Pizza question

My son is 12 and he was diagnosed w/type 1 three months ago.

His basketball team is having a end of season pizza/cake party today.

He is afraid to eat pizza because he has heard that it will really mess up his bg and its hard to cover with insulin unless you have a pump.

He is currently on MDI's. He takes 1 unit to cover 15 carbs.

How do I calculate pizza? Is the pizza going to need an additional bolus later to help cover it? He plans on eating two pieces of pizza (from a medium pizza). I would also like him to enjoy a piece of cake too, if I can get this all figured out. He will be eating at 6 p.m., so I can just take my best guess at it, then do a correction at bedtime, although, that scares me a bit. We usually don't have to do bedtime corrections.

Any advice would be appreciated.

Thank you.

what a conscientious kid to be worried about pizza! he sounds like he is very well informed and tuned in to everything!
if the pizzeria is a chain you can ask for the nutritional info, tho it might not be completely accurate-every pizza made is gonna be a bit different, isnt it? you can also look at the calorie king book/website ( to get a general idea of the carb content for the average slice of pizza.
i only eat pizza on special occassions and the first couple of times i shot up as i regularly would have-one unit of novorapid for 30 grams of carbs. a couple of hours later i was really tired, checked my bg and was in the 200s. its a trial and error game the first couple of times.
i only induldge when im in nyc and i go to my favourite pizzeria. i have a unit on starting to eat-i dont wait 15 minutes or anything. about an hour and a half later i shoot another unit. this usually keeps me at or below 200-not far below but on mdi i havent figured out a way to get to 140 after 2 hours.
this summer we got pizza from costco (i know, gross, right?). i did the normal unit on eat start and unit like an hour and a half later, but i was high as a kite. so again, trial and error. ill never eat that pizza again!
the cake, i dont know. usually if i have pizza, i have salad or something and no dessert.

maybe to keep him relaxed about his numbers you could do his bg and correct if necessary without him even having to know the numbers? i dont know if i would make him able to enjoy himself more, to hand over complete control to you.

i also hate correcting at bed time and only do it if i am above 170 because i know my correction factor is about 1:85 or so. if you know his correction/insulin sensitivity factor and keep in mind the iob (insulin on board), it is easier and less stressful to do night corrections.

good luck, im sure youre doing a great job!

If it's not too late to answer now, pizza really plays havoc with BG. Your son is right. Smart guy. The combo of high carb & high fat is a monster. Also, hard to guesstimate how many carbs. What helps, though doesn't solve the pizza dilemma, is to keep testing & take two (or more) smaller bolus injections several hours apart. Not really different than a pump. Yea, bedtime corrections are problematic. Understand wanting your son to eat what everyone else is having, but honestly I don't think pizza's worth the trouble & neither is cake.

I called the pizza store already and they do not know the carb count. Even it they did, it sounds like it will be hard to give him a dose w/out him going high.

We have the calorie king app on Kindle and the book. I can use that to get an idea of the carbs, but I'm still worried about the effects on his bg. He is really sensitive to highs and lows and tries to avoid them because they make him feel sick. Maybe I should feed him a really good dinner before we go and then he can just eat the cake (with some protein). Cake is really hard to calculate too though. Both of the things that will be served are things that he tries to avoid eating.

It is so hard for us to eat out. It is so frustrating. He just wants to be able to eat the pizza and cake like the other kids w/out it making feel sick. He wouldn't even mind (too much) if he only ate one of them. I just remembered that since he missed practice tonight, his coach sent out an e-mail that he would be bringing ice cream to the pizza place too as an end of year treat. That makes 3 things that will be served that are difficult to eat. Our culture is so wrapped up in rewarding kids with sweets.

We just ordered him a Ping pump. I hope that will make things easier for him.

Yes, he has been keeping well informed on everything. He just had a dr. appt. today with the endo. and his AIC is really good. They were very impressed. I'm proud of how he has been managing his diabetes. He does all his own shots, tests, and carb counting. He is also finally starting to feel good and he has started working on his hobies again. :)

Thank you for your advice.

Thanks. He tries to avoid too many extra shots, so, I think he will probably opt out of eating the pizza and the cake.

I'll let him pick something else for us to feast on for dinner on Sunday to make up for him not eating the pizza on Saturday. Hmm....I bet my husband will suggest that he chooses steak. We haven't enjoyed steak for a very long time. Maybe also a scoop of ice cream on a cone. That doesn't seem to mess up his bg.

Thanks again.

Sorry don't really have much advice on pizza and cake using MDI, unfortunately the only success I've had is with a pump and using a dual wave bolus, personally whatever his dosage would be for the pizza and cake, I'd half it give half up front, then an hour or hour and half later give the remainder or as posted above do a 1/4 of the remainder then, and retest two hours later and see if you need the remainder. My personal advice I'd choose 1 slice of pizza and a small piece of cake, versus two slices of pizza and then cake too. I can tell you from my own personal experience a "small" piece of cake is approx about 45 grams. That's what I conservatively estimate when we do bday cakes at work. I try to think of a regular size cupcake when I do cake.

Good luck, I think you will see when he gets his pump how much more flexibility you have with dosing.

I was diagnosed at this age and I remember being afraid to eat pizza too! I think it's important for him to feel a part of the group. If he wants to eat pizza and cake as a 'splurge' I say go for it! It's definitely possible on MDI. Here is what I would do.

