Eating Pulses

[Cheryl]

Hi all,

Does anyone regularly eat lentils/beans etc. and use a pump?

This is one type of food that I really struggle to deal with.

Before I went on the pump, the dietician told me to ignore pulses in my carb calculation. But now, it seems sensible to include it in my carb caluculation but to extend that part of my bolus over a long-ish period to deal with the very slow absoprtion of the carb from this type of food.

If you eat pulses, how long do you extend your insulin over to cover that part of the carbohydrate?

But, just to complicate matters: :?
Last night, for the first time in a while, I had a lentil bake (with added cheese & cream to slow down the absoprtion even more!). The problem is that it was part of a high carb roast dinner (150 grammes of carb/15 units of insulin in total) so I wanted to have a multiwave/combo bolus due to the amount of insulin that I was taking on board.

However, how long do I stretch the extended part over? The lentils made up 22 grammes of carb and I wanted to bolus 8 units over an extended time period. If I extend it over a number of hours, I will go very high as the other carb (roast potatoes & sponge pudding) will absorb pretty quickly, and if I extend it over 30 mins as I wanted to, I would probably go low.

So, I extended over 30 mins, my BG started at 4.7 before dinner, was 4.7 2 hours after dinner. I ate 18 grammes of carb to avoid a hypo & was 5.2 4 1/4 hours after dinner. I had another 4 grammes of carb, then as I know my insulin keeps working in me for up to five hours. I woke up this morning at 12.1!

So, I had to eat the exact equivalent of the amount of carb in the lentils within 4 1/2 hours of my meal to avoid a hypo, but then my BG rose approximately 6% between 4 1/2 & 11 hours after the meal.

I had an idea today that when I eat pulses again, perhaps I'll ignore the carb in them in my bolus calculation & programme a TBR at bedtime of perhaps 120% to try and avoid the long slow rise during the night.

Does that sound sensible? Has anyone had success with other approaches? Anyideas would be appreciated.

Sorry for the length of this post, it's hard to explain what I mean otherwise

 

[jopar]

Before jumping to TBR's etc over night I think you need to look again at your meal..

You need to work out what really happened after your meal..

Sounds as either you misscalculated your dose for your meal and/or set up the duel wave wrong.. Which is pretty difficult to tell because you ate more carbs to avoid a hypo, and it could easily be these carbs that were impacting on your morning reading rather than your main meal..

Before setting TBR's overnight I would try extending the second part of the duel wave much longer to see if this levels things out for the morning, and if it looks like you might go hypo turn your pump down this will give you a better picuture as you won't have addiontional carbs that could be impacting on your BG's..

P.S

Roast potatoes are slow adsorbers not fast!

 

[Cheryl]

I've always considered roast potatoes to be fairly fast absorbers similar to jackets, but just a little slower due to the fat content (certainly a lot faster than lentils). I don't use much fat in my roasties, compared to restaurant ones anyway.

I definitely got the amount of carb right as I cooked the meal from scratch (cept pudding) & I weigh everything & read packets religiously. If I had eaten a much smaller amount of carb overall, I would probably have extended a couple of the total units over 3 or 4 hours, but I'm not sure if that's long enough. The way I reacted suggests that the lentils didn't get to work on my blood sugar until at least four hours after eating them, after all if my BG was only 5.2 over four hours after insulin delivery & two hours after having an extra 18 grammes of carb, it suggests that the total amount was right, but that the lentils hadn't started "working" yet.

The trouble with the high carb meal is that I'd like to have had 13 units immediately & 2 units over 4 hours, but have always been told by the DSNs to extend any bolus of more than 6 units as it's absorbed better that way. Perhaps I should have had 13 units over 30 mins then programmed another bolus of 2 u over 4 hours afterwards. It just occurred to me that a 120% TBR might do the same job & I wouldn't have to remember to programme the additional bolus later on (and I am a total airhead sometimes) :roll:

Any ideas on what other people on pumps do with pulses would be appreciated.

 

[jopar]

The general rule given for duel wave bolus is a 60% up front then 40% extended the extention over 2 hours... And remember this is a general rule, so need to experiment to what suits best..

One the extend bolus, you looking for BG control that stays within in a 2.2mmol/l-4.4mmol/l of your starting point..

In your case dropping you up front bolus, might increase your BG slightly more at the 2 hour mark, but the higher extended amount would increase that every curtailed as the slower carbs start kicking in,,,

As to what the DSN advises, well they give you a guide and you then need to fine tune it to fit your needs.. Same as the general rule I've given.. A lot of time this is roughly split, I use, but at other times it's a lot different depending on what I'm eating..

If you find that the above causes a high spike at the hour mark, you can always try the super bolus, which I find impossible to explain, so would have to find a link for you.. But based on adding your basal to your bolus and delivering it all with a bolus...

 

[Cheryl]

It's amazing the gulf between what one clinic says & another. I have never been told to set a "standard" baseline to extended & multiwave boluses, then adjust as I see fit, merely to extend any bolus of more than 6 units over at least 30 mins so that the insulin isn't sitting in a big lake under the skin and also to extend or multiwave boluses which involve very slow acting carbs such as oats or pulses. I specifically discussed my usual breakfast (porridge) with the dietician for which I used to have a multiwave bolus of 4u +1u over 1 hour, which she never said was not a good place to start. (I don't extend at all for it now, works better that way.)

My usual problem is a high after 2 hours (rarely under 12) and no amount of basal testing & insulin/carb ratio changes has ever solved that without sending me hypo after 4 hours, so it's rare for me to find myself at 4.7 after 2 hours and I will always have to have extra carb to prevent a hypo in that situation.

I've gone back to the drawing board with my erratic control the drawing board is falling over from overuse :?

Why is managing diabetes sooo complicated?!

 

[Cheryl]

It's amazing the gulf between what one clinic says & another. I have never been told to set a "standard" baseline to extended & multiwave boluses, then adjust as I see fit, merely to extend any bolus of more than 6 units over at least 30 mins so that the insulin isn't sitting in a big lake under the skin and also to extend or multiwave boluses which involve very slow acting carbs such as oats or pulses. I specifically discussed my usual breakfast (porridge) with the dietician for which I used to have a multiwave bolus of 4u +1u over 1 hour, which she never said was not a good place to start. (I don't extend at all for it now, works better that way.)

My usual problem is a high after 2 hours (rarely under 12) and no amount of basal testing & insulin/carb ratio changes has ever solved that without sending me hypo after 4 hours, so it's rare for me to find myself at 4.7 after 2 hours and I will always have to have extra carb to prevent a hypo in that situation.

I've gone back to the drawing board with my erratic control the drawing board is falling over from overuse :?

Why is managing diabetes sooo complicated?!

 

[jopar]

I'm always amazed myself, and never quite sure where this differental actually lays or whether it is one factor or combination of factors involved... I've got my theories though :roll:

I learnt many years ago not to rely on just my clinic for information, but to support this with my own reasearch and learning to get all the information required to be succesful... A lot of people struggle with managing their diabetes both with MDI and with pumps... Because they just aren't getting the right information to achieve and controlling making managment decisions are too heavily based on the DSN doing it for them...

I've actually not had any help from my pump nurse, not because she rubbish but purely I've not needed it... But I did research, study and learn insulin pump therapy for over 3 years before I started pumping so really had a head start on it.

A good book that I found very helpful for understanding insulin pump therapy, is Pumping Insulin by John Walsh, he's himself his an diabetic Endo who is T1 and uses a pump..