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Scott Benner 0:00
Hello friends, and welcome to episode 796 of the Juicebox Podcast.

On Thanksgiving morning in 2020, I woke up with this idea of how to talk people through Thanksgiving. And I recorded it and put it up for people to listen to. It got a great response. I see this episode shared online quite often actually around days like Thanksgiving where there's going to be consistent food throughout the day, you know, grazing, not some kind of set meal times. People seem to love it. They share it with each other. But there are so many new people listening to the podcast and I thought anyone not on Facebook are lucky enough to see it on Facebook isn't going to know it exists. So today, I'm going to replay it for you. If you've already heard it as Episode 412, you're done. There's nothing for you to do, you can leave. But if you'd like to hear me talk it through sadolin while you're making the gravy, I will talk about how to Bolus on a hectic day like Thanksgiving. There aren't going to be any ads but I will list the advertisers before the program starts. Please feel free to use my links if you ever have the need, as it supports the show great like I'm going to say this here just quick even though I think it gets set again on the recording but nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan. The Juicebox Podcast has been sponsored for a long time by some great companies on the pod makers of the Omni pod five and on the pod dash Omni pod.com forward slash juice box by Dexcom. Makers of the Dexcom G six continuous glucose monitor. See if you're eligible for a free 10 day trial to Dexcom g six@dexcom.com. Forward slash juice box use the most accurate and easy to use meter that I've ever held. The Contour Next One at contour next one.com forward slash juice box. My daughter carries G vo glucagon and you can find out more about it at G vo glucagon.com forward slash juice box. One an insulin pen that does more. You're looking for the in pen from Medtronic diabetes in pen today.com We get our diabetes supplies from us Med and you could as well. Us med.com forward slash juicebox would you like to see an organization helping people with type one, all you have to do is go to touch by type one.org and ag one by athletic greens is the drink I drink every morning. You could go to athletic greens.com forward slash juicebox get yourself some ag one. All right, let's find out what I sounded like two years ago. Hello, everyone, and welcome to episode 412 of the Juicebox Podcast. Think of today as a pep talk for Thanksgiving. Today we're just going to talk about how Arden is going to manage on Thanksgiving Day. Which if I'm being honest, really is about how we manage every other day. Just that people seem to get very nervous around these holiday situations. Can I understand why there's probably more grazing and snacking. There's also a lot of variables in what you're eating. We'll break it all down. Talk about how I'm going to attack it. See if you can find some good ideas in here for yourself. Please remember while you're listening that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making changes to your health care plan. Becoming bold with insulin or stuffing your turkey and that's not some weird euphemism actually think when you stuffed the turkey. You can like mess it up and cause a problem is it trick and Gnosis botulism? Botulism that sounds like something to do with a can. Alright, so before we get everything else, let's just figure out what undercooked poultry does to prolong cooking you're stuffing in the turkey they're calling that a mistake to avoid I can tell you personally, I used to put my stuffing in the turkey but it slows the cooking time way down and doesn't allow an even heat to go through the bird and I don't do it anymore. I prepare my stuffing and actually make it by hand I bake the bread tear it up days in advance let it become stale almost and then combine it with a whole bunch of different that's not the point I make my own stuff. Make the stuffing and I put it in a pan and bake it in the oven. Because I found when I put it the stuffing in the bird took too long to cook and I wasn't getting a cook through the way I wanted. So now I'm drying the outside of the turkey took took the internal portion what Hold on a second uncooked. I know we'll get through the rest of it. Just give me a second Turkey causes Wow. Raw and undercooked meat and poultry can make you sick. Most raw poultry contains Wow can't be low Baxter can't be low back there needs a better name. It also may contain salmonella, Clostridium perfringens and other bacteria. Raw meat may contain salmonella, E. E stands for EU in this situation. How long does it take to get? I'm falling down a rabbit hole here. How long does it take to get food poisoning from Turkey? 