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Effects of different foods

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Spearmint

Well-Known Member
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244
Not sure if this should go in here or in the food forum or in the ask a question forum :?:

My daughter has now recovered from last weeks infection, thought to be food poisoning.
So, this week we have now started MDI properly.
I have been struggling with it a bit, mainly from her doses being nothing like i was told to start her with and also from lack of information on what to do!
From this forum i learned that the ratios are different depending on the time of day and that she no longer needs snacks inbetween meals - that is where i was going wrong :oops:

I 'think' i have cracked breakfast and lunch now though
Not sure i have the Levemir right yet
I am struggling with dinner and hypos the most!!

Last night we had indian takeaway so i put her plate on the scales, weighed how much she wanted to eat and worked out the carbs and then how much novorapid to give.
She was 6.4 before eating and then 4.3 and hour and a half later before bed :?
I panicked and gave her a cup of fruit smoothie - 25g carbs
I tested her at midnight and she was 16.3 :shock:
I was tempted to give novorapid so she didn't wake up that high but i was too tired and confused to try and guess how much to give so left her and she was 8.3 on waking at 7am this morning.
Is that just the effect that eating curry has or did i do something wrong???

I went wrong the night before, she wanted jacket potato with cheese and beans for dinner so i worked out the carbs for both and gave novorapid for the total but then she was hypo from 7pm-3am :oops:
Apparantly with baked beans i only need to count the sugars and not the full carbs but when i asked exactly what carbs to count i was told the only veg to count was baked beans, parsnips and potatoes

So i was wondering if different meals have different effects and rates of effect?
 
Hi,

What sorts of food did she have with the indian?

was it high in carbs?

With takeaways the issue is they can be quite fatty, a high fat meal can slow down the apsorbtion of carbohydrates. So the insulin may take affect before the carbs are processed, which can mislead you into thinking you have a good reading (the 6.4) then test again and your low (4.3) but after treating the low reading the carbs take affect too which shoots your BG right up!

This may have been the case.

Or it could be that you mis calculated the carbs or your ratio needs some work.

The starting doses given to start with you should find they dont seem to be enough, this is because to avoid hypos it's better to work your dose up from higher BG readings rather than having too many hypo's which can be worrying when starting a new regime.

Personally i don't take into account baked beans when carb counting, this is because i was told the rate that the carbs are released is far too slow to be tackled with insulin so you may indeed hypo as you experienced. The only thing i would take into account is the sauce which would be the 'of which sugars' bit. But i rarely have that many beans so i personally never count them.

Novorapid has a life of 2-4 hours, so if she is going hypo more than 4 hours after a meal, it could be that it's the basal insulin thats making her go low.

I was taught that if you hypo in the night, reduce your background insulin immediately, do not wait for a pattern to appear as you need to address these straight away.

Your not doing anything 'wrong' the bolus/basal regime can be quite tricky at first, with carb counting and taking all the possible factors into account before pinpointing an issue and addressing the problem.

Keep a diary and note down your readings, carbohydrates, insulin doses and what she's eating if you don;t already do this, it's much easier to spot patterns of highs and lows when you look at a full days readings. You could spot that maybe she's higher just before dinner so she may need more insulin in the morning.

Keep going with it and you will get there, it's trial and error in the beginning and don't beat your self up about it if something doesn't go quite right
 
Thanks for your reply

I did not know that about fat in meals!

She had:
basmati rice - 45g carbs
chicken korma - 8g carbs
naan bread - 75g carbs
I worked out the carbs as per the carb book given to me by the hospital

If she has this again should i get her to inject after eating instead of before?

I managed to work out by myself that she needs more insulin at breakfast than lunch so has 1:10 and 1:15, she always has the same thing every day so i think they are right.
 
Spearmint said:
Thanks for your reply

I did not know that about fat in meals!

She had:
basmati rice - 45g carbs
chicken korma - 8g carbs
naan bread - 75g carbs
I worked out the carbs as per the carb book given to me by the hospital

If she has this again should i get her to inject after eating instead of before?

I managed to work out by myself that she needs more insulin at breakfast than lunch so has 1:10 and 1:15, she always has the same thing every day so i think they are right.
Click to expand...

