I hate pizza. Sure, it has that great smell. Yeah, it has an amazing look, as steam rises up over a landscape of melted cheeses dotted with toasted veggies and crisp meats. Oh, and the taste is wonderful, a molten fusion of flavors that rocks the taste buds.
But I still hate pizza.
Because no matter what I do, it effs up my blood sugar. Big time.
And I’m not alone.
The problem is that every pizza is two glucose highs waiting to happen. There are fast sugars in the crust and in the sauce, and there are slow carbs in the cheeses and meats. And pizza’s challenges for the pancreatically-challenged are everywhere.
- Pan, hand-tossed, or thin crust?
- What toppings?
- How generous or stingy is the cook?
- Does one brand have more sugar in their sauce than another?
- And what about the slices? A “slice” of pizza has a published carb count in many cases, but rarely are pizzas cut uniformly. It’s a nightmare.
In wondering how on earth we're supposed to deal with all of this, my solution has been to avoid pizza altogether.
So you can imagine how I felt when the 'Mine team asked me to take on pizza as the next in our line of "great food experiments" that have included ketchup, coffee, and craft beer so far. Given that March is National Nutrition Month, it seemed like a perfect time for the so-called Great Diabetes and Pizza Experiment.
Know Thy Enemy
I started by studying the enemy. And there’s a lot of information out there, despite the fact that pizza sales are actually on the decline with only $38,504,164,116 in sales last year. For those of you who can’t count your commas, that's $38 billion!
There are more than a dozen brands of pizza out there and they have a pretty big carb range. Or so it would appear at first glance. But something interesting is lurking in the math. As I compared products, I noticed that the serving sizes varied a lot, too, ranging from 85 grams up to 152 grams.
Digging deeper into the math, I divided the carbs into the serving sizes to find out the carb impact of each kind of pizza on a per-gram basis. And when I did, I was stunned. Pizza -- regardless of crust or topping or brand -- has a carb impact very close to 0.23 carbs per gram.
Could it be true? Was there, lurking in all the confusion of size and style and brand, a universal pizza bolus? Do we just need to weigh any piece of pizza and multiply the results by 0.23 to get the carb count? Could it really be that simple?
Time to find out...
Pizza Science in Action
I ran a small-scale scientific experiment. And to gain the most data beyond just myself, I recruited a second lab rat: a fellow T1D sister who is a pizza-lover and didn't need much arm-twisting to join in on this experiment offering free pizza dinners.
Like me, she’s on insulin pens and CGM. We agreed we’d both do a fingerstick calibration as a baseline before the meal, then record the CGM readings at two and four hours.
In a perfect world, peak glucose would be in two hours, and at four hours we should be back to our normal fasting blood sugar levels.
Of course, a perfect world wouldn’t include a diabolical food like pizza.
Each of the pizza meals would be limited to two pieces of pizza, with no sides. I wanted my data to be as pure as parmesan. But to drink I selected low-carb dry red wine, because I love wine more than science.
Here’s my lab journal:
Experiment One: Pizza Hut
We opened the cardboard box and beheld the pizza. “You have a really tough job,” said my D-sis, “Having to eat pizza and all...” Then she pointed to a slice on the left, and then one across the pizza from it. “I’ll take this one, and that one.”
I transferred her choices to the waiting paper plate on my digital Salter kitchen scale. We had used the “tare” function to erase the weight of the plate before adding the pizza. Her two slices clocked in at 207 grams. I multiplied that by our theoretical universal constant of 0.23 and came up with a carb count of 47.61. “Round it up to 48,” I suggested, and she entered the figure into her RapidCalc app, along with her (grossly) above-target blood sugar, and took a combined pizza and correction bolus.
She said the carb count sounded waaaaaaay too low to her. I did the math on my two slices after weighing them, and the count sounded waaaaaaay too high to me.
What happened? Surprisingly, not much. I went up a bit, but not too badly. D-sis came down, but not as far as she would have liked. Here, check it out:
Base 2 HR 4 HR
Wil 137 193 235
D-sis 342 242 201
The glucose response to the pizza was better than either of us usually see with traditional carb counting, and we were amazed by how close our final sugars were, especially given how far apart they were at the start.