12 to 72 hours the symptoms usually lasts around four to seven days. Wow. Cook your turkey. You know poultry it has to be cooked to 165 degrees, right? Hold on Turkey. Done. 100%. Right. Yes, 165 degrees. A whole turkey is safe when cooked to a minimum internal temperature of 165 degrees Fahrenheit, as measured with a food thermometer. Check the internal temperature in the innermost part of the thigh and wing and the thickest part of the breast. All right. There's our little turkey tutorial. Whoo, I just found the name of the episode by mistake Turkey tutorial. That'll be fun. Alright, I'll do that. Let's talk about some other stuff. Everyone freaks out around holidays. Oh my god, we're gonna be snacking all day. There's food in the house. There's bowls of food on the cabinet. There's grazing, I hear you. Maybe this COVID Thanksgiving might not be exactly the same as most but still, it's here, right? You're gonna get up have a breakfast, there's going to be a big launch or a big dinner. grazing in between pie. I'm assuming cookies. gluttonous extravaganza. Here's how I think about a meal with insulin. First, I wonder how long does it take for the insulin to start working? How long till it effects the blood sugar? And how long will it last in the body? That's my first thing. How does the insulin work? And Arden first thing to consider? Second thing? What is art and eating carbs? How many? Yeah, that's easy, right? You count the carbs. Everybody's like, no, no, it's not easy, Scott. Because stuffing. And it's pretty easy. You don't I'm saying handful of stuffing ish is probably a piece of bread and a half something you got to you got to wing it a little bit. Just didn't mean weighing it because of the turkey. You got to just kind of like roll with it, you got to look and guess be kind of aggressive. But still, the most important thing here is Pre-Bolus thing, getting your insulin in and working so that it can time itself up with the impact of the food. So what we're talking about here is timing. So that the insulin kind of comes online, at the same time that the food comes online, meaning while the food is pulling up on your blood sugar, you want the insulin to be pulling down, you want them to get involved in a tug of war that no one wins. That's how you keep a stable line. You know, when you see people's lines are super stable on their graphs. But they have food in there. And they're like, Yeah, but you can't find the bagel, you won't be able to hold on work. I'm sorry, I've been sick. How do you not see the bagel on the line is because that as the food impact is trying to push the blood sugar up, the action of the insulin is trying to pull it down. And so it just creates this stability. No side is winning the fight. So you have to Pre-Bolus your food, you can't let the carbs get ahead of the insulin. And to understand Pre-Bolus thing better, you can check out episode 217 diabetes pro tip Pre-Bolus. Now the next thing to consider is the impact that the food or the drink you're having is going to have on the system.

And it's not as easy as saying this is 10 carbs, because 10 carbs of Hawaiian Punch will impact your blood sugar differently than 10 carbs of macadamia nuts. I don't know how many carbs are in macadamia nuts. But imagine you've eaten 10 carbs of them. The punch will hit you quickly and harsh right your blood sugar will shoot straight up while the macadamia nuts which by the way, I've checked on and one cup of whole or halved macadamia nuts have 19 carbs. So if you have a half a cup of macadamia nuts, which is probably what like a handful, you've got 10 carbs, but they're not going to hit with the same exuberance that a simple sugar like a juice would. So keep that in mind for a second you have 10 carbs worth of impact on your system. If it's something liquid, like the juice or something sugary, it's gonna happen very quickly. So you need the insulin to be working when the Hawaiian Punch goes on. I have no idea why I picked one punch. I've never drank wine punch in my life, nor do I know anybody that drinks it, but that's not the point. The point is, you may need a longer Pre-Bolus so that you can match the action of the insulin up to the impact of the Hawaiian pot. And now for something like the nuts, you might be able to Bolus with the carbs, wait a couple of minutes and start eating. Because as the insulin slowly comes online and begins to work, the nuts are slowly coming online and trying to push your blood sugar up. Now the key around these bigger days, I think, is understanding there's going to be a mix of foods, a mix of impacts. Pumpkin pie is sugar, and milk, right, there's like, like milk in it, I think. So there's some fat, but then you have the flour from the pie. So you have two different impacts, you have the sugary filling impact, and the karbi flour impact. Same with a cherry pie, apple pie, sugary and carby. At the same time, it's not dissimilar to Chinese food, where you'll get the slower carbon pack of rice, but the quicker sugary impact of some of the sauces. So imagine that for pumpkin pies and example, you'll need enough of a Pre-Bolus that you'll head off the sugary spike. But you still need enough insulin over the timeline that the pie is going to