November 4, 2025 • 32 mins
In episode three of our ongoing nutrition series, Jennifer Smith and Dana Roseman dive into the unique challenges of holiday eating for people living with diabetes. They share practical strategies for insulin management, discuss the benefits of technology in diabetes care, and highlight the importance of accepting blood sugar fluctuations during festive meals. Before heading into another holiday season, tune in to hear Jenny and Dana’s expert tips and personal insights for managing diabetes and enjoying the festivities.
MEET YOUR HOSTS:Dana Roseman, MPH, CDCES, RDN, LDN, is the Director of Technology and Applied Research for Integrated Diabetes Services. She is a Certified Diabetes Care & Education Specialist and Registered Dietitian with a Master’s in Public Health from the University of Illinois at Chicago, a Bachelor’s in Science from the University of Texas at Austin, and clinical nutrition training from UT Southwestern Medical Center. Diagnosed with Type 1 Diabetes, she has spent nearly 20 years improving diabetes care through technology, research, and patient education—including expertise with insulin pumps, continuous glucose monitors, and hybrid closed-loop systems. Dana serves as Research Information Liaison for the Dallas JDRF, is active on nonprofit boards, and empowers people with diabetes to thrive physically and mentally, making her a leading voice in diabetes innovation.
Jennifer Smith, RD, LD, CDCES is the Director of Lifestyle and Nutrition for Integrated Diabetes Services. She is renowned for her expertise in nutrition, diabetes education, and athletic performance. With a Bachelor’s Degree in Human Nutrition and Biology from the University of Wisconsin, Jennifer is a Registered Dietitian, Licensed Dietitian, Certified Diabetes Care & Education Specialist, a certified trainer for insulin pumps and continuous glucose monitors, as well as a published author. Having lived with type 1 diabetes since childhood, Jennifer offers unique insight into day-to-day diabetes management, pregnancy, sports nutrition, and technology integration.
WHAT YOU’LL LEARN:✔️The importance of knowing how your insulin delivery system works.
✔️ Ways to spend more time socializing and less time monitoring blood sugar levels over the holidays.
✔️ Large meals require longer insulin delivery.
✔️ How fasting holidays can help your diabetes management.
CHAPTERS:00:13 Welcome and introduction
02:59 Knowing your insulin delivery system
06:54 And then comes a GLP-1
07:47 Out of the box thinking helps with holiday eating
09:59 Making Peace with Blood Sugar Fluctuations
11:40 Strategies for Enjoying Holiday Treats
15:03 Jenny’s insulin strategy for her Thanksgiving meal
18:09 Adding physical activities to the holidays
19:38 What to do when the holiday requires fasting
22:52 Sitting, Drinking, and being Stressed! Final tips to get you through the holidays
RESOURCES MENTIONED:IDS Diabetes Experts, The Trynamic Trio Share Personal Experiences with Open-Source Application
https://youtu.be/peMzQHn1j9w?si=-oe74TUOIWGy287w
https://integrateddiabetes.com/diy-services-support/
CONNECT WITH US
🔵Website: integrateddiabetes.com
🔵 Follow on Social Media: @integrated_diabetes_services and @ integrateddiabetesservices on Facebook
🔵To work with the Integrated Diabetes Services Team , visit https://integrateddiabetes.com/how-to-start-the-process/ , or email info@integrateddiabetes.com
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Disclaimer
The information contained in this program is based on the experience and opinions of the Integrated Diabetes Services clinical team. Please discuss any changes to your treatment plan with your personal healthcare provider before implementing.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:12):
Welcome to Think Like a Pancreas-The Podcast where our goal is to keep you informed, inspired and a little entertained on all things diabetes.
The information contained in this program is based on the experience and opinions of the Integrated Diabetes Services Clinical team.
Please discuss any changes to your treatment plan with your personal health care provider before implementing.
(00:35):
So here we are today to talk about what?
Well, I think we're going to dive into some holiday eating.
It is now October.
I don't know if it's getting a little bit cooler where you are.
It is for sure for me, which is a nice change in Texas.
Again, I'm Dana Roseman.
I'm also a dietician and certified diabetes care and education specialist working with Integrated as the Director of Technology and Applied Research.
(01:01):
I think we wanted to kind of talk about some tricky holiday eating. Things that really, I think a lot of people that I work with just get anxious and stressed about. What's going to be served at, you know, the next party or the next event?
And certainly think that, as fall gets a little bit cooler, people turn to some comfort food that may be a little bit harder to take insulin for.
(01:24):
And those are questions I get kind of throughout the fall and certainly through the winter.
No, absolutely.
And this time of the year sort of starts out while we are not really cooler.
You're not?
That's unfortunate.
We're not.
It's kind of odd.
The past couple of years have been sort of moving.
I should qualify.
We're not in the nineties.
I'm not saying that, you know, I'm wearing a jacket outside.
(01:46):
You're not in the sixties, right?
No.
Yeah.
Our early mornings are what have changed.
Our early mornings are nice, like 58, 60 ish.
But then the past, I don't know, a couple of weeks we've been like at least 80.
I think today it's supposed to be 85.
But it is still a little bit cooler differently.
And it is a time of the year, you're right, that a lot of my recipes, I end up thinking about changing them over and I haven't really done it yet because it's not been cool enough outside.
(02:14):
Yeah.
But yeah, chili recipes or things like stew and casserole and more hearty meals.
Absolutely.
Potatoes and gravy.
Potatoes.
And even this time of the year starts out like it's holiday after holiday after holiday after holiday.
You almost don't really get a break and it ends up setting you up then to start the year on this slide down that you've done for like a month and a half of food that wasn't your typical stuff.
(02:47):
Right.
And it becomes harder to navigate.
And then you throw in football season in that.
Yeah.
Yeah.
And all of the parties and all the different football.
Yes, exactly.
Anyway.
And all the systems too, right?
I mean, just as dieticians, we know the food angle, but we also as educators know the technology angle and each of the different systems can be used in their own way to navigate the different kinds of foods.
(03:13):
I was just going to say, you know, when someone says, well, how do I, you know, bolus for pizza?
Or how do I boluls for, you know, that, that high fat chili?
The first thing I have to ask is what system are you on?
Because I don't know how to approach it without really first going back to the basics, which is how that insulin is being adjusted.
Right.
(03:33):
Right.
You know, those are two. There's a great way to say it is the basics is how the insulin being adjusted or what have you learned about navigating
And then.
And then what are your features available to you, right?
Because if you're using Omnipod 5 in auto mode, you know, that the extended bolus is not an option unless you go into manual mode, which is very different from Tandem, which is very different from the open source systems.
(03:59):
Right. And even Medtronic, right?
Yes.
And that's kind of, I think about Omnipod 5 and Medtronic in terms of those smarter features that you might want access to.
They're both similar that you just have to go out of automation and use manual mode in those circumstances.
And I think that's a hard thing to consider when you've been so used to the automation helping you. You'd think that you'd want it back there for these types of foods and meals when in the truth, it's like, well, maybe manual mode works better because you know how to cover the food without the system helping because you can do more.
