Bolusing for pasta - big fail

How do you guys bolus for pasta? I had some elbow pasta tonight, a little bit of stored brought carbonara sauce mixed in and some protein. No cheese and the sauce used was really minimal - like 3 tablespoons for a large pot of pasta.

I bolused 80/20 and the first 2 hours was fine, didn’t spike and remain steady but heading towards the third hour it started drifting up very slowly and I’ve been trying for the last 2 hours to get it to turn around with a 30% temp basal increase and manual injection of 1 unit at a time( so far I’ve done 4 injections so at 4 units now). Bg is steady but at 162mg mark and has been like this for the last 2 hours and it has just started to drift down very slowly (it’s 4.5 hours after my meal). I’m going to up my temp basal to 40% for the next hour and then lower it to 20-30% for a few more depending where it lands in one hour).

Why is pasta a extended bolus food, isn’t it a high carb meal? Is it because it’s low GI?

With pasta (any kind of spaghetti, light on the sauce, heavy on the Romano) I pre-bolus by 45-60 minutes, depending upon other factors. Sometimes it works, sometimes it doesn’t. There are so many variables to consider.

How you cook the pasta, makes a difference too. Over cooked pasta will raise BG quicker and longer than al-dente. We prefer al-dente, but if we are at someone else’s home and and they overcook it, I can tell not just by taste, but by the rise in BG.

I’ve never extended a bolus for spaghetti, even if I had made lasagna or ravioli. I will use an extended bolus for pizza or for a Thanksgiving Day type meal where we generally move from one dish to another, without much time between.

I should mention I am using my pump right now for basal only, so my reference to extended bolus is from a few years ago. Today, if I need to extend a bolus, I do it manually with a needle and syringe.

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I always have to use an extended bolus whenever I eat pizza, rice, or pasta. Since we all have different insulin tolerances, the best you can do is to see what works the best for your personally. For pasta, I always go with a 60% up front and then 40% delivery over 1.5 hours. That seems to work for me, but everyone is different. I would suggest using the extended bolus, but gear it for what works best for you.

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For me it’s is all in the calculation of the carbs.
Pasta has more carb than you might think.
So let’s say you eat 100 g of carb you need to bolts a large bolus for that, however large boluses are absorbed more slowly than small ones.
So there you go. You get these surge hit levels and they resist correction.
I avoid pizza completely. I eat very small portions of pasta.
I wish I had the key.

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I usually bolus 30-40 minutes before I eat spaghetti. I use a ton of sauce, whole wheat noodles, 7 grams of fat and 4 carbs are in a half a cup of the sauce. I have never had an issue with pasta. But it depends what’s on the pasta? I am wondering because it shouldn’t be the pasta itself causing a spike later that maybe it’s the sauce you used has a higher fat in it delaying absorption?

Last night I bolused for 59 carbs. One item was a cup of miso ramen soup, some tofurky, half a blueberry turnover and some vegan chocolate puffed rice (chocolate craving). I did 31 carbs 45 minutes before as the ramen is pretty fast acting. I did 28 carbs when I ate. For the first 2 hours I only went up to 117 for about a half hour, At the 2 and a half hour mark I spiked to 131 for about 30 minutes and then started dropping to land at 80.

But I assume the spike later was from the fat content in the spaghetti and the turnover combo. I was itching to give myself an extra dose but I knew that I still had active insulin and that I had been pretty accurate on dosing. I was watching it though!!!

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I don’t eat a lot of pasta, but there’s mac and cheese on the menu for tonight. I’ll have to test myself to see how I fare with it!

My usual strategy is to just throw insulin at it and see what sticks, though. Having the ability to reduce/suspend basal is a game changer.

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Thats interesting, you would think it’s the other way around because if its more cooked, then it’s absorbed more water so shouldn’t be as carby? But that said, perhaps because its absorbed more water, its able to digest quicker hence raise BG quicker. :sweat_smile:

Is this a common known fact? Its strange because for me, large boluses work but small ones don’t (especially after I switched over to novorapid from apidra). I wonder why?

No, the sauce I had was so minimal i don’t think it would have had caused much of a dent in the BG.

I ended up dropping very quickly about the 4.5 hour after eating for the stacked up insulin. Its weird because that extra insulin i injected didn’t take effect until like an hour or so later. Usually when I inject insulin, I see my BG start trending down at the 20 min mark but it was just steady.

Does anyone know why so long to do anything? The only thing i can think of is maybe at the 20 min mark my sugar was still rising and the insulin counteracted it so its steady but it all seems to come crashing down at the same time an hour or so later.

Large bolus can’t absorb in the small space as fast as small ones.
If you are taking injections and take 5 units in 5 different places it would hit you much faster and be gone faster too, as compared to one pump site.

It’s a known thing. People will take large doses of regular insulin for their basal. Insulin. Yes basal. Because it absorbs slower.

That works best for type 2 who generally can take very large insulin doses.

It wouldn’t really work for me because I don’t use that much however on rare occasions when I stack insulin because I ate more than I thought, I see a much slower absorption

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Very interesting. Im not seeing that for me. I find that small doses fail to move my BG, only if I give it a bigger hit (more than 3 units) does it seem to turn my sugars around. I don’t know whether it’s just novolog or other insulins as well. I’ve tried manual injections with small doses as well and still the same.

