Madi Cheever MPH RD LDN CHES (00:00.81)
All right, so so much learning has happened in this past month or so, especially with Diabetes Awareness Month. There have been so many questions, comments, DMs, emails, conversations in the T1 Dream Life and the weekly Q &A. There's been so many things I've gotten questions on and I want to give you some answers. So here are a few of the top things I learned from you all this November on what you need, what you want, what you're confused about questioning.
and how to fix it. So the themes that we're going to talk about, number one, we're going to talk about bolusing, dosing, timing, amounts of insulin. That seemed pretty high priority from everything everyone said. Number two, we're going to talk about some food-related struggles. That was also on the list. I think bolusing was number one, but also on the list. Post-meal spikes and hyperglycemia, high blood sugar. I know it kind of is like
dosing, but we'll separate it out and make it make sense together. Roller coaster ups downs inconsistency and how to deal with it. And then last but not least, fear of going low. If that sounds like a game plan to y'all, then let's just jump right in with the top category, which was bolusing dosing timing amounts, you name it. I saw so many struggles in this area. People were asking me about
pre-mail bolusing, were asking about when to dose for total versus net carbs, if you have fiber or not, and when to what bolus for food and carbs counting and matching the insulin you're taking, giving correct doses and eating, using correction, stacking insulin, rage bolusing, if you know, you know, there's so many things. And here's what I want you to know about this. First of all, the confusion, the overwhelm, totally valid. is diabetes is tough.
but so are you, keep that in mind always. But there are ways to go about it. So here's my one tip that can help with all of this, okay? If it works, great. If it doesn't work, it doesn't feel great, but great because you can learn from it. What do I mean by that? Let's say you go to a dinner at a restaurant with your significant other.
Madi Cheever MPH RD LDN CHES (02:28.366)
and you are going to go and have a pasta dish. Cool. First of all, have fun. Second of all, enjoy. Third, I don't know, phone eats first, take a picture of it. Fourth, how do you manage the blood sugar, the insulin, all of those things? Well, here's what I say, do your best and then figure out what happens and then update and then do your best again. So here's what I would say. If you don't know the carb count of that pasta dish, let's say you're getting like a, I don't know, like a chicken Alfredo.
Enjoy. Yum. Can you tell that I'm a little hungry right now? So if you're getting that chicken alfredo, okay, great. Do you know how many carbs is in that dish? If yes, good, use it. If no, could you look it up? Could you research it? Just to double check, just to confirm, because maybe you're estimating 60 carbs, but then you go into the nutrition information that the website has and then it says 75.
Well, I don't know about you, but a 15 carb difference isn't the worst, but it's two units of insulin for me. And that makes a huge difference in how long I stay high and how high I go. So for me, just double checking, I would say, oh, I was going to take for 60, but it's 75. And you girls going to eat. I know whatever it is. I'm about to finish it. So I'm going to take for the 75 carbs. If you know you'll eat half or if you know you'll eat three quarters or whatever it may be, know yourself as best as you can and estimate for that too.
Though that's a lot of information and we're just talking about carb counts, right? What if a restaurant doesn't have the carb count? Let's say you go to this wonderful mom and pop Italian shop, right? Well, could you compare it to, I don't know, an Olive Garden? Is it going to be accurate? No. Is that potentially a little disrespectful to compare it to an Olive Garden? Maybe yes. I'm sorry. But use what you can, right? If you have no clue how much pasta is or no clue how much is there any carbs in Alfredo sauce?
Double check. I'm not going to you the answer here. Are they using a breaded chicken? Are they using a grilled chicken? What's going on? The more you can figure out, better. Now, that's again, step one. So let's say you go. And here's what I'm telling you. I'm telling you to get that pasta multiple times. So you go that first thing. You do everything you can. You figure out probably when it's going to come out. Maybe you pre-boil it. Maybe you can't. It is what it is. You count the carbs. You take the insulin. And then what happens? If it works, great.
Madi Cheever MPH RD LDN CHES (04:51.446)
You figured it out. Now you know. Good. If it doesn't work though, again, that's not a statement on you. That is actively, I think it's so cool. And I know someone's gonna roll their eyes when I say this. It is so cool when our blood sugar doesn't work out, not because it didn't work out, but because we get to learn from it. And yes, I'm a total nerd. Like academics were totally where I thrived throughout my entire life. So if you don't agree that it's cool, I respect that. But you know, nerd alert, it's cool.
