April 8, 2025 • 34 mins
In episode 29 of Think Like a Pancreas--The Podcast, host, Gary Scheiner and his guest, Rabbi Hirsch Meisels, of Jewish Friends With Diabetes International explore Powering Through Passover with Type 1 Diabetes.
Listen as they delve into the challenges of extended meal times during the Seder and discuss effective glucose management strategies.
Learn about the importance of timing insulin dosages, especially in relation to the Seder's unique structure, and gain insights into carb counting techniques for matzah and other Passover foods to ensure a balanced and healthy observance.
Key Takeaways- Rabbi Hirsh Meisels explains the significance of Passover for non-Jewish listeners.
- Adjusting Observances for Health: Rabbi Meisels discusses how Jewish law prioritizes health and allows for adjustments.
- The Rabbi shares his tried and true method of carb counting for Matzah.
- Hypoglycemia Management: Recommended products for treating low blood sugar during Passover.
- Maintaining Quality of Life: Gary and Rabbi Meisels emphasize the importance of enjoying Passover while managing diabetes effectively.
00:00 Introduction and Disclaimers
00:43 Meet Rabbi Hirsch Meisels
02:38 Living with Diabetes During Passover
03:42 Understanding Passover Traditions
07:12 Managing Blood Sugar During the Seder
11:00 Carb Counting and Insulin Tips for Passover Foods
18:27 Wine and Blood Sugar Management
23:56 Diabetes and Jewish Law
26:06 Hypoglycemia Management During Passover
27:59 Final Thoughts and Resources
Links DisclaimerThe 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.
If you enjoyed today's episode, don't forget to like, follow or subscribe on your favorite podcast app.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:13):
Welcome to Think Like a Pancreas,the podcast where our goal is to keep
you informed, inspired, and a littleentertained on all things diabetes.
The information contained in thisprogram is based on the experience
and opinions of the IntegratedDiabetes Services clinical team.
Please discuss any changes to yourtreatment plan with your personal
(00:33):
healthcare provider before implementing.
So welcome everybody to today's podcast.
I'm Gary Scheer, and I amthrilled to be joined by my friend
and colleague, rabbi Hirsch.
Meisels.
I. Rabbi, tell us alittle bit about yourself.
Yeah, thank you, Gary.
We've seen each other many times andthanks for getting me on this show.
(00:54):
So Shalom.
My name is Rabbi Hirsch Mazel.
I've been living with Type onediabetes for the past 46 years.
Currently I use a tandem basal IQinsulin pump, alongside with a Dexcom G
six sensor to help manage my diabetes.
I'm the founder of Friends withDiabetes, an organization established
30 years ago with the mission of helpingindividuals integrate Jewish lifestyle
(01:20):
while managing Type one diabetes.
Our goal is to provide guidance onhow Jewish law called HALAKHA relates
to managing diabetes and offer socialand emotional support to those living
with the condition and their families.
We run support groups with children.
Teens, parents and adults helpingthem navigate life with diabetes
(01:41):
while maintaining a strong connectionto their faith and community.
I've had the pleasure ofparticipating in almost a dozen
of your programs over the years.
Um, I, I find them soulful.
I find them rejuvenative.
(02:01):
The tremendous learning opportunity.
I always make new friends, sothe name Friends with diabetes
is a very appropriate one.
Uh, those are tremendous programsfor the Jewish community.
And like you, I I've been throughmy share of Passovers with diabetes.
I'm coming up on 40 years.
(02:22):
I haven't quite caught you, but I'm still,I'm still trying catch up on 40 years with
type one and, uh, 40 years of Passovers.
Uh.
Through the mix.
So our, our, the title of our programtoday is Powering through Passover.
But it's interesting, a lot ofpeople find Passover challenging
when you have diabetes.
I find that my glucose controlimproves for the eight days.
(02:46):
Uh, I find I'm more ontrack with my diet because.
Stuff I normally nos on.
I'm not notching on, uh, therestaurants I might normally go to.
I'm not going to, I, I do abetter job with my, my eating
during those eight days, and henceI've got better glucose control.
During that time, what have youfound to be the case for you?
(03:09):
Is your blood sugar betteror worse, or about the same?
During Passover?
Sometimes on the first few days I'llstruggle with some low blood sugars.
Until I got used to this new regimen.
But yes, you're correct.
Uh, with less food choices aroundblood sugar control is much easier.
So, uh, yeah, the, the lows, there's a lotto work out those first couple of days.
(03:32):
You know, there's a lot of detailsand response, new responsibilities and
that mental energy can, can contributeto a bit of a glucose decline.
So for our non-Jewish listeners,and we have quite a few.
Can you tell us, uh, just the quicksummary of what Passover is all about?
Let's try.
Passover or Pesach is one of the mostsignificant holidays in the Jewish
(03:55):
calendar celebrating the liberationof the Jewish people from slavery
in ancient Egypt, the holidaysspent eight days with the first two
nights centered around the Seder.
Special meal that includes symbolicfoods, prayers and storytelling.
The Seder is an opportunity forfamilies to retell the story of the
(04:15):
Exodus, using the hagada to guide them.
The children traditionally ask thefour questions which help engage
everyone in understanding theholidays, meaning the symbolic foods
on the CER plate include matza andunleavened Bread represents the bread
the Jewish people ate in their Egypt.
(04:37):
Bitter herbs, usuallyhorseradish symbolizes the
bitterness of slavery and wine.
Four cups are drunk during the Sederto symbolize freedom and redemption
During Passover, Jewish people refrainfrom eating chametz, levan foods
like bread and pasta for eight days,and remembrance of the unleavened
bread they ate during the exodus.
(04:58):
Some individuals, particularly amongAshkenazi Jews also avoid legumes.
Called kitniyot during this time,these dietary restrictions can
make, can make finding suitable,ready-made foods challenging.
So it's important to chooseproducts there are specifically
certified as kosher for Passover.
Do you have any, uh, traditions outside ofthe normal, you know, reading of the Haga?
(05:23):
I know we, we, uh, we hide the Afikomen.
The afikomen is a--that half pieceof matza that you wrap and, uh,
someone in the family hides it andone of the children is supposed
to find it and they get a, youknow, a prize if they're able to.
Uh, so we always have fun with that.
But we, we send the adultsscouring the house as well.
(05:46):
We, we find some creative placesto hide the afikomen, so that,
that's kind of a fun activity.
You do anything like that at your Seder?
Yes.
It's part of the Seder ritual.
Uh, by us.
We don't really hide it On the couch,we sit on, there are two pillows and we
just put them between the two pillows.
(06:06):
The, the kids try to take it away whenfather is not seeing, and then when
the time comes to eat it, which isthe last food eaten during the night,
the father looked for the a Tacoma,can't find it, and asked who stole the
ama, and then they would come back.
And try to argue, if you promiseme to do this or get me this,
(06:30):
I'll give it back to you.
That's sort of permitted stealing.
Yeah.
Our other family tradition is, uh,one of the, you know, post meal
songs, Chad gadya, we all take onthe role of one of the characters.
Uh, and my mother-in-law, God rest hersoul, she used to be the ox and she
(06:50):
would make the sound of an ox that.
