Hello, I’m a type 1 on a pump and recently have really cut back on my carb intake. Eating less carbs and taking less insulin is really the only method I have found to manage my weight. As a dietitian and diabetes educator, most of my coworkers do not support eating less than 150 grams a day but then again they aren’t diabetic either! 
Anyway, I am just really stumped and hope some of you all may have some words of wisdom. My husband and I are scratching our heads because even though I’ve been eating way less carbs than I used to (now no more than 10-30 grams/meal) my post-prandials are higher. I have been diligent about carb counting and using the bolus wizard so we can’t figure out what’s going on. For example this morning my fasting bg was 51 I only ate 8 grams of carbs so the pump recommended 0 units…then about 4 hrs later I’m at 230! Then tonight I had chicken and stir fried veggies and 1/4 c brown rice(about 20 grams) my bg was 77 before supper. I bolused 2.1 u and my bg 2 hours later was 262! This is just driving me crazy! Has anyone had similar experiences? I jogged 2 miles before breakfast and walked 1 mile before supper. I know my site is good so I just can’t wrap my mind around it. I did see something about TAG but had never heard of that before. You don’t see that in any nutrition text books but I’m wondering if that may just be the ticket. Any help or advice is greatly appreciated!!! 
I'd disagree w/ the 0 units w/ breakfast, it's very inconvenient sometimes but, if I'm running low in the AM, I will correct, very gently, like 5G of fast acting and test again. Pretty regularly, 4-6 jelly beans (about 1G each, maybe a shade less...) will kick me up to 131 and then I dose and eat based on that (really, I'll dose, shower and eat after, to give the insulin time to get its teeth into the DP hormones or whatever it is...).
Dinner, OTOH, I usually use 1/2 c. of rice= 55G of carbs so maybe 20 was a bit light, particularly depending on what the "veggies" were? I don't TAG per se but would probably include about 5-10G of carbs for the chicken, depending on how much chicken it was. It may also be that the ratio is off a shade? I'd perhaps try the reconceptualizing above and perhaps try a carb/ insulin ratio of 9-1 or 8-1 if 10-1 results in regular runs up like that?
Your ISF and carb ratios, as Acidrock, mentioned, probably need tweaking. Read Pumping Insulin for tips on hw to do this.
Keep up the good work.. You are trying so hard One of the things I LOVE about Tudiabetes is that we can talk about issues such as these with people who have experience and who Truly understand the day to day struggles. My endo is good as gold: I would not trade him for another. But,even he said he just started realizing, in the past 2-3 years, how VERY hard it is to manage diabetes on insulin(whether type o1 or type 2).. He has more compassion as a result and really listens to his patients with an open mind.
God bless,
Brunetta
U sure we don't have the same one??? LOL! I know he stays in TN for a few days then he flies to OH!!! LOL!
He is a true "Buckeye" Doris.. and I do not think he visits the "Volunteer State" very often.. :+)
God bless,
Brunetta
LOL! Well there's 2 good Drs out there right???
You fell victim to one of the classic blunders. The most famous is: Never get involved in a land war in Asia. Only slightly less well known is this: Never assume you don't need insulin at breakfast based only on a carb count.
Oh, breakfast is hard. If I don't take insulin at breakfast time my bg goes way super high throughout the whole morning. This is true even if I don't eat anything at all or eat something with zero carbs. You might believe the textbooks or websites that say that if you don't eat carbs you don't need a bolus. This is wrong, wrong, wrong. It's a case of "I can pay a little now, or I can pay much more later." I can take a few units at breakfast, or I can take a bunch more units later in the day trying to bring the highs down from not taking the few units at breakfast.
And about your supper... A bolus of just a couple of units for a meal is going to be too low unless you are super unusually insulin sensitive.
I know for me, 1/4 cup of brown rice will take way more than 2.1 units of insulin.
Hi Katie. Unless I'm low, I automatically take one unit of Apidra when I get up in the morning. It doesn't count against breakfast; I just need it to prevent a morning rise in BG. I read Dr. Bernstein's book years ago, and he said he does the same thing.
I think everyone's suggestions are great. I bolus for protein at (50% of my I:C and fat at 20%) using a duel wave, about 30 min before my morning meal I do not bolus early for lunch or dinner but I always tag if I consume more than 2 or 3 oz of protein.
You need to weigh your food and rice should be weighed dry...45g brown rice (1/4 cup)= 35g carbs. There can be a huge discrepancy if you try measuring servings by volume..I eat rice maybe once a month but it's never a perfect meal.
Note: I also wash and scrub rice until the water runs clear...this can make a big difference.
Suggestion: Try eating 100g of white baked potatoes and see if your I:C will cover the tough carbs...make sure you have no active insulin when you do the test. I would consider the test a success if my BG was lower than my high target after 3 hrs. and still slowly moving toward my post meal target...120mg/dL. YMMV (100g =22 g of carbs)
You count 55g for half a cup of rice?? I thought a cup was 40g (according to Calorie King and package information on the rice I've eaten), and I also use 20g for half a cup.
