Every night I eat a grilled chicken salad for dinner. 2 units of insulin usually covers it. Lately, though, I’ve noticed my blood sugar has been climbing 3 hours later. I have to take another unit to curb the spike.
I’m guessing the protein is causing a delayed spike? I am on a pump - would this be a combo bolus situation, or should I adjust my basal rate? I’d really appreciate some advice. Thanks!
In general, any spike from a meal should be taken care of by bolus adjustments. Extended bolus, or dual wave or whatever name your pump uses, or by doing a larger bolus.
But you also should make sure your basal is set right. If you were to spike without eating, then that would be a basal issue.
I can’t think of a scenario where a meal spike would be reason to adjust basal, but maybe someone else has a different opinion.
In your scenario, if it is predictable, than you can try extending with that extra unit later on. And of course, depending on what else is in the salad could affect it. Dressing that contains fat, if any carbs are hiding in there, etc.
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If the chicken salad is low carb and you prebolus adequately, I’d put my money on the basal being off.
Before my shift to the Loop artificial pancreas, I dosed every meal for carbs first as an immediate bolus, then separately, I dosed for protein and fat as an extended bolus. I never used the % split combo or dual wave bolus because that just complicated things. I found the extended bolus to be a rock solid performer. I used this system for over four years.
You should make sure your basal is set well. That means if you miss a meal your BG stays relatively flat. I have a formula that I use to dose for protein and fat when eating a low carb diet. I’ll give details if you’re interested.
I would agree with others. I find that for a low carb meal I get best results by count half the grams of protein as “virtual carbs.” I’ll often split my dose (I am on MDI), half as a pre-bolus and half after the meal.
I would also note that (at least in my case), salad is a “bulk” food. It can trigger what Bernstein calls the “Chinese Restaurant Effect” where the shear volume of food causes a rise in glucose and hence additional insulin for the meal.
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Your last paragraph is now my “I learn something new every day” item.
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All of the advice above is pretty much orthodox. But here’s the part of the OP that bothers me:
If I’m interpreting that the way it was meant, this is a recent change in a pattern that had been working properly for some time. So the question needs to be, what changed? Medication? Portion size? IR? What? When something that was working no longer is, step 1 is to reassert control, which is being done with the additional bolus. Step 2 is to analyze why it happened, so that the regime can be modified to prevent it altogether if possible.
I have this same problem. My bg goes up 3-4 hours after dinner, as well as the normal amount expected from the ingested food within the first few hours. Initially I would bolus 1-2 units for this unexpected spike. In the last six months I switched to increasing my basal. This works much better and seems safer for me. I triple my basal 6-9pm. If it seems my bg is not going to spike, then I can change the basal amount but this rarely is needed. It took me awhile before I felt comfortable to triple it, at first I just doubled it.
@Trying – Some times it’s good to be bold with your insulin! (Stealing from Scott Benner) Nice adjustment.
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I seem to have the same issue recently. I notice it happens whenever I have a small piece of dessert + a glass of wine/champagne after dinner. Knowing that alcohol leads to delayed rise in BG, I extended my insulin delivery over 2 hours, but that doesn’t seem to help. My BG continues to rise and peak at 4 hours after the dessert+wine/champagne! It is frustrating as I used to be able to keep my BG in <200 using the 2 hour extended insulin delivery whenever I have dessert+wine/champagne after dinner.
Does anyone has any tips for insulin delivery in such scenario?
Never knew that about salad…thanks for the tip. It explains a a lot.
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The simple answer is you need more insulin to cover that dessert plus wine/champagne. Figuring out the details of adding more insulin is more complicated, but very doable, and I think worthwhile.
Is your basal rate set well for this time of day? In other words, if you don’t eat your meal, will your blood glucose stay relatively flay, like within 30 mg/dL?
The context of your question implies a meal eaten directly before the dessert you question. Have you successfully dosed for this meal before without eating the dessert? I’m sure you’re aware that the fat and protein in the meal can also significantly drive blood glucose 4 hours after dinner/dessert.
If your basal is set well and your meal dose has proven successful previously then let’s just consider the dessert. I don’t know what the carb content is of the dessert you ate. Are you confident that you know the carb content? I often check Calorie King to do this. Calorie King also has an app you may use on your smartphone.
I dose as usual for the carb content first using an immediate bolus using your insulin to carb ratio. Don’t forget that wine has carbs too, about 5 grams/5 ounce serving. Then I add a second extended bolus to take care of the fat/protein in the dessert as detailed below.
The blood glucose rise 4 hours after eating is typical of a meal with high fat and/or protein. I use a formula to calculate the total insulin needed for a fat/protein extended bolus. I basically count 10% of the fat grams and 50% of the protein grams, consider them as “equivalent carbs,” and add them together.
I divide my equivalent carbs by my insulin to carb ratio to figure the total dose needed for the extended bolus. Let’s say the equivalent carbs = 48 grams and my insulin to carb ratio is 1:10. I’ll divide 48 by 10 and get 4.8 units of insulin. When I deliver an extended bolus, I never exceed 1.2 units per hour. So I deliver the 4.8 units over 4 hours at the rate of 1.2 units per hour.
I do not combine this extended dose as part of “combination” or “dual wave” two-step percentage split process. I do the extended or square wave bolus all on its own and in this scenario I’d likely deliver when I prebolus for the main meal unless dessert time is an hour or two later.
This process has been highly successful for me but you may need to experiment a little to adjust for your needs.
I think eating dessert once in a while is totally bolus-worthy!
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Thank you for such a thorough reply! I was never taught to bolus for protein and fat, I should start calculating those in my meals for extension purposes.
To answer your question, my basal is well set. Without eating the dessert, I have successfully dosed for the meal itself. I also have successfully figured out a regime for meal+wine/champagne. Just failed on meal+dessert+wine/champagne. But your suggestion about the fat content in the dessert is enlightening. I hope I have luck with that!
Thank you!!