Confused

[astbury1]

If you are on MDI, I have read a few people mention that they have had a hypo due to a delayed meal which confuses me? I know this can happen with insulin like insultard of other 2 injections a day, but I thought the whole advantage of MDI was that you could eat when you wanted? Also heard that some people on MDI didnt eat enough carbs, again I thought the point was that you did not have to eat carbs in every meal ie have a chicken salad and be ok? Can anyone help me with this confusion or am I missing something?
I also do not understand why you would eat more carbs if exercising? Becuase you would bolus for the carbs anyway? So surely this wouldnt make any difference? Unless you did not bolus for all of the carbs?

 

[Caroline]

I don't inject so I may have the little I know wrong.

Some folks inject before meals so the insulin is ready and waiting for whatever they eat. If the meal is delayed the insulin is there but the food isn't so the person will have a hypo.

As I don't inject I don't know if it is the complete story, so hopefully someone else will come along and tell me I'm right or wrong.

 

[DeusXM]

I have read a few people mention that they have had a hypo due to a delayed meal which confuses me? I know this can happen with insulin like insultard of other 2 injections a day, but I thought the whole advantage of MDI was that you could eat when you wanted?

You're right - people who have hypos from delayed meals are generally doing MDI wrong. You're supposed to inject when you start eating. However....many people find that the bolus insulins don't start working as quickly as they'd like and so will still tend to inject 15 minutes before eating - which can cause problems. Also, meal composition can be an issue too. Fat delays carb absorption. If I inject just before eating pizza, I will generally drop too low (as the carbs in the bread are blocked by the fat) but then will rocket back up because the bread just sits in your guts spilling out glucose for hours.

Also heard that some people on MDI didnt eat enough carbs, again I thought the point was that you did not have to eat carbs in every meal ie have a chicken salad and be ok? Can anyone help me with this confusion or am I missing something?

YOU'RE not missing something. The problem is twofold -firstly, the medical establishment still has incredible difficulty in accepting the fact that people with diabetes don't need to stuff themselves with carbs. So doctors and dieticians will continue to indulge in weird double-think where they prescribe an insulin which they know only needs to be taken when you eat carbs but still insist that you need carbs to stop your blood sugar dripping. So firstly, you've got incompetent advice. Secondly, some people on MDI simply aren't taught that they're supposed to adjust their dose for each meal - they're told to take a set amount of insulin regardless of what they're eating. Which essentially defeats the entire point of MDI. In other words, they're not taught to carb count.

I also do not understand why you would eat more carbs if exercising? Becuase you would bolus for the carbs anyway?

Exactly - and this is why so many T1s put on weight and can't shift it. They're told to eat carbs and to cover those with insulin. And then they're told to eat more carbs to stop their blood sugar dropping when exercising - instead of the far more sensible suggestion of taking less insulin. Given that all glucose in the blood over 7mmol/l gets converted to fat by insulin, you can see why constantly eating before exercise will probably make you fatter than not exercising at all - you take in more calories, thus negating the calorie deficit you need to lose weight, and you're also generally eating precisely the thing that encourages your body to store fat.

If you ate an all-fat diet, you would lose weight very quickly. Why? Because fat can only be stored by insulin. If you don't eat carbs, a normal person produces hardly any insulin, which means it can store hardly any fat.

 

[everydayupsanddowns]

If you are on MDI, I have read a few people mention that they have had a hypo due to a delayed meal which confuses me? I know this can happen with insulin like insultard of other 2 injections a day, but I thought the whole advantage of MDI was that you could eat when you wanted? Also heard that some people on MDI didnt eat enough carbs, again I thought the point was that you did not have to eat carbs in every meal ie have a chicken salad and be ok? Can anyone help me with this confusion or am I missing something?

Not sure what you have read astbury1, but you are quite right MDI *should* mean that you can skip a meal, or eat a meal with little or no carbohydrate without risking upsetting your BG. Here are a few possible explanations...

1. The person doesn't have their basal insulin set right. By splitting apart basal (background) and bolus (meal) insulin you allow yourself to skip or miss meals as the basal will keep BGs from rising as the trickle of glucose from the liver will be taken care of. BUT, basal needs change from time to time, and unles you keep an eye on them you can end up with a general drift of BG upwards or downwards. Inaccurate basal can also make your 'usual' meal boluses/ratios misbehave in either direction. Basal dose(s) are not a case of set once and ignore. Every so often they will need tweaking.

2. The meal being 'too late' might mean between the bolus and eating the food. For very fine-tuned post-meal control some people on MDI bolus a short while before eating. 15-20 minutes in not uncommon, but some leave longer. If you bolus and then dont eat soon enough after the insulin will begin to work before the meal has started to digest

3. Similarly 'not enough carbs' might just mean a miscalculation in the meal size. eg dosing for a best guess at 40g CHO, which turns out to be 25g

I also do not understand why you would eat more carbs if exercising? Becuase you would bolus for the carbs anyway? So surely this wouldnt make any difference? Unless you did not bolus for all of the carbs?

This one's easier - exercise makes you much more sensitive to insulin and so people on MDI either reduce meal doses before exercise or eat extra fast-acting carbohydrate (without bolus) during/after exercise or a combination of the two. Exercise affects everyone differently, so it's another one of those things that you need to test and see what works for you.

Hope that helps 🙂

 

[astbury1]

Thanks caroline this makes sense to me now!🙂

I don't inject so I may have the little I know wrong.

Some folks inject before meals so the insulin is ready and waiting for whatever they eat. If the meal is delayed the insulin is there but the food isn't so the person will have a hypo.

As I don't inject I don't know if it is the complete story, so hopefully someone else will come along and tell me I'm right or wrong.

 

[astbury1]

Thanks Deusx and Every day for this explanation as I was getting confused by what some people had put in their posts. The timing of bolus makes sense and so does the carb and exercise thing. When I start MDI i think I will bolus just after as makes more sense to me at the moment especially if you decide you cant eat all of your food!


I have read that with some food like pizza and low GI you can even wait a litlle while after you have finished eating to bolus?

 

[everydayupsanddowns]

I have read that with some food like pizza and low GI you can even wait a litlle while after you have finished eating to bolus?

That's very much somethig you have to assess yourself by testing what happens to your BG after food with different injection timings.

The *usual* advice I think is to take the insulin just before eating, but by testing different foods at 1 or 2 hours after eating you will see what happens to your BG (which can vary at different times of day too!).

Your suggestion to begin with one strategy then review it is perfect. 🙂

 

[trophywench]

Also depends how quickly you eat - bearing in mind as soon as you put food in your mouth, saliva starts the digestion process (well enzymes in saliva to be precise) and eg if you are hypo, some glucose will be absorbed through the insides of your cheelks to start bringing your BG up a bit. Which obviously continues as you swallow what ever it was.

With pizza, the usual strategy is to split the bolus for it actually. Esp with added chips! Half now, half in 40 minutes; or 60/40 after half an hour - or whatever works for you once you've tried different things a few times.