Also, as that meal was quite high in carbs it might just take a little longer for the insulin to cover it.

You could experiment and split the dose into two injections, so she has some with her meal and some a little later, however it can be tricky finding the right balance of how much to split it by and how far apart and of course it's an exra injection which isn't nice.

IT's quite common to need more insulin at breakfast, my ratios are 2.5u:13g at breakfast and 2u:10g at lunch.

I use an insulin pump and when i have fish and chips i extend my bolus over 1.5 hours! so that means my pump slowly delivers my insulin over that time instead of having it all at once.

Also when i eat pizza as it can be very very tricky i usually extend my bolus over 3 hours!! as i've found it affects my BG over a very long period of time.

The higher amount of carbs i eat the longer i need to extend my boluses by.

It took me quite a bit of experimenting to learn how to handle high fat and carb meals. It won't ever be the same as another person as everyone is different so it's about you finding what works best for your daughter which you seem to be doing very well :)
 
I think you have two effects going on here:

1. Indian can be high in fat and cause a peak BG at say 2.5 - 3 hours post meal... the rapid insulin was likely dropping BG's quicker than the carbs were being absorbed for the first couple of hours.. This lead to the low... When the carbs were then hitting the blood stream the insulin has started to lose its peak effect, combined with the additional un-covered carbs this lead to the high

I would guess you may have wanted to split the dose and done 30-40% with food and another 60-70% 1 hour later this is what I probably would do (although far to many carbs for me!)

2. BG's of 16.3 at midnight dropping to 8.3 at 7am would suggest to much Levemir to me.. that's a lot for BG's to drop without any active rapid insulin, unless the meal was late in the evening I wouldn't expect the rapid insulin to still be working post midnight? your background insulin should keep BG's stable within 1 mmol/l over the period of effect.. i.e. if she was 16 at midnight I would expect her levels to be the same or slightly higher (with a bit of DP) at 7am without any additional correction insulin being administered.
 
Pneu said:
I think you have two effects going on here:

1. Indian can be high in fat and cause a peak BG at say 2.5 - 3 hours post meal... the rapid insulin was likely dropping BG's quicker than the carbs were being absorbed for the first couple of hours.. This lead to the low... When the carbs were then hitting the blood stream the insulin has started to lose its peak effect, combined with the additional un-covered carbs this lead to the high

I would guess you may have wanted to split the dose and done 30-40% with food and another 60-70% 1 hour later this is what I probably would do (although far to many carbs for me!)

2. BG's of 16.3 at midnight dropping to 8.3 at 7am would suggest to much Levemir to me.. that's a lot for BG's to drop without any active rapid insulin, unless the meal was late in the evening I wouldn't expect the rapid insulin to still be working post midnight? your background insulin should keep BG's stable within 1 mmol/l over the period of effect.. i.e. if she was 16 at midnight I would expect her levels to be the same or slightly higher (with a bit of DP) at 7am without any additional correction insulin being administered.
Click to expand...

Thanks for your help, it is just all confusing me and her nurse is not working today so i can not ring her again!

She doesn't normally have that many carbs for dinner, it was a 1 off for her sisters birthday.
Breakfast is about 30g carbs, lunch about 45g and dinner about 80g

This is how yesterday went:
7am - 4.2, drank smoothie at 25g carbs
7:30am - 6.1, had 12L & 3NR, ate porridge at 30g carbs
9:50am - 10.7
12pm - 10.0, had 3NR, ate sandwich and crisps at 48g carbs
3:30pm - 5.3, ate fromage frais & strawberries at 10g carbs
6:30pm - 6.4, had 8.5NR, ate curry, rice & naan bread at 128g carbs
8pm - 4.3, had 12L, drank smoothie at 25g carbs and went to bed
12am - 16.3
I meant to test at 3am as well but i slept through the alarm :oops:

Today so far:
7:25am - 8.3, had 12L & 3NR, at porridge at 30g carbs
12pm - 7.9, had 3NR, ate sandwich and crisps at 47g carbs
 
Spearmint...

I am sure one of parents with a type 1 will be along shortly to help... unfortunately I was diagnosed at 17 so I am not sure what is normal for a child but from the looks of it the levemir does looks high?

