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Bolusing for Burgers ... I s#ck at it! Advice?

Discussion in 'Parents of Children with Type 1' started by DavidN, Nov 2, 2012.

  1. DavidN

    DavidN Approved members

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    It happened again last night. Different approach, same outcome. Dinner was a homemade burger, using Whole Foods grass fed beef, and 1.5 cups of macaroni and cheese. BG pre-meal was 97, carbs of 92, carb ratio of 1:25 but we gave only 3 units because he was a tad low and it was a late dinner and burgers make us nervous. So I give him 1 unit pre-dinner, wait an hour and give him 2 units. (In the past I've tried waiting 30 minutes, or 2 hours, or all up front - none of them have been effective). 30 minutes later he says he feels low, I check and he is 42! I probably over-reacted but this is his lowest BG since diagnoses and give him 3 tabs, 1 cup of chocolate milk and 19g of chips ahoy cookies.
    8:13 pm - 42
    8:17 pm - 49
    8:29 pm - 82
    8:37 pm - 93
    and you can all guess what's coming next ...
    10:37 pm - 311
    We're still nervous about correcting at night so do nothing ...
    2:04 am - 270
    3:17 am - 240 (he not surprisingly got up to pee)
    6:46 am - 161

    So that's pretty much our routine for burgers. I know every child is different but surely there are some common threads as to how to handle higher fat foods. Any advice / shared experiences would be greatly appreciated.
     
  2. danismom79

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    Well, it's hard to tell what the burger did when you add in the mac & cheese, and about 45g of extra uncovered carbs. When my daughter was on shots we used Regular and/or NPH for fatty foods, which worked like a combo bolus on the pump. The only thing I can suggest for Humalog is to space the shots out even more. So if you give 3 units, maybe give 1 right after he eats, then another an hour later, and the last an hour after that. It is a lot of extra shots, though.

    ETA: Oh, it was chocolate milk! So more than 45 uncovered carbs. I know it's hard at first, but try not to panic and overtreat.
     
  3. danielsmom

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    I think the chocolate milk and cookies put him over the top.. The hardest thing for me to learn after diagnosis was Patience... Waiting out those 20 minutes to retest without falling apart. Daniel doesn't always need 3 tabs...depends on the low...in the 60's 2 will do it...As for burgers I don't know much about the meats since my picky boy only eats chicken and very rarely a plain mickey d burger..
     
  4. DavidN

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    I even lecture my wife "do not overtreat! do not overtreat!" She was out for the evening and what do I do? Clearly I over-reacted but I wasn't 100% sure the carbs from dinner were coming around the corner .... and his BG was 42. I was glad I didn't have to glucagon.

    We have our first pump meeting with NP in a couple weeks. If we go that direction maybe that will help. Thanks for suggestion.
     
  5. nanhsot

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    It'll get easier, promise! That first low is panic inducing. I'd suspect the mac and cheese was the problem, not the burger, btw.

    You definitely overtreated, but all is well today, and today is a new day! Give yourself a break, this is tough business being a pancreas.
     
  6. RomeoEcho

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    I still frequently over treat and I've been doing this a long time now. As an adult with D, when I'm alone, I have on occasion been known to eat the entire kitchen before the first 10g of sugar kicks in. As in a handful of jelly beans, a couple bowls of cereal and a sandwich. And every single time I regret it. It doesn't mean it won't happen again, though I try and keep it to a rare low binge. So, don't worry it happens. And it will happen again, and someday, he'll do it too.

    A couple of suggestions though for when you're not in a low panic. The milk and cookies actually makes it slower to come up than if you just had the three glucose tabs. Counter-intuitive, but true. If he feels bad, try the glucose tabs, give him a hug, don't leave him alone while you wait. (I feel much better and rarely binge if I'm with someone) Try using either reading a book or watching a tv show as a distraction while you wait. Lots of tv episodes and cartoons are in the ~20 minute range. So sometimes I will treat, watch a show and test again when it's over. Retesting too early can make me more panicky. I know I won't come up in 5 minutes, but if I see another low number its easy to think it's not working and keep eating.

