#391 Diabetes Pro Tip: Glycemic Index and Load
Scott Benner
All carbs aren’t created equally
Scott and Jenny Smith, CDE share insights on type 1 diabetes care
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Scott Benner 0:10
Hello, friends, welcome to Episode 391 of the Juicebox Podcast. This episode is a another in the pro tip series. That's right, Jenny Smith is here today, Jenny and I are going to be talking rather loosely, more colloquially, if you will, about the glycemic load and glycemic index. Now, please don't turn off your podcast player. I know that seems boring. But what we're really going to be talking about is understanding that different foods impact blood sugar differently, even if those two foods both have the same amount of carbs in them. This is incredibly important. This is something that many of you just undervalue. So while you're listening today, please keep in mind that I think this is incredibly important. And also keep in mind that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, please always consult a physician before making any changes to your health care plan. We're becoming bold with insulin.
Today, I've invited Jenny Smith to come back. Do you know Jenny, Jennifer has had Type One Diabetes for 32 years now. Jenny also holds a bachelor's degree in human nutrition and biology from the University of Wisconsin. She's a registered and licensed dietitian, a certified diabetes educator, and a certified trainer and most makes and models of continuous glucose monitors and insulin pumps. So you know, Jenny from the pro tip episodes, and from defining diabetes, and from ask Scott and Jenny, I know Jenny from my life. And there's no one I'd rather talk about stuff like this with that her. So today, Jenny and I are going to dig a little deeper into glycemic load and index. There are other episodes that deal with this topic. But it deserves to be in here in the pro tip series as well. Because so many people think a carb is a carb is a carb. And that's just not the case. Today, I'm gonna put the ads up front, so that we can talk straight through this episode of The Juicebox Podcast is sponsored by the Contour Next One blood glucose meter. This is the blood glucose meter that my daughter uses every time she checks her blood sugar. And there's a good reason why it's not because they're advertisers on the podcast, we had the meter before the podcast that Contour Next One is small, easy to handle has a beautiful bright light for nighttime viewing a test strip that allows a second chance blood drop, meaning you can go in, get some blood not enough and go back without ruining the accuracy of the test. And speaking of accuracy, this thing is gold standard. I trust it implicitly Contour Next one.com forward slash Juicebox Podcast get there, there's gonna be a lot more than just the next one meter. Here's some other information you'll find at the website. First of all, contour makes other meters. I use the next one, and I love it. But you may want a different one that's under the products tab. Under the resource tab, you can get the contour diabetes app, which works with the Contour Next One meter, it's really great helps you make a ton of sense of your data. Then we get to the meters and test strips tab. Free Contour Next One meter, it's possible Can you imagine that that you could be eligible for a free meter. So check it out. There's also a choice card that may help you save on test trips. And of course support if you need it. All this should be enough. But while you're there, there's one more thing to look into. And it's this is it possible that the cash price for the Contour Next One would be cheaper than what you pay through your insurance. Hmm. It is possible look into it. So whether you just want the Contour Next One meter, want to read more about how it works. You need to get that app you want to look at other meters. Find out if you're eligible for a free meter. Or look into that choice card to save on test trips. Everything you need to know about this is at Contour Next one.com Ford slash juicebox. Please don't forget to check out touched by type one.org if I'm not mistaken. Dancing for diabetes is coming up very soon. Check them out touched by type one.org also find them on Facebook and Instagram. Last thing before we get going t one D exchange dot org forward slash juicebox, it will take you less than 10 minutes to add yourself or your child's information to the T one D exchange registry, you need to be a US citizen. But once you put that information in there, and it's just there's the simplest things asking you questions about life with diabetes. And then they use this data to help make better decisions in the world for people with type one. One example, just one example is that the data from the T one D exchange, led to the ADA lowering target a one C for children. That's a big important step. Because of how it impacts the practitioners and how they talk to you about expectations. It seems like one of those things you just kind of wouldn't think about, but they need to happen. T one d exchange.org. forward slash juicebox. Support the sponsors support the show I thank you very much. All that's out of the way now. So let's get to my conversation with Jenny Smith, about understanding the difference between one carb and another. And the importance of that difference, and how it's going to impact your management. I know it sounds convoluted. I know it sounds boring. But it's it's everything. So please, lesson.
Okay, Jamie? 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. You are adoring glycemic load and glycemic index of 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. 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 at 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. And 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 being wheat bread doesn't make it bread.
Jennifer Smith, CDE 8:19
I think of especially in the past five years, I would say maybe even more than that.
Scott Benner 8:27
I know what you're gonna say God,
Jennifer Smith, CDE 8:28
I think of
meal bars. Okay, I don't know
Scott Benner 8:35
what else to call them. That's not what makes a good.
