blasted pasta

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Patricia

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Okay all, this is probably rather pump-specific, but I'm after any feedback...

This is what we know: it's now completely clear to us that my son rises from pasta (and probably other things like rice and pizza, certainly chips), for up to eight hours or so after eating it...

We have played with lots of different dual waves (eg 30% of insulin in immediately, followed by 70% spread out over 3 hours etc), and while we have got this to the point where it can 'do' the first five hours or so, he inevitably rises over the next few hours after that, albeit usually only by 3 mmols or so...

SO. We want to try a temp basal with him after a 30% or so bolus...Any thoughts on what level for how long? We're thinking maybe 125% for eight hours? Does that sound stupid?

For anyone on MDI, do you ever do more than split the dose, say give something a few hours later? If so, how much?

Thanks!
 
You say is rise after 5 hours is +3mmol/L, but what is the total? What readings does he get at the peak? If it's <9mmol/L then I would not worry too much.
If I get something like that happening on MDI, I will usually just increase my dose with my next meal. (Although I don't usually test much between meals anyway).

Could you set up a different profile on the pump for when he has pasta?
 
Another suggestion, but more to do with the pasta than the pump. have you tried whole meal or whole wheat pasta? this will release the carbohydrates more slowly than pasta made from refined flour.
 
Hi Alan

We've found that it goes something like this:

starts at good number. After 30% of total insulin given right away, is *usually* about 8 or 9. Then end of dual wave (eg dripping the rest of the insulin dose in over time) is usually about 7mmols. Two hours later can often be 4 or 5 mmols. BUT THEN begins to climb, slowly, so that four hours after that can be as high as 13 or 14 mmols.

If we increase his bolus, he will hypo. We've tried, alas. On MDI we used to split his dose, two hours apart. It kind of covered it, but we began to see him too high every morning after pasta or rice, no matter what we did...

And yes, we can set up a system on the pump for such things, but at the moment we are at a loss where to even start with this system -- the dual wave only does part of the job, obviously. We want to keep putting extra insulin through for a LONG time, but not too much! So we're thinking 115% or 125% for HOURS...but that means testing every two hours through the night...We shall have to do it, though, methinks!

We could try the experiment in the day, but his rise in the day is less pronounced, as the accumulating high seems to get picked up through normal corrections and adjusting dosage for meals...
 
Caroline said:
Another suggestion, but more to do with the pasta than the pump. have you tried whole meal or whole wheat pasta? this will release the carbohydrates more slowly than pasta made from refined flour.
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I would say this is probably exactly the opposite of what you want in this case.

Patricia, do you give him wholemeal pasta? I think what you ideally need to do is aim for a short acting rise that you can bolus for. Try to reduce the fat content as this will slow the rate that the carbs are absorbed. Go for the higher GI pastas in this case.

BTW, I'm no professional, so take my advice with caution. If you go for a quick acting pasta based meal, you will probably see a higher peak, but you should be able to cope with this more easily than the long rise you have been seeing.
 
You're right Alan -- sorry Caroline! Yes we need short acting with a peak we can manage...but we only give him the usual durum wheat white stuff, so it's the shortest you can get. We have noticed a bit of a difference in fat content of sauce -- but this is more reflected in how effective the initial 30% bolus is rather than the length of digestion of the overall meal, eg with a light sauce he hypo-ed at 2 hours!

Sigh. I so appreciate everyone's thoughts!
 
It does sound as though he needs an increased basal for the period when he rises after the bolus is 'spent'. If it were me, I would probably increase basal by a smaller amount than 25% - that sounds a bit too much, so maybe 10% at first. Is there some way of calculating how much x amount of extra basal will reduce levels by (for example, 1 unit of NR will reduce me by 3 mmol/l)

It's very strange though, isn't it? You'd expect that all the food would be completely digested long before 8 hours, and especially if high GI pasta!😱
 
Oh this one is such a trauma I know!

I have been given a new format by my DSN to try (2 weeks ago) but I have avoided pasta (yes my way of dealing with problems is to RUN in the opersite direction!).

If I were to eat for example 80gms of pasta, I have now been informed by lovely DSN I should bolus my normal pasta ratio in the dual which for that would be 12 units and then take the same for the square, so another 12 units over the 6 to 8 hours profile (I wish I could draw a diagram to explain the dual wave for others, sorry). I get hit hard like you and I havent tried this yet. Whenever I ask about pasta etc I always get the lecture because apparently I should avoid all big bolusing and big carb meals. She specifically doesnt like me eating 100gms of carbohydrates or over in one meal sitting, which with pasta/pizza/rice is hard not to sometimes- especially if eating out.

The guy on the US forum I follow swears by the 8 hour profile and it works for him. I get annoyed by the 8 hour profile as I eat my main predominantly in the evening and its unpractical to follow the effect over that 8 hours of the night for me. Im also not keen to use so much insulin. But I guess if that works then it works. I havent tried doing that since it was recommended to me.