So what you can do is then you can use that to your advantage. So, okay, let's say we took for 75 carbs and we still kind of stayed at like 200. Like you didn't spike how you thought you would, but you kind of rose up and stayed at 200 for a little bit. You kind of rose up quickly, like maybe in the first 20, 30 minutes of eating. Well, to me, that would say that maybe we didn't get enough insulin if we never come back down. And if that's the case, then you have to ask yourself, okay.
Well, one, is the nutrition information online? Two, was I estimating? Three, was there something I didn't consider? Maybe I got a side salad, didn't realize the dressing had 10 carbs, okay. Or was my pump failed, something like that? Or did the thing happen where you get to chatting with the waitress and then you guys are vibing, now girlhood, whatever, and then she goes and she's like, do them up real good, and then you get a double portion of the meal.
calculated for the nutrition online, but you got this awesome portion. I don't know if that happens to anyone else at like Chipotle's and stuff or just me, but I'm a little too much of a talker, too social. I will talk to anyone and sometimes that happens, right? That's just a part of it. So knowing those kinds of things, you could say, okay, well, yeah, this doesn't look like the picture that's online. This looks a little different, a little more, a little less, little whatever it may be. Use all of the information. Knowledge is power. I know I've said that before. So if you have
been here for a while, you know it too. If you're new here, knowledge is power. So like I said, those highs, that's why it's awesome to learn from. Not because having a high blood sugar is awesome, it sucks. But because knowledge is power, your blood sugar is actively saying this didn't work and here's why. A high is very different from a low, right? If a low happens, it's kind of the opposite of a high, right? Okay, now that's more information.
Madi Cheever MPH RD LDN CHES (07:17.006)
And then you keep going. So that second time that you go back, let's same waitress and it's like, I don't know, another Tuesday night, whatever it may be. And you go and get that pasta again. Well, you took for 75 carbs, but you stayed up at 200. Let's say you need about two units to get back down from a 200 blood sugar typically. Okay, well, what's 75 carbs plus a carb estimate for those two units? Well, oh, okay. For me, that would be like a 90 carb estimate.
Are you following the math? This is complex, right? If you are listening to this right now and you're following along, you are getting to learn some deep stuff. So all of a sudden, I would try maybe 90 cards this time. And let's say that works out better. And you realize, yeah, I kind of went up and I did spike, but I came back down to like, I don't know, insert pretty close blood sugar compared to wherever you start. Great. That is what I mean by use information to your advantage.
try and try and try again. So this is dietitian Maddie telling you maybe you need to have, I don't know, a chicken Alfredo three nights in a row or three weeks in a row for a date night or whatever it may be. Is it my long-term nutrition recommendation? No. But can it tell you so much about you, your body, your blood sugar, your insulin, your strategy? Yes. And that is gold. You can do it.
I know you're here, you're smart, you're listening, you're capable, you can figure it out. And if you can't, maybe reach out. Let's have a conversation, see if we can make something make sense, or maybe there's just a little tweak that we were missing. But that, if you are following along, that should help. And if you don't feel confident to do so, then definitely reach out. Let's talk, let's figure it out together. Feel free to DM me on Instagram, I'm usually there. So let me know. But that's thing number one is dosing.
bolsing timing amounts, because it's either our system or our settings, right? Either what we choose or what we think is right or wrong, or our settings are right or wrong. Okay, cool. Number two, food related struggles. Now let me clarify what I mean here, because I'm not talking about my chicken alfredo anymore, although that may be it. I've heard phrases about like, fun foods like pizza or Chinese food or things that can't eat anymore or
Madi Cheever MPH RD LDN CHES (09:39.406)
My diet is so difficult to follow and I've heard carb counting, carb counting, carb counting. I've heard I love carbs, but I don't like this or how do I eat enough of this or how do I lose weight and have good blood sugar and insert whatever nutrition goals someone has. Those are complex, right? There's a lot of information to consider here. Again, I'm giving you a lot of the highlights of what I've heard over the last few weeks, okay? And here's my thought for you.
When you have food related struggles, it's, we can kind of think about it like our chicken Alfredo example. Similar but different. So what is it that's going on? Well, first of all, if you feel like you can't eat your fun foods, but you want to, we got to figure out the insulin, the strategy, all of that. Again, hit me up if you need some help there, but hopefully that first point gives you a good framework just for starting with anything. It's not specific numbers, but it is intentional action and that can make a difference.
