How would you Bolus for this type of meal

[O_DP_T1]

So how would you bolus for this 52g carbs 55f Fat 45g Protein.

Meal is a spicy salmon in a wholemeal wrap with fresh Avacado.

My insulin to carb ration at night is 1u to 10g carbs so I am thinking just take 5u.

 

[NicoleC1971]

Mmmm. It sounds lovely btw. The fat in the avocado should slow down the rise caused by the carb but there again the protein in the salmon might need a little bolus so all in all your dose sounds right to me. Hope you enjoy(ed it....
Btw I find that if not eating carbs I do need to bolus for protein but less so if I am due to less gluconeogenesis/liver dump I guess.

 

[Deleted Account]

I would bolus for the carbs only.

In fact, it sounds so good, I might try it myself

 

[jlarsson]

Salmon does next to nothing to my blood sugar, and it also takes quite some time for it to take effect. If I inject before eating it'll just drop way too much so I tend to wait a while after finishing my meal to inject unless it's high beforehand.

 

[db89]

I would just use the carb value for the dose amount but given the amount of fat I'd be looking to either delay the dose or ideally split it in a slower absorption place.

 

[O_DP_T1]

Might just take the shot at the time of eating rather then the 20mins before hand I usually do.

 

[Deleted Account]

Might just take the shot at the time of eating rather then the 20mins before hand I usually do.

This is where I think something like the Libre would come in handy - we're all different, with different carb ratios, different tastes and different digestion/absorption rates.
With a CGM or Libre, we could work out for next time, when the insulin started working relative to the digestion rate and tell whether we should inject earlier or later next time.
As I have mentioned before, I didn't find the Libre or Dexcom accurate enough to check my dosage but I could see it being useful for working out timings for next time I eat the same (or similar meal).

And with a meal that sounds as good as that, there must be a next time.

 

[karen8967]

So how would you bolus for this 52g carbs 55f Fat 45g Protein.

Meal is a spicy salmon in a wholemeal wrap with fresh Avacado.

My insulin to carb ration at night is 1u to 10g carbs so I am thinking just take 5u.

maybe 5 and a half if youve got half unit pen i dont bolus for ft or protien but sometimes split the doses

 

[Celsus]

So how would you bolus for this 52g carbs 55f Fat 45g Protein.

Meal is a spicy salmon in a wholemeal wrap with fresh Avacado.

My insulin to carb ration at night is 1u to 10g carbs so I am thinking just take 5u.

With your ratio than 5 units at meal start time sounds perfect to me.
Though I would probably have taken 6 units myself, as such a royal meal would deserve a glass of nice cold Chablis with it!

 

[O_DP_T1]

Soooo an update on this.

Come dinner time:

• Starting BG 4.1 =
• Take 6u NovoRapid instead of 5 (just take 1 extra for luck in case)
• Start eating (Dinner was lovely by the way, I added rocket, spinach and fresh red jalapeños to the salmon and avocado inside the wraps)
• BG at 1hr after eating 7.9
• BG at 2hr after eating 11.1 (I'm like ***)
• BG at 3hr after eating 10.9 (I'm like *** again)

At about 3.5hrs I took a correction dose of 2u and woke up this morning at a 3.8. which is fine for me.

So either something went wrong, incorrect dose calculation, didn't get absorbed correctly or maybe I should have just waited the 20 mins after injecting to eat as I usually do. Lets see,

 

[Celsus]

Soooo an update on this.

Come dinner time:

• Starting BG 4.1 =
• Take 6u NovoRapid instead of 5 (just take 1 extra for luck in case)
• Start eating (Dinner was lovely by the way, I added rocket, spinach and fresh red jalapeños to the salmon and avocado inside the wraps)
• BG at 1hr after eating 7.9
• BG at 2hr after eating 11.1 (I'm like ***)
• BG at 3hr after eating 10.9 (I'm like *** again)

At about 3.5hrs I took a correction dose of 2u and woke up this morning at a 3.8. which is fine for me.

So either something went wrong, incorrect dose calculation, didn't get absorbed correctly or maybe I should have just waited the 20 mins after injecting to eat as I usually do. Lets see,

OK @O_DP_T1 , come clean with us!
What else did you eat and indulge yourself with???
Confess to your foodie pleasures!

