Sips. That's the series on the Juice Box podcast that listeners are talking about like it's a cheat code. These are perfect little bursts of clarity. One person said I finally understood things I've heard a hundred times. Short, simple and somehow exactly what I needed. People say Small Sips feels like someone pulling up a chair, sliding a cup across the table and giving you one clean idea at a time. Nothing overwhelming, no fire hose of information, just steady, helpful nudges that actually stick. People listen in their car, on walks, or while they're actually bolusing anytime that they need a quick shot of perspective. And the reviews, they all say the same thing. Small Sips makes diabetes make sense. Search for the Juice Box Podcast Small Sips Wherever you get audio, have a podcast. Want it to sound fantastic. Wrongwayrecording.com.