I wanted to share with the group and would like to know your thoughts:
4 hour BG: 121
Tuesday
7:25 pm pre dinner BG : 101
bolused 6 units for about 55 g of carbs consisting of:
Costco Rotisserie chicken breast (unknown carbs- best guest 3g) on two slices of rye pumpernickel bread (28g) sandwich, less than 1/2 grapefruit (< 15g), some carrots/chickpeas (4g) , and broccoli (5g). I did not prebolus figuring that I would eat the broccoli first and the sandwich next.
10 pm BG 100 - this looks very encouraging
11 pm - 187 - what’s this? Is the Costco Rotisserie Chicken breast one of those nasty fatty foods that would cause a delayed BG rise? I will have to read the ingredient label more thoroughly. I decided to take 1.5 units - I currently only have 8mm pen needles. looked for a spot on my lower thigh with less fat, hopped into the shower.
12 midnight : 165 - yup - I guess there was something in the prepared outside food - the Costco Rotisserie Chicken.
Perhaps I could have bolused more aggressively than the 6 units for this dinner. However, I wonder if the 10 pm BG would have been lower than 100, and then I would likely have overreacted, and over corrected. As it is, most endo’s would say to me, 187 it’s not bad. And I brought it down to 165. (I just started a new cartridge of expired, but refrigerated Novolog, today, Tuesday. It may or may not be related to these wonky numbers. I don’t think that it is the cause because if the insulin were ineffective, my BG’s would be in high 200 to mid 300’s)
Your analysis seems right. You needed more insulin, but not at the beginning. A protein-heavy meal can call for this, and your number suggest that 9:30 or 10pm would have been the right timeframe for the second half of the split bolus.
I agree with you also that I really don’t think the insulin was bad.
I understand. So here is where I am puzzled- the 10 pm BG=100 would not indicate the need to correct. What would prompt me to bolus when the BG is 100? This is one of the most difficult aspects of diabetes management: what type of food am I eating?!! My BG is 100, why correct? Do we now all have to become expert nutritionists, dietitians. I also understand that we have to learn the impact of certain foods on our bodies. Nevertheless - It’s truly frustrating as heck!! (The Costco Rotisserie Chicken is OK- it’s not fantastic.)
You are absolutely right. To really handle eating we have to learn how it works. It’s not as simple as just counting carbs. And it’s not a matter of just checking the BG 2 or 2-1/2 hours later, because the digestion isn’t all done by then, depending on what was eaten.
What you encountered this time is that in a meal with a good amount of carbs plus a significant amount of protein, the carbs hit relatively fast, but the protein arrives later. So with a conventional insulin like novolog or humalog, we need a bolus to start (maybe even as a pre-bolus) plus more later.
It’s not the BG=100 at 10pm that tells you to take more insulin, it’s the knowledge that there’s still a bunch of protein that is digesting and converting into glucose. It’s really hard without CGM. For those of us privileged to have trustworthy CGM, we can see what the graph is doing, and it’s the trend, not just the BG value that tells us what to do. In my case, my CGM high alert (daytime) is 130. So if I had eaten your meal, I probably wouldn’t have known anything was wrong at 10pm unless I happened to look at the CGM. But soon after that it would have yelled at me, so I would have looked, and then I’d have taken a bunch of make-up insulin to steer the BG back in a good direction. Without CGM, you’d just have to learn the hard way that this kind of meal needs an additional dose of insulin after 2 to 3 hours. You can indeed learn this, but it is extra work as you point out. Good BG isn’t easy. We earn our A1C.
Yes it is.
As you keep experimenting and learning about it there will be fewer unpleasant surprises. It will still be tedious, but it will be more routine and less frustrating.
I appreciate all of the support from this wonderful community.
Diabetes is so annoying !! I’ve never learned to navigate and manage carb rich and together with protein/fat foods because I was eating, initially, LCHF, and then added a little more carb. I’d like to eat like a regular healthy person, not one who only eats a spoonful of rice, lol. Let’s face it, there are lots of delicious foods that contain carbs. Apologies -That’s my venting for the day. (It’s also been frustrating because of change in insurance, I have to find a new Endo. Unrelated to insurance, my previous PCP left the practice. The ones who took over her patients aren’t as conscientious, and aren’t as knowledgeable as she was.) Sigh…
Point one is unfortunately so true. Just when you want to forget it is there, blammo - DIABETES makes itself known. Point 2 is close just a bit more trial and error, you are doing great!