Experiment Two: Little Caesars
Much like KFC has fried chicken cooked and waiting, Little Caesars has cheese and pepperoni pizzas waiting for eager eaters at all hours. During the dinner rush, a wider array of options is available. Price-wise, they are about half the cost of Pizza Hut, and the flavor was great. How’d it work out blood sugar-wise?
I’m happy to report that, using the universal constant of 0.23 carbs per gram, the Little Caesars hand-tossed 3 Meat Treat treated my blood sugar similarly to the way that the Pizza Hut Pan Meat Lover’s did. Which is to say, hardly perfect, but better than I’ve ever experienced in the past.
Both of the test subjects started with respectable numbers this time. I stayed flat with a slight rise towards the end, but had no excursion whatsoever. My D-sister dropped a bit in the middle, and rose more sharply towards the end, but nothing to write home about -- especially since this is pizza we're talking about.
Here are our numbers:
Base 2 HR 4 HR
Wil 146 151 161
D-sis 134 106 186
Despite the fact that Little Caesars and Pizza Hut pizzas have radically different crust styles, the “universal” constant delivered similar results: Basically a fairly flat response, ending above target, but not hideously so.
Experiment Three: Totino’s Frozen Pizza
Science is a lot of work: Get the frozen pizzas out of the oven, cut them, weigh the servings for me and my D-sis on the scale, multiply the grams of weight by the universal bolus figure of 0.23 to get the carbs, enter the carb count and current blood sugar into RapidCalc, and record all the figures in my notes for this article—all before the damn pizza got cold!
Meanwhile my D-sis quickly turned her iPhone upside down after entering her blood sugar. I sighed. “How bad is it?” I asked her.
Four hundred and thirty-five fricken’ mg/dL. “What on earth did you do?” I asked, whereupon she admitted to eating “yummy” cake and forgetting to bolus for it. Naturally I read her the riot act about being an irresponsible D-person. Then I sat down to eat my pizza.
When the two-hour alarm went off I checked my CGM. I was at 276 with a quartering arrow up. What the f---?! How could that be?! That high… And still rising!
We put our heads together to figure out what went wrong. One idea was that the “universal bolus” didn’t work for frozen pizzas, as they have a higher crust-to-topping ratio than restaurant-type pizzas. While I could buy that, I just couldn’t reconcile it with an excursion that bad. “It almost looks like I didn’t take any insulin at all…” I started to say.
“That would be being an irresponsible D-person,” said my D-sis with a triumphant twinkle in her eye.
I activated my Echo pen and looked at the
Base 2 HR 4 HR
Wil 155 276 --
D-sis 435 -- --
I terminated the experiment at two hours. Then I took a rage bolus, and ate the leftovers.
Experiment Four: Local Fare
Of course, none of this science does us any good if it only works for chain pizza. The real prize is having a method for taking on local mystery pizza. The final phase of our experiment was to apply the universal constant to local pizza and see if the numbers came out similar to the numbers we saw on the brand-name pizzas.
I packed my scale and we headed to J.C’s New York Pizza Department, a combination eatery and three-lane bowling alley on the Plaza in the heart of my town of Las Vegas, New Mexico — the Las Vegas you can’t see from space.
Did it “work”? Did we get readings similar to our first two experiments?
No. Damn it.
Base 2 HR 4 HR
Wil 127 128 263
D-sis 188 317 359
D-sis shot up crazy-high before the two-hour check and continued to drift up. Eight minutes short of the final check she bailed and took insulin. I stayed flat for the first two hours, then began a sharp rise.
So much for science.
What did I prove in the end?
Well, even if there may be a universal carb-count for pizza, navigating this using traditional insulin may not allow for steady numbers unless you can plan ahead and dose accurately each and every time.
In other words, Your Pizza May Vary (YPMV), just as Your Diabetes May Vary and everything under the sun plays into the Blood Sugar Effect you'll experience when consuming this kind of pie.
For me in the end, the Great Pizza Experiment proved nothing... beyond the fact that I’m justified in really hating pizza.