Jennifer Smith, CDE 8:38
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. Yeah, bake some bread how 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 since the purpose 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 zekiel bread. Yeah, major difference.
Scott Benner 9:32
Even 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 flowers processed and the sugars processed. But you can buy a loaf of wheat bread and the first ingredient is high fructose corn syrup. And people are like, I don't know what
Unknown Speaker 9:59
happened. Right, right? I do.
Jennifer Smith, CDE 10:02
I do, too. Yeah, absolutely. 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 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, if 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 is 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, go make yourself a peanut butter sandwich or
Scott Benner 11:12
something? No, 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. But he can take like a half of one of those bars and power them through a baseball game. There's so much jammed into it. So he likes them because they don't fill a 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 you 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. Okay, 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 12:33
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, I don't eat 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. Yeah, 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. There are 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 processed 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 brings in glycemic index. It's made out of very high glycemic, quick impacting refined carbohydrate, right 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. Yeah, but um,
Scott Benner 14:24
well, the reason I bring it up and I'm sure this happens to you constantly been to me far less 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 is low into what they say in the beginning. When someone say to me, oh, I get really low. I'd go right over it. Now. I stopped and I go What does that mean? What number is really low? Because sometimes the person will 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? 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 dis concerned with the fact it's in the avocado, and there's high fructose corn syrup and the toast they made and I'm like, Yeah. Okay. 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 the 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 it, and
Jennifer Smith, CDE 16:25
you knew what you put in it. Yeah, and I didn't have an idea.
Scott Benner 16:28
And I didn't fry it in any of the in, I don't use processed oil either. And the and the olive oil I use is the 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 16:56
And you're not concerned with your own blood sugar overall. I mean, you're concerned with your daughters.
Scott Benner 17:00
Yeah, I want a glucose monitor a couple of times my body handles my diet. So that that's and I'm not overtaxing it. I didn't eat like three pints of Ben and Jerry's ice cream. You know,
Jennifer Smith, CDE 17:11
but I 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's showing that your body was actually being taxed.
Scott Benner 17:41
It was fascinating. Yeah,
Jennifer Smith, CDE 17:43
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 in understanding and that's been 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 is 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 19:13
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 19:22
That's okay, that's, 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, maybe looking that up.
Scott Benner 19:40
Here's what it made me wonder about, you know, when somebody tries to catch a low by turning their bezel off for an hour, and then they create like, a void 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 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 bazel, in, these foods are going to still hit on this chart. And before we go on, like I just want, I'm gonna roll 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 boiled is 78. But a potato mashed is 87. 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. And
Jennifer Smith, CDE 21:11
so it's fructose 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're more come there are more combined chemical sugar structures. So your body has to break it apart, to get the glucose out, okay, to actually impact the blood sugar. So
Scott Benner 21:52
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 at the tabs fighting with is that is that what you would infer from that,
Jennifer Smith, CDE 22:05
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. Yes. Okay.
Scott Benner 22:43
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 try to say to people, like when they're really learning about the podcast, 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 with me 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 24:00
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, right? 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's 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 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 this 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 your 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 25:36
right. And so 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 at all. And I was
Unknown Speaker 25:53
more right. So I
Scott Benner 25:53
forced myself for you people, I hope you're happy. I forced myself by the way, I did not enjoy it. 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 my goodness. And and when I get to like 132 something like that my blood sugar like,
Jennifer Smith, CDE 26:14
stayed under the defined like 140 mark. Yeah, no, yeah,
Scott Benner 26:18
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 130 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. You know, 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
Jennifer Smith, CDE 27:12
paint curious. I was Thank you pancreas. Thank you. No, I
Scott Benner 27:16
hate 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 work. 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 gonna 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. Hmm. You know, I think most people are like, I would like corn. Would you like corn flakes or bran flakes? No. 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 boss MADI rice. It just hits Arden differently. Oh, it just does and who cares Why? Like, I tried four different races. 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 28:52
does it differ based on how you cook it or prepare it?
Scott Benner 28:56
I only prepare it one way Jenny. I have the zeros is it's a Roshi, people are making fun of me now a 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 I luckily for me, is it zeros z OJIRUS hai they make bom bom rice cookers right? Wow. And my eye catches this rice cooker that I know in my heart costs like $500 right and obviously I'm not going to own a $500 rice cooker in my lifetime. No. And I looked over and that thing said 75 bucks. And I moved across that store, like Usain Bolt in his prime. I was like allaway people, I snatched this box up and I was holding it. I was like hugging it back. 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 went, 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 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 I place tinkle. Take a little star when you start up, but it does.
