When insulin does nothing...?

We had a family pizza night, which I’ve apparently got to experiment a lot more with or just give pizza up to avoid these stubborn spikes. I’m currently sick (but not a drive-your-BG-up sick), so exercise is out of the question with my muscle disorder. I ate with this last correction because normally an 8u of Afrezza sends me to the 60s, plus sometimes if I eat a little while high, my pancreas will squeeze out something to help. Doesn’t seem to be the case this time, though. It’s getting close to bedtime so I don’t really want to keep stacking more insulin, so I probably won’t do anything but wait tonight, but for future - what do you do? Keep dosing small amounts til it budges? How do you avoid dosing too much to then end up on a rollercoaster of ups and downs?

Pizza is a special kind of bastard. Your cgm trace is a textbook pizza graph. You can virtually be assured that it’s going to skyrocket after 2 hours no matter what kind of initial bolus you use and how well the first 2 hours go. I’d be willing to bet that at 8:20 your bg was still skyrocketing when you dosed the afrezza— and even though you had the treats with it it still stopped it in its tracks. Pizza delayed spikes are like freight trains.

I fell asleep 2 hours after eating pizza once, my bg was flat as a pancake at about 100 and I had not a worry in the world. I had my cgm on silent— but in the morning I saw I’d spent most of he night well over 200, think I peaked at about 279 very shortly after I fell aslee at 100

If you ate pizza and only spiked to 180ish you did quite well by my standards. If it starts to go up again hammer it hard with afrezza and you still may have to do an additional afrezza later if you ate a lot of it. A good pizza feed can often keep driving your bg up for up to about 6 hours after eating


Ugh, yeah, I remember hearing that pizza does this to diabetics, but so far I’ve been “lucky,” and it hasn’t ever lasted very long. Two weeks ago, I was back to 83 4 hours after (dosed 8u Afrezza, 1u Novolog, 4u Afrezza with a snack over the first 2 hours). I ate the same pizza tonight; just also had a small salad and 1/2 a hard cider (9 extra carbs). I’m noticing hard cider seems to also be problematic for me.

If you get a cgm you’ll see the true evil of pizza. I doubt 9g of hard cider is having much effect it’s just a simple carb/insulin equation unless you’re drinking enough to get wasted

Ha, still a big “if” on the CGM right now. :roll_eyes: I see my doctor tomorrow…kinda glad right now she doesn’t ever ask to download my numbers off my meter…

I got frustrated and dosed another 1.5u Novolog an hour ago. Finally back down to 106, phew.

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Some ciders act basically like apple juice! I drink them sometimes to treat a low, it can definitely give a quick carb load.

If you know when you are going to have cider, just plan a low for that time. Take enough insulin 30 minutes before so you will be heading into a low. Well-planned lows are awesome. Not only will the cider taste awesome, it won’t spike you nearly as much.

Alternatively, you can try some of these, which have less sugar and won’t be as difficult to deal with! :yum:

The rule is - if you drink it, you review it!
Virtue Michigan Brut
Samuel Smith Organic Cider
DeMunck’s Belgian Style Cider
Harpoon Cider
Julian Hard Cider (some more than others)

Dude, that’s the quote of the day. I kinda want to frame it and hang it in our kitchen. Where the only pizza that appears is bought pizza. Because why would I make something that I can buy which is better bought than homemade?!? Also, any day which has someone saying “he’s going to pick up pizza” doesn’t need an explanation of how crazy it was. 'Nuf said.

/pizza soliloquy off

Um, one other thing, we’ve noticed a pretty big difference in GF pizza versus normal pizza. GF is far sugar-y-er and is kinda a BG nightmare in a different way.

We also had GF pizza tonight (and salad). 12u Afrezza at the start, crashed from the speedy onset down to 67, added 3oz apple juice then because he felt crummy, drifted up to 100 after an hour, injected 2u Humalog and it’s on the climb to 125 now. (We ate dinner quite late.) I think I might’ve heard another injection of 2u Humalog happen a moment ago, which would make sense, as we finished eating about 1.75 hours ago.


