Full disclosure before I complain. Life has happened and concentration on meal planning has taken a back seat to home cooking. Though I am eating more carbs than usual I still try to be careful. However: we have eaten more than our share of high fat, high carb meals lately. While I know this is not optimal, I don’t overeat. I usually only eat half my meal. I feel my bolus is on target, Plus I do a large temp rate. Yet hours later I am fighting high sugar.
Example: Today we ate a late breakfast at Cheesecake Factory. I had the breakfast combo. Scrambled eggs, bacon, and one pancake. Sugar free syrup. Figured 65 grams of c carb. Added11.7 units of insulin from a Pimping Insulin chart to avoid highs. Took a brisk 10 minute walk after eating. Did a 200% temp rate and 4 hours later my sugar is well over 200 and climbing. Pump says I have 3 active units on board.
I will be able to get back on the wagon soon. How should I have dealt with this?
One of the problems is probably the combo of high fat, high carb. Fat slows down the absorption of the carbs. 65 carbs sounds generous for the one pancake, although they are high in carbs. Whatever amount is needed is what is right, but I am suspicious that some of the the carbs hit later after the insulin was absorbed and gone? Try splitting your dose so at least half of the dose is a half hour to an hour out after a higher fat meal.
People bolus up to 4 hours later when they eat pizza!
You didn’t mention the timing of your bolus. Did you “pre-bolus”? What was your BG doing before the meal? If already on the high side or trending upward I find that I must “pre-bolus” very aggressively to avoid a high BG later especially when I eat bacon. That type of fat seems to make me very insulin resistant. So, I end up bolusing up to an hour before eating and then again 1 to 3 hours after to combat the bacon induced insulin resistance and the digestive delay that is also caused by the fat. It’s too bad that it tastes so GOOD! It is a real challenge for me to stay in good control after eating bacon. Also, if I had a high fat meal for dinner the night before, the bacon seems to add to the affect of that previous meals fat. In other words, your results don’t sound that strange to me. I probably would see a similar blood glucose spike after that type of breakfast.
Thanks for the responses. My BG was 106 when I bolused and 30-minutes before my meal. I know that some add extra for the fat and protein, but I am not sure how to calculate what that should be. I am working my way through the latest Pumping Insulin book and trying the suggestions for different types of situations. Treating highs, lows, etc. but am a long way from knowing what each situation calls for without looking it up.
I have always been what used to be called a “brittle diabetic.” For the first time, with the G5 Dexcom I am able to see in real time what is happening with my glucose. It is fascinating and I am learning so much. Today, following my hours of high BG, of course, I crashed. I looked up the formula for correcting a low without the risk of going too high. The writer advises that we should use only glucose tabs to treat lows, use a particular calculation involving, the correction factor, weight, IOB, etc. This formula supposedly treats only the low, and you still bolus for any food consumed during that time as always. I followed the instructions to a T, but still went high although it did come back down in a reasonable amount of time.
I use Fitness Pal to plan my meals, input all my recipes and that helps a lot. For the most part I do really well. My CDE has told me numerous times that when we are on a pump, we should be able to eat whatever comes our way and stay in control. I know that does not apply to me. I react to carbs in a major way and work to keep my carb counts low. I eat no bread, chips, pasta, potatoes, no fast food, etc., because even small amounts spike my BG too much. It is just not worth it to me most of the time.
I am learning so much since getting the Dexcom G5. Being able to see what is happening in real time has been an eye opener. The G6 is supposed to be released to me soon and I am hopeful it will prevent the lows and highs. I am still working to fine tune all the pump settings.
I am a little frustrated right now because we are eating out more than usual and there are so many unknowns when doing that. Even though I always eat only half my meal, trying to control the outcome, it is still a challenge.
Thanks for the encouragement. Clearly, we do reap what we sew.
Gastroparesis perhaps? I have never ever found a way to eat carbs of any amount over 13ish that provides a long term stable glucose profile. Carbs and diabetes just dont work in my experience, I tried everything for over 40 years and it never worked ever, all it led to was misery and complications for me.
Restaurant meals are notorious for mystery nutritional content but I think you can master it. I would go to the same restaurant and order the same serving. Keep a written record of how you do BG-wise and adjust.
Here’s what I would have done when I used a pump and CGM without automation to counteract a meal like you describe.
I carefully calculate the nutritional content of the meal including carb, protein and fat grams. I would use the carb grams to figure the immediate insulin bolus using the standard insulin to carb ratio. Using your CGM after giving this bolus, I would not eat the first bite until the CGM displays a decided downward bend in its trace. This is the optimal pre-bolus time and it might vary from the standard 15-30 minutes proscribed in the books.
While “waiting for the bend,” add 50% of the protein grams to 10% of the fat grams to calculate a “carb equivalent.” Divide the carb equivalent by you insulin to carb ratio to discover the total insulin needed to cover the fat and protein. This dose will be delivered over time using the extended bolus pump feature.
How much time to use for the protein/fat bolus extension? For me, an older male when I weighed 160 pounds, I limited the hourly rate to 1.2 units and let that determine how long to deliver the extended bolus.
