A step-by-step guide to how I managed a massive breakfast...
Arden had a couple of friends sleep over last weekend and before they went to bed the girls asked if they could have french toast in the morning - I said, "sure!"
The meal consisted of:
- French toast with home made bread, eggs, milk & a sprinkle of powdered sugar
- Sliced Bananas
- Green Grapes
- Chocolate Milk
- No Carb Syrup
Let's start at the beginning...
Arden's BG was steady at 75-80 from midnight until three in the morning when I decided to do a thirty minute temp basal off (probably should have tried 50% decrease). I was woken at six in the morning when her Dexcom alarmed as it reached the high threshold of 160 (since changed to 130). I waited fifteen minutes before acting because I noticed that the line was beginning to trend down. Decided to do nothing (probably should have bolused). A little after seven I decided that this BG wasn't going to move (morning BGs are stubborn for Arden) on it's own and I began to try and nudge it down. I only used tiny boluses because I was trying to get her BG down, while also letting her sleep; all with an eye on being prepared to eat a high carb meal soon.
Ask yourself - Do I find morning BGs difficult to effect? Meaning, do they take more insulin and time then normal, to get moving?
Over the next hour and a half I used three small boluses (refer to image) to get Arden's BG moving, without it moving so fast that I may have to wake her prematurely. Her BG leveled off around 120 for a while. It began to drift down again as the girls appeared in the kitchen. It was time to get a portion of her pre-bolus going, but not too much. She was still dropping albeit slowly and I wasn't totally sure how long it would take for the meal to be completed. But French toast without a pre-bolus would not go well, so I started small (1 unit) with something that I could effect with the fresh fruit - if needed.
Food and Carb Counting - So I've got three girls to feed, a plate with a randomly sliced banana and a bowl of grapes as back-up (in case my pre-bolus gets wonky). Time to get cooking! I never specifically counted any of the carbs Arden would soon eat. I was sure that she would have some of the banana, probably a few grapes, lots of french toast - maybe with some powdered sugar. She was definitely going to drink the milk because we don't so chocolate milk very often, so that was looking like a treat. I made all of my insulin decisions based on my historical knowledge of how much Arden eats on average and what that amount generally requires in insulin. I was counting on her Dexcom CGM to tell me the rest of what I would need to know.
My definition of a successful Pre-Bolus - If Arden's BG is between 75 - 100 and falling when food consumption begins, I'm a happy pre-boluser. The girls threw a monkey wrench into my plans by asking for the fruit plate before I was planning to put it out - no matter, now I could bolus the balance of my intended initial insulin. I say initial because this meal was going to be a free-for-all and undoubtably require more insulin as it went on. The fruit and milk went on the table and I bolused again soon after, this time 4 units - again that amount was based on nothing but my feeling for what the meal, as it appeared so far, would require.
Feeding frenzy: Soon after the french toast hit Arden's fork her BG leveled off around 100, I knew then that an increased temp basal was in order. Why, you wonder? Five units is a good amount of insulin for Arden and the fact that it wasn't causing a fall in BG at this juncture indicated to me that the food was now pulling in the other direction and would soon overtake the bolus. I mean this is a lot of carbs. A combination of a heavy dose of simple sugars and more complex carbs.
So I increased the temp basal, 95% for one hour. Not long after that Arden asked for seconds of french toast (it is good!), I bolused for what I believed the seconds would require, 2 units. That bolus brought the total to 7 units of bolus insulin and an .60 of additional basal. I was happy with where we were and ready to see what would happen next. Oh wait... the girls want one more banana sliced up. Would Arden take two slices of it? Would she have four? I couldn't be sure but as I was deciding, I saw her put a fork full of powdered sugar on her french toast and so a bolused 1 more unit.... based on nothing but my gut feeling. Arden's BG began to drift up past 120 about an hour after I set the first increased temp basal so I extended it for another thirty minutes.
The girls finished eating and went back upstairs to do what ever little girls do during a sleepover. Three hours after the meal began... Arden's BG was 97 mg/dl by finger stick.
I wish that I could tell you that I was a great carb counter or that we have a perfect insulin to carb ratio figured out. I could lie and tell you that we do a lot of basal testing, but that's not true (I've actually never done that once). It certainly wasn't a low carb approach that got us to 97 three hours after this breakfast.
So I'm assuming that you want to know how I did this?
- Proper Insulin use; timing and amounts
- I trusted myself and what I've learned from past experiences
- I relied on the Dexcom G5 to tell me where I went wrong
- I bumped and nudge BGs instead of over-reacting and climbing on the diabetes roller coaster
- I was bold with insulin!!!
- I made my decisions based on the singular idea that I would rather (because it is far easier) stop a falling BG with a juice box, then spend five hours fighting with a high BG
I want you to remember a few things. First, this isn't medical advice, second the amounts of insulin and it's timing is different for everyone so you can't copy what I did and think it work. Third, I didn't do anything special, I don't have some super diabetes secret that you don't have. Anyone can do this. I mean it. It takes a little bit of practice and some trial and error - of course, the Dexcom sure does make the entire process simpler. But I promise that you can do this too and just imagine how easy regular meals and snacks will be if you can do this with a high carb, sugar infested meal like the one I described here. Right?!
Last bit. You may be inclined to think that what I described was a lot of work or that it was insanely time consuming... it was not. It just seems like it when it's written out and explained in detail. This blog post is representative of a few minutes of my focus during this morning. Trust me, it's far simpler than it seems and incredibly less stressful than watching, chasing and feeling the guilt that a high BG could bring after food.
You can do this too, I know that you can! Believing that is most of the battle!
If you are interested in following these thoughts further, I recommend listening to my podcast to hear these themes spoken about in real-life situations with people just like you. Best, Scott