Pasta & Hypos

[DancingStar]

I keep getting a hypo a couple of hours after eating pasta. Last night I calculated the amount of carbs in the dish I was cooking and ate at 7pm. At 9pm I started feeling hot and shaky, checked blood sugar which was 3.2. This has happened before when I've eaten pasta - three times in the last three weeks.

At first I put it down to a miscalculation of my bolus insulin but now I'm starting to think it's related in some way to the pasta. I don't understand what's happening and how to prevent it in future.

Advice gratefully received.

 

[Proud to be erratic]

Hello @DancingStar,
Pasta is one of those foods that disobeys the carb counting guidelines for many people with DM. I've reached a point that I now avoid it. I think it is partly because the pasta itself either (for some) digests really quickly and creates a big spike upwards in BG, or (for me) digests very slowly, so the insulin from the bolus has too little glucose to manage so sends me towards hypo. I don't go hypo, because I have my Alert (alarm) set pretty much at the top end of what Libre allows (5.6) and knowing pasta is a difficult food for me I then monitor a lot and respond with extra mid-range carbs (eg savoury biscuits @ c.50% carbs) to nudge my BG away from the downward trend.

But also it can be the combined effect of what else you are eating with the pasta. If a low fat bolognese sauce with spaghetti, where the sauce has very few carbs, then I'll get a very different response than if the pasta is in a full fat high cheese content meal such as home made lasagne. The high fat content definitely further slows the digestion - assuming I've got my Creon dose about right!

Once my bolus has dissipated, NovoRapid after say 4hrs, then I always see a steady rise in my BG - partly from the extra carbs I took plus the eventual digestion of the pasta meal. I know that as I go to bed after an evening meal of pasta I will need to take a correcting bolus to either bring me down or to keep me in range overnight. How much bolus depends upon whether I still have some bolus Insulin on Board (IOB) and what extra carbs I've had. Even with due care on this counting, it is still a bit 'hit and miss'. One other way would be to split your meal bolus into say 50% pre-bolus and 50% after 2 hrs. In the final analysis it is a matter of "trial and learning".

Or just step away from pasta!

 

[helli]

Do you go high later?
I find my body can take a long time (4 or 5 hours) to absorb the carbs in pasta. As a result, if I bolus for it all up front, my levels fall soon after because the carbs are not available for the insulin and then I go high later because I have no insulin for the tail end of the pasta.
Therefore, I need to split my bolus for pasta. This requires some trial and error but I started with 50/50. The first half before eating and then the second half 90 minutes later.

 

[Inka]

Pasta is generally lower GI so the carbs are absorbed more slowly. I always split my bolus for pasta. I suggest you experiment with that @DancingStar eg 50% before eating, 50% at 2hrs post-meal, or 1/3 up front and the other 2/3s at 90 mins or whatever. Just a question of finding what works for you.

 

[Eternal422]

Same for me as others have said here. For me pasta takes ages to digest and if I prebolus, say, 30 minutes before eating it then the insulin misses the boat, so I will drop and then steadily rise some hours afterwards. When I have pasta now i will bolus at the same time as eating to give the pasta a head start. Doesn’t always work though and @Inka ’s split bolus technique is probably a very good call and a good way to deal with it.

 

[nonethewiser]

Pasta dishes for me usually involves sauces & meat, so could never bolus all upfront as hypo would be guaranteed, plus later in evening would end up high, so always always split dose.