Bolusing for high-carb/high-fat meals

A big hello to the community. First post!

My grandmother (who is also a T1D) and I had a discussion today and I thought I’d post a question here to help us settle on the answer.

We went out to a big family lunch today to celebrate my cousin getting accepted into her dream university (full scholarship). The restaurant she picked had a VERY limited menu. For lunch I ate a turkey sandwich (which came on a GIGANTIC roll). The side was french fries or sweet potato fries (only options - no fruit or salad on the menu). The fries portion was HUGE! After eating, my cousin ordered an entire pie for the table to share, which of course I had a slice. This meal was way over the top compared to how disciplined I normally am.

My grandmother and I share very similar basal rates and boluses. I told her “I ate fries and a ton of bread, and then the pie … I’m going to pump ten units.” My grandmother was like “WHOA! I’ve never pumped 10 units … that seems like a lot of insulin.” I gave myself 10 units which I thought was WAY more than enough. Two hours after the meal I had gone from 109 to 306. I gave myself even more insulin (insulin stacking = not good, but I was desperate to feel better). Two hours after the second bolus, I’ve leveled out and my BG is now at 325. It isn’t dropping even though I’ve got 5 units of insulin on board.

Why does it sometimes feel like my insulin just isn’t working?! What am I doing wrong? I’ve been T1D for 20 years and I’m still surprised that eating terribly can have such horrible effects. My doctor always tells me “If you want to go over-the-top and have a naughty meal and dessert sometimes, do it. Just check your sugar and give insulin. Life is too short to be disciplined 100% of the time.” I agree with him … up until I feel like crud 4-6 hours after a meal. This sucks!

Hi Justyne @JKKS, Welcome to TypeOneNation Forum! Thanks for jumping in and posting three or four comments on your first visit - that is why this site exists.

It looks as if you did the right thing by giving yourself the extra insulin. What hit you was the “double whammy” of a starchy carb loaded food [potato] combined with the fat. Oh yeah, and that big fat roll - the pie was just a nice tasty nothing. <<< smiling >>> The fat in a meal will very often push your BGL way up a few hours after the carbs have peaked and you would be expecting your glucose levels would be sliding back to normal. These days I don’t often eat fries, although I like them, because of the delayed action of pushing my glucose too high but, like you, when I do eat them I will take more insulin a few hours after eating.
Like your grandmother, I’d “never” take ten units of insulin [I have 7 unit maximum set on my pump] at once because in old-age I’ve become very sensitive to insulin - 60 years ago I had to fill a syringe twice to get the proper amount of insulin in me.

Thoughts and suggestions I post here are based on my experience living with diabetes; I am not a medical professional.

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Very fascinating! Thank you so much, Dennis! What you said actually matched my Dexcom perfectly. I could see exactly where my BG was rising due to the carbs, then it leveled out briefly, then the fat pushed it much higher. I should’ve considered an “extended Bolus” on my pump, but that is essentially what I did by giving myself more insulin a few hours later. Our bodies are mysterious things! Thanks for your response. I’m loving this forum!

Justyne @JKKS, I should have included a “caution”, learned the hard way, about the second dose of insulin, especially if we use extended bolus. Carefully observe the IOB amount and its anticipated duration. This is where “stacking” may occur, so carefully watch the trend-line on your Dexcom; unless my BGL is hanging in the 300’s, like yours was, I try waiting four hours before giving myself an adjustment.

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Justyne, just thought I’d join in, If I was still on my pump, I’d do the same thing, but since I am off ( I want it back) I do the same thing with my injections, sometimes I piggyback, and yes it can take some time, but I will gladly pay that price for a great family celebration meal. Hope all is well now. Bye Jan

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Another possibility is that when you took so much insulin at once it pooled in the fat because it WAS so much, and then was taken up slowly by your body to get to work a LONG time later. This can happen to anyone taking more than 6 units at once. Of course that’s what I heard for shots, not pumps, but pretty sure it still applies, especially iif shooting in an area of scar tissue.

Yes, the fats will extend the high bg. Pizza has been claimed to create a 3 day high bg.

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i have had ;type 1 for 56 years. i feel that our bodies have their own minds sometimes. i was at the medalist weekend in Boston yesterday and I woke up at a terrific number which was 120. then 2 hours later i could not get my bs’s down. until maybe 4 p.m. they started coming down. for no reason i feel. i was high-like over 300. so i say to myself, tomorrow is another day. otherwise we all would go crazy. just forget it. sometimes we overeat, we are only human.