Newbies’ first big carb meal

[betheaton]

I’m just over a month into my TD1 journey and have recently been taken off my restricted insulin. I’ve been pretty good with sticking to low carb, however my family are having a trip to Wagamama this coming week. On the website, my usual meal (steak teriyaki soba) is 84g of carb. This will be the highest bolus I’ve taken (novorapid), so is obviously a bit scary. Any tips on how to successfully eat this meal without having hypos/massive spikes all night? Thanks!!

 

[Bruce Stephens]

Any tips on how to successfully eat this meal without having hypos/massive spikes all night?

If you want to handle it gracefully, you probably want to split the dose. So have some just before you eat, and then the rest a bit later (a couple of hours later). (Larger meals take longer to digest, and larger amounts of Novorapid will likely take you too low too quickly to match up. That's what happens to me, anyway.)

On the other hand, when I was discussing lunchtime pizza with my dietician (we were looking at the graph going rather too high for comfort because I'd got it rather wrong) she agreed that I could have split the dose, but also suggested I just shouldn't worry about it: it's once in a while, after all.

So long as you're safe (so don't go hypo (at least, don't go too hypo) and don't go too high overnight) once in a while isn't a disaster.

 

[betheaton]

If you want to handle it gracefully, you probably want to split the dose. So have some just before you eat, and then the rest a bit later (a couple of hours later). (Larger meals take longer to digest, and larger amounts of Novorapid will likely take you too low too quickly to match up. That's what happens to me, anyway.)

On the other hand, when I was discussing lunchtime pizza with my dietician (we were looking at the graph going rather too high for comfort because I'd got it rather wrong) she agreed that I could have split the dose, but also suggested I just shouldn't worry about it: it's once in a while, after all.

So long as you're safe (so don't go hypo (at least, don't go too hypo) and don't go too high overnight) once in a while isn't a disaster.

Feel like a mad scientist trying to dose myself!!! Crazy illness!

 

[Bruce Stephens]

Feel like a mad scientist trying to dose myself!!! Crazy illness!

And no two experiments turn out exactly the same even when you think they ought to.

(And then weird things happen. I had half a pizza for dinner and then changed my Libre sensor. Which, after warming up, read 4.7. And a bit later, 4.7. And then 4.7. (It read 4.6 and 4.8 too, but mostly 4.7) Thought it was broken, but when I checked with test strips they pretty much agreed.)

 

[SB2015]

I found that were a lot of lower carb options in Wagamama’s but if you want to stick to your favourite, then as others have said, you could try splitting your Bolus. I also find that if I have a bigger carb load I sometimes need a bit of extra insulin. It is all a case of trial and improvement.

Think of your meal out as some research and enjoy it.

 

[Amity Island]

I’m just over a month into my TD1 journey and have recently been taken off my restricted insulin. I’ve been pretty good with sticking to low carb, however my family are having a trip to Wagamama this coming week. On the website, my usual meal (steak teriyaki soba) is 84g of carb. This will be the highest bolus I’ve taken (novorapid), so is obviously a bit scary. Any tips on how to successfully eat this meal without having hypos/massive spikes all night? Thanks!!

Hi Beth,

We're all sooo individual. To say you've only had type 1 for a month, you are certainly asking the right questions (e.g avoiding hypo or late spikes) which shows you already have a good grasp of things.

So I looked at the nutritional info on the steak and noodle dish from their website - see below.

The key thing about bolusing (insulin for meal times) is the time of day one is eating. Many diabetics have varying ratios across a daily 24hr window, starting from the time we wake. For me, roughly, I need to use 2 units of rapid insulin (humalog) per 10g of carbs for breakfast, 1.5 units rapid insulin per 10g at lunchtime and 1unit of rapid insulin to 10g for evening meals.

Once you have established your own personal ratios throughout the day you will be in a better position to carb count.

I take it you are eating the meal in the evening? If so, for me I would be working on 1unit of insulin for each 10g of carbs. For 85g I'd take either 8 or 9units depending on the blood glucose reading before the meal (I might add in a correction) and also take into account what I had planned (exercise wise after the meal).

There's quite a bit of protein in that meal which could take time to digest and slow the whole meal down in terms of when to take the bolus. For me there are 3 possible options.

1. Take all of the bolus as usual just before the meal and fingers crossed it may work well.
2. Take part of the total bolus insulin just before eating and the remainder an hour later (or whatever works best).
3. It may work out better to just delay taking the whole bolus say 30mins or an hour after starting the meal.

