Reducing carbs.

[lely]

Hi All.
18mths on a pump and pretty much understand it although the execution is sometimes a little hard to get right.
One thing I am struggling with is reducing carbs and then having hypos.
I'll explain.
My basal rates are set and good recently tweaked. My bolus rates recently tweaked and good. So when I try to reduce my carb intake and adjust the foods I'm eating for example eating more fruit less starchy carbs I end up having low bgs ( not so much Hypo, as i always feel them coming on).
Surely if my basal and bolus are set then as long as I'm measuring my carbs and bolusing accordingly, I should stay stable. I appreciate different types of foods digest at different rates so for example an apple has a lower GI than a bag of crisp. But will this effect my bolus calculation in the long run?
I try to eat healthy, have lows, get discouraged and give up its like a vicious circle.
Anyone else have same issue?
Hba1c pre pump 96
Hba1c 18 mths with pump 72.

Want to attempt 50/55 by Feb. Next appointment.




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[azure]

You've hit the nail on the head really @lely Different foods do get digested differently and raise BS at different times. Some fruits I prefer to,eat after a meal, for example.

All you can do,is keep notes of your meals and learn what works for them eg I use a combi bolus for pasta and have some insulin upfront and the rest as an extended bolus.

To lower your HbA1C, I recommend testing lots and watching out for spikes or sneaky nighttime highs. After meal spikes can be dealt with by advance bolusing, and you might even find you can slightly reduce your bolus if you have it more in advance. I found that with my breakfast.

How many carbs are you aiming for a day?

 

[noblehead]

How soon after eating are you going low? If it's within an hour or two then maybe you need to work on the bolus timing, for example if the food item is low gi then try bolusing just before or just after eating.

 

[lely]

You've hit the nail on the head really @lely Different foods do get digested differently and raise BS at different times. Some fruits I prefer to,eat after a meal, for example.

All you can do,is keep notes of your meals and learn what works for them eg I use a combi bolus for pasta and have some insulin upfront and the rest as an extended bolus.

To lower your HbA1C, I recommend testing lots and watching out for spikes or sneaky nighttime highs. After meal spikes can be dealt with by advance bolusing, and you might even find you can slightly reduce your bolus if you have it more in advance. I found that with my breakfast.

How many carbs are you aiming for a day?

I've not got to grips with extended/combo bolus yet. I just learned not to eat foods like pasta and couscous, which I love for my evening meal. I'll eat them for lunch. Need to break out the think.like a Pancreas book again for guidance I think.
I do find I don't drop as quick if I eat fruit with meals, like you says seem to slow the digestion of everything else and create a gentle rise but then I end up with it peaking 3/4 hours after coz the insulin has done it's thing and moved on. ( which is exactly why and extended bolus would be suitable in that instance) Id like to aim for around 40g carbs per meal and then 40/50 carbs for additional snacks. So 160/170 per day. But at the moment I'm hitting between 210-220.


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[lely]

How soon after eating are you going low? If it's within an hour or two then maybe you need to work on the bolus timing, for example if the food item is low gi then try bolusing just before or just after eating.

My drops have been round 2 hours after. Which is what caused me to do a round of basal tests and revaluate bolus in recent weeks. That seems to have settled now. I was having a lot of lows late afternoon causing me to eat before dinner then still eat dinner and ending up with it too high going to bed (11/12) I have that sorted now.
I have trouble trusting my BG is gonna do as pump says.
Woke on 4.4 8am this morning, ate breakfast bolused and it stayed round 4.6 for 2/3 hours then rose to 6.3 by lunch 1pm my target is 6. (this is a rare occasion for me)
While it was in the 4 zone I felt low and when you read IOB. And there's still 2u to work I head for the cupboard. I didn't today and that was the result. I think I ultimately need to trust it's under Control. Of course on a week day I'm driving this is just to low then so I'd have had to have a snack to bring it up.

