Anatomy of a High Carb Breakfast
A step-by-step guide to how I managed a massive breakfast...
This image is here to help you to visualize what I am describing. Clicking on it will open a new page so you can refer back and forth.
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
- Bacon
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?
- Pre-Bolus
- 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
You many also like:
Blog post: You Too Can Bolus for Chinese Take Out
No CGM, No Problem
I completed a rather exhaustive set of parent, user and creator interviews last week about CGM in the Cloud.
Arden turned ten years old in July but in softball years she is consider to be nine. 9u Little League all star play is a one tournament and done setup -- district play does't begin until 10u when it is then possible to play in a District, Section, State and finally Regional tournament (The World Series only exist at 12u).
Arden's team won the 9 tournament in our district and with that, softball was to be over.
Until she tried out for the 10u team and made it as a sub. Now you know, if you already didn't, that the "u' in the age bracket stands for "and under".
Arden's 9u tournament began in early June before school was over and they practiced for weeks before the Father's Day tournament. SO she had already been playing for a while when..
The 10u practices started just days later in June and on the evening of August 8th, the 10s played their last game. Three straight months of softball. There were practice almost daily and games when there weren't practices. It's been a mild summer here but at times the heat has been grueling. Blood glucose levels have been mostly stable during play but late night lows have been more common this year than in the past. We are handling it well.
With three games left in the Regional Tournament, oh yea by the way... they won the whole thing (Arden had the winning hit in the championship game). Anyway, with three games left in the fourth tournament Arden showed up at the field without her CGM. Too far from the hotel to go get it, we went old school diabetes and never missed a beat.
With DexCom we test after warmups which is about thirty minutes before the game begins and make any adjustments that are necessary. After that Arden uses hand signals (she holds up her fingers) about every two innings to let us know what her DexCom is reading. If there is an issue, we handle it.
Without DexCom we tested after warmups which was about thirty minutes before the game began and made the necessary adjustments (she needed a few carbs). After that Arden used hand signals (thumbs up or thumbs down) about every two innings to let us know how she felt. We tested before the fourth inning. There were no issues.
Why did I blog this non-story about not having Arden's CGM?
I completed a rather exhaustive set of parent, user and creator interviews last week about CGM in the Cloud (I'll be explaining CGM in the Cloud soon for those who aren't aware) and if I'm being quite honest, I'm still wrapping my head around all that I learned. So much good stuff there, between having better access to data and comfort for parents, but there's something about it that makes me uneasy and I'm trying to find the words to share that feeling without diminishing the joy that I felt hearing the parents talk about their peace of mind and the people who are using the data to better their health. But there is a conversation to be had about fear and I want to have it... just need to find the words.
More great blog posts of Arden's Day
Insulet and Dexcom Agree to Develop a CGM-Integrated Personal Diabetes Manager
You are about to read the most exciting grouping of sentences that an OmniPod user could ever wish to hear.
You are about to read the most exciting grouping of sentences that an OmniPod user could ever wish to hear.
This is the entire announcement from Insult. If you want the legalese and investor info, you can read it here.
New Insulet PDM Will Receive Dexcom G5 CGM Sensor Signals
BEDFORD, MA -- (Marketwired) -- 08/05/14 -- Insulet Corporation (NASDAQ: PODD), the leader in tubeless insulin pump technology with its OmniPod® Insulin Management System, and DexCom, Inc (NASDAQ: DXCM), the leader in continuous glucose monitoring ("CGM") technology, today announced their intention to allow information from Dexcom's 5th generation CGM system to be identified, received and displayed on Insulet's new Bluetooth-enabled Personal Diabetes Manager ("PDM"), currently in development.
This project expands upon the initial agreement announced in June to enable the Dexcom mobile app platform to integrate data from Insulet's OmniPod System. That platform will be the first of its kind to enable glucose and pump data to be displayed on a smartphone.
"We are pleased to expand our development relationship with Dexcom to receive and display Dexcom G5 Sensor data on our new PDM, eliminating the need to carry a separate CGM receiver," said Duane DeSisto, President and Chief Executive Officer of Insulet. "This collaboration furthers our shared vision of helping people living with diabetes by providing greater access to the data they need to make smart and effective decisions to better manage and control their disease."
"We are pleased to be back working with Insulet to bring our leading-edge technologies together to help people living with diabetes better manage their disease," said Kevin Sayer, President and Chief Operating Officer of Dexcom.
Interview: Miss Idaho Sierra Sandison #ShowMeYourPump
All any of us want is to be anonymous and in a world where different is often looked upon with fear, the people who want, need and deserve that anonymity sometimes have to stand front and center to get it.
A few weeks ago Sierra Sandison was a contestant in the Miss Idaho Pageant. She wasn’t a diabetes advocate or even a person who widely shared with her friends that she was diagnosed with type I diabetes at the age of eighteen. Much has changed since then.
Sierra was backstage at Miss Idaho during the first night of competition when she had a chance meeting with Miss Idaho’s Outstanding Preteen, 12 year old McCall Salinas. Sierra stepped out of her dressing room and heard these words, “Oh my gosh, is that an insulin pump?”