impact your system to keep down any slow risers. So there's two things in there, a more fast acting carb and a more slow acting carb. If you're pumping, you may use an extended Bolus, a Bolus that we put in a portion upfront and drag the rest of it out over time. I'm also a big fan of manipulating Basal insulin. top line idea being that if your Basal is set to keep your basic body function stable, and now all of a sudden, you're adding a whole lot of carbs over many, many hours. It's reasonable to think that the Basal insulin you're using on a normal day might not work as well, on a carb heavier day. To learn more about Temp Basal increases and decreases go to Episode 218, also part of the diabetes Pro Tip series for Temp Basal. While we're at it, you're going to want to look at episode 263. It's about how fat and protein impacts your blood sugar to things that you don't think of as being impactful on your blood sugar, but they are fat slows down digestion, slower digestion lengthens the time that the carbohydrates impact your system and protein. As your body breaks it down. Your body turns protein into anybody. Glucose and glucose is anybody. sugar and sugar makes your blood sugar go up. So all those proteins people like those are free carbs, those are free carbs. Are they diabetes, pro tip, Episode 263, fat and protein. Some people who aren't MDI multiple daily injections who are injecting their Basal insulin and not manipulating it with their pump. Find on days like Thanksgiving, a little little extra basil might be the way to go. The idea being your Basal insulin, again is only supposed to keep you stable at a number and stable. So if you're super stable all day without food and your blood sugar's 200. My opinion your Basal is not strong enough. But if you're super stable all day at 95. Without food, Basil is probably right on. But what if you put in a tiny bit extra, it would be holding your blood sugar down a little farther. But if you're planning on grazing all day, and eating that may again be necessary. All we're talking about is manipulating the insulin to put it where you need it. My goals during the day are really simple. Yours should be to I'm trying to maintain the steadiest blood sugars as I possibly can. And I want to avoid spikes and significant lows. After food. I don't want Arden's blood sugar to go over 140 and in a perfect situation, I'd like Arden's blood sugar not to go below 70. But you know, if it hits 65 for a second, it's not the worst thing in the world my opinion. I follow a few rules around this. First one is, it is far easier to stop a low or falling blood sugar than it is to return a high blood sugar to a safe range. Right? So stop a fall with a little juice, get it leveled out, start over again, or have a 300 blood sugar that you're fighting with all day. Which scenario would you rather Bing for me? I'd always rather be on the other side. But don't get me wrong. I'm not trying to make a low blood sugar. I'm saying that they're easier to fix without a rebound. How do you stop a high blood sugar from happening if you've messed up the Bolus? Well, I'd look into bumping and nudging a little bit. That's going to be in Episode 225 diabetes pro tip, bump and nudge. Basically the idea is this. I think of type one management as driving. There's lines on either side of the lane and I I'm trying not to leave the lines. That's why I have my daughter's Dexcom CGM set at a high alarm of 120. A low alarm of 70. If she should drift under 70, we bump it back up with a little bit of juice. The idea being, the less you use in carbs, the less likely you are to overcorrect up. So I'd like to know sooner, so that I can kind of bump it back up. Same thing with the high blood sugar getting over 120 legit back down again. Again, the idea being the amount of insulin that it takes to turn on 120, that's rising into a 90 that stable is far less insulin than it would take to turn a 200 into a 90. And you know, once you start getting up 151 8200, you start using more and more insulin, which eventually causes a low later. And then should you miss address the low now you're on the roller coaster and you're up and down. So I like keeping what feels like tighter tolerances, so that you can just make small adjustments to stay in your lane. Over time, that turns into better bolusing. Better correcting, you just get better at it. In general, before you know it, you don't really leave the 70 or 120 or whatever range you said, that's been my finding. If you're interested in learning more about the Dexcom G six continuous glucose monitor, go to dexcom.com forward slash juice box. There are links right there in the show notes of your podcast player, and at juicebox podcast.com. Now I think it's important to remember to Bolus for what you're eating. But all of that infers that your settings are good to begin with. And for many of you, this might end up being your Achilles heel. What do I mean? Well, many people I find have Basal insulin that is not well dialed in. So either your blood sugar's are