Would frighten the, uh, you know,frighten anybody who could hear it.
Uh, and we would all come up withthese creative voices to animate the,
uh, different characters in the song.
So it was always a fun, fun ritualthat our family, uh, likes to do.
So the, the Seders usually take placethe first two nights of Passover.
(07:14):
Um, and there's a lot aboutthe Seder that's different
from a, a normal evening meal.
What do you find are some ofthe bigger differences between a
Passover Seder and a normal meal
starts much later at night, way, wayafter sundown, and it ends usually not
(07:34):
before midnight or many hours later.
Very different schedule.
And then having to say to recite allthe hagada and many families with
many translations and commentariesand stories, this takes a long time,
even before we start, the actual mealcould take between one to two hours
(07:57):
until we get to the actual meal,which would be very late at night.
So for somebody with diabeteswho takes insulin specifically.
That can create some challenges.
People who are on injections, uh,might start to see their glucose
decline while they're waitingto eat late into the evening.
And even, you know, just thatlong drawn out aspect of the
(08:20):
meal can, can be problematic.
Somebody who takes injections mightfind that their insulin is working
before they have a chance to finishtheir meal and could go low from that.
Uh, insulin pumps offerus some opportunities to
manage a little bit better.
How do you use your insulin pump to manageyour glucose with that kind of a meal?
(08:43):
Interestingly enough, as youmentioned, the The Seder is
different for every family.
We always eat it with family.
We have no clue how other families do it.
Like you mentioned with the Chadgadya, I've never heard this, so by us.
Interestingly enough, we have tofinish the last piece of matzah for
the Afikomen, and then we can'teat anything, anything afterwards.
(09:06):
We have to finish that before midnightand think about starting the whole
Seder when it's already dark or later.
The Hagada would take one to two hours.
There's not much timeleft for the actual meal.
Traditionally, in our family,it's a extremely rushed meal.
Shorter than a typical holiday or Shabbat.
(09:27):
I never had that problem with prolongedeating in terms of the insulin.
But if people do it the other wayaround and the meal is a dragged out
meal, they'll have to handle this likewith any other holiday extended meal.
And each person's different.
Many families, uh, the story ofof, of the Passover run through
(09:49):
the the Hagada, and then the mealactually goes on for several hours.
Uh, you know, there's alot of courses, et cetera.
There might be some prayers setduring the meal, some songs that
are done during the meal and after.
We used to save the dessert itemsuntil, uh, after all the post dinner
(10:09):
songs, uh, and prayers take place.
So the meal part can sometimesgo on for quite a while.
And, uh, the pumps give us achance to, you know, dose our
insulin as we go fairly easily.
And there's a feature in mostpumps called an extended bolus
that can be used as well.
The interesting thing about some ofthe newer systems that are out there,
(10:30):
like the Tandem, the the Omnipod fiveand the Medtronic, and even the open
source systems is some of them don'tallow you to extend boluses while
they're making automated adjustments.
So you have to turn off theautomated feature to extend the
boluses for those drawn out meals,but I find it's still worth doing.
(10:53):
Uh, you know, the one food thatis most closely associated with
Passover, of course, is matza.
Tell everybody what matza is.
Matza is basically flourand water, nothing else.
Pure starts, high glycemic index.
If it's not whole wheat, if it's wholewheat, it's a bit better or spelt.
(11:13):
And, uh, eating mat could potentiallyraise blood sugars to very high level and
very rapidly, very quickly, high speed.
Um, many families have a custom notto mix the matza with anything else.
No spreads on it, no dips.
So this takes away the advantage ofhaving it mixed with a protein or a fat.
(11:38):
So it stays a high glycemic indexand, and, and it is an issue.
Yeah.
So if somebody is taking their, a bolusof insulin for matza, uh, they need
to ideally take in it adv in advance.
Because that matza does raisethe glucose very quickly, but
you mentioned toppings and dips.
Uh, chopped liver, for example, wouldcertainly slow down the digestion
(12:02):
of the matza a bit to keep it fromspiking the glucose all at one time.
Uh, so that's an optionpeople can turn to.
Um.
Other than Matza, well let, let's talkabout the matza a little bit more.
Now.
The carb counting, uh, can be a littlebit of a challenge, but you've come
up with some techniques and tools thatcan help people estimate the carbs in
(12:26):
Matza, as well as some other peoc foods.
Any, any tricks you can shareabout Matza carb counting?
People using machine matzah, thesquare matzah, they're pretty simple.
They're usually not too heavy.
Would be about one ounce each,and you'll get somewhere between
20 and 25 carbs per matzah board.
(12:46):
It's not overdone if youeat one whole matzah.
That's usually simple.
When it comes to the matzah, we usethe Ultra Orthodox, the round Shmura
matzah, they can be very heavy, large.
And discrepancies between one matzahand the other matzah in the same box.
So there's no real choice but to weighon a scale the portion you are consuming.
(13:12):
What I've come up with isthat matza, roughly I like
averages, makes life simpler.
It's roughly 70% carbohydrates.
The other 30% I guess, is the wateror whatever else is in the wheat.
70% is carbohydrates.
The way the, the easy way would beput it on a scale, use a calculator to
(13:33):
calculate the carb counts, or, in mymind, I have a simple way of doing it.
I view it as 10 gram portion.
Each 10 gram portion wouldbe seven carbs, 70% of 10.
Seven.
If I would eat a whole matza, whichwould be 60 grams, then weight, I'll
(13:54):
view it in my mind as six such portions,each portion having seven carbs, six
times seven, and you got the answer 42.
Roughly.
If you matza weigh 70, 70 of suchportions, seven times seven would be 49.
Sure.
That's easily done in my brain.
If someone doesn't, youknow, have a a food scale.
(14:15):
I teach them how to use surface area.
This the volume, this, thekind of the radius, the di,
or the diameter of the matza.
As a way to estimate, if someone had around matza that was the size of a hand
with the fingers spread, about how muchcarb would you estimate that to be?
I would say it's, it weighs 20.
(14:36):
Then it's, you got 14 grams, 14 carbs.
Okay.
The problem, the challenge withthe matzah we use, which people
make by hand is that the thicknessof each mat could be different.
Mm-hmm.
It's, it's, the real best way wouldbe, uh, using a scale in particular.
It's so high in starches, it's so highin carbs, and so rapid glycemic index, we
(15:01):
wanna try to be as accurate as possible.
Okay.
We teach, uh, I, I use pizzaas an analogy with the matzo.
Yeah, you're right.
If you're getting pizza, you could havethin crust, hand tossed, deep dish.
It, it varies a lot.
So we, we teach with pizza.
A hand size piece is about 30if it's an average thickness of
(15:21):
crust, if it's thinner, it's 20.
If it's thicker, it's 40.
So as a general rule of thumbaround matza, the size of a
hand is gonna average about 15.
If it's a thicker.
Type of a matza might be 20.
If it's a thinner, it might be 10.
So if somebody just has to ballparkit, they don't have a scale available
(15:42):
that that's one way they can do it.
The scale will give you the more accuratemeasure, but you could estimate pretty
closely, at least if you use that 10, 15,20 number for a hand size piece of matza.