    Next time try having burgers without the mac and cheese. A normal bolus should be fine for a burger (assuming he's eating it with bread.) The high fat mac and cheese was probably the culprit here. Then try the mac and cheese as a separate meal as well. You may want to try using regular insulin for the high fat meals, it's a little bit smoother than multiple shots.
     
  7. swellman

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    I would be more concerned with the extra untreated carbs, a 270 at 2:00 AM and the 160 at 7:00 AM - that's a pretty big uncorrected drop IMO.

    My gut tells me it wasn't the burger or mac-n-cheese but instead either too much IC and possibly too high Lantus or a combination of the 2.
     
  8. DavidN

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    The big overnight drop is not unusual for us. He's never woken up over 175 or under 90. I've always attributed it to Honeymoon. Our current Lantus dose of 6 units has been working well and 1:25 coverage has been pretty reliable including today. What I should have done is checked BG before injecting final 2 units of bolus. I'm guessing if I had seen that number I would have proceeded with more caution. Live and learn. Thanks for feedback.
     
  9. StacyMM

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    For us, the likelier culprit would be the mac and cheese. We're really struggling with delays from pasta, and that's new for us.

    It is hard to find the right number of carbs when facing a lot. Especially if you check quickly and don't see a rise. I know that we never re-test before the 20 minute mark. Even with glucose tabs (our standard 'you're low, eat this' option), we won't see a noticeable change until that time. It looks like you did 4 checks in about 25 minutes and I'm wondering if you were treating with each number? 3 tabs at first, then the milk at the recheck, then the cookies at the next?

    I hope you can find the right balance soon!
     
  10. Melissata

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    A pump is almost essential for my daughter to be able to eat foods like that. I wouldn't even know where to start to let her eat a meal like that without at least a 3 hour combo bolus. Before pumping, she did the exact same thing, went low right away and then high later. She actually ate mac and cheese last night at a restaurant along with her usual baked haddock. I estimated that mac and cheese at a cup and a half, but it must have been a bit less than that. Based on her Dexcom reading, I cancelled the last part of the 3 hour bolus and she ate one candy for a bg in the 65 range. I used to underestimate for meals outside of home, but now with the Dex I am braver and know that I can catch a low if I overestimate.

    I know how scary it is with lows and new diagnosis, but you should rely on more testing and less carbs. We use only tabs for a low like that. Anything else slows things down. Giving anything with fat is not a good treatment for lows. My daughter realizes that, and knows the tabs make her feel better much faster.
     
  11. Lakeman

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    If I read that right he started at 92, ate a lot of fat (burger and mac and cheese), got 1 unit, then went low half an hour later. Clearly too few of the carbs had kicked in to meet the insulin.

    You could eat just the burger or just the mac and cheese and also include some fast carbs like juice with the meal. Also if lows are expected it is Ok to dose after the meal.
     
  12. steph

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    burgers aren't high fat meals. in fact they should be relatively low fat unless you are buttering the buns and adding tons of cheese and mayo. but even then, not really high fat. and mac and cheese, if the boxed kind, isn't high fat either. the homemade kind def. is though. i have never heard of burgers causing a problem for bolusing but sometimes mac n cheese can.

    i think the problem here might just be that you gave a huge amount of slow acting carbs to treat a low. like others have said, try fast acting carbs (honey, Smarties, juice) to treat a low. i recommend having some handy in prepackaged amounts (like a 10-15 carb juice box) so that you dont overtreat and you know ahead of time exactly what you will be using to treat. that way you aren't scrambling for ideas when you are already freaked out about the low.

    you may want to consider reducing the amount of carbs in a meal. the more carbs, the bigger effect any error will have on BG. and weighing food is more accurate than using measuring cups. after we got a scale, just 2 months ago, i saw improvement in DD's post meal numbers.

    also, and it has taken me quite a while to realize this, but 97 is a great number, not a tad low. i used to treat it as a low bc i was so deathly afraid of lows. but finally i am comfortable keeping my DD at healthier numbers.
     

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