Probably a silly questions, but I’m wondering if others here snack between meals. And if so, do those snacks include carbs? I’ve always been a grazer, and I rarely don’t have some sort of snack mid-morning and mid-afternoon. I try to choose healthy snacks, but rarely zero carb. Usually something like greek yogurt, a Kind bar, a few apple slices with peanut butter, etc. Even with insulin these things are going to raise my BG somewhat, and i worry that those extra BG rises (even if they’re small) during the day aren’t healthy when i’d be staying mostly level during that time if i hadn’t eaten.
Am I overthinking this? Do I need to do a better job figuring out snacks and doses that keep me pretty level? Stick to cheese and almonds forever? Any suggestions are appreciated.
I don’t think there’s a right answer. Your lines will always be flatter if you eat lower-carb, slower-digesting foods or don’t eat at all. Most of the population would probably be healthier if they ate this way, but it isn’t always fun. A lot of my decisions personally come from what I am doing during the day. If it’s a summer weekend and I’m out doing outdoorsy things or whatever, I’ll stuff my face with ice cream and pizza because I’ll burn most of it off and won’t spike much anyway. If I’m at work, stressed and not moving around a lot, it’s a different story. I also think you have to balance having the flattest lines with what works for your lifestyle. I tried going full-on Bernstein for a few weeks and had the flattest lines I’ve ever seen. The downside, aside from the limiting diet, was that I started to get anxious from any spike at all and realized when I was out with my girlfriend or friends that I was spending more time anxious about my CGM lines not being perfect than living.
Can’t say you are doing it right or wrong, but we always have some cheese and salami or summer sausage laying around for snacking. With that said, I have a teenager who is at times a never ending pit of eating. So having low carb high calorie food laying around isn’t too much of a hassle, i.e. I don’t get to eat much of it…
I have read that ideally you should leave 3 hrs between meals/snacks in order to let your blood sugar return to baseline before rising again, but I don’t completely agree with the timeline aspect of that. I do, though, have to eat frequently because of another medical condition, so I had to find some way to make it work without sticking to that. I personally approach it with the mentality that, as long as I’m only getting a small rise from whatever I eat, it’s not much different from a non-d who eats like I do (totally not scientific, but just my thoughts). For example, I almost always eat an apple with peanut or almond butter between lunch and dinner. I just took a few days and experimented to see how much I needed to dose to keep to a small rise (because apples are a spiky food for me if I just dose by straight carb count). In the mornings, I do try to make a lower carb/higher fat breakfast to last me til lunch, because my insulin needs are higher and so it’s just harder to keep spikes down if I snack. If I need a morning snack, that’s when I go for the low carb option like plain nuts.
That being said, I do make some snack decisions (what I eat or when I eat it) based on where my BG levels are - I try never to snack when I’m already at 130 or above. However, I usually am proactive and do a correction ahead of time if I think I’m going to be that high at snacktime so I can still snack - the worst that happens is I don’t end up needing the insulin for correction, and I have to eat a snack to keep from dropping. Oh, darn.
Samson snacks constantly as a result of the daycare schedule, and it’s certainly frustrating because his blood sugar never has time to normalize before it’s disrupted again. If he were an adult, I’d say eating two meals a day would be the easiest to control. Even on the weekends we snack less and though he eats unhealthier foods like pancakes and waffles from a restaurant, he has about the same amount of time in range as on the weekdays when he’s eating healthier. This is 100% because he’s snacking less so we have time to correct his BG down or up after a meal.
So my personal advice would be to avoid the snacking if possible; you can definitely do zero-carb snacks or you can wait till you’re going low to have a snack. Of course that’s the ideal, as if you’re a robot. In practice, life has to happen and having perfect blood sugar is less important than enjoying your life.
I love this question and enjoy seeing where people fall on it. Prepare for my overly long overshare answer:
Based on my standard meal sizes for best spike control (which I spike higher than I want but I’m working on that), I have to snack at least twice a day to get enough calories to maintain my weight, let alone gain.
I’m more likely to snack on the weekends because I’m more active, so my insulin duration is shorter due to my activity, and I’m much much less likely to get too much insulin stacked on weekends than I am on work days when my insulin duration is closer to five hours.
