I had Pizza for dinner on Sunday night. Coincidentally, it was a meal identical to the one I’d eaten for dinner the Sunday prior.
Pizza is one of those foods that I could simply eat and eat and eat, and easily lose count of how many slices I’ve had. I’ve been playing around with extended boluses on my pump a lot lately. Although I was extremely tempted to eat more, I behaved and stuck with two slices to keep my experiment on par with the pizza I ate the weekend prior.
Last Sunday, I had estimated 30g of carbs per slice, and gave a 30/70 split bolus extended over 4 hours. I went low on the tail end of the bolus, which carried through into the night and left me hypo again after midnight.
This week, I went for 25g of carbs per slice, and gave a 40/60 split over 3 hours. Levels were smooth sailing through the first two hours of the bolus. By the time I entered my third hour, insulin for 40 of the 50g of carbs had been delivered. Levels were still steady, and I had an inkling that I needed to cancel the remainder of that bolus.
Intuition proved right, and I was bordering on hypo territory within an hour of cancelling the bolus. By some strange miracle I managed not to over treat my hypo, and ended up at a perfect 5.9 mmol by bedtime.
By 1.37am, I found myself slightly hypo at 3.8. Being uber cautious not to over treat once again, I ate 5 skittles. When I woke up at 5.45am, my blood sugar was 3.4. I honestly don’t know what I felt more guilty for – running low for more than four hours or for sleeping over it.
You know how some people with diabetes say that certain foods just aren’t worth the effort? I’m starting to think that Pizza might be mine.
When I want to eat a donut, I can simply back up the math with a pre-bolus and avoid the skyrocketing levels.
But with Pizza, the effort is full on.
The low defies logic. I’m struggling to understand how I could end up so low. I find it impossible to believe a slice of pizza had fewer than 20g of carbs in it. I’m doubtful I need to spread out my extended bolus for longer than 4 hours. No matter how many different variations of extended boluses that I try, I always seem to end up low on the tail end.
Then there’s the night spent warding off lows. It’s been a while since I’ve had a night like that one. Sure, I still wake myself through the night to check my blood sugar levels. Some nights small correction doses are needed. But I normally go back to sleep and wake up in range by morning without even remembering anything. Nights where I wake up sweaty and shaking are a rarity these days. Yet an extended insulin bolus that runs much closer to my bedtime than normal, was enough to bring me back to the days of Lantus lows.
I never thought I’d say it, but maybe the day has come that Pizza is not so bolus-worthy anymore.
Pizza is all different. I think usually 25-30g per slice is a good guess for most types of pizza. I do MDIs and have found that two shots, one before and one towards the end of the meal, can often smooth BG over until morning. Works for Indian food and stuff like that too.
I applaud your experimenting and paying attention! That’s the only way to handle diabetes.
Frank – I think you are running your bolus too short. Pizza is loaded with fat – run the split bolus for 6 hours. Keep experimenting – you are well on the way to mastery. What have you got to loose? 4 hours didn’t work – and you like pizza – so try something different!
This is really nerdy (which perhaps I am – Mechanical Engineer?) – but I can not recommend enough the book “Pumping Insulin” by John Walsh. Subtitled – ‘Everything you need for success on an Insulin Pump’. The book will give you heaps of strategies and is a fantastic resource. Deals with drinking alcohol, exercise, sick day management, carb counting, diet, foods, how to check your basal rates, insulin sensitivity ….. And heaps more. Get it delivered for free from bookdepository.com or find the cheapest price on booko.com.au
It is a marvellous resource.