Seriously guys, BEANS!?!?!?!


#41

I need to take between 5 and 6 units of insulin just for one cup of chili. And the chili also includes ground beef, tomatoes, onions and bell peppers. It is a far cry from just beans. My blood sugar reacts to carbohydrate far more than average for a person of my weight, though. It is unlikely that your mother would need nearly that much insulin. My suggestion is to try a specific weight or measurement of a specific recipe one time. Record BG readings before and about 4 hours after, along with the dose of insulin. Adjust insulin dose the next time according to your findings. Then when you try different recipes that include beans, you can compare the likely number of carbs to the original recipe and go up or down on the insulin dose accordingly.

I know it all seems almost overwhelming at first. But I encourage you to take some time to read up on diabetes generally. As you get a better handle on it, you’ll see that it really is manageable, but don’t expect to be perfect at it. None of us are.

I’d encourage you to read either Using Insulin by John Walsh or Think Like a Pancreas by Gary Scheiner. Both are available through Amazon or almost any bookstore. Or perhaps your local library has a copy.

After I was diagnosed as a type 1, after setting my starting doses my endo was going to turn me back over to my PCP. I felt certain that she knew little about diabetes; after all, she had treated me for a year and a half as a type 2 and said she didn’t want to put me on insulin because she was afraid I’d try to adjust my insulin doses myself. My endo later told me “But that’s what you are supposed to do!”

Anyway, I got the first of those books I mentioned and did just that - used the information to get my doses adjusted before I even went back to my PCP. I don’t think she even knows how to use I:C ratios. She acted like she didn’t know what I was talking about. I think she’s still back in set doses or sliding scale days.

I think the information in those books will help you to get a better handle on the insulin situation. You can ignore the charts with starting ratios, as once you were given a place to start, you need to move on to adjusting based upon experience. But you’ll learn to see how various things affect dosage. And you’ll be in a better position to work with your mother’s endo or CDE.

Be aware that those of us on insulin are likely to have some hypos. Some doctors and CDEs who don’t have diabetes themselves seem to almost panic at the thought of a hypo and keep their patients at too high a BG level as a result. They are especially afraid of hypos among the elderly. And there is reason for that. Hypos are particularly dangerous for anyone with heart disease. I’m age 75, and have had hypos as low as 30 and was able to treat it myself without any assistance. But not all elderly can get away with that. I don’t have heart disease or other major comorbidities, though. By contrast, my friend’s aunt was found unresponsive with a BG of 31 one morning. She was in a coma from which she never recovered. So doctors have reason to be concerned about risking severe hypos. But mild hypos won’t really hurt most of us, at least not in the short term.

Oh, don’t be so afraid to experiment due to fear of highs, either. Just last night I went out to eat at a fancy place for my birthday and ended up spiking to 263 three hours later. Last year it ended up with a spike to 307 after my birthday dinner. But both times I corrected and within six hours from original bolus, I was back under 140 again. It is not something one wants to do often, but I consider it worth it to try something different. As long as I have good control most of the time, things are good. I’ve consistently had an A1c under 6.0 since on insulin, and many aren’t able to do that.


#42

There was, for a while, a discount card that covered the copay so that the insulin was effectively free, but it expired after a year or so. And anyway, there is no copay right now so that wouldn’t apply even if it were still in force.

A vial lasts me around 60 days or so, so with just a little bit of luck I won’t need to buy another one before I can switch drug plans and get coverage again. We’ll see. Thanks for the suggestion, I’ll keep it in my back pocket.


#43

One thing about chinese food: a reasonably good restaurant will omit sugar from most dishes if you specifically request them to. I’ve done it and it does work. Particularly if you are a regular customer whom they recognize; they won’t want to lose your business.


#44

we have many topics here on Chinese food - here’s one I found by using the magnifying glass icon (upper right) and searching for "Chinese Food"


#45

Tinsyl, your response (avoiding beans completely) is totally understandable…but I would say, from my experience with a dad who has Type 2 and a toddler with Type 1 Diabetes, that it’s futile to try to micromanage someone else’s diet, especially if they are not a child. In my dad’s case, for instance, he routinely eats what he wants no matter how much my mom tries to control things. Does your mom have any friends? Does she ever eat in a restaurant? Does she get invited to other people’s houses? In all those instances, she will want to eat what others eat, and she will resent you telling her no!

It’s better to do the (hard, time-consuming, scary) work of figuring out how to dose insulin for the foods she does want. The ones that are horrible for BG she can eat in special situations or in moderation. I’m of the firm belief that there is a way to bolus for almost any food, as long as it’s not spiking BG too fast, there should be a way to cover it with insulin. The trick is figuring out the crazy dosing regimen.

Personally, I would keep a food log. As the column headers, write out the time, the BG reading, the dose of insulin, the food, the grams of carbs. Then just track how the BG changes over the course of 4-8 hours in response to that food, and record any additional insulin you give. I’d test BG every hour after one of these mystery foods.

Keep changing the dosing schedule based on what you see. Is she going low after beans before going high? Experiment with delivering the insulin after her meal. Is she going high for hours and hours? Up the upfront bolus, add up the total amount of insulin you gave her over a 4-8 hour period and then try to administer some of that insulin upfront or soon after her meal. If she’s high for 4-6 hours, I’d experiment with bolusing upfront, then again at 1-hours, 2-hours, 3-hours.

We’ve been doing this for weeks on pancakes. We go to the same restaurant each Saturday, my son eats basically the same meal, and we try different boluses. We are getting progressively closer to the perfect pancake bolus. Pancakes aren’t great food for anyone, but it’s not fair that my two-year-old has to completely eliminate them just because we couldn’t figure out how to bolus for them.

I’d also figure out how to subtract the insulin on board for your mom and administer correction doses or additional insulin earlier than 3 hours after her last dose. Humalog has a DIA of 5-6 hours, and about 20 percent of it is active each hour. There are IOB calculators online to help, but you can roughly assume that 80 percent of the insulin you gave is still active after an hour, 60 percent after 2 hours, 40 percent after 3 hours and so forth. It really is HUGE to be able to proactively prevent a high rather than retroactively chasing one with more insulin.

Finally, hypoglycemia of 50 is not great, but not necessarily dangerous. Most of us non-diabetics spend at least half our time between 60 and 100. I wore my son’s almost expired transmitter a while back and it was eye-opening. I spent most of my time between 70-80 – which is considered hypoglycemic for my son. I dipped briefly down to 59 on my own once, and only then started feeling shaky. When I was in the mid-60s I felt vaguely not great but certainly not overtly hypoglycemic. I would be less scared of hypoglycemia between 50 and 65 when your mom is not sleeping and know that the procedures in place, such as checking blood sugar and treating with fast-acting carbs, will work to get her back up.

Everyone on here is right that certain foods do spike blood sugar much more than others with the same carb count for some people. Ultimately, you will find if you test your mom an hour after eating that many, many foods are sending her high post-meal, not just the ones you see raising her BG 2 or 3 hours later. You can’t eliminate all of them, so if you have the mental energy, I really would try cracking the code to individual foods she really loves. At least that way you won’t be so stressed out when she does wind up eating them.

You will figure these things out for your mom! But also remember to take it easy: you have years to figure this stuff out, and you should pace yourself. Being a caregiver is exhausting and you need the emotional reserves to be a good daughter and caregiver to your mom.
Be okay with letting someone else do the care sometimes – even if it means her BGs aren’t perfect.


#46

Just had a nutrition class at the ADA and the nurse/dietician said it doesn’t matter if it’s 1 gram or 10 grams you subtract it to get your net carbs.