I doubt we (family with t1 toddler) are alone in having these kinds of meals, where we ask this question: “How did we dose for this last time?”
And its usual partner: “Did it actually work last time or should we change something?”
For us, it’s generally restaurants, for pizza, pancakes, or burgers & fries. We keep a little notebook in our go-everywhere bag and write down what we do every time we eat out. So, for instance, at pancake breakfast yesterday, at a favorite diner, we were able to look up what we dosed last time, and it’s actually getting pretty darn close to keeping our kiddo in range.
Do you do this too? Any brilliant tips we might be missing? Maybe a good notebook, or a good system, or maybe even an app?
@joshjs this is what we used to do – the Notebook. it was really helpful in the beginning. Now I got lazy and my purse has too many other things (baby stuff, glucometer, etc.) and so we wing it more. But I do have in my head certain cheat codes for our most popular meals. (Mac 'n Cheese, pizza from our favorite joints)
I did look around for an app to track it but in the end I found that a notebook with like seven or eight columns was actually easier to handle. Each food got its own page. I put the time in one column, the starting BG in another, the dose, the peak BG (and at what time), and each subsequent dose and the BG at that time, and the time when BG finally came back down to normal. We also had a column where we guessed how many carbs…since his carbF changes, sometimes for very carby meals that’s more helpful to know. But most of the time, we use simple cheat codes like “0.6 to 0.8 units of insulin upfront for Mac n’ cheese, followed by another 1.2 units at 1 hours post-meal” or something like that.
One thing I found helpful at the beginning was looking at how much insulin I was giving over the course of, say, 5 or 6 hours. This was huge for pancakes out – our son would spike to 300 and hover there for hours… and once I added up all the insulin I was using over that 6 hours, i felt more comfortable just giving it all at once as the starting point next time. I will look for my notebook and upload a sample page.
*Oh, and the other thing I would do is at the end of each page I would write what my hypothesis would be for the next dose to test. Sometimes you have an insight then you forget, so it’s good to write down what hte next starting point is
If there are two parents doing the bolusing, I do think it’s helpful to put these cheat codes in a common document or folder or in a highly visible place so everyone is on the same page. There’s no reason now that Samson our son should go high from pizza, but if someone else is doing the bolusing there’s that chance since they don’t know my formula.
My app-free system is a bit old-fashioned, I guess, and probably too much work for many people. I keep a food log in a 300-page notebook, and I keep the one before that. Every day I write down what I eat and the carb count. On a separate pieces of paper I have my monthly BG/carb/dose charts, and then of course there’s Diasend and Clarity online (Diasend having the advantage of combining carb and dose history with BG records). So if I’m eating something I’ve had before, I can flip back in the food log to find the date, then check the BG log and/or Clarity to see what the dose and outcome was, and decide if a change is needed.
Granted this is impractical for restaurant use, but restaurant meals can be weird to begin with. Even if you’ve had the same thing before, it might be made differently by a different cook, and there might be other parts of the meal that skew things, so I tend to disregard mishaps on restaurant nights (which aren’t that frequent for me anyway).
I have been using MySugr and I love it. I enter my carbs, my BG, insulin given, and a description if what I ate. There is quite a bit of data that can be entered for each entry, but you can pick and choose what you want to enter. You can even take a picture of your meal if you want. There are search capabilities which allow you to easily find the last time that you ate that thing and how you handled the bolus. If you enter all of your BGs and/or feed your CGM data into the app, you can also see what happened after the meal (i.e. was the bolus successful or not). In order to get all of the functionality you have to pay a subscription fee, but I think it’s worth it.
I used to enter everything into a notebook, but I found it hard to find the last time I ate that meal. This makes it much easier.
Thanks for posting @joshjs, a really good question to boot. Do you guys use a CGM? We found that after we got a CGM, we were better able to handle different meals, although hey, we still #$%^ up, that is the nature of things, we just do it less regularly.
@Chris Oh, yeah. CGM has been huge for us. When I consider whether I dosed well for a meal, I’m looking at CGM data, and how close to in range the line is over the next few hours. (Sometimes up to eight hours, like with pizza.)