i do a lot of finger sticks. my finger tips are so callused 
but i hated the dexcom and this is so worth it to me to maintain control. my previous endo thought i was insane. but, as so many of you know, he was a horseās ass, so i put an end to that and to him. 
1 Like
This is one of the reasons my daughter likes the Dexcom. Obviously we get good (accurate) data from it. But the ability to allow her fingertips to heal is a big plus.
Nothing wrong with a touch of insanity.
2 Likes
For protein, I seem to remember the guideline was something like 3 oz; anything over that, you calculated for in your bolus. But I havenāt found this to be consistent. Sometimes protein under 3 oz looks like the likely culprit in a later rise; sometimes when I donāt bolus for a big hunk oā meat, I donāt rise. So there are other factors at play, and just the thought of trying to figure them out is exhausting. Plus, for me, now that any bolus over 5U is extended to prevent tunnelling, Iād have to do extended boluses within extended boluses, and that makes my head hurt.
1 Like
@Thomas You figured out my strategy perfectly!
1 Like
I do okay with amonds but have to limit cashews and peanuts, go figure! A cheese stick is good with a few carrot and celery sticks.
Deli meat can be kinda carbyāweird additives and such. 
i was on the dexcom for about 1 1/2 years. i gave it my best effort, but it just didnt work for me. i am too skinny and could not find a place to attach it comfortably. i could never get more than 3 days wear out of it. was always getting the ??? icons that would last forever. kept hitting capillaries. and, worst of all, i have OCD and i could not stop checking the receiver and would panic if my direction arrow was anything but flat.
i really dont mind finger sticking. its been very helpful as i do it constantly and get a pretty good idea of how my BGs are going. my last A1c was 5.5%, so i must be doing something right 
My CDE is trialing the Freestyle LibreāIf possible, I will find out what she thinks of it for you.
Yeah, practically all deli meat has potato starch added to it. Same with many of those those pre-shredded bags of cheese (though I donāt eat cheese). People think avoiding potato on a low-carb diet should be easy, but itās surprisingly difficultā¦
1 Like
I saw the Libre the other day and itās quite nice! Iām hoping my insurance will cover it (I pay for my Dexcom entirely out of pocket).
Me too. Cheese, nuts, eggs, pickles, olives, wine, the first beer
Pretty much anything if Iāve just done a long run.
2 Likes
I sometimes enjoy this strategy
Back to the original question - I am in the @daisymae camp and I pretty much bolus for everything most of the time, but sometimes I fall into the @docslotnick camp when I exercise a lot and then I just āsnack to my CGMā. For example, if I am going to do physical work after lunch, I will not do the extended bolus for the protein.
The only things I can eat without bolusing is salad, green vegetables, dried seaweed, and lillyās sugar free chocolate which has like 1 carb in it for a few squares.
Here is a real-life example from last night - I was sitting on the couch and my wife brought me some cheese and sparking wine (I actually have the best wife in the world) so I had some sparkling wine with some cheese (probably 50 g cheese = 12.5g protien) and a few handful of nuts - probably 3 g of carbs and 3 g of protein. I did not bolus at all. Normally I would bolus up front for the carbs and then do an extended bolus for 50% of the protein.
Doing the math - 3g carbs + (15.5g protein total)*0.5 = 10.75 carb equivalent.
Generally 1g of carb raises my BG by 0.22 mmol/l (4 mg/dl) - so my BG should have gone up by 2.4 mmol/l (43 mg/dl) over 2-3 hours. (of course while I was sleeping and not paying attention to my CGM)
And here it isā¦ from 4.1 to 7.1 (a rise of 3 mmol/l or 56 mg/dl) over a period of about 2.5 hours. I really should be less lazy and bolus for everything.
1 Like
I usually try to deliver the extend bolus at a rate of somewhere in the range of 1 to 1.5 U/hr depending on my blood sugar and how many carbs in the meal. (i.e.if I am eating high glycemic index carbs it makes sense to get more insulin up front to stop the spike). For most meals I will use the 1.5 U/hr maximum.
My I:C ratio is 1:6 so if I eat 20g of protein, I will deliver the bolus for 20g of protein over 1 hour.
1 Like
it depends on the fat more than the protein. the fat seems to slow the digestion a lot. just a few examples:
- grilled cheese sandwich 50/50% over 2 hours
- dark meat chicken 40/60% over 2 hours
- hamburger with bun and some fries with guacamole and chips 25/75% over 3 hours
- japanese sashimi (no rice) 40/60% over 2 hours
- pizza (1 1/2 slices ) 50/50% over 2 hours
i generally need less up front and greater extended bolus to catch the tail end of the fat digestion. figuring out the hamburger meal was the most difficult. when i started experimenting i was giving myself too much up front, so i would crash after eating and then spike as the meal digested. it was a rather long education. same with the dark meat chicken. and, most recently, with the sashimi fish. (i realized, after watching my BGs over 2.5 - 4 hours, that my BGs were perfect 2.5 hours post bolus, but would rise at 4 hours. someone in our community suggested that it was b/c of the fat in the fish. so then i decided to do an extended bolus and it worked out perfectly. a complete flat line straight through.
hope this helps a bit. i know weāre all different, but i hear similar stories from many others when it comes to extending your bolus.
i did 2 test trials with the Libre maybe 6 months ago. the first 2 weeks were great. the second round was not. it peeled off during my swim and i had to perserve it in a plastic sandwich bag and bring it to my endo to be downloaded. b/c it was so $$$$ i called the company, Abbott, and spoke to a customer service rep/tech. it was a miserable experience and they would not stand by their product.
i wrote a post about this under the āVendorsā category. it would be great to get it for free, but IMHO, their customer service was something i would never want to deal with. especially if you are used to DEXCOM, which is a fantastic company in all respects.
1 Like
Right now I use the Dexcom, but I pay for it 100% out of pocket. If my insurance covers 80% of the Libre and I only have to pay 20%, Iāll switch because it will be WAY cheaper. But if I have to pay for either one out of pocket, Iāll stick with the Dexcom.
1 Like
An interesting sidenote:
When Gary Schreiner spoke at the TypeOneNation DC Summit a couple years back, I remember him stating that eating vinegar with carbs can actually help slow down the digestion of carbs. A quick google search seemed to confirm this idea. Iām sure the effect is limited and I havenāt experimented with it myself, but it is interesting.
Balsamic vinegar is likely a different story though.
1 Like
different brands of balsamic vinegar have different amounts of ācarbsā in them per TBS. (basically, sugar). i even found that it helped to do a 1/2 hour extended bolus when i made salads, especially if i put anything like cheese or nuts in the salad.
havent a clue about regular wine vinegar, though.
1 Like
Yes pleaseā¦
2 Likes