Type 1 Carb Counting when eating out.

[Ann48]

Hi, I have for sometime been signed up on the forum, but have never posted a topic. I am Type 1 in my sixties and use a pump. I struggle when I eat out to know the carbs in foods. I have the Carbs and Cals app on my phone. Recently I had a croissant in a well known coffee shop and checked the app for the coffee shop. The amount of carbs listed was way out,I bolused the amount listed, but my BG spiked to 15 2 hours later. Does anyone else find the Carbs are often more than listed.

 

[col101]

I quite like cafe Nero because most of their stuff is wrapped with carb values printed and I find them pretty accurate. Values in apps and various online sites I take as only a guide them use experience and judgement to guess a figure. Restaurant portion sizes seem to be totally at the whim of the chef though! Maybe they think it's a favour to shovel load of cheap carbs on the plate?

Sent from my LG-H815 using Diabetes.co.uk Forum mobile app

 

[GrantGam]

Recently I had a croissant in a well known coffee shop and checked the app for the coffee shop. The amount of carbs listed was way out,I bolused the amount listed, but my BG spiked to 15 2 hours later. Does anyone else find the Carbs are often more than listed.

What was your BG 3-5 hours after the croissant @Ann48? Did you need to correct?

It's possible to spike but return back to the correct range within the action time of the insulin. Some foods have a pretty poor GI and require (in my experience) insulin to be taken a fair while before I eat.

Carbs and Cals is an alright app, but I've found it to be a bit ropey at times. The issue with things like baked goods, is that the sugar content can vary substantially depending on the recipe.

 

[himtoo]

without looking at any other source I would estimate a croissant in a coffee shop to be around 40-42 carbs

eating out can be difficult though !

how long have you been pumping @Ann48
and also -- welcome to posting on the forum !!

 

[azure]

Part of the problem eating out is that we can't pre-bolus as far in advance as we might usually (unless it's just me who can't sit looking at a croissant for 30 mins : D ).

I find the coffees often have hidden carbs, so now I check them too.

I've had highs after eating out but then try to remember and adjust my bolus next time until I perfect the amount.

 

[Scott-C]

Agree with all of the above, particularly @azure ,s pre-bolusing point.

I tend to deal with meals out by anticipating what the likely carb count is going to be, guestimating service time based on previous experience of past meals at that place, take about 50% of the bolus in advance before I get there so there's at least some insulin in stream working 10/15 mins ahead, which gives me a bit of leeway on service delays then the other 50% (and adjustments based on eyeballing the day's portion size) when it arrives.

But that's by the by...you mentioned this was a croissant in a coffee shop. If you had a coffee with it, my understanding is that caffeine causes an adrenaline rush. And an adrenaline rush causes the liver to release glucose.

So, it might be part inaccuracy with croissant carb count, lack of pre-bolus, but maybe also the coffee caffeine content inducing a liver dump.

Or one of the several hundred other things which makes chess look simple compared to T1!

 

[Ann48]

Himtoo, I've been pumping for 4 years, I was travelling at the time, I bolused 4 units and my BG was 9.8. So looking at it again, I think I needed a bit more insulin for the correction. My BG was 15.2 at 13.53 though.

 

[Ann48]

Part of the problem eating out is that we can't pre-bolus as far in advance as we might usually (unless it's just me who can't sit looking at a croissant for 30 mins : D ).

I find the coffees often have hidden carbs, so now I check them too.

I've had highs after eating out but then try to remember and adjust my bolus next time until I perfect the amount.

Good point, I never bolus for coffee.

 

[Ann48]

What was your BG 3-5 hours after the croissant @Ann48? Did you need to correct?

It's possible to spike but return back to the correct range within the action time of the insulin. Some foods have a pretty poor GI and require (in my experience) insulin to be taken a fair while before I eat.

Carbs and Cals is an alright app, but I've found it to be a bit ropey at times. The issue with things like baked goods, is that the sugar content can vary substantially depending on the recipe.

My next reading wasn't till the evening, when I dropped to 2.7. Generally my control is good, HBA1C last week was 52. I not good at keeping a check when I'm out.

 

[Ann48]

What was your BG 3-5 hours after the croissant @Ann48? Did you need to correct?

It's possible to spike but return back to the correct range within the action time of the insulin. Some foods have a pretty poor GI and require (in my experience) insulin to be taken a fair while before I eat.

Carbs and Cals is an alright app, but I've found it to be a bit ropey at times. The issue with things like baked goods, is that the sugar content can vary substantially depending on the recipe.

GrantGam, I agree it is so hit and miss when eating out. It's difficult to have a small low sugar snack in a lot of these coffee shops. BG did spike, I must have over corrected as I then went low.

