Fatty foods/takeaways

[Kirsssty]

Someone please help me I am losing my mind.

I'm currently on MDI but been approved for an insulin pump (hooray), I'm on fiasp and tresiba.

Without fail I can never eat a Chinese, McDonald's or any takeaway in that matter without having awful high glucose in the night at bed time.

I have tried prebolusing and taking the whole dose before eating - this lead to instant hypo and still after hypo treatment serious high glucose hours after with it refusing to come down with fiasp.

I have tried splitting the dose and taking half before eating and other half just under an hour - still spiked really bad in the night even after corrections - barely came down for hours.

I have tried splitting the dose and taking half before and the other half dose an hour after with an extra 30% bolus on top - still spiked in the night and hours of correcting.

I am at the point now of being depressed that I simply cannot eat any takeaway.
Surely life shouldn't be like this? I am doing a DAFNE course next year and this is one of the reasons.

But in the mean time - does anyone have any advice for the spikes and insulin resistance during sleep? I am so down

 

[Anna DUK]

Hi @Kirsssty. Sorry to hear what's happening for you. Are you carb counting when you take your insulin?

 

[silentsquirrel]

Have you tried leaving a longer gap before the 2nd bolus? Maybe try increasing the gap gradually?

 

[Inka]

@Kirsssty DAFNE won’t help with that. Unfortunately, it’s just a case of experimenting and, often, correcting. Some things to try in your experimentation (you can possibly adjust these as you get experience):

- eat your takeaway ‘early’ - ie at evening meal time, giving your body and you time to sort things
- initially choose something simpler and have a smaller portion of the rice/noodles than you’d normally have (you can increase as you gain experience)
- choose the same meal for these initial experiments (to remove one variable)
- know that different takeaways (ie Chinese, Indian, fish and chips, pizza) will require different strategies
- watch your Libre but use your meter/fingerprick to check what’s happening at intervals after eating, eg at 90mins, 120mins, etc.
- be ready to correct if needed but do a moderate correction (smaller than you’d calculate) to avert later lows
- accept that these early tries will be information-gathering activities, so don’t let a high/low upset you: see it as information you can use in future.

What did you have for your take-away? And what time did you eat it?

 

[Kirsssty]

Hi @Kirsssty. Sorry to hear what's happening for you. Are you carb counting when you take your insulin?

Hi! I am trying to the best I can still quite in confident in it. X

 

[Kirsssty]

Have you tried leaving a longer gap before the 2nd bolus? Maybe try increasing the gap gradually?

No I haven't I've always started the second dose about an hour after usually as that's when I start to see them rise x

 

[Kirsssty]

@Kirsssty DAFNE won’t help with that. Unfortunately, it’s just a case of experimenting and, often, correcting. Some things to try in your experimentation (you can possibly adjust these as you get experience):

- eat your takeaway ‘early’ - ie at evening meal time, giving your body and you time to sort things
- initially choose something simpler and have a smaller portion of the rice/noodles than you’d normally have (you can increase as you gain experience)
- choose the same meal for these initial experiments (to remove one variable)
- know that different takeaways (ie Chinese, Indian, fish and chips, pizza) will require different strategies
- watch your Libre but use your meter/fingerprick to check what’s happening at intervals after eating, eg at 90mins, 120mins, etc.
- be ready to correct if needed but do a moderate correction (smaller than you’d calculate) to avert later lows
- accept that these early tries will be information-gathering activities, so don’t let a high/low upset you: see it as information you can use in future.

What did you have for your take-away? And what time did you eat it?

Hi Inka, thank you so much for your reply. I will take this into consideration 🙂

At 8pm I had 2 burgers and about a small handful of fries from McDonald's. (Wasn't even worth it it was horrible lol) - but every time I eat it without fail I constantly spike during sleep. That's whether I take half bolus before then the other half an hour after and correct, and that's even if I take half bolus before and the rest of the dose split in half again over the next 2 hours x

 

[CliffH]

Someone please help me I am losing my mind.

I'm currently on MDI but been approved for an insulin pump (hooray), I'm on fiasp and tresiba.

Without fail I can never eat a Chinese, McDonald's or any takeaway in that matter without having awful high glucose in the night at bed time.

I have tried prebolusing and taking the whole dose before eating - this lead to instant hypo and still after hypo treatment serious high glucose hours after with it refusing to come down with fiasp.

I have tried splitting the dose and taking half before eating and other half just under an hour - still spiked really bad in the night even after corrections - barely came down for hours.

I have tried splitting the dose and taking half before and the other half dose an hour after with an extra 30% bolus on top - still spiked in the night and hours of correcting.

I am at the point now of being depressed that I simply cannot eat any takeaway.
Surely life shouldn't be like this? I am doing a DAFNE course next year and this is one of the reasons.

But in the mean time - does anyone have any advice for the spikes and insulin resistance during sleep? I am so down

Is it possible that the fats in the food are causing a spike as they're broken down in the body? Would it happen that quickly?

