Hi all.
I am a type1 for 4 years and on humalog (3x8 units) and lantus (20 units) currently. For those using MDI and glucometer for BG levels, how do you deal with attending functions or social gatherings with meal invitations (sometimes with starters).
As Its not possible to avoid attending functions all the time and if I do attend I am always worried about me getting low or high after some starter cold drink or sweet, let alone entire separate meal to be taken later. If I dont take to eat, I will be subjected to many questions like, āits very common, why are you always like this. Everyone is enjoying and eating something.ā and then I will explain there is a situation with me, please understand. In a big close ceremony, there will be 20s of relatives and friends will individually question me for not eating when everyone else standing is. Most of them may know I have diabetes, but there is a deep lack of knowledge about difference between T1 & T2. So they consider sometimes me as behaving rudely. It gets worse when I dont have glucometer with me.
and about main meal, its not always possible to estimate carb content, so need to take some guess and hope, insulin taken is just right. i am sorry if I am ranting, Its just at some occasion for social reasons I ended up reaching 500 mg/dl when I get home. Anybody had similar experience? ANy suggestion is highly appreciated.
I donāt have any silver bullet on this one, but Iāll offer a few suggestions. First, a BS of 500 isnāt the end of the world. You can still have a respectable A1c if you are in range most of the time. If I came home with a number that high, all meals would be almost carb free until I got it down. I would take extra Humulog based on experience to drop to the normal range. If it were bedtime, I would also take the extra insulin and set the alarm for a middle-of-the night check. If I was still high in the morning, Iād go with a very low carb breakfast.
You say it gets worse when you donāt have your meter. I donāt go anywhere without my meter, even if itās just to the corner drug store! Since Iām a guy, someone mentioned my āmurseā a few days ago. I told them it was a fashion statement! 
I also do all my testing and injecting (through my shirt) in public. Most people donāt notice, but I donāt mind if itās a conversation starter either.
Iām surprised that you donāt have more options at a social gathering. Most restaurants or social gatherings Iāve been to have options of unsweetened ice tea, diet beverage or water. You get better over time at estimating these dine-out meals, but I almost always leave some carb on the plate. If I am going to have a dessert, Iāll take extra insulin to cover it.
Iām also surprised at how people are rude to you. Iāve had people who are inquisitive and I use that as a āteaching moment.ā If someone really was rude, I think I would ask them how much they knew about diabetes. Within a few questions, I think it would be apparent how little they knew. This would not be an attempt to embarrass them, but perhaps to offer a suggestion that we sit down some time and discuss in more detail.
If all that fails, this is MY diabetes! And no friend or relative is so important that I wouldnāt walk away from continuing harassment.
This is a situation where the pump really shines, because you can continuously bolus as you are grazing discreetly without leaving to take a shot, and can set it to deliver an amount over a period of time to keep you from going high. Of course itās not for everyone and can be cost prohibitive, but if you havenāt tried or thought about it I recommend looking into it.
Based on what youāre stating your bolus doses are, it sounds to me youāre trying to manage dosing for a typical Western high-carb meal for someone with a functioning endocrine system. While this might be fine for your non-diabetic friends and family, I can completely understand why this is a roller coaster for you and a cause of such anxiety.
I travel a lot for work and also attend many public and personal events and find myself in these situations all the time. However, I remain consistent in how I eat regardless. I have learned that about a 1/4 plate of protein and 1/3 a plate of vegetables is reliably covered by about 4 units of a fast acting analog injected right at the time of eating (Novolog/Humalog) - irrespective if Iām using pens or a pump. I avoid the breadsā¦pastasā¦potatoesā¦etc. If thereās a starter, Iāll make sure itās without carbs too - things like salads, shrimp cocktails, etc require a small dose, like 1 unit. This way I avoid having to get the ācarb countā right and the ensuing possible volatility. And Iāve never had anyone notice or mention if I left the potatoes, or whatever the starch was on the plate. And if by chance there might have been a sauce involved with hidden sugar that causes a surprise spike, I carry Afrezza too that does a great job of giving a quick correction.
This approach has worked reliably everywhere in the world for me, regardless of the cuisine. I donāt think Iāve ever been in a situation where I couldnāt fill my plate with a good protein and vegetable. And I agree with you, there are many times where I really donāt want to get dragged into a discussion around diabetes, the differences in types, how best to treat itā¦etc.
Iām not suggesting you should eat low carb all the time - thatās up to everyoneās personal preference on how they best want to manage their own BG. However, Iāve found it the most effective way to manage variability and volatility when in the social settings you mention.
hi @ran_peace, I see you live in India. I understand family functions and celebrations there can be large and centered around a lavish meal, with many carb heavy dishes, always accompanied by rice. First, Iād make sure not to drink anything that has sugar in it. No one will know if youāre having unsweetened tea. Ask a family member to help you. or drink water. and then Iād choose a small amount of rice and try to load up more on vegetables and proteins.
