Grazing and dosing

[dannybgoode]

Just got back from a friend's - been round for our usually pre Christmas catch up (which was really nice and got to see some other friends who have just had twins so great to see them too).

My question is how do you eat when an offered meal is a 'slow release' buffet so food just kept appearing over a few hours.

Dips and crisps, cheese and crackers, pulled pork brioche buns etc. All delicious, all irresistible.

I dosed up 12U of NR and then a correction of 3U based loosely on what I was reading however as food just kept coming I are the last morsal around 3.30pm so my pre-tea reading was high at 16.

I'm not concerned about that in and of itself but is there a better way of dosing in such scenarios or so you just have to avoid grazing as much as possible?

 

[Lucyr]

My question is how do you eat when an offered meal is a 'slow release' buffet so food just kept appearing over a few hours.

Inject every time you eat carbs, for the amount of carbs that you are eating each time. Or inject for x grams of carbs then stop eating carbs when you get to x, unless you’re injecting more insulin

 

[rebrascora]

I graze very often, propbably more often than eating full meals, but I follow a relatively low carb way of eating and I just inject for what I am about to eat, doing my utmost to keep my levels below 10 because once they get above 10, I will be high for hours and I usually get frustrated and end up jabbing silly amounts of insulin to bring me down which might then end up being too much, otherwise referred to as a "rage bolus". I might end up having 10 or more injections a day eating this way but that doesn't bother me particularly.

This works for me and I record each insulin dose on my Libre log so I can keep track of how much insulin is still active in my system, particularly as it comes towards another mealtime or bedtime.

Pleased you had a good time catching up with friends and enjoying the food. Hopefully you will come down from 16 quicker than I would. 🙄

 

[rebrascora]

@Lucyr I love how simplistically you explain that.... and many other things. Always short and to the point!

 

[dannybgoode]

Inject every time you eat carbs, for the amount of carbs that you are eating each time. Or inject for x grams of carbs then stop eating carbs when you get to x, unless you’re injecting more insulin

Difficult to do either when grazing over 2 or 3 hours however I can experiment next time I'm in this position.

 

[dannybgoode]

but I follow a relatively low carb way of eating

This was err... Shall we just say not a low carb situation .

Was delicious though so don't regret it for a moment.

I'll see what my bedtime reading is and decide if I need to take any action tonight or just level things out tomorrow...

 

[Lucyr]

Difficult to do either when grazing over 2 or 3 hours however I can experiment next time I'm in this position.

Why would it be difficult? Look at the food available and either put food on your plate first or decide how many carbs you’re going to eat. “Looks carby and I’m starving I’ll start with 60g”. Inject whatever your ratio is for that and eat it. When you get to the amount you’ve injected for then reassess. “Oh those new items or puddings look nice and I’m still hungry”. Repeat the above.

 

[rebrascora]

Yes, but even so, I still have to inject for the carbs I have and sometimes protein release afterwards. This afternoon I have been naughty and had dried figs with mature cheddar. I would keep injecting for one or two figs and then going back for another one or two half an hour later and then there were only 2 left in the bag, so might as well finish them since I was enjoying them so much, so another 2 units, then I fancied some peppadew stuffed peppers and a tub of those needs 2 units and then I was really naughty and had a cup of tea with a dark chocolate ginger biscuit, so that was another 1.5 units, so just small amounts of carbs each time needing 1-2 units but probably 5 injections over the course of the afternoon with different foods I have had. In some respects what you did, injecting a larger dose up front and then topping up later if you know it is going to be a substantial amount of food, rather than me not intending to eat much but then wanting more and more as so often happens when I eat carb rich foods. 🙄

 

[dannybgoode]

Why would it be difficult?

Simply constantly injecting for 2-3 hours every time a new dish appears. Just something to get used to I guess. I'd have done about 8 injections today however if that's the correct method then I'll have a play around next time I'm in this scenario. Won't be very often but useful to understand.

 

[CliffH]

Yes, but even so, I still have to inject for the carbs I have and sometimes protein release afterwards. This afternoon I have been naughty and had dried figs with mature cheddar. I would keep injecting for one or two figs and then going back for another one or two half an hour later and then there were only 2 left in the bag, so might as well finish them since I was enjoying them so much, so another 2 units, then I fancied some peppadew stuffed peppers and a tub of those needs 2 units and then I was really naughty and had a cup of tea with a dark chocolate ginger biscuit, so that was another 1.5 units, so just small amounts of carbs each time needing 1-2 units but probably 5 injections over the course of the afternoon with different foods I have had. In some respects what you did, injecting a larger dose up front and then topping up later if you know it is going to be a substantial amount of food, rather than me not intending to eat much but then wanting more and more as so often happens when I eat carb rich foods. 🙄

I've never tried dried figs with mature cheddar, although I like both of those foods. I'm less keen on mature figs or dried cheddar though.