always on the higher side. And you're making these very aggressive bonuses at meals because you don't realize that but when your Basal is off, well then your meal Bolus is off to here's what I mean real quickly. Let's say that your Basal insulin should be one unit per hour, but you have it at a half unit per hour. That means that every two hours of the day, you're missing out on a unit of insulin. So if you're at a half, and you're really a one, you're 12 units deficient over a 24 hour period. So you're trying to make that insulin up somewhere, you're very likely making it up with your meal insulin. So if you're not using enough basil, you probably think you need more for your meals than you actually do. Meaning if you had more basil, which would hold your blood sugar lower and more stable, you would need less insulin, mealtime. And vice versa. If your basil is too heavy, you're probably one of those people who's like, oh, I

barely use any insulin at meals. Because you have so much Basal insulin going throughout the day, you're basically feeding the Basal to stop you from getting low. Does that make sense? And if that does make sense to you, but you'd like to learn more, check out episode 237 diabetes, pro tip setting Basal insulin. So back to my original thought here, you need to put insulin in for the food you're eating. If you eat something at 9am, and then at 10am, and 11:30am. And then again at 11:45am. These things all need to be covered by insulin. Now if your settings are right, then put what you put in at 9am is for that food, what you put in a 10 is for the next food, etc, and so on. But if you're too aggressive with your meal, insulin, meaning your settings are way off, maybe what you put in at 9am and 10am was too much for that. So you're thinking oh, the thing is, you know, 1130 that's free? Yeah, it may be but it'd be better to just get your Bolus is down better. So that you can continue to Bolus for the things that you eat. That becomes very important on days like today while grazings in line. Because what happens is you start thinking, Oh, I have enough insulin for that, then you don't then you're 100 blood sugar turns into 150 You know, like it'll come back down. And then it doesn't, you have to Bolus for what you're eating. My opinion is to stay aggressive with the foods that you're eating. Keep after them with insulin, and if you do cause a low later, well, lucky you. It's the most food horrific day of the year, there's something to eat. Again, I'd rather be on the lower side than the higher side. And you might be thinking, Scott, that stacking my doctor told me never to stack insulin. to that. I would say it's only stacking if you don't need it. If you do need it. That's called bolusing if things do go wrong, please do not throw yourself into a tizzy. Don't start yelling about diabetes being unfair and you always knew this was gonna happen and falling into the drama because the drama stops you from learning the lessons because everything that happened is right there in front of you. You can see I Bolus here then this happened. I wanted that to happen next time I should Bolus a little more or a little less or a little sooner or a little later. You don't want to give up the lessons. They're hard fought Right. And you don't want to keep having to have them over and over again just to learn them. So get rid of the drama. Try to figure it out, you can do it, you can absolutely do it. Make your best guesses about carbs. Keep in mind that potatoes are going to hit a little more substantially, then I don't know green beans, right green beans, thought Garza. Um, I think green beans, carbs, I don't really eat green beans. Hold on a second. Yeah, green beans have carbs. A couple of green beans has seven carbs. I don't really count carbs. Actually, I just sort of guesstimate the plate. And you probably can too, if you have enough. If you have enough time in the simulator, and you've really been able to figure it out. You just sort of looked down you go, I'll tell you right. Now, here's how I do a plate I go potatoes 30 piece of bread 20. Turkey 10. Beans, 10. We got here cranberry sauce, I don't know. Little bit of it five. I just roll like that was bang, bang, bang, bang, bang, insulin goes in good Pre-Bolus Get a good fight set up between the food and the carbs. And then correct on the backside. If you have to, you may have to correct with insulin, then you may have to correct with food. I'm not sure. But sitting around and waiting and crossing your fingers. It's not a good planet, I would much rather punch first. That's sort of how I think about bolusing. Because when it this is a sports metaphor. So I'm sorry if you don't get it right off the bat. But you need to dictate the pace. Right? You come out swinging any way you want to think about it. You act first. So that the next thing that happens is because of you because at least that you can measure. Right when you cover your face. And you're kind of hiding and you're just hoping not to get knocked out. You don't know what's