It's all trial and error, and it's worthwhile keeping a record of what happened so next time an improvement could be made.

energy kcal	900kcal	138kcal
energy kj	3781kJ	579kJ
protein	69.26g	10.61g
carbohydrates	84.33g	12.91g
sugars	18.07g	2.77g
fat	31.43g	4.81g

 

[betheaton]

Hi Beth,

We're all sooo individual. To say you've only had type 1 for a month, you are certainly asking the right questions (e.g avoiding hypo or late spikes) which shows you already have a good grasp of things.

So I looked at the nutritional info on the steak and noodle dish from their website - see below.

The key thing about bolusing (insulin for meal times) is the time of day one is eating. Many diabetics have varying ratios across a daily 24hr window, starting from the time we wake. For me, roughly, I need to use 2 units of rapid insulin (humalog) per 10g of carbs for breakfast, 1.5 units rapid insulin per 10g at lunchtime and 1unit of rapid insulin to 10g for evening meals.

Once you have established your own personal ratios throughout the day you will be in a better position to carb count.

I take it you are eating the meal in the evening? If so, for me I would be working on 1unit of insulin for each 10g of carbs. For 85g I'd take either 8 or 9units depending on the blood glucose reading before the meal (I might add in a correction) and also take into account what I had planned (exercise wise after the meal).

There's quite a bit of protein in that meal which could take time to digest and slow the whole meal down in terms of when to take the bolus. For me there are 3 possible options.

1. Take all of the bolus as usual just before the meal and fingers crossed it may work well.
2. Take part of the total bolus insulin just before eating and the remainder an hour later.
3. It may work out better to just delay taking the whole bolus say 30mins or an hour after starting the meal.

It's all trial and error, and it's worthwhile keeping a record of what happened so next time an improvement could be made.

energy kcal	900kcal	138kcal
energy kj	3781kJ	579kJ
protein	69.26g	10.61g
carbohydrates	84.33g	12.91g
sugars	18.07g	2.77g
fat	31.43g	4.81g

That’s amazing advice, thank you so much! I’ve not established individual ratios for mealtimes yet, just on 1:10 throughout the day which seems to work pretty well.
Might be a case of doing what I’d usually do for mealtimes (take it all in one go) for this time round and use it as a baseline so I know where I need to adjust moving forward.
if only doctors would teach you how to actually eat carbs as a diabetic! Would make my life 10 times easier!!
Thank you for your help!

 

[Bruce Stephens]

if only doctors would teach you how to actually eat carbs as a diabetic! Would make my life 10 times easier!!

Maybe your doctor won't, but you should at some point see a dietician, who will (or darned well should) be willing to talk about strategies for handling the kinds of meals that you'd like to eat. (Though quite a lot of the advice will be suggestions of things to try rather than anything definitive.)

This is also the kind of thing that DAFNE (and similar) courses cover. (Though again the answers are more about how to do trial and error effectively than definite ways to handle anything.)

 

[trophywench]

That's A LOT of fast acting insulin in one go - and once it's in it's in, and can't be removed. Soooo - if the insulin gets there before the carbs do - you could quite easily find yourself in trouble. I have done that so many times and having to get emergency far too sweet c**p down my neck when I've only eaten half of a really lovely meal out is no fun whatsoever. Please please reconsider - have half upfront and the rest later. Sooo, have it before that dessert and test when you get home to see if you need a correction.

 

[Bruce Stephens]

Please please reconsider - have half upfront and the rest later. Sooo, have it before that dessert and test when you get home to see if you need a correction.

That's the sort of thing I'd do. If I'm eating that much carbs I just know if I take the insulin in one go it's going to work faster than my body can digest that much, so I end up trying to fix the hypo (which tends not to work too well because I've eaten so much). It works much better (for me) to deliberately inject less, and plan to inject some more later. @betheaton uses Libre so can watch things easily more or less as they happen.

(It does probably mean paying attention for a few hours after the meal which is annoying, but with practice you can mostly arrange the dose so you won't go too high overnight and then maybe you need a bit of a correction dose for breakfast for the next day.)

 

[Ivostas66]

I would agree with what has been said above - especially trophywench's advice. I am just over 2 years into my T1 journey and remember being caught out a number of times during the 'honeymoon period'. My levels were great and I was a strict carb counter, but would be caught out by hypo's for no discernible reason - looking back my body was still kicking out small doses of insulin occasionally, which threw things out of kilter.

