How do you handle 15 g of carbs when starting at a low/normal BG?

Type 1 & LADA
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I’m not looking for medical advice, and, in fact, I might not do anything any differently than I’m already doing it anyway (which includes wild guesses and living for the moment), but I thought I’d present a scenario and see how the professionals would handle it…

I’m still learning about extended boluses, and, believe it or not, I’ve just started playing with them. Better late than never. I normally do them by hand (a .1 here, a .3 there), but I’ve recently discovered the use of the temp basal and the square wave bolus (Medtronic fancy-talk) to help cover spikes. Now I’d like to ask you all, if any of you care to share, how you’d handle this type of situation. And if an using an extended bolus is NOT part of your plan, I’d love to hear that, too… (@Eric, I know this is getting ahead of my “prediction” level, and I hope it’s still okay).

Let’s say your current BG, confirmed, is a 70. You’ve got little to nothing on board. You have a salad in front of you which is approximately 12-15g of carbs (mostly carrots, etc). This kind of salad CAN cause a rise about 30 or so minutes after eating, and it can be a fairly significant one if you were to undershoot.

So here would be MY questions (but, again, please add whatever you like as even my questions might be lacking):

  1. ASSUMING a 1:10, what would you bolus and how?
  2. Would you include an extended bolus?
  3. Would your extended bolus, if you use one, be in the form of a temp basal, square wave, or dual wave (i can try to translate if you use different terms)
  4. What would you expect to see in a blood sugar climb if you’ve gotten it all “right”?

No pressure. Just thought I’d throw one out…

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Just what we do, but the only circumstances (usually) where we use the extended bolus (exceeding 1 hour) is for high-starch foods that “kick in” (begin digesting) 1 - 5 hours after you eat. The extended bolus (exceeding 1 hour) allows for the insulin to be injected coinciding with the digestion of the high-starch foods.

In this situation, for Liam (yes, he loves salads), that’s actually the perfect scenario we would PREFER him to always eat in. Nothing in salad (unless you’re using a dressing that has a low glycemic index value and digests slower) is low GI value so it digests fairly rapidly (at least to my knowledge and from our experience with Liam).

We would typically, in this scenario, bolus + feed him at the same time (if he were 70) OR bolus him 25% up front with the other 75% over the next THIRTY MINUTES, AND feed him at the same time.

We would ensure that he eats at the same time that he gets his bolus in this situation since he’s right on the border (70), and waiting the usual 15 minutes could make him go under 70, which we want to avoid.

So, although we DO use extended bolus, it’s not extended in the same sense that a high starch (low GI value) food would be extended.

For high-starch foods we give 25% up front and 70% over 1.5 - 2 hours (but it’s usually a VERY large amount of insulin being given over that time.) AND during that 1.5 - 2 hours, if he starts rising at a rate we don’t like, we suspend the extended, and re-do the remaining amount with 50% UP FRONT, and the rest extended over x minutes/hours.

For regular, non high-starch foods, we typically just do a straight bolus, wait 15 minutes, then feed OR straight bolus and feed right away (as we would probably do in this scenario), OR bolus some up front and the rest extended over just 30 minutes or so AND feed right away.

Hope that all made sense.

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27 posts were split to a new topic: Discussions around Picking eaters

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Depends. If the arrow on the Dex is going down, then I won’t bolus until after I’m finished eating, if at all. If the arrow is flat I’ll take half of normal bolus up front, if going up it’s the full bolus ten to fifteen minutes before.

Of course this is MDI strategy, but it works fine for me.

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@nickyghaleb I eat salads almost every night for dinner and they run around 10-15g of carbs. Sometimes they are a bit more if I add in a bit of sweet potato or something else that is starchy.
I really do something different each night depending on my BG and how it’s trending and my IOB. When my BG is around 70 and stable with no IOB I give my bolus right away. If my BG is trending down then I do 50% up front and 50% over the next 0.5 hr. I don’t extend for a long time because, even though I think I am really eating barely any carbs, they hit me faster than I think they will. What I do does not always work, but I am constantly sugar surfing, so if I see my BG trending up for too long, I will give a bit of extra bolus until I see it stabilize.

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It varies a lot from one person to the next and how their metabolism works, which everyone continues to get more familiar with throughout their life…

For me my considerations would be how active I planned to be for the next 1-2 hours… if I was going to be moving around and exerting myself appreciably for the next 2 hours I probably wouldn’t bolus at all for a salad with 15ish veggie carbs… (not all carbs are created equal to me) and if I was going to sit around and do nothing I’d probably throw 1-2u of insulin at it right before or right after I ate it…

This is very different from how I’d have approached it if the example was a sandwich where the 15g of carbs came from grains/sugars

I can’t really respond to the pump specific questions

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Your response was great. I’ve been doing more things “right” than I’ve given myself credit for. This is how I’ve always handled a salad, the way you describe, but I always thought of it as being disorganized or undisciplined. I think I’ve spent 15 years in doctors’ offices being told to “establish a routine”. Maybe there’s more regimented bolusing with a routine, but without one, there’s doing what you describe.