Yes! This is exactly how I feel it works for me, at least the kind we like to drink (a local brand). I’ll have to see if our stores have any of those others. They don’t sound familiar.

Ha, exactly. If I actually pay someone to deliver pizza (last night), you know I NEED a night off cooking/washing dishes. I hope y’all’s pizza experiment ended well.

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My man @Sam nails it.

I’ve figured out pizza and bagels with a combo of Novolog and Afrezza. Plus, I keep my eye on my AW for about 3 hours after eating it to make sure I’m on top of the late climb.


for us pizza is pretty consistent – we always need to do two different boluses, one upfront for less than half the carbs, then another one about 1.5 to 2 hours later for the remaining carbs + a 50% bump. We will also often log “phantom” carbs throughout the night so he gets a higher temp basal – usually about double his normal nighttime dose for a few more hours.

But there’s also a threshold effect for us. If our son eats 30 to 45 grams of carbs in pizza, that formula works well.

Once he gets to the gorgefest level of 60 g of carbs, he’ll be high all night unless you aggressively bolus, and he might need, overall, 4 times the insulin you’d normally expect. Another confounder is how much cheese is on the pizza. Thicker crust pizza that has more cheese always takes more insulin, even if it’s the same amount of carbs. Basically my impression is that you want most of the carbs digested before you go to sleep, because once you go to sleep the pizza will just keep BGs high for 6 to 8 hours and the insulin seemingly does nothing. By the way, eating it for lunch (like at birthday parties) doesn’t seem to have this same effect.

If I were you I’d try being a little less aggressive initially with the insulin and then be incredibly aggressive about 1.5 hours after you’ve eaten, even if you’re totally flat, because you will usually rise soon after. And if not and you drop low, just have a tasty dessert handy :slight_smile:


bagels are really easy for us… we just bolus up front for all the carbs and then that’s it. what do you do special for them?


Pizza isn’t a problem for Liam. We do extended bolus over an hour and a 95% temp basal for 4 hours and he does fine. Hoping we continue to have good results since every kid has to include pizza in their diet. :smiley:

If it’s after 7pm though he doesn’t eat it because he’ll end up high through the night


Yes, pizza is pretty crazy. Our current recipe for handling a slice of Costco pizza is 100% bolus up front and and extended bolus of an additional 75% over 3 hours to mop up the residual digestion. Hope you find your personal recipe for success.


Hoping we continue to have good results since every kid has to include pizza in their diet. :smiley:

Same. If I had a dollar for every birthday party we’ve been to with pizza as the main dish – I’d have like $45 bucks!! IT would be a shame if we had to stress about Samson eating it.


Thanks for all the input! I think I’m going to try dosing Novolog up front next time, then hit the delayed rise with Afrezza (once I get a steady supply of it anyway…). It’s hard to time the Novolog as followup without a CGM or pump.


this is what I do.

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I find pizza fairly easy to manage, perhaps because I prefer pizzas that are heavy on the vegetables rather than meats, and aren’t bogged down with stringy, tasteless cheese. (Favourite: caramelized onions, rosemary, and Gorgonzola.) When I had my previous pump, I found a 50/50 extended bolus over 4 hours worked really well. The intervening years of MDI were problematic. When I started on a pump again nearly a year ago, I used the same 50/50, but for some reason recently it hasn’t worked very well, and now I find 60/40 over 3 hours works.


If you know your recipe for success why not just repeat it with MDI? E.g. Instead of 8u up front why not 4u then 2u every hour for the next 4? Sure it’s a little more work but how often does one really eat pizza…

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That would certainly have worked, if one didn’t tend to eat around 8 or even 9, and wasn’t in bed by 10:30, and didn’t want to be getting up every hour for the next four hours to give oneself a shot. And, given that one eats pizza fairly infrequently, it sometimes seemed easier to just ride out the high. Says one.