Never had any issues with Wagamama to be honest, on a similar amount of Insulin that you are using. It's pizza and Chinese takeaways that I have simply stopped eating, as I have never managed to get things right. Make sure you check your levels several times after your meal and prior to sleep. The reason I have stopped eating pizza and Chinese takeaways is because I have checked my blood before bed and it is usually around 7, without a spike after the meal. I think I have finally nailed it only to wake and see that whilst asleep during the night I had a spike of 16 or so. Pretty sure it is the high fat content that slows the release of the carbs, which is what I am caught out by.

 

[betheaton]

That's A LOT of fast acting insulin in one go - and once it's in it's in, and can't be removed. Soooo - if the insulin gets there before the carbs do - you could quite easily find yourself in trouble. I have done that so many times and having to get emergency far too sweet c**p down my neck when I've only eaten half of a really lovely meal out is no fun whatsoever. Please please reconsider - have half upfront and the rest later. Sooo, have it before that dessert and test when you get home to see if you need a correction.

Okay, amazing. So I’ll split my dose in half and do the other half a little after my meal? Thank you in advance!

 

[trophywench]

Beth - whenever we try to get it right cos it's a new situation we don't know how much insulin we are going to need or what the best time is to inject it, before, during, after - which? the best thing is to err on the cautious side ! It won't be 100% smack-on and especially not when so newly diagnosed. It gives a cracking reason to try the same/similar meal again in the future and see whether what worked the first time works again, or, knowing it didn't work the first time - do something a bit different to see if that's a better solution!

 

[Amity Island]

Okay, amazing. So I’ll split my dose in half and do the other half a little after my meal? Thank you in advance!

Hi Beth,
Please let us know how you get on with the meal and which strategy you decide to try.

 

[Amity Island]

I would agree with what has been said above - especially trophywench's advice.

Hi Matt,

That's why I wouldn't encourage or advise anybody (nor should we) to try a particular strategy or dose. I prefer to present various options and ways diabetics generally manage their diabetes. It's up to the individual and their Doctor or DSN to come to a more personal solution.

What seems like a high dose of insulin to one person, would seem minuscule to another because "you need what you need".

 

[everydayupsanddowns]

Most of all, enjoy your meal @betheaton! when is it happening?

And all this need to experiment with various options gives you copious excuses for more Wagamamas too 😉😎😛

 

[betheaton]

Hi Beth,
Please let us know how you get on with the meal and which strategy you decide to try.

So I had my meal (it was amazing) and decided beforehand to do 4 units and do the rest a couple of hours later when I saw another spike. I haven’t had this second dose yet as my sugars have a pretty much stayed exactly level which is spooky to say they should be through the roof since I’ve only had half my required insulin. I’ll keep checking my levels through the night but I don’t want to administer 4 more units and just hypo all night!

 

[trophywench]

Correct decision for now IMHO - carb and fat AKA the pizza effect usually spike me after approx 5 hours so a real PITA timing wise.

 

[rebrascora]

So pleased you had a great time and enjoyed your meal.
You made a wise decision. Far better to correct tomorrow morning if necessary than risk hypoing through the night. It may be that your own pancreas has helped out with the remaining insulin since you are so newly diagnosed and probably still in the honeymoon period or as Jenny suggests that the fat content has slowed the digestion of some of the carbs and you will spike later. Nothing to lose sleep over and far better to go to bed with the risk of going a bit high than be worrying that you might hypo through the night.
Let us know how you get on in the morning and sleep well.

 

[betheaton]

So pleased you had a great time and enjoyed your meal.
You made a wise decision. Far better to correct tomorrow morning if necessary than risk hypoing through the night. It may be that your own pancreas has helped out with the remaining insulin since you are so newly diagnosed and probably still in the honeymoon period or as Jenny suggests that the fat content has slowed the digestion of some of the carbs and you will spike later. Nothing to lose sleep over and far better to go to bed with the risk of going a bit high than be worrying that you might hypo through the night.
Let us know how you get on in the morning and sleep well.

I set alarms every couple of hours to make sure everything was okay and that worked well. I checked at 12 (3.5 hours after I ate) and my sugars had started to rise again so I had 2 units (expecting to need another 2 in the night) as the levels were definitely going up but not at a rate I was scared of. So I took the units, went back to sleep, then everything was good! Didn’t need any more after that point and stayed at around 5mmol all night. A success story if ever there was one! 84 carbs for a lovely 6 units! (Probably just a one off but I’m still very happy!)