Of course, we're talking aboutan average adult man's hand.
You know, a, a woman or a childis gonna have a smaller hand,
(16:03):
you got a different number.
So you, you gotta have a man'shand on, you know, handy to
be able to do that properly.
So with Matza, getting the carbs rightor close is part of the challenge.
The other is the timing.
And as you said, it's a veryhigh glycemic index food.
It's gonna raise the glucose very quickly.
So pre bolusing taking insulin, 10,15, even 20 minutes ahead is ideal.
(16:27):
Most other foods we eat on Pesach, mostof the starches are potato based, so we're
not having, you know, many other typesof starches other than potato and potato.
At least white potato is also avery high glycemic index food.
So we're looking at alot of high GI foods.
So pre bolusing on Passover throughout theweek is gonna be necessary to avoid the
(16:52):
big spikes and drops throughout the day.
That is that safe to say?
Definitely safe to say.
People will try to limit their starcheslike low carb dieters, et cetera,
could do the same thing on Passover.
We eat meat, chicken, fish.
Many families do eat dairy, some don't.
There's still enough protein options.
(17:13):
Whichever way you use potatoes duringthe, during the year, you could do the
same on Pesach, add some fat, eat ittogether with protein, don't overeat.
You know, all the tips you use aroundthe year could be used on Pesach as well.
I've discovered the joy ofmatzo with cream cheese.
I find that very tasty, and ifI slather on a decent amount of
(17:34):
cream cheese, it does slow downthe digestion, uh, a decent amount.
You know, I'm not encouraging everybody toload up on a ton of fat during Passover,
but you know, like you said, chopped liverdips, things like that, it can help a bit.
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(18:17):
Or call 8 6 6 6 9 2 8 0 24 and select option three.
And now back to our program.
Um, wine is another importantaspect of the Passover Seder
drinking multiple glasses of wine.
Or, you know, the young peoplemight drink grape juice, but
let's talk about wine first.
(18:39):
'cause wine can have more than onetype of effect on glucose levels.
It can raise it.
It can lower it.
Can you talk about that a little bit?
It's always the question to choosebetween wine or grape juice.
For the four cups during theSeder, it's always important to
be mindful of blood sugar levels.
Grape juice on one hand are highin carbohydrates and cause rapid
(19:02):
spikes in blood sugars, especiallywhen consumed in large quantity.
For those managing diabetes, Ioften recommend to dilute the grape
juice, dilute the grape juice withwater, or opt for a lower carb
option like cas light grape juice.
Wine, on the other hand, can have adifferent effect, and as you mentioned,
could have, it's a double whammyas it's double-edged sword alcohol.
(19:25):
Can lower blood sugars byinhibiting livered release of
glucose, especially when consumedbefore a meal on an empty stomach.
For people with diabetes, it'scrucial to manage this carefully
or in large quantities
Or in large quantities.
Um, sweet wines are also goingto have the opposite effect, that
you could have a rise in bloodsugar levels and following a dip.
(19:51):
I'll get into a low blood sugar.
Dry wines typically have fewer carbsor none, but much more alcohol.
Moderate wines like Chablis providea better balance, not too much
alcohol and not too many carbs.
That would be a good, uh, in between.
Yeah, I find with the, uh, the dry wines,you know, higher quality wines, uh, we
(20:14):
don't tend to see much of a glucose rise.
There might be one or two grams ofcarbohydrate or sugar per glass,
but the alcohol can accumulate.
Somebody who has four glasses of winehas a decent amount of alcohol there,
and if the liver isn't making as muchglucose as usual after the Seder,
blood sugars can drop overnight.
(20:35):
People who use automated insulin deliverysystems are somewhat protected against
the lows, but if you wanna play it safe.
You can turn off the automationand then lower the basal insulin
that you get during the night.
Uh, you would run a temp basal andmaybe lower the basal by 30 or 40%
(20:56):
through the night just to re lower Therisk of of having a hypo and people on
injections could cut back a little biton the dose of long-acting insulin,
whether it's Tresiba, Toujeo, Lantus,glargine, whatever they're using.
Basaglar, taking that dose downa little bit just to protect
against the low during the night.
(21:16):
The sweet wines though, uh, will usuallyit's like drinking grape juice with
alcohol, essentially, they can causea pretty rapid rise in the glucose.
So I, I still recommend taking a bolus ofinsulin, of rapid acting insulin to cover
the carbs in those, uh, four ounces of,of sweet wine or grape juice can have as
(21:37):
much as 15 grams of rapid acting sugar init, so it's necessary to dose for those.
Go ahead.
Here's the recommendation Imake-- prepare for the Seder, both
options, a dry wine and grape juice.
The first cup, whichstarts the whole Seder.
You still have.
(21:57):
Probably close to two hours untilyou're going to eat the meal
without long period of time.
I say you have to judge before drinkingthe first cup if, if you, if you should
use grape juice or wine, if your bloodsugar would be low at the start of the
Seder, use grape juice for the first cupso it'll help you raise your blood sugars.
On the other hand, if your bloodsugar is higher using a dry wine.
(22:19):
It may actually help lower it, possiblywithout the need of a correction dose.
It's interesting it, that'sthe same approach I use when
I do any distance running.
I'll get to a rest stop and I'llchoose between water or a sports drink,
depending on what my blood sugar is doing.
So it's diabetes.
We gotta make decisions on the flya lot of the time, based on the
(22:40):
situation, the sitting is another issue.
When we sit for long periods of time,our bodies are burning less glucose.
We become a little less sensitive toour insulin and blood sugars can climb.
So during a prolonged Seder,there may be a tendency for the
glucose to climb throughout.
Do you just not worry aboutthat and let it happen?
(23:01):
Or do you wanna address it and.
Keep it from happening.
Here's the way I address it.
You know, the Hagadais like a long prayer.
Many pieces in it could be madeinto a song and just stand up and
start dancing with the whole family.
You do that once or twicein the middle of the Hagada.
You're not sitting that long.
You're actually moving a little.
(23:23):
Get your body active.
That helps with, uh, that issueof losing the insulin sensitivity.
I love that approach.
We should do that whenwe're on airplanes too.
Sit in all those hours, just get up inthe aisle and start dancing every hour.
That works for me.
Um.
Now, obviously in the Jewish faith,we have people who are orthodox,
(23:48):
conservative, reform, reconstructionists,so there's, there's different levels
of observance that take place.
Is there anything about having diabetes,that should keep somebody from following
any of the observances during Pesach.
Good question.
Uh, as a general rule, Jewish lawprioritizes health and wellbeing,
(24:12):
allowing commandments or customs to beadjusted in life-threatening situations.
However, adjustments can also be madefor medical or health reasons, not
just life-threatening circumstances.
With that in mind, let's focuson, on on relevant details.
Jewish law is complex and often thereare different opinions on the same issue.
Interpretations, yeah.
(24:34):
Correct.
This is where a competent rabbi whounderstands the medical situation comes
into play, helping to determine whichmore lenient opinion one should follow.
For example, in Halakha Jewish law, thereare various opinions regarding the amount
of wine or grape juice required foreach of the four cups during the Seder.
