#1020 Diabetes Pro Tip: Glycemic Index and Load

September 24, 2023Scott Benner

Scott and Jenny discuss the importance of understanding the glycemic load and glycemic index of foods. They emphasize that different foods can impact blood sugar levels differently, even if they have the same amount of carbs.

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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.

Scott Benner 0:03
Hello friends, and welcome to the diabetes Pro Tip series from the Juicebox Podcast. These episodes have been remastered for better sound quality by Rob at wrong way recording. When you need it done right, you choose wrong way, wrong way recording.com initially imagined by me as a 10 part series, the diabetes Pro Tip series has grown to 26 episodes. These episodes now exist in your audio player between Episode 1000 and episode 1025. They are also available online at diabetes pro tip.com, and juicebox podcast.com. This series features myself and Jennifer Smith. Jenny is a CD and a type one for over 35 years. This series was my attempt to bring together the management ideas found within the podcast in a way that would make it digestible and revisit double. It has been so incredibly popular that these 26 episodes are responsible for well over a half of a million downloads within the Juicebox Podcast. While you're listening please remember that 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 or becoming bold with insulin. This episode of The Juicebox Podcast is sponsored by assenza diabetes makers of the contour next gen blood glucose meter and they have an amazing offer for you. Right now at my link only contour next one.com forward slash juice box free meter you can get an absolutely free contour next gen starter kit that's contour next.com forward slash juice box free meter. while supplies last US residents only. The remastered diabetes Pro Tip series from the Juicebox Podcast is sponsored by touched by type one. See all of the good work they're doing for people living with type one diabetes at touched by type one.org and on their Instagram and Facebook pages. This show is sponsored today by the glucagon that my daughter carries G voc hypo pen. Find out more at G voc glucagon.com. Forward slash juicebox. Okay, Jenny, so I know how people's minds work. And the problem with this episode is it's going to be incredibly important. And they're going to see the title and not listen to it. Right? Nobody. I'm just going to curse and I'll bleep it out later. For some reason. Your mother during glycemic load and glycemic index foods you're making me crazy. Okay. So here's the here's the problem. The core of this cod podcast, the concept behind it is I don't think you should have to limit your diet. The unspoken part of that sentence is I also don't think you should have a bag of sugar every day. Right? So I want you to Yeah, listen, if you get crazy one day and you're like having a pop tart, or I want to eat a bowl of cereal, I want you to understand how to Bolus for that that's really the the reasoning for the podcast that it's at its beginning, like I said, but the amount of people who say hey, listen, I counted these carbs. And it didn't work. So I don't know what you want me to do about it? Well, what I want you to do about it is understand that there's a difference between 10 grams of potatoes and 10 grams of sugar and 10 grams of Pop Tarts. And Cheerios are the I'm fascinated by how many unhealthy foods people think are healthy. Which one jumps into your mind when you say that? Because I think of wheat bread right away. Like somehow it being wheat bread doesn't make it bread.

Jennifer Smith, CDE 4:09
Right, I think of especially in the past five years, I would say maybe even more than that. I know what you're gonna say go ahead. I think of meal bars. I don't know what else to call them.

Scott Benner 4:27
I was gonna say go ahead.

Jennifer Smith, CDE 4:28
It's kind of like the bread idea. Just because Wonder Bread now says that it's wheat bread versus white bread. That's like if you want real bread, like go back to granny. She made her bread right? And even you know breads today being there's a plethora of them on the market. Right? But just because it says wheat bread doesn't mean that it's healthy bread. I mean if you're talking about like healthy bread, if you're going to eat it, you're talking About the sprouted like low glycemic, we'll talk about the glycemic sunsets yes of this whole episode. But right I mean, those types of breads the unprocessed, you can actually physically see the grains in it or the seeds or whatnot. There's a big difference between wonder wheat bread and sprouted grain Ezekiel bread. major difference.

Scott Benner 5:23
Even when I make bread at the house, I'm only just making white bread, but it's at least sugar, flour, yeast, water, butter. That's it. That's what's in it. Like salt. Excuse me, that's, that's what's in it. It's of course, the the flour is processed and the sugars processed. But you can buy a loaf of wheat bread. And the first ingredient is high fructose corn syrup. Right. And people are like, I don't know what happened. Right? I do.

