How much carb is in my lunch? (pics included)

[ollie1234]

How much carb is in my lunch? (pics included) Update - why has my BM gone up?

Hello,

I'm re-learing to count carbs as my knowledge is rusty and not as good as I'd like it to be. Here's a photo of what I'm having for lunch today - could you help me count the carbs?

I've made two ham, mustard and lettuce sandwiches from the loaf. Here's my estimates of the carbs:

• Bread (4 slices) = 10g each = 40g
• Ham, mustard, lettuce, margarine = 0g (trace)
• Tomatoes = 5g
• Nectarine = 15g

Total = 60g

Also I'm curious about the bread's GI. It's one of these artisan loaves with seeds in it from a local baker. I would say it's "wholemeal-ish", definitely not white bread but not properly wholemeal either. I estimate it's slow-release carb / sugar (is this called low GI, or high GI?). What do you think? Would you recommend bread like this or would you usually look for wholemeal?

Here's a picture of it:

Thanks!

Ollie

 

[Mark T]

I was wondering if your 10g per slice of bread is a bit high - but it's difficult to guess as those slices are smaller then conventional sliced bread but thicker. Possibly 10g is OK especially since a conventional sliced bread can be 15g.

I would say that the bread is mid GI at least. It's much less seedy then Burgen. I believe Burgen is only just inside Low GI.

Conventional wholemeal and white are usually High GI.

I would of estimated 4g for the tomatoes too - but that's being niggly 🙄

 

[novorapidboi26]

Pretty good counting in my opinion, when it comes to bread I always just use 20g unless its a smaller sliced loaf.........

I wouldn't personally count tomatoes unless there was a substantial amount and spot on for the nectarine...........I would normally use 10g, so 1 unit of insulin.....

As a type 1 diabetic GI inst as important as it would be being type 2 as we can time our dose of insulin with an educated guess.....[BG analysis].....

It seems you are not that rusty though.........

Let us know the results............

 

[trophywench]

Aaargh, French bread. Some of it is 10g per slice like that, some of it's more. Never less than that. We've just had a longish holiday in France so eating bread like that every day and it was pure guesswork on the bread front. Never disastrously wrong, though I did do quite a number of later corrections. (i mean on a number of days. not multiple corrections for the same meal, LOL) So all you can do is test then tomorrow - if it's still edible or the rest of your family haven't scoffed it! - you'll know.

 

[ollie1234]

Thank you both 🙂

I have some news about my blood sugar... here's the numbers:

1pm (before lunch) 14.4, took 1u humalog correction
2.50pm (just before eating lunch) 8.8, took 7u humalog, ate 60g carbs
4pm (right now) 10.4

(Yes, I had a late lunch today!)

I'm concerned. I thought the 7 units would serve as both a dose for lunch and a correction for my 8.8, I was expecting to be around 6 now, but instead I'm at 10.4.

Wish I had a CGM so I could see if I'm trending up or down... I feel so blind at moments like this.

Could you help me with some practical questions? When should I next test to see the trend? Is 15 minutes long enough?

If I'm steady or trending up, would you take a correction dose? Or should I wait until two hours after lunch, when (I think) I'll have finished digesting and 'processing' the carbs and insulin?

Any feedback would be greatly appreciated, thanks.

Ollie

 

[Robster65]

Hi Ollie.

Humalog starts to work after 15-30 minutes and peaks at about 1.5 - 2 hours, tailing off over 3-5 hours, varying from situation to situation.

You need to test before eating, after usually 2 hours to see if you've hit the spike right, but the food can peak after 1 hour or 3 hours, depending on the GI.

One more note, wholeMEAL bread isn't that brilliant. You need wholeGRAIN, which contains the cereal in its husk, and/or seeded, like you're having.

You need to account for the 1u correction dose you took when calculating your ratio for lunch. If you can keep the rise from pre to 2 hours post meal to within about 3mmol/L then you can calc your ratio and keep checking it as you go.

If 1u brought you down that easily, it sounds like you may need to review your basal. It may be a bit high.

Also, your lunch is quite late in the afternoon, which will have an effect.

Otherwise, well done

Rob

 

[RSVP]

Another quickie

What time did you have breakie? & what was it??

The high before lunch could be due to lack of quick acting insulin on board?



sarah 🙂

 

[everydayupsanddowns]

I'd rteckon the count was pretty good Ollie. But I would suspect that bread would be quite fast acting for me. I no longer consider 'brown' to be safe - let alone brown-ish Not that I don't still make those food choices, I just factor them in to later results

1pm (before lunch) 14.4, took 1u humalog correction
2.50pm (just before eating lunch) 8.8, took 7u humalog, ate 60g carbs
4pm (right now) 10.4

(Yes, I had a late lunch today!)

I'm concerned. I thought the 7 units would serve as both a dose for lunch and a correction for my 8.8, I was expecting to be around 6 now, but instead I'm at 10.4.

