I’ve begun to think there is another distinction among all us unique PWDs. That is, we already know that some people are more insulin-resistant than others, regardless of type. But now, I’m beginning to wonder if there is such a thing as carb-sensitive vs. non-carb-sensitive.
Today I had lunch with a friend, and had a cup of potato cauliflower soup (20g?), a grilled cheese sandwich (30g) and a cupcake (30g?), all of which were “normal” size, not restaurant huge. I bolused for it, was 189 4 hours afterward, corrected, and was 187 3 hours after that, corrected again, and finally, rapidly came down to 87 a total of 8 hours after lunch. I don’t THINK I have gastroparesis, but I was full for a long time, and I really don’t want to be around 190 for that long. And I don’t think it was a liver dump – I just stayed high because the food was digesting, and I don’t think it was an extraordinarily big meal. I DO think I’m carb-sensitive, rather than insulin-resistant because if my stomach is empty, it doesn’t take much insulin to bring down my BGs drastically, but a carby lunch does me in.
Maybe, if some people are more “carb sensitive” than others, it’s one reason why some people find doing low-carb makes a dramatic difference in their control while others find it doesn’t make much difference at all?
Sort of related to this, I wonder if some of us have blood sugars that are more sensitive to biological changes than others (hormones, stress, illness, rebounds, etc.)? I’ve said many times here that I feel like there are a TON of things that affect my blood sugars just as much as (or even more than) food that I think contribute a lot to my craziness (er, my control craziness, that is!).
Interesting question Natalie. 8 hours to come down? Were there any other factors during the 8 hours (stress, etc)? It doesn’t sound as if there was a huge amount of fat in what you ate, and for me at least even if there were it wouldn’t take 8 hours to digest.
I do find that if I feel full after a meal it does take longer for my BG to come down. The shock to my system of a lot of food when I’m not used to it? I do also come down quickly with no/very little food on board. I think part of eating low carb is eating less at a time - for me anyway. Did you pre-bolus?
No other factors. There WAS fat in the cheese. If I’d eaten cheese with no carbs, I just wouldn’t have gone up so high, but I do find that protein has a long, low curve, whereas a pure carb meal means a high spike, but then I plunge, often too low, and get hungry again within 2 hours. This meal was both carb AND protein, and I got the worst of both worlds. CDEs and dietitians usually recommend carbs and protein together, and it must work for some people, but it really doesn’t work for me. And I did pre-bolus about 5 min before I was served – it’s always dangerous to do that in restaurants because you really don’t know when the food is coming. And I really don’t think pre-bolusing makes all that much difference – you might go a little high for a few minutes, but the insulin SHOULD catch up with the food fairly quickly. I pretty much do know how to handle my own body, but I’m really curious about other people’s experiences, especially the ones who seem to do well with high carb.
If someone is carb sensitive, then lower carbs would positively effect BG. Some people seem to be more effected by protein than others… From what low carbers report & from my own experience, it makes a dramatic difference. I’m carb sensitive, & that may be due to my size, since 1 gram glucose raises me 10 points.
Of course, always the possibility you miscalculated the carbs which is easy with restaurant meals. Thick soups typically have flour or corn starch.
My theory with stubborn highs is that BG is continuing to climb. So, what looks like a static reading is really insulin preventing BG from going even higher, but not enough insulin to bring BG down. Then there’s the problem of a larger bolus taking a while to absorb, though yours was a long stretch. Logical that it’s easier to correct with little or no food on board.
Shouldn’t be a liver dump since you ate & not much slow digesting protein.
One way to test how carb sensitive you are is to eat 1 gram glucose to see how much this effects BG, based on your weight.
I really think it’s about the law of small numbers. The more food in the system, the more the returns from insulin diminish.
I have no problems eating my standard donut serving (1/4 of a small original glazed), which at 5.5g carb, I don’t even need to bolus for if I am at an in-target fasting blood sugar. On the other hand, a very large mixed leaf salad with shrimp and ham, with the only carbs coming from red peppers and tomatoes, once sent me up to almost 180.
Basically I can eat whatever carbs I like, as long as I eat like a mouse. Which is a bit freaky but I can live with that. It’s better than not being able to eat carbs at all. Like the time it took me 2 days to eat a Domino’s medium thin crust pizza. One small size every 2 hours, accompanied by 20g’s carbs worth of insulin each time. Throughout, my BG never went higher than 7.2 and never lower than 3.6, which is pretty good for 2 days of non-stop pizza. And it’s a lot more pizza than my friends with coeliac could ever manage…
I think that Gerri is probably onto something w/ the suggestion that the restaurant food was more loaded than you estimated? An extra 5G/ food item would get me up to 180 pretty readily?
I can never eat even 5 grms of carbs without bolusing. One 4 g glucose tab will raise me about 40 points if my blood sugar is in the 50s-60s. One grape raises me 10 points. When I was first diagnosed I tried the 15/15 method (4 glucose tabs) for lows and found myself then fighting highs. I have wondered if this is a carb sensitivity or just another example of how we are all different.
