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Permalink Reply by PedsRN on May 19, 2012 at 1:46pm

TAG? Finally I've got SWAG figured out today and here's another one.

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Permalink Reply by Tim on May 19, 2012 at 6:18am

You fell victim to one of the classic blunders. The most famous is: Never get involved in a land war in Asia. Only slightly less well known is this: Never assume you don't need insulin at breakfast based only on a carb count.

Oh, breakfast is hard. If I don't take insulin at breakfast time my bg goes way super high throughout the whole morning. This is true even if I don't eat anything at all or eat something with zero carbs. You might believe the textbooks or websites that say that if you don't eat carbs you don't need a bolus. This is wrong, wrong, wrong. It's a case of "I can pay a little now, or I can pay much more later." I can take a few units at breakfast, or I can take a bunch more units later in the day trying to bring the highs down from not taking the few units at breakfast.

And about your supper... A bolus of just a couple of units for a meal is going to be too low unless you are super unusually insulin sensitive.

I know for me, 1/4 cup of brown rice will take way more than 2.1 units of insulin.

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Permalink Reply by Trudy on May 19, 2012 at 6:23am

Hi Katie. Unless I'm low, I automatically take one unit of Apidra when I get up in the morning. It doesn't count against breakfast; I just need it to prevent a morning rise in BG. I read Dr. Bernstein's book years ago, and he said he does the same thing.

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Permalink Reply by Katie on May 19, 2012 at 9:32am

Yes I think I put too much trust in the pump sometimes! About the high bg in the morning without carbs or insulin- its at least comforting for me to know I'm not the only one and I am not going crazy! I am having to retrain myself on managing dm and sort of having to forget most of what has been taught to me most of my life which is really hard. It helps having you all to sort out these issues! As far as supper goes, i actually usually do well with only 2-2.5 u without a bg spike but I am very insulin sensitive at night...unfortunately morning is a different story! Thanks for your response!

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Permalink Reply by JohnG on May 19, 2012 at 7:00am

I think everyone's suggestions are great. I bolus for protein at (50% of my I:C and fat at 20%) using a duel wave, about 30 min before my morning meal I do not bolus early for lunch or dinner but I always tag if I consume more than 2 or 3 oz of protein.

 You need to weigh your food and rice should be weighed dry...45g brown rice (1/4 cup)= 35g carbs. There can be a huge discrepancy if you try measuring servings by volume..I eat rice maybe once a month but it's never a perfect meal.

Note: I also wash and scrub rice until the water runs clear...this can make a big difference.

Suggestion: Try eating 100g of white baked potatoes and see if your I:C will cover the tough carbs...make sure you have no active insulin when you do the test. I would consider the test a success if my BG was lower than my high target after 3 hrs. and still slowly moving toward my post meal target...120mg/dL. YMMV  (100g =22 g of carbs)

 

 

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Permalink Reply by Katie on May 19, 2012 at 9:38am

Hey John I tried that TAG method today and it seems to be working well. I think it's true whenever I eat more carbs I don't necessarily need the extra insulin for fat and protein but when I go low-carb it seems I really need the extra insulin. I've wondered if since on a lower-carb diet your body burns more fat-if your liver isn't releasing more stored glucose in the blood? Just a thought...
You are so right about rice- I usually try to avoid it because even the brown rice is not kind to me! I will try your suggestion. Thank you for the advice!

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Permalink Reply by still_young_at_heart on May 19, 2012 at 7:52pm

I've been eating quinoa instead of rice for several years. It's healthy, doses true and tastes great.

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Permalink Reply by Jim on May 19, 2012 at 7:48am

I know in the morning it seems like if I even smell a carb it rockets my BS. The most frustrating thing is it isn't consistent either. Sometimes a 1:5 ratio will cover the carbs and then sometimes that will rocket me way low at 1 hour and I will have to deal with trending low all morning. It's maddening at best. I wish this disease was more of a "science" than an "art" to treat.

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Permalink Reply by Katie on May 19, 2012 at 9:41am

Jim I hate that for you but I'm glad I'm not the only one. My pump trainer thought I was crazy. You are so right about diabetes management being an art. What seems to work for me one day fails the next. My husband is a mech engineer so he will drive himself nuts trying to figure out a "reasonable explanation" for everything. Lol! Thanks for your help. Have a great weekend!

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Permalink Reply by MegaMinxX on May 19, 2012 at 7:51am

I agree with AR, I would do a minor correction for a 51 in the morning (5g of sweet tarts). But my BG ALWAYS rises in the morning, even without food. Getting up, and having a diet coke will usually raise my BG 20-30 pts - independent of what time I get up. Having cheese in the morning (0 carbs) will raise 20-30 pts, so I bolus for that. But having cheese later in the day, often do not need bolus.

My theory is that when eating high carb, the protein/fats are a smaller impact of BG rise, percentage wise, and so not counting them doesn't make much difference. But when eating lower carb, and often more protein/fat, then I needed to start counting them. The info in the TAG group helped, but mostly I had to experiment with what worked for me.

But even if carb ratio is correct, I still find some carbs are just too fast to match the insulin, so I usually avoid cereals, rice/pasta and breads. Once my BG goes over 160-180, then I'm more insulin resistant, so it takes MORE insulin to bring it down, and the original dose for the carbs won't bring it down in 4 hours.

I also found I needed to wait longer after bolus, and eat the faster acting carbs later in the meal. If the timing is right, and no spike, then no additional insulin needed.

I think your activity level/metabolism/insulin sensitivity play a big role in this, and for some, BG does come down in 4 hours, even with spike > 180. It also varies throughout the day, as most are more insulin resistant in the morning or liver is dumping glucose.

Having a CGMS and more frequent meter BGs really helped to figure out how it worked for me!

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Permalink Reply by Katie on May 19, 2012 at 9:44am

MegaMinx, I have noticed my bg rises in the morning too but esp with caffeine-I have heard thre may be a correlation but not sure. I think you are right about needing more insulin when you reduce carbs and eat more protein and fat. I have been experimenting with TAG today and so far it seems to be working well...but we will see. Whenever I think I've got it right something changes! I would definitely like to get the cgms because I think that would really be enlightening! Thanks for your suggestions!! :)

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Permalink Reply by MegaMinxX on May 19, 2012 at 10:00am

Be careful.. just when you think you have it figured out, it will be 'that time of the month', and all bets are off !

You're on the right track..
My endo gave up trying to convince me to concentrate just on carb counting, especially in the morning. And I think she finally understands.

And interesting that the early pumps only provided 1 basal pattern, and 1 carb ratio / ISF. Now most provide timeframes for different numbers, but it takes alot of work to figure out what specifically works for each individual.

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