Jennifer Smith, CDE 5:53
I do too. Yeah. It's kind of like I said to though, with the bars, people, lives are busy today. Very busy. And I actually did a whole like, I think I did a blog post about this actually, or it was in part of our newsletter or something all about, like, sort of the false advertising of nutrition bars, right? You're eating your nutrition bar, because it's like, it's low carb, or it's low glycemic, or it's follows your keto plan, you know what they're, you're gonna follow a plan, follow a plan and eat real food. Most I say most of the time like these, like 9010 8020, kind of, most of the time you're doing real food, you know where it came from, your grandmother could identify it, I can guarantee that if I showed my grandmother who was no longer living something like, I'm not gonna name a brand, but a general like, a store bought processed meal bars to be like, What is this? What is this? What is this gonna make yourself a peanut butter sandwich or something, you know,

Scott Benner 7:04
those things are so dense, with calories and carbohydrates and all that stuff. My son uses them. So my son does not like to have a full stomach when he's playing baseball. But you can't go play college baseball in the heat without fuel, right? But he can take like a half of one of those bars and power him through a baseball game. There's so much jammed into it. So he likes them because they don't fill his stomach. But it goes to show how much fuel is in it and you know, things that impact your blood sugar. I thought, you know, when you said, you know, a bar, I thought you might say vegan food. And I thought your vegan diet and I thought you might say no gluten stuff. Because I had to remember one time, they were trying to figure out my iron issue. And a doctor said, Hey, don't eat gluten for a month. And in a month of eating not gluten. I gained like eight pounds. And I thought, but I'm eating healthier. And then I looked back and I went No I'm not. I'm just eating things that don't have gluten in them. Right? Right. I confused no gluten with health. And my daughter's friend is a vegan. But she's basically a human garbage can. You know, it's fascinating.

Jennifer Smith, CDE 8:23
It is in terms of I mean, just those two, vegan or even being vegetarian is kind of the first right. Okay, you don't want to eat meat. Great. I mean, for the most part, the only animal that I eat is fish, okay, than any of the other animals on the planet. I eat fish. It's occasional, not very often. So for the most part, we are mostly vegetarian. And but you could be a very unhealthy vegetarian, you could also be a very unhealthy vegan. I mean, if you're doing a heck of a lot of the processed, oh, but it doesn't have any animal based product in it. Great, but like, how long has it been sitting in the bag or the box on the shelf just because it doesn't have animal product in it? Or? Right I mean, there are healthy ways to be vegetarian or vegan. They're also healthy ways to be on a ketogenic diet. You know, a lot of the products that are on the market for that type of an eating fueling plan are very processed, you can be healthy and actually eat good real food on a ketogenic diet or on a vegetarian diet or on a paleo or a caveman diet. But much of the process stuff that's out there like you found with the the gluten free stuff. Yeah. Unfortunately a lot of the gluten free packaged processed stuff. It's made out of very this is brings in glycemic index. It's made out of very high glycemic quick impacting refined carbohydrate, rice flour, tapioca starch, potato flour, I mean, the lower glycemic ones would be things like if it's made out of like an almond flour, or like the nut flowers or like a coconut flour or something like that. Those tend to be lower impact, lower glycemic, still processed. But

Scott Benner 10:15
the reason I bring it up, and I'm sure this happens to you constantly, then to me far last, because I don't speak to nearly as many people one on one as you do. But I am just endlessly inundated with people who want to know like, I don't understand why this isn't working. I eat healthy. It's almost like when people say it's almost like when people say to me, Oh, my blood sugar got really low. I've learned not to infer what I think of his low into what they say in the beginning, when someone say to me, Oh, I got really low, I'd go right over it. Now I stop. And I go, what does that mean? What number is really low? Because sometimes the personal say, 85. And I'll go oh, well, that's not really well. And so it frames my conversation. So when people say I eat healthy, I do. I'm like, what does that mean? Right? Because I need to understand what you're eating to talk to you about the insulin you're using, because we did everything right here. Your blood sugar should not be 200 right now, why don't understand I had a really healthy meal. And then when you talk to them, you know, it's like, oh, I had avocado toast and you think oh, that does sound healthy. Except a they don't know there's carbs and avocados for some reason. They're completely disconcerted with the facts in the avocado and there's high fructose corn syrup and the toast they made and I'm like, yeah. Okay. So, so So I don't care how anyone eats I would think of myself as the only real diet I stick to is an intermittent schedule. I only eat in a certain hours. But other than that, in the past week, I've had Ben and Jerry's ice cream. I'm making ribs tonight for dinner, Texas style, in case anyone's wondering gonna smoke them. And you know, I think last night we had I had chicken parm that I made last night. But keeping with Jenny's point, I made the chicken parm I took a chicken breast, I hammered it flat. I put bread crumbs on it, and a little tomatoes and some mozzarella cheese you at least you could see what was on and

Jennifer Smith, CDE 12:15
you knew what you put in it.