 

[rebrascora]

Is it possible that the fats in the food are causing a spike as they're broken down in the body? Would it happen that quickly?

Only about 10% of fat is broken down by the body in the absence of enough carbs and 40% of protein, so the protein will have 4x the effect that fat does and fat releases over a much longer period than protein even which is much longer than carbs. This is why on a low carb way of eating we often have to inject insulin to cover protein release about 2 hours after eating but unless you are eating mostly fat and not much else, then fat is not of itself something to consider injecting for. However, it may be that the fat is slowing down the release of glucose from the carbs and therefore the body starts breaking down the protein and fat into glucose, so that you get glucose from all 3 components to a greater or less extent, the fat being the least impactful in respect of glucose but potentially triggering this situation. Two quarter pounder burgers will have a decent amount of protein in them so it is likely mostly protein release which will happen for about 6 hours, starting about 2 hours after eating. So I would bolus about half up front for the carbs and then the remainder 2 hours later but with an additional bolus for the protein. Trial and error will be the only thing which will tell you how much extra you need, but it can require a surprisingly significant amount.

Added to that, from my experience of Fiasp, once levels get above 10mmols, it is much less effective both in terms of being much slower than it's normal fairly prompt action but for me also significantly less effective in lowering BG and I now have my high alarm set at 8.2 to prevent levels getting into double figures otherwise I usually have to significantly increase my correction factor, or my preference which is to stack 2 smaller corrections an hour apart. Of course stacking corrections is frowned upon so you need to decide if it is a safe and valid strategy for you.

I usually find I need two stacked corrections after a high protein and fatty meal using Fiasp, 2-3 hours after the meal. Obviously going to bed with 2 stacked corrections in your system would be extremely controversial, but it works for me when I need it. I sleep badly when my levels are above 8mmols, so for me I am prepared to take that risk and if I get t wrong, then I can always wake up and eat a jelly baby or two, which I find much less disruptive than being high and potentially having to calculate and inject a correction at 2am.

 

[littlevoice359]

McDonald’s food is actually much higher in carbs, fat and protein than I realised.

For example, attached are three sample meals. I took the nutrition information from the McDonald’s website and plugged it into my meal planner. Each of these, quite small meals with no soft drink, would be double what I normally eat for my main meal (dinner).

Also, each meal has quite a high FPU number (a measure of fat and protein ratio). In my experience, a meal with an FPU number of 3 or more can cause my blood sugar to rise 3 hours or more after eating. I have learned to watch for that and, if it happens, I take a correction bolus then to stay within target.

 

[Lucyr]

I have tried splitting the dose and taking half before eating and other half just under an hour - still spiked really bad in the night even after corrections - barely came down for hours.

Are you counting the carbs correctly? Sounds like you simply need more insulin for these foods.

 

[everydayupsanddowns]

You have my sympathies @Kirsssty

Partly for me it’s about persevering, and keeping going with your experiments, and knowing that you will be able to crack it…

And then your diabetes will bloomin’ well change the rules, and you’ll have to adjust your system again!!

Another thing for me is to make the effort where it’s worthwhile. So I’m prepared to take the risk for a cracking burger from our local cafe-bar, but I’m way less tempted by the disappointment of a McSoggy and cold worms fries.

Like you I also found I needed to add extra insulin above my carb count / estimate. And I’d generally split 60:40, so more ‘up front’, and the rest a couple of hours later.

Good luck, pick your battles, and you’ll get there eventually.

 

[Inka]

Hi Inka, thank you so much for your reply. I will take this into consideration 🙂

At 8pm I had 2 burgers and about a small handful of fries from McDonald's. (Wasn't even worth it it was horrible lol) - but every time I eat it without fail I constantly spike during sleep. That's whether I take half bolus before then the other half an hour after and correct, and that's even if I take half bolus before and the rest of the dose split in half again over the next 2 hours x

Probably a shocking confession to some but I haven’t eaten at McDonalds for many years! But - firstly, check the carb count so you’re sure that’s right; secondly, if you want to eat a McD again, have the exact same thing but eat earlier, eg 6pm.

As Lucy says, if you’re staying high, it might just be you need more insulin for that meal. If you’re spiking during sleep, that’s a bit trickier - hence my suggestion to eat earlier so you can monitor and sort any problems. If you have a Libre, I’d set a high alarm at a slightly lower level than you probably usually do, so you wake and fingerprick your blood sugar. If high and rising, you can then decide whether to correct. If you do correct, initially take half the correction you think you’ll need, then see how things are in the morning and adjust your strategy if necessary next time.

 

[Robin]

The only take away I normally eat is the occasional fish and chips if we’re on holiday, but it took me ages to work out how to bolus for it, because I eventually realised that the portion size was way bigger than I’d normally have, and way bigger than I was bolusing for.