Today I did a little experiment.

Fasting BS was 80.

Didn't take any basal before breakfast. No bolus after.

Breakfast was a piece of fried fish (no batter - just fish - the piece was about the size of my hand and not thicker than my hand either, salt and olive oil), and a small cup of plain coffee with just a touch of milk. Probably about 1 gram of carb or less. I haven't noticed that caffiene raises my levels.

At 2 hours, I was 98. Not terrible, but a rise. I like to get back down to close to fasting by 2 hours.

Normally if I eat very low carb I don't add anything for protein or fat, and just count on my basal (curently 14 units in the morning and 8 units at night) to cover it.

I adjust my basal based on fasting bs. If I get to 90 then I would add one unit of insulin each to the morning and the evening dose until my fasting is back to 70 - 80. This was not told to me by a doctor, this is just how I do it. If I've eaten a heavy dinner (occassional) then I would also just for that evening add 1 - 2 extra units of basal.

If I eat < 10 g of carbs (and moderately of protein or fat) I would be fairly close to or back at fasting back at 2 hours without any bolus (except for breakfast where 5 g is my target now). Lunch and dinner - 10 g of more of carbs I now dose at about 1 unit:10 g.

However, I don't want to be forced to eat on any fixed schedule - the reason why I switched from 70/30 to basal bolus.

So should I be taking less basal, and using more bolus for carbs, as well as counting protein and fat?

Pregnancy insulin resistance is obviously starting and things I could eat before without going high are now sending me above target. I think I need to work out a more accurate approach before things get worse.

Hope this is not a stupid question. I don't have anyone outside of this forum to ask these sorts of questions.

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You're doing an amazing job controlling your BG! Congratulations on finding what's working well. Non-diabetics experience a rise after eating & they quickly go back to normal, so a rise of 18 pts is hardly anything.

You mention basal & previous use of 70/30. What rapid acting do you use for bolus?

The issue using basal as you do, while clearly successful, will not work to lower future highs, if you have them from pregnancy. Basal works too slowly & isn't intended for this, of course.

With very few carbs, how are protein/fat effecting BG at 3-4 hours? I hope nothing, but am questioning what happens when protein/fat hit later. Is BG stable between meals with no lows?

I eat low carb & do bolus for protein. I calculate protein as 50% since about 58% of protein converts to glucose. As best I can, I try to account for high fat meals regarding bolus timing.
Gerri,

thanks so much for your response.

I do go low if I don't eat lunch in time. Usually 2 hours after breakfast I would be 80 - 90. If I don't eat by 2- 3 hours later I will go below 70. This doesn't seem to happen with dinner and I've gone 7 - 8 hours after liunch (more than once) without eating and only been 10 points lower than I was at 2 hours after lunch. Of course this means if I'm high after lunch I have to adjust else I'll still be high by dinner time.

I use humalog to adjust for highs / bolus for food. Before it was 1 unit to bring me down 20 points, but now its less than that - about 15 last time I used it.

As far as I can tell no significant effect from protein and fat at 3- 4 hours, unless it's acting to stop much drop on the basal (Humalin-N). Whereever I am 2 hours after eating, 3 or 4 hours later I'll still be not more than 10 or so points lower. However, I have noticed now that protein does tend to raise me a bit (even when no carbs) - before it didn't. Joy of pregnancy! But will all worth it! :)

I think I'll start adding humalog, even for protein.... anyway, I test at 2 hours so there's time to catch if I'm low... Seems that usually humalog has most of it's action for me by 2 hours. If I've taken humalog to cover something and test at 2 hours and I'm high, I'll already inject extra humalog to cover the high... stacking... from what I've read here... but so far not a problem for me.

The good thing about using basal like this (with relatively low use of humalog due to the low carbing) is things generally don't happen very fast.....
Sally, you're doing fantastic! You should be giving classes on GD. The gold standard is having a low standard deviation & yours is phenomenal.

Could be that a delayed protein rise is preventing a low, but you're so level that it doesn't matter.because what you're doing is working beautifully.

Hormones for sure & you also weigh more regarding insulin effect. Yep, two hours is the typical Humalog peak. Wonderful that you don't have rapid drops due to basal. It's the worst feeling.
I guess ii can just count myself very very lucky to have found something that works.
The hard part now is that it's a moving target.

I am prone to occassional food slip ups, particularly when eating out..... I have hand-mouth syndrome when at restaurants - when food can go via my hands to my mouth, without my eyes or brain registering..... Don't eat out very often. And I guess that's a pretty common syndrome...
More than just luck! You're disciplined, smart & are paying close attention.

You're not alone in restaurant syndrome:)
Thanks so much Gerri for your very kind words and support!

I love this site and am so grateful for you and everyone else here!

I wouldn't be in the 'good' (and getting better) place I am now if it weren't for what I've learned here! Here is where to learn the best management practices and options in the world!
You're most welcome. My pleasure.

Agree. We certainly don't get the info we need from medical professionals. Shuddering thinking of where I'd be if I followed what I was told by them.

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