On the suggestion of intelligent people here, I have started splitting my preprandial bolus. I checked my blood sugar this morning. It was 120 before anything.
Breakfast was a small slice of ham simmered in butter, and a “purple thing”, consisting of one eighth of a cup of bread flour, cut with a pad of butter, mixed with a small dollup of sour cream and a splash of milk, folding in carefully a small handful of blackberries. And a sprinkle of baking powder. The crime itself was the two packets of sugar, but still listen to me.
For all this, starting at 120, I used 5 units of Humalog. Not nearly enough, but I am just starting to do this. With breakfast we had Hazelnut coffee with cream.
Thirty minutes later, I checked. It was 195, but I was not shocked. Remember, I was complaining about high numbers, and I still eat incorrectly. My wife enjoys those “purple things”, and what I was trying to do is find how to use insulin to keep it manageable.
I used 4 more units of Humalog. Later I was driving in the car and checked my blood glucose after this and I was 111. It looks like eating like a fool and splitting the bolus into two actually worked. Only problem was the coffee ran straight through me and I had to stop the car to pee.
Before I started using a hybrid artificial pancreas system, I almost always took two doses for each meal. This system worked out very well for me. Using a pump, I would deliver a carb bolus with adequate pre-bolus time to metabolize the initial fast digestion of carbs.
Since I was consuming a carb-limited diet I found that protein and fat in meal could be covered with an extended pump bolus delivered over time. I think your tactic of splitting a prandial bolus is well worth the experimental effort on your part.
I’ve also found I could affect the post-meal BG profile by altering the order that I ate my food. If my mealtime glucose was sinking too low at mealtime, I would eat my carbs first. If my BG was on the high side, I’d eat the protein and fat first, followed by the carbs. If my mealtime sugar was good, I’d just mix it up like most people do.
Let me describe lunch. It was an hour later, do my BG was 100. My wife and I go to a place. I did not take insulin in the car, but took my insulin equipment in the restaurant. There was no line but it took several minutes because they had to clean a table. The waiter was busy so it took three minutes to get a menu. He was quick with the iced tea, but it was twenty minutes to get catfifh out of the busy kitchen. Had I used insulin in the car at 100, that would have gone low.
On the plate were the macaroni noodles that I had ordered, plus a dinner roll. My wife did not eat her country potatoes, so I nibbled four or five of them while she finished working a crossword puzzle.
The vagaries of restaurant service make insulin dosing tricky, especially if you want to give your insulin a sufficient head-start on you food. Looks like you’re discovering a good two-dose system for yourself. I would ideally like to keep my post-meal BG < 140 (7.8), but your system has minimized going low in a restaurant while waiting for the food while it also allows you a buffer to account for the common delays in getting food in front of you. For me, the next best thing to keeping post-meal BGs < 140 is to keep the time above 140 to a minimum, say, < 60 minutes.
I think returning to the restaurant and eating the same meal will allow you to fine tune this two-dose meal tactic.
Lunch today allowed the two-dose system. BG was 140 so I hit it with 5 units of Humalog. It was going to take thirty minutes to cook lunch.
My wife was out at a woman’s thing so I cooked Robert’s Famous Sriracha Chicken Breast. Place one whole can of Rotel tomatoes in the pan. This dish is blazing hot. The moisture in the Rotel will help cook the chicken. I add one pat of butter. Cook slowly and then flip the breast and coat it with Sriracha sauce. Eat with a small glass of milk if the heat bothers you.
This time I had a small serving of noodles which with the Parmesan cheese was the only significant carbs.
Post meal BG = 148, which got 3 units of Humalog to correct.
Arranging the order of the foods I am about to eat works really well for me also. I am on MDI but unless I split my mealtime bolus I will surely have a severe low right after I eat. Very uncomfortable because I can’t treat a low with a full stomach.
My doctor told me to nibble five small meals throughout the day instead of three big meals. That is doable, when I can. In restaurants, I can choose an appetizer instead of an entree. Or just leave things on the plate.
3/18/2017. Started BG at 156. Shot 5 units of Humalog. Ate dinner of a tomato and lettuce salad with Texas Pete hot sauce and Ranch dressing. spinach cassarole with goat cheese and a large slice of ham. One hour later, BG = 128. I am so impressed with this dosing plan.
5/9/2017 I now use 20 units of long acting Toujeo in the morning. 100mg of Januvia in the morning. And three (3) units of Humalog before each meal and then I correct with another dose of Humalog. I am delighted with my numbers at this point.