I’ve been diabetic 15 years. I’ve missed some very important stuff along the way. :upside_down_face:

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Nicky,
Is your question specifically about salads? I can’t offer you much advice there, because while I do eat salads, I never eat “only” salads. :wink:

Or are you asking more in general about eating, extended bolus, and eating when low?

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Thank you for your numbers. I eat salad every night as well, I ALSO try to consider the things you mentioned, but that’s only ever impacted the AMOUNT of insulin I’ve done. I’ve never tried to break things up. I’ve found a few combos in your response that I can try with my next few salads. The only thing I know right now is I usually spike, and I’m never sure when it’ll be…

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Yes, Eric… it was a very specific general question. :grin:

I don’t know what I’m asking. I’m gathering info. And trying to use things…and that should all scare you because I’m here in your site. :grin:.

I’d love to hear about how people handle eating when low but not necessarily crashing… this is tough for me to navigate. I think there’s probably a good opportunity for some kind of extended bolus there?? But am always so hesitant to add insulin… to injury. :grin: terrible joke. Sorry. I dislike this scenario because it’s a fine line for me… too much insulin, and I’m going to have a hard time climbing out from under it, but even enough insulin that I’ve done too late becomes My next high.

Eating and bolusing with a low/normal blood sugar (even a light low) and extended bolusing… that seems to be what I’m asking about…

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Like… ?? What would be an example? The only things I seem to know about are salad and high starch foods. :slightly_smiling_face:

A lot of sense. Thank you very much. :slightly_smiling_face:

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Been 50+ for me, but only the last 20 years with pump, CGMS and peer support from online groups got me to being similar to what others have said… it depends!!!

In fact, I never use the pump bolus wizard. I consider so many recent and future factors (activity, stress, IOB, days since site change, etc), and have been pretty good at my bolusing. And with CGMS, I only need to get in the ballpark, then watch the trend, to ride out the sugar surfing.

EDIT: Having Afrezza helps too for the times I way under-estimate !

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Thank you for the response. And I agree that when I know I’m in for a rebound, and a big one, I don’t hesitate to cover it. I have been afraid of insulin, it seems, for a very long time and tend to hold back, but I’ve gotten a lot more aggressive in the last year (and have had the best a1c ever, not coincidentally), but I do find there are times I’ve just really, really overshot.

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I’ve heard that a couple of times around here. You’ve just turned it off? I override mine so often that I wonder why I use it in the first place, but it’s been so long since I’ve calculated boluses that I can’t remember how.

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Are your Dexcom arrows that reliable?? The arrows on my Guardian are laughable…

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I’m not sure if my answer will be helpful for someone using a pump.

If I’m having a salad (15 grams) that’s not too heavy on the protein, I’d probably just wait until I see an upward trend on my Dex and then dose with a 4 unit Afrezza cartridge (sort of similar to 2 units of Humalog but super fast-acting).

If it’s packed full of protein, then I’d probably dose 3 units of Humalog right before I start eating and watch my Dex pattern. If I trend up above a certain point then I might subsidize with with a 4 unit Afrezza cartridge. Alternatively, I might dose with Afrezza right after eating (instead of the Humalog) and then follow up with another dose an hour later. Probably just depends on my mood :stuck_out_tongue:

The time of day is a factor for me too. I’ve had some troubles lately with late afternoon highs after eating a heavy protein salad at lunchtime. If I eat the same salad at dinner after walking home from work though, I might not have the same problem. Being sedentary all day affects how much insulin I need for the same amount of carbs/protein, and I also suspect it impacts how quickly the carbs digest.

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Have you ever had oven roasted brussel sprouts tossed with seasalt and clarified butter?

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I see the arrows in passing, but what I’m watching is the shape of the Dex graph. The arrows show history, what was happening over the past several points, but I’m looking to see how the line is starting to bend as a clue to the future.

To your original question, if I’m lower than 65 I’ll take a glucose dose that would get me over 90, then a few minutes later (to give the glucose a head start) I’ll take the normal meal bolus and eat. If I’m in the 70s I’ll probably take a few bites of the food before taking a bolus. Above 80 I’ll bolus and eat. Above 100 I’ll pre-bolus then eat maybe 10 minutes later. Above 130 I’ll bolus+correct and wait until the CGM graph has actually turned down before starting to eat. Above 160 I’ll do the bolus and correction, and wait until I’m back below 140 before starting to eat. And all of the above are just general tendencies, to be modified in either direction by my guess as to how fast the food will digest and whether I expect to have more insulin sensitivity or resistance than “typical”. I don’t have rules for this, just wishy-washy tendencies based on past experience. But I do tend to surf the Dex graph carefully if circumstances are unusual or I suspect that things may not be working out right.

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33

?!!!

What he said. And don’t forget the good black pepper. Or could pan fry them with split grapes and toasted slivered almonds. I usually wouldn’t be depraved enough for the butter and would go with a good olive oil out of sheer terror.

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We do olive oil, too (but I’m dairy free…). And season with Cajun or creole seasoning, my family’s staple seasoning. :laughing: It sounds weird, but it’s so good.

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