Less Basal, Bolus for Protein?

Diabetes and Pregnancy
1

Today I did a little experiment.

Fasting BS was 80.

Didn’t take any basal before breakfast. No bolus after.

Breakfast was a piece of fried fish (no batter - just fish - the piece was about the size of my hand and not thicker than my hand either, salt and olive oil), and a small cup of plain coffee with just a touch of milk. Probably about 1 gram of carb or less. I haven’t noticed that caffiene raises my levels.

At 2 hours, I was 98. Not terrible, but a rise. I like to get back down to close to fasting by 2 hours.

Normally if I eat very low carb I don’t add anything for protein or fat, and just count on my basal (curently 14 units in the morning and 8 units at night) to cover it.

I adjust my basal based on fasting bs. If I get to 90 then I would add one unit of insulin each to the morning and the evening dose until my fasting is back to 70 - 80. This was not told to me by a doctor, this is just how I do it. If I’ve eaten a heavy dinner (occassional) then I would also just for that evening add 1 - 2 extra units of basal.

If I eat < 10 g of carbs (and moderately of protein or fat) I would be fairly close to or back at fasting back at 2 hours without any bolus (except for breakfast where 5 g is my target now). Lunch and dinner - 10 g of more of carbs I now dose at about 1 unit:10 g.

However, I don’t want to be forced to eat on any fixed schedule - the reason why I switched from 70/30 to basal bolus.

So should I be taking less basal, and using more bolus for carbs, as well as counting protein and fat?

Pregnancy insulin resistance is obviously starting and things I could eat before without going high are now sending me above target. I think I need to work out a more accurate approach before things get worse.

Hope this is not a stupid question. I don’t have anyone outside of this forum to ask these sorts of questions.

2

You’re doing an amazing job controlling your BG! Congratulations on finding what’s working well. Non-diabetics experience a rise after eating & they quickly go back to normal, so a rise of 18 pts is hardly anything.

You mention basal & previous use of 70/30. What rapid acting do you use for bolus?

The issue using basal as you do, while clearly successful, will not work to lower future highs, if you have them from pregnancy. Basal works too slowly & isn’t intended for this, of course.

With very few carbs, how are protein/fat effecting BG at 3-4 hours? I hope nothing, but am questioning what happens when protein/fat hit later. Is BG stable between meals with no lows?

I eat low carb & do bolus for protein. I calculate protein as 50% since about 58% of protein converts to glucose. As best I can, I try to account for high fat meals regarding bolus timing.

3

Sally, you’re doing fantastic! You should be giving classes on GD. The gold standard is having a low standard deviation & yours is phenomenal.

Could be that a delayed protein rise is preventing a low, but you’re so level that it doesn’t matter.because what you’re doing is working beautifully.

Hormones for sure & you also weigh more regarding insulin effect. Yep, two hours is the typical Humalog peak. Wonderful that you don’t have rapid drops due to basal. It’s the worst feeling.

4

More than just luck! You’re disciplined, smart & are paying close attention.

You’re not alone in restaurant syndrome:)

5

You’re most welcome. My pleasure.

Agree. We certainly don’t get the info we need from medical professionals. Shuddering thinking of where I’d be if I followed what I was told by them.