Carbs absorption

[Kuba85]

Hi.

We were wondering what experiences people have in the peak + pace of glucose build up post some staple carbs?

Some of foods we eat:

1) breakfast porridge made from oats with berries

2) boiled potatoes

3) baked potate db (if different)

4) lasagna

5) pasta

6) sourdough bread


Basically we seem to observe (keep in mind we have been < week into this) that some foods increase sugar level faster than others, e.g. porridge vs lasagna. I think it’s the fat in lasagna.

So in order to smooth the pattern of her insulin around meals, we were hoping to better understand the timing of the above foods vs insulin intake. E.g. we want to avoid situations where we wait ‘typical 15mins’ and then we have a big drop post the insulin shot, followed by a slow creep/fast spike on the way back.

It would seem to us that when eating bread, insulin shot can be made ~10mins before the meal, though with lasagna I would almost wait a little after starting it (especially if the starting level is low).

Is this timing important down the line? Do these things matter at all or in grand scheme of things no big deal?

 

[Chris24Main]

Hi there - it sounds like you are looking for advice to aid in the dosage of insulin for a family member, is that correct?
You have to understand that a key principle on the forum is really not to diagnose or suggest treatment for anyone..

it also sounds like this is very new to you, so bound to feel overwhelming.
Can I ask what all of this is based on? are you measuring sugar levels? using a CGM etc?

Just one thing to add, there really isn't much of an insulin response to fat - one of the key tenets of the low-carb high-fat diet that many here have great success with is simply that; insulin response is almost entirely driven by the speed of absorption of sugar in it's various forms; so all the foods you list will have quite a hit as far as insulin response goes. Exactly what and when is very individual, and of course what you eat is entirely your choice.

But - the "high-fat" side of the equation is exactly that, fat tends to be a much better option than we have been told all our lives.

You may have heard the term Glycaemic Index - this is really about understanding the speed at which a given Carby food will be absorbed and turned into sugar. The very simple way to think about it is the more processed it is, the easier the body can absorb.. so an apple is very different to apple juice for example, although the maker can claim that the juice is 100% apple.

Potatoes, oats, pasta and most breads are all one step removed from sugar - they are all very high in starch, and as you surmise, the overall makeup of the meal will play a part. There are some who suggest having some leafy greens before anything starchy as a way of slowing absorption as well.

At the start of my journey, I think I would have made a similar list. Not so much these days, but everyone is different.

I'll leave it to the type 1's in the forum to comment on the timing of shots.

 

[Kuba85]

Hi. Yes, looking for a daughter. To be clear, we have direct contact with our diabetes team that is very helpful. We do not make any changes to ratios/amounts/habits unless we discuss with them. However, through the question I asked, I thought I can get some range of perspectives and someone may even say ‘doesn’t matter’ which would be helpful.

We are measuring sugar levels using CGM.

I think the general question was whether there are some ways that people found practically helpful in timing the shots around different foods. We are still to have a session with our dietitian about GI so maybe that will shed some extra light on this topic.

 

[SimonP78]

Fat takes time to be broken down so it slows the transit time though the small intensive where the majority of complex carb digestion and absorption occurs. This is likely why your daughter sees a significant difference in BG rise time when comparing porridge and lasagne. Pizza is often mentioned as an extreme case of this phenomenon - lots of fat in the cheese, which means you often need to do multiple boluses (aka split bolus) as the insulin action time is, for once, faster than the arrival time of glucose in the blood stream from the digested pizza.

Things like take aways which often contain lots of fat do similar things. There is a happy medium somewhere in the middle where one can, with luck, judge the insulin absorption vs the glucose arrival, and meals that contain a mix of macro-nutrients (so not just carbs) tend to be the right place to aim, not only for BG but for general health too - handy that!

I always split bolus for my supper (my large meal of the day) as it's typically large enough (and contains sufficient fat and protein) that if I inject all the insulin for it I will go low immediately after supper and then still need to bolus for the food that is yet to be digested.