The carbs for a generic medium pizza slice is about 26 grams(this is my favorite nutrition fact site - The carbs for half a cup of vanilla ice cream is about 17g ( The pizza is high in fat and will digest slowly and the ice cream is less so and will digest quickly. So if he were to take insulin for it all at once the insulin would run through his system faster than he could digest all of the carbs. This might cause his blood sugar to spike 3-4 hours after his meal. To prevent this, I would suggest taking insulin for 1 slice of pizza and the Ice cream at the begging of the meal, then taking insulin for the second slice of pizza two hours after the meal. So that would mean (26+17=43/15=~3units) taking 3 units at the beggining of the meal and (26/15=~2units) 2 at two hours after. I would test his blood sugar before the second shot and add a correction if needed. Let him test whenever he wants and tell him to pay attention to how he is feeling. Taking a little more precaution when trying something new is important, soon it will be old hat.

I saw you mention that he doesn't like taking more shots than he needs to, but maybe you could get him to think about it as taking one for each treat food he's getting. Two treat foods and two shots.. that's a pretty good trade off! Type-1 diabetes with kids is as much of a psychological challenge as a physical one. After I was diagnosed I went to a camp for kids with Type-1 diabetes and it really changed my perspective on everything. Having people to relate with taught me so much and really made a difference. If you haven't already though about it you should look for one in your state or ask your doctor about one. I was 13 and really didn't want to go but my parents made me and now I couldn't thank them enough. Now I'm 20 and I go back every summer to work as medical staff because I love it so much. That's where I learned the 2 shot pizza method by the way, in case you were wondering if it was just something I came up with.

Best of luck, this is a hard time but I promise it gets easier.

Let me know if you have any questions, Hannah

The only pizza that I eat now is small thin crust pizza. I avoid chain restaurant pizza like the plague simply because one slice can be approximately 40 carbohydrates (which would be a waste of insulin, in my opinion. I usually don't eat that much carb in one sitting anymore)and it isn't worth the resulting BG swing (and the subsequent adjustments that have to be taken into account).
I just think it is terrible that your son's well being is not being taken into consideration by the team. I imagine there are other ways to celebrate these kids without feeding them junk food.
On the bright side it is wonderful to know that your little boy is so concerned about his health, especially when dealing with that kind of peer pressure.

MDI for 15 years here.

I usually try to limit myself to 2 slices of pizza and one piece of cake. A large pizza from a chain is usually ~35 carbs a slice. and a small slice of cake is around 30 carbs. Usually I'll have to give another shot of 2-3 units a few hours later to prevent a fat spike.

Pizza is one of those things that'll come up a lot in middle/school and college and I would definitely try to figure out what works now. Skipping the high carb/high fat food might seem like a good idea, but having to sit out while everyone else is enjoying themselves is one of the most depressing things ever.

I agree with Toddy about the thin crust or what some frozen brands, e.g. Home Run Inn, market as "ultra-thin" being easier to manage. I also kind of like it better as the crispy crusty speaks to my junk food brain. We don't go out for pizza since going out is a bit of a chore for us and we are really "nesty" but get a delivery 'za or have frozen pizza probably every 2-3 weeks.

My other whacky strategy is to cut it into more, thinner pieces, instead of 8, like 30. I still eat 1/3 of the pizza but I like it more. One of my friends has occasional "Walking Dead" beer & pizza parties and is an 8-cutter but leaves the knife out so I can subdivide the pieces. It doesn't make any difference to the carb count but is pleasing to my sense of food.

Didn’t you know that carbs escape when you cut things into smaller pieces???

Actually, you can see them escape if you look reaaalllyyy close. It looks a lot like steam. And since carbs keep things from cooling off, it makes sense that smaller pieces cool faster, since their carbs are flying free in the air!

Thank you everyone for your advice.

Kyle had a great party. He ate pizza and a Klondike bar.

Hi BG was on a roller coaster though, so we will hold off on pizza until he gets his pump.

Here's what we did. The carb count was approx. 87 grams. By far, the biggest amount of carbs he has had since diagnosis. I gave him 50% bolus which was 3 units with w/his pizza and ice cream (skipped the cake). Then two hours later his numbers looked good (around 110) so I was afraid to give him any more insulin. Three hours after the meal (at 9 p.m.) his number started going up, so I gave him 1.5 units and he went to bed. Checked him at 11 or 12 and he was 82. Gave him a snack because dr. doesn't want him that low at night (plus he had two sports ealier in the day). Guess we gave him too much of a snack, because at 2 a.m. he was a bit over 200 and we had to do a correction. Number was good this morning.

All in all, he said it was the best pizza and Klondike bar he has ever eaten and he had a wonderful time with his friends at the party.

I'm just really hopeful that the insurance will approve the pump we just ordered so that his bg is not on such a roller coaster.

Thanks again for everyones help. We really appreciated it.

All in all esp on MDI, I think that was a very successful first attempt. Way to go, not only for you but your son, and so glad he had a nice time at the party. While we can't eat like that EVERYDAY, I think its important too for kids to be able to feel somewhat like kids, and be able within reason to enjoy the same festivities as other kids. Yes maybe not eat AS much as the others, but I personally feel a goodie or two is within the possibilities now and then,