Hi, all.
This may seem like a weird question, but I’ve asked people and even the people at my Endo office, and they sort of smile at you and don’t understand that I’m serious. My birthday is later this month and I have been post-honeymoon phase for a year and a half. I have stuck to mostly same meals and same times and no snacks for over 2 years now. I need to learn to live and hopefully enjoy a restaurant meal every once in a while and maybe an ice cream cone or treat when out and about. We have a local bakery where we used to get this wonderful birthday cake, pre-t1d diagnosis. If it is possible to enjoy a big piece of cake, can y’all advise how best to do this? I am currently on the tandem t-slim, having returned to it after OP5 site failures galore, even with 2 day changes. I am sort of gathering data from it to support my return to op5 (do not love tubing, but love that its algorithm seems so much better and performs much better - the control IQ, versus OP5 automated). I hope with another reset and input of good basal and other numbers, that it may work. But, that is just to say, I have pump technology to help with birthday cake bolus (unless it is a definite no-no). I am in tight control (80-140 and TIR about 87% with this week one of t-slim). So, are there ways to bolus for birthday cake? I don’t mind reminding myself to give more insulin later or pre-bolus for any amount of time, or even choose the best BG to go in to such an endeavor as eating cake. Cake will be homemade from that bakery, not store-bought. And if you have time/inclination, I may as well say, I would love to know how to eat cheese enchiladas and nachos and pizza. I emman avid exerciser, weight training twice per week, and fast walking at least 6 days a week (4-5 miles). I am healthy weight and try to have balanced nutrition for my 3 meals, but want to travel and eat-out sometime, and even maybe have a restaurant meal of Indian, Mexican, or pizza on occasion, but my health is a priority. Do I just not open this can of worms or can I live like a regular person sometimes? Thanks for any help!
Hello @Quadgirl! My son enjoys cake all the time…he has 5 brothers and we celebrate all the birthdays with cake/ice cream. A couple of things…one, it’s a birthday, so for us, we value the MEMORIES he’ll have, over the tight control we like. Two, I know bolusing strategies will vary from diabetic to diabetic but what I usually do is bolus him up from just a small amount for the fast carbs in the cake (the icing and anything in or on top of the cake that is a faster carb.)…. And I guesstimate that. So if one slice is 50 carbs I would generally Bolus 25% up front. Then, I wait and watch and when I see the rise starting from the cake mixture slower carbs, then I add more carbs and Bolus.
But birthdays only come once per year so to us, those memories are much more important than having a BG flat line.
My advice…enjoy your birthday!!! Correct as necessary (with insulin or more cake/fast carbs) and keep on rolling! Life should be enjoyable so we take every opportunity we can at doing that.
Good luck!
I could almost cry, I am so happy with your response. Time to start living. Thanks for suggestions on how to do this. I will surely enjoy my birthday and the meaning of these memories. Thanks for sharing. I am ever so grateful!
Laura
Laura,
I suggest pre-bolusing and waiting for your BG to start dropping. Then eat a big slice and take more insulin.
I don’t mess around with formulas. Because I know I can eat myself out of whatever insulin I’ve taken. So I take a bunch of insulin and enjoy as much cake as it takes to level out.
If you are comfortable doing this, take a bunch. Because it’s easier (and tastier 
) to eat yourself out of a low than to treat a high for hours.
Only caution is to not do this too close to bedtime. As long as you are awake and have access to BG numbers and more cake, take the insulin and enjoy the cake.
Of course you can eat like a normal person. As a type 1, our bodies pretty much process carbs the same as a non-diabetic, it’s just that we don’t make the insulin, so we have to take it.
When I’m going to eat a big piece of cake, I weigh it, guess it’s 50% carbs, and take the bolus. Usually it turns out to be a bit less carb, but they are fast carbs so I’d rather overdose and have a second helping instead of having too little insulin and have to chase the high BG with multiple rage boluses. Eric’s tip is good; sometimes it’s called “wait for the turn,” i.e., take the insulin pre-bolus and wait to see the CGM graph actually start to turn slightly lower, then eat.
Wow, I love, love this and never thought of it that way. It sound s like a great way to approach this. Thanks, Eric! I am so glad I finally am getting answers about this sort of stuff.
@bkh Thanks so much for the phrasing of what this is called. I will remember to wait for the turn. And what a beautiful way to use cgm technology. This puzzle is coming together now. I might be a little less bold the first time, but I think I can do this! Thanks!
Live your life, girl! I have had type 1 for almost 30 years. No CGM for the first two decades; pumping for most of it. I was diagnosed at 8 and now at 35 have no complications. I had some high A1cs when I was younger (9%ish) but now more in the upper 5% range. Technology will only get better with time, so assume your control will only get better too.