happening to you. You don't know why your blood sugar is doing what it's doing. But at least you can say, You know what, I had an eclair. I thought it was 35 carbs, my blood sugar went to 200. And later I had to correct with another unit. So next time I'm going to get that unit into the original Bolus, I'm going to say it gets that ICLEI or maybe it is 35 carbs, but it punches like it's 45 carbs, or whatever. You know, your numbers may vary. But the idea is there. I learned from that and move on. And the next time I have an eclair they do a better Bolus job. That's it. Get out be aggressive. Don't be scared. Do your best test if especially if you don't have a Dexcom CGM test, use your meter My daughter loves the Contour Next One meter. And you can learn more about it at contour next one.com forward slash juicebox. But that's how we roll Arden pumps, I should have said that up front, Arden has an Omnipod she's had an iPod since she was four. And she is 16. Now, as a matter of fact, if you'd like to learn more about Omni pod, you go to my omnipod.com Ford slash juicebox. And Omnipod would be delighted to send you a free, no obligation demo pump, you can actually try it in your home, see if you like it. But that's beside the point, I digress. You have to do what you have to do. Whether you're on MDI and you're going to be a little more aggressive with basil for Thanksgiving, where you're on a pump. And you think yourself yeah, this is the second day of my arm, the pod but my site starting to get a little funky. So I'm going to change my insulin pump the night before Thanksgiving. So I have a nice fresh infusion going on Thanksgiving Day. Those are the kinds of little things you can do to prepare. From there. Don't get behind because when you start chasing blood sugars, it takes a special kind of ninja level to crush a high, bring it down and get it stable again. So as corny as it sounds, you'll never get high if you don't get high. Make sure your base was right. Learn your Pre-Bolus times understand the differences in different glycemic loads and glycemic indexes of foods. Ie how hard and how fast they hit you and go for it. Test when you need to test. Be ready. But don't let it ruin your day. And I'm saying you can have a good day too. And if you're catching this one the day before Thanksgiving, you're like well this would have been helpful last month. The podcast is always here for you will get the guts Get it together for Christmas dinner. Right? doable. It's very, very, very, very doable. For perspective. My daughter has a once he has been between five two and six two for almost seven years. She has no diet restrictions. Her blood sugar's are very stable. Her time and range is excellent. She has the consistency that you want. And the only thing I know how to do is use insulin. Everything else is extra. There's a ton of variables don't get me wrong. A lot more than what we spoke about here today. As a matter of fact, in Episode 231 diabetes proto variables we talked about a lot of them. We talked about it ton of stuff, how exercise impacts things. And there's no doubt that it'll take time for you to understand all the variables in a way that's actionable in the moment. But it is incredibly doable. So if this is your first time hearing the podcast, I hope you jump into those pro tip episodes, and see what you can figure out. They're all available at diabetes pro tip.com are right here in your podcast player. And if you're a longtime listener, you're just looking for that pep talk for Thanksgiving. Go get at it, you can do it. Oh, you know what I should say, if you're gonna have time around family and friends who don't understand diabetes, and you wish they understood it better. Episode 371 explains type one diabetes to an outsider. Maybe then Mom will understand why you're a little agitated. Because all the different pies are coming and nobody told you how many carbs are in them and etc, etc. All right. I really enjoyed this. I hope you have the happiest of Thanksgivings. I know you can do this. And if you need help, check out the private Facebook page for listeners of the podcast Juicebox Podcast type one diabetes. There are over 7000 people in there talking about management. And if you have a quick question, I can't think of a better place to ask. I want to thank the sponsors even though there were really sponsors on this episode, but I slipped them in you know I'm saying the Omni pod tubeless insulin pump, you can get a free no obligation demo of the AMI pod sent directly to your home by going to my Omni pod.com Ford slash juice box. You can learn more about the Dexcom G six continuous glucose monitor@dexcom.com forward slash juicebox. You can also get yourself a Contour Next One blood glucose meter which is the easiest to use and most accurate blood glucose meter that I've ever used for my daughter. Contour next one.com forward slash juice box. Add your voice the type one diabetes research with the T one D exchange T one D exchange.org forward slash juicebox. That's for US residents only.