Jennifer Smith, CDE 30:49
My kids would probably love that. They would think that
Scott Benner 30:51
other than that I am the worst. I can't make rice. I screw rice up six ways from Sunday every time I try to make it so
Jennifer Smith, CDE 30:58
I barely have rice. I only have rice when we do sushi.
Scott Benner 31:01
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. You know? Yeah,
Jennifer Smith, CDE 31:10
my choice is 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 there's little education for you.
Scott Benner 31:23
I love I love a nice long rice because I like the the this sort of like, you know, spices that go on with it too.
Jennifer Smith, CDE 31:30
Yeah, but those some they work glycaemic Lee better. And I've just found long term that I mean, my family likes it. So it's not like I even have to cook it separate for me, and then something like brown rice. So
Scott Benner 31:42
yeah, I can't believe I spent so much time talking about my excitement about getting a cheap rice cooker in this podcast episode. I'm sorry for all that for everyone who's listening is like yeah, buddy. This is not helping me. I'm not buying a $500 rice cooker? Well,
Jennifer Smith, CDE 31:54
well, because of the way I asked him how you cooked it. And that does bring in as you were talking about the glycemic index before about like a baked 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 is 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 like the nutrition in it. I don't care how it tastes right. I cannot eat a green but
Scott Benner 33:10
he's dry on the outside when you're biting Do you notice that like the fob? Like, why is that doing that to my mouth?
Jennifer Smith, CDE 33:15
In the my mouth? Yeah, I wish people could see us that we make when we're talking. Oh, but I mean, I bring that in because glycemic index is higher for a ripe for 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 33:47
well, you hit one with Arden loves cherries, and they like I have to like swing at those with both hands. You know, when your bolusing there, 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. So it's 10. I do 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 used two units or three units. And I was like, 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'd like to go 70 to be perfectly honest with you and and and they're very 2030 they're not sure. And then the kids blood sugar jump 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 won't and it goes by and it's just, it's never ending,
Jennifer Smith, CDE 35:12
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 how to get that squared away, right? 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're 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 then maybe another step further is how is 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 but
Scott Benner 36:06
what 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 F 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, 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 somehow recognize me as a person who could help people with diabetes. You know, 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 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, 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 as 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 bazel. 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. I was like there's a lot more to understand before you dig into that, you know, they're 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 in boring. That's for people who eat good. Like that's how it made me feel when somebody said 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 none of it matters at all matters, but there's a core of it. And if you do the core, you're okay. I'm telling you bazel Pre-Bolus glycemic load glycemic index. Is anyone seen 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 help it. Of course, it's not fair. But first your poison.
Jennifer Smith, CDE 38:58
I remember the last time I had an
early 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 39:08
my insulin Chinni assigned 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. You're making me sad because I want to come say all this stuff to you. 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 him do it and then they stopped doing it. I'm just going to tell you like I don't follow many people's tax comms. 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 got to stop following you. It just it breaks my heart like I just can't like it eats me up. You know, I look at the graph and I'm like, Oh my god, like they didn't Pre-Bolus? Or why are they not correct?
Unknown Speaker 40:05
Could have
Scott Benner 40:06
been a bad pump site or could listen, 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 40:15
But it's 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 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, I 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? There are people that I care about the people that I get the privilege to work with, and help and I want the best. And I sometimes I feel like I could just like go home with everybody. I
Scott Benner 40:57
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 I listen, I'm not trying to turn this. It's hard on me. Like a 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 habits
Jennifer Smith, CDE 41:29
are hard to break.
Scott Benner 41:30
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 you say I understand I now you know what it is. 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 hundred percent 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 it. 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 a guy. 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? bazel? And they go No, you know what I think? And I always think to myself, I actually started saying it out loud. I started going like, why don't we stop worrying about what you think cuz what you think led to this graph I'm looking at, you know, so try what I think first I get and see what happens.
Jennifer Smith, CDE 42:32
That's even try it my way for a little bit. Yeah,
Scott Benner 42:35
here and listen, I'm gonna cost Jenny some money and save all of you and our paying or Freddie, 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 not getting you to a better blood sugar thing. You know what I mean? Right? How many stories people tell you where you're just like, stop talking, this doesn't matter.