If you die in a car accident tomorrow, will your tight control have been worth it? Maybe - but it’s not worth missing out on life with family and friends - building those relationships and memories.
Eating cake once in awhile - or often - won’t completely derail all of the work you’ve done. It’s completely possible to eat pretty much whatever you want and be fine. (The only things I truly avoid are non-diet drinks.)
So true. As our skill in dosing insulin grows, no foods are prohibited or somehow bad or dangerous because of their effect on blood glucose.
I’ll add that we each get to decide that some foods just aren’t worth the trouble. For me that’s Thai red curry. If I eat that, I’ll be struggling high BG for 8 to 10 hours. I know that there is some combination of bolus and temp basal and temp ISF change that would make it work, but for me it’s just not worth the effort of running those experiments.
Thanks, @allison! You have ramped up my high hopes for stepping out of this overly micro-managed, fear-based life I started upon diagnosis. I am going to do lots of learning and bolus strategies and will still eat to be healthy, but also to enjoy all aspects of life I took for granted before T1D. Thanks for the boost!
@bkh Thanks. I sort of started thinking like that as well about what is worth the effort. I was never a foodie, thankfully, so I really just think if I can spice up my life a bit by adding a few of what seemed prohibited, then I won’t obsess over it and feel deprived. I am sure I will find things as well that are not worth it. Thanks for chiming in again.
If you haven’t seen these, the book Think Like a Pancreas and Sugar Surfing (a PDF you can get - google it!) are great resources.
Maybe you should do some practice before your birthday. Maybe you should make a cake today and just try it out, playing with insulin timing etc. You know, for your health.
Unfortunately this means you’ll have to eat a bunch of cake all by yourself. You might even be too full later for a sensible meal of broccoli and kale so you might have to skip that meal. But the regret will eventually pass.
It will be a tough job, but you can do it! 
You wouldn’t be channeling that infamous Australian outlaw, Ned Kelly? Eating cake instead of broccoli and kale, what torture. 
@allison Thanks! I have the book, just need to finish reading it. I will seek out the pdf. Thank-you!
@ned Funny! I agree - practice can be a good thing. And I am sure the guilt will pass. Slippery slope, though - I could work on perfecting it quite frequently😁.
Hi there - have been T1D for 52 years and have managed my blood sugars through blood testing strips and injections but now use a Dexcom g6. Also use an Omnipod but there is no linkage to create a closed loop.
To enjoy some cake what I do is get a package of small Angel food mini cakes. They should have the carbs listed on them as we shop at a Safeway or possibly SuperStore despite their prices.
For icing, get some real whipped cream and cut a very moderate slice of Angel food. Squirt a bit of unsweetened whipped cream in it and then put some fresh fruit on top - maybe unsweetened blueberries or other fresh fruit you have.
As I have been doing this for so darn long, I do allow myself to splurge very moderately on a a treat like this occasionally.
Hope you find something that works for you. Know this isn’t easy but I remember to minimize high glycemic carbs and keep such carbs to a reasonable amount. Take care!
@Shecamp Thanks so much for your “recipe” for success with the angel food cake. I appreciate the balance here. I am gemini and can got to extremes and I was pretty much asking for how to eat decadent cake, and thinking of a huge piece as well. My good angel like the one your angel food cake recipe helps with, says do that. My side that wants to feel like a normal person enjoying the tastes of special treats like this bakery’s key lime cake (yes, not pie and it is green and tart and sweet and awesome and I had forgone it a few years prior to my diagnosis and wished I hadn’t🤪) wants me to have that. But in the middle, I think I still have fears to deal with (switched back to MDI the night before last and when sugars were high last night I wondered if my insulin even worked - crazy doubts. . .) and will need to prepare myself for what could happen, and have the plan, as people have offered so helpfully given to me here, or postpone, and now you offer another choice which my all-or-nothing side says is a compromise. In truth though, I have found substitutions for pizza (zucchini boat things, and spaghetti squash with spaghetti - I love it even more, I think) and other things. And even found a similar approach, though more carbs in these King’s brand cake-mix muffins which I put apples in the middle of and enjoy, but I haven’t had in quite a while). I am thinking out loud here, and I think I just want to have a special treat just a few times a year (like an ice-cream while walking in our downtown Vista area, or a Starbuck’s fancy coffee, or something from a food truck). On the other hand, I don’t want to tempt fate an open floodgates that then make me feel like I can’t have it. I quit red wine, and all alcohol 8 years ago, before diagnosis, for the same sort of reason. Loved it too much and never could fathom 1 glass. And did not want to be beholden to it. Not sure a true analogy, but what I am pondering here in this instance. Balance is the challenge for me in life. But I still suspect that if I don’t just grin and bear it, and allow some dalliances with special things, I might actually have a balance where I am not thinking of it much. And yet, the answer could be the substitution idea you have woken me to. Still, I may have to do the big-deal cake attempt or I will never know what may have been possible.