14.5 units of NR to 24 Levemir looks a bit off for a ratio? normally 50:50 to start with? and looks like that was a high carb day as well?

Again I have no experience with diabeties and children!! so might be worth waiting for one of the more experienced posters.. I am not sure if you do fasting tests with children? is the best way to determine that the levemir is correct.. and the levemir the the important thing you need to sort.. once thats right then you can understand her true NR ratio's.. until that's right you are playing a guessing game
 
Hi Spearmint

My Son James is on MDI's since Feb this year. He is 14 and has been diabetic since 3 and Coeliac since 8.

He is on Novorapid and Lantus.

We started on a regime of
1:10g for breakfast
1:10g for lunch and the same for tea. He does not have insulin for his supper which equates to 70g and Lantus of 15 units before bed.

Now he is on
1:10 for breakfast
1:15 for lunch
1:10 for tea and still 70g carbs for supper without novorapid. But we are now trying 16 Lantus before bed as he does tend to get a higher reading before breakfast.

Meals consist of
70g breakfast
snack at school say 11am (yogurt only but if low reading before breakfast has 8 pringles as well)
70g lunch
tea varies up to 120g and
70g supper (without Novorapid)

If James has a low BG before breakfast, we tend to let him have breakfast straight away and inject after his food so we are not having to treat a hypo as well and I will add that if his BG is low before any meal we tend to give insulin after food which works out ok.

Best Wishes :)
 
Pneu said:
Spearmint...

I am sure one of parents with a type 1 will be along shortly to help... unfortunately I was diagnosed at 17 so I am not sure what is normal for a child but from the looks of it the levemir does looks high?

14.5 units of NR to 24 Levemir looks a bit off for a ratio? normally 50:50 to start with? and looks like that was a high carb day as well?

Again I have no experience with diabeties and children!! so might be worth waiting for one of the more experienced posters.. I am not sure if you do fasting tests with children? is the best way to determine that the levemir is correct.. and the levemir the the important thing you need to sort.. once thats right then you can understand her true NR ratio's.. until that's right you are playing a guessing game
Click to expand...

This is what i have been thinking :?
She was having 14 in the morning and 12 at night but i felt she was dropping too much by dinnertime so changed to 12 and 12.
On a normal food day she would have 24 levemir and 11 novorapid in total

When she was having humulin twice a day and i used novorapid either to boost a bigger meal or to bring her levels down, the novorapid would have a massive effect on her - just 1 unit would bring her levels down by 10 and for food 1 unit would cover 60g of carbs.

What messed it up is the day after we changed to MDI she came down with suspected food poisoning which was last week and she was having 40 units of novorapid per 24 hours split into 2 hourly doses which barely touched her BGL's :shock:
I'm wondering if as the days go on i might have to drop the levemir although she might not stay on it due to a reaction where she is injecting her, been told to give it another week.
 
stoney said:
Hi Spearmint

My Son James is on MDI's since Feb this year. He is 14 and has been diabetic since 3 and Coeliac since 8.

He is on Novorapid and Lantus.

We started on a regime of
1:10g for breakfast
1:10g for lunch and the same for tea. He does not have insulin for his supper which equates to 70g and Lantus of 15 units before bed.

Now he is on
1:10 for breakfast
1:15 for lunch
1:10 for tea and still 70g carbs for supper without novorapid. But we are now trying 16 Lantus before bed as he does tend to get a higher reading before breakfast.

Meals consist of
70g breakfast
snack at school say 11am (yogurt only but if low reading before breakfast has 8 pringles as well)
70g lunch
tea varies up to 120g and
70g supper (without Novorapid)

If James has a low BG before breakfast, we tend to let him have breakfast straight away and inject after his food so we are not having to treat a hypo as well and I will add that if his BG is low before any meal we tend to give insulin after food which works out ok.

Best Wishes :)
Click to expand...

Thanks for that info

She doesn't have a morning snack at the moment as she doesn't seem to need one, after school i have been trying to make her snack 10g of carbs or less, before bed she has nothing except sometimes a hot chocolate which is just a teaspoon of options in hot water.
 
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