(24:54):
Most lenient opinions suggeststhat only one and a half ounces.
Per cup is necessary.
While other opinions may requireup to five plus ounces per cup for
someone with diabetes, drinking20 plus ounces of wine or juice.
If you wanna follow the moststringent opinion that could lead to
significant blood sugar fluctuations.
(25:16):
Therefore, it's important to follow thelean opinion and aim for a smaller amount.
This would allow you to fulfillthe Seder's obligation while
effectively managing your health.
Same would be true formatza as we discussed.
It's a pure star, a high glycemicindex, it Ali to blood sugar spikes.
Different opinions exist regardingthe required amount of matza.
Generally, it's recommended to eataround 30 grams at the beginning
(25:39):
of the meal with additionalportions as the meal progresses.
If that amount would lead to erraticbot sugars, you can reduce and consult
with a rabbi for guidance and how toadjust based on personal health needs.
I'll give one more example.
Some families follow strict customsduring Passover permitting only
homemade products with everythingprepared from scratch at home.
(26:01):
However, there are situationssuch as managing diabetes
where exceptions are made.
For example, using store-bought candy totreat low blood sugars during payoff is,
is necessary and practical exception,allowing the individuals to maintain their
health while still honoring tradition.
That was actually the next thing I wasgonna ask you was about hypoglycemia.
(26:23):
Uh, what are some of therecommended products, uh, for
treating hypos during pesach?
Technically we have kosher for Passoveritems, you know, all over the grocery
store, and there are candies and allkinds of junk, uh, that, that we can get.
Um, the typical.
winkie or fizzers, they are notavailable and not kosher for Passover.
(26:50):
Yeah, there's it calledSmarties in the secular
Yeah.
Uh, interestingly enough that we, friendswith diabetes recommend people if they
use year round only one specific thingfor lows, like in the case of Winkys,
just use it for Passover as well.
Don't fiddle around.
Okay.
I'll use chewing gums for Pesach.
(27:11):
It would take much longer timeto raise your blood sugars.
Just do the same thingyou've done all year round.
Grape juice is always an option as well.
At home during case when we're athome, it's easy to have grape juice.
When we're outside,we're going for a ride.
It's a little difficult to carry alongthe back drink or bottle of grape juice,
(27:31):
so we look for some packet items likethe candies to, to have them handy
while going on a hike, et cetera.
It's a shame Manchezdoesn't make juice boxes.
That would be so convenient.
Yeah, the part juice boxes
stick the straw in.
Imagine taking a hike, there'senough you have to schlep along with
you can fit better in the pocket.
(27:52):
Yes,
absolutely.
So considering, you know, Pesachis a fairly long holiday, eight
days, there are a lot of, uh,dietary restrictions involved.
How important is it tomanage blood sugar levels?
During Pesach and there's a certaintrade off with anything, should
(28:13):
we just say, you know what, I'mjust not gonna worry about it.
Let the blood sugars do what they may.
Or should we really still focusin and dig in and manage the
glucose well like we normally do?
What do you think?
We've gotta live life.
And quality of life is very important.
Uh, that's why we're here, togive them the easy tips on how to
(28:34):
manage it easily so you don't haveto go out of your way that much to
still control your blood sugars.
Whatever's doable is doable.
If it's not, it's not.
As you mentioned, happens to be thatwe have better blood sugar control
during Pesach for whatever reason.
I speculate maybe there are chemicalsand the food all year round.
Create a stress on the body.
(28:55):
I don't know.
But yes, we do have an easier timecontrolling blood sugars, but uh,
if one finds that it's impossible,you know, don't lose sleep over it.
You try your best.
Two nights are tricky.
No.
And the rest, just follow, followthe regular diet and try your best.
And as we discussed, the mostimportant would probably be
the matzah and the potatoes.
(29:17):
Once you know how to handlethose, you're in good shape.
It's refreshing to hear you say that.
Uh, I, I often have to remind mypatients that the reason we manage our
diabetes is to have good quality life.
If we have to start sacrificing the thingsthat give us a quality life to manage
the diabetes, we're missing the point.
(29:39):
We gotta live life first.
We gotta enjoy ourselves and do ourbest to manage it, but don't let it
interfere with what's really important.
Family, friends, religion, thethings that are, you know, really
make, make life worth living.
Uh.
If somebody's interested inlearning more about friends with
diabetes, how can they do that?
(30:00):
Probably best would be to send me anemail to be added to our email list.
I think that's gonna be fairly easy.
Uh, you can go onto my website.
It's very outdated, but there you'llfind an email to be able to communicate.
To connect.
The website is friends with diabetes.org.
That's simple enough.
(30:20):
Do you have any, uh,conferences coming up?
Um, not in the near future.
Thanks.
I know you, you've, you've had,you know, countless programs over
the years, you know, mostly in thenortheast, in the Greater New York
area, but in other places as well.
Some are for couples, some arefor children, some are for adults,
some are for men, some for women.
(30:43):
Uh, and they're, they're just such,they're, it's a warm environment.
People there have a lot ofcommonality and they do make, you
do make a lot of friends there andyou learn some valuable things and.
All within the contextof a, a Shabbas weekend.
It's terrific events and you havesome excellent resources as well.
(31:03):
Specific things about the variousholidays and managing diabetes.
Um, so just to summarize, a,you know, Passover is, uh,
it's an eight day holiday.
It's commemorating the exodusfrom Egypt by the Jewish people to
observe and recognize the holiday.
There are certain dietary restrictionsthat are placed, number of ritual meals.
(31:25):
That occur.
And they include somechallenging things like matza.
Uh, there's a lot of potatoproducts because we don't have,
you know, bread or anything that,that contains yeast or can rise.
Uh, wine is a big part of, of the holiday.
Um, and, you know, there are tricksfor, for managing diabetes effectively.
(31:46):
Talked about, you know, estimatingthe carbs in Matza as well as
specific carb counting techniques,adjustments for alcohol.
Um.
Adjustments for changes in activity levelor making sure you still get some activity
even during, uh, prolonged ritual meals.
And, uh, point,
I think we missed point.
(32:06):
Point is enjoy it.
Enjoy pay.
That's what it's, it's meant for, uh.
If your diabetes isn'tjust so, that's okay.
We do our best.
That's all.
Anyone can ask for.
Anything important that I missed?
I think we missed onepoint regarding the Seder.
I only say it because I've heardpeople, newbies, especially, uh,
(32:28):
doing it, doing it the wrong way.
From when we start the Sedernight until we get to the
meal, could take a long time.
Taking your insulin before the Sederbegins would be a very bad choice.
I mean, you would pass low evenbefore the meal, um, to, to,
to think about the insulin.
The appropriate time would be rightbefore drinking the second cup,
(32:52):
which is followed by the meal.
So there, and then before drinkingthe second cup, you can factor
the insulin for the second cup.
The mat, the meal, and even the thirdcup, they could all, all could be
included in, in that one bolus, regularor extended right before the second cup.
Thank you for sharing that.
(33:13):
Uh, I often tell my patientsthat getting the right amount of
insulin is only half the battle.
The timing has gotta be right.
So thank you for sharing that.
