Dietary advice please

I’ll ask my endo this Q and I’ll go see her dietician/CDE, but I’d also like to ask now for some advice please.

I occasionally have trouble getting my BG up and keeping it up. (I said my BG! :stuck_out_tongue_closed_eyes: read carefully!)

For the last 48 hours or so, I’ve gone low numerous times. I’ve dealt with it as usual, with glucose tabs, a small can of juice, etc. It raises my BG 40-50 points in an hour or so, but quite often in another hour or so I’ve dropped back into the 70s. The Tandem pump with Control IQ turns off basal as it should, which helps but not enough. Right now, Saturday Nov 20 around noon, it’s been like that since mid day Thursday. When it happens at 3 am it’s a royal PITA. It’s like smoke alarm batteries! They NEVER go dead at 3 in the afternoon!

I know there is a connection between eating carbs and also eating fat or protein. My endo has explained this to me but that’s what I’ve forgotten. She says eating fat and protein along with whatever carbs I’m taking helps the carbs’ effects on BG “take hold and set in” (her expression).

Can someone here help me recall what else I need to do in this situation besides JUST eating carbs?

Clearly, adjusting pump settings is called for and I’ll deal with that with my endo who is excellent at this. But in the meantime, what else do I need to eat in the short run for a quick fix that works, to make the carbs do their job and “set in”? I.e, what sorts of things should I snack on for the quick effect when I’m in the 70s and dropping? JUST juice or tabs isn’t doing enough.

Quick acting carbs, like juice or glucose tablets don’t need anything else to do their job. Their nature, however, is short acting – they don’t have any glucose metabolic staying power. Sometimes, simple carbs are all you need.

If, however, the source of your problem is a basal rate that is too high, the persistent basal insulin will drive you hypo again after the simple treatment carbs do their work.

In this situation, I will add a tablespoon or two of peanut butter. Be careful since hypoglycemia and peanut butter are a potent combination that will tempt you to overdue the peanut butter. Then you’ll be fighting high blood sugar for many hours.

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I add a couple of tablespoons of full fat (4%) cottage cheese or a slice or two of cheese. The “staying power” your endo is referring to is the fact that protein and fat slow down the digestion of the carbohydrate that you take and keep you from plummeting again.

In the good old days, they would recommend half a peanut butter sandwich after treating a low with fast carbs. If I did that now, I would could crazy high if I didn’t bolus for the sandwich.

If this is an ongoing problem, you should contact your endo sooner rather than later if you’re not comfortable adjusting the settings yourself. I have a couple of profiles with Control IQ. One is called Control IQ. Another is Less Basal and the third is More Basal. I often copy the current profile and make changes to the copy rather than adjusting the profile that had been working previously.

Although I sometimes get frustrated with Control IQ not being good at preventing highs, it prevents almost all lows for me. So a change in settings in probably in order for you. The only time I see a lot of lows is when I try to beat the Control IQ Sleep Mode target range of 110-120 by making my settings too powerful.

Good luck!

I agree with w already been said.

Eat some protein with your fast-acting carb so low BG is unlikely to return. Or if it’s not already too low then put it on sleep mode or shut off your basal and see if this brings it up.

We don’t have full control or any control of our liver which can convert protein or fat to sugar or just drop sugar into the blood. I used to try to think of any possible reason when my sugar went high on my sugar went low but I’ve stopped trying to figure that out as I have no control over my liver. I do everything I can to keep my blood sugar at a certain level but if it goes high or low and I cant figure it out then I just stopped trying.

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Something that occurred to me about a month ago was dropping in BG levels at night, I reduced basal and still struggled with dropping. Not eating or dosing over 6 hours before bed. I ended up having to cut my nightly basal rate in half for a few weeks and then it stopped. Totally unexplained.

The other thing I would consider besides a possible too high basal rate is too high of a IC rate too. Almost all of the insulin I take is used within the first two hours, but I get a slight kick at about the 5-6 hour mark.

I don’t have a tendency to eat after around 6-8 and that way I know I am usually steady when I go to sleep. But I’ve had it happen where I ate and dosed 4 hours before I go to bed and had been nice and steady before bed and then drop 1-2 hours after I am asleep.

I agree with the advice already given, but sometimes there is just no damn reason. I have times where I can’t get my sugar up and times when I can’t bring it down.

It’s the factor x that no one seems to know how to pin down.

Last week I went to bed and my pump alarmed at 58. So I got up and ate a banana. Went back to bed. No insulin being delivered I could see it on my screen. In a half hour I was at 56.
So I did a finger stick and drank half a glass of apple juice.
An hour later I was at 70. That’s 2 hours of no insulin and enough carbs to ice a cake and my sugar just wouldn’t budge.

It finally settled out in the 110s but why it happened I can’t explain.

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You’re absolutely right Timothy. Sometimes you just can’t explain it. I really need to be more comfortable accepting that.

Maybe my real problem is I’m a recovering engineer! I always knew there would always be SOME explanation for anything I ever observed, even if I also knew I might not understand it. It just wasn’t part of my universe that there just wasn’t any explanation at all!

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For me, sometimes the missing piece relates to activity level. Sitting for long periods (eg driving) after even relatively little carbs can lead to a very stubborn high. That lasts for hours and resists 10 additional units of frustration-blousing. Often followed by a long gradual decline hours later that needs treatment with — you guessed it — more glucose.

And relatively minor exercise sometimes has prolonged carbohydrate resistance. I call it “carb resistance” and not insulin sensitivity because I can keep dropping despite having no measurable insulin on board! What did I just do, start making insulin again?



Ahh you need an engineer explanation. Think of it as an equation with 25 variables.

Bg= a+b-c(de) ^ f3.14- g+h/ijk(Lmn*o) ± 10 percent

Fat and protein can definitely contribute to BG levels, especially when they are not minimal.

Some use a method called T-A-G, Total Available Glucose.
So instead of just counting carbs to calc bolus, you add more insulin for fats and proteins. But also use an extended bolus to last 1-2 hours. This portion delays the timing of insulin for the fats and proteins. Without it, you first go low, because it takes more time for digestion and impact on BG.

Search for TAG on this site for more details.
This is more common for those who do “low carb/higher fat, protein” meals.

Here’s a good article.