Our friends at CarbDM have made this document available showing carb counts for many Asian foods. If youāve figured out your insulin to carb ratios, this might help you if you want to have that extra samosa (27 grams)
https://carbdm.org/wordpress/wp-content/uploads/2015/05/Carb-Counting-Asian-Food.pdf
Sorry,sending support. I ended up 350 after a new baby visit. Just got carried away with having fun.i was shocked. Learned my lesson. I carry a glass of diet ginger ale. I can offer to bring a veggie platter. This too is my hardest challenge . My family is fair understanding. Nancy
@DiabetesOldie Thanks for your invaluable suggestions. I should keep glucometer with me on these occasions.
@Scott_Eric Thanks, Yes, pump provides more flexibility in daily life. I will be moving to pump soon.
@Christopher5 Thanks for your wonderful tips. I have to confirm whether Afrezza is available here or not. If yes, it would be extremely useful in this case.
@MarieB Thanks for this food conversion file, it seems to contains most of the foods in asian region/India, it will be very helpful. If available on menu, unsweetened tea I always take.
@twinchick Thanks, its a very similar situation. I guess I should keep glucose tabs also, in case of lows.
Is a CGM (continuous glucose monitor) available to you in India? If so, you would only need to use the glucometer twice a day for calibrations. The CGM would be tucked in your pocket so you could check your blood sugar level without finger sticks any time. And since youāre going on the pump you could correct with a discrete insulin correction in the midst of your social gathering. Otherwise, the tips above are good ones.
Good to hear, itās no magic bullet but these are exactly the types of situations where I think if I were on MDI my life would be more limited if I wanted to maintain good control. I often take insulin by just reaching into my pocket while I am talking to people at a social gathering, and they donāt even know Iām doing it! Itās hard to carb count in these situations but Iāll continuously take small amounts throughout without anyone knowing or without having to leave. And this isnāt even getting into the extended bolus functions on the pump.
Iāve done such family parties - some that last 3-6 hours, with intermittently servers foods, beverages, etc. - with and without a pump and with and without a CGM. Theyāre not easy, that is for sure. Iāve had a mix of ātotal successā at a recent wedding, to ātotal disasterā at one of my cousinās Bar Mitzvah several years ago. What Iāve done definitely involves a fair degree of guessing, sure, but I try and compartmentalize it, so that my guesses have a better chance at success.
Since I usually need a little lead time from bolus to eating, I have to plan ahead of each portion of the meal. For example, I consider a pre-reception/hors dāoeuvres period as a separate meal. I figure that I will eat a certain minimum amount, say 30-40g carbs, during that time, and bolus accordingly immediately before or just after I arrive - though, when possible, I scan the offerings to get an idea of what I might likeā¦ As I go thru it, I count to make sure that I eat at least enough to keep from going low. I know, itās chasing the insulin, but I usually try to underestimate the bolus, rather than go all-out, so Iām almost always safe at that time. When it comes to the main meal - which can take quite some time to serve - I piece together each course, bolusing for any bread I might want, ignoring any salad (even though at these affairs, the dressings usually have quite a lot of carbs in them!), and focusing on the main course. I always test before the main course, and in that particular case, I usually wait until it is actually being served, so I can more accurately guess the carbs in it - knowing that there is usually a dessert that I can use to ācorrectā any over-bolusing errors. As to dessert? More often than not, it isnāt worth more than a taste or two, so I donāt worry about it too much, though, if thereās some fruit, all the better.
Not scientific, for sure, but Iāve managed. In the end, I take a look at the results and try and learn from it for the next time. As to conversations about diabetes? It really depends on the context. At that recent wedding I attended, I had only three people discuss diabetes with me. One was a doctor and seemed genuinely interested in how I was handling things. One was a relative who thought he would be āhelpfulā by telling me not to eat something (I was annoyed by him at that moment and āthankedā him for giving me the benefit of the knowledge he had from his non-existent medical degreeā¦), and the third mentioned it in a ācongratulatoryā way to comment on the fact that Iād been keeping up on the dance floor with people 25+ years younger than me! 
I donāt do this often for obvious reasons, but every once in a blue moon someone will be so overbearingly, relentlessly āhelpfulā that I will assume a puzzled expression, apologize for my poor memory, and ask them to remind me again where they attended medical school. That usually does it. Of course I will only do this with someone with whom Iām perfectly willing (or even eager! 
) not to be on speaking terms.
The best is when thereās not even a hint of logic to it, like the person at work who told me I shouldnāt be drinking black coffee!
The all time champion of no-logic is when youāre low and some concerned person asks, ādo you need insulin?ā
Haha and no matter how many times you explain the low is caused by the insulin you will still get the same question!
Or, alternatively, when youāre driving with a colleague and they constantly ask you āis your BG OK? Do you need a snack?ā
sigh
Those are some amazing tipsā¦I think ā¦experience teaches well how to cope in these situationsā¦In the mean time glucometer, insulin, glucose tabs and carb knowledge of servings I should always carry with me.
Thanks Aanchal. For these good tips. I now carry glucometer and insulin pen everywhere with me. Also glucose tabs.