Tonight, I experimented and baked some almond flour cookies using only 4 ingredients: almond flour, butter, egg, fructose. These ingredients were what I had around the house.
about less than 3/4 Cup almond flour
4 teaspoons of fructose.
There weren’t many cookies in total. it was a small batch. I bolused about 6 units for these cookies at 9 pm, and I ate and enjoyed them. FYI -Dinner bolus was at 6 pm for 6 units. Dinner was a slice of pumpernickel bread- 22g carbs, quarter pound of ground turkey, stir fried kale and carrots - estimated 5-6 g carbs, with less than 5 black beans (estimated 3-5 g carbs), 1 piece of chocolate estimate 6-7 g carbs, and 2 strawberries for a total of about 42g. I ate my protein, vegetables first and ate the bread last. I did not pre bolus. By the time I ate the bread, it had been 30 minutes since I bolused.
at 7:22 pm BG 130
at 7:45 pm BG 112
at 8:13 pm BG 119
9 pm - bolused 6 units for the almond flour cookies
at 9:30 BG - 73.
10 pm - BG 48 _ at this point, I ate 1/4 of a pear, 1/4 cup berries, 1/8 of a grapefruit and 18 smarties, it was what I could find
10:06 pm BG 47 - had a small teaspoon of maple syrup. 2 Trader Joe cheese sticks - 11 g of carbs - ok…maybe this is over correcting.
10:16 pm BG 59
11 pm BG 121 - I thought to myself, this is not too bad.
12:25 AM BG 127 - I am encouraged…hopefully, I didn’t have too many cheese sticks.
1:30 AM BG 181 - What’s this??
2 AM BG 160 - at least it’s decreasing and going in the correct direction.
What puzzles me is the 1:30 AM BG reading of 181. I would appreciate comments and suggestions.
I am guessing that the fat and protein in the almond flour and cheese sticks precipitated some insulin resistance after you recovered from the low. At a BG of 48 (scary, I know!), I would have just had the smarties and maybe the maple syrup—the fastest carbs among the choices you listed. YDMV
The 10pm treatment needed to be strong because 48 could become serious. I’d have taken only smarties because they have the same ingredients as glucose tablets (plus an astringent that for me limits the number I can eat.) The fruit slows down the digestion because of the fiber and mixed sugars, so I wouldn’t use them in the 40s or 50s. They’re best in the 70s and above. The maple syrup probably is a little bit slower than the smarties so personally I’d avoid it in the 40s and probably in the 50s where my only goal is immediate self-rescue.
The cheese sticks at 10:06 slowed down the recovery even more than the fruit did. Avoid when 55 or lower.
You ate cheese at 10:06, and were high 3.5 hours later. The relatively slow digestion of cheese could explain that, especially depending on what you mean by 11g carb for the cheese sticks. About 40% of the grams of protein and 10% of fat are eventually digested into glucose and dumped into the bloodstream. When you said 11g of carbs for the cheese sticks, was that from the protein and fat, or were there actual carbs listed on the label of the cheese sticks?
By the way, you handled the experiment just fine and got yourself out of a low and rebound high. There’s nothing wrong about that, it’s how we figure it out.
You are not a chicken, you are just figuring out what works for you. If my son is a chicken because of rebound highs, then I should be enjoying eggs almost every morning from his bedroom. Sadly, no eggs (I checked).
I’d call those things cheese-flavored bread sticks. I would just dose for the 11g carb. It would be different if the nutrition label showed 20g protein, 8g fat, and 2g carb. Then I’d think about how I’d need some additional insulin after a few hours.
But let’s go through the arithmetic just as an example. For the cheese sticks you ate, a serving has 11g carb, which you would bolus for. The amount of protein is 4g and fat is 3.5g, so after 3 to 5 hours the additional glucose released into the bloodstream would be about 40% x 4g + 10% x 3.5g, or about 2g additional slow-release carb. For myself, I’d ignore that as unimportant. If it were a large amount, like 10 or 20g of delayed glucose from a large serving of protein-heavy food in a low-carb meal, I might anticipate that I’d need a second dose of insulin after a few hours. But I pretty much never pay attention to protein and fat except to be generally aware that it may slow the digestion and cause a late bump.