Scott Benner 12:16
Yeah, and I didn't. And I didn't fry it in any of the I don't use processed oil either. And the and the the the olive oil I use is only cold pressed I don't I don't use the heat pressed. So those are pretty much the only things that I follow and besides taking, you know a reasonable amount of like, you know, vitamins. I don't really do anything differently. But I'm also not really interested. I'm not trying to impact my weight. I just want to be healthy and I want to eat something

Jennifer Smith, CDE 12:46
and you're not concerned with your own blood sugar overall. I mean, you're concerned with your daughters, but

Scott Benner 12:50
other than a glucose monitor a couple of times my body handles my diet. So that's and I'm not over taxing it. I didn't eat like three pints of Ben and Jerry's ice cream. The remastered diabetes Pro Tip series is sponsored by assenza diabetes makers of the contour next gen blood glucose meter and they have a unique offer just for listeners of the Juicebox Podcast. If you're new to contour, you can get a free contour next gen starter kit by visiting this special link contour next one.com forward slash juice box free meter. When you use my link, you're going to get the same accurate meter that my daughter carries contour next one.com forward slash juice box free meter head there right now and get yourself the starter kit. This free kit includes the contour next gen meter 10 test strips 10 lancets, a lancing device control solution and a carry case. But most importantly, it includes an incredibly accurate and easy to use blood glucose meter. This contour meter has a bright light for nighttime viewing and easy to read screen. It fits well in your hand and features Second Chance sampling which can help you to avoid wasting strips. Every one of you has a blood glucose meter, you deserve an accurate one contour next one.com forward slash juicebox free meter to get your absolutely free contour next gen starter kit sent right to your door. When it's time to get more strips you can use my link and save time and money buying your contour next products from the convenience of your home. It's completely possible that you will pay less out of pocket in cash for your contour strips than you're paying now through your insurance. Contour next one.com forward slash juice box for a meter go get yourself a free starter kit. while supplies last US residents only touched by type one has the back of people living with type one diabetes. Take for instance their D box program touched by type one knows firsthand the intricacies of living with type one diabetes. And so their team has created a D box, which is a starter kit that provides important resources and supportive materials to individuals with diabetes. They want you to thrive. The D box is completely free and available to newly diagnosed people. All you have to do is go to touched by type one.org. Go to the Programs tab and click on the box. While you're there, check out all the other resources and programs available at touched by type one.org. Speaking of support, touched by type one.org is available in English and Spanish. Don't forget to find them on Facebook and Instagram too. You do not want to miss what touched by type one is doing. When you have diabetes and use insulin, low blood sugar can happen when you don't expect it. G voc hypo pen is a ready to use glucagon option that can treat very low blood sugar in adults and kids with diabetes ages two and above. Find out more go to G voc glucagon.com forward slash juicebox G voc shouldn't be used in patients with pheochromocytoma or insulinoma. Visit je voc glucagon.com/risk. You know, I

Jennifer Smith, CDE 16:18
think it's also I think that actually brings up kind of a good a good visual of the difference between glycemic index and glycemic load when you were wearing that continuous monitor. I remember you either I think you texted and you texted like how much you physically had to eat. In order to get the CGM to register like a bump up in your blood sugar is showing that your body was actually being taxed. He was fascinating by the amount that you ate. And that actually speaks to the load impact. Right. So when we talk about glycemic index and glycemic load, glycemic index is really just it considers the amount of food that you've eaten carbohydrate that will turn into impacting sugar in the next two hours after you consume the food. But that's just the tip of the iceberg and understanding. And that's when when I talk to people, you know, who are trying to consider glycemic index and like, you have to take it a step farther, there are depths or there is depth to glycemic index and a step farther as glycemic load in terms of glycemic load talks about the amount of the food that you're eating at a particular time. And my favorite example to give is watermelon. Watermelon has a very high glycemic index. If you're not familiar with glycemic index, or not quite sure it's a scale of zero to 100, with 100 being pure glucose. So as foods are rated on that scale with a number, that higher the number or the closer to 100, the faster the impact should be on your glucose level. Okay, but again, this is in a simple lab generated testing, right? Where you're only eating my example watermelon, you're not eating watermelon on top of chicken parm on top of like a whole stick of butter. Right?

Scott Benner 18:20
I also wonder, are these things tested on people with diabetes when they come up with the index or people with a working pancreas when they come up with the index?

Jennifer Smith, CDE 18:30
I believe it was, I believe it's people with a working pancreas. Yeah, to give a true definition of what the impact could be when sort of outside insulin dosing isn't in the picture. But that is a really good thing it makes me think of maybe looking that up.