For pasta: always use a food scale to weight out your portion dry before you boil it. I usually also boil my serving in its own pot so I can have some confidence in my carb amount. I also time it to make sure it’s cooked the same every time. I give it 7 minutes which might be a little soft for some. Softer helps it digest quicker but is not foolproof.

If meat is served in the sauce, I’ll usually do a second bolus, maybe a third of the dinner bolus, a few hours after the meal to help squelch the inevitable slow rise hours after dinner. Other than that, I have not discovered the formula for preventing a delayed BG rise from pasta.

Cooking spaghetti (any kind of pasta) al dente has always been our family’s way of cooking it.

After I was diagnosed, I started to read a lot about nutrition and came across many articles talking about the benefits of al dente vs normal/soft.

I looked at a lot of articles for you, this seemed to be the best to share. The FAQ I’m referring to is #13 in the listing, but the link to it is #12:

I added the bold emphasis below:

  1. Why does pasta have a low GI?

Pasta has a low GI because of the physical entrapment of ungelatinised starch granules in a sponge-like network of protein (gluten) molecules in the pasta dough. Pasta is unique in this regard. As a result, pastas of any shape and size have a fairly low GI (30 to 60). Asian noodles such as hokkein, udon and rice vermicelli also have low to intermediate GI values.

Pasta should be cooked al dente (‘firm to the bite’). And this is the best way to eat pasta - it’s not meant to be soft. It should be slightly firm and offer some resistance when you are chewing it. Overcooking boosts the GI. Although most manufacturers specify a cooking time on the packet, don’t take their word for it. Start testing about 2-3 minutes before the indicated cooking time is up. But watch that glucose load. While al dente pasta is a low GI choice, eating too much will have a marked effect on your blood glucose. A cup of al dente pasta combined with plenty of mixed vegetables and herbs can turn into three cups of a pasta-based meal and fits easily into any adult’s daily diet.

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Okay, I’m 3 hours into my pasta experiment. I’m calling it an experiment because I don’t ever count carbs anymore. This is probably the first time in nearly a year that I’ve tried to count carbs and used the bolus wizard, rather than the quick bolus. I’m gonna call it mostly successful, but I probably over-bolused a little bit.

Dinner was chicken tenders and instant pot macaroni and cheese with some leftover caramelized onions and mushrooms mixed in. I weighed the pasta and counted chicken tenders, coming in at 91.5 grams of carb. Then I rounded it up to 115 to account for the cheese, veggies, and honey mustard that I didn’t bother measuring. I didn’t actually measure my portion of finished pasta, either. Just eye-balled 2/5 for my portion. Sorry, that’s as scientific as my kitchen gets.

I pre-bolused at 5:00, when I started cooking the pasta. The bolus wizard calculated 10.5 units, and I delivered 65% immediately and extended the remaining 35% over 1.5 hours. I was 118 and already dropping at the time . (Was sipping on coconut water this afternoon, and intentionally didn’t bolus cause it was a manual labor kinda day, and was coming down from a spike up to 140).

Sat down to dinner at 5:22. I was 109 at that time, and continued to drop to 78. In the hours that followed, I ranged between 66 and 87 mg/dl.

I say I over-bolused because Control-IQ did intervene. It’s reduced my basal all evening, and completely suspended it twice. I probably could have avoided any numbers below 70 if I had finished my portion of pasta, but my dog was happy to have it.

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Wow, that’s nicely done. It’s easier to fix a low than a high in my opinion so you did really well! I’m surprised you didn’t get a delayed rise several hours later as per all the literature on the internet says pasta has!

The next time i’m eating pasta I’ll probably deliver 70/30 and turn up the temp basal for 6 hours based on how my BG was like yesterday. I probably would bolus a bit more insulin too. I was chasing down the high all night.

Thank you for feeding back your experience.

I have this tendency as well. I just eyeball my meal and declare this is how much carbs it is without measuring. :sweat_smile: It is only recently when I’m trying to basal test and get my dosage right that I’ve been more diligent.

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Seriously, I love Control-IQ. This is just how I do it now. I eat whatever I want, within reason. Most days run 100-150 g total carb. Less than a typical American diet, but not low-carb by any means. I throw extra insulin at it, and Control-IQ uses what it needs and suspends the extra from my basal.

I can’t wait til you, and all our other non-American friends, can try it out too!

Tonight wasn’t normal, but I was laying a new floor in the fitness room and knew I wouldn’t have time for a complicated meal. It was a nice indulgence. Most meals are made from scratch and homegrown where possible.

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I multiply the weight of cooked pasta by 0.25 to get the carbohydrate content. Then, bolus according to the amount of carbs.

John

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Interesting @DrJohn! How did you come up to this formula?

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I was told to block bolus, 0 insulin up front and the reast doled out over time. I was told to spread it out over 4 hours but I find it is better over 3 hours. Most of the time it works. I only eat whole wheat pasta because it is lower carb when you take away the fibre. If you have garlic bread with it block bolus will not work.

Thank you, @DrJohn. It looks like an interesting site.

@Murray1 That is interesting, 0 insulin up front. I don’t think that would work for me, but I am going to doing an extended bolus, but most likely with 50-75% up front.

They call it a pizza bolus with 50% up front and the other 50% spread over 2 hours which I do with pizza. I do it with high fat dinners like fish and chips. I do not do as well the pizza bolus as the pasta block bolus. Its all an experiment. If you go high then you end up taking more insulin. Having a CGM or a Libre really helps.

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