[Adjitater]

I made a statement in another tread about how food and carbs were not high on the list of things to consider when eating. So now I will attempt to let you see what goes through my mind and what must be considered in order to treat my diabetes.

Lets take breakfast as it is everyones favorite meal. Now I can't just get up and eat. I have to take my steroids a couple hours before I eat. Those consist of, prednisone, fludrocort, DHEA, levithroid, crestor and a baby asprin. Although they are not all steroids 4 of them are horemone replacements. This is usually taken in the early morning hours between 4 and 6.

When I do get up for the day I will check my blood glucose level and think about what the day has in store. I ask will I ride my bike today, will it be hot out and if so how hot. With this information I can decide what to eat and when Yo take my first bolus and what type of bolus do I want to take.

Ok so lets run through it real qiuck. Got up at 4:45 and took pills, checked blood glucose and it was at 84. Good no weed for any thing to eat right now. If it was 20 points lower i would but this is good so dack to bed. Get up at 9:20 and check again and it is now 136. Not bad I can live with that. Now how hot is going to be today. OK only going to be in the upper 80's today so I will ride for a couple hours.

Now with all this I decide it will be a breakfast of waffels, sausage, fruit, and coffee. So I count the carbs and do my bolus. It was 58 grams total so I bolus for 60. Now I will be riding so I will just do a normal bolus as I want my glucose up to abot 200 when I start. Then after I take this bolus I turn down my basal rate on my pump to 50% of normal. This is done so I don't crash and burn while I am riding. So 2 hours have gone by and my glucose is now where I want it. Check right before leaving and it was 224. Do I have all the things I need. Glucometer-check, plenty of test strips- check, hypo fixxers-check, water-check, phone-check.

Half an hour in I check and glucose is at 142. Good keep riding and drink some water. Second half hourand I am now at 71 so it is time to eat a little. I will go with a fruit snack package and a beef stick. about 20 grams but I am not going to bolus. 30 minute break taken snad ride another half hour and check again and something must be wrong or I have been riding a lot harder than expected as I am now at 42. Weather has been good so it is not that but it could be that I need a steroid boost to get me home so I take some cortisone accitate and eat crackers and cheese, rest of my beef sticks, pour 2 pacakges of Koolaid into my back up water bottle , and have some fruit snacks. I am now an hour and a half away from home, about 35 miles. So I will not bolus for this stop. Ok blood sugar is bak up after that 60 gram stop, lets ride home. The other stops were good with glucose levels around 100 and when I got home it was 96. So I get undressed and shower and then turn my basal rate back up to normal.

This is just an example of what it is like to plan a day for a simple bike ride. If I get it wrong or if somthing out of my control goes wrong I pay a dear price.

So when I say food is not high on the thought list I was wrong it is up there but in a different sort of way. It is up rhere in the since of do I have enough to do what the day calls for not in what will it do to me but rather what is going to do for me.

 

[Strawberry]

Thank you for posting the bird's eye view of your day. You've explained it very well I think. When I try to tell my husband that food isn't the only thing to consider when planning a meal for myself, his eyes glaze over and I know he just doesn't get it. He is very fortunate and doesn't have any major health problems. I will ask him to read your post and then maybe he will have a better understanding.

 

[Adjitater]

After reading it myself I didn't even mention considering things like fat contents and fiber as well as what time of day it is. For me my bolus rates are different in the middle of the day and at night than they are in the morning.

 

[Strawberry]

Amen Brother. My bolus rates are different for every meal and my mid-day basal rates are half of what my early evening rates are. When I was on MDI, I kept telling the Doctor that I "always" go low in the middle of the day. He kept fobbing me off and telling me that "it is all in your head". Now I know he is the one who needed a different understanding of diabetes.

Adjitater - do you have any success at all with doing a bolus for pizza (if you can eat that kind of food occasionally)?

 

[Adjitater]

Amen Brother. My bolus rates are different for every meal and my mid-day basal rates are half of what my early evening rates are. When I was on MDI, I kept telling the Doctor that I "always" go low in the middle of the day. He kept fobbing me off and telling me that "it is all in your head". Now I know he is the one who needed a different understanding of diabetes.

Adjitater - do you have any success at all with doing a bolus for pizza (if you can eat that kind of food occasionally)?

I eat all that stuff all the time. Pizza, spaghetti, all the stuff that we were told for years not to even think about as it was out of the question. I use my dual wave bolus a lot. The more fat there is the the moer that is in the square wave. But 50/50 is a good place to start. Thats 50 percent of the full amount up front and 50 percent over the next 2 or 3 hours. It is not always perfect but it is better than going low and then rebounding when the pizza kicks in through all the fat.