Anyway, sorry this got long, but I greatly appreciate you for offering this up. When I make decisions, I like to know I considered all angles and you have reminded me of other ways to walk this path. And, since I am probably the only person here who has been on 3 months plus of Omnipod 5, 7 or 8 days of T-slim, and now am trying MDI again, all in the last 5 months or so, you probably can tell I am looking for my best way and just hope to recognize it when I see it (and live it). And so I keep learning. And I am grateful for your response and for all here who have helped me learn more in a couple of months that I did my first 2 years with T1D. Thank-you!
Hi @Quadgirl, I sympathize with all of your struggles here. I’m still in the phase of simply avoiding challenging foods that I’ve enjoyed. I can’t imagine ever having Ethiopian again, for example. But I do have pizza once or twice a year when I’m gathering with a particular friend group. Here’s a Dexcom graph from this weekend’s attempt.
I started at BG 86 and estimated I was going to eat a little more than 1/4 of a 14" pie (this is square cut thin crust) plus salad and a glass or two of wine. I guessed my ratio at about 1:18u so gave 2u up front and started eating 10 minutes later. At 1hr I was still at BG 82 so I held off on the next shot until I started to rise a bit. At 75min I was at 101 so I gave another 2u. Finally I noticed a late rise to 130 at 4hrs so I gave another 1u and that took care of it.
That’s just to say that it’s possible to dial this stuff in for specific dishes that you like–I don’t think this would transfer to other pizza meals, for example, but we always go to the same restaurant so I’m confident I can eat anything relevantly similar. With practice the same will go for you and your delicious sounding cake options.
@Quadgirl I have been lurking on your tasty thread about eating cake and the helpful suggestions of how to eat more normally as a type 1 diabetic and how to properly bolus for cake.
Well there are cakes and then there are cakes. They have varying carbohydrate grams per serving, along with varying amounts of fats and protein. There is some evidence that protein needs to be bolused somewhat less than our normal units insulin per grams of carb ratio. Fat is more problematic as it tends to delay the rise in blood glucose and can increase insulin resistance temporarily causing a rise in BG. This is the pizza conundrum.
The easiest cake to bolus for would be angel food cake because it is close to fat free. Here’s the numbers on 5 different cakes without icing except the Black Forest Torte.
Angel Food Cake - 100g 0.3g fat, 59g carbs, 6g protein.
Devil Food Cake - 100g 11g fat, 27g carbs, 4g protein.
Blk Forest Torte - 100g. 9g fat, 41g carbs, 6g protein.
Pound cake. - 100 g 14g fat, 57g carbs, 5g protein.
Jr’s NY Cheesecake - 113g 28g fat, 23g carbs, 6g protein.
I have inherent insulin resistance as a type 2, so that compounds the dietary fat increasing insulin resistance. I tried doing the extended bolus feature on the Tandem pump, but it was not particularly helpful. This is an issue with C-IQ, I need a more square wave extende bolus.
Of the cakes above the only one I will eat is the Junior’s New York cheesecake. I bolus for the 23g of carbs and do a correction later if and when my BG starts to rise. This is basically a manual square wave extended bolus. I did pretty much the same on MDI.
The following is a quote from “Using Insulin” by John Walsh et al,
…the fat in certain foods may delay the absorbsion of carbohydrates from the intestine and reduce the expected rise in blood sugar.* The fat in old-fashioned ice cream that has a low glycemic index (raises the blood sugar slowly) is a good example of this. On the other hand, certain high fat meals create a rapid, temporary state of insulin resistance for up to 8 to 16 hours, making blood sugar rise more than expected.** The fat content of many chips and pizzas cause a greater than expected rise.
- A. Schiffrin and M. Belmont: Multiple daily blood glucose monitoring: its essential role in long term glucose control in insulin-dependent diabetic patients treated with pump and multiple subcutaneous injections. Diabetes Care 5: 479-484, 1982
** D.S. Bell and F. Ovalle: How long can insulin therapy be avoided in the patient with type 2 diabetes mellitus by use of a combination of metformin and sulfonylurea? Endocr Pract 6:335-336, 2000.
And
N. Perrotti, D. Santoro, S. Genoese, et all.: Effect of digestible carbohydrates on glucose control in insulin-dependent diabetic patients. Diabetes Care 7:354-359,1984.