By AmyT on February 20, 2014

I’ve started working with Gary Scheiner’s Integrated Diabetes Services (diabetes education) practice again, in the hopes of rescuing what has been a pretty poor autumn/winter in Blood Sugar Land for me. (Don’t ever think that just because someone runs a website about diabetes and does advocacy work, that they get perfect glucose control as a bonus — Lordy, no!)Anyhow I’ve been virtually meeting with sweet and kind CDE Jennifer Smith for about the last 8 weeks. I told her I wanted to get more precise with my carb counting and dosing for exercise, but most importantly, it seemed time once again to tweak the basal settings on my insulin pump. I mean, if your background doses are off, everything else falls to pieces, right? So maybe my carb counting skills aren’t as lousy as I think, but rather my basal settings are off (I told myself in hopeful tones).

What resulted was MATH. A lot of it.

Which I generally suck at, and which reminds me of why I’ve not been more precise in my diabetes-everything in the past.

Well, first there’s been the basal testing — the extra testing overnight, and then in turn skipping breakfast, lunch and dinner to see how your background insulin performs without any interference from food or bolus doses. I hate the heck out of skipping meals, but generally this has gone better than expected. Wearing the Dexcom G4 is a huge help, since it made up for any hourly readings I forgot to take, and gave me a sense of security that I was not going to pass out before the test period ended.

... unless you're diabetic!

… unless you’re diabetic!

 

We upped my morning basal rates, and discovered that afternoons are all good. So any highs I’m experiencing then are definitely carb counting failures. Grrr. But good to know…

Jenny explained the whole high-protein conundrum: I often eat meals with loads of the stuff and pat myself on the back for going as low-carb as possible. But then I still end up high. WTF?

Yes, I know we recently reported right here at the ‘Mine about how experts are saying PWDs definitely need to account for protein and fat content when dosing insulin. But heck, I’m old school (and lazy, like most humans), so I wasn’t doing that. It seemed awfully fussy, and not guaranteed to work.

But Jenny explained that it really does make a difference if you eat a meal with a protein count above 20 grams: what you need to do is account for the amount of protein over 20g as if it were carbs. So for example, if you ate a meal containing 40 grams of carb + 25 grams protein, you would dose for 45 grams carb (the 40 plus the protein amount beyond 20). On top of that, you’re supposed to take the bolus at the end of the high-protein meal and extend the portion of the dose covering the protein (5g) for two hours.

See what I mean about MATH?

Plus what’s hard for me is doing all of this in the face of hunger. When I’m really hungry and ready to eat, I have very little patience with looking Hungryat all the nutrition labels in question and trying to calculate the amount of carbs for the relative portion I’m eating, let alone doing the same for protein count and then the additional math above. The Google X guy was right: Managing diabetes really IS like having an extra part-time job!

My hubby was shocked to learn that there are special instructions for eating sushi, for example. Heelllooo, these foods are tricky! (btw, the formula is: a medium sushi roll = 6-7 gram carbs/piece; large roll = 8-9g carb/piece; and you should bolus for 30g of carb in advance when you hit the restaurant.)

No wonder I’m not always so exacting! Even with one-on-one help from the best educators in the country and precise instructions, it’s a lot of never-ending fuss with a lot of room for error that requires willpower of steel and the professional, unbending pep of a Dallas Cowboys cheerleader. Geez.

But sitting at my PC one Friday afternoon after talking with Jenny, it hit me: I only have about 3-4 typical breakfasts I eat regularly, so why in the world haven’t I done the precise calculations on these, and plugged the results into my insulin pump as meal pre-sets? Am I stupid or something?

The answer is… wait for it… MATH.

Here’s how my calculations went:

bolus dosing calculations

Jenny noted that the other way I can do this is to just use the numerical counts, as in: for the yogurt & granola breakfast, dose for 47 grams up front as a normal bolus and then at the end of the meal, set an extended bolus for the additional 7 grams to be delivered over 2 hours. The catch there is remembering to set the extended bolus after I’ve finished my breakfast.

I don’t know about you, but it all looks awfully daunting to me — and this is just for a few high-protein breakfasts that I once thought were oh-so-D-friendly. Not to mention all other meals that involve sauces and bits of carb and protein all jumbled up together, like in beans.

* sigh *

That’s all I have to say about that.

 

{Except that I am extremely grateful for the hard work and knowledge of Gary Scheiner and his team at Pennsylvania-based Integrated Diabetes Services.}