Wil Dubois

Hey All -- if you've got questions about life with diabetes, then you've come to the right place! That would be our weekly diabetes advice column, Ask D'Mine, hosted by veteran type 1, diabetes author and community educator Wil Dubois.

Pass the cranberries! Thanksgiving Dinner is just around the corner. In today’s column, Wil tackles the question on the lips of every insulin shooter in the country: How come the @#$%& bolus I spent two hours calculating for last year's feast didn’t work?! And what am I going to do this year?


{Got your own questions? Email us at AskDMine@diabetesmine.com}


Wil@Ask D’Mine answers: Happy Thanksgiving, everyone! I say that today the glass is half full, and there’s always something to be thankful for. If you were just diagnosed and are down about it, just remember you could be dead (seriously). If you are a longtime PWD reaching burnout, you could be dead, too (a few times over). And hey, in the past, with fewer tools and treatment options we D-Folks didn’t have as much to be thankful for as we do today. The mere fact that you can raise your glass and toast your loved ones at Thanksgiving is something to toast.

OK, enough touchy-feely philosophy. Let’s get down to business. Because here in the States, the central element of Thanksgiving Day is a huge family feast. And no matter how well most of us try to plan for it, it never seems to come out right.

Some parts of Thanksgiving are simple. Working out the carbs for the Pillsbury crescent rolls only takes reading the label on the tube and keeping track of how many of the damn things you eat. (They are so light and fluffy and flaky it’s kinda hard to stop…)

If you help cook dinner, it just takes a pencil and a piece of scrap paper -- and quite a bit of time -- to figure out the carb load of the entire batch of stuffing. And while reverse engineering that into how much you actually eat is problematic, it’s doable. As is estimating gravy consumption volume. Of course, we’re dealing with a meal that mixes fast carbs with slower high-fat carbs, but that’s true of pizza night, too. 

The portions are large. Seconds, and sometimes thirds, are involved. Plus there’s dessert. And booze. It’s a tricky meal. Pumpers might deploy fancy extended or combo boluses, while shooters will need to whip out their insulin more than once over the course of the meal.

But we survive tricky meals all the time. 

So why is it that even with scales and measuring cups, deep thinking and careful planning, Thanksgiving dinner always ends up with profanity and multiple correction boluses for hours downstream?

I have a theory. 

I think T-day is a bad blood sugar day for many of us because of occult carbs. Yes. There are carbs hiding in plain sight on the Thanksgiving Day table that most D-Folks are completely unaware of. I’m not talking about the carbs in the flour that thickened the gravy. I’m not talking about the unexpected secret ingredient in your aunt’s stuffing. I’m not talking about more sugar than expected in the pie. And I’m not talking about the fact that some fool added high-fructose corn syrup to the cranberry. Are you sitting down? There are carbs lurking right where you least expect them, right under your nose, in the center of the table. In the guest of honor. In the big bird itself.

Yes. Sorry. The idea that turkey is carb-free is a lie.

Whoa, whoa, whoa, you say. Turkey doesn’t have any carbs! They taught us from day one that meat is a freebie! Sorry, Virginia, they lied. Meat has carbs. The hidden, forgotten, ignored fact is that meats are only granted their “carb-free” status when consumed in their proper portion sizes. Which, of course is two ounces. And actually, even that paltry amount of poultry isn’t really carb-free. My personal favorite, white turkey breast meat, has one gram of carb per serving. Sure, little enough you can get away with not counting it as part of a meal when it comes to calculating insulin dosing, but its not really carb-free like water.

Ahhh…. I can see the flamers out there. Cracking their knuckles. Grabbing their thesauruses to find new and creative insults. Looking at the Nutrition Facts labels on their roasted deli turkey that clearly says zero carb, as they get ready to roast me for being “wrong.” (Really, you people need to all go out and get a life. And whatever happened to the notion of a civil society??)

Anyway, before you go make fools of yourselves, check your facts. Because I already have. The cold, hard truth is that food labels vary in their level of truthfulness. And the truth is that the food industry isn’t required to report small fractions. In the case of carbs on Nutrition Facts labels, Title 21, Part 101, Subpart A, Section 101.9 (6) of the Code of Federal Regulations states that if the serving size contains less than 0.5 grams of carbohydrate, “the content may be expressed as zero.” 

Image Attribution

Image Attribution

Author: Wil Dubois

Oh. But it gets better. Because while the recommended serving size of a protein in a real-world human diet is generally two ounces (sometimes three, depending on whose guidelines you read, how old you are, and what your gender is), a serving size for industry labeling is usually only one ounce.

This means that if your deli meat has 0.4 carbs, reported as zero, and you eat the right amount, you have 0.8 carbs. Of course most people eat double the recommended amount of meat, so now we are at 1.6 carbs. OK, I grant you, in the normal real world, this isn’t enough carbohydrate to torpedo our therapy efforts.

But Thanksgiving doesn’t live in the normal real world. The average American will eat three pounds of turkey on Thanksgiving. That’s twenty-four servings, if my Staples solar-powered calculator hasn’t failed me.

That’s 24 carbs you need to bolus for. For most of us that’s a unit and a half right there.

Plus, although I couldn’t find any statistics on it, I’ll bet most people with diabetes eat more than the average American amount of turkey on T-Day, on the theory that if we fill up on turkey, we’ll eat less of the high-carb stuff that’s “bad for us.”

I say bolus your drumstick.Turkey drumstick

Of course, I know that some of you will hold steadfast in your belief that meat has no carbs, even in decimal fractions. For those of you out there in that camp, I want you to consider some backdoor biology that will leave your religion intact while you bolus for your turkey.

Although we get most of the glucose our body runs on from carbs (because that’s the easiest way and the body is lazy) it’s not the only source of sugar. Remember that the human body is like a wolf that will chew it’s own paw off to escape a trap. It is designed and prepared to do anything to survive. No carbs? the body asks. Fine, it says. I’ll turn meat into sugar instead.

And like water into wine, T-bones and turkeys become sugar via your new vocabulary word for the day: gluconeogenesis, which is the formation of glucose from non-carbohydrate sources. The body can and will turn meat into sugar; and the more meat, the more sugar. Thus if you are going to eat a lot of meat, you still need insulin to metabolize the sugar.

(For you more science-minded folks, you can check out this study that dug into unexpected sugar levels in folks on extreme caveman-style diets.)

So that’s why T-day so often turns into a blood sugar Waterloo. From occult carbs or neogenesis—or both—turkey will raise your blood sugar if you don’t take insulin for it. I suggest that this year you be thankful to Banting and Best, and just take your damn shot.

Only take a bit bigger one than you took last year.


DISCLAIMER: This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.
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This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.