Here’s an example. Deliver the 11.7 units up front to cover the carbs and wait for the bend before eating. if your meal includes 30 grams of protein and 40 grams of fat then take 50% of the protein grams and add it to 10% of the fat grams to calculate the equivalent carbs. 50% of 30 = 15 and 10% of 40 = 4, so the equivalent carbs = 15+4 or 19 grams.
If your insulin to carb ratio is 1:5, then divide 19 by 5 which = 3.8. If you limit the extended bolus rate to 1.2 units/hour (your experience may vary), then you would deliver 3.8 units over 3 or 3.5 hours.
I’ve found this method to work well for me. It may take some tweaking to customize it for you but you can use my experience as a place to start your experiment.
The beauty of eating the same meal over and over again is it will allow you to home in on getting your insulin dosing close to the right amount. Now we all know that our bodies do no respond the same way to same meal every time, this experience should allow you to get into the right “neighborhood” and then subsequent corrections will be smaller.
By the way, I agree with @Edward2, that eating fewer carbs makes everything simpler and more repeatable but if you want to eat like you describe, I think it can be done.
Thank you so much. This makes it understandable for me. I always wondered how to know I had timed the bolus correctly.
You mentioned that our bodies do not respond to the same meals the same way always. A number of years ago my Endo tested this theory while I was in the hospital. Same food, same time, same activity for several days and no two outcomes were the same.
I will give your method a try and bet it works. It is when life gets crazy and I stop paying attention that I get into trouble.
I agree there are a lot of variables at play here - restaurant food for us needs double the carb count as the same food made in your home, high fat slows things down and then for my son Caleb, sugar free things like ice cream or syrup never end well. There’s something about the sugar substitutes (things that end in -tol) that seems to drive his bg through the roof for an extended period of time. Not something I have heard many other people dealing with, but for Caleb, it’s easier to manage regular syrup in moderation. Just a thought.
I don’t think it’s the same with all type 1’s. So be careful. But when I went to a lecture by a well known type 1 he said to bolus for half the sugar alcohols you consume. The ones that end in -tol.
As a type 2 it’s different as it is supposed to metabolize so fast as to not effect their blood sugar levels. That’s why the sugar free status.
I generally just stay away from them, my stomach or gut get upset when I have tried to eat them.
Many of the sugar free foods contain starches and fillers. Often when I look at the carb count for a sugar free (and fat free) item and compare it to its regular counterpart, the sugar free (and fat free) item is often higher in carbs.
One example of many …
Sugar free and fat free cool whip have 1.5 carbs per tablespoon; regular cool whip has 1 carb per tablespoon. Go figure!
I agree that carbs and diabetes do not mix. I have tried to eat carb free but end up with lots of lows. I usually eat salads with protein when eating out. I don’t know what they put in them but the results are very different from what I make at home. I am anxious to try the suggestions you good people have given.
Yes, the latest Pumping Insulin book I got addresses ways to control all the variables we deal with. I am still learning and testing them to see if they work for me. I think we could all be lined up and no two would react to the same situation the same.
If your having lows, no matter what your doing its too much insulin. Oh and for the not so sharp, no csrb doesnt mean you dont have carbs for hypos, I dont remember the person who said that, but teuly there are people who thing if your on low carb your restricting carbs carte blanche.
The first thing I do when going out to eat at a chain is look at the nutritional information guide which is a great planning tool to determine bolus insulin requirements. All of the larger chain restaurants have this and if you forget to look in advance or last minute get convinced to go to a chain, ask for a copy. It usually takes the manager a few moments to find a copy but usually find one. You can of course also find the information online on your phone as most of these restaurants also have free wifi.
Just saw your post. I am also on G5 but plan to go to T:slim Control IQ and G6.
My thoughts:
Research (reading, forums like this) and then safely experimenting on yourself will pay awesome dividends. Ask anything and safely try it if it makes sense to you.
Set goals and work to achieve them over time. Remember that failing is another learning tool.
I eat in restaurants as little as possible. Even items I think are very safe tend to spike my BG.
There is nothing easy about controlling diabetes. Yes, there are basic things you should know. For example, I think one of the most important items is to get your basal rates as close to correct possible. I call items like basal rates the planning phase. But even if you plan, you could find that doing the identical thing on different days could result in different outcomes. That’s why the reactive phase is as important or more important than the planning phase. How you deal with an unplanned BG is more important than the plans because obviously the plan did not work on that day.
One way I deal with high BG is to give myself more insulin that I need. For example, the plan is that if my BG is 200 and I want it to go to 120 I need to take 2 units of insulin. That may be true but it will also take 4 hours for the insulin to take me to 120. So rather than conforming to the plan, I double the amount of insulin which takes me down to 120 twice as fast (or faster) and as it approaches 120 (actually at 150) I would eat something to keep it from going too low.
Once I knew the rules (correction factor, duration) I experimented on myself and now I do what works for me.
My advice is to know the basic rules and theories, test them out and then safely experiment on yourself to see if you can come up with a better idea for you.
