Searching for the Right Combo

I can never seem to get the hang of using the dual wave and/or temp basal setting for high fat/carb meals. I’ve seen/heard/read other people’s stories of what works best for them, but so far I have not found what works best for me.

Case in point – we have a local fast food place here called Taco Bueno. I have been experimenting (which has been easy, because I love me some Taco Bueno) with getting the same meal every couple of weeks, and trying different coverages for the meal. So far nothing has worked. I am still high afterwards.

The food I’m getting is 116 carbs (don’t judge) and I’ve tried a 50/50 dual bolus, a 70/30, a 60/40. I’ve tried adding a 10% basal increase to the dual bolus – usually over a 2 hour timeframe. But nothing seems to work.

I know lots of people have the same issues with pizza (as do I) but this is driving me crazy. I do understand that what works one time, may not work the next .. but I have yet to find a combo that works at ALL.

Does anyone have suggestions on what works well for you when you have a high carb/fat meal?

And to clarify – I do not eat like this all the time. But I do occassionally, and would like to know how to cover it properly when I do. I am currently 23 weeks pregnant with twins, and eating more than usual (even though I have not gained a single pound, even being pregnant with twins!) so I’m taking in more carbs/calories than usual.

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About Shannon

I am a wife, a mommy, and a Type 1 diabetic (since '92.) I have had two successful pregnancies - one of which was with twins. I wear an insulin pump- - off and on for 17 years; currently on the Medtronic pump and CGM. I am not a medical professional, nor am I giving medical advice. I am just sharing my day to day stories of someone who lives with this disease every day. My ultimate goal is to raise awareness.
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10 Responses to Searching for the Right Combo

  1. It’s always a shot in the dark for me, too.

    What are you seeing when you try those examples above? Normal for a while, then high? High, then low? Low then high? High then higher?

    Sometimes when I eat big fast-food meals, the insulin I need doesn’t always jive with the calculated carb counts. You might need to play around with the total amount of insulin too.

    • Shannon says:

      I’m pretty much always seeing 200s at my 2 hour check.. and then I correct and it goes down.

      • Any checks in-between? To really get it dialed in, you might need to check every hour and keep playing around with the splits of immediate vs extended. Are you having any lows after you correct at 2 hours? I’d bet your extended bolus is still active at that point.

        What about your care team? Any good CDE’s that can really dig into this with you, especially while you’re growing those babies?

      • Shannon says:

        Honestly, I don’t have a “care team”. I see my Endo every 3 months but I pretty much manage my disease on my own … :/ Not the best scenario, but it’s been that way for so long now. I do know I need to look for a new Endo – mine pretty much just looks me over and writes my Rx’s every 3 months.

  2. Scott E says:

    I try to separate basals and boluses entirely, so I won’t use a temp basal to cover for food. That’s just my own preference.

    How are your sugars looking from the zero-to-two hour period? Do you know? I’m not sure if spreading out the insulin over time will help, or of you’re spiking at the two-hour mark. If you always need a correction at the 2-hour mark, though, and you can’t add that to your initial bolus for risk of going low, I’d suggest the following.

    Let’s say, for the sake of argument, your meal requires 10 units. At the two-hour mark, you correct with 2 units because you’re still running high, or your BG is climbing. I’d try dual-bolusing a total of 12 units at mealtime: 10 for an initial delivery, and 2 spread over the next two hours. That’ll hopefully take care of what you need so you don’t have that spike later on.

    It’s not perfect, but it could be a starting point.

  3. You may want to consider bolusing for the protein as well. I have read that in some cases, such as high protein meals, adding some insulin to cover the protein can help as well for post-prandial spikes. I’m not entirely sure, that’s just what I’ve read. When bolusing for protein, most people seem (including myself) to count grams of protein, divide by half, and then add to total carbs. I think some have even tried adding fat. Might be worth looking into! This is something I found: http://www.presentdiabetes.com/etalk/Do-You-Suggest-Bolusing-Extra-t5481.html#-1

  4. Karen says:

    Sounds like you have a bunch of really good suggestions already. Remind me – do you use a CGM? i think that’s what really helped me nail down my meals like this (not that it works every time, mind you). In any case, it’s a drag, but testing every hour for like 6 or 8 hours after a meal like that can really help you see what’s going on and where you need to tweak (I did that even with my CGM). And I agree that it sounds like you need to take 2 more units up front – either increase your total bolus by 2 units, or if you are going low later (after your correction) move two units out of the square dose and into the up-front dose. And feel free to email me any time!!

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