Fruit is not slow, especially in liquid form. Orange juice is a traditional treatment for hypos. But in the 40s I’d definitely want glucose because it is fastest. In the 50s I’d lean towards glucose but might take another kind of pure sugar like sucrose or honey or 100% maple syrup (no added fats or anything like might be found in a commercial pancake syrup). In the low 60s I’d be happy to take whatever tasty fruit I had, and in the upper 60s or the 70s I’d look for something bad and harmful, like chocolate or a cookie or cake or donut (limited quantity though: just looking for 10 or 15g carbs max in this case.)
Absolutely, this is a good thing to be uncomfortable from. I think the hardest part of this whole thing for me is the internal voice that says “be the best…Have the best A1c…never have lows…never have highs…”
For some people the right thing is to run in the 200’s until they figure out how to run in the 100’s, then maybe never progress past that, when others will figure out how to safely run in the 80’s and 90’s most of the time. I don’t think the final step is right for my son right now as a goal, so we live with running in the 100’s most of the time. That is not to say he doesn’t have long periods of time in the 80’s, just that he isn’t obsessively trying to keep it there. I hope when he gets past college, he learns to keep it in the 80’s and 90’s most of the time. But I am happy now that he is managing things as if he is an adult and doing a good job.
Something to consider - fructose does not act the same as glucose. Fructose is metabolized in the liver, and it will predominantly replenish your liver glycogen compared to an equal amount of glucose, which will raise your blood sugar and be used by your muscles for energy.
What is tricky about fructose is that if your liver glycogen stores are full, it will go toward raising your blood sugar more than if your liver glycogen stores are empty.
You may already know this, but table sugar is half fructose and half glucose. So dosing for fructose may not always be the same as dosing for other types of sugar.
Knowing this part does not help you directly, but it is of interest. Table sugar is known as sucrose, and it is a disaccharide, which means it is made of two simpler sugars. They are the monosaccharides, glucose and fructose.
It seems to me that when I try to eat like a “regular” “normal” person, (that is without restricting, or limiting my carbohydrates), my lunch and dinner meals almost always require a second bolus, estimated carbohydrates around 55-60g from a bowl of rice. I did not know that this would be needed for practically all of my meals! Wow…! This really has been an eye opener and a learning experience for me. For now, I will be ok with post meal BG around 140’s. When I was a “good” diabetic and ate much less carbohydrates than recently, my numbers were much closer to 100. However, I was missing out on too many foods that I missed. In addition to all the mini cannolis, cheesecakes and rainbow cookies that I’ve had, I’ve even had bananas, and apples which until recently, I mostly avoided. I still have a healthy respect and fear of hypoglycemia. My supply of smarties have decreased. We don’t drink orange juice. Does regular Dominoes Sugar work well to correct a low in the 40’s or 50’s?
Sheltering in has also made it more difficult for me to exercise. I will continue to try HIIT (jumping jacks or running in place) as best as I can, Walking in place - this I can do in my teeny tiny apartment .
It’s great that you are figuring it out. Everyone gets to decide for themselves whether it’s worth the effort of learning to dose to get a good BG while eating plenty of carbs. For myself, I enjoy the tasty carbs, so I do what is necessary to make that work. Other folks will prefer the relative ease that comes with a low-carb diet: smaller amounts of carb mean smaller insulin doses which means smaller errors in dosing insulin. Either way is perfectly reasonable and can be managed for good health and A1C values.
I’d say it works, but it doesn’t work well for BG in the 40s or low 50s: it’s slower than glucose. I’d always go for the pure glucose if available, but if I didn’t have glucose then I’d consider pure sugar — it’s faster than raisins and dates. The problem is that it will take longer to bring my BG up, which is not what I want in my 40s or even 50s. The local Wal-Mart sells a bottle of 50 glucose tabs for $4; that works for me.
