Off the proverbial rails...

Emmotha said:

Hi all,

It's been a while since I posted, as I've been doing alright.

I manage day to day on low carb, and that's fine I keep my levels low and stable.

But, if I do ever want carbs, I just can't seem to bolus for them anymore. Even if I greatly increase my ratio, it just doesn't cut it anymore.

Do you think it's because my basal is tuned for a low carb diet? If I know I'm going out for a meal the next day do you think I should up my basal?

I'm confuuuuused

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If your basal is OK for low carb then it's ok whatever you eat.

The problem must be with your fast acting insulin. Have you tried a new cartridge?

My basal has reduced considerably since I started low-carb and I also don't cope well with bolusing for higher carb stuff if I fancy it. I never had that problem when I was even medium carbing.

dancer said:

If your basal is OK for low carb then it's ok whatever you eat.

The problem must be with your fast acting insulin. Have you tried a new cartridge?

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Totally disagree with this....

I lower carb.

I used to a few years ago stuff myself for December... My basal rate would also have to be on 250% constantly for tbe whole month.

Eg... Just an example..

If you run on a 50/50 ratio of basal to bolus.. That could mean you are having say 10 units of both basal and bolus.

If all of a sudden you are say having more food then your bolys could go up to 20 units... And this would mean your basal bolus is totally out of sync....

I had pump for 5 years snd guaranteed every December when I ate more carbs everyday then my basals had to increase too.

Even now back on MDI if for one dayI go out and have a huge carby meal with friends then I have to increase my basal too.

I no longer have any treats for Christmas so avoid having to think about the changes to basals.

I remember reading an article about this somewhere. It may have been something that @phoenix posted.

When a non-diabetic moves from a low carb diet to a high carb diet, they have an abnormal insulin reaction for around 72 hours after the switch while their body reacquaints itself with a carb based diet. I would expect to see something similar in a diabetic, in that you would need more insulin to cope with a short binge, as a result.

In the longer term, I suspect that you would need to increase your basal insulin as a result of an increase In insulin resistance caused by the high intake of bad carbs and fats. It would be a bit of a vicious circle as the greater insulin dosage with the meals would result in more fat being laid down resulting in greater insulin resistance.

I'll have to have a look around and see what I can find.

Agree with above. If you regularly eat x amount of carbs, your body will output x amount back out which your basal deals with. Do this for a period of time your body adapts to it. If you do low carb and eat a higher carb meal as a one off you should be able to counteract with bolus, but, as its not regular will be hard to find how much needed with accuracy. As I don't low carb, when I so have a reduced carb meal I have the opposite problem as I have to reduce my bolus.

Obviously, I have nothing material to add to the insulin discussion, but @tim2000s , were you thinking og the "Last Meal Effect"? That spoke volumes to me.

Also, occasional carb binges against a background of a high fat diet is likely to have the same effect as occasional fat binges against the background of a high carb diet - immediate insulin resistance, so your normal bolus ratios will not be OK (I reckon).

The last meal effect wasn't what I was thinking of @AndBreathe

I have the same problem. I was talking to clinic doctor about it only last week as I have had problems on holiday this year when my usual lowish carb diet went out the window!! Eating more carbs and eating later at night also didn't help.
I tried to deal with it by using a split bolus. Increasing the bolus and having half up front and the rest over a longer period.
I tried the extended part over 4 and 6 hours but still found that my blood sugar still rose rapidly at the end of this time having been ok before. So I would wake up at 4 or 5 am with blood sugar of 16-20 or more and feeling rough.
He suggested that I use a temporary basal as well as a split bolus. And suggested something in the + 120% to 130% range.

But I have questions: When do I start the temp basal before or after meal? and how long do I leave it on for? I do worry about having both an extended bolus and a temp basal in progress when I am asleep?

Emmotha said:

Thanks for the replies all. Quite as I expected. I just need to develop some will power and lay off the Minstrels binges! (I type with a mouthful of Minstrels )

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Hi Emmotha,

Over the last years I've stuck with a routine of 13 days Ketogenic (LCHF) with a scheduled binge at the end of the fortnight. Then immediately back on the Keto horse.

As I honed the requirements for this routine, it was really a revelation to me just how much I needed to adjust my Basal dose in the wake of the binge. I developed a little formula which calculates the adjustment needed, based upon how many Carbs in the binge.

My current normal Basal (Lantus) dose is 8 Units before bed. My Basal dose before bed at the end of the binge day can be in excess of 58 Units. This is needed to handle the hugely exaggerated Gluconeogenesis that will occur over the next 24 hours, now that I've stuffed my liver with a s***load of Glycogen.

Your Post made me smile, as I'm very partial to a bag of Galaxy Minstrels! . . .

In my most recent binge, a 126g pack of Galaxy Bites cost me 25 Units Humalog, and +8 Units Lantus.

Regards
Antony

Emmotha said:

Lol I'm glad it's not just me that munches through one of those bags. Love how you know the weights of the pouches and everything. I'm not so partial to Galaxy Bites but Revels, Minstrels, Malteasers, M&Ms. Yum.

I'm also on Humalog and 8u Lantus (when I low carb) so this is very interesting for me. Do you have to split your humalog dose when you eat the Bites?

Thank you

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Revels! Had forgotten about those! Next binge

I haven't found that I've needed to split any Humalog doses on the binge day. I think it helps that I still have Ketones during the binge day, so I'm buffered against the unpleasant effects of low blood-sugars. I've discovered it takes around 12 hours after I start my binge, for Ketones to disappear. It might be that the Humalog profile is steeper than the food profile, and maybe my level drops lower before the food catches up. But I've never had any problem, so never needed to check this.

Regards
Antony

Any chance you could find a sweet spot thats not 'low carb' but just low enough to make for easy bolusing but also that allows you to maintain that 'normal' insulin sensitivity incase you do have that binge it doesnt spike abnormally ?

Maybe try eating at, like, 75g of carbs per day ?