Now when it comes to carb counting itself, there are a lot of things to consider here. Now one of my favorite things to do personally is I will quiz myself. How many carbs do I think this is? I just went through this with several examples the other day. How many carbs are in a cup of shredded carrots? How many carbs are in a half a cup of blueberries? How many carbs are in a half a cup of raspberries compared to blueberries? Right? I'm not going to give you the answers. I want you to
estimate in your mind how many do you think they are. And then use a resource to double check. Now my personal favorite resource is Chronometer. Chronometer, if you're listening, I love you. I've been using Chronometer for over a decade for nutrition related tracking and food information. They're incredible and for whole foods specifically, I really trust their database. Not everything's going to be perfect because some things are user generated, but it is a verified database as compared to something like MyFitnessPal where
Anyone can put anything. And if they're counting calories and they don't care about macros, then you'll see a cup of rice for 200 calories is zero carbs. And we know that that's not true. It's just that all they cared about was calories. So that's all they put. Credometers not so much like that. They have the macronutrients typically. So pretty great. Now what I will do, like I said, I quiz myself. Yes, I know. Nerd status. We've already addressed that. I quiz myself, how many carbs do I think it is?
Madi Cheever MPH RD LDN CHES (12:03.916)
Look it up real quick. It takes an extra few minutes. I know that those few minutes add up, but doing this for just a few days or even just a few weeks will make a difference for your confidence, clarity, and comfort in carb counting. And if you're not understanding the carb counts, maybe that's different. Maybe numbers are not a strength for you or maybe there is something going on in the math. But if you look some things up for a little bit, you're going to realize some things that you didn't know. Do you know?
That's my fun fact of the day. I was just talking about this again this week. With free foods, do you guys remember talking about free foods? Depending on when you were diagnosed, this may or may not like immediately mean something to you. But free foods, when people were like, you don't have to take insulin, but you can eat this. If you had a free food mentality and then you went on an automated insulin delivery system, pump of some sort, then sometimes what happens is those free foods add up.
And it kind of makes sense why some of our blood sugars didn't make sense back in the day, at least when I think about mine. Because fun fact, a cup of broccoli has a few carbs. It's not just free. And a cup of broccoli, right, a few carbs, whatever. For most people, that's max a unit of insulin. But all of a sudden, if you have a few pieces of broccoli, and then you also, you had a spoonful of whatever it may be. and you haven't tasted this. and you haven't tasted that.
That could be several units of insulin that we're missing, which is OK. But if we know that upfront, we can take for it, right? And we can manage the blood sugar, and then we don't have to deal with it. My favorite thing to say is, would you put in hard work, would you rather work for it for five minutes and have five hours of freedom or not take those five minutes seriously and then deal with the consequences for five hours? I'm lazy. I know what I'm picking. Five minutes. Give me the rest off. Cool.
Great, not always how it works, but if you can learn that strategy, take the few minutes up front, do your best with the carb counting, everything else is easier, and sometimes you can be lazier. It works, it works, okay? So, food-related struggles, especially if it's for weight loss and things like that, something that people don't consider is insulin sensitivity changing, adding in physical activity, the insulin strategy for that physical activity.
Madi Cheever MPH RD LDN CHES (14:27.202)
There's a lot to consider the nutrition piece. People are trying to hit certain macros these days and it's like, okay, well you need this for this, but that for that. And everyone has different numbers. Even if you Google things, you will find different numbers on that very first page for the most part, whatever you're looking for. So understanding what actually matters can be important. If you don't understand what actually matters, here's my pro tip. Look into actual research. It's possible to find actual research online.
And that can give you a little more info than respectfully, the Wikipedia page that comes up automatically or the blog post from that one girl who she is probably great and doing her best and she's not meaning to provide misinformation. But what if her information came from another blog post and oh, okay. Well, all of sudden, maybe it's true, right? I have a blog, maybe it's true. But also maybe we don't always trust it. What are their credentials? What are their motivations?
think through those kinds of things. I know this is a ton to throw at you for food related struggles, but hopefully this touches on some of what some of you are after. And if you need more support than that, then number one, again, reach out. Number two, I have some food information in this book. If you don't already have one, I'll give you a free copy. I'll make sure that that link is down below. But I have a nutrition section towards the end. This is carb count specifically if you're watching this podcast.
So there's a section in there that can be helpful for some more answers if you have those questions. And if not, do reach out. If you have a question I haven't answered, I'll answer it. Just let me know. Okay, thing number three, the big thing that I was getting, post meal spikes and highs, hyperglycemia, right? So I was getting questions on my automated mode, is pausing my insulin for too long, and then I get a spike after eating when low, so low is turning into highs.
Just highs with carbs in general, high sugar levels in general. Why am I staying at 200 today for no good reason? How do we lower our blood sugar? Where do we even start? What if our insulin is wrong? How do we even figure out how to adjust that? Well, shameless plug number two. I have some math in this book.