I’m looking for some guidance and help … I don’t tend to measure, weigh my food, and do not quantify or think about carb/protein/fat proportions or grams or anything.
The question is:
Is a sandwich considered to be a high carb/protein/fat meal?
Specifically:
The bread portion would be between 26g to ~ 30g, for example, made from rye/pumpernickel and
protein/fat about no more than 1/3 pound dark meat chicken,
the meal would have green vegetables, some fruits. I don’t use mayonnaise,dressing etc, maybe an extremely small amount of avocado. The total carbs for this meal may be 40 (bread, fruit, maybe tomato/avocado)
Would this be a high carb/protein/fat meal? (The sandwich ‘protein’ can be substituted with liverwurst, ham, bologna…etc )
My sandwiches aren’t that bready. I keep my bread portion and size reasonable.
I’ve seen Subway sandwiches - those breads are HUGE! Maybe Subway sandwiches contain 60 g carbs? My sandwiches are not that large.
As a follow up question:
A chicken fettuccini Alfredo dish I can see as being extremely high carb/fat/protein. The pasta carb is likely to be anywhere between 80g-100+, maybe 150g, based on standard serving size that is served at restaurants.
What “meal” is carb only? The ones that come to mind are oatmeal, store bought cereals, bread only. Does this mean that many/most meals are carbs/protein/fat?
I appreciate all the help!
Feeling like I need a better understanding about carbs/fats/protein and digestion
Great response. One question though, why don’t you, yourself, have your high alert set to 100 to head off a spike?
I don’t use the high alerts myself because I am constantly monitoring my BG. I’m on Loop with auto bolus which still, at times (as in tonight!), requires corrections for potential highs.
I think this is really an individual question. Just like Type 2’s have a certain number of carbs their bodies can “handle” easily, I think each Type 1 does as well. What may be high carb for you may not be for the next person. For my son this would be a normal carb meal that we are used to managing every day. For someone eating low carb, this would be a very high number. If I were to give a more general categorization that I would say medium carb easy to manage in our experience.
My philosophy is that I don’t want an alert unless I should take an action; I don’t want to intervene at 100 because I consider that “normal”. And loop is trying to keep me around 95, so I want to give it a bit of room before I start doing manual overrides.
What is the filling, home made or purchased? How many carbs are you guessing? Are you adding a sauce? Pot stickers look amazing btw, a good meal.
We often get some pot stickers from our local shop and make our own dipping sauce to control the sugar. Soy sauce, little fish sauce, bit of sriacha or sambal. Makes for a great dish.
Purchased from Trader Joe. The filling consisted of pork and vegetables.
There is a nutrition label. However, I am loathe to “rely” the carb content, because I seem to have to adjust anyway. I had a little IOB (about 0.75 unit) before I took the 7 units at 6 pm for dinner. At 1.5 hr, BG=70. At 2 hours, BG = 89. Because it’s getting late towards the evening, I decided to take 1.5 units, instead of taking 3 units. I’m still a chicken - fear of lows. The BG rise was from 70 to 89, much less than I expected. If the number were near 130’s, I may have taken 3 units.
Could be, but there are many factors that move the BG around.
That’s all perfect in my book. Although you don’t strictly know whether it drifted gently from 122 to 93, or did it go from 122 to 187 and then fall to 93, or from 122 down to 57 and then it climbed up to 93. Early on I learned that if I’m 95 when I go to sleep, and I wake up at 185, it could be because of too much basal overnight, driving me quite hypo in my sleep, then my body dumped counterregulatory hormones which sent me sky high.
I don’t have a stringent goal. For myself anywhere 80-120 is ok.
I never expect the BG to remain anywhere. My BG often tends to wander off in some direction or other. I change the basal if it tends to wander off in the same direction at the same time of day for a few days in a row, but usually it wanders in some random direction, so I just push it back toward the middle if it looks like it’ll go outside of the 80-120 range.
!! I’ve never learned to navigate and manage carb rich and together with protein/fat foods because I was eating, initially, LCHF, and then added a little more carb. I’d like to eat like a regular healthy person, not one who only eats a spoonful of rice, lol. Let’s face it, there are lots of delicious foods that contain carbs. Apologies -That’s my venting for the day. (It’s also been frustrating because of change in insurance, I have to find a new Endo. Unrelated to insurance, my previous PCP left the practice. The ones who took over her patients aren’t as conscientious, and aren’t as knowledgeable as she was.) Sigh…