Sierra told me that her stomach “flip flopped” when she realized that McCall recognized her insulin pump for what it was. I thought, “Oh no, people are going to notice, I was hoping that it was little enough that no one would notice”.
Sierra’s second reaction to McCall’s words, “I got scared”, but then McCall quickly explained that she also had type I diabetes and that she didn’t use an insulin pump because "she was scared of what her friends would think and of how it would look”.
It was during this brief encounter that a diabetes advocate was born. Sierra Sandison, a 20 year old woman who was diagnosed with type I diabetes only two years prior, was about to make a decision that would change her life. She could disconnect from her pump when she took the stage in her swim suit or leave it on and help McCall to not feel quite so alone.
At the time that their exchange took place Sierra told me, “I had no idea that I would even make the top ten, let alone become Miss Idaho - but I thought, I have to do this for McCall”.
During the interview I mentioned to Sierra that I believe people become advocates when they realize that they care more for another person than they do for themselves. This was that moment for Sierra. When she left that conversation with McCall she was a different person, and that person didn’t want McCall to be worried about what other people would think.
It only took Sierra a second to decide that she was going to walk on stage wearing her insulin pump, “I have to do this for McCall”, she thought.
“It was really scary (to walk out on stage) but thinking about McCall gave me a whole new confidence”. Suddenly Sierra didn't care what the audience or the judges thought and the prospect of becoming Miss Idaho or Miss America became secondary.
When she came off stage McCall walked up to Sierra and said, “now I want to get a pump”.
Sierra and McCall
Sierra “balled her eyes out” when she realized that something she had done helped another person to find the confidence to be him or herself.
If this story stopped here it would be amazing and completely worth sharing. It’s a story of two strangers who find each other by chance, both unaware of how much they are in need of the other’s support. A simple and beautiful story of humanity, empathy and the power of sameness. But social media had other plans for this moment and later when Sierra shared a photo of herself and McCall on Facebook, along with a brief description of how they met backstage and the events that transpired immediately after, Sierra found a community of loving people living with diabetes that she didn't know existed - and they had her back.
The outpouring of support that she received on Facebook prompted Sierra to share a different photo, this time of her walking on stage in her black bikini with her insulin pump on her side. This is the first time that she would use the hashtag #ShowMeYourPump.
In an instant 20 year old Sierra Sandison went from being a hopeful pageant contestant who got caught up in the desire to support a little girl, to the face of confidence and security for people everywhere who live with insulin dependent diabetes. Her image was about to inspire countless thousands to share pictures of themselves with their insulin pumps on social media. Sierra’s very unintended coming out party was suddenly and gleefully part of the ethos.
Now everywhere you look on Tumblr, Facebook, Twitter, Instagram, Google+ and the rest of social media, people with diabetes are showing their pumps to the world in an effort to become invisible. The chain of events is continuing on. Sierra’s decision to support McCall has become a phenomenon of strangers holding up their pumps in support of Sierra, and in support of themselves. We are witnessing humanity at it’s best, we are witnessing people whose desire to support a stranger is helping them to overcome the same insecurity that brought Sierra and McCall together.
All any of us want is to be anonymous and in a world where different is often looked upon with fear, the people who want, need and deserve that anonymity sometimes have to stand front and center to get it.
Show them your pump, until no one sees it.
Today, because a little girl noticed and insulin pump on a strangers hip, people who live with diabetes are a lot closer to that goal. I told Sierra that my hope is that one day soon another girl will walk onto a stage wearing an insulin pump, and that no one will notice. No one will post a picture, ask for an interview or bat an eye. That’s the world I want to live in, it's the world McCall needs and the world that Sierra Sandison’s bravery brought us all one-step closer to… when she showed us her pump.
#ShowMeYourPump
#ShowMeYourPump Until No One Sees It
Almost instantly the hashtag #ShowMeYourPump was replicating all over the Internet, the diabetes community was retweeting, reblogging, liking and posting pictures of their own.
#ShowMeYourPump is everywhere! Instagram, Twitter, Facebook, Tumblr, diabetes blogs, news outlets - absolutely EVERYWHERE!
Less than two weeks ago Sierra Sandison was competing to be Ms. Idaho. When she walked out on stage in her black bikini, her insulin pump clipped to her waist, she had no idea that the image of her doing so was about to become a viral sensation. Later that evening, Sierra was Ms. Idaho, if you go back into her Twitter feed you can see the excitement, pictures and celebration that she was experiencing.
Photo from Sierra's Twitter feed. @sierra_anne93
Then she decided to post the picture of her in that black bikini, insulin pump at her side, on her social media platforms. Almost instantly the hashtag #ShowMeYourPump was replicating all over the Internet, the diabetes community was retweeting, reblogging, liking and posting pictures of their own. Later today I'll be speaking with Sierra for an Arden's Day interview that will also run on Huffington Post. In the meantime, get out your camera and show them your pump...
... Until No One Sees It!