Wish I had a CGM so I could see if I'm trending up or down... I feel so blind at moments like this.

What is your insulin sensitivity generally? How much would you expect that 1u to bring you down over it's 4h duration? My guess would be around 3-4mmol/L for me depending on how accurate my basal that week. My problem is that insulin activity rarely seems to be very linear. Sometimes I get a fairly steady activity over 4 hours, other times after 2h it seems pretty spent.

Your 14.4 to 8.8 is quite a lot in the first 2 hours, and the initial 1u may have nearly done its work (smaller doses tend to have a shorter duration). And of course either/both of those levels might be out by meter innacuracy of 10-20% 🙄

I think the 8.8 to 10.4 (at just over 1h after eating) is driven by the rapid-ish absorption of the food. The 7u will only just be getting going and still has 3hrs or so to run.

If you are concerned I'd say test again at 5 and see how things are faring.

 

[Robster65]

@ Everydayupsanddowns .. Spot on.🙂

Rob

 

[ollie1234]

Wow, thanks everyone. I'm so grateful for all of your kind words and consideration 🙂

I had late start today (I have a day off work!) so I had a lie in until about 10.30, breakfast at 11.37 (3 slices of the same bread, toasted with marmite, plus a cup of black coffee). I've been using the Diabetes Diary iPhone app and have recorded everything so far:

@Robster65 I think you're right that my basal is a bit high, I keep having hypos at night. Going to drop the units by 2 to 18 and record my before bed and morning readings tonight.

I see that some of my ideas about insulin and food carb absorption are off. I had been told that lispro acted immediately and was absorbed within 30 minutes.

There's a lot to think about here...

Edit: just did another test, 10.1 at 4.54pm. Thought my sugar would have come down a bit by now but on reflection I suppose the insulin and the food are both still being processed.

 

[Robster65]

That's really informative Ollie.

I've never tried to do lie-ins that late, so not sure whether it affects things. I tend to stick with routines as much as I can. A hangover from the old days I suppose.🙄

The hypos at night do suggest a basal overdose. Unless you're eating late and over injecting the bolus. But try the basal first.

It looks like you're rotating your injection sites nicely. Just watch for fat build up.

Your test at midday was around the peak of your humalog action and possibly your breakfast absorption. The 1u correction will have acted in conjunction with the breakfast dose. Something to be wary of when correcting. It can stack up and cause hypos later.

I'll leave it there for now from me. Too much at once could be bad. 🙂

Rob

 

[everydayupsanddowns]

Ahhhhhhhhh! It all becomes clear!

That overnight hypo may well still be messing you about. (causing your liver to drop in glucose from its stores)

I would just ride out today until you liver has calmed down a bit 🙂

Oh... and if you've got the blue Autopen24 that only does 2u increments I'd suggest you pop to your DSN and ask for a green one. Still horrid, but at least you'll get 1u doses (a smaller max dose, but that won;t worry you looking at your suggested change). I often found 2u was too much change and just caused other problems 🙄

 

[ollie1234]

An update - at 5.54pm my blood sugar is now 5.9! Finally coming down.

Going to try to keep it steady through dinner.

 

[ollie1234]

Another update - feeling a bit funny at 6.30, took a reading at 6.40 - 3.3.

I had the possibility of a hypo at the back of my mind when I got that 5.9 result. I've also done some light exercise today (a few pull ups, sit-ups and shoulder raises with dumbbells).

I've eaten one finger of a kit-kat bar and another nectarine, I estimate 20g total.

Highs and lows today, hmm. Heading out for dinner and a drink with friends. Wish me luck for tonight and tomorrow!

Thanks again for everything, it's been incredibly supportive to get all this feedback throughout the day. You are all so amazing 🙂

 

[novorapidboi26]

might want to think about having something quicker absorbed than that for a hypo, but you may find this out for yourself...........😉

 

[everydayupsanddowns]

I'd agree with NRB Ollie. I used to use chocolate, even though I knew it wasn't very quick acting, but having switched to fruit pastilles (or skittles or locozade for nasties) I found my awareness improved. Partly because other work began to reduce the total number of low-level dips, but also I think, because I spent less time in low numbers. It also helped prevent overtreating as the response/rise was always quicker and I didn't feel the need to reach for something else after 10 or 15 mins.

Do you use the '15 rule'? (15g cho, 15 mins, test again)

 

[ollie1234]

Thanks for the tip about faster acting sugars, that sounds really good. I'll get some lucozade for the future.

I did the 15 rule - 15 minutes later my blood sugar was even lower (2.9), I ate two fingers of a kit-kat (15g). Next test was half an hour later and 6.4.

I've been doing lots of tests again today (Saturday) and thinking about what I eat. I feel really motivated to learn about how diabetes, carb counting and my body are working, it's great to be thinking about it this much. Here's my readings for both days (the Diabetes Diary app is really useful):

And a graph of the last 24 hours:

I have mixed feelings about today and would really appreciate your feedback again.