You mentioned porridge, I find this is particularly terrible at causing very fast BG rises so I avoid it and eat granola instead (still wanting some oats as they are good for you), everyone's different though

Timing is important to avoid spikes both up and down, though it's very hard to get it right all of the time. With practice you (she) will learn what sort of advance/delay is required for a certain type of food (it also depends on what BG is before eating, whether it's rising or falling, level of activity, etc.)

Keep up the good work, you're asking the right questions

 

[Kuba85]

Hi Simon.

This is top advice!

“I always split bolus for my supper (my large meal of the day) as it's typically large enough (and contains sufficient fat and protein) that if I inject all the insulin for it I will go low immediately after supper and then still need to bolus for the food that is yet to be digested.”

-> Exactly what I noticed in our case. And it was frustrating. Because she started at ~8, got a dose base on 80 carbs (it was chicken noodle soup so all carbs through the noodles); and then before this was broken down she went <4 so we decided to give her glucose. Rest of the night she was >10…. And then around 1am required a correction.

Splitting the shot will be something I will ask our diabetes team about.


“You mentioned porridge, I find this is particularly terrible at causing very fast BG rises so I avoid it and eat granola instead (still wanting some oats as they are good for you), everyone's different though ”

-> We went so far by advice there is no diabetes diet, so eat what is healthy for a normal person. Porridge + strawberries + blueberries. She is .. swallowing it all. Diabetes gave us a correction to bfast as they said this is top food in general but she still peaks around 12-13 (starting point 9-10), within an hour and then drops to <4 within 2 hours. (We still think the long insulin may be touch too high in the morning; but will consult on Monday).

Granola - will give it a go but she doesn’t like yoghurt much so not sure how that will work.

“Timing is important to avoid spikes both up and down, though it's very hard to get it right all of the time. With practice you (she) will learn what sort of advance/delay is required for a certain type of food (it also depends on what BG is before eating, whether it's rising or falling, level of activity, etc.)”

-> Today lunch was very smooth. She had bread and avocado and then dessert with berries + my mom made her some ‘pancakes’ from just whisked eggs (amazingly they looked like pancakes somehow); and despite eating 45gr of carbs through bread + another 10 through berries her sugar level increased by ~1 (this time we were eating about 10mins after the shot and she took her time with the meal).



“Keep up the good work, you're asking the right questions ”

-> Thank you! I out work on a side for now as fortunately got some flexibility and this is now my life focus Her smile is making up for all inconveniences!

 

[Hopeful34]

Timing is very important with meal and correction insulin, but everyone is different and reacts differently.

I used to have porridge for breakfast and spiked really high regardless of when I had my insulin. Granola had the same effect, so I gained much steadier blood glucose skipping breakfast completely (not suggesting your daughter does that).

Jacket potatoes raise my bloods the most out of any way of making potatoes, so I choose to rarely have them.

Wholewheat bread with added seeds doesn't raise blood sugar as quickly/by as much as sourdough for me.

I use split doses (am on a pump now, so use extended bolus as well) for pasta and any meal with a fair bit of fat.

You're doing really well, and it's a credit to you to have such a good result after lunch, when you're daughter's so newly diagnosed.

As you go further on this journey, it quickly becomes clear that diabetes isn't an exact science, and what works one day may produce a completely different result another day. Sometimes you can work out why (more exercise, starting with a cold etc), but often you can't, so don't be disheartened when that happens.

As the weather turns colder, some of us need more insulin, some less, so for example I have 2 different basal profiles on my pump - summer v winter.

 

[Kuba85]

Cheers. Indeed, I thought I was super logical in my line of work and in life in general but some of her charts from the last 3-4 days defy logic ha.

She was today 4.5-5.5 range post lunch until about 3pm. She sat down for ~30mins, and spiked to…14… But then our son got sick yesterday and she had runny nose in the afternoon so suspect now the sugar level is telling me she is getting sick (the spike was just too high in the absence of any carbs with the long insulin still in the background). She has also been feeling visibly weaker in the afternoon.

So I hear you that sometimes there are no patterns, and different people react differently. But I am hoping we can observe some rules that apply to her and hopefully can use them 80-90% of the time.

Appreciate all the comments - very useful to learn from those with lots of experience!