# Trying to figure out pasta & extended bolusing



## Sprogladite (Jan 9, 2019)

As above - can't seem to crack this one and I'm determined to!  I've been tinkering with splitting boluses and trying different things, and the closest I've come to success is somewhere between doing 50% upfront and extending the rest over 3 or 3.5 hours.  My trouble is, if I do it over 3 hours I don't hypo but then shoot up later (while I'm sleeping - starts at around midnight-ish), but if I do it over 3.5 hours, I hypo after about 3 hours.  If i treat the hypo I'm back in range for bed, but I then shoot up again, again seems to start at around midnight.

If I do a fasting basal test I have a perfectly flat line at around 6 - 7 for the entire night until I get out of bed.  The more I think about it the more I'm scrambling my brain and I'm not sure how to address it.  I've tried contacting my DSN but after 3 days I'm losing faith I will hear from them!

Does anyone have any bright ideas on what to try next?  Maybe a different split?  I'm a little reluctant to tinker too much as I live in fear of hypoing while I sleep thanks to my previous issues with basal insulins (pre-pump) but I'm having to get up anyway at 2 or 3am to bolus and counter the highs.  Help!


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## HOBIE (Jan 9, 2019)

That's what is good about pumps ! Adaptable


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## Lanny (Jan 9, 2019)

Have you tried cooking the pasta, letting it cool completely in the fridge & then reheat it again. When you do that with pasta & potatoes, it changes the starch molecules & it dosen’t impact upon the blood sugars as much: halved in my case!

Also, after reading a post by @trophywench, some time ago on a thread, I can’t remember which one, about how to deal with difficult meals like takeaway curry, pizza & the like that hit later with spikes in blood sugars. I tried it myself with takeaway fish & chips on the eating thread in the Food forum thread “What did you eat yesterday?” I had just seen my sister for the last time before she passed away from Cancer at that time:-

07/06/18 A bit patchy in terms of testing & been a bad girl food wise!
12:13 woke up BS 9.1. Posted on waking thread & was affected by what I posted. Cried & pulled myself together.
13:13 BS 9.0. 6 units Novorapid 29 units Levemir & all other meds! Breakfast:- 2 ham, cheese & mustard sandwiches & 150ml pressed pear juice granini. 15:26 BS 14.1.

Walked 7000 steps to pick up prescription, ready yesterday but, couldn't pick up, & got fish & chips at my awarding winning chippie! Got home around 18:30 before diving straight in & forgot to test! Lunch:- 12 units Novorapid chip shop fish & chips!

Flashing warning ***** DO NOT follow my example:- 330ml bottle of full sugar coke! There was a moment of surprise from the server when I asked for this! It's a small town & we tend to know everybody & the server & I went to school together! I hadn't been going that much these days & the last time I went, 1.5 to 2 months ago, we had a chat about my recent hospital stay & problems after. She knows I'm a diabetic & has never taken full sugar coke before! I would be quite happy to explain if she asked but, it was busy & she didn't! I have my own reasons for not eating or drinking food & drink with sweeteners in it! I tried to cover the extra sugar by guessing my dose & don't know if it's correct due to the fat of the fish & chips! But, had an idea thanks to @trophywench 's advice on a thread I read about how to cover things like this! But, to be fair, I'm sure she never thought it would be used to try & cover full sugar coke: how to cover the sugar & fat in takeaway curry Chinese or Indian!

21:35 BS 9.6. Will monitor for a few more hours & have an idea on how much insulin to add & when, as referred to above!

I thought I was hit hard with the emotional shock yesterday but, it's still hitting me with no distractions of travel today! I'm not doing what I KNOW I shouldn't completely blind but, all theories are exactly that until you try it out! If it's a mistake & my BS goes crazy in the morning; I'll know this doesn't work for me!

07/06/18
22:24 BS 11.2. 4 units Novorapid!

08/06/18
00:54 BS 12.9. 4 units Novorapid.

Needed to check again in about 2 hours time but, fell asleep.

10:32 BS 11.5. Jury’s out! I didn’t know the starting figure as I forgot to test before eating & I should have checked 1 last time! The theory is that fat can slow the release of sugar for up to 10 hours. So, you work out what needs to be covered & the dose you need! I worked out 24 units, have 50% upfront. Have 30% of the remaining dose 4 hours after, 50% of remaining dose 2 hours after that & the last bit 2 hours after that! I fell asleep before the last dose of 4 units. So, maybe better; maybe worse: best not to do THAT again! If you pig out on sugar & fat, you have to stay up to monitor & add extra doses as the fat continues to raise blood sugars


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## Lanny (Jan 9, 2019)

Oh, if you PM @trophywench, I’m sure she would be happy to help out as I may have remembered things wrong!


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## nonethewiser (Jan 9, 2019)

Do the 50/50 split over 3 hours and then bang on a TBR through the night, or at least from bed to the early hours of the morning.

Start gradually, so +10% TBR and increase if need be.


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## Sally W (Jan 9, 2019)

I don’t know about injecting I’m afraid but I do eat Asda protein pasta, which doesn’t spike my blood. Maybe worth trying as it could help?


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## HOBIE (Jan 9, 2019)

HOBIE said:


> That's what is good about pumps ! Adaptable


This is the pumping Post. You could not do this on injections ?


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## SB2015 (Jan 9, 2019)

@Sally W has a good idea if you are happy to consider alternatives. 
 I switched to black bean pasta, and in the summer courgetti. 
 The carbs are so much lower so no spikes.

If determined to eat pasta, you could try extending the timing on the split even further, and/or change the ratio of instant to extended.  I have never cracked it and did not like the idea of an overnight TBR as I found things so variable depending on the sauce I had with it.


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## trophywench (Jan 9, 2019)

@Sprogladite - no need to PM me - I look in and read the forum most days anyway.

To draw anyone member's attention to something, merely type - eg - @Lanny - and they'll soon know!

Sprog I've never cracked it 100% yet, except to identify that yep I can deal with the first spike by having as you say c. 50% up front - but then I need a respite of an hour or two or three depending on how much pasta - or rice, or pizza base - I ate because the second BG increase can hit me up to 5 hours later.

Hence I have to limit the amount I have at one sitting and for me that's max 50g carb worth of