Conventional food habits vs flexibility on basal-bolus insulin

Good question, and I had to think a bit for the answer. First of all I don't know what the "normal bg level" your doctor asks you to target at 2 hours is. For me, it is under 140. So I still have room to slip down a bit more without running into danger of a low. Even the 120 many people target allows 60 more points before going low. Also, the insulin does not get distributed in even time. (there's a maths term but I can't think of it). The end period of your insulin is it's "tail" and it is less insulin than the first couple hours. I also use Apidra which has less of a tail which I like.

Bottom line if you are under 140 let's say at 2 hours and you are going low at 4 it is due to your basal being too high and driving you down between meals rather than keeping you level.

I don't know about eating and bolusing every 2-3 hours, that sounds complicated (and unnecessary).

There's a saying, "Take what you need and leave the rest". Meaning there is lots of information you receive, and you figure out which is right for you. Using Insulin is a great book and based on the experience of a lot of diabetics. But bottom line is your experience, because over time you will see what works for you (and what doesn't). We've all learned to trust our doctors (I wonder if that is even stronger in India), but where Diabetes is concerned many of us have learned that we live with this condition 24/7 and we know our own bodies, and many doctors have only limited knowledge of Type 1. I have a "nodding and smiling politely" face for doctors who give me info that isn't useful to me. Practice it!

I wanted to add to what I said above (about the 2 hours and 4 hours which is even more true when I see your target is <160!). Btw research shows that damage begins to form with consistent time spent above 140; 160 is a pretty lax goal, though the ADA here still says <180 most of us think that's absurd!
That smiling politely face I mentioned? You might have to use it on your parents too. If you stick with the 6 times a day regime there is no reason it can't start an hour later. If you don't, well I have no advice for how to tell parents you know what you're doing when you're 20 and live in their house. My own solution to that problem was to leave home at 17.

Great advice, Jean!

No problem, Zoe. Just didn't want Guruprasad to think I could help there.

It's very hard to find info for Indian food. Such complex & wonderful dishes. Carb spices can really add up. Only way to get accurate carb counts is to calculate each ingredient to get a total.

Zoe, lol about nodding with a polite smile thing. I already do it often and there is this slight hesitation in me that says “even though it is my body that I know best, what if occasionally i am wrong and they arent?” I need to understand my body and its semantics much better to gain confidence and overcome the hesitation.

can you elaborate on timing the bolus right part? Right now i take bolus shots thrice a day within a couple of minutes after eating. Should I advance the bolus based on the glycemic index of the food i eat? Same food same quantity consumed and same shot doesnt result in same bg level. I guess that is because our body is ver complex and so are Indian foods :frowning: I should build a temple for those who have 5% a1c. Sounds supernatural to me. I realize that i am on the right track to improvement but there is a long way to go. :slight_smile:

NovoRapid starts to work about 15 minutes after injection & peaks at around 90-120 minutes. You should be taking it before meals so it has time to begin working. The goal is to have insulin peak at the same time as food digests. Hardly an exact science:) Most people take bolus about 15 minutes before eating.

Afraid, once again, it's a matter of experimenting. Flour products hit the bloodstream quite quickly. Carbs begin disgesting immediately from the enzymes in saliva. Protein & fat digest much more slowly. If you test at 1 hour & 2 hours after eating, you'll see when the spikes occur to adjust bolus timing.

When you get different results from the same food, are you starting out with similar BG before meals? If your BG isn't in range before eating, do you include a correction with your bolus?

So very complex, indeed. There are so many variables! The best approach is to limit the variables that we're able to. It's far easier to control eating a lot less carbs for obvious reasons

Guruprasad, I wish I could do more to help you, but you are dealing with things that I don't really understand. I have been thinking a lot about how to balance your cultural and dietary situation with your diabetes and...I just don't know.

I come from a rice-eating culture (people from South Louisiana eat more rice per capita than any other peoples outside of East Asia) and I haven't had rice in so long that I can't even remember when the last time was. I used to be a vegan and there is no way I could do that now and keep my blood sugars under control -- not unless I cut back my daily consumption to near-starvation levels. Just one cup of cooked rice has more carbs than Dr. Bernstein recommends in an entire day -- and that's less rice than I used to eat in one meal.

Diabetes is so hard for me to control, that I had to completely change my diet...and I'm still not there yet. I rely heavily on poultry, meat and eggs -- plus lots of low-carb veggies like mushrooms, asparagus, broccoli, greens, etc. But without the poultry, other meat and eggs, I'd feel like I was starving.

I do also eat Greek-style yogurt (strained to remove a lot of the moisture) and occasionally drink milk (at 13 gm carbs per cup, milk has to be limited) but I use up the majority of my daily carbs on organic vegetables.