 

[GrantGam]

GrantGam, I agree it is so hit and miss when eating out. It's difficult to have a small low sugar snack in a lot of these coffee shops. BG did spike, I must have over corrected as I then went low.

@Ann48, you'd really benefit from finding out where your BG is around 4-5 hours after eating. In my experience, it's very difficult to get within range two hours after eating carbs; when not bolusing in advance. I pre-bolus for every meal apart from dishes like lasagne (with a high fat content) - it's the only way I can get back to my target values.

Because of the above, it's easy to over-correct after seeing a high value at the two hour mark. Remember that the majority of quick acting analogue insulins have a DIA (duration of action time; or how long they will lower BG) of around 3-5 hours. If you correct before the time is up, "insulin stacking" can occur and that's what can cause hypos a fair while after you've eaten.

I must say I have to agree with @azure about the coffee. I was shocked at my BG after a real coffee last year (last one I had) - I went from around 6mmol/l to 12mmol/l - madness!

Long story short, keep up with the regular testing after meals to find out what's really happening. Also, jot down what you ate and where your BG ended up. Once you've got that info at hand, you can amend your dose and timings to suit. I'm very forgetful and need to write everything down; otherwise I forget and it's a viscous cycle...

Here's an example of what I do for meals; you only need to do it once which is handy, then you'll have good idea of what will happen when you eat the same thing again, to a certain degree. Note that the 5g dextrose at the carb total was because I don't have a half unit pen, so can't administer less than 1u.

What did I learn from that lunch? That I'm not bolusing in advance enough, so next time I'll start eating half an hour after my injection to try and stay <8mmol/l at the two hour mark. The dextrose probably didn't help with the small spike, but I'll have a better idea when I have the same lunch again, but with a slightly higher BG at the start and don't need dextrose

**pred BG = predicted BG

 

[Ann48]

without looking at any other source I would estimate a croissant in a coffee shop to be around 40-42 carbs

eating out can be difficult though !

how long have you been pumping @Ann48
and also -- welcome to posting on the forum !!

I've been pumping for 4 years, I did attend a course in 2009 which was similar to the DAFNE, it gave my a great insight to a visual plate of food. Generally I can get it about right at home, I still weigh certain foods at home. I just find when I'm out or on holiday my Glucose levels go to pot. Thanks for your feedback.

 

[Ann48]

@Ann48, you'd really benefit from finding out where your BG is around 4-5 hours after eating. In my experience, it's very difficult to get within range two hours after eating carbs; when not bolusing in advance. I pre-bolus for every meal apart from dishes like lasagne (with a high fat content) - it's the only way I can get back to my target values.

Because of the above, it's easy to over-correct after seeing a high value at the two hour mark. Remember that the majority of quick acting analogue insulins have a DIA (duration of action time; or how long they will lower BG) of around 3-5 hours. If you correct before the time is up, "insulin stacking" can occur and that's what can cause hypos a fair while after you've eaten.

I must say I have to agree with @azure about the coffee. I was shocked at my BG after a real coffee last year (last one I had) - I went from around 6mmol/l to 12mmol/l - madness!

Long story short, keep up with the regular testing after meals to find out what's really happening. Also, jot down what you ate and where your BG ended up. Once you've got that info at hand, you can amend your dose and timings to suit. I'm very forgetful and need to write everything down; otherwise I forget and it's a viscous cycle...

Here's an example of what I do for meals; you only need to do it once which is handy, then you'll have good idea of what will happen when you eat the same thing again, to a certain degree. Note that the 5g dextrose at the carb total was because I don't have a half unit pen, so can't administer less than 1u.

View attachment 23565

What did I learn from that lunch? That I'm not bolusing in advance enough, so next time I'll start eating half an hour after my injection to try and stay <8mmol/l at the two hour mark. The dextrose probably didn't help with the small spike, but I'll have a better idea when I have the same lunch again, but with a slightly higher BG at the start and don't need dextrose

**pred BG = predicted BG

Thanks for your reply, I allow pretty much the same for a similar lunch. The pump calculates any active insulin still going on and will adjust, my Monitor is linked to the pump, if I'm above target it will adjust the dose. I probably underestimate the carbs when I'm eating out, fear of going low. I appreciate your feedback.

 

[GrantGam]

Thanks for your reply, I allow pretty much the same for a similar lunch. The pump calculates any active insulin still going on and will adjust, my Monitor is linked to the pump, if I'm above target it will adjust the dose. I probably underestimate the carbs when I'm eating out, fear of going low. I appreciate your feedback.

That's no problem

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