Dealing with large carb meals

Ideally you only want a 1.5 drop or rise in before bed and before breakfast readings, but dawn phenomenon can make that REALLY difficult to achieve.

You may well find that this is actually impossible to achieve without having a hypo during the night, and therefore the pump will hopefully help that. Injections have their place, but the pump certainly gives better flexibility than injections.

I'm on injections myself, but as far as I can tell, I am unaffected by dawn phenomenon, so 90% of the time, my BGs are within the ranges I want them to be. If I was having trouble with dawn phenomenon though, then a pump would certainly be something I was considering.

There are a range of short-acting, regular and basal insulins available, and it is possible to find a combination that suits you, but if you are going to be on a pump by the end of July anyway, then it is probably best just to try and manage as best you can with your current knowledge and then get used to managing with your pump.

In terms of whether you should reduce your basal tonight, it does seem like a large drop, so I think that a decrease is indicated (although if you have dropped it already in the last day or two, then best to wait a few days to see if a pattern emerges). But definitely do a 3 am too, because if you find that your BGs rise too much with dawn phenomenon, then until you get the pump, you probably need to work out which is worse for you - high BGs from DP, or low BGs from taking enough basal to handle DP.

The book "Think Like a Pancreas" by Gary Scheiner is a good resource and discusses ways to combat DP if you decide to stick with injections, although a large part of the book covers pumps too so is valuable for both injectors and pumpers.

All the best with it.

taniahealy said:
I always take my lantus 7 and 7. Last night I took 8 units and was 12.2 at 10:30. When I got up 6:15am which I normally do. I was 4:8. This was a result for me. The first time I haven't had a hypo during the night for over a week. Did set my alarm for 3am but was too lazy to get up. Do you think I should reduce my pm lantus again tonight, cos there was still a drop. I don't normally eat after lunch so am wondering if this is also making me drop through the night. Really appreciate everyone's reply's. It's good to talk with people who have been in the same boat.I was running at 10 all day yesterday, so going to increase my lantus this morning.

Sorry didn't explain myself properly. I took 43 lantus this morning, checked my blood at 12 before lunch and it was 15.3, guessed I would be higher cos I reduced my lantus last night. Will probably be high all day. If I am then will increase my am lantus tomorrow. Seem to need loads throughout the day.
I've only been eating breakfast and lunch cos I'm trying to keep my weight down.
The think like a pancreas book I will Definately send for. If it gives good info with regards to the pump and dp. Both I need to learn about a bit more. Only now keeping good control of my diabetes so only now really aware of how much dp affects me.

taniahealy said:
Sorry didn't explain myself properly. I took 43 lantus this morning, checked my blood at 12 before lunch and it was 15.3, guessed I would be higher cos I reduced my lantus last night. Will probably be high all day. If I am then will increase my am lantus tomorrow. Seem to need loads throughout the day.
I've only been eating breakfast and lunch cos I'm trying to keep my weight down.
The think like a pancreas book I will Definately send for. If it gives good info with regards to the pump and dp. Both I need to learn about a bit more. Only now keeping good control of my diabetes so only now really aware of how much dp affects me.

Hi youone sorry for assuming you were a she. So can i just clarify. I believe i am similar to u in that the most QA i can give is about 10iu. So if you were eating a meal of 18iu you would give 10 at the start and 8 at the 2 hour mark. If the meal however was 29 you would give 10, 10 and then at the 4 hour mark give the other 9iu. Or at the 4 hour mark do your test and give however many units at this stage to bring yourself into range. Eg at the 4 hour mark you are 10mmols u would give 1iu. If you could clarify that would be great. Gari

I would also like to just say my original thread question was not really looking for advice to eat out. It was just looking at high carb meals. Thanks

My dafne nurse hasn't really said a lot about the lantus, I think she is just waiting for me to have the pump. I'm on novo rapid quick acting insulin and have only taken 9 units altogether today. 3 of that was a correction. Have really had enough with changing my dose of lantus all the time, surely after 4 weeks I should be getting it right by now.I used to do 1 dose of lantus before but the nurse suggested I change to 2, to try and helP with the dp.

Hi Gari
At a normal meal I have a method which matches Dafne to the maximum
A large carb meal dose not, it’s been turned over many years to suit me. Although since my Dafne course I've re tuned it using the Dafne methods.
What I'm going to write may seem long and what's the point, but it’s the only to clarify what I do, they'll be calculations and so on things that I'm use to and do on auto now I apologize for this I don't want people to think going for a meal is a combat exercise.

