Food in addition to what you've calculated carbs for

[DancingStar]

What do you do if you've injected your bolus insulin based on the carbs in your food but still feel hungry when you've finished eating and want to eat more? For example, I calculated my bolus in respect of the bowl of cereals I was having for breakfast but then when i'd finished those was still hungry and wanted a slice of toast. Should I inject a bit more insulin or should I assume my basal insulin will "deal with" the toast?

 

[khskel]

If your basal rate is correct it shouldn't deal with the toast. Have another jab of bolus for the toast.

 

[Pumper_Sue]

Basically your bolus is needed to cover all carbs.
Background is just that.

Obviously if you are low then you need some carbs to mop up excess insulin.

 

[Eternal422]

My DSN recommended only adding more bolus insulin if the extra carbs were more than 10g, so one slice of toast should mean you wouldn’t need any extra insulin and if your basal is correct then it will cope with the small additional amount of carbs.

Of course, everybody is different and you may find that even one slice of toast pushes up your BG too much, so taking more bolus may be needed, even if only 1 unit.

Sorry! With this game there are no simple, universal answers and it is all about trial and error and what works for you.

 

[Pumper_Sue]

My DSN recommended only adding more bolus insulin if the extra carbs were more than 10g, so one slice of toast should mean you wouldn’t need any extra insulin and if your basal is correct then it will cope with the small additional amount of carbs.

So are you saying you can have 5 x 9gms of carbs through out the day with no bolus?

There are very few slices of bread less then 10 carbs either.

 

[Bruce Stephens]

So are you saying you can have 5 x 9gms of carbs through out the day with no bolus?

I think that would be pushing it. The idea is just not to worry too much about (say) the milk in tea or coffee (or the little biscuit that comes with it in some cafes).

 

[Eternal422]

So are you saying you can have 5 x 9gms of carbs through out the day with no bolus?

There are very few slices of bread less then 10 carbs either.

No, this was in relation to having a snack between meals or fancying something extra after a meal that you had already accounted for in a bolus. Obviously having multiple 10g snacks throughout the day wouldn’t be covered and you would need either to bolus them or make a correction to your bolus for your next meal.

I appreciate that a slice of bread may well be anything up to 20g carbs, so would need a bolus to cover, but a small slice (24g weight) could be around 13g carbs.

Sorry - didn’t mean to cause confusion!

 

[DancingStar]

I thought the basal insulin was to cover the kind of thing that Bruce mentions above. I have some fruit as a snack at around 11am every day and I specifically asked my DSN about this and she said that my basal insulin should deal with this, but the bread we buy is 19g per slice. Neither my consultant or DSN mentioned extra insulin outside of the bolus I take before Breakfast, Lunch & Dinner and I wasn't sure if this was something I should consider.

This is a steep learning curve. If you were going to have a carby snack in the afternoon would you have another bolus then? For example my sister offered me a hotcross bun yesterday afternoon and I was sorely tempted but didn't know what to do re the insulin so turned it down even though I love hotcross buns

 

[Eternal422]

Basal covers the glucose your liver pushes out throughout the day. You need the bolus to cover carbs eaten, but from what my DSN was saying (and also from what yours is too about the fruit snacks), carb snacks less than 10g carbs should be covered by the basal in your system. Anything over 10g needs additional insulin, in which case you bolus for the whole amount.

So, for your toast which is 19g per slice, you would take additional insulin to cover the full 19g. For the hot cross bun - maybe 48g carbs? I would definitely take a bolus to cover that.

The problem I find is that if I fancy something, such as your example of the hot cross bun, I can’t wait 15 mins or longer for the bolus insulin to start working before eating it! Nevertheless, insulin doesn’t mean that you can’t have things, just that you need to total up the carbs (which often is a guess) and give yourself insulin to cover them.

Hope this helps 🙂

 

[rebrascora]

I think DSNs try to keep it simple in the early days of diagnosis. That is partly so that they can see how your levels are doing if you are just having 3 meals a day, so that they can tell if your bolus is bringing you back down into range and it also helps them assess if your basal is holding you steady.

In reality, your basal insulin is there to deal with the glucose released by the liver, day and night. If there is enough excess to mop up 10g carbs which would normally raise your levels about 3mmols, then potentially without that 10g snack your levels would drop by 3mmols. There is no harm in bolusing for a snack between meals or extras on top of a meal if you are still hungry..... dessert after a meal would be a prime example of a situation where you would do that.
Your average slice of bread is going to be about 15g carbs, so yes, I would certainly bolus for it and absolutely for a hot cross bun which will be near 40-50g carbs. It can become confusing when you start doing corrections because when you go to eat that mid meal snack, your levels are likely to be above range and you might be tempted to do a correction, when there is active insulin in your system already to bring that high level down, so for a mid meal snack, you would not do a correction. Just inject for the carbs you are going to eat. Similarly, when you come to eat your next meal, if it is within 5 hours of the snack, don't be tempted to do a correction if your levels are above range then either as that insulin will still be working to bring them down. I always make a note of insulin injected and carbs on my Libre so I don't lose track of the insulin in my system.

 

[Bruce Stephens]

I thought the basal insulin was to cover the kind of thing that Bruce mentions above.

I understood it similarly, but more that there really isn't that much difference between the two interpretations. For someone not eating low-carb, a small snack just doesn't make that much difference. Less difference than just ordinary day to day variation (often of unknown cause), anyway.

So it's fine to think of it as being covered by the basal insulin, or by the bolus you had for the previous meal. Or some combination. Doesn't matter enough to worry about it.