Scott Benner 18:47
Here's what it made me wonder about, you know, when somebody tries to catch a low by turning their basil off for an hour, and then they create, like, avoid in front of them a black hole where there's no and then they have the tiniest bit of carbs, like my blood sugar shot way up, I don't understand it, well, your pancreas doesn't work, and you took away all the insulin in your body and then added even the tiniest bit of carbs. So the glycemic index of anything away from insulin is probably 100, right? Like everything probably hits like 100 away from insulin. And so when you've got the right amount of basil in these foods are going to still hit on this chart. And before we go on, like I just I'm gonna run through it real quick and just pull a couple out to give people an idea. whitebread is a 75 Right? White rice is a 73 cornflakes are 81 but an apples 36. Right strawberry jam is 49 A potato boil to 78 but a potato mashed is at seven. So everything hits differently and when I stand on stage, I try to simplify it down by saying Foods punch at a different weight, some of them just hit harder than others. And that's and it's interesting to they have sugars listed out here. Sucrose is 65. Glucose is 103. Honey is 61. And fructose, if I'm saying that right is 15.

Jennifer Smith, CDE 20:18
Yeah, because toast is fruit sugar. And that kind of brings into the treatment for lows, then the reason that glucose tablets technically work the best or anything in which dextrose is one of the first three ingredients in like a candy kind of thing. That's the reason it's going to work the best because glucose is the simplest form of sugar that there is, there's no breakdown to it, it gets in and it gets distributed and use. Whereas something like fructose, or galactose, which is milk, sugar, sucrose, they are more calm, there are more combined chemical sugar structures, so your body has to break it apart, to get the glucose out to actually impact the blood sugar.

Scott Benner 20:59
So in a scenario where a person takes a glucose tab, and it takes forever for their blood sugar to go back up, but eventually it rockets up, that means they have a lot of active insulin that the tabs fighting with Is that Is that what you would infer from that,

Jennifer Smith, CDE 21:12
that would be the estimate, you know, if there's iob, and there's a load of it, and there's a low and you only take one glucose tablet, that's like a drop in like the ocean of impact the other. The other reason could possibly be whatever is in the stomach already might be hampering the true absorption of that if the glucose tablets kind of sitting on top of that digestion. And if that other food is really highly fibrous or very high in fat or a lot of protein, it may take longer for that little bit of glucose to definitely impact and get absorbed. Yeah.

Scott Benner 21:50
Okay. All right. So I'm sorry, we kind of got away from it for a second. But it all feels really important, you know, that, that you can't just I mean, all carbs aren't created equal. I guess that's how I've boiled it down for the podcast. But again, the the amount of you out there who I tried to say to people, like when they're really learning about the podcast, and they're going through the pro tip episodes, and they're getting the ideas down, but they're still spiking, and they're getting low later. I always say like, why don't you just simplify your food choices for a little while while you're practicing? You know what I mean? Like, I think I think I said to somebody recently, if you got it in your head that you wanted to learn how to box and you went to the gym a couple of times, you took some sparring, and you were starting to get confident. Once you had a little bit of confidence under your feet. Your next thought wouldn't be, you know, I had to go find iron Mike Tyson and see if he wants to go a couple rounds. And because you're not ready for that yet, right? But people make a couple of good boluses in a row and they're like, I'm gonna try Cheerios like, no, don't try Cheerios, it's day three. You're not good at this yet, you're getting better at it. And so if you're having trouble putting tools into practice, I always say, go for things that are you know, that don't punches hard. While you're practicing it, cut yourself a break, you know,

Jennifer Smith, CDE 23:07
and also learn and I think I've said this before to some other episodes, but learn the foods are the that are most common for you. Take a look at what you love to eat, write them down. Most people have about 20 foods that are over and over what they eat almost every single day, write, mark them down, look up their glycemic index and see how does it work when you try to cover these foods, even if it's like a meal, let's say you eat chicken and broccoli and rice three nights a week because it's like one of your favorite things in the whole, great, write it down, figure out what you did. What happened if it especially if it didn't work the way that you wanted it to work out, and then eat it again, you know, two nights from now and try it again. Maybe it was more insulin that you needed. Maybe the timing was a little bit different. Maybe it takes into consideration though. Well, gosh, tonight I ate a whole cup of rice with the chicken and the broccoli. And maybe Wednesday night I decided to eat only a half a cup of the rice with the same amount of chicken and broccoli. So there's the load impact, right? It's the portion of the rice, the rice itself in one cup versus half a cup versus four cups, still has the same glycemic index. That's not going to change. But the load takes into I guess what you have to pay attention to is you're eating now like a whole cup versus a half a cup. And that load impact is going to then be the big driver of blood sugar after In fact, you might need to play with timing of the insulin a little bit differently based on portion

Scott Benner 24:43
right now Jenny brought up earlier that I tried to drive my blood sugar up when I was wearing a glucose monitor and I obviously don't have diabetes. And I took a I think it was a big piece of cake with a lot of icing on it. And I ate it and waited and my blood sugar did not go up very much All right, so I forced myself for you people, I hope you're happy. I forced myself by the way I did not enjoy. I did not enjoy the last third of the first piece. And I really didn't enjoy the second piece. And I was just like, oh, we get this and, and what do I get to like 132? Something like that my blood sugar like something like that