I think the adjustment to 18 lantus worked well, I went to sleep at 8.7 and woke up at 5.8, that seems good.

I seem to have taken the right doses (6) for breakfast and lunch as I stayed at a steady 6. Although I am pleased with the results I would like to understand why I got them; how could I have had the carb counts right if taking 6 units for 30g and 6 units for 45g both kept me steady?

No pic of breakfast but here's a pic of my lunch - would you say these sandwiches were 45g?

I was thinking that each one was a quarter, so half a slice of bread. 4x 1/2 slice = 2 slices. 2 x 15g = 30g, plus 15g for both the fillings and for some of them being white bread. This is a bit of a fuzzy way to add them up - could you improve on it?

Also this wasn't an entirely steady 6 as I went hypo (3.1) at 6pm. I drank a can of coke, which I read as having 30g carbs (all sugar) on the nutritional information on the can. Intuitively I'd expect coke to have more sugar than that; does it, or did I read the numbers correctly?

With hindsight I wish I'd just drank half the can (15 rule again) as I went hyper (9.3) 45 minutes later.

I also don't understand why I didn't go hypo in the morning but did after lunch.

Dinner arrived at 7.20pm (I've been out all day), I ate 3/4 of a pizza then about another half a pizza (I got greedy, there was free pizza!). The pizzas had quite thin crusts so I thought their carb counts would be quite low (I estimated 50g for 3/4 of a pizza), but looking at my sugar levels afterwards (9.1, then 15.5) I think I got this very wrong. Here's a picture of 3/4 of a pizza, how many carbs would you say it had?

I took the 2 units at 9pm to correct for the high blood sugar - do you think this was the right thing to do? Also is there anything else I can do (other than just a dose) to bring my levels back to normal as quickly as possible, or do you just have to wait it out?

Finally I just did a test (10.30pm, 15.3). How am I doing at managing this hyper? Should I just wait?

Thanks for reading!

Ollie

Update: tested again at 11.20pm, 14.4. Been hyper for three hours, since 9pm.

I'm thinking that as I ate dinner around 8pm, it will have stopped being absorbed by now, because 11.20pm is 3hrs 20mins after eating, and (as I currently understand it) food is absorbed for up to 3 hours.

This means (again, as I understand it) that my sugar level shouldn't go up any more. My last dose was the correction at 8pm, that will have effects for three hours, so at 12 midnight it should have run it's course. If I test again at midnight then I should get a result that shows me the final results of dinner, my dinner dose and correction dose.

At that point, if I'm still around 15 I might take one more correction unit (risking a night time hypo, but hopefully just bringing me down to a better level for the morning). I'm also going to take my night time bolus now.

Phew, there's a lot to think about sometimes, isn't there? I'd really appreciate some feedback on how I'm thinking it through - it's great to learn how to manage this properly.

 

[RSVP]

Pizza is renowned for causing problems We just don't there.

Insulin requirements vary at different times of day Rob has 1 unit to every 9 grams carb at breakie but 1 to 12 grams come teatime. This is different for everyone.

We also found that having our main meal at Lunch helped as the body processes food easier. For Rob it seems to sit all night causing fluctuating blood sugars if we do it the other way round.


Jelly babies are quick an easy for hypos 3 = 15 gram of carb and are easily stashed in pockets saves carrying oodles of stuff round 🙂


I'm sure others will be along with further pointers Ollie, I can't really advise on the hyper it will be the pizza no doubt. Over nights are tricky for treating hypers as I'm sure you know the yo yo effect can (treat a low and end up high and vice versa) come in to play



Take Care

Sarah 🙂

 

[Robster65]

Hi Ollie.

Something to try and keep in mind while you're getting things stable.

If you can try and stick to some kind of routine time-wise. I notice you inject your Lantus at different times (11pm, 2am). It's meant to last 24 hours but doesn't in meveryone. Mine wasn't lastign the course, so I had to split it. If you inject at 11pm one night and 2am the next, it's going to be running out and overlapping at different times, which will confuse your bolus calcs.

Also, things like pizza might be best avoided until you understand things better. The fat in the cheese delays absorption for hours potentially and then the white bread base fires through to spike you late. You'd be better with a low to medium GI meal with less fat in it. Just for now while you're sorting things out.🙂

I've always found that a structured day works best for me btu realise not everyone can or wants to do it. But without a semi-routine for a few days running, you'll struggle to find patterns you can adjust for.

Rob

 

[ollie1234]

I've set an alarm for 11pm each day, I'm going to aim to take my lantus regularly at 11 from now on. I can see how that's an 'easy win' and will make everything else less complicated. My daily routine does vary quite a bit, switching to regular hours for everything would be too big a jump right now but I'll keep it in mind and see where I can get more easy wins on this front.

Having a main meal at lunch is an interesting idea... also avoiding pizza and going for simpler foods appeals to me a lot right now, it's another way to make things more understandable.

Thanks again for the kind words and advice 🙂