Madi Cheever MPH RD LDN CHES (16:41.326)
If you need help with ratios or settings or something like that, there's a lot of strategy in this book, the back of the book specifically. If you want to read the first 200 pages or 280 pages, that's cool too. But the last 75-ish have hardcore diabetes education. If you have questions about insulin strategy, it might be answered in there. Again, link below, free copy, I got you. with that being said though, automated mode is something I want to talk about here.
And If you're on a manual injection stick with me for just a second. I want you to learn this too, because who knows maybe you will go on a pump, but long story short, your pump is smart. You are smarter. Okay. What I mean by that is if you keep going high, you need to change something. Even if your automated insulin delivery system means well, it's making adjustments for you for certain reasons, but not anticipating the rest. You
have the ability to anticipate. You have the ability to understand what you're going to choose. Your pump does not. So I mean to be intentional with taking action there. What I do not mean is when I say you're smarter than the pump, you are, but what I do not mean is don't mess with it so much that it's like, feels like it's out of whack and spiraling, right? That is specifically pointed towards with love, pointed towards my folks who take a one to two carb
every 10, 15, 20 minutes when they're even kind of maybe going high and then we have a bunch of insulin and then there's a lot of things. basically if that's happening, if it's because your settings are wrong, we can change it. If it's not because of your settings, then we work on mindset. So things to consider, but post meal spikes are totally possible to manage and it...
If we spike after eating, it's terrifying and frustrating. But like I said, in point number one, there is a solution. And if you don't know it yet, knowledge is power. You need to figure it out. If that leads you to a specific question, or if I haven't already answered that question, then you know what to do. Find me. Now, I think number four, roller coaster ups and downs, inconsistency with blood sugar. This kind of goes back into that point as well, which is why I held off. But the roller coaster.
Madi Cheever MPH RD LDN CHES (18:58.99)
highs and lows, we've kind of already talked about that. But what about the inconsistency or like, like, do you ever wake up and your blood sugar is just different or the meal you ate yesterday is acting different than it is? Or sorry, the meal you eat today is different than it was yesterday. Insert a million things. A lot of us T1Ds joke that it's like, oh yeah, the wind shifted. That's why your blood sugar is messed up. Or, oh yeah, your left elbow's itchy. Must be the reason. In reality, here is my belief.
Sometimes things make very clear sense, right? Like you eat carb, you go high. That makes sense. You are physically active and you go low. That makes sense too. But what happens when you're physically active and you don't get that low until 14 hours after your activity, right? Or what happens when you wake up kind of late, so you're kind of stressed because your alarm clock went off and you did the, what time is it? You did that kind of wake up.
What happens when you wake up and that's your reality? And then your blood sugar is stuck at 200. Why did that happen? okay. Well, if that's ever happened to you, by the way, that was my real example. If I wake up like that, I'm stuck at 200. If I wake up like that, in fact, I just straight up take a unit or two of insulin. I'm not telling you to just straight up take a unit or two of insulin. Please don't do anything that your body does not need. But I know from my patterns and many years of in-depth data analysis, I just have to take that insulin.
because my cortisol spike is just like, yeah, no, you are going to be high. Good luck. And all of sudden I know what I need. things like that, though, that example, again, not medical advice. Do not take insulin in the morning for no good reason. You need to know that you need to know it or you need to know that you need to take it. But that's it. If you know that you need to take it, take it. Right. I get this question a lot. Well, I already took my insulin for dinner, but I want to have dessert. Take insulin for dessert.
People will be like, but I'm not supposed to take two shots in three hours or two boluses or whatever it may be. Yeah, sure, that's what they tell us. And absolutely, if you can consolidate, that's helpful a lot of the times too. But sometimes life lifes right? I mean, life lifes for me most days. So if you find yourself in that situation, if you are gonna eat more carbs that you didn't take insulin for, if you don't take the insulin, what's gonna happen? Unless you're new to diabetes, you know.
Madi Cheever MPH RD LDN CHES (21:22.968)
You're gonna be stuck high. You're gonna have to crack your blood sugar. So might as well just take it when you know you need it, right? Now take it or leave it, but that is what I tend to do. And again, to each their own, some people don't actually need to do that. Some people need to wait to take their insulin, especially for people with digestive considerations. What I'm getting at, sleep, stress, digestive considerations, all of these things, they contribute to the roller coaster.
It's not actually that the wind shifted and now your blood sugar is doing wacky things and that meal's not making sense. There is a factor that is impacting your blood sugar. I believe that for the most part, we can find many of those factors. If not though, then we need to have a deep dive, a discussion and really figure out what's going on. Again, in my book, you will find a factors chart that was originated by Dietribe, who is a fantastic organization. have so many resources.
and I talk through my personal thoughts on the factor chart. So go ahead and take a look there. Now, last but not least, if you're still listening, I love you, thank you for being here. We're gonna talk about a fear of lows because I hear this all the time. I hear this so often and I hear "I'm scared of going low," or "I need correction but I don't wanna go low or "I don't wanna correct my blood sugar before bed because I don't wanna go to sleep and then go low."