Jennifer Smith, CDE 25:21
right state under the defined like 140 Mark. Yeah,

Scott Benner 25:26
I couldn't eat myself over 140 If I tried and, and, but still I got to 130 in a life where I wasn't getting to 130 a lot I was having to like, do what Jenny said to get the 1/3 he was having to stack multiple different tough foods on top of each other, like layer them on top of each other's having to have bread with potatoes, and then something else and more and more. I was I spent one night I don't know if you know those little spearmint leaf candies that are just like they're just sugar with like, they literally they take sugar and then they dip it in sugar. I sat with a glucose monitor in front of me just going like just popping one of those in like every three minutes. And my blood sugar would not move off of 89 like it just wouldn't move. And I was just like I'm not trying to make people jealous curious

Jennifer Smith, CDE 26:19
did you I was Thank you pancreas thank you so much. No,

Scott Benner 26:23
I I told you I had a deep feeling of guilt. Eating food and watching my blood sugar not go up like a significant it makes me sad thinking about it. I had a real deep feeling of guilt the first number of days I award. And I was just you know, I'm trying to do these things. So I can talk about them on the podcast. And at the same time I'm looking over at my daughter while we're like correcting a 130. So it doesn't turn into a 170 You know, and and I'm just but anyway, like, let's get back to the fun part. I am throwing these candies into the point where I was like, I hate these things now. I couldn't get my blood sugar to go up. That was it. It was it was pretty fascinating. Having said all that, again, I think that the podcast exists because I think people are going to have a candy once in a while. I think that when people look at the you know at Harvard's good you know what you can swap out for lower glycemic index things. And I think oh, I could have corn on the cob or a leafy green or peas. You know, I think most people are like I would like corn would you like corn flakes or bran flakes? I want corn flakes. You know, even white rice to brown rice is you know now there are ways like you'll learn how to like for us. We I've switched the house over just a basmati rice. It just hits Arden differently. It just does. And who cares why? Like I tried four different Rice's and I finally got to one and I was like this is the one that doesn't hit her as hard. This is the one we eat now.

Jennifer Smith, CDE 28:00
Does it differ based on how you cook it or prepare it?

Scott Benner 28:03
I only prepare one way Jenny. I have this aroma is it's a Roshi, people are making fun of rice steamer. I have the greatest rice steamer on the face of the planet. And let me tell you why I am able to afford this rice steamer. I was walking through a Macy's one day and they had this little rack of things that had clearly been returned to the store but bought online that they don't stock in the store. And so they just want to get rid of it because they have no place to put it. And my eye luckily for me, is it zeros? It's ZOJIRU Shi they make bom bom rice cookers right? Wow. And my eye catches this rice cooker that I know in my heart costs like $500 and right and obviously I'm not going to own a $500 rice cooker in my lifetime. And I looked over and that things had 75 bucks. And I moved across that store. like Usain Bolt in his prime. I was like out of the way people. I snatched this box up and I was holding it. I was like hugging it. Everybody just moved like I felt like everyone else knew as I looked around, I realized I was the only one aware that I was holding a very expensive rice cooker with a $75 price tag on it. And I actually it was so crazy. I went over to an employee I was like, This is $75. And she goes yeah, and I would I will buy this. Thank you. So I took it. It makes perfect rice. It is fascinating. You put the rice in, you fill the water up to the line that corresponds with the cups, the number of cups of rice you use. You push a button, it plays Twinkle, twinkle, little star and 55 minutes later, you're eating the best ratio ever had in your entire life. I don't know why it plays tickle. Take a little star when you start up but it does.

Unknown Speaker 29:56
My kids love that.

Scott Benner 29:58
Oh my god. Other than that I am The word I can't make rice. I screw rice up six ways from Sunday every time I try to make it so I

Jennifer Smith, CDE 30:05
barely have rice. I only have rice when we do sushi.

Scott Benner 30:09
When my son is trying to gain weight, he wants it in the house too. So I make it and I and it goes in the um, it goes in the refrigerator. He just adds it to everything he's eating.

Jennifer Smith, CDE 30:17
Yeah, my choices always. My kids love quinoa, thankfully. And then wild rice, which isn't technically even rice, it's it's the seed of a long grass. So education for you. Oh,

Scott Benner 30:31
I love I love a nice long rice because I like the the the sort of like, you know, spices that go on with it, too.