I eat at 8AM, 11AM, 2PM, 5PM and 8PM on weekends (3 meals, 2 snacks).
If I skip snacks, which frequently happens on work days, my next meal will spike faster because my body is hungry and is mainlining sugar to my system. That’s my theory anyway. But if I go too long between eating, it hurts me from a spiking perspective.
One thing I do is overbolus for lunch on work days, because the duration is so long when I’m sitting all day that I end up getting to use that for my snack around 2PM and then I don’t have to re-start the IOB thinking for snacking with dinner coming up.
I love all these thoughtful and varied responses! I think I know deep down that not snacking, or sticking to low/no carb snacks. would be better for blood sugar control, but i’m resisting because i want to do things the way I’ve always done them. And darn it, I’ve been having a morning snack for years and that’s just what i do, haha.
On work days my breakfast is pretty much always whole grain toast and an egg, somewhere between 7am-8am, and without a snack I’m hangry by lunchtime. That feels like a big breakfast to me, so I’m not sure what I’d do different at breakfast time to not feel like I need the morning snack later. I tend to eat lunch a little later (makes the afternoon go by faster!) so maybe I’m just creating that problem by not spacing my meals well. Something to think about I guess.
When I started out with all this I wasn’t snacking on anything other than cheese, nuts, etc. between meals because i was freaked out about stacking insulin, so i avoided eating anything that required it outside of three main meals a day. That wasn’t really sustainable, I got bored of cheese slices and almonds, and now I’m afraid i’m swinging in the other direction and am getting a little disorganized in my snacking habits. I may need to simplify and experiment with one or two good healthy snacks until i can get the hang of dosing it right so I can eat it without such a big impact. Maybe just once a day? And go low carb for other snacks or avoid them altogether?
For purposes of experimenting, I am curious… I hope this isn’t too personal to ask as I know everyone is different. For those who do snack between meals, Is there a certain amount of BG increase that you are comfortable with? For example, @Pianoplayer7008 you mentioned that you feel like if something only results in a small rise, it’s not that different than a person without diabetes. How do you define a “small rise?” if you don’t mind me asking? In my head it feels like if I’m going to have a snack, it should be something with less impact than what i might consider ok in a meal. Again though, I understand everyone’s different and what works for one won’t work for another, so I understand if people don’t like talking numbers.
And I appreciate those that pointed out that living life is more important than perfect blood sugar and perfect dexcom graphs. I wholeheartedly agree and that’s such a good reminder.
The way I look at it, I’m trying to be back near target by the next meal, and I try not to do anything that’s going to result in a weird dip or spike with the next meal. Ultimately, I’m trying to keep my tracking uncluttered so that I know that x was caused by A and y was caused by B. I’d love to keep all spikes under 160 but that just ain’t happening with all of my factors. So I try really hard to never hit 200 each day, but that depends on my hormones as to how likely that is. Ultimately, I want to be at my healthy weight, which requires eating. My weight is more important to me than my spiking profile for now…so that requires spiking at times (for me).
I don’t know that it’s a certain amount, exactly, so much as it’s just wanting to keep it low enough that, as Allison said, by next meal, I’m in target (which for me, I want to be =<100ish when I’m about to eat a meal). Ideally, that means not going over 120-130, or no more than a 40 pt rise, but that’s just me throwing numbers out there; I don’t usually put too much thinking into it these days (as most of the time I’m just eating what I’ve been eating for a while). At all times, I’m trying to keep below the 140-160 range. I should also point out I’m still honeymooning/not on basal, so things are “easier” to keep under control.
Personally, I don’t snack much at work. I find it tends to be a hassle, and I’d just rather not deal with it if things don’t work out as planned. I’m not really much of a snacker anyway though. I tend to crave meals more than snacks.
I think that eventually you’ll be comfortable with dosing based on where you predict your blood glucose levels are headed combined with the I:C ratio for the food you eat at each meal/snack. Really trying to limit the peaks is probably key if you’re going to be snacking often or you may end up in the higher range more often than you’d like. There are lots of ways to limit the peaks though… pre-bolusing, low carb snacking, going for a walk after a snack to speed up the insulin. Just depends on what works best for you.