(04:35):
But then I always get nervous because settings are set for the way that you're delivering insulin most of the time.
So if you're mostly in the automated system, your carb ratio is probably a little bit more aggressive than if you're in manual mode and using it in the extended way.
So that can be a little bit tricky for sure if people aren't understanding their system and wanting to manipulate those trickier foods.
(05:00):
And I think that makes the thing that really makes these foods a little bit tricky is, is the slower digestion or the high fat component that is going to, I call it the gift that keeps on giving.
It's just, you know, you have a high fat food and the blood sugar just continues to rise.
Yeah.
Or it just sits there.
I feel like it rises eventually, but then it almost gets stuck.
(05:21):
You feel like they're on this just plateau of, is the insulin even working?
Am I giving it at all?
Is the system even helping me? Because you just sort of float along at a higher level than you want to be.
And that is the case then of knowing your system well enough to be able to say what, you know, like Tandem, lovely, especially with Control IQ Plus now, the ability to use a temporary basal on top.
(05:44):
Absolutely.
It's been life-changing for so many people.
And even the extended bolus, there is a huge advantage for, you know, you brought up chili.
My chili tends to need an extended give of insulin rather than a big bolus up front.
Chili, depending on the content of your chili, I tend to do bean chilies.
(06:05):
I was just going to say, I've got a lot of beans in mine.
Right.
Versus like high fat, high, you know, meat, it could be a chicken chili, but that still tends to be pretty high fat with the other ingredients that are added.
Especially if you put cheese on it.
Yep.
Right.
So that tends to have a lag effect and you end up needing something extended that's going to give more.
(06:26):
And most of the automated systems aren't going to give more because they don't know the reason you're sitting high.
Right.
Right.
And so then, you know, you, you almost have to enter those, those carbs or the protein and fat components later on.
And a lot of times people just forget, right?
Because they're busy and, or they're going to sleep after a high fat meal and then you just sit high for the whole night.
(06:51):
I would say one other thing that kind of complicates this is so many people now are using a GLP-1 that even exaggerates that delay of some of these tricky foods.
And I was working with someone earlier this morning who, we noticed that some of his food was hitting four hours after he ate. Right?
(07:11):
And his automated system wasn't helping bring it down and he was asleep.
So yeah, I know the open source systems are a little bit more lenient.
You can really schedule things in the future.
You can adjust things in the future, but really knowing your commercial system and how to, how to navigate that is so key.
Right.
And also the base understanding that you're working with your system, your algorithm, having an understanding for how it works and how you may need to work with it.
(07:40):
In these examples, this type of a meal or this type of a season of different meals, you end up often needing to step outside the box of what's been taught and used.
And you need to be able to say, well, I've historically seen a rise at the three hour mark after I have high fat, goodness, tonight's holiday meal is going to be pretty high in fat.
(08:02):
Or the assumption is that it is because it's not typical fare made by a whole bunch of other people.
And I might need to watch for a rise starting at 10, 11 or midnight that the system isn't going to catch, which means you have to do it yourself or you just have to be able to make peace with where your blood sugar is going to sit until the system gets it down.
(08:23):
I was just going to say that I think a lot of times people have such anxiety about what is going to happen, but I think you said it so beautifully. Making peace with that rise and knowing that the system will bring it down.
It just may not be as fast as desired.
Yeah, exactly.
And that fast piece too is something within food that is hard to get over because we have rapid insulin.
(08:47):
Rapid isn't rapid like right now.
And when you have rapid insulin on top of high fat environment where the fat is depressing the impact of the insulin anyway, rapid becomes like old school R-insulin, kind of.
Totally, yes.
And I would always say, I swear I think this is going to be on my tombstone one day, that more is not faster, right?
(09:08):
I mean, more insulin is not faster insulin, but that is the knee-jerk reaction that so many people have is that they're seeing this rise, they want more, more, more, but then it's not faster.
No, and it ends up in the end, depending on the more that you're given, and if you're not watching it, you're going to have a low later.
Absolutely.
Could you catch it? If you know that your more now is going to need to be taken care of later, then great, fine.
(09:34):
But the more now still isn't going to hit the high.
No.
Yeah.
Yeah.
But I do think, you know, in this world of technology and constant data, seeing those highs and maybe anticipating those highs, it does cause sometimes those holiday meals not to be as enjoyable.
I hope that folks kind of learn to be OK with maybe that high that will eventually come down.
(10:01):
You're not staying high forever, but maybe it's a touchpoint and that, you know, instead of being focused on that high blood sugar, hopefully they can focus on the happy memory that they had sharing a great meal with their family.
Correct.
Or a special, you know, again, a lot of people talk about grandma's cookies or the special pie that their family makes for this particular holiday or celebration.
(10:23):
And there's a lot of thought within diabetes about food.
And in general, you might have your typicals figured out.
And when those special things come in, there is already a little bit of first thought of, as you said, anxiety.
It's a concern of I've got these targets in mind and I don't know what's going to happen with grandma's apple or pecan pie.
(10:45):
Right.
Well, again, that's where you kind of have to, like, make peace with the it's not going to be perfect.
And if it is? Great! Awesome.
But it's not going to be perfect.
And you kind of have to let it play out and navigate it in that moment, because otherwise you're not really going to enjoy the special treat as much.
Right.
(11:05):
And I do think, you know, as much education and kind of strategy that you can come up with it, it hopefully allows diabetes to take kind of a backseat in those events, because, you know, diabetes and food is such a key part.
But, you know, those those normal foods that you eat 80 percent of the time is really what we want to focus on and make sure that we can, you know, understand how our bodies reacting to that, understand the insulin and the system we're using in terms of the 80 percent of the time.
(11:32):
And then the 20 percent is grandma's pecan pie.
Let's try to to get that to work.
But we're going to learn if it doesn't work perfectly.
Right.
And the learning part, I think, is also almost like a historical view that you can take forward with you. For people who have had diabetes long enough,
you may have had that pecan pie for years and years.
(11:54):
And now that you have the technology you have, which maybe you didn't have before, you know the advantage that that could bring in to manage things even a little bit more smoothly.
I mean, I know years ago when I was MDI around the holidays, I just found that I needed to add a little bit kind of extra and that helped to coat the background for meals that were just heavier, longer duration and just more.
(12:17):
And then once I finally had a pump, it was super exciting to learn about temp basal and extended boluses because I could help myself without having to pay such close attention.
Right.
Right.
And that makes it different.
I know the extended bolus is great just because you can front load insulin, but it'll be delayed delivering and then it allows you to have that pecan pie or that special sweet that you're wanting to have.
(12:42):
Yeah.
You know, protein, as you mentioned earlier, is a big part of a lot of holiday types of meals or even in the summertime, which we're kind of passing through now, the cookouts or barbecues or whatever.
And I think the protein piece is one that, similar to fat, can have a big impact, even if it's pretty lean protein, larger portions at a time can delay the meal impact and then have a lingering overall hit on your blood sugar, too.