You know, I cook every year Thanksgiving and the one thing I can't figure out is how to make gravy myself. I am bad at it. And it had something to do with the drippings. And flour. There's whisking involved, but I just can't do it. I don't know what your plan is. This year, I'm going to actually smoke a turkey a smaller one and a pellet grill and make a smaller one in the oven bacon tubers. I'm trying to cook two birds with two ovens at the North. Trying something new but didn't want to mess up and have forever to be like oh great. This sucks. So I'm gonna double up on the birds this year and see which one flies. That was a terrible joke. Mashed potatoes I'm great at going to be some yams, beans, vegetables, cauliflower, making some fresh bread. Like I said earlier, I make the stuffing myself learned from my grandma. I hope you have a great day too. No matter what your tradition is. I think you can do this. I swear you can. Let me just leave you with this. If you told me I could, in two sentences explain diabetes on Thanksgiving to you. I'd say get ahead and stay ahead. And then if you didn't cut me off right away, I'd say you have to get your Basal rates, right. You need to learn how to Pre-Bolus and please understand the different impacts of different foods. That's really the basis of this. That's enough to get you through tomorrow. And those pro tip episodes, they'll teach you the rest. Thank you so much for listening, have a happy Thanksgiving. There's a lot more coming on the show between now and the end of the year. I actually have a doctor coming on next week who is so well versed in treating thyroid issues I just recorded with her today. It's a it's an absolute joy to treat you're gonna love and you know what I'm asked will say here, all the sponsors are back in 2021. And I'd like to thank them Dexcom on the pod Contour Next One touched by type one, G vo Capo pen, T one D exchange. Their support allows the podcast to get produced the way it does. I'm sitting in front of a microphone the day before Thanksgiving recording this for you. Because this is my job. And I get to have this amazing job because you guys support the show and your support leads to add support and add support pays my bills and then I get to sit here and do this. So it's a circle of life kind of a situation for everyone except the turkey.

Well, thank you so much for listening. I hope you enjoyed it. I'm sure you're going to do terrific today or whatever day we're talking about. Maybe it's Christmas or a baby shower or something like that. I hope This helped you get through it. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. Don't forget to support the sponsors. There are links in the show notes of your podcast player, and links at juicebox podcast.com. To all of the sponsors. When you use them, you're supporting the show. Don't forget to take the T one D exchange survey and T one D exchange.org. Forward slash juicebox. And of course, share this episode and the podcast itself with someone else who you think might enjoy it. No matter what day you're celebrating, I hope it's a good one. If things aren't going well or you're looking for a little more help, you should head over to the private Facebook page for the podcast Juicebox Podcast type one diabetes, and there will be someone there to answer your questions. The Facebook page is always free. And and this is amazing. And it's inhabited by over 30,000 people just like you have a question ask it I bet you someone answers it might even be me. And now for the next 35 minutes I'm going to do my turkey calls which I've been working on all year

Wait, I gotta get closer to the microphone. Sorry

let me get clear. I got it ready Yeah, I'm just getting alright. Happy Thanksgiving.