I don't know about others but for me some foods take a lot more insulin to cover, than I would expect by the carb-counting books and tables. Rice is certainly one of them.
Don't we all apply the "tweak factors" knowing from decades of experience that carb counts don't always account for how much insulin we'll need? Carb counts are a good start, I don't want to discourage anyone from carb counting, but real meals seem more complicated than just a single number.
I know in the morning it seems like if I even smell a carb it rockets my BS. The most frustrating thing is it isn't consistent either. Sometimes a 1:5 ratio will cover the carbs and then sometimes that will rocket me way low at 1 hour and I will have to deal with trending low all morning. It's maddening at best. I wish this disease was more of a "science" than an "art" to treat.
I agree with AR, I would do a minor correction for a 51 in the morning (5g of sweet tarts). But my BG ALWAYS rises in the morning, even without food. Getting up, and having a diet coke will usually raise my BG 20-30 pts - independent of what time I get up. Having cheese in the morning (0 carbs) will raise 20-30 pts, so I bolus for that. But having cheese later in the day, often do not need bolus.
My theory is that when eating high carb, the protein/fats are a smaller impact of BG rise, percentage wise, and so not counting them doesn't make much difference. But when eating lower carb, and often more protein/fat, then I needed to start counting them. The info in the TAG group helped, but mostly I had to experiment with what worked for me.
But even if carb ratio is correct, I still find some carbs are just too fast to match the insulin, so I usually avoid cereals, rice/pasta and breads. Once my BG goes over 160-180, then I'm more insulin resistant, so it takes MORE insulin to bring it down, and the original dose for the carbs won't bring it down in 4 hours.
I also found I needed to wait longer after bolus, and eat the faster acting carbs later in the meal. If the timing is right, and no spike, then no additional insulin needed.
I think your activity level/metabolism/insulin sensitivity play a big role in this, and for some, BG does come down in 4 hours, even with spike > 180. It also varies throughout the day, as most are more insulin resistant in the morning or liver is dumping glucose.
Having a CGMS and more frequent meter BGs really helped to figure out how it worked for me!
Thanks for the help acidrock! I’ve found I am more sensitive to glucose in the am-dang DP! I knew better but I think I trust the pump too much sometimes.
I’ll try correcting very gently first next time. As far as the rice goes I normally don’t eat it but if I do it’s brown rice and only 1/4 c cooked or less. I typically count the total carbs I do not ever subtract for fiber even though I’ve always been taught to do so. I have never included carbs for meat but this morning I did try the TAG for my breakfast and I had no bg spike at all…ah diabetes is constant trial and error, right? Anyway thanks again for the help. Have a great weekend!
Hey Brunetta! Maybe I do need some tweaking-seems like when i think Ive got it figured out diabetes proves me wrong! ;)Although yesterday was the first time I had those kind of post-prandials highs so I’ll probably keep going steady for a few days and see how my pump reports look. At work I am downloading others’ pumps and helping them figure it out so it’s frustrating for me when I can’t find a pattern for myself! That’s the great thing about tudiabetes-y’all help me so much because a lot of times you just need another pair of eyes to figure out the issue! Thank you for your help! have a good weekend!
Tim you are so right about that! We have carb counts drilled into us for years but I try to explain to my endo that sometimes there’s just no rhyme or reason to diabetes. I remember in my dietetic internship my instructor got mad because I argued that just because a food has 15 grams of carbs doesn’t mean it will affect every diabetic the same. There’s no textbook for really managing diabetes we just have to do our best! Thanks for your help!
Yes I think I put too much trust in the pump sometimes! About the high bg in the morning without carbs or insulin- its at least comforting for me to know I’m not the only one and I am not going crazy! I am having to retrain myself on managing dm and sort of having to forget most of what has been taught to me most of my life which is really hard. It helps having you all to sort out these issues! As far as supper goes, i actually usually do well with only 2-2.5 u without a bg spike but I am very insulin sensitive at night…unfortunately morning is a different story! Thanks for your response!
Hey John I tried that TAG method today and it seems to be working well. I think it’s true whenever I eat more carbs I don’t necessarily need the extra insulin for fat and protein but when I go low-carb it seems I really need the extra insulin. I’ve wondered if since on a lower-carb diet your body burns more fat-if your liver isn’t releasing more stored glucose in the blood? Just a thought…
You are so right about rice- I usually try to avoid it because even the brown rice is not kind to me! I will try your suggestion. Thank you for the advice!
Jim I hate that for you but I’m glad I’m not the only one. My pump trainer thought I was crazy. You are so right about diabetes management being an art. What seems to work for me one day fails the next. My husband is a mech engineer so he will drive himself nuts trying to figure out a “reasonable explanation” for everything. Lol! Thanks for your help. Have a great weekend!
I agree with this, but to me this is different than saying 1/2 cup of rice is 55g of carbs when it's really 40g (if that's the case). For some meals I will add on extra insulin, but I still put in the carbs as whatever the carb count is, then add on the extra just before delivering.