And Rabbi, thank you for taking time outtayour busy schedule, um, to join me today
on the Think Like a Pancreas podcast.
Thanks for tuning in to ThinkLike a Pancreas, the podcast.
(33:36):
If you enjoy today's episode, don'tforget to like, follow, or subscribe
on your favorite podcast app.
Think like a pancreas.
The podcast is brought to you byIntegrated Diabetes Services where
experience meets expertise, passionmeets compassion, and diabetes care
is personal because we live it too.
(33:56):
Our team of clinicians all livingwith type one diabetes understands
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We're here to help no matterwhere you are in the world.
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I'm Gary Shiner, wishing you afantastic week ahead, and don't
(34:39):
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 littleentertained on all things diabetes.
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Please discuss any changes to yourtreatment plan with your personal
(00:33):
healthcare provider before implementing.
So welcome everybody to today's podcast.
I'm Gary Scheer, and I amthrilled to be joined by my friend
and colleague, rabbi Hirsch.
Meisels.
I. Rabbi, tell us alittle bit about yourself.
Yeah, thank you, Gary.
We've seen each other many times andthanks for getting me on this show.
(00:54):
So Shalom.
My name is Rabbi Hirsch Mazel.
I've been living with Type onediabetes for the past 46 years.
Currently I use a tandem basal IQinsulin pump, alongside with a Dexcom G
six sensor to help manage my diabetes.
I'm the founder of Friends withDiabetes, an organization established
30 years ago with the mission of helpingindividuals integrate Jewish lifestyle
(01:20):
while managing Type one diabetes.
Our goal is to provide guidance onhow Jewish law called HALAKHA relates
to managing diabetes and offer socialand emotional support to those living
with the condition and their families.
We run support groups with children.
Teens, parents and adults helpingthem navigate life with diabetes
(01:41):
while maintaining a strong connectionto their faith and community.
I've had the pleasure ofparticipating in almost a dozen
of your programs over the years.
Um, I, I find them soulful.
I find them rejuvenative.
(02:01):
The tremendous learning opportunity.
I always make new friends, sothe name Friends with diabetes
is a very appropriate one.
Uh, those are tremendous programsfor the Jewish community.
And like you, I I've been throughmy share of Passovers with diabetes.
I'm coming up on 40 years.
(02:22):
I haven't quite caught you, but I'm still,I'm still trying catch up on 40 years with
type one and, uh, 40 years of Passovers.
Uh.
Through the mix.
So our, our, the title of our programtoday is Powering through Passover.
But it's interesting, a lot ofpeople find Passover challenging
when you have diabetes.
I find that my glucose controlimproves for the eight days.
(02:46):
Uh, I find I'm more ontrack with my diet because.
Stuff I normally nos on.
I'm not notching on, uh, therestaurants I might normally go to.
I'm not going to, I, I do abetter job with my, my eating
during those eight days, and henceI've got better glucose control.
During that time, what have youfound to be the case for you?
(03:09):
Is your blood sugar betteror worse, or about the same?
During Passover?
Sometimes on the first few days I'llstruggle with some low blood sugars.
Until I got used to this new regimen.
But yes, you're correct.
Uh, with less food choices aroundblood sugar control is much easier.
So, uh, yeah, the, the lows, there's a lotto work out those first couple of days.
(03:32):
You know, there's a lot of detailsand response, new responsibilities and
that mental energy can, can contributeto a bit of a glucose decline.
So for our non-Jewish listeners,and we have quite a few.
Can you tell us, uh, just the quicksummary of what Passover is all about?
Let's try.
Passover or Pesach is one of the mostsignificant holidays in the Jewish
(03:55):
calendar celebrating the liberationof the Jewish people from slavery
in ancient Egypt, the holidaysspent eight days with the first two
nights centered around the Seder.
Special meal that includes symbolicfoods, prayers and storytelling.
The Seder is an opportunity forfamilies to retell the story of the
(04:15):
Exodus, using the hagada to guide them.
The children traditionally ask thefour questions which help engage
everyone in understanding theholidays, meaning the symbolic foods
on the CER plate include matza andunleavened Bread represents the bread
the Jewish people ate in their Egypt.
(04:37):
Bitter herbs, usuallyhorseradish symbolizes the
bitterness of slavery and wine.
Four cups are drunk during the Sederto symbolize freedom and redemption
During Passover, Jewish people refrainfrom eating chametz, levan foods
like bread and pasta for eight days,and remembrance of the unleavened
bread they ate during the exodus.
(04:58):
Some individuals, particularly amongAshkenazi Jews also avoid legumes.
Called kitniyot during this time,these dietary restrictions can
make, can make finding suitable,ready-made foods challenging.
So it's important to chooseproducts there are specifically
certified as kosher for Passover.
Do you have any, uh, traditions outside ofthe normal, you know, reading of the Haga?
(05:23):
I know we, we, uh, we hide the Afikomen.
The afikomen is a--that half pieceof matza that you wrap and, uh,
someone in the family hides it andone of the children is supposed
to find it and they get a, youknow, a prize if they're able to.
Uh, so we always have fun with that.
But we, we send the adultsscouring the house as well.
(05:46):
We, we find some creative placesto hide the afikomen, so that,
that's kind of a fun activity.
You do anything like that at your Seder?
Yes.
It's part of the Seder ritual.
Uh, by us.
We don't really hide it On the couch,we sit on, there are two pillows and we
just put them between the two pillows.
(06:06):
The, the kids try to take it away whenfather is not seeing, and then when
the time comes to eat it, which isthe last food eaten during the night,
the father looked for the a Tacoma,can't find it, and asked who stole the
ama, and then they would come back.
And try to argue, if you promiseme to do this or get me this,
(06:30):
I'll give it back to you.
That's sort of permitted stealing.
Yeah.
Our other family tradition is, uh,one of the, you know, post meal
songs, Chad gadya, we all take onthe role of one of the characters.
Uh, and my mother-in-law, God rest hersoul, she used to be the ox and she
(06:50):
would make the sound of an ox that.
Would frighten the, uh, you know,frighten anybody who could hear it.
Uh, and we would all come up withthese creative voices to animate the,
uh, different characters in the song.
So it was always a fun, fun ritualthat our family, uh, likes to do.
So the, the Seders usually take placethe first two nights of Passover.
(07:14):
Um, and there's a lot aboutthe Seder that's different
from a, a normal evening meal.
What do you find are some ofthe bigger differences between a
Passover Seder and a normal meal
starts much later at night, way, wayafter sundown, and it ends usually not
(07:34):
before midnight or many hours later.
Very different schedule.
And then having to say to recite allthe hagada and many families with
many translations and commentariesand stories, this takes a long time,
even before we start, the actual mealcould take between one to two hours
(07:57):
until we get to the actual meal,which would be very late at night.
So for somebody with diabeteswho takes insulin specifically.
That can create some challenges.
People who are on injections, uh,might start to see their glucose
decline while they're waitingto eat late into the evening.
And even, you know, just thatlong drawn out aspect of the
(08:20):
meal can, can be problematic.
Somebody who takes injections mightfind that their insulin is working
before they have a chance to finishtheir meal and could go low from that.