(13:11):
So knowing your system.
Yeah, exactly.
And I think a lot of times when people are eating what they perceive as a keto diet or low carb, they don't factor in that protein and a good part of that protein will convert into glucose energy.
It's just delayed.
You know, these automated systems can be helpful with them, but I do think it comes back to knowing your system.
(13:33):
It does.
And the learning of how to work with it. Again, not expecting that it's going to take care of everything and even almost looking at what your typical is,
as you said before, like 80 percent of your intake, you've got it figured out.
How is this meal that you're coming into different than your typical intake?
What other factors might you have to consider?
(13:53):
I think it is truly a look every time we sit down to something that is not the normal meal for us.
It's a new look, a new experiment, if you will, to be able to say, OK, well, Thanksgiving, if you celebrate it, Thanksgiving meal is full of carbohydrates, but it could also be really full of protein depending on what your family prepares and puts together, which could overall have an impact where you use multiple different features of the system that you've got.
(14:23):
And I would say a meal like that, just the massive amount of intake at one time is going to delay your metabolism and your digestion,
right?
Your body can't absorb 100 grams of carbs at one time.
And so I always try to explain to people that, you know, the larger the meal, you really do want to drop that insulin delivery.
(14:43):
Right.
I know for Thanksgiving years ago, I kind of figured out even without it, without an automated system.
Yeah.
I figured out that I needed about a 20 percent increase behind Thanksgiving in particular.
We used to have pretty like good holiday family gathering for it, which usually includes like the nibble food.
(15:05):
Right.
Just sitting out, you know, it could be nuts, it could be olives, it could be cheese, it could be crackers.
It could be all the things,
right?
And then you end up coming to the meal and then you end up coming into dessert.
So I found, gosh, if I just coat the background with a little extra basal insulin with a temporary basal, I'm also not being as precise in the counting around holidays.
(15:26):
I try to really enjoy being in the moment and the social piece of it.
And so then you're a little bit lax on the precision and that ends up just getting kind of covered with a little extra in the background.
The precision doesn't have to be as heavy.
And then at the end of the meal where dessert comes in, we've or I've always found that doing an extended bolus specific to that because I've got so much other food in my system.
(15:53):
It was either an extended bolus for the dessert or you try to go outside and like do something active in between and get the insulin kind of moving a little bit.
Supercharge it.
Yeah, exactly.
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(16:22):
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And now back to our program.
(16:43):
Well, that's one of the... I love the feature of Save Without Bolusing that the open source loop system has for that situation.
You know, you're grazing, you're not really sure what you're going to have, but you certainly are going to have 15 to 20 grams, even if you're just kind of hanging out with whatever food is there.
And I do think, sometimes going into these trickier meals that people perceive as trickier, entering in 15 grams over an extended amount of time, you can always recover from 15 or 20 grams, you know, even if you're under eating a little bit.
(17:20):
Right.
Cover your favorite low treatment.
Right.
If it's 10 grams, bolus for 10 grams, because you can always eat yourself out of that 10 grams.
Exactly.
It's a good idea, too, when you're going into meals that are going to be lengthier and you're not quite sure what you're going to pick off of a holiday sort of meal table, that 10 or 15 grams pre bolus, getting that insulin going as soon as you can before you sit down.
(17:46):
Then once you finally sit down and you know how much more you've added to your plate or that you're going to pick, bolus for the rest at that point.
Exactly.
At least you have some insulin going to catch that quicker upswing with especially holiday meals.
They tend to have lots and lots of carbs to begin with.
Yeah.
And then I love how you mentioned during Thanksgiving meals, you know, finding some sort of activity to do in between. You know, whether that is just going for a walk with a dog or, you know, little ones or or playing, you know, football in the backyard.
(18:17):
I mean, that's just the insulin going.
For the past number of years I've tried to do, and now that my boys are a little bit bigger, they can go with me,
I try to do a turkey trot.
Yeah.
Mainly because it's a nice way to sort of mobilize some increase in metabolism early in the day, knowing that you've got probably a little bit more sedentary just sitting time for the rest of the day.
(18:42):
And I love the turkey trot.
It's so fun.
So they're way fun.
Yeah.
Ours are our funny one here.
They have,they serve, one of our local bakeries always does the donuts.
And at the end you get like donuts.
Right.
I'm not much of a donut person, so I could care less about it.
But everybody else seems to like them.
Yeah.
Ours,
people seem to dress up in fantastic costumes, which is always fun to see.
(19:05):
Lots of turkeys running around.
Yeah.
Last year we had a guy who had actually like a was a turkey costume that fit over.
So the legs were like pointed like above his head.
And as he was running the legs like... it was hilarious.
We actually have headbands that have turkey legs that kind of are on the spring like that.
That's way fun.
Yeah.
Thanksgiving is a big favorite in my house.
(19:26):
And so we are eating from day break until sundown.
So a lot of extended boluses, a lot of activity tried to mix in within the day.
You also do a lot of the bigger food based kind of holidays around your your Jewish holidays, right?
Yeah.
We just finished break fast.
(19:47):
And that is very carb centric.
Of course, you're fasting all day, which I always get the question, well, do you fast?
And this is my annual time to do a basal check because I'm not eating and my basal insulin should be so that I don't have to eat.
I did have a little bit of a low yesterday, so I need to make some adjustments for that.
(20:09):
But otherwise, it was kind of set
well. But that is my annual basal check.
And just to make sure things are kind of going the way that they're supposed to,
but that is not food related
it's the opposite.
No.
But the breaking the fast can also be, especially for meals that are going to be a little bit carb heavier in any, you know, any kind of that sets up for a fasting time ahead of time.
(20:30):
Do you have a plan that you use for when you break that fasting time so that you don't have just this big escalation from your body saying, oh, finally, food! Let's get it.
Yeah, I know, because that's why breakfast is oftentimes so tricky for people because you go from a fasted to a fed state.
And we have a tradition in my house,
we break with these cookie balls that I make.
(20:51):
And so I'm breaking my fast with pure chocolate.
I mean, it is pure chocolate.
It's delicious.
And so I do a pre-bowl for that because it's going to hit my body super fast.
And then the rest of the meal is pretty high carb, high fat.
And so I get that insulin cooking a little bit early and then definitely have an override.
(21:13):
I'm using an open source system.
And so I have a little bit more features on my insulin system.
But the overrides are fantastic for adding more for that high fat.
Yeah.
And anybody using some of the open source systems like Loop or Trio or AAPS or whatever, there are the nice thing about the dials is that you can accommodate.
(21:33):
Then the other nice thing about those adjustments, rides, it's whatever they are,
it does override all of the things, not just like conventional systems have temp basal that you can use.
It just hits your basal.
But the other systems actually allow adjustment with insulin to carb and your correction factor anytime you tell it to give a little more or take a little bit of a way.
(21:56):
So it is, I think it's a game changer because when you need more insulin, you kind of need insulin throughout the, all the profiles, not just your basal rate.
Right.