And then I'm scared of lows, so I overcorrect them, so that I'm stuck high." Like, if that's happening, especially at night, especially fear of correction, it's paralyzing, right? It's so, so concerning. Like, emotionally, it's terrifying. But logically, here's my thought. Logic will not take away emotion, right? If you're scared, that's valid. But we've already learned it. Knowledge is power. So if you know why,
you're going low or why you went low, you can do something about it. I just got this, this, this question was in my DMs this past weekend. I posted a screenshot of my blood sugar. I had five units of insulin on board at a 55 blood sugar for my millimole folks listening. My blood sugar was three basically. And what happened? I got several DMs about this. Actually, they were like, how are you comfortable with that much insulin on board at that blood sugar? Now, first of all,
Madi Cheever MPH RD LDN CHES (23:40.694)
I'm fine with 20 units on board if it makes sense. So for my folks who are scared of five units altogether, this might be a conversation that you need to come back to. We need to get comfortable with that five units first, but I'm comfy with however much insulin I need. But with that insulin on board, what I knew was, yeah, well, I have that five units of insulin on board, but I know what I've eaten. I know what I've done and I know what I needed to do to correct it. So I had the carbs and my blood sugar wasn't going lower. I was
staying at 55, so I knew I was going to go up. Now, if I was going to be physically active or if I was going to, if I had taken that insulin without like me having carbs, of course, I would maybe be a little more panicked, but really I need about 30 carbs to correct that anyways. And even if I'm so full, I can down two tablespoons of honey, right? It's possible. I have the volume to save my life. I can. But if that wasn't the case, I had that insulin on board and I was low and that's okay.
Pretty much what happened was I went low and I ate some cookies and the cookies were really good. So I had more cookies and those cookies were also really good. So guess what I did a third time? I had another serving of cookies. I love that you guessed that too. So I had these cookies, they were great. I was in Hawaii the other week. I got these Lilacoy cookies from Costco, from Diamond Company, something like that. they're so good.
I love them so much. They were only available locally. So anyways, I ate three whole servings, was 19 times three, 57 carbs. And I took insulin for the 57 carbs. anyways, long story short, when I mapped it out, eventually I was able to come back up. I actually took more insulin after that low, but some of the insulin on board was from my meal plus.
the cookies and then this may not be making sense. You kind of had to be there and see blood sugar. I'm sorry, I'm not describing it that well. But here's what happened. I knew that 60 carbs was overkill, approximately 57 or whatever, was overkill for correcting my blood sugar, a 55 blood sugar, even at my, you know, largest terror of blood sugar, like 55 carbs is a lot to correct it unless I have the insulin on board for it, but I definitely did not. And so I had to take insulin.
Madi Cheever MPH RD LDN CHES (26:04.654)
So took a picture and was like, yeah, you know, that was, think when I was one or two servings in. So I had some insulin on board for it. don't pre-bullet anyways, this is a whole long story. If you want more details on this or want to know exactly what happened, feel free to DM me and let me know. But that is what happened. And I was okay. I was comfortable. Fear of going low is valid, but even when we're low, a lot of things can make sense. Now, if you are the type of person where your brain is literally spiraling when you're low,
do what you can to survive in that low. But as soon as you get out of it, okay, is there anything we need to do to correct? Is there anything we need? I just had this conversation with someone and I was like, okay, when you go low, you tend to panic and you have like 30 something carbs. And I was like, you need five or six carbs, my dude, like you only need a few. And we were talking about it and it was like, okay, well, you know, maybe what we could do is have a little less carb, have a little bit of insulin.
So we settled on having about 20 cards. We again, still only need five or six and that person still needs to take about two units of insulin. But we take it after we're done being low so that we don't spike back up into the 200s and deal with the roller coaster again. So anyways, those are personal examples and I hope that that helps paint the picture. Fear of lows is valid, but how you handle it makes a world of a difference. You can be scared, but also feel safe.
And if you don't know how to do that, then let me know. I'm happy to help. I want you to feel safe. I want you to feel supported. Those are the top five things that overarching lessons, stories, things that you all have asked. I hope that it's helpful. Again, DM, email, reach out. If you have questions, comments, or concerns, I am here for you. But for now, I know we've chatted quite a bit. So I'm setting you free. Until next episode, take care, friends.