Uh, insulin pumps offerus some opportunities to
manage a little bit better.
How do you use your insulin pump to manageyour glucose with that kind of a meal?
(08:43):
Interestingly enough, as youmentioned, the The Seder is
different for every family.
We always eat it with family.
We have no clue how other families do it.
Like you mentioned with the Chadgadya, I've never heard this, so by us.
Interestingly enough, we have tofinish the last piece of matzah for
the Afikomen, and then we can'teat anything, anything afterwards.
(09:06):
We have to finish that before midnightand think about starting the whole
Seder when it's already dark or later.
The Hagada would take one to two hours.
There's not much timeleft for the actual meal.
Traditionally, in our family,it's a extremely rushed meal.
Shorter than a typical holiday or Shabbat.
(09:27):
I never had that problem with prolongedeating in terms of the insulin.
But if people do it the other wayaround and the meal is a dragged out
meal, they'll have to handle this likewith any other holiday extended meal.
And each person's different.
Many families, uh, the story ofof, of the Passover run through
(09:49):
the the Hagada, and then the mealactually goes on for several hours.
Uh, you know, there's alot of courses, et cetera.
There might be some prayers setduring the meal, some songs that
are done during the meal and after.
We used to save the dessert itemsuntil, uh, after all the post dinner
(10:09):
songs, uh, and prayers take place.
So the meal part can sometimesgo on for quite a while.
And, uh, the pumps give us achance to, you know, dose our
insulin as we go fairly easily.
And there's a feature in mostpumps called an extended bolus
that can be used as well.
The interesting thing about some ofthe newer systems that are out there,
(10:30):
like the Tandem, the the Omnipod fiveand the Medtronic, and even the open
source systems is some of them don'tallow you to extend boluses while
they're making automated adjustments.
So you have to turn off theautomated feature to extend the
boluses for those drawn out meals,but I find it's still worth doing.
(10:53):
Uh, you know, the one food thatis most closely associated with
Passover, of course, is matza.
Tell everybody what matza is.
Matza is basically flourand water, nothing else.
Pure starts, high glycemic index.
If it's not whole wheat, if it's wholewheat, it's a bit better or spelt.
(11:13):
And, uh, eating mat could potentiallyraise blood sugars to very high level and
very rapidly, very quickly, high speed.
Um, many families have a custom notto mix the matza with anything else.
No spreads on it, no dips.
So this takes away the advantage ofhaving it mixed with a protein or a fat.
(11:38):
So it stays a high glycemic indexand, and, and it is an issue.
Yeah.
So if somebody is taking their, a bolusof insulin for matza, uh, they need
to ideally take in it adv in advance.
Because that matza does raisethe glucose very quickly, but
you mentioned toppings and dips.
Uh, chopped liver, for example, wouldcertainly slow down the digestion
(12:02):
of the matza a bit to keep it fromspiking the glucose all at one time.
Uh, so that's an optionpeople can turn to.
Um.
Other than Matza, well let, let's talkabout the matza a little bit more.
Now.
The carb counting, uh, can be a littlebit of a challenge, but you've come
up with some techniques and tools thatcan help people estimate the carbs in
(12:26):
Matza, as well as some other peoc foods.
Any, any tricks you can shareabout Matza carb counting?
People using machine matzah, thesquare matzah, they're pretty simple.
They're usually not too heavy.
Would be about one ounce each,and you'll get somewhere between
20 and 25 carbs per matzah board.
(12:46):
It's not overdone if youeat one whole matzah.
That's usually simple.
When it comes to the matzah, we usethe Ultra Orthodox, the round Shmura
matzah, they can be very heavy, large.
And discrepancies between one matzahand the other matzah in the same box.
So there's no real choice but to weighon a scale the portion you are consuming.
(13:12):
What I've come up with isthat matza, roughly I like
averages, makes life simpler.
It's roughly 70% carbohydrates.
The other 30% I guess, is the wateror whatever else is in the wheat.
70% is carbohydrates.
The way the, the easy way would beput it on a scale, use a calculator to
(13:33):
calculate the carb counts, or, in mymind, I have a simple way of doing it.
I view it as 10 gram portion.
Each 10 gram portion wouldbe seven carbs, 70% of 10.
Seven.
If I would eat a whole matza, whichwould be 60 grams, then weight, I'll
(13:54):
view it in my mind as six such portions,each portion having seven carbs, six
times seven, and you got the answer 42.
Roughly.
If you matza weigh 70, 70 of suchportions, seven times seven would be 49.
Sure.
That's easily done in my brain.
If someone doesn't, youknow, have a a food scale.
(14:15):
I teach them how to use surface area.
This the volume, this, thekind of the radius, the di,
or the diameter of the matza.
As a way to estimate, if someone had around matza that was the size of a hand
with the fingers spread, about how muchcarb would you estimate that to be?
I would say it's, it weighs 20.
(14:36):
Then it's, you got 14 grams, 14 carbs.
Okay.
The problem, the challenge withthe matzah we use, which people
make by hand is that the thicknessof each mat could be different.
Mm-hmm.
It's, it's, the real best way wouldbe, uh, using a scale in particular.
It's so high in starches, it's so highin carbs, and so rapid glycemic index, we
(15:01):
wanna try to be as accurate as possible.
Okay.
We teach, uh, I, I use pizzaas an analogy with the matzo.
Yeah, you're right.
If you're getting pizza, you could havethin crust, hand tossed, deep dish.
It, it varies a lot.
So we, we teach with pizza.
A hand size piece is about 30if it's an average thickness of
(15:21):
crust, if it's thinner, it's 20.
If it's thicker, it's 40.
So as a general rule of thumbaround matza, the size of a
hand is gonna average about 15.
If it's a thicker.
Type of a matza might be 20.
If it's a thinner, it might be 10.
So if somebody just has to ballparkit, they don't have a scale available
(15:42):
that that's one way they can do it.
The scale will give you the more accuratemeasure, but you could estimate pretty
closely, at least if you use that 10, 15,20 number for a hand size piece of matza.
Of course, we're talking aboutan average adult man's hand.
You know, a, a woman or a childis gonna have a smaller hand,
(16:03):
you got a different number.
So you, you gotta have a man'shand on, you know, handy to
be able to do that properly.
So with Matza, getting the carbs rightor close is part of the challenge.
The other is the timing.
And as you said, it's a veryhigh glycemic index food.
It's gonna raise the glucose very quickly.
So pre bolusing taking insulin, 10,15, even 20 minutes ahead is ideal.
(16:27):
Most other foods we eat on Pesach, mostof the starches are potato based, so we're
not having, you know, many other typesof starches other than potato and potato.
At least white potato is also avery high glycemic index food.
So we're looking at alot of high GI foods.
So pre bolusing on Passover throughout theweek is gonna be necessary to avoid the
(16:52):
big spikes and drops throughout the day.
That is that safe to say?
Definitely safe to say.
People will try to limit their starcheslike low carb dieters, et cetera,
could do the same thing on Passover.
We eat meat, chicken, fish.
Many families do eat dairy, some don't.
There's still enough protein options.
(17:13):
Whichever way you use potatoes duringthe, during the year, you could do the
same on Pesach, add some fat, eat ittogether with protein, don't overeat.
