Type 1 Stacking

[Nadia19]

I feel hungry in between meals been told to have snacks under 20g of carbohydrate. However, if I have a meal at 12pm 60g carbs, and again at 3pm I’m hungry and I want to have 40g for example. how would I go about this?

 

[Rokaab]

You just have the 40 carb meal/snack and take the relevant amount of insulin for it

However do note, there may well still be insulin in your system so if you were also thinking about correcting your blood sugar you need to take this into account as you dont want to go hypo - you shouldn't be be correcting within 4 hours for many of the fast-acting insulins

 

[Deleted member 574368]

I would apply a correction dose rather than your normal ratio, thats me though so check with your DSN/Practitioner and ask their advice.

 

[In Response]

I would apply a correction dose rather than your normal ratio, thats me though so check with your DSN/Practitioner and ask their advice.

Correction for what?
I would definitely follow @Rokaab and dose for the snack.

 

[Nadia19]

Okay thank you, I seem to be hungry after meals and I am constantly saying no to food. I lost a lot of confidence after norovirus stomach bug which happened in March, I still feel a bit skeptical. However onwards and upwards, sometimes it’s better advice from a diabetic than the nurses.

 

[Deleted member 574368]

For the 40g of carbs that was eaten between meals

 

[In Response]

For the 40g of carbs that was eaten between meals

Maybe we have different terminology.
To me, a correction is taken when I see my levels are too high. A bolus dose is taken because I am about to eat 40g carbs.

When bolusing for a meal, I would calculate the dose as the correction needed if I was too high plus the dose for the carbs that I am about to eat.
If I have insulin on board (active fast acting insulin that was taken less than 4 hours ago), I would ignore any correction needed for a higher BG.

 

[Deleted member 574368]

I would be careful about applying a full dose based on your normal ratio, stacking is an overlap of your regular dose plus additional doses in between.

I don't know anyone elses thoufgts on this but I have always considered dosing again while insulin is still active from your previous dose an instant invite to hypos.

I have attached a document from alderhey hospital and I appreciate the age group may not be the same but i believe that it is pertinent.

 

[JAT1]

Beware of stacking. I've had some serious hypos because of it. If I were hungry after 3 hours since the last meal, I would ask myself why because I find life as a type 1 easier if I don't snack. If I decided to have the snack, I would check my blood sugar. Sometimes my bolus takes up to 3 hours to really start working and so it's very hard to assume how much insulin is still to be used. Absorption of carbs also depends on the fat/protein/carbs content of the last meal. If I do end up snacking and taking insulin to cover, I watch my blood glucose very carefully to make sure I'm not dropping too fast to easily fix. Usually I choose a low-carb snack that won't affect my blood glucose so that I won't need insulin, such as cheese, eggs and meat.

 

[Nadia19]

Ok thank you I think I will speak to the nurses, for example I have had dinner at 5.30pm. And now I would like to have 2slices of toast and eggs. Would you cover the 40g of toast with insulin? If so, do you take all the amount or do you miss a few units.

 

[JAT1]

Ok thank you I think I will speak to the nurses, for example I have had dinner at 5.30pm. And now I would like to have 2slices of toast and eggs. Would you cover the 40g of toast with insulin? If so, do you take all the amount or do you miss a few units.

I would measure my blood sugar and I wouldn't have toast, just the eggs, so I wouldn't have to take insulin when I may still have an indeterminable amount still to work through.

 

[In Response]

I think it is a matter of experimentation and finding what works for you.
I have always been a grazer and never had a problem with stacking as long as I consider insulin on board ... or not applying the correction dose.

On this forum, I have read a number of times "if you need to snack between meals you haven't eaten enough" or "you have eaten the wrong thing" but I cannot eat that much in one meal. It is not the way my digestion works.
I also find that eating only protein for a snack will cause my blood sugars to rise so I would still need insulin if I ate eggs and no toast (yes, I have tried it).
As I have no problems with hypos or weight gain or anything else, I do not see a problem with my approach for my body. I would advise others to find what works for them and not let diabetes control what and when they eat.

It is very important to remember that we are all different. What works for one person does not necessarily work for the next. This maybe because their insulin sensitivity is different, their digestion is different, their lifestyle is different, their mental attitude is different.

 

[Nadia19]

Thank you for the clear instruction of reply I have taken that on board. Not to let it control when and what I eat. Great motivation and great quote. Thank you