I think it is more complicated than “carb sensitive.” Most “experts” argue that dietary carbs convert to blood sugar through a direct path and the blood sugar rise we observe is directly proportional to our body size. They even go through explanations of blood volume and calculations of grams of carbs/liter of blood. And I think for meals, this is the dominant effect. So if you are a petite woman and weigh 100 lbs your blood sugar will rise twice as much when eating the same meal as a 200 lb man.
That being said, what differs more from person to person is the “other stuff.” When we eat, there is signaling that happens. This signaling does stuff (like the Chinese Restaurant effect) and that can have a significant effect on what meals do to our bodies. If you “felt” full, you were probably full and your body generated those signals, further increasing your blood sugar.
Also, the effect of insulin is variable in our bodies. Insulin affects different tissues, muscle, fat, liver in different efficiencies. I think that can cause some significant differences. For some of us this is reflected in differences in what our I:C and ISF should be from ideal. I am using an I:C of 4 and an ISF of 50. That is way off from what people like Walsh of “Using Insulin” would suggest.
And finally, we have to note that carb sensitivity and insulin sensitivity are not idealized. Once you go high (and Natalie was high at 190 mg/dl 4 hours after her meal, probably well into the 200s before then), you become insulin resistant. So while you might have bolused perfectly in proportion to the carbs in your meal, you actually required more insulin to properly cover the carbs and more insulin to properly correct.
ps. And I think AR and Gerri are correct, something like potato soup is fire. I can have a terrible time with restaurants and unknown sauces, liquids and goop.
One other thing I was thinking, in terms of my very vague reflection of chemistry is that perhaps there’s something analogous to the slower absorption of larger doses of insulin that takes place with larger “doses” of food? Particularly when it’s yummy, salty, potato soup with butter and who knows what other tastiness ground into it, it probably gets eaten quickly and then hits your stomach. Your stomach doesn’t “give up” but sort of goes more slowly and that could explain how it gets the bigger meals spread out for hours and hours? Not so much “carb sensitivity”, as “dose of food” sensitivity?
I think you are right. The pyloric valve operates by releasing stomach contents in a measured manner into our intestines. In gastroparesis, that valve get’s messed up, often staying closed too long. But I have also notice that if I totally pig out, I’ll often end up with a totally bloated stomach and it feels for hours like everything is stuck in my stomach. I think that sometimes my body shuts that valve down to protect itself from my pigging out. And as you note, when we eat a “manly” size meal, perhaps that valve takes hours to slowly release all the food we have jammed in our mouths.
Your comments are spot on for me! I’ve only been at this for three years, but in the beginning followed the guidelines set by my CDE for # carbs per meal. It just didn’t work for me, and I have been low carbing ever since. For example, my favorite quick dinner would be tuna steak, a little mayo, on a ciabatta roll, a total of 48 carbs. Bolus for it and would be at 290 two hours later. Tried it with 1/2 a ciabatta roll, bolused for 24, and would almost be in range. The problem is, I don’t want 1/2 of a roll! My calculations would work if I ate 1/2 of what I wanted to eat, which was just cruel. After a while (2 yrs., 11 mo) the carb restriction is almost bearable! I am also very insulin sensitive, one unit drops me 120 points, so low carbing is much safer for me. As Dr. Bernstein says, big input, big mistake, small input, small mistake, or something like that.
Another consideration is not just the carbs, but what they were. Cauliflower is an “evil” food when it comes to gastroparesis because it is very hard to digest. Even if you don’t have gastroparesis, it is like a normal stomach and protein – it isn’t going anywhere for awhile. Then you threw in some cheese on top of it and it got stuck and took even longer to digest (and that was meant as a joke!). The fact that you felt full for a long time means that cauliflower was still floating around in your stomach. One of the joys of gastroparesis is when your food finally does start to digest and your BS goes up, you no longer need just a simple correction bolus, you need a food bolus on top of that correction because the bolus you previously took is long gone and you have round two of lunch starting to hit.
This meal seems to be higher in fat than most people are suggesting. Potato cauliflower soup could have been made with half and half (with cornstarch etc like others suggested). Fat + protein in the grilled cheese. Significant amount of fat in the cupcake. Not to mention the potato soup and cupcake are ones notoriously hard for me to count carbs on. Natalie I think if I ate the same meal I would get a similar result. More than likely more carbs needed to be counted and a Dual Wave bolus needed to be given with most of it coming up front to account for high carbs, moderate fat, and with a little protein sprinkled in meal. I agree that the bolus was not “enough” but your blood glucose didn’t keep climbing because there was “enough” insulin just to keep it stable. I notice that in situations like that (with no correction along the way) I will flatline at a higher blood glucose and when the insulin is all used up I will the go even higher. SO in the end your “corrections” ended up being insulin given for the food. I also think there is something also to be said for needing more insulin at higher blood sugars. I do not notice this effect until I am well over 300 mg/dl but YMMV.
