What Can You Eat Without Bolusing For?

4-7 mmol/L, which is about 70-125 mg/dl.

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holy cow!! whats your A1c like? are you able to keep your BGs that tightly?

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thats how i am feeling now (lol)

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My last was 6.3%.

Through a combination of using a CGM, pump, ā€œsugar surfingā€, low-carb eating, and frequent dose adjustment, during good times I can stay in my target range more than 50% of the time. But I almost always go outside that range multiple times every day. My main goal is to get back within that range as soon as possible when I do go outside it.

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thats amazing.

i am wondering, though, about why you choose not to bolus mildly for your carb intake. i mean, if you want to be more inside your target range, wouldnt taking a little bolus help you to do that? no judgement here, just curiosity.

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I do bolus for all carbs I eat. Itā€™s protein and fat I donā€™t bolus for, because I havenā€™t figured out how to without going low, and also because I just dread that level of complexity in my management.

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i totally get that. i have to bolus for protein and fat and its very very challenging. a lot of guess-work goes into it and a lot of experimenting. it can be extremely frustrating. fortunately, though, after enough experiments, i am learning how my body reacts to different foods and different combinations of mixtures of foods (like pizza or burgers).

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I know some people bolus for 50% protein grams and 10% of fat grams, and extend it out over a certain amount of time. Thatā€™s what Iā€™d like to learn to do. Then I can just weigh any food (which I already do) and use its nutritional information to calculate my bolus. But so far my attempts have ended with lows. And often I donā€™t have to bolus, but then sometimes I do, so I think there might also be a certain threshold of fat/protein that, when itā€™s crossed, makes them matter more than other times. Something I have to do more research on. Since Iā€™m making the upcoming year about my health (rather than career, school, etc.), this might be a good time to do it.

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Currently TDD is between 65 and 85 units, depending on what I eat (44 units of which is Tresiba). Last A1c was 5.8, and it generally stays between 5.6-6.0. I consider myself truly blessed.

For instance, I finished dinner about an hour ago and didnā€™t bolus. I had grilled salmon, sauteed squash, and boiled spinach in butter sauce. Plenty of protein and fat, probably less than 6 or 8g carbs. Preprandial Bg was 95, 1 hour postprandial is 108. If at two hours Iā€™m rising at all Iā€™ll take five units.

ETA: Two hours postprandial Bg is 100

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this facinates me, b/c i have to take insulin for everything, yet my TDD is around 20units. my total basal is 12 and the rest is all bolus. since i havent been swimming, my carb intake has significantly decreased, but only by a few less units a day (TDD for a swim day was around 25 units)

my last A1c was 5.5 and i am anywhere between that and 6.4%. do you think that perhaps some of your basal insulin is what is covering some of your bolusing for meals? i think eric once mentioned something like that to me. not 100% certain, though. do you do MDI?

hooray for you :sunny: i am truly in awe!

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@daisymae Yes, Iā€™m certain that basal insulin has some impact on this. And yes to the MDI protocol.

I think the only reason this works for me is that I keep my daily carb intake under 100g. More like 60-70g.

Iā€™ve documented here my problems with a higher carb diet and how it caused me to take way too much insulin. I documented a period of several consecutive days without bolus insulin. I figured out that was due to way too high a basal dose.

Since Iā€™ve gone lower carb Iā€™ve cut basal from 72 units of Toujeo to 44 units of Tresiba. Still a bit too much, but I eat regularly so rarely get into trouble.

i dont eat many ā€œrealā€ ā€œpureā€ carbs . i just have to bolus for things like eggs, fish, meat, cheese, etc. if i didnt have to bolus for these foods, i would probably cut my TDD by 50% easily. of course there are the days where i have a total pig-out and will bolus for 75gms for the occational hamburger/fries, chips, or a few slices of pizza. even if i want a grilled cheese, i need to bolus to cover 65gms (but if i want to have a slice of key lime pie, i only bolus for around 30gmsā€¦weird, huh? )

also, i have to use the dual bolus feature on my pump very often, b/c anything with fat in it slows down my digestion and i need to match up my insulin with the slower rate of absorbtion. even a food like dark meat chicken requires mathematics :wink:.

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How about overnight when you are (probably??) not snacking. What BG do you tend to wake at?

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i dont use a cgm, but i get up a couple times during the night to P, so i test then. i am pretty stable through the nights at about 80ish and wake up at about 90, sometimes less, sometimes a bit higher.

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Wow, Iā€™m super impressed that you have an A1c of 5.5% without using a CGM, @daisymae! Iā€™ve never had an A1c that low, and my A1c wouldnā€™t be as low as it is without a CGM.

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I tend to run slightly higher after 11 pm. Generally 140ā€™s. But when I wake up at 6:30am Bg is generally right back on track. By the time Iā€™m ready to leave the house at 7:45am Iā€™m trending downward and take care of it with a 7g bolus free breakfast on the drive to work.

At least thatā€™s how it works most of the time. Sometimes it just doesnā€™t.

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Being still in the honeymoon phase, Iā€™m similar to @docslotnick - I can eat up to 10g carbs and not bolus (generally rise ~20-30mg/dL). Thatā€™s provided, of course, that those 10g carbs are made up of plenty of protein/fat and no sugar (so, example, Iā€™d still bolus if that was 10g of fruit or something). Nutā€™s are my go to snack while out or when I donā€™t have time (or really am too hungry) to prebolus. Iā€™ll go back to cheese being that snack when I can have dairy again. :heart_eyes:

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@docslotnick
It does sound like you are likely benefiting with a higher basal and often times compensating with snacking?

But that the higher basal does not cause overnight lows. Or is the nighttime downward trend from basal at just the right angle such that starting the night at 140 (which would be our ideal nighttime starting target) give you exactly the cushion you need to wake up at your target waking number?

Or does this not sound accurate?

When Tandem releases its PLGS update next year (hopefully around Summer 2018), I was wondering if we could do something similar with tweaking the basal a bit higher than we need and letting the pump cut it off when it starts to drift into the low territory. Assuming we can specify what ā€œlowā€ is for us. If the Tandem PLGS algorithm predefines low as 100 or whatever that ā€œotherā€ pump does - that would be sorta stupid and pointless. But if we could configure our own threshold and set ā€œlowā€ as 60 or 65 then it might work pretty nice.

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i enjoy nuts as well, but for me they do contain carbs, so if i want more than just a few of them i need to bolus. :frowning: depending on the type of cheese, i can get away with a lite snack w/out a bolus. (but cheese does raise my BG about anywhere from 5 - 20 points so i generally will only go for the cheese when i am on the low side like in the 70s)

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