I also cook almost all (98%) of my meals for myself at home -- no one else has to adjust or change their cooking/eating for me because I do it all for myself.

You have a challenging situation! Learning what's in your food by watching your mother cook (learning how to cook?), weighing/measuring what you eat, trying to figure out the carb content, testing your blood glucose and noting your results will be a trial-and-error process that will take time and good record-keeping.

Hi Jean, rice and wheat are the staple food for the Indians. And there is no way I can eat non-vegetarian food :( I have to find out the minimum quantity of carbs required for body metabolism and normal functioning and try to stay as close to that as possible. But I guess if I do that, I will end up feeling that I am starving or I won't feel full. Anyway this is a process that takes time and effort to gain some idea about.

Well, as a vegetarian, most of your food will contain carbs. The only things you eat that do not contain carbs (or very little) would be nuts/seeds and oils. All grains (rice/rava/etc.) vegetables, beans/legumes/dhal, fruits and dairy products contain carbs (ghee has very little, depending on how well it is clarified.)

In order to maintain your body (not get too thin) and have the nutrients you need to live, if you are vegetarian, you will be eating quite a few carbs. There's no way around that.

You'll need to figure out the carbs in the food you eat, and make substitutions that will keep you in energy balance.

For example, if you normally eat two cups of rice, eat one cup of rice and add 30 dry-roasted almonds to keep your calories the same while cutting carbs by a considerable amount (45 grams less.) Instead of a sweet rice dish, eat a bowl of dhal stew with no rice (more protein, fewer carbs.) Instead of a big serving of rava/upuma, have a small serving and add some vegetables sauteed in a little ghee to keep the calories the same.

You could start by cutting out the obvious: let go of sugar in tea, soft drinks, sticky desserts, canned fruit in heavy syrup, etc. Most tropical fruits are high in carbs. You'll need to do some research to see what you can have without spiking your blood glucose too high, but the first step is staying away from dried fruits (concentrated sugar) -- especially if they have been dipped in sugar-syrup -- also fruit juices/purees and canned fruit in syrup. Plain, natural, lower-carb whole fruits in small quantities will keep your carb-count down. For example a cup of canned fruit has 35 gm of carbs, while a medium kiwi has only 10 gm of carbs. Three ounces of banana chips have 45 gm of carbs, while three ounces of avocado has only 2-3 gm of carbs.

Most vegetables, with the exception of starchy root vegetables, have few carbs. Problem is getting sufficient protein without eating high carb beans, lentils, etc. You can make your own Greek style yogurt easily by straining regular yogurt. Higher protein, less carbs & very delicious & rich. Unsweetened coconut is healthy, low carb & high fiber. Nut butter would be a good choice for protein.

Paneer is low carb & high protein. Ghee has no carbs. Neither does butter.

Are you taking B12 vitamins? Only source of B12 is from animal sources & it's a necessary vitamin. When I vegetarian I ate a lot of fermented foods & also took B12.

A lot of these foods have high fat content and my doctor has asked me to avoid them as my bad cholesterol levels are marginal and I have started mild medication for the same :(

Hi Jean, your suggestions are really helpful as they touch upon various foods that I eat regularly - rice, upma, rava and etc. :) It's been a while since I stopped sugar in milk and direct sweets, desserts, colas and other dangerous stuff.

My doctor has said that my LDL cholesterol levels are marginal 105 (normal levels are < 100 and ideal is around 70). So I have started cholesterol medications.

I understand that more the carbs, more the fluctuations and risk of losing control. So I will try to gradually cut down carbs. I now consume around 200-300g of carbs every day. I am now trying to consciously bring it down to a maximum of 180g and see its impact.

My doctor has also prescribed a multi-vitamin supplement capsules and a protein drink (which of course has some carbs as well :().

I am checking my bg levels at least 6 times a day this week so that I can better understand the interplay between the food items I eat, insulin, activities. Keeping my fingers crossed :)

There's a lot of progressive research showing that dietary fat doesn't impact serum lipids providing the fats aren't vegetable oils & transfats. Saturated fat is not the enemy, nor are the good fats in nuts & seeds, & is necessary for nerves, hormones & general health. You can Google to find lots of info on the dangers of low fat diets & the fat myth. High carb diets cause unhealthy lipid profiles & high BG contributes as well. Once you get your BG down (which you will), your cholesterol will greatly improve.

What medication did he prescribe?

I've been prescribed StorVas 20 mg to be taken once a day at night.

I am taking a dietary supplement capsule Nuala E that contains Vitamins including B12. So I guess I am safe here. :)

That's a statin, not exactly a mild medication. Please let your doctor know right away if you experience muscle pain or weakness. One side effect of statins is muscle wasting.