And in a holiday setting, using something like that, it could be a huge advantage mainly because I used to only use a temporary basil for like Thanksgiving, right.
And I could have very likely needed and have found much benefit now using these open source systems to just setting an override because I also get more food bolus.
(22:26):
Right, right.
And I think we probably felt like, Oh, we'll add a half a unit to our bolus or we'll add a full unit or five units depending on, on your carb ratios for bigger meals.
And now this, the automations do it nicely for us.
Nicely for us.
Yeah.
Anything else about holiday meals?
Yeah, I think that, you know, oftentimes people think they're tricky.
(22:49):
I think one, we're sitting for a really long period of time. We're eating a larger amount than we typically do.
And then maybe we're out of our routine. You know, we're, we're maybe taking the day off from work.
And what does that look like?
Are we sitting more?
Are we, you know, watching holiday movies with our family and snacking?
I think it just kind of shifts your schedule, but it's all doable.
(23:12):
I think that especially with the insulins we have now, you know, just kind of learning the system and working through that.
Well, and as you're mentioning that, I'm also thinking of some things that I tell people as tips, you know, when we work with people with Integrated Diabetes, it's a lot of what's coming and what, what do you expect to happen?
What have you historically seen happen?
(23:33):
How can we set up some strategies so that you can feel better about what you're doing?
Right?
And one of the things I often tell people is most times holidays have set meals that you know are going to be the celebration, but it's usually not the whole day.
Like it's not breakfast and lunch and dinner, not usually.
Right.
And so if you can keep as much normal as you would usually have and make that holiday gathering or celebration meal, the main point that's not going to be your typical, then you controlled again, 80% of your day outside of this couple of hours that might just be odd.
(24:12):
Right.
The other thing is to keep activity in the picture, right around holiday times, whether it, you know, Christmas or Hanukkah or any other holiday celebrations that are kind of days of celebrating.
If you can keep going to the gym or if you've traveled, use the hotel gym or take a walk outside, keeping that movement in the picture helps to keep your metabolism where it was.
(24:38):
Yep.
And your insulin sensitivity.
Right.
So those are some of the, not food specific, but it definitely helps with the food.
Right.
But I think you're right in that, you know, oftentimes people do have the same foods that they have for every holiday.
And so if you can kind of get an idea of those macros counts, you know, people, I laugh kind of, I don't know if you have the same experience.
(25:01):
People are like, well, I just don't know what I'm going to eat.
Well, yeah, you do.
You kind of do, you know, you're going to an Italian restaurant.
You kind of know what you order already at that Italian restaurant.
Its the same thing that you're going to your mom's house. You kind of know what she's going to make and yeah
and it may be a different tweak here and there for sure,
bBut I always think, you know, you kind of already do know what you're going to eat for the most part.
(25:25):
And so, um, it can help you strategize a little.
Yeah.
No, I a hundred percent agree.
I mean, especially again, going back to Thanksgiving, that's kind of coming up.
You kind of know you're eating turkey.
I kind of know what I'm going to eat or what I'm going to make or what somebody is going to bring because we discuss it ahead of time.
So I know my sister-in-law usually brings like this sweet potato casserole thing, right?
(25:49):
My mom and many other people love stuffing.
I love it.
Not my thing in any manner of making it.
I will send you my recipe.
It's a hazelnut dressing as we call it.
And it's so good.
Jenny, I'll send it to you.
It's good?
Maybe I will,
I will give it a try just because it's coming from you.
(26:09):
And I know your recipes are usually really good, but yeah, I don't.
So I know that I can cut that out.
Right.
So you're not going to have it.
Yeah, I'm not going to have it.
I really like green beans at Thanksgiving.
I will have probably a lot of green beans.
So, you know, some of the things, you know, ahead can be very, very.
Right.
And you look forward to them and yeah.
(26:29):
Yeah.
It's different than a vacation where you're going someplace where you really have less of an idea.
Especially when you're traveling.
Or a new culture or a new country and yeah.
International.
You have a clue.
Yeah.
Yeah.
I mean, I, when we went to Peru, I, it was pretty much just a guess.
Yeah.
Every time we sat down for something, it was just, maybe we'll try this.
(26:51):
Let's see how it works.
Right.
Although now I would say with carb counters and technology, there's, there's more of an educated guess.
You know, it used to be that we'd have to carry around a book or something, but now we've got the whole internet on our fingertips and, you know, certainly AI is improving, it's not perfect.
But I always tell people, you know, give AI a chance to at least get you in the ballpark and then you can kind of tweak from there.
(27:18):
That's one thing I tell people all the time, even if a free version of Chat GPT or something like that, you can get a pretty close analysis of a meal.
Some of them will even take pictures of your plate.
So it'll give you a little bit more formal information, which is nice because we don't really, I mean, my trip to Peru was absolutely, I wasn't bringing books along.
(27:40):
Right.
There was no internet that I could really use. It just was, so it was a guess.
Yeah.
But I would say now with, you know, if you had a combination of an automated insulin delivery system with kind of a close estimate or even a, you know, a general estimate of your carb counter, you're going to do pretty well.
Absolutely.
(28:00):
Use your tools. Use the tools like we've just talked about-- apps, AI, whatever you might need. Know your system. Know your algorithm. Know the tools that come with it, and also be willing to say that ,while automation may serve you most of the time, that going out of automation and using manual mode for temp basal, extended bolus, there is nothing wrong with doing that.
(28:25):
It does not ruin your automation.
Not at all.
We promise it doesn't, and it may serve better and you may feel a lot safer
actually doing that.
Because sometimes the safeguards on the automated system is really just not
allowing the system to deliver what's needed. You know, all of these commercial
(28:45):
systems have a limit as to how much it could deliver and with large meals, with,
you know, various body changes, you know, separate from, from food in terms of
hormones and stress and lack of sleep maybe, you probably do need a little bit
more insulin.
Yeah.
That the system will give you.
You know, one thing that I just thought of as you're talking about kind of knowing things and thinking about holidays in the back of my mind, something else that often comes in, that's not really food, but I think people also don't have a good idea how to navigate is alcohol.
(29:21):
Right.
Absolutely.
Right.
That's a big piece of holiday gatherings for some people, not everybody.
Sure.
So navigating alcohol in the picture can also mean that with some previous experience, you can use that in the picture of what you know and what you're doing, but if you have no experience, then it's kind of a cautionary, you know, piece because the more alcohol you have, the more your liver has to process, the more potential for swings down in blood sugar that you might have.
(29:52):
Um, and then you've got the other part, which is the meal, which might be trying to boost your blood sugar up so they, they might even each other out.
Right.
Exactly.
Uh, with the automated systems, I do find, you know, drinking in moderation can be kind of an easier navigation.
When we were having these straight line basal rates in old, old systems or even MDI, you know, we would have to make some major adjustments when folks had alcohol in the mix, but again, all that education and kind of knowing your body.
(30:24):
But I was going to say, probably stress of holidays can also impact blood sugars.
That's a non-food one.
Absolutely.
