Do you bolus for a lowish carb meal?

[the_anticarb]

Any insulin experts out there? I don't usually bolus for low carb meal or snack ( <15g) but now I am pregnant I have to get my bgs as close to a non diabetic as possible, and the post prandial target is particularly strict at 7 -7.8 at one hour after.

I'm trying to low carb whilst I get my basal dose sorted, but whilst I could tolerate a slight rise (say up to 11) after a low carb meal before, so didn't bolus, I tihnk I may now start needing to do so. Or should I just increase my lantus? Should it be able to cope with a meal of less than 15g carbs?

What amount of carbs do you think I should bolus for, ie should I bother if it's less than 10g? 5g?

And what kind of ratios do you use at these low levels? I know everyone is different but I need to get an idea of where to start.

Heeeeeeeeelp!!

Thanks

 

[mrman]

It does depend on your ratios. For example if your radio was 1/20 then probably would tolerate a low carb snack. If however it was 1/10, then you would need a unit. However if you have bolused for a meal and are say 6.0 2 hours later, then probably you would drop further and need a small carb snack to stay steady. You should not increase base for snacks as it is only meant to you maintain you whilst not eating, also incase you are not able our want to have a snack you won't be in danger of a hypo.

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[donnellysdogs]

I would never have changed anything concerning food with lantus..always quick acting.

Me, i have always bolused for everything since mdi.. On biphasic no I didnt.. Bur always done for every mouthful I eat .. Unless hypo.. Or going lower. However, it was only in my 'complacent' days when I have tolerated levels above 9. I have pretty much always tried to keep levels under 9 for the vast majority of my diagnosed time- more so after eating..

 

[the_anticarb]

Thanks. I had previously been told not to bolus for less than 15g carbs, and whilst this is ok whilst not pregnant (my hba1cs have in the main been under 7 which is fine by me), it really is a different ball game in pregnancy.
I'm trying to have low carb at the mo so I can get my basal dose right, but its very hard to eat no carbs so I think I will need to inject a little.
How the hell do you stay so motivated? My problem is I can be motivated for a while but then I lose interest and slide.
I was told by DSN that it is ok to go up to 11 after a meal if you are not pregnant, so long as it is back in the 5-7 range before the next meal.
However that's all changed now!

 

[mrman]

We all have moments I'm sure where we think fxxx it. However in your situation you have added pressure and not just yourself to think about. My family.keep me motivated as I want to be around a long time for then and enjoy daily life with them not.just feeling sorry for myself in the corner. Also they are great support. Obviously I'm not pregnant lol, but try not to be above 8 2 hours after food. Through trial and error I have found out if I'm 8 or less 2 hours after food and injecting I need a 10 to 20 carb snack between meals to avoid a hypo and stay steady. some might say to have less qa but then I'm too high. If I know I won't be able to have a snack for some reason I do have less qa but am then 11 2 hours later not need a snack and no hypo. Do I rather give myself a little extra qa with food be 6 to 8 2 hours later knowing il have a snack and be around 5 to 6 before next meal.

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[AMBrennan]

I was told by DSN that it is ok to go up to 11 after a meal if you are not pregnant, so long as it is back in the 5-7 range before the next meal.

Tell her to re-read NICE guidance which recommends a target of <9 mmol/l.

Should it be able to cope with a meal of less than 15g carbs?

Well, that's a rather meaningless question. Ideally healthy people should be able to cope with carbohydrate meals but we have already established that you are diabetic.

Some people can have a 15g carb snack without exceeding BG limits and some cannot as it all depends on how each individual reacts to different foods (contrary to conventional wisdom, it's a bit more complicated than "carbs eaten = BG up")

 

[phoenix]

Yes, I would bolus for a low carb meal. I don't tend to eat snacks though.
Some low carb meals I have to take a relatively high amount of insulin for. We've discussed this before I think.
TBH I give such insulin on the basis of past experience of similar meals rather than a specific ratio ( though I reckon boiled eggs need almost a unit each for me ???!!)
Doesn't help much when you are pregnant and the ball gaming is changing daily.

Congratulations by the way.

 

[kezz01489]

Always use insulin for carbs its getting used to how your body copes with it and then adjust it. Always reffer to your diabetes team. Especially since your pregnant hun.

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[smidge]

Hey the_anticarb!

Congratulations!

The answer to your question is 'yes' - I bolus for all meals. I've just had a chicken salad (whole chicken breast, leaves, 2 cherry tomatoes, 2 radishes, cucumber) total of about 5g carb and bolused 1.5 units Apidra for it. If I'd had half a clementine (about 60g) with that (which I often do), it would have taken the meal to 12g carb but I would still have only needed 1.5 units Apidra. However, if I decided to have the clementine on its own during the afternoon, I would have to bolus seperately for it. So, how much you need to jab for a low carb meal depends. If the meal is very low carb but high protein, your body will turn a fairly high percentage of the protein to glucose (I think Bernstein says 36%, but i'm not sure about that), so you need to cover that with your bolus. However, if there is a small amount of carb available such as the clementine in my example above, your body will prefer to use that for glucose and probably convert less of the protein. I'd recommend you start out with a unit or 1.5 units bolus for a very low carb or no carb meal e.g. bacon and eggs and adjust from there - or make sure you include a few carbs e.g. a ryvita (6g carb) with each meal so that you can base your bolus ratio on that, maybe adding a half unit extra for the protein.

Sorry, it's not an exact science - it's a bit trial and error, which is probably not what you want to hear.

Smidge

 

[the_anticarb]

Thanks everyone. The diabetes team at antenatal have said I can't low carb, and to have 30-40g for each meal, so I'm trying to get my ratios sorted for that.

When I'm not pregnant I can low carb and just take lantus/metformin and generally keep my hba1c below 7, which is good enough for me, so I may be a bit different to some on here in that usually a low carb meal won't spike me.

But now I am pg I need to get it bang on right, which is not made easy by the fact that the goal posts keep changing. And I haven't even got morning sickness yet!

 

[DarkForcesRebel]

I always do