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[azure]

I've not got to grips with extended/combo bolus yet. I just learned not to eat foods like pasta and couscous, which I love for my evening meal. I'll eat them for lunch. Need to break out the think.like a Pancreas book again for guidance I think.
I do find I don't drop as quick if I eat fruit with meals, like you says seem to slow the digestion of everything else and create a gentle rise but then I end up with it peaking 3/4 hours after coz the insulin has done it's thing and moved on. ( which is exactly why and extended bolus would be suitable in that instance) Id like to aim for around 40g carbs per meal and then 40/50 carbs for additional snacks. So 160/170 per day. But at the moment I'm hitting between 210-220.


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Sounds perfectly reasonable

Do try experimenting with the extended bolus for meals like pasta. You could maybe try a small portion in the evening and not eat too late so you can see how things go. It takes a little experimentation to find what works for you, but it's a really useful feature. I also use it for high fat meals. I used to bolus 1/3 up front and 2/3 spread over 2 hours, but now I'm on porcine insulin, I've tweaked that slightly.

I try to be around 6 at two hours after some meals where I know I usually go lower, so then any small drop just brings me down to an ok BS not a low one. Perhaps you could double check your meal time ratios, looking at how your body reacts to that meal? If you know you're going to drop a bit at 3 hrs then being 6 rather than 4.5 at two hours might help avoid lows and having to snack when you don't want to.

It's a pain having to do different things for different meals. That's one reason why I usually have the same breakfast and a similar lunch each day - less thinking required! : D

 

[noblehead]

I've not got to grips with extended/combo bolus yet.

The extended bolus features of a pump is a game changer, I use them quite often for difficult meals like those that are high in fat. As well as Think like a Pancreas the book Pumping Insulin has some great info and advice on using the bolus features on a pump.

Woke on 4.4 8am this morning, ate breakfast bolused and it stayed round 4.6 for 2/3 hours then rose to 6.3 by lunch 1pm my target is 6. (this is a rare occasion for me)

There's nothing wrong with a 6.3 before lunch @lely

 

[himtoo]

My drops have been round 2 hours after. Which is what caused me to do a round of basal tests and revaluate bolus in recent weeks. That seems to have settled now. I was having a lot of lows late afternoon causing me to eat before dinner then still eat dinner and ending up with it too high going to bed (11/12) I have that sorted now.
I have trouble trusting my BG is gonna do as pump says.
Woke on 4.4 8am this morning, ate breakfast bolused and it stayed round 4.6 for 2/3 hours then rose to 6.3 by lunch 1pm my target is 6. (this is a rare occasion for me)
While it was in the 4 zone I felt low and when you read IOB. And there's still 2u to work I head for the cupboard. I didn't today and that was the result. I think I ultimately need to trust it's under Control. Of course on a week day I'm driving this is just to low then so I'd have had to have a snack to bring it up.

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this morning ending up with a 6.3 at lunch sounds like perfection to me .
trusting your pump is hard to do when you have done MDI for years before.....
but that is an excellent result

 

[lely]

Yes 6.3 before lunch is a great result and to be honest the only part of the day I seem completely in control of.

After this discussion yesterday. I decided to use the combo bolus as we decided to have fish and chips ( chippy) for tea. One of my harder to control, guilt trip meals. Counted card as accurately as i could, used combo bolus 30/70 split over 2hrs.
8.2 at meal time
2 hrs after 8.6
4 hrs after 6.9
I'm think this is great. Aware I might now head for Hypo
Six hours after 8.8
Made up with myself and gave a 0.30 bolus as suggested by pump goes to bed this is at 11.15

2.33am awake 3.3. Didn't need that 0.33 correction dose, Still some work to do. Maybe it was the length of time I had the extended bolus on for maybe the food had done it's job and the insulin was still working.
I do have an issue with my ISF settings so need to look at that more closely.

I used to do a lot of suduko, don't need that now I have a pump.

Thanks all for the discussion yesterday. It's amazing how you can get clarity from a conversation from people who understand. My family listen but you can tell they are think WTH is she going on about.


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[himtoo]

WOW !! awesome result after a chippy tea !!
and yeah you didn't need the correction -- but store it in the memory for next time - LOL

were you showing any IOB ( insulin on board )when you gave the correction -

haha == that has made me laugh out loud -- not needing to do Sudoku now that you have a pump
only a D could think like that !!