Depending on who the holiday is with and what the factors of family and friend interaction might look like and how stress impacts you. You know, maybe you handle that totally fine, despite not liking two people at the party.
(30:45):
Okay, great.
But some people are very, very.
It's a hard, it's a hard time of year for a lot of people.
And there's so many things that impact blood sugars.
That's certainly one of them.
Oh, cool.
Well, this was fun.
Absolutely.
Yeah, we'll do it again and talk about something different next time.
Sounds fantastic.
As always, if you need some help with holiday types of fair or any celebrations, especially coming up in our season of holiday after holiday, please remember that Integrated Diabetes Services is full of lots of clinicians.
(31:18):
We all have this type of really good tech knowledge, all the systems and lots and lots of good food knowledge between all of us.
So we're here to help if you need.
Thanks.
Absolutely.
Thanks for tuning in to Think Like a Pancreas--The Podcast.
If you enjoyed today's episode, don't forget to like follow or subscribe on your favorite podcast app.
(31:40):
Think Like a Pancreas--The Podcast is brought to you by Integrated Diabetes Services, where experience meets expertise, passion meets compassion, and diabetes care is personal because we live it, too.
Our team of clinicians, all living with type one diabetes, understands the challenges firsthand.
We're here to help no matter where you are in the world.
(32:01):
From glucose management to self-care strategies, the latest tech, sports and exercise, weight loss, type one pregnancy and emotional well-being, we've got you covered.
We offer consultations in English and Spanish via phone, video chat, email, and text.
Want to learn more?
Visit integrateddiabetes.com or email info@integrateddiabetes.com to schedule a consultation.
(32:29):
On behalf of Think Like a Pancreas--The Podcast, I'm Gary Sheiner, wishing you a fantastic week ahead.
And don't forget to think like a pancreas.
!
Welcome to Think Like a Pancreas-The Podcast where our goal is to keep you informed, inspired and a little entertained on all things diabetes.
The information contained in this program is based on the experience and opinions of the Integrated Diabetes Services Clinical team.
Please discuss any changes to your treatment plan with your personal health care provider before implementing.
(00:35):
So here we are today to talk about what?
Well, I think we're going to dive into some holiday eating.
It is now October.
I don't know if it's getting a little bit cooler where you are.
It is for sure for me, which is a nice change in Texas.
Again, I'm Dana Roseman.
I'm also a dietician and certified diabetes care and education specialist working with Integrated as the Director of Technology and Applied Research.
(01:01):
I think we wanted to kind of talk about some tricky holiday eating. Things that really, I think a lot of people that I work with just get anxious and stressed about. What's going to be served at, you know, the next party or the next event?
And certainly think that, as fall gets a little bit cooler, people turn to some comfort food that may be a little bit harder to take insulin for.
(01:24):
And those are questions I get kind of throughout the fall and certainly through the winter.
No, absolutely.
And this time of the year sort of starts out while we are not really cooler.
You're not?
That's unfortunate.
We're not.
It's kind of odd.
The past couple of years have been sort of moving.
I should qualify.
We're not in the nineties.
I'm not saying that, you know, I'm wearing a jacket outside.
(01:46):
You're not in the sixties, right?
No.
Yeah.
Our early mornings are what have changed.
Our early mornings are nice, like 58, 60 ish.
But then the past, I don't know, a couple of weeks we've been like at least 80.
I think today it's supposed to be 85.
But it is still a little bit cooler differently.
And it is a time of the year, you're right, that a lot of my recipes, I end up thinking about changing them over and I haven't really done it yet because it's not been cool enough outside.
(02:14):
Yeah.
But yeah, chili recipes or things like stew and casserole and more hearty meals.
Absolutely.
Potatoes and gravy.
Potatoes.
And even this time of the year starts out like it's holiday after holiday after holiday after holiday.
You almost don't really get a break and it ends up setting you up then to start the year on this slide down that you've done for like a month and a half of food that wasn't your typical stuff.
(02:47):
Right.
And it becomes harder to navigate.
And then you throw in football season in that.
Yeah.
Yeah.
And all of the parties and all the different football.
Yes, exactly.
Anyway.
And all the systems too, right?
I mean, just as dieticians, we know the food angle, but we also as educators know the technology angle and each of the different systems can be used in their own way to navigate the different kinds of foods.
(03:13):
I was just going to say, you know, when someone says, well, how do I, you know, bolus for pizza?
Or how do I boluls for, you know, that, that high fat chili?
The first thing I have to ask is what system are you on?
Because I don't know how to approach it without really first going back to the basics, which is how that insulin is being adjusted.
Right.
(03:33):
Right.
You know, those are two. There's a great way to say it is the basics is how the insulin being adjusted or what have you learned about navigating
And then.
And then what are your features available to you, right?
Because if you're using Omnipod 5 in auto mode, you know, that the extended bolus is not an option unless you go into manual mode, which is very different from Tandem, which is very different from the open source systems.
(03:59):
Right. And even Medtronic, right?
Yes.
And that's kind of, I think about Omnipod 5 and Medtronic in terms of those smarter features that you might want access to.
They're both similar that you just have to go out of automation and use manual mode in those circumstances.
And I think that's a hard thing to consider when you've been so used to the automation helping you. You'd think that you'd want it back there for these types of foods and meals when in the truth, it's like, well, maybe manual mode works better because you know how to cover the food without the system helping because you can do more.
(04:35):
But then I always get nervous because settings are set for the way that you're delivering insulin most of the time.
So if you're mostly in the automated system, your carb ratio is probably a little bit more aggressive than if you're in manual mode and using it in the extended way.
So that can be a little bit tricky for sure if people aren't understanding their system and wanting to manipulate those trickier foods.
(05:00):
And I think that makes the thing that really makes these foods a little bit tricky is, is the slower digestion or the high fat component that is going to, I call it the gift that keeps on giving.
It's just, you know, you have a high fat food and the blood sugar just continues to rise.
Yeah.
Or it just sits there.
I feel like it rises eventually, but then it almost gets stuck.
(05:21):
You feel like they're on this just plateau of, is the insulin even working?
Am I giving it at all?
Is the system even helping me? Because you just sort of float along at a higher level than you want to be.
And that is the case then of knowing your system well enough to be able to say what, you know, like Tandem, lovely, especially with Control IQ Plus now, the ability to use a temporary basal on top.
(05:44):
Absolutely.
It's been life-changing for so many people.
And even the extended bolus, there is a huge advantage for, you know, you brought up chili.
My chili tends to need an extended give of insulin rather than a big bolus up front.
Chili, depending on the content of your chili, I tend to do bean chilies.
(06:05):
I was just going to say, I've got a lot of beans in mine.
Right.
Versus like high fat, high, you know, meat, it could be a chicken chili, but that still tends to be pretty high fat with the other ingredients that are added.
Especially if you put cheese on it.
Yep.
Right.
So that tends to have a lag effect and you end up needing something extended that's going to give more.
(06:26):
And most of the automated systems aren't going to give more because they don't know the reason you're sitting high.
Right.