 

[Lucyr]

Simply constantly injecting for 2-3 hours every time a new dish appears.

You don’t have to inject for every dish, I explained that above?

 

[Lucyr]

I'd have done about 8 injections today

I’ve easily done 8 injections today, it’s how diabetes works. By the time you’ve injected your basal, plus for every meal, plus for any snacks or milky drinks, plus a between meal correction if you’re unwell (I have a cold) or are guessing carbs (I’m away and guessing everything), it’s easily 7-8 injections a day.

You basically have 3 choices, which I explained above. Inject for x grams of carbs then choose what exactly to eat after injecting. Inject for each dish as you choose to eat it. Or don’t eat much / eat before going.

 

[dannybgoode]

You don’t have to inject for every dish, I explained that above?

I didn't know what was coming next though. We'd have a bit of something then another dish would appear.

I did initially start of trying to think hmm, I'll need xU now but lost track a bit.

I'll get used to it all I'm sure and thank you for your help. It does make sense, just takes a bit of processing my end...

 

[Lucyr]

I didn't know what was coming next though. We'd have a bit of something then another dish would appear.

You don’t have to know what’s coming before it’s coming. Maybe you need a bit more detail…

Eg I choose to inject for 60g initially and inject that then see what’s available. I start with some little sandwiches and sausages, maybe 20g. I know I need another 40. Some cheese comes out so I eat that, no carbs, still need another 40. Warm little sausage rolls come out, oh they look good, another 10 eaten I still know I need another 30. Pulled pork brioche buns, oh maybe that’s 30g. I’ve injected for 60g and eaten 60g now so at this point if I eat anything else with carbs I know it’s another jab time.

Throughout all of this I’m monitoring my cgm too, if I start heading down I need to eat the carby foods first, if I’m heading up I can sprinkle in low carb foods and eat the carbs more leisurely. There’s always a snack with me and the option of a sugary drink if I get it wrong and head down.

 

[dannybgoode]

Throughout all of this I’m monitoring my cgm too,

This is one thing I don't have yet and can see how useful it will be if T1 is confirmed or it's T2 and I stay on insulin.

I did start of doing a quick 'rough sketch' of what I was going to be eating but rather lost track.

What you say makes sense and next time I'll be better prepared 🙂

 

[rebrascora]

I think the beauty of Libre is that we can wing it a lot more now and just correct later. I appreciate that you don't have Libre or other CGM yet (or at least I think you don't) but they can be useful for situations like this in the future where it is all a bit of a guessing game. I tend to respond to my Libre readings more than actual carb counting these days knowing I can jab more insulin later or eat a jelly baby or two if needs be. I inject a rough guess up front and then just keep topping up as the food keeps coming. Chinese buffets are like this. A rare occurrence for me but I just keep jabbing a guess for each course and usually end up jabbing a late correction at midnight or early hours when I wake up high.

 

[Lucyr]

This is one thing I don't have yet and can see how useful it will be if T1 is confirmed or it's T2 and I stay on insulin.

You can always put the one in your cupboard on if it would help with these situations eg snacking more over Christmas

 

[dannybgoode]

I appreciate that you don't have Libre or other CGM yet (or at least I think you don't

Not yet. Waiting for confirmation of type before they decide whether I can have one. Hopefully that side of things will still be resolved in the next week or two.

 

[Inka]

Difficult to do either when grazing over 2 or 3 hours however I can experiment next time I'm in this position.

I’ve done exactly that at wedding and celebration buffets. Take some food, carb count it, inject for it and repeat. The only thing not to do is correct a ‘high’ sugar without giving it time to come down. That is, don’t eat a plate of vol au vents, then half an hour later take a slice of pizza, see your blood sugar is 12 (from the vol au vents) and add a correction to your pizza dose. Just carb count and inject for what you eat. If you over-estimate the carbs and go low, correct the hypo and be cautious with your next bolus.

 

[SB2015]

Grazing over a long period does make it more difficult to keep track. I ted to do what @Lucyr has said and inject a bolus, then eat up to that injection, then if I am wanting to eat more, add a bit more insulin for the next lot of carbs. I may well los track a bit and that there will be a series of boluses involved.

I just accept that I am likely to end up a with BG a bit higher in these circumstances but that is fine, anD at the end of the day I am likely to be walking home so that will knock off a bit of the glucose, and I can do a correction before bed if necessary.

All we can do is the best that we can, and it is worth a few extra boluses to enjoy a good evening with friends.