Jennifer Smith, CDE 42:59
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, adjust. You're
Scott Benner 43:24
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. It's much it's interesting. Anyway, it's like it's like trying to do I don't know it's 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 She's so I do drop bombs of knowledge and truth all over this episode. So I really appreciate that. I will talk to you soon. Awesome. Huge thanks to Jenny Smith. Hey, Jenny services are for hire. You can find out more about her at integrated diabetes. There's a link right there in the show notes. There's also a link for the Contour Next One meter touched by type one, the T one D exchange, and all of the other sponsors of the various podcast episodes that includes Omni pod Dexcom and G Vogue glucagon. All right, they're right there, right there right there. In your podcast player notes. Those links are also available at Juicebox podcast.com. But I'm gonna roll through them really quickly for you just in case and then I'm going to do a little freeform chatting about this topic. All right, ready, touched by type one.org. Contour Next one.com forward slash juicebox T one d exchange.org. forward slash juicebox. The other sponsors that aren't in that aren't on this episode, but are still incredibly important. Dexcom is available@dexcom.com forward slash juice box, you can get a free no obligation of the Omni pod at my Omni pod.com forward slash juice box and learn more about GMO glucagon at G Volk, glucagon comm forward slash juice box. Okay, now, almost everyone who uses insulin runs into this specific problem. And that problem is this. You count your carbs, you put in your insulin, and everything goes exactly the way you expect. Next day, you make a meal, you count your carbs, you put in your insulin, and nothing goes the way you expect your blood sugar gets low later, or it gets incredibly high. This is confusing, because yesterday, I counted my carbs, I put it in my insulin and everything worked. Today I did it again, some of you will question your carb counting skills. When this happens, some of you will run out and buy a very expensive scale. Very few people say to themselves, I bet the glycemic load of the food was greater or lesser than the glycemic load of the food from yesterday. Now you wouldn't think that because nobody tells you to think it or they say too soon after you've been diagnosed, and you feel like somebody just hit you in the head with a baseball bat. So you're not really listening, or the words glycemic load and glycemic index seem difficult, or maybe next level or whatever. But it's not. It's very simple. Some foods impact blood sugar differently, even if their carb count is the same. That's it, you just have to see it happen, except that it's true. Remember, and adjust your insulin for that food. That's what this entire episode told you. That very simple idea. You make yourself meatloaf mashed potatoes, you put some broccoli with it, you count the carbs. And somehow you've decided it's I don't know I'm making up a number. It's 40 carbs, which by the way, it's more. And you give yourself your insulin, your blood sugar shoots up later you correct with, I don't know, a couple more units, your blood sugar comes back down, it doesn't get low. The next time you have mashed potatoes and meatloaf and broccoli, and you count the carbs and you come up with 40. Again, you have to remember the two units you corrected with, you have to remember that those two units belong in the initial bolus. Maybe not every drop of two units, but pretty close. The reason I say that is because once you have a higher number, it takes more insulin to bring it down. But some of that insulin, if it was in the initial bolus, the spike would not have happened from these potatoes. And by the way later, the fat and protein and the meat that keeps your blood sugar higher layer, which you know, you need to go listen to the fat and protein pro tip episode to understand that.
So the next time you have this meal, I don't care what the carb counts that you have to trust that what you know is going to happen is going to happen. So all these little sayings and isms that you hear throughout the show, they're really just shortcuts to understanding that there is a different glycemic load from food to food to food. Because the next day, you could have a meal with 40 carbs in it that doesn't have those starchy potatoes in them. And I don't know wasn't mixed with the fat and the protein. And all that insulin could end up being too much. Now your meal ratio works. So what you're hearing is that your meal ratio isn't set in stone. It's all dependent on the foods you're eating, the glycemic load and the glycemic index of the foods. But you know, you can go check it out if you want. It's a matter of fact, I'll I'll find the chart that Jenny and I were talking about. from Harvard right now. I find it right now for you. And I'm typing. So I'm vamping a little trying to kill time. Because I don't feel like editing this part out. You're looking for a link called a good guide to carbs the glycemic index from Harvard health publishing and a link called glycemic indexed for 60 plus foods, which will give you an idea of what we're talking about that white bread punches different than corn tortillas. It's sweet corn punches different than porridge that on orange raw hits you differently than a potato boiled, which by the way hits you differently than a potato mashed which by the way hit you differently than a potato fried. These are the things you need to understand when you're watching your blood sugar's move all over the place, and sometimes it works. And sometimes it doesn't you love to hear people say, Oh, you know that about diabetes? One day, everything just works. And the next day it doesn't. It's not really true. If you had the right ratio of insulin, it would work every day. That is true. I promise you. All right, I'll put links in the show notes to those two blog posts from Harvard. I hope you're enjoying the pro tip episodes. If this was the first one you heard, you're probably like, you should definitely go back to Episode 210. And start at the beginning. Diabetes pro tip newly diagnosed, we're starting over and then listen through those pro tips. The pro tips are also available at diabetes protip.com. But you know, listen to your podcast app because that's how kids do things and they know way better about technology than us. Thanks for listening. I genuinely appreciate it. I'll talk to you soon.
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