I have always found diabetes extra challenging to manage around big meals. I’m the kind of person who likes to try a bit of everything at a party. I try not to let diabetes get in the way of enjoying myself on special occasions like birthdays or Christmases, because they only come around once a year. Often the consequence of this has been high blood sugar levels that are tricky to bring down in the hours that follow.
One of the biggest advantages of having an insulin pump is the extra flexibility that it gives me to work around high blood sugar levels. With tricks like temporary basal insulin rates, the pump has definitely saved me hours of frustration in trying to bring my blood sugar levels down in the aftermath.
Yesterday my pump got it’s first taste of a high carb meal, as I took the wheels out for a spin over breakfast. I had been craving pancakes all week, so my order was going to be a no brainer.
In anticipation of the extra carb load, I set a temporary basal rate of +100% to ensure that my mealtime insulin did its job effectively. I did this before I left home, so that the basal rate would kick in by the time I sat down to breakfast.
The cafe looked pretty busy, and I wondered how long I would be waiting for my pancakes. I guessed that I would probably need insulin to cover somewhere in the vicinity of 60-80g of carbohydrates, but I didn’t know for sure how big the serving would be. I decided to play it safe, and pre bolused half my insulin when I placed my order, and the other half when my meal arrived.
When I left the cafe, my blood sugar was 13 mmol. When I checked again at home half an hour later, I was 13 mmol once again. I noticed my blood sugar begin to creep up again at around the 3 hour mark, as I would expect for a higher loaded meal. I entered my blood sugar reading into the pump, overrode the insulin on board subtraction, and gave a correction dose. I kept the temp basal running, anticipating that I would need it to cover the delayed fat/protein spikes.
By around 2pm, my blood sugar was almost back in range at 8.3.
The majority of my numbers throughout the morning were around the 12-13 mmol mark, save for one brief peak at 15.7 mmol. To put that into perspective, a loaded meal like that has the potential to send me well above 20 mmol.
Safe to say I was pretty damn pleased with my handy work.
Take that, food police.
OOOOh Breakfast…… I love pancakes always have. Keep the syrup however. I like them without anything on them, plain.
I referred your blog to the TUDiabetes.org blog page for the week of August 1, 2016.
Well done! Pancakes are so worth the extra work. 🙂
Jeremy, T1D traveler
The other night I had Indian food. Heaps of cheese naan, curry and stuff. Samosa. And beers. (No rice.) Took 14 units of Humalog before, then ate more than I thought I would. So I took 4 more units – one of my first times splitting a dinner shot, in effect. Actually ended up a little low before bed and had some juice, but woke up the next day right in range and was fine all day. Me on MDIs, and I navigated through naan and beer. I was shocked and quite impressed with myself 🙂
I’ve seen people on Twitter talking about pre-bolusing and split-bolusing; lo and behold it seemed to work. There’s always a way – as you say, why let diabetes get in the way of having what you want!