it’s an optical illusion: we were out of range for about 1/2 hour in the last peak according to the CGM.: we peaked around 146 per the CGM. Also, our Dexcom (I am sure like everyone’s) underestimates sharp transient peaks, so we probably were quite a bit higher in both peaks.
The other problem is: our dosing strategy was really brittle and we were lucky: if you look around 10:20pm we were down to 83 before climbing up to 146 when we injected again. So we basically went the full range there. I am scratching my head as to what we should try next time. Maybe try for more than 60% before the meal, then less that 40% on the first peak? Somehow we will need to increase the full amount of insulin, but I really don’t know how we can tackle the almost low followed by the high peak 4-5 hours after eating. I am thinking we were lucky because he could easily have gone into a low around 10:20, or on a higher high afterwards: we were lucky to be straddling that full range perfectly.
So I feel that we really had higher peaks than shown, and that we don’t have the right strategy yet. But I am happy that we were not too far off! We spent 45 minutes reading up on pizza dosing strategies before “going in”
I also think your BG management tactics and performance were excellent. The only fault I see is the slight rise above 140 @ 11:43 p.m. – but that’s a nitpick. So you kept the BG in range for a high-90% time in range, no hypos (!), low variability, and what looks like a low 100’s or high 90’s average. In my world, that’s hitting 4/4 goals. I don’t have many days better than this.
That looks like a perfect strategy to me. You are talking about the most notorious food for its difficulty, after all! Good job. Most of my “low carb” days are not as good as that (even if you did go higher than the Dex shows).
This is really audacious:-) We had never dared for basically almost a year, since my boy was diagnosed!
As a note:
your slice is 1/6th of a pizza when you buy it at Costco. We bought the whole pizza and baked it at home, then cut it in 8, so our slices were smaller than yours (54 carbs I believe). I also think yours is 70 carbs per the nutrition info.
We read up on different people’s strategies. Gary Scheiner at one time suggested 60% right before and 40% right after - we inspired ourselves from that, except we waited for the peak before injecting the 2nd bolus to make insulin available later. He also suggests to dose for the fat, but we didn’t.
we got an “almost low” about 4 hours after eating, and addl peak almost 5 hours after eating, which we had not planned for.
we used a slightly lower carb factor than usual (i.e. more insulin), because it is such a huge number of carbs.
Thanks so much @Terry4! We look up to all of you guys, and are learning a tremendous amount from this thread. We would not be sugar surfing without this thread!
Well you did really, really well! I spent more than 40 years on pizza dosing strategies and I’d not be able to do that well In fact, I’m pretty sure l’ll never be able to do that well after two slices of Costco pizza. Reading your posts, I think you may have a slightly pessimistic notion of what damaging highs really are. Depends on the diet of course, but in general non-D people (also known as sugar-normal people around here), do spike to 140’s and regularly spend (brief) periods of time at those levels. We do not know for sure, but it is very likely that damaging effects of elevated bg are extremely small below 180 or so, and then start to accelerate sharply in the 200’s and beyond. If this were not true, most of us with T1D would have been dead long time ago No reason not to try to do even better, but certainly no reasons to worry because of some minutes spent about 140 either.
I do have another thought now: if I can learn how to make a good pizza dough, even regular dough, I am thinking I could make a much easier pizza to eat by going low on olive oil and using very little cheese but highly flavored - aged parmiggiano for instance.
This way, the carbs would be the same but there would be a lot less fat, so the carbs should not remain captive so long, and the curve should not last as long,
But my learning to make good pizza dough is a high threshold:-)
I suspect if this thread weren’t in existence, you would’ve found another resource. But it’s good to read it helped. For me, knowing that someone else with diabetes using insulin could trace impressive in-range lines was my epiphany. If someone else could do it, what about me? Knowing it’s possible provides half the motivation!
I am sure you are right about my being too pessimistic - it is hard for me not to because I am his dad. I try hard to protect his health as much as I can, while at the same time giving him as much responsibility as possible for his dosing and management. I am an analytical guy, but I have to say the psychology of not being able to help your kid more is hard
You are so right! But - this is the first time he has had real pizza since he was diagnosed not quite a year ago. This was a pretty big thing for him (and me too). You are one of the primary influences that have steered me towards letting him become more adventurous, Eric!
I am not sure about you:-) But as for D, he is definitely smarter than me! To my immense satsifaction, I am finding out that, in the past 6 weeks, his gut calls on dosing have been better than mine! I am always pleased when my boys outsmart their old man, but THIS makes me particularly happy
I am a parent, and I completely understand the feeling. What I am saying may not make it any easier, but in my opinion you are taking the best route possible with your son’s D - empowering him to take care of it on his own (and so well) is just wonderful to see. Yes, I totally agree, he and you (and all of us) should try to do even better next time!
I totally agree with the ‘gut’ calls. I depend more on that then actual calculations. With cgms and being able to catch up/down trends after meals, it doesn’t even matter that much if you get the initial dose right. Just have to be in the right ballpark.
Thanks for explaining the difference in our carb counts. I think my friend got the 70g that day using an online search, but said that she usually used 80 or 85. we both agree to try the 70g and see what happened. She only spiked to about 140 and it worked well for her. I can’t remember exactly how we split the combo bolus, but it might have been 70-30. I spiked up to at least 200 and it took a boatload of insulin to get it turned around.
Normally at Costco I eat 1/2 piece with the crust and then just the toppings of the other half. That definitely works better for me. On the other hand it was really nice to get eat the whole thing like any other person would. And it was so good and I will do it again. Or maybe go back to my old strategy.
My normal pizza is the thin crusted pizza from Papa Murphy’s and that is much easier to dose for than Costco. Pizza, like everything else at Costco, is super-sized:-)
I have always wondered how long it would take me to get tired of pizza if I ate it every day…
I could not approve more! I figure if we do it multiple times we’ll end up understanding how to deal with it as well as can be. Btw, this is exactly how I felt about my boy getting to eat pizza like everyone else:-)
Kinda one of those “argh” days, but a flatline nonetheless. Corrections (overriding IOB) and running a +100% (so double) basal rat for four hours hasn’t made a difference. I put in a new site yesterday morning and yesterday was probably a 90% in range day. Today might be a 10% in range day. If only I had diabetes telepathy and could tell what exactly my body wants!!
Your day reminds me of something I’ve seen often with my diabetes. Certain trends can be “sticky.” It takes more to knock them off their trend-line. So, you have a higher average than desired but your variability is very low. And that’s a good thing.
Yeah, it is good that it’s stable for a while, even if high. I don’t know what’s up today. Tonight I’ve spiked to 21.5 mmol/L even though I did an injection and site change. Maybe I’m getting sick, since I have been feeling a bit off today. Ugh. Some days diabetes just wins.
In fact, I’m pretty sure l’ll never be able to do that well after two slices of Costco pizza. Reading your posts, I think you may have a slightly pessimistic notion of what damaging highs really are. Depends on the diet of course, but in general non-D people (also known as sugar-normal people around here), do spike to 140’s and regularly spend (brief) periods of time at those levels. We do not know for sure, but it is very likely that damaging effects of elevated bg are extremely small below 180 or so, and then start to accelerate sharply in the 200’s and beyond. If this were not true, most of us with T1D would have been dead long time ago 