Right.
And so then, you know, you, you almost have to enter those, those carbs or the protein and fat components later on.
And a lot of times people just forget, right?
Because they're busy and, or they're going to sleep after a high fat meal and then you just sit high for the whole night.
(06:51):
I would say one other thing that kind of complicates this is so many people now are using a GLP-1 that even exaggerates that delay of some of these tricky foods.
And I was working with someone earlier this morning who, we noticed that some of his food was hitting four hours after he ate. Right?
(07:11):
And his automated system wasn't helping bring it down and he was asleep.
So yeah, I know the open source systems are a little bit more lenient.
You can really schedule things in the future.
You can adjust things in the future, but really knowing your commercial system and how to, how to navigate that is so key.
Right.
And also the base understanding that you're working with your system, your algorithm, having an understanding for how it works and how you may need to work with it.
(07:40):
In these examples, this type of a meal or this type of a season of different meals, you end up often needing to step outside the box of what's been taught and used.
And you need to be able to say, well, I've historically seen a rise at the three hour mark after I have high fat, goodness, tonight's holiday meal is going to be pretty high in fat.
(08:02):
Or the assumption is that it is because it's not typical fare made by a whole bunch of other people.
And I might need to watch for a rise starting at 10, 11 or midnight that the system isn't going to catch, which means you have to do it yourself or you just have to be able to make peace with where your blood sugar is going to sit until the system gets it down.
(08:23):
I was just going to say that I think a lot of times people have such anxiety about what is going to happen, but I think you said it so beautifully. Making peace with that rise and knowing that the system will bring it down.
It just may not be as fast as desired.
Yeah, exactly.
And that fast piece too is something within food that is hard to get over because we have rapid insulin.
(08:47):
Rapid isn't rapid like right now.
And when you have rapid insulin on top of high fat environment where the fat is depressing the impact of the insulin anyway, rapid becomes like old school R-insulin, kind of.
Totally, yes.
And I would always say, I swear I think this is going to be on my tombstone one day, that more is not faster, right?
(09:08):
I mean, more insulin is not faster insulin, but that is the knee-jerk reaction that so many people have is that they're seeing this rise, they want more, more, more, but then it's not faster.
No, and it ends up in the end, depending on the more that you're given, and if you're not watching it, you're going to have a low later.
Absolutely.
Could you catch it? If you know that your more now is going to need to be taken care of later, then great, fine.
(09:34):
But the more now still isn't going to hit the high.
No.
Yeah.
Yeah.
But I do think, you know, in this world of technology and constant data, seeing those highs and maybe anticipating those highs, it does cause sometimes those holiday meals not to be as enjoyable.
I hope that folks kind of learn to be OK with maybe that high that will eventually come down.
(10:01):
You're not staying high forever, but maybe it's a touchpoint and that, you know, instead of being focused on that high blood sugar, hopefully they can focus on the happy memory that they had sharing a great meal with their family.
Correct.
Or a special, you know, again, a lot of people talk about grandma's cookies or the special pie that their family makes for this particular holiday or celebration.
(10:23):
And there's a lot of thought within diabetes about food.
And in general, you might have your typicals figured out.
And when those special things come in, there is already a little bit of first thought of, as you said, anxiety.
It's a concern of I've got these targets in mind and I don't know what's going to happen with grandma's apple or pecan pie.
(10:45):
Right.
Well, again, that's where you kind of have to, like, make peace with the it's not going to be perfect.
And if it is? Great! Awesome.
But it's not going to be perfect.
And you kind of have to let it play out and navigate it in that moment, because otherwise you're not really going to enjoy the special treat as much.
Right.
(11:05):
And I do think, you know, as much education and kind of strategy that you can come up with it, it hopefully allows diabetes to take kind of a backseat in those events, because, you know, diabetes and food is such a key part.
But, you know, those those normal foods that you eat 80 percent of the time is really what we want to focus on and make sure that we can, you know, understand how our bodies reacting to that, understand the insulin and the system we're using in terms of the 80 percent of the time.
(11:32):
And then the 20 percent is grandma's pecan pie.
Let's try to to get that to work.
But we're going to learn if it doesn't work perfectly.
Right.
And the learning part, I think, is also almost like a historical view that you can take forward with you. For people who have had diabetes long enough,
you may have had that pecan pie for years and years.
(11:54):
And now that you have the technology you have, which maybe you didn't have before, you know the advantage that that could bring in to manage things even a little bit more smoothly.
I mean, I know years ago when I was MDI around the holidays, I just found that I needed to add a little bit kind of extra and that helped to coat the background for meals that were just heavier, longer duration and just more.
(12:17):
And then once I finally had a pump, it was super exciting to learn about temp basal and extended boluses because I could help myself without having to pay such close attention.
Right.
Right.
And that makes it different.
I know the extended bolus is great just because you can front load insulin, but it'll be delayed delivering and then it allows you to have that pecan pie or that special sweet that you're wanting to have.
(12:42):
Yeah.
You know, protein, as you mentioned earlier, is a big part of a lot of holiday types of meals or even in the summertime, which we're kind of passing through now, the cookouts or barbecues or whatever.
And I think the protein piece is one that, similar to fat, can have a big impact, even if it's pretty lean protein, larger portions at a time can delay the meal impact and then have a lingering overall hit on your blood sugar, too.
(13:11):
So knowing your system.
Yeah, exactly.
And I think a lot of times when people are eating what they perceive as a keto diet or low carb, they don't factor in that protein and a good part of that protein will convert into glucose energy.
It's just delayed.
You know, these automated systems can be helpful with them, but I do think it comes back to knowing your system.
(13:33):
It does.
And the learning of how to work with it. Again, not expecting that it's going to take care of everything and even almost looking at what your typical is,
as you said before, like 80 percent of your intake, you've got it figured out.
How is this meal that you're coming into different than your typical intake?
What other factors might you have to consider?
(13:53):
I think it is truly a look every time we sit down to something that is not the normal meal for us.
It's a new look, a new experiment, if you will, to be able to say, OK, well, Thanksgiving, if you celebrate it, Thanksgiving meal is full of carbohydrates, but it could also be really full of protein depending on what your family prepares and puts together, which could overall have an impact where you use multiple different features of the system that you've got.
(14:23):
And I would say a meal like that, just the massive amount of intake at one time is going to delay your metabolism and your digestion,
right?
Your body can't absorb 100 grams of carbs at one time.
And so I always try to explain to people that, you know, the larger the meal, you really do want to drop that insulin delivery.
(14:43):
Right.
I know for Thanksgiving years ago, I kind of figured out even without it, without an automated system.
Yeah.
I figured out that I needed about a 20 percent increase behind Thanksgiving in particular.
We used to have pretty like good holiday family gathering for it, which usually includes like the nibble food.
(15:05):
Right.
Just sitting out, you know, it could be nuts, it could be olives, it could be cheese, it could be crackers.
It could be all the things,
right?
And then you end up coming to the meal and then you end up coming into dessert.