 

[C6H12O6]

Now thats real life not the clinical model that the docs expect,

Sent from my Nexus One using Diabetes

 

[Strawberry]

I detest 'Docs' who tell a patient "if you do X, Y & Z" then everything will be hunky dory. Baloney. People are individuals, not robots or machines.

 

[Adjitater]

Thats why pumps have so many settings. They can be invidulized to fit the person. If we were all the same they would only have 2 settings. On and OFF.

 

[beefy]

Thanks for posting this... my gosh you have a lot to consider!

Do you do continuous BG monitoring, or do you take it every so often during the ride? I'm lucky in that I seem to have no risk of hypos, so I no longer bother to check my BG when I ride ... just wondering what the process is for you.

 

[Adjitater]

I do have a continuous glucose monitour but I still need to check it every every 30 minutes. I can drop 100 points in 30 minutes when I ride and no continuus monitour will keep up at that rapid of change so finger pokes are the best option in this case.

 

[LarryT]

Adjitater thanks for posting this great info, a lot to consider!

I am in process of changing Insulins (T2 insulin dependent) and the Basal - Lantus seems to be doing well. You mention in your first post "dual wave Bolus" is there somewhere I can read more about that? Mastering the bolus is my next task :violin: Have so far just given lower dose of Novolog 2 - 4 units with second/third meals. But now need to refine that.

 

[Adjitater]

Dual wave bolus is a pump feature that spreads the bolus out over several hours.

 

[Cadydid]

You did a fantastic job with this post! You showed that we have to consider not only what food can DO to us, but FOR us. I especially like your comment on the pumps LOL

Strawberry.. couldn't have put it better myself. That's why I like my PCM as much as I do. She treats me for me.. not what like everyone else just because a study, drug rep, or whoever else says she should.

 

[Strawberry]

Thank you for your kind words. Adjitater is very experienced in using the pump and I've learned much from him. I think the thing that confuses me the most yet, however, is the dual wave bolus. Sometimes I wonder if I should use it for the particular food I'm going to be eating, or should I use just a straight normal bolus?

 

[Adjitater]

Thank you for your kind words. Adjitater is very experienced in using the pump and I've learned much from him. I think the thing that confuses me the most yet, however, is the dual wave bolus. Sometimes I wonder if I should use it for the particular food I'm going to be eating, or should I use just a straight normal bolus?

I wish I had an answer for this problem. It is unique to each individual as diabetes itself. As a general rule I use my Calorie King and the more fat and protein that a meal has the less I take up up front and the lomger I extend the square wave portion of the bolus. There are some meals like pasta that I do increase the bolus by 20% of what the wizard says and then do the split. I don't know why but for some meals thats what works.

 

[Shanny]

I decided to make this thread a "sticky" because so much of the general population knows so little about the difficulties faced by our friends who manage type 1 diabetes and multiple other very serious medical issues as well. Thank you Adjitater, for starting the thread, and Strawberry for adding some of your experiences.

 

[Adjitater]

Well thanks Shanny. Iam not sure what a "sticky" is but I am sure it something good.

 

[Shanny]

Well thanks Shanny. Iam not sure what a "sticky" is but I am sure it something good.

It is "stuck" at the top of the list so it can't get lost in subsequent threads - doesn't require new posts to keep it bumped to the top. So thank you for thankin' me . . .

 

[Strawberry]

I wish I had an answer for this problem. It is unique to each individual as diabetes itself. As a general rule I use my Calorie King and the more fat and protein that a meal has the less I take up up front and the lomger I extend the square wave portion of the bolus. There are some meals like pasta that I do increase the bolus by 20% of what the wizard says and then do the split. I don't know why but for some meals thats what works.

Adjitater, I've learned more from you in this post than I ever thought of learning from the pump trainer. Information regarding the dual wave and/or square wave is pitifully lacking even in the training I received. Don't get me wrong, I love the pump and I am really grateful that Medicare and my insurance are covering the majority of its cost. But having this wonderful piece of technology and not being able to use it properly and confidentally is frustrating.

As I may have mentioned before I have given up eating pasta and other things like that because I could never make my BG what it should be 2 hours after meals. After reading your post - I might give it a go again.

 

[Strawberry]

Well thanks Shanny. Iam not sure what a "sticky" is but I am sure it something good.

Adjitater - Do you suppose a "sticky" is something like a cinnamon roll ?

Shanny - Thanks from me too because even though I've had the pump for a while, I haven't learned as much as I would like to have learned. Some of the principles that apply to pumping can also be applied to MDI. The extended bolus can be used by people that are on MDI simply by dividing the bolus into 1 or 2 injections spaced evenly apart. I have a friend who enjoys pasta and gives herself an injection at the beginning of her meal and another (the rest of the bolus) at the end of the meal. Works for her, may not work for everyone in the same way.