Jennifer Smith, CDE 30:38
Yeah. They work glycemic ly better. And I've just found long term that it been my family likes it. So it's not like I even have to cook it separate for me and something like brown rice. So yeah,

Scott Benner 30:50
I can't believe I spent so much time talking about my excitement about getting a cheap rice cooker and this podcast episode. I'm sorry for all that. For everyone who's listening. It was like, Yeah, buddy, this is not helping me. I'm not buying a $500 rice cooker. Well,

Jennifer Smith, CDE 31:01
well, you shared it because the way I asked you how you cooked it, right, that does bring in as you were talking about the glycemic index before about like a big potato versus a boiled potato versus you know, the glycemic index can change based on how something is prepared and or how ripe something is. So for example, like your apple that you mentioned before, I think it's in like the 30s or 40s or something right? Most apples are considered low glycemic, anything under 50. On the glycemic index scale of considered low glycemic slow impact. Apples are there a kiwi fruit is there most of the berries are there. But then you get into the fruit that you really eat at its peak sweetness. You're talking about the summer melon, you're talking about pineapple, papaya, mango, bananas, grapes being cherries, they're all high glycemic, because their sugars are so developed to get that flavor that you want. I mean, I guarantee you're not going to eat it. Well, some people do. My husband doesn't care. He's one of the people can eat like a green banana, put it in a smoothie, he doesn't care. He's like the bananas there. Because I liked the nutrition in it. I don't care how it tastes, right. I cannot eat a green but

Scott Benner 32:18
on the outside when you're biting Do you notice that like the FMD? Like, why is that doing that to my mouth, my mouth.

Jennifer Smith, CDE 32:23
I wish people could see us sometimes that we make when we're talking. But I mean, I bring that in because glycemic index is higher for a ripe or fruit and the impact is going to be faster. And I can tell you if I make a smoothie with a less than ripe banana because it's what we've got, and I want a smoothie. The impact is definitely different for me. And I strategize my Bolus timing, different based on that. Based on that,

Scott Benner 32:54
well, you hit one with Arden loves cherries, and they like I have to like swing it those with both hands get you know, when your Bolus saying they're really tough. That is see i i find all this fascinating. And I find it sad, because I don't think that many people think about it at all. They just count the carbs. And then they're like, well, this I counted the number and the number says 10. And so it's 10 I, I'm right, you know what I mean? Nobody thinks about the insulin, because I don't think about the carbs that much like I look at the food and I pick the insulin. I saw somebody the other day. They were, you know, they had this meal. And they're like, We use two units or three units. And I said, Well, what is this? Like a, like, I don't understand is this like a four year old kid and it wasn't it was a teen and I'm like, that's not gonna work. And you know, and then I asked them their ratio, and they're like, oh, it's one to 10. And I was like, You think this is 25 carbs, I was like, this is 60 carbs. You know, if it's one, it's 60. And I'd be scared to say 60. As I was looking at it, I was like, I don't know, I'd like to go 70 To be perfectly honest with you. And, and there are 2030 they're not sure. And then the kids blood sugar jumps up to 240 and they don't know what happened. And then they're correcting, correcting, correcting, then the food gets digested out the kids crashing down and then they're correcting and then they want and it goes by and it's just it's never ends.

Jennifer Smith, CDE 34:19
I think you know the topics of glycemic index and glycemic load are they really are such they're kind of the like further down the road when you're talking about like just correct carb counting. Get that squared away. That is step number one get get some carb counting, get some labels read even if you have to do portion estimation, that's your tool that you get good at portion estimation. Then for again, those foods that are on your these are the typical things that I eat. Great. Then we can move on further to things like glycemic index glycemic load a little bit better Bolus timing, and then you kind of that maybe another step is, how was it cooked? Right? Am I boiling? My potatoes? Are my baking my potatoes? Am I you know eating a green banana? Am I eating a completely black bun? So?