You know, all the tips you use aroundthe year could be used on Pesach as well.
I've discovered the joy ofmatzo with cream cheese.
I find that very tasty, and ifI slather on a decent amount of
(17:34):
cream cheese, it does slow downthe digestion, uh, a decent amount.
You know, I'm not encouraging everybody toload up on a ton of fat during Passover,
but you know, like you said, chopped liverdips, things like that, it can help a bit.
A word from our sponsor.
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(17:55):
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(18:17):
Or call 8 6 6 6 9 2 8 0 24 and select option three.
And now back to our program.
Um, wine is another importantaspect of the Passover Seder
drinking multiple glasses of wine.
Or, you know, the young peoplemight drink grape juice, but
let's talk about wine first.
(18:39):
'cause wine can have more than onetype of effect on glucose levels.
It can raise it.
It can lower it.
Can you talk about that a little bit?
It's always the question to choosebetween wine or grape juice.
For the four cups during theSeder, it's always important to
be mindful of blood sugar levels.
Grape juice on one hand are highin carbohydrates and cause rapid
(19:02):
spikes in blood sugars, especiallywhen consumed in large quantity.
For those managing diabetes, Ioften recommend to dilute the grape
juice, dilute the grape juice withwater, or opt for a lower carb
option like cas light grape juice.
Wine, on the other hand, can have adifferent effect, and as you mentioned,
could have, it's a double whammyas it's double-edged sword alcohol.
(19:25):
Can lower blood sugars byinhibiting livered release of
glucose, especially when consumedbefore a meal on an empty stomach.
For people with diabetes, it'scrucial to manage this carefully
or in large quantities
Or in large quantities.
Um, sweet wines are also goingto have the opposite effect, that
you could have a rise in bloodsugar levels and following a dip.
(19:51):
I'll get into a low blood sugar.
Dry wines typically have fewer carbsor none, but much more alcohol.
Moderate wines like Chablis providea better balance, not too much
alcohol and not too many carbs.
That would be a good, uh, in between.
Yeah, I find with the, uh, the dry wines,you know, higher quality wines, uh, we
(20:14):
don't tend to see much of a glucose rise.
There might be one or two grams ofcarbohydrate or sugar per glass,
but the alcohol can accumulate.
Somebody who has four glasses of winehas a decent amount of alcohol there,
and if the liver isn't making as muchglucose as usual after the Seder,
blood sugars can drop overnight.
(20:35):
People who use automated insulin deliverysystems are somewhat protected against
the lows, but if you wanna play it safe.
You can turn off the automationand then lower the basal insulin
that you get during the night.
Uh, you would run a temp basal andmaybe lower the basal by 30 or 40%
(20:56):
through the night just to re lower Therisk of of having a hypo and people on
injections could cut back a little biton the dose of long-acting insulin,
whether it's Tresiba, Toujeo, Lantus,glargine, whatever they're using.
Basaglar, taking that dose downa little bit just to protect
against the low during the night.
(21:16):
The sweet wines though, uh, will usuallyit's like drinking grape juice with
alcohol, essentially, they can causea pretty rapid rise in the glucose.
So I, I still recommend taking a bolus ofinsulin, of rapid acting insulin to cover
the carbs in those, uh, four ounces of,of sweet wine or grape juice can have as
(21:37):
much as 15 grams of rapid acting sugar init, so it's necessary to dose for those.
Go ahead.
Here's the recommendation Imake-- prepare for the Seder, both
options, a dry wine and grape juice.
The first cup, whichstarts the whole Seder.
You still have.
(21:57):
Probably close to two hours untilyou're going to eat the meal
without long period of time.
I say you have to judge before drinkingthe first cup if, if you, if you should
use grape juice or wine, if your bloodsugar would be low at the start of the
Seder, use grape juice for the first cupso it'll help you raise your blood sugars.
On the other hand, if your bloodsugar is higher using a dry wine.
(22:19):
It may actually help lower it, possiblywithout the need of a correction dose.
It's interesting it, that'sthe same approach I use when
I do any distance running.
I'll get to a rest stop and I'llchoose between water or a sports drink,
depending on what my blood sugar is doing.
So it's diabetes.
We gotta make decisions on the flya lot of the time, based on the
(22:40):
situation, the sitting is another issue.
When we sit for long periods of time,our bodies are burning less glucose.
We become a little less sensitive toour insulin and blood sugars can climb.
So during a prolonged Seder,there may be a tendency for the
glucose to climb throughout.
Do you just not worry aboutthat and let it happen?
(23:01):
Or do you wanna address it and.
Keep it from happening.
Here's the way I address it.
You know, the Hagadais like a long prayer.
Many pieces in it could be madeinto a song and just stand up and
start dancing with the whole family.
You do that once or twicein the middle of the Hagada.
You're not sitting that long.
You're actually moving a little.
(23:23):
Get your body active.
That helps with, uh, that issueof losing the insulin sensitivity.
I love that approach.
We should do that whenwe're on airplanes too.
Sit in all those hours, just get up inthe aisle and start dancing every hour.
That works for me.
Um.
Now, obviously in the Jewish faith,we have people who are orthodox,
(23:48):
conservative, reform, reconstructionists,so there's, there's different levels
of observance that take place.
Is there anything about having diabetes,that should keep somebody from following
any of the observances during Pesach.
Good question.
Uh, as a general rule, Jewish lawprioritizes health and wellbeing,
(24:12):
allowing commandments or customs to beadjusted in life-threatening situations.
However, adjustments can also be madefor medical or health reasons, not
just life-threatening circumstances.
With that in mind, let's focuson, on on relevant details.
Jewish law is complex and often thereare different opinions on the same issue.
Interpretations, yeah.
(24:34):
Correct.
This is where a competent rabbi whounderstands the medical situation comes
into play, helping to determine whichmore lenient opinion one should follow.
For example, in Halakha Jewish law, thereare various opinions regarding the amount
of wine or grape juice required foreach of the four cups during the Seder.
(24:54):
Most lenient opinions suggeststhat only one and a half ounces.
Per cup is necessary.
While other opinions may requireup to five plus ounces per cup for
someone with diabetes, drinking20 plus ounces of wine or juice.
If you wanna follow the moststringent opinion that could lead to
significant blood sugar fluctuations.
(25:16):
Therefore, it's important to follow thelean opinion and aim for a smaller amount.
This would allow you to fulfillthe Seder's obligation while
effectively managing your health.
Same would be true formatza as we discussed.
It's a pure star, a high glycemicindex, it Ali to blood sugar spikes.
Different opinions exist regardingthe required amount of matza.
Generally, it's recommended to eataround 30 grams at the beginning
(25:39):
of the meal with additionalportions as the meal progresses.
If that amount would lead to erraticbot sugars, you can reduce and consult
with a rabbi for guidance and how toadjust based on personal health needs.
I'll give one more example.
Some families follow strict customsduring Passover permitting only
homemade products with everythingprepared from scratch at home.
(26:01):
However, there are situationssuch as managing diabetes
where exceptions are made.
