How to alter bolus for pasta based on results

[curlygirl]

Hi,
ok, so it's been a few weeks now since i started on the pump and whilst i am still trying to get my head around things and feeling kind of overwhelmed still, there are also brief moments where i think ' i think i could really like being on the pump once i get things sorted more' - so hopefully that is good.

If anyone can give a bit of guidance it would be appreciated. I initially stuck with pretty much the same foods and kept them very straightforward. This was becoming somewhat repetitive however and my dsn said it was time to branch out a little. A few nights ago i had pasta - it is wholemeal pasta- and veggie sausages, with a homemade spicy tomato sauce.
The total carb count was 72g - this is higher than my usual meals which are around 50 or 60g of carbs.
The advice from the pump rep was to split 50/50 between upfront and a multiwave of 1 hour. I did this and now need to know how to improve the results i got, so if anyone can suggest wheter it should have been split differently, or spread over a different amount of time etc that would be much appreciated.
I know everyone is different and require different splits etc, but if i give the results i got hopefully someone with experience of translating them into what to do next might be able to advise...
Pre- tea bg - 5.3
2 hours after meal - 11.3
Bedtime (approx 4 hours after meal) - 10.9
1.30am (i got up to the toilet so thought i'd see what my blood was doing) - 13.5
Woke up at 7.30am - 6.4
Thanks for your time
Curlygirl

 

[Annette]

Hi Curlygirl
My thought is - are you sure your overnight basal is right? Putting aside the bolus for the pasta for the moment, its just that, by 1:30am, both your insulin bolus and your food should be pretty much out of your system, and yet you are dropping from 13.5 to 6.4 in 6 hours. Just think how low you'd be if you'd started at an in range number and dropped that much!
The other thing is, 72g maybe too much for your system to handle on its current ratios. What I mean is that everyone has a limit at which their carb ratios don't work so well, and if they eat more than that amount, they need a greater amount of insulin than normal. (for example, my evening carb ratio is 1:8, but if I have more than 60g cho, I need to manually adjust it to closer to 1:6.) So it might be worth trying a similar pasta meal but with fewer carbs, to see if its the way your system digests pasta, or if you've found your upper cho limit.

 

[Mark T]

Although I'm T2, so I don't exactly know the response time of insulin, but hopefully this might be relevant...

I have experimented with Pasta a couple of times. What I found is that my BG didn't actually start rising until 2-3 hours after the meal (even later if I combined pasta and alcohol).

So might be worth you also doing some extra tests to figure where it enters your system.

Note, when they measure the GI of a food I believe they only measure +1hr and +2hr. Pasta is usually stated in the books as low GI - I suspect it's actually more medium GI.

 

[trophywench]

I have a 5 or 6 hour 'spike' after pasta and rice. if I eat more than about 50g worth of it.

There is a gap before that - my BG having gone back down to normal pre-meal level again a couple of hours after eating, then stays the same for an hour or so - then shoots up high again.

There is no way you can set a bolus for that, I need about 40% upfront, the other 60% over the next 1.5 hrs, then no bolus just basal then a load more bolus to deal with the spike.

Consequently I either eat only 50g worth - or I say Han it, do the same jab adjusted for the amount of carb, and deal with the aftermath next morning.

I can't see any way of doing it otherwise, cos I can't tell what time it will happen, and it's impossible to plan alarm clocks for.

If I knew when it was going to happen I could change my basal pattern for that time, to incorporate the extra - but I can't!

 

[curlygirl]

Thanks for your replies.

Annette - i too have wondered about my overnight basal, but the odd thing is that i wake on six point something each morning regardless of what i ate or what my bedtime reading was. My feeling is that this will have to be altered at some point, cos like you say - if i was in range before bed regularly then i would likely go hypo over night, at least in theory - but while my bedtime figure is tending to be higher than ideal due to still trying to figure out ratios etc my dsn says to leave it as it is for now.

Mark T - thanks for responding. I have found pasta to be something that behaves in both a low gi and a med/high way at various different points in time and will have to continue trying to figure it out by experimenting i guess.

Trophywench - i have wondered whether what you and Annette said is the case and it is just too many carbs to process at once - maybe i'll cut down the quantity and see the effect on blood sugars...

Thanks again.
Curlygirl

 

[trophywench]

Well just try it once to see what happens - if it seems to work try it again another day.

It is a PITA indeed when you don't eat masses of it in any event - I was the same, never had a mountain of anything - but there you go. And I still have the same amount of whatever sauce I have with it, so it's only 'carb rubbish' you cut down on, so you shouldn't be hungry, since protein fills you up for longer than carb anyway. You know, like having a one slice sandwich, but with twice as much ham !

 

[everydayupsanddowns]

My experience with pasta is a mystery. My body seems to go through phases of having absolutely no bother with it (60-70g CHO of pasta shapes dosed all up front) but at other times it needs really careful handling.

I have a note in my phone where I jot down things I have tried for various meals that have worked pump-wise and the pasta section(s) are by far the longest!

Even the shape of the pasta seems to make an extraordinary difference (white spaghetti/tagliatelle needing much more 'spread out' dosing than wholewheat pasta shapes). It also esems to need different handling in the evening to at lunchtime, despite basal being apparently OK when tested.

Another thing that seems to be paying off more recently (though this has not always been the case) is to add an extra amount of insulin to the calculated dose for pasta meals only. Carb load is pretty common so I don't know if this would scale with larger smaller meals, but it can be up to 2u at times.

As an example, here's my current system for spaghetti:

Pasta CHO, plus 10g allowance for sauce. Deliver dose plus additional 0.8u as 35:65 Dual Wave over 3.5 hours. Then add an extra 0.8u up front.

This does involve going to bed with quite a large amunt of insulin still active, but my Libre readings oer recent months have reassured me that my BGs don't crash overnight.

I suspect I will need to change/tweak the system again within the next 2-3 months.

If we didn't like those meals so useful I would have given up by now!

 

[Maryanne29]

For once I must have done something right with pasta. Last night I had what should have been 50g of carbs of pasta - everything else with it was carb free. But I entered 70g of carbs into the pump handset and three hours later when I went to bed BG was 6.5 - a good number for me. And this morning I was 4.7 so a good result. What my BG did during the night I don't know but I slept well. This may have been a one-off good pasta result but I'll try over estimating the carbs next time and see if I get similar results. 🙂