I have just dipped into the bible according to John "the god" Walsh to see what he says about it all. Not a lot (GRRRRRRR!) but he does suggest the bolus for these kinds of foods (pg 228) is given pre meal about by about 20 mins. I myself cant fathom this would make a great deal of difference given we are discussing a very long profile of effect. It would be very interesting to see your son use a CGM just for this test alone.

Sorry I havent been much help! Its one of those things if someone finds the solution for they should bottle it and sell it!

xx
 
Patricia said:
You're right Alan -- sorry Caroline! Yes we need short acting with a peak we can manage...but we only give him the usual durum wheat white stuff, so it's the shortest you can get. We have noticed a bit of a difference in fat content of sauce -- but this is more reflected in how effective the initial 30% bolus is rather than the length of digestion of the overall meal, eg with a light sauce he hypo-ed at 2 hours!

Sigh. I so appreciate everyone's thoughts!
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The whole pasta and carbs is quite a minefield with the peaks and the troughs. ALl we can do is make suggestions. Someone is bound to come along with one that works.
 
Just had a quick google for GI valuse for pasta.

Glycemic Index of Pasta

Spaghetti 43
Ravioli (meat) 39
Fettuccini (egg) 32
Spiral Pasta 43
Capellini 45
Linguine 46
Macaroni 47
Rice vermicelli 58
Wholewheat Pasta 50

Also, How pasta is cooked will affect the GI. The more well cooked, the higher the GI. Basically cooking will start the digestion process by breaking down the long chain molecules. This is why mashed potato is much higher GI than baked.

Try wholewheat pasta or Rice Vermicelli and overcook it slightly. Add a low fat high GI sauce, such as tomato and basil. Also, keep an eye on portion sizes. Go for more sauce and less pasta.

Unfortunately though at the end of the day it's going to be trial and error to come up with something that works.
 
I'm on MDI at the moment, so I can't comment on the actual pump issues (sorry), but I wanted to mention that I had this problem with white pasta, but when I swapped to wholewheat pasta, it stopped. I'm not sure why, because like the others have said it should have made it worse! But I thought I'd put my tuppence in incase it helps. 🙂

I'm really curious to see what solution you come up with on the pump, because I'm having this exact problem with any carb-heavy dinner I have. Anything over 70 g of carbs, and I'm fine at bed and sky high in the morning. I'm in the process of being considered for a pump at the moment, so I'm hoping this is one of the things it can help with!
 
Wow, so interesting everyone...

Sugarbum, I think we're just going to have to *go for* the 8 hour profile thing. Like you, our main meal is evening too -- we've been kind of running from it for this reason. But we are all slim people, big eaters, love our food...and exist off of pasta, rice, potatoes...Actually, truth be told, I do fine without a lot of it, but my husband and E actually feel not very good without real carb.

I know that eating less carb is one of those issues (eek!), but it's not unusual for E to have 100g CHO pasta meals -- without sauce. We always give as much sauce as the pasta can actually handle -- or try to. He eats this in minutes and then looks around for more to eat. He is growing like a bean pole. So it is tremendously hard for us to fill him up on other things -- he's just incredibly unsatisfied. However, I really hope in the long run that he will be able to 'fill in' his eating by other means; as he's growing we don't fight it now, but he will need to look at other ways of feeling full in the future, I'm sure...(Problem is both he and husband have very high metabolisms -- they could eat several hot meals a day with no problems, very happy thank you very much...)

GI is a great thing to try to go by, I agree, but ultimately we find parts of it all a bit head-scratching...sometimes it seems to correspond, sometimes not! Argh. I'm therefore absolutely fascinated by what you say randomange -- wholemeal works better for you! Wow. Getting him to eat this may be impossible -- not to speak of anyone else in the family. Love food, love the Italian way, love the 'real stuff'. May be hard...

We are frightened of bolusing for the whole lot in one go, as I know some do, because we are *certain* this will put him on the floor; our experience is that he hypos when we give too much of the insulin up front. However I do know people who do this, and then in addition raise the basal for a period of time.

I take your point Northerner about the percentages -- we may well start lower. What frustrates me is that as soon as we start working out the *actual* maths, it comes out to another whole unit per hour if we spread out the dose -- which just is way too much! So somehow basal (which of course on a pump isn't even a different insulin, just differently dosed) works differently, as you say. I guess it's more about keeping a lid on the rise, rather than exactly dosing?

I think Northerner that your point of estimating how much we want him down at the end of the eight hours is the way to do it -- so, backward. Rather than working from how much insulin the carb content/ratio warrant and spreading it out. It's just so *strange* that the ratio for pasta suddenly seems to go out the window. A ratio's a ratio, isn't it?! Guess again.

Thanks for all this. Finding it so helpful.

xxoo
 
Just re-read your post Sugarbum -- does your DSN want you to bolus straight in the say 12 units? Then follow with another 12? Or dual wave the first 12 somehow, over some number of hours...?

John the man Walsh yes says precious little about this. He is keen to bolus before eating though, and we have been trying this quite a lot when possible. I think it *does* work well, generally...It's more a finesse-ing question though, maybe! A lot of hassle...
 
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