Hi
@Standup,
@Inka touched on
a possible issue: your digestion. Are you certain you are taking enough Creon to be sure your counted carbs are all getting digested?
I certainly agree that after the basal check it's most helpful to systematically sort out one meal at a time. I do remember that somewhere in my 2nd year after diagnosis, by which time I had Libre 2, changed my DSN and Consultant - I set about getting my bolus arrangements improved. I looked at one meal at a time, starting with breakfast.
Until then my breakfasts were quite different from day to day, so I went with yoghurt, various fruits, seeds and nuts and a frothy coffee. I standardised the amounts of each to achieve a fairly standard breakfast but because of fruit availability in our village shop there was always some variation; so I weighed, measured and carb counted. In hindsight I could have used frozen fruits and quite fixed portions. I spent 3 or 4 weeks persisting with this and started to get a fair amount of uniformity with my breakfast results.
I then repeated that with a different sort of breakfast based on eggs, bacon and toast. This took less time to get the repeatability and stability - but it served me well because I was needing to travel and take overnight stays in hotels or B&Bs. I then had a useful launch pad for my day. There were glitches from time to time, but because I'd spent a decent amount of effort in assuring myself that my processes worked, I'd check after a glitch if I'd got an obvious explanation. Sometimes I could explain to myself why - and when I couldn't explain I moved on; tomorrow was a fresh start, forget yesterday
Having sorted breakfasts I did the same for lunches; these were always pretty simple: cheese, cold meat or paté and bread or biscuits, plus more latte.
Dinners became my next target, and my wife most helpfully played her part by creating 20 or so very repeatable home cooked meals, which we carb counted from the ingredients initially but then developed a composite % carb content per 100 gms and now I could have different sized portions just weighing out however much I wanted. I could also have seconds, provided I weighed the second portion and bolused just before eating.
This all took a fair amount of time. I kept an alphabetical indexed book with notes and records against each type of meal. I still use that index book - it's my variation on the carbs & cals book (which I still also use). The bonus is that when eating out I can often find menu choices that work with my own data and invariably chefs are happy to give me the weights of different portions, particularly potatoes.
Since then I've felt happy that my guestimates for the carbs in any one meal are about right. I used to scrupulously use different bolus / carb ratios for breakfast, lunch and dinner. These days I use 1:10 for all meals including snacks. After doing the maths I find the bolus requirements are too small for even my half unit pen. Also because the bolus dose needs an adjustment factor to mitigate against how active I'm going to be or have been, I decided there is little point in deriving an exact figure for the carbs, which is then going to have an arbitrary reduction based on my instinct, but with no justifiable precision.
I always keep an eye on my CGM and have a reserve 10-20 gms of carbs available, in case it's all going wrong. At home that's easy; when away I have various snacks easily accessible, from known sources. These can be things like Graze or Nakd bars, biscuits, a small pack of crisps, etc; and of course hypo response foods. Those used to be JBs, but nowadays the mini packs of haribos or a small carton of orange juice work well for me; if there are grapes that need eating up from home I'll take a small tub of 100gms, ie 15gms CHO.
If this sounds that I have this cracked and it's all easy, then I'd be misleading you. My systematic approach only works most of the time. There are always glitches and mishaps - some of my own making, some not. But I feel happy that I can have some confidence in my food calculations. I probably need to do a bedtime correction 1 day in 5, maybe once a week. During daytime, I only deal with highs over 14, otherwise I let the day's events overtake highs; just sometimes I'll specifically go for a fairly brisk walk to knock down a high. Anything up to 14 I'll usually wait and correct in the pre-bolus before the next meal. When high just before a meal I will probably wait after my prebolus until there is clear evidence from my sensor that my BG is falling; this can be a major intrusion into family life and really irritating to my wife who wants to put hot, but not overcooked, food on the plate.
I often do a split bolus with home meals and always when eating out. At home I prebolus for the main meal and then a second bolus if I decide to have a dessert. Puds are rare for us, but I can often have some ice cream and banana or whatever ... (measured of course) or a magnum, or a supermarket "off the shelf something" (heavily processed of course) with a given carb count from the packaging.
The other reason for not getting too bogged down in tight carb calculations is that there are 41 or 42 known factors that can affect our blood glucose and several of those (like exercise and activity) can not be calculated, only estimated and some not even foreseen. So with so many other things at play in this D malarkey, I find it less stressful to directly manage what is in my reach and deal with those I can't foresee or pre-empt by bolus, snacks or exercise as appropriate. All of that is relatively doable thanks to CGM and I can't start to imagine how people managed before CGM!
In his book Think Like a Pancreas, the author Gary Scheiner tells the reader that Diabetes is Complicated, Confusing and Contradictory. It is so true. I could write pages with examples of each of those descriptions. The 43rd factor is a wrong colour socks day.