I have a good BI insulin control I can go 6 hours without a carb meal longer but I've never tried this and my BI stays within 1 on the meter
Meal time is 7pm I took a test at 5pm it was 7.2 say 7
I do a 2 hour test before the meal to see if my BI is constant [this is from my diving years]
At the table my BG is 7 it’s slightly higher but I round down
My ratio is 1:1
[1 QA = 1CP].
I calculate the CPS to be 27 I've used an odd number

[Using the Dafne ratio 2 to 3].
The calculation I use is 27 CP's would increase my BG between 54[2] and 81[3] if I didn't take any QA.
After the 4 to 5 hour period I want my BG to 7 to 9
The 7 would be ideal the 9 or higher would be where I correct.
My aim is to do a 3 way split
If I divided the 54 / 3 = 18
If I divided the 81 / 3 = 27
I will work from here on the higher limit since I match the higher number 81
That is for every 1 CP I eat my BG goes up 3
When you take 1 injection at the meal end of 27 you would expect after the absorption period of 4 to 5 hours your BG would be 7 (true Dafne, regards to when you inject QA)
I will split the 27 like this for this meal
Time is 7.30pm
After the starter I would inject 8 to 10 I'll call it 8
After the main course I would inject 10
Total 18 [so far, noted].
Note the time its 8.30pm.
At 9pm the sweet comes it’s more than I estimated from the menu I'll say 3 more
That means I'm now looking at 30 CP not 27 I've taken 18/12 short [note]
I then inject the other 9 that means I expect a correction for the 3 [noted].
Time is 9.30pm
Two hours have passed.
At 12pm “what should my BG be”, should I take 1 now?
I decide to do 1 at 12.30pm.
The 1st QA was 8 at 7.30. That’s longer than the absorption period. All been used. S/UP 24
The 2nd QA was 10 at 8.30. That matches the absorption period all used. S/UP 30
The 3rd QA was at 9.30. That’s less than the absorption period? But its 2 hours after the 1st so I would expect from my experience that 1/2 has been used.
[9/2 = 4.5 QA used.] Round up.
[28/2 = 14 BG absorb.]
Absorption in total = 24 + 30 + 14 BG's total 68
Taking the 81/BG from above - the 68/BG absorbed = 13/BG still left (note this)
Because were still in the 1:1 ratio QA that is 1unit QA = 1 CP
[Note 1 CP = 2 to 3 BG]
My BG should read 20 [7 + 13].
It does so that idea of the sweet being more was incorrect
A high number but you've still got the 4 to 5 QA working [note].
Which is 12 to 15 BG?
I would expect by another two hours I would be close to 9 then level off at 7
You will see from where I’ve put a [note] that I have 5 QA still in the system which if I’m working to the higher number would bring me down to a 5 BG, yet I have only 13 BG to absorb.
The calculation isn’t perfect but as you go higher in your CP intake you’ll see this insulin acts with other things in your body.
I’m cautious here about corrections I would leave it if it’s like this and correct in the morning if needed.
Seeing high BG number scares some Type 1’s, but if you understand what’s happened and know what you’ve eaten, also the amounts you’ve matched with, from experience you know to wait.
I will add here I don’t normally have meals this size in CP’s I usually only reach about 20 CP’s when I have a pizza or other large CP meals I’m not a large eater.
A normal meal for me is between 6 and 12 CP where I would split by 2 on the 12.
Notes.
We know QA has a 15min delay in starting to work.
The split method mirrors a drip feeding system into your body.
I feel better after a large CP meal.
I enjoy a large CP meal.
The BG of 20 after the 4 to 5 hour absorption period isn’t 7 to 9
But it will be from the last injection at 9.30pm
Some people would say what’s the point.
Let’s not forget the meal is to enjoy and also have a good next day with no or only very small corrections, from experience the BG of 20 would be 7 after all the QA is absorb which is about around the 3pm mark it may take a little longer on a meal of 27 CP a lot in anyone’s book.

taniahealy said:
My dafne nurse hasn't really said a lot about the lantus, I think she is just waiting for me to have the pump. I'm on novo rapid quick acting insulin and have only taken 9 units altogether today. 3 of that was a correction. Have really had enough with changing my dose of lantus all the time, surely after 4 weeks I should be getting it right by now.I used to do 1 dose of lantus before but the nurse suggested I change to 2, to try and helP with the dp.