For example, using store-bought candy totreat low blood sugars during payoff is,
is necessary and practical exception,allowing the individuals to maintain their
health while still honoring tradition.
That was actually the next thing I wasgonna ask you was about hypoglycemia.
(26:23):
Uh, what are some of therecommended products, uh, for
treating hypos during pesach?
Technically we have kosher for Passoveritems, you know, all over the grocery
store, and there are candies and allkinds of junk, uh, that, that we can get.
Um, the typical.
winkie or fizzers, they are notavailable and not kosher for Passover.
(26:50):
Yeah, there's it calledSmarties in the secular
Yeah.
Uh, interestingly enough that we, friendswith diabetes recommend people if they
use year round only one specific thingfor lows, like in the case of Winkys,
just use it for Passover as well.
Don't fiddle around.
Okay.
I'll use chewing gums for Pesach.
(27:11):
It would take much longer timeto raise your blood sugars.
Just do the same thingyou've done all year round.
Grape juice is always an option as well.
At home during case when we're athome, it's easy to have grape juice.
When we're outside,we're going for a ride.
It's a little difficult to carry alongthe back drink or bottle of grape juice,
(27:31):
so we look for some packet items likethe candies to, to have them handy
while going on a hike, et cetera.
It's a shame Manchezdoesn't make juice boxes.
That would be so convenient.
Yeah, the part juice boxes
stick the straw in.
Imagine taking a hike, there'senough you have to schlep along with
you can fit better in the pocket.
(27:52):
Yes,
absolutely.
So considering, you know, Pesachis a fairly long holiday, eight
days, there are a lot of, uh,dietary restrictions involved.
How important is it tomanage blood sugar levels?
During Pesach and there's a certaintrade off with anything, should
(28:13):
we just say, you know what, I'mjust not gonna worry about it.
Let the blood sugars do what they may.
Or should we really still focusin and dig in and manage the
glucose well like we normally do?
What do you think?
We've gotta live life.
And quality of life is very important.
Uh, that's why we're here, togive them the easy tips on how to
(28:34):
manage it easily so you don't haveto go out of your way that much to
still control your blood sugars.
Whatever's doable is doable.
If it's not, it's not.
As you mentioned, happens to be thatwe have better blood sugar control
during Pesach for whatever reason.
I speculate maybe there are chemicalsand the food all year round.
Create a stress on the body.
(28:55):
I don't know.
But yes, we do have an easier timecontrolling blood sugars, but uh,
if one finds that it's impossible,you know, don't lose sleep over it.
You try your best.
Two nights are tricky.
No.
And the rest, just follow, followthe regular diet and try your best.
And as we discussed, the mostimportant would probably be
the matzah and the potatoes.
(29:17):
Once you know how to handlethose, you're in good shape.
It's refreshing to hear you say that.
Uh, I, I often have to remind mypatients that the reason we manage our
diabetes is to have good quality life.
If we have to start sacrificing the thingsthat give us a quality life to manage
the diabetes, we're missing the point.
(29:39):
We gotta live life first.
We gotta enjoy ourselves and do ourbest to manage it, but don't let it
interfere with what's really important.
Family, friends, religion, thethings that are, you know, really
make, make life worth living.
Uh.
If somebody's interested inlearning more about friends with
diabetes, how can they do that?
(30:00):
Probably best would be to send me anemail to be added to our email list.
I think that's gonna be fairly easy.
Uh, you can go onto my website.
It's very outdated, but there you'llfind an email to be able to communicate.
To connect.
The website is friends with diabetes.org.
That's simple enough.
(30:20):
Do you have any, uh,conferences coming up?
Um, not in the near future.
Thanks.
I know you, you've, you've had,you know, countless programs over
the years, you know, mostly in thenortheast, in the Greater New York
area, but in other places as well.
Some are for couples, some arefor children, some are for adults,
some are for men, some for women.
(30:43):
Uh, and they're, they're just such,they're, it's a warm environment.
People there have a lot ofcommonality and they do make, you
do make a lot of friends there andyou learn some valuable things and.
All within the contextof a, a Shabbas weekend.
It's terrific events and you havesome excellent resources as well.
(31:03):
Specific things about the variousholidays and managing diabetes.
Um, so just to summarize, a,you know, Passover is, uh,
it's an eight day holiday.
It's commemorating the exodusfrom Egypt by the Jewish people to
observe and recognize the holiday.
There are certain dietary restrictionsthat are placed, number of ritual meals.
(31:25):
That occur.
And they include somechallenging things like matza.
Uh, there's a lot of potatoproducts because we don't have,
you know, bread or anything that,that contains yeast or can rise.
Uh, wine is a big part of, of the holiday.
Um, and, you know, there are tricksfor, for managing diabetes effectively.
(31:46):
Talked about, you know, estimatingthe carbs in Matza as well as
specific carb counting techniques,adjustments for alcohol.
Um.
Adjustments for changes in activity levelor making sure you still get some activity
even during, uh, prolonged ritual meals.
And, uh, point,
I think we missed point.
(32:06):
Point is enjoy it.
Enjoy pay.
That's what it's, it's meant for, uh.
If your diabetes isn'tjust so, that's okay.
We do our best.
That's all.
Anyone can ask for.
Anything important that I missed?
I think we missed onepoint regarding the Seder.
I only say it because I've heardpeople, newbies, especially, uh,
(32:28):
doing it, doing it the wrong way.
From when we start the Sedernight until we get to the
meal, could take a long time.
Taking your insulin before the Sederbegins would be a very bad choice.
I mean, you would pass low evenbefore the meal, um, to, to,
to think about the insulin.
The appropriate time would be rightbefore drinking the second cup,
(32:52):
which is followed by the meal.
So there, and then before drinkingthe second cup, you can factor
the insulin for the second cup.
The mat, the meal, and even the thirdcup, they could all, all could be
included in, in that one bolus, regularor extended right before the second cup.
Thank you for sharing that.
(33:13):
Uh, I often tell my patientsthat getting the right amount of
insulin is only half the battle.
The timing has gotta be right.
So thank you for sharing that.
And Rabbi, thank you for taking time outtayour busy schedule, um, to join me today
on the Think Like a Pancreas podcast.
Thanks for tuning in to ThinkLike a Pancreas, the podcast.
(33:36):
If you enjoy today's episode, don'tforget to like, follow, or subscribe
on your favorite podcast app.
Think like a pancreas.
The podcast is brought to you byIntegrated Diabetes Services where
experience meets expertise, passionmeets compassion, and diabetes care
is personal because we live it too.
(33:56):
Our team of clinicians all livingwith type one diabetes understands
the challenges firsthand.
We're here to help no matterwhere you are in the world.
From glucose management toself-care strategies, the latest
tech, sports, and exercise.
Weight loss type one.
Pregnancy and emotional wellbeing.
We've got you covered.
(34:17):
We offer consultations inEnglish and Spanish via phone,
video, chat, email and text.
Wanna learn more?
Visit integrated diabetes.com oremail info@integrateddiabetes.com
to schedule a consultation.
On behalf of Think Likea Pancreas, the podcast.
I'm Gary Shiner, wishing you afantastic week ahead, and don't
(34:39):
forget to think like a pancreas.
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