I had an excursion to 210 today, and was back down to 89, with a little bit of running in place. It was bad timing of bolus for 2 rainbow cookies. The quantity of insulin was accurate, the timing was not good. Oh well.
That is perfect, once you know the quantity from a starting place, that is really close, all you need to do is dial in the timing, and you are eating RAINBOW COOKIES, sounds unlimited to me! (We celebrate the days we don’t hit 200, there ain’t that much celebration happening around here)
It looks like you are disappointed? There’s nothing particularly harmful about an excursion to 210 that you bring back down promptly. As long as you notice the excursion and solve it you’ve done it right. Of course try more pre-bolus time to clip off the peak, I’m just saying what happened really doesn’t hurt you. A good A1C is what really matters, and that reflects where you are for the bulk of the time.
Thank you everyone for all the support. It means a lot to me
How do I “determine” the impact of a food on BG? I hope that this doesn’t sound silly:
I very rarely only eat 1 food. For example, I may eat a banana with some walnuts. It would seem to me that it is quite difficult to conduct a “clean” experiment to determine the impact of a single food on BG. If I have a croissant, it could be part of breakfast with eggs, or as part of a sandwich, or by itself as a snack. I suspect that the impact of the croissant on BG may be different depending on whether 1. by itself or 2. with eggs only or 3. as part of a sandwich as part of a meal with vegetables…etc.
On a different topic:
I have a tendency to graze. For some reason, I get hungry, between lunch and dinner, often between 4- 5:30 pm; sometimes ravenously hungry. I try to have walnuts (about 1/4 cup) or cheese and avoid bolusing. (This is a HUGE change from when I was a teenager, or in my early 20’s when I would eat cookies to satiate my hunger I may have had 100+g of carbs from Oreo cookies) Do you have recommendations or suggestions to make it easier to calculate IOB? as well as suggestions for snacks that may not require insulin?
A good question. Running separate experiments for each food and combination of foods is not practical. For the most part I just notice patterns. Whenever I have red curry, I need to take extra insulin for the next 10 hours. Bread with cheese isn’t as spiky as bread alone. I just watch and learn what happens. In your case, you’re watching anyway to figure out the amount of insulin and the amount of pre-bolus time that works for you, so over time you’ll see some patterns. In my case I don’t especially care if my initial dose of insulin was right, because I’m going to steer the BG in a good direction using additional insulin or carbs as needed. Getting the initial dose right just makes the following corrections smaller—a convenience; nothing more.
Mmmm… I’ve noticed that with the meals that can have delayed BG rise, (high carb -with protein) I may not pre bolus at all, or have a shorter pre bolus because I have to follow up with a second or third bolus anyway. I’ve observed that any meal where I exceed about 22 g in the form of bread/rice/pasta results in a delayed BG rise around 3+ hour. The 2 hour number would be decent. There is something sinister (lol) about the refined processed “grain/white stuff”…Last night for dinner, I had one slice of Paleo bread 8 g carbs, with ground turkey, vegetables (carrots, broccoli) and a small portion of apple, and munched on some walnuts (< 3g carbs). The total estimated carbohydrate for the dinner ~ 20 g. The BG was very steady around 90! There was no delayed rise- Yay!. I haven’t had numbers like 85-90 except when I ate rather reduced carbohydrates, that is around 20 g of carbs. Therefore - my challenge is: How do I feel satiated, not hungry on about 20 g carbs for lunch and dinner without overdoing the animal protein (chicken, pork, turkey…etc). I do not wish to follow LCHF; don’t want to eat too much animal protein therefore I was thinking about having seeds and nuts to supply protein. Ideally, I would eat about a quarter pound of animal protein and supplement with nuts/seeds so that I feel satiated. Walnuts provide protein and fiber without too many carbohydrates. Any thoughts and comments?