So I found, gosh, if I just coat the background with a little extra basal insulin with a temporary basal, I'm also not being as precise in the counting around holidays.
(15:26):
I try to really enjoy being in the moment and the social piece of it.
And so then you're a little bit lax on the precision and that ends up just getting kind of covered with a little extra in the background.
The precision doesn't have to be as heavy.
And then at the end of the meal where dessert comes in, we've or I've always found that doing an extended bolus specific to that because I've got so much other food in my system.
(15:53):
It was either an extended bolus for the dessert or you try to go outside and like do something active in between and get the insulin kind of moving a little bit.
Supercharge it.
Yeah, exactly.
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(16:22):
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And now back to our program.
(16:43):
Well, that's one of the... I love the feature of Save Without Bolusing that the open source loop system has for that situation.
You know, you're grazing, you're not really sure what you're going to have, but you certainly are going to have 15 to 20 grams, even if you're just kind of hanging out with whatever food is there.
And I do think, sometimes going into these trickier meals that people perceive as trickier, entering in 15 grams over an extended amount of time, you can always recover from 15 or 20 grams, you know, even if you're under eating a little bit.
(17:20):
Right.
Cover your favorite low treatment.
Right.
If it's 10 grams, bolus for 10 grams, because you can always eat yourself out of that 10 grams.
Exactly.
It's a good idea, too, when you're going into meals that are going to be lengthier and you're not quite sure what you're going to pick off of a holiday sort of meal table, that 10 or 15 grams pre bolus, getting that insulin going as soon as you can before you sit down.
(17:46):
Then once you finally sit down and you know how much more you've added to your plate or that you're going to pick, bolus for the rest at that point.
Exactly.
At least you have some insulin going to catch that quicker upswing with especially holiday meals.
They tend to have lots and lots of carbs to begin with.
Yeah.
And then I love how you mentioned during Thanksgiving meals, you know, finding some sort of activity to do in between. You know, whether that is just going for a walk with a dog or, you know, little ones or or playing, you know, football in the backyard.
(18:17):
I mean, that's just the insulin going.
For the past number of years I've tried to do, and now that my boys are a little bit bigger, they can go with me,
I try to do a turkey trot.
Yeah.
Mainly because it's a nice way to sort of mobilize some increase in metabolism early in the day, knowing that you've got probably a little bit more sedentary just sitting time for the rest of the day.
(18:42):
And I love the turkey trot.
It's so fun.
So they're way fun.
Yeah.
Ours are our funny one here.
They have,they serve, one of our local bakeries always does the donuts.
And at the end you get like donuts.
Right.
I'm not much of a donut person, so I could care less about it.
But everybody else seems to like them.
Yeah.
Ours,
people seem to dress up in fantastic costumes, which is always fun to see.
(19:05):
Lots of turkeys running around.
Yeah.
Last year we had a guy who had actually like a was a turkey costume that fit over.
So the legs were like pointed like above his head.
And as he was running the legs like... it was hilarious.
We actually have headbands that have turkey legs that kind of are on the spring like that.
That's way fun.
Yeah.
Thanksgiving is a big favorite in my house.
(19:26):
And so we are eating from day break until sundown.
So a lot of extended boluses, a lot of activity tried to mix in within the day.
You also do a lot of the bigger food based kind of holidays around your your Jewish holidays, right?
Yeah.
We just finished break fast.
(19:47):
And that is very carb centric.
Of course, you're fasting all day, which I always get the question, well, do you fast?
And this is my annual time to do a basal check because I'm not eating and my basal insulin should be so that I don't have to eat.
I did have a little bit of a low yesterday, so I need to make some adjustments for that.
(20:09):
But otherwise, it was kind of set
well. But that is my annual basal check.
And just to make sure things are kind of going the way that they're supposed to,
but that is not food related
it's the opposite.
No.
But the breaking the fast can also be, especially for meals that are going to be a little bit carb heavier in any, you know, any kind of that sets up for a fasting time ahead of time.
(20:30):
Do you have a plan that you use for when you break that fasting time so that you don't have just this big escalation from your body saying, oh, finally, food! Let's get it.
Yeah, I know, because that's why breakfast is oftentimes so tricky for people because you go from a fasted to a fed state.
And we have a tradition in my house,
we break with these cookie balls that I make.
(20:51):
And so I'm breaking my fast with pure chocolate.
I mean, it is pure chocolate.
It's delicious.
And so I do a pre-bowl for that because it's going to hit my body super fast.
And then the rest of the meal is pretty high carb, high fat.
And so I get that insulin cooking a little bit early and then definitely have an override.
(21:13):
I'm using an open source system.
And so I have a little bit more features on my insulin system.
But the overrides are fantastic for adding more for that high fat.
Yeah.
And anybody using some of the open source systems like Loop or Trio or AAPS or whatever, there are the nice thing about the dials is that you can accommodate.
(21:33):
Then the other nice thing about those adjustments, rides, it's whatever they are,
it does override all of the things, not just like conventional systems have temp basal that you can use.
It just hits your basal.
But the other systems actually allow adjustment with insulin to carb and your correction factor anytime you tell it to give a little more or take a little bit of a way.
(21:56):
So it is, I think it's a game changer because when you need more insulin, you kind of need insulin throughout the, all the profiles, not just your basal rate.
Right.
And in a holiday setting, using something like that, it could be a huge advantage mainly because I used to only use a temporary basil for like Thanksgiving, right.
And I could have very likely needed and have found much benefit now using these open source systems to just setting an override because I also get more food bolus.
(22:26):
Right, right.
And I think we probably felt like, Oh, we'll add a half a unit to our bolus or we'll add a full unit or five units depending on, on your carb ratios for bigger meals.
And now this, the automations do it nicely for us.
Nicely for us.
Yeah.
Anything else about holiday meals?
Yeah, I think that, you know, oftentimes people think they're tricky.
(22:49):
I think one, we're sitting for a really long period of time. We're eating a larger amount than we typically do.
And then maybe we're out of our routine. You know, we're, we're maybe taking the day off from work.
And what does that look like?
Are we sitting more?
Are we, you know, watching holiday movies with our family and snacking?
I think it just kind of shifts your schedule, but it's all doable.
(23:12):
I think that especially with the insulins we have now, you know, just kind of learning the system and working through that.
Well, and as you're mentioning that, I'm also thinking of some things that I tell people as tips, you know, when we work with people with Integrated Diabetes, it's a lot of what's coming and what, what do you expect to happen?
What have you historically seen happen?
(23:33):
How can we set up some strategies so that you can feel better about what you're doing?
Right?
And one of the things I often tell people is most times holidays have set meals that you know are going to be the celebration, but it's usually not the whole day.
Like it's not breakfast and lunch and dinner, not usually.
Right.
And so if you can keep as much normal as you would usually have and make that holiday gathering or celebration meal, the main point that's not going to be your typical, then you controlled again, 80% of your day outside of this couple of hours that might just be odd.
(24:12):
Right.
The other thing is to keep activity in the picture, right around holiday times, whether it, you know, Christmas or Hanukkah or any other holiday celebrations that are kind of days of celebrating.