I personally do not believe in the negatively that surrounds insulin stacking. If I want to eat a snack, or have a beer or an ice cream cone at the beach - I just give the insulin to cover the carbs with an appropriate prebolus. If I am grazing I just keep bolusing.
With that said, I target keeping my BG below 144 (8.0) at all times, so I am pretty careful about what I eat and when. So usually that ice cream cone is followed by exercise or something.
Another thing I will do, for high carb meals like pancakes, is over-bolus for the meal and then follow-up with a snack to cover the remaining IOB.
Two things are required for this approach to be successful.
Either use a CGM or test often to avoid impending lows.
Carry glucose with you so if you make a bolus mistake you can fix it before you go low.
Back when I did R/NPH MDI, I would generally be forced to snack because of the long duration of the R insulin (as in the R dose for breakfast to cover the carbs would still be around for a long time and it would also cover a morning snack 2 hrs later.)
I don’t worry about insulin stacking as much on days 6-12 of my cycle. Outside of those days, it’s a variable I have to eliminate as much as possible to keep tabs on my hormones. Insulin stacking when I’m running higher basals or when I’m waiting for The Drop has lead to some moments I don’t care to repeat. YDMV.
So much good stuff here! I like that everyone seems to have their own approach that works for them. I was a little worried i was going to get entirely “SNACKS = BAD” responses, but although i think avoiding a lot of snacking is probably better for me, maybe there’s enough wiggle room in there for experimenting.
I think I’m going to work to limit my workday snacks including carbs to maybe one a day, either morning or afternoon, unless I’m truly truly hungry and not just bored or feeling snacky for no real reason.
I’m also going to start experimenting with getting the bolusing right for a couple small healthy snacks that I can have on hand for when i really do need a little fuel in the morning or afternoon.
Since I have an office job and am mostly at my desk during the day (near my snack stash), and I use a CGM, I’m pretty comfortable overdoing a bolus for breakfast or lunch and snacking later to avoid the low. For some reason i just don’t do it much. I may work on using that approach more though… Did it with breakfast this morning by just a little, so we’ll see where things are at later on this morning
Unfortunately you got the “snacks = ok but you need to work out how to make them work for you” response which is harder
You need to set your BG goals and come up with a strategy that works for you.
I am a low carb person - so I usually eat low carb snacks (nuts, cheese, kind bars, chocolate sweetend with stevia or erythrotol http://lilyssweets.com/) and generally try to limit to 10g of carbs or so and keep them healthy… I do not regularly snack high carb, but I just want to point out you can make it work.
Last week I was at a pub for dinner and it was a stream of beer (carbs) and snacks (carbs) - I was about 25 units IOB but just had to trust it. I also had to give more insulin later (always happens when I eat a lot of carbs - you carb count the dinner and then end up giving more insulin later.
Not often. I am usually only about 4-6g of carbs off which sucks because a cookie is around 10g of carbs. On Saturdays I make pancakes for breakfast and since switching to gluten free flour they can spike pretty good if you don’t watch out. My current strategy is to overbolus for the pancakes and follow-up with a cookie and a cup of coffee about 2 hours later. Works pretty good - last Saturday is below - did not go much over 108 (6.0 mmol/l). At a 10g cookie with coffee about 2 hrs after breakfast.
Here’s a question about the overbolusing concept. How does it affect the BG response to the meal? As in, do you see less spike than if you did less, plus you go lower later? Same spike but drops faster? Does it ever drop you too much before the carbs have had a chance to kick in, or does it have more effect on the tail end?
I’ve tried it a little bit but my results have been a little all over the place.
Yes, over-bolusing will reduce the spike. You are getting more insulin earlier in the whole equation than you would if you took a normal bolus amount.
It’s a comparative thing. You might still spike a little, but compared to if you had taken a normal bolus, you will spike less (or not at all).
That is a possibility. Depends on how much you take and the type of food you are eating, and how quickly you metabolize food. It can definitely happen, so you always need to have food available to treat it, and test frequently.
I like to over-bolus, and then follow the resulting BG drop with dessert.
It will also increase what you have on the tail end.
As a side note - Dang! I am impressed with what you are doing in such a short time since being diagnosed. Nice progression, KP!