They are probably not exactly the same, but when I eat those tasty corn-wraps you get with Mexican food like Tortillas, Burritos, taco shells etc, then I also experience a quick bg ramp-up. So probably down to the glucose index of those devils being rather high, up around the 70ties I think? Now you wrote you got your delicious meal with some whole-wheat wraps, or?
In such they should be in the low-medium glucose index type. Only other thing is mainly if you just simply ate more as it was such a tasty meal your got there?

 

[JoeT1]

I tend to see it like this. I fancy eating moderate carbs again, to the point I may need to bolus 4-5units.

What I noticed before was if I had a meal of 30-40g of carbs, and took the (what I thought was) the right amount of insulin, if the food kicks in first and raises my levels to say 10.0mmol, the insulin won't bring it down to what is was before, because the insulin is second. However, if I took the insulin another 15-20mins before I normally would, and the drop starts before the food kicks in, it'll probably come back to normal.

 

[O_DP_T1]

@Celsus yep whole meal wraps made the meal at home I generaly don't eat any white breads, wraps or white pasta etc. I think JoeT1 might be right as I usually bolus 15-20mins before hand. Lets see.

Oh I was tempted to try some of the red velvet cup cakes my Mrs had made.........tried soooooo hard to resist!!! But resist I did!!!!

 

[Antje77]

Dinner was lovely by the way, I added rocket, spinach and fresh red jalapeños to the salmon and avocado inside the wraps

This is the best part! So next time perhaps a bit of pre-bolusing and/or split-bolusing. Or some other type of wrap. For such a meal I would keep on trying until I got it right!

 

[Bertyboy]

I would just use the carb value for the dose amount but given the amount of fat I'd be looking to either delay the dose or ideally split it in a slower absorption place.

When you say "slower absorbtion place", what do you mean? Do different injection point have an effect on insulin uptake?

 

[jlarsson]

When you say "slower absorbtion place", what do you mean? Do different injection point have an effect on insulin uptake?

Different foods are absorbed at different rates, a jelly baby to use what your diabetes nurses seem to consider the holy grail of quick carbs will get absorbed very quickly whereas something like fish may take longer, meaning that injecting before a slow acting food can cause a hypo before it eventually starts to act, and something that acts quickly will spike it to stupidly high levels if you decide to inject after.

Edit: Oh never mind me, not reading your post properly.

 

[Celsus]

When you say "slower absorbtion place", what do you mean? Do different injection point have an effect on insulin uptake?

Yes they have!
Insulin is absorbed fastest (and in a more stable and predictable rate) when injected into the subcutaneous tissue in the abdomen. Reasons are several, but mainly because this torso area remains at constant body temperature and the natural vascularization is permanent happing at same rate no matter your other physical activities that you may or may not engage in. And your insulin absorption rate is less quickly in the upper arms, thighs, and buttocks/hips. (and they are more dependent on your physical activity level also)

 

[db89]

When you say "slower absorbtion place", what do you mean? Do different injection point have an effect on insulin uptake?

Sure do - the thighs and buttocks are supposed to have the slowest absorption rates, followed by the arms at medium speed and fastest is the abdomen and lower back*.

* I don't know how people use that last one without a mirror or assistance.

 

[jlarsson]

Sure do - the thighs and buttocks are supposed to have the slowest absorption rates, followed by the arms at medium speed and fastest is the abdomen and lower back*.

* I don't know how people use that last one without a mirror or assistance.

I've always wondered why they keep asking where I inject, it seems rather challenging to inject in places other than the abdomen or thighs.

 

[Celsus]

@Celsus yep whole meal wraps made the meal at home I generaly don't eat any white breads, wraps or white pasta etc. I think JoeT1 might be right as I usually bolus 15-20mins before hand. Lets see.

Oh I was tempted to try some of the red velvet cup cakes my Mrs had made.........tried soooooo hard to resist!!! But resist I did!!!!

**** @O_DP_T1 what a teasing wife you have!
Good you stayed in character and showed her your firm resolve and discipline!