If you can keep going to the gym or if you've traveled, use the hotel gym or take a walk outside, keeping that movement in the picture helps to keep your metabolism where it was.
(24:38):
Yep.
And your insulin sensitivity.
Right.
So those are some of the, not food specific, but it definitely helps with the food.
Right.
But I think you're right in that, you know, oftentimes people do have the same foods that they have for every holiday.
And so if you can kind of get an idea of those macros counts, you know, people, I laugh kind of, I don't know if you have the same experience.
(25:01):
People are like, well, I just don't know what I'm going to eat.
Well, yeah, you do.
You kind of do, you know, you're going to an Italian restaurant.
You kind of know what you order already at that Italian restaurant.
Its the same thing that you're going to your mom's house. You kind of know what she's going to make and yeah
and it may be a different tweak here and there for sure,
bBut I always think, you know, you kind of already do know what you're going to eat for the most part.
(25:25):
And so, um, it can help you strategize a little.
Yeah.
No, I a hundred percent agree.
I mean, especially again, going back to Thanksgiving, that's kind of coming up.
You kind of know you're eating turkey.
I kind of know what I'm going to eat or what I'm going to make or what somebody is going to bring because we discuss it ahead of time.
So I know my sister-in-law usually brings like this sweet potato casserole thing, right?
(25:49):
My mom and many other people love stuffing.
I love it.
Not my thing in any manner of making it.
I will send you my recipe.
It's a hazelnut dressing as we call it.
And it's so good.
Jenny, I'll send it to you.
It's good?
Maybe I will,
I will give it a try just because it's coming from you.
(26:09):
And I know your recipes are usually really good, but yeah, I don't.
So I know that I can cut that out.
Right.
So you're not going to have it.
Yeah, I'm not going to have it.
I really like green beans at Thanksgiving.
I will have probably a lot of green beans.
So, you know, some of the things, you know, ahead can be very, very.
Right.
And you look forward to them and yeah.
(26:29):
Yeah.
It's different than a vacation where you're going someplace where you really have less of an idea.
Especially when you're traveling.
Or a new culture or a new country and yeah.
International.
You have a clue.
Yeah.
Yeah.
I mean, I, when we went to Peru, I, it was pretty much just a guess.
Yeah.
Every time we sat down for something, it was just, maybe we'll try this.
(26:51):
Let's see how it works.
Right.
Although now I would say with carb counters and technology, there's, there's more of an educated guess.
You know, it used to be that we'd have to carry around a book or something, but now we've got the whole internet on our fingertips and, you know, certainly AI is improving, it's not perfect.
But I always tell people, you know, give AI a chance to at least get you in the ballpark and then you can kind of tweak from there.
(27:18):
That's one thing I tell people all the time, even if a free version of Chat GPT or something like that, you can get a pretty close analysis of a meal.
Some of them will even take pictures of your plate.
So it'll give you a little bit more formal information, which is nice because we don't really, I mean, my trip to Peru was absolutely, I wasn't bringing books along.
(27:40):
Right.
There was no internet that I could really use. It just was, so it was a guess.
Yeah.
But I would say now with, you know, if you had a combination of an automated insulin delivery system with kind of a close estimate or even a, you know, a general estimate of your carb counter, you're going to do pretty well.
Absolutely.
(28:00):
Use your tools. Use the tools like we've just talked about-- apps, AI, whatever you might need. Know your system. Know your algorithm. Know the tools that come with it, and also be willing to say that ,while automation may serve you most of the time, that going out of automation and using manual mode for temp basal, extended bolus, there is nothing wrong with doing that.
(28:25):
It does not ruin your automation.
Not at all.
We promise it doesn't, and it may serve better and you may feel a lot safer
actually doing that.
Because sometimes the safeguards on the automated system is really just not
allowing the system to deliver what's needed. You know, all of these commercial
(28:45):
systems have a limit as to how much it could deliver and with large meals, with,
you know, various body changes, you know, separate from, from food in terms of
hormones and stress and lack of sleep maybe, you probably do need a little bit
more insulin.
Yeah.
That the system will give you.
You know, one thing that I just thought of as you're talking about kind of knowing things and thinking about holidays in the back of my mind, something else that often comes in, that's not really food, but I think people also don't have a good idea how to navigate is alcohol.
(29:21):
Right.
Absolutely.
Right.
That's a big piece of holiday gatherings for some people, not everybody.
Sure.
So navigating alcohol in the picture can also mean that with some previous experience, you can use that in the picture of what you know and what you're doing, but if you have no experience, then it's kind of a cautionary, you know, piece because the more alcohol you have, the more your liver has to process, the more potential for swings down in blood sugar that you might have.
(29:52):
Um, and then you've got the other part, which is the meal, which might be trying to boost your blood sugar up so they, they might even each other out.
Right.
Exactly.
Uh, with the automated systems, I do find, you know, drinking in moderation can be kind of an easier navigation.
When we were having these straight line basal rates in old, old systems or even MDI, you know, we would have to make some major adjustments when folks had alcohol in the mix, but again, all that education and kind of knowing your body.
(30:24):
But I was going to say, probably stress of holidays can also impact blood sugars.
That's a non-food one.
Absolutely.
Depending on who the holiday is with and what the factors of family and friend interaction might look like and how stress impacts you. You know, maybe you handle that totally fine, despite not liking two people at the party.
(30:45):
Okay, great.
But some people are very, very.
It's a hard, it's a hard time of year for a lot of people.
And there's so many things that impact blood sugars.
That's certainly one of them.
Oh, cool.
Well, this was fun.
Absolutely.
Yeah, we'll do it again and talk about something different next time.
Sounds fantastic.
As always, if you need some help with holiday types of fair or any celebrations, especially coming up in our season of holiday after holiday, please remember that Integrated Diabetes Services is full of lots of clinicians.
(31:18):
We all have this type of really good tech knowledge, all the systems and lots and lots of good food knowledge between all of us.
So we're here to help if you need.
Thanks.
Absolutely.
Thanks for tuning in to Think Like a Pancreas--The Podcast.
If you enjoyed today's episode, don't forget to like follow or subscribe on your favorite podcast app.
(31:40):
Think Like a Pancreas--The Podcast is brought to you by Integrated Diabetes Services, where experience meets expertise, passion meets compassion, and diabetes care is personal because we live it, too.
Our team of clinicians, all living with type one diabetes, understands the challenges firsthand.
We're here to help no matter where you are in the world.
(32:01):
From glucose management to self-care strategies, the latest tech, sports and exercise, weight loss, type one pregnancy and emotional well-being, we've got you covered.
We offer consultations in English and Spanish via phone, video chat, email, and text.
Want to learn more?
Visit integrateddiabetes.com or email info@integrateddiabetes.com to schedule a consultation.
(32:29):
On behalf of Think Like a Pancreas--The Podcast, I'm Gary Sheiner, wishing you a fantastic week ahead.
And don't forget to think like a pancreas.
!
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