Scott Benner 35:14
Well, you're you're kidding on something that I know I want to talk about on the podcast more with you in the future, which is after speaking to so many people, like I realized that there's a, an order in which you should pay attention to things when you're starting, right? And like in an overly simplistic way, like I always say, if I was if I was on the Titanic, and I was thinking you, you, you somehow recognize me as a person who could help people with diabetes. And like, Scott, I have a tape recorder, you're 30 seconds, what do you want to tell people about type one diabetes, I'd say get your Basal insulin right? Learn how long your Pre-Bolus is, and then understand the glycemic load and index of food. And then I would go under and freeze to death and drown. But but those like if the if I could only say those things to you like three things to you, I'd say that. And then from there, I'd start talking about well, it's timing and amount. And you know, and you can't forget about overnight, this happens. And you know, protein and fat cause rises, like there's the variables, I just think of it is the seed of the idea. Like I always think of like management of diabetes is a tree, it's 100 year old tree with 1000 branches. And every point of that tree is important, but at its core at its seed, it's basil. And then it's you have to Pre-Bolus and then it's you have to understand the impact of the food. Like that's the start of it, you never, but I see so many people who are out on the tip of the 700th branch going, I really want to understand this part. And I was like, there's a lot more to understand before you dig into that, you know, back at the trunk. And here's the problem, right? No one tells you to Pre-Bolus No one ever tells you Basal insulin is important. And the words glycemic index and glycemic load are not sexy, and I don't like to pay attention to them. When I hear them. My brain goes. Boring. That's for people who eat good. Like that's how it made me feel when somebody said it to me in a doctor's office one day, I'm not trying to run a marathon. I don't care about glycemic load. They instead of saying, Hey, you over here, these are the three most important things you need to understand. They told me the most important things and then moved on to stuff that doesn't matter as much. So not that it none of it matters. It all matters, but there's a core of it. And if you do the core, you're okay. I'm telling you, Basal Pre-Bolus glycemic load glycemic index isn't a one seeing the sixes. That's my guess. You want it in the fives, start crawling out in the edges of the tree and figure out the rest of it. But this is an exercise. Yeah, get a pump and go for a walk. Like there's I could say stuff all day. But you know, stop eating pop tarts and telling me like it's not fair. I can't have it. Of course, it's not fair. But first your poison.

Jennifer Smith, CDE 38:05
I remember the last time I had a pop. They're not really college because there was like nothing left in the cafeteria or something. And I was like, oh my god, I have to eat something. But

Scott Benner 38:15
my insulin Chinni assign to that if you want to goddamn Pop Tart, eat it. I don't care. Just don't act like you don't understand what happened afterwards. Because that makes me sad. Like, I just, you're killing me online, okay, you're putting things up online, and you're making me sad because I want to come sell this stuff. The I don't have time. And you're breaking my heart. So and and when I when I help people privately. Some people get it more quickly. And some people get it slowly. And then some people give it away, like after they know it. And I've seen them do it. And then they stopped doing it. I'm just gonna tell you, like, I don't follow many people's tax comps. And when I do, I don't for long. But when I do, and I've seen you do it, and I've seen you understand it, and then you have a 300 blood sugar, I gotta stop following you. It just It breaks my heart like I just can't, like it eats me up inside. You know, I look at the graph. And I'm like, oh my god, like it didn't Pre-Bolus Or why

Jennifer Smith, CDE 39:12
are they bad pump site or Cutlass?

Scott Benner 39:15
It could have been anything. The problem is, it's just it's ripping my guts out. I can't look at it anymore. Like with my daughter, I can do something about it.

Jennifer Smith, CDE 39:23
It's hard to follow people I agree. I mean, with the with the many, many, many people. I see their data. Yeah, it is. It's hard because and I think, you know, there's, there's no, there's no stop to, like my job isn't like, I go to the office and do my job. I put everything away. I close the door and then I go home, right? Like the people that I work with become like, they're almost like family to me, right? They're people that I I care about the people that I get the privilege to work with and help and I want the best and I Tonight, I feel like I could just like go home with everybody

Scott Benner 40:05
just texted a person this morning. And I said, if you could just come here for, I think 18 hours, I could just do this for you and you could see, but they and they know what to do and they won't do it. And I'm just like, oh my god, it just really listen, I'm not trying to turn this. It's hard on me. Like I really does. Like it just rips me up. Like, I'm like, you keep making the same mistake over and over again. But it's not out of ignorance. You you quite honestly know not to do it. And you just I don't know if it's fear bits are hard to break. Yeah, or habits are hard to break. But you're just you're doing the wrong thing. Like it's and I've told you it's the wrong thing. 10 different ways. And each time I say it, you say I understand I now you don't have this. I now know what my wife feels like when she's talking to me. It must be Kelly. I'm so sorry. It must be incredibly frustrating to say the same thing to me a million times, amigo. No, no, I understand. I 100% understand it three days later. I'm just doing it again. But But and so it's like, I don't mean to come down on me. I'm not trying to come down with evil. I'm just saying that. Jenny's not wrong, like following someone's blood sugar is it's a lot. And it's tough to win. Like, I don't think I know everything. And I but it's tough. When you look at a graph and you go, hey, you know what, you need more basil? And they go, No, you know what I think? And I always think to myself, I actually started saying it out loud. I just started going like, why don't we stop worrying about what you think? Because what you think led to this graph I'm looking at? Try what I think for a second and see what happens.

Jennifer Smith, CDE 41:39
That's my way for a little bit, please. Yeah, here. And

Scott Benner 41:43
listen, I'm gonna cost Jenny some money and save all of you an hour paying her Friday. Stop explaining to Jenny what you think, let her tell you what's going on. Because you're just in therapy at that point. And that's like getting you to a better blood sugar thing. You know what I mean? Right? How many stories do people tell you where you're just like, stop talking, this doesn't matter.

Jennifer Smith, CDE 42:06
And sometimes, you know, sometimes it's a marriage of what I see. And sometimes it's adding in then what they've seen, but they're addressing a certain way, because they think something's happening, that isn't really the reason for it. So it's kind of a marriage of what I see and how to tell them about what to do differently. It's not that what you're seeing is wrong, it's that the adjustments are not quite the right adjustment. You're

Scott Benner 42:31
100% right. And I was being too flippant, like you do need to hear it from them. But it's fascinating how infrequently their interpretation of what they're seeing is right, right. You know, you need to you need to hear what's happening. You don't need their interpretation of what's happening is much it's interesting. Anyway, it's like it's like trying to do I don't know, it's the weirdest customer service in the world like it people. This is like that except times like a million. So anyway, Jenny has to go. She's show I do drop bombs of knowledge and truth all over this episode. So I really appreciate that. I will talk to you soon. Cool. Awesome. I want to thank assenza diabetes for sponsoring the remastered diabetes Pro Tip series. Don't forget you can get a free contour next gen starter kit at contour next one.com forward slash juicebox free meter, while supplies last US residents only. If you're enjoying the remastered episodes of the diabetes Pro Tip series from the Juicebox Podcast you have touched by type one to thank touched by type one.org is a proud sponsor of the remastering of the diabetes Pro Tip series. Learn more about them at touched by type one.org. A huge thank you to one of today's sponsors G voc glucagon find out more about Chivo Capo pen at G Vogue glucagon.com Ford slash juicebox you spell that GVOKEGLUC AG o n.com Ford slash juicebox. Jenny Smith holds a bachelor's degree in Human Nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian, a certified diabetes educator and a certified trainer on most makes and models of insulin pumps and continuous glucose monitoring systems. She's also had type one diabetes for over 35 years and she works at integrated diabetes.com. If you're interested in hiring Jenny, you can learn more about her at that link. If you're living with diabetes, or are the caregiver of someone who is and you're looking for an online community of supportive people who understand, check out the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes there are over 41 1000 active members, and we add 300 new members every week. There is a conversation happening right now that would interest you, inform you, or give you the opportunity to share something that you've learned Juicebox Podcast, type one diabetes on Facebook. And it's not just for type ones, any kind of diabetes. Any way you're connected to it, you are invited to join this absolutely free and welcoming community. I hope you enjoyed this episode. Now listen, there's 26 episodes in this series. You might not know what each of them are. I'm going to tell you now. Episode 1000 is called newly diagnosed are starting over episode 1001. All about MDI 1002 all about insulin 1003 is called Pre-Bolus Episode 1004 Temp Basal 1005 Insulin pumping 1006 mastering a CGM 1007 Bump and nudge 1008 The perfect Bolus 1009 variables 1010 setting Basal insulin 1011 Exercise 1012 fat and protein 1013 Insulin injury and surgery 1014 glucagon and low Beegees in Episode 1015 Jenny and I talked about emergency room protocols in 1016 long term health 1017 Bumping nudge part two in Episode 1008 teen pregnancy 1019 explaining type one 1020 glycemic index and load 1021 postpartum 1022 weight loss 1023 Honeymoon 1024 female hormones and in Episode 1025, we talked about transitioning from MDI to pumping. Before I go I'd like to share two reviews with you of the diabetes Pro Tip series, one from an adult and one from a caregiver. I learned so much from the Pro Tip series when our son was diagnosed last summer. It really helped get me through those first few very tough weeks. It wasn't just your explanations of how it all works, which were way better than anything our diabetes educator told us. But something about the way you and Jenny presented everything, even the scary stuff. That reassured me that we could figure out how to deal with us and to teach our son how to deal with it too. Thank you for sharing your knowledge and experience with us. This podcast is a game changer 25 years as a type one diabetic, and only now am I learning some of the basics. Scott brings useful information and present it in digestible ways. Learning that Pre-Bolus doesn't just mean Bolus before you eat but means timing your insulin so that is active as the carbs become active. Took me already from a decent 6.5 A one C down to a 5.6. In the past eight months. I've never met Scott But after listening to hundreds of episodes and joining him in his Facebook group, I consider him a friend. listening to this podcast and applying it has been the best thing I have done for my health since diagnosis. I genuinely hope that the diabetes Pro Tip series is valuable for you and your family. If it is find me in the private Facebook group and say hello. If you're enjoying the Juicebox Podcast, please share it with a friend, a neighbor, your physician or someone else who you know that might also benefit from the podcast. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.