I have been following a very low carb diet since diagnosis and reading Dr Bernstein's book and it has helped me maintain fantastic control despite moving to full insulin. I am currently using rapid acting insulin for meals and am trying to figure out timing for checking BG after meals. I am getting 'reverse' curves (ie BG dips down right after meal and then comes back up as food is digested)and want to make sure I don't go too low. When do others test after low carb meal to make sure insulin 'covered' meal? Also any tips on fat's impact on I:C ratios?
Suggest you look for the book, "Think Like a Pancreas". I has been a great help in getting my insulin injections correct.
Ron--thanks from me.... I just ordered the book!
This is a complex question but here's a few thoughts:
If you're finding that your dropping right after meals, you can try one of two things: 1) take the rapid insulin at mealtime or a bit after you begin eating (assuming you're taking insulin about 15 mins before eating) 2) switch to regular insulin as Dr. B suggests for boluses and take it about 30-45 mins beforehand. Wal-mart sells Regular insulin for less than $30 a vial without a prescription - so it's a pretty cheap experiment all in all to see if it helps. While it takes longer to get into the bloodstream, it also lasts longer and won't likely drop your BG and may more evenly match your digestion a few hours later.
I usually test about 30 minutes after eating, then another hour later, then an hour later after that. Haha. . . I test like crazy actually and just buy cheap strips beyond what my insurance pays for from either Wal-Mart or Amazon (lookup Prodigy test strips).
Hope this helps.
Thanks for suggestions Kevin. Actually I had asked my doctor to try regular insulin instead of rapid some months back when I was first starting with bolus insulin but was told no because it was more likely to cause lows...don't think this doctor understands the impact of low carb diets :)
It is interesting how doctors are not taught much about nutrition/diet in medical school when it is so key to managing diabetes and other chronic diseases. My doctor is an endocrinologist and definitely wants to be helpful but I also get the impression does not understand just how a low carb vs higher carb diet impacts insulin dosing. Maybe I will try asking again at my next appointment.
I use Humalog. My endo has not been excited about Regular. So we have agreed that I can use a dual bolus. Simply split your meal bolus in half, take half about 15 minutes before eating and then the other half 1-2 hours after eating. I use pens, so I just take the first dose, leave the needle on and then take the second dose and discard the needle. This approach can give you an insulin profile that much better matches the extended glucose surge that a low carb protein dominated meal creates.
Dr. Bernstein in his book specifically warns of the "minor dilemma" caused by the action of humalog when using it for meal boluses and thus recommends that it only be used when time is tight such as when dining out. I told my doctor I would just buy regular at the store if he didn't prescribe it. You are right when you say he just does not understand how a low carb diet impacts dosing. Regular insulin should reduce hypos if its applied correctly but those people don't get taught anything meaningful in med school, just ADA and pharma propaganda and many apparently won't even take time to look at the numbers and evaluate their own position in light of the science.
But I think the dual wave bolus can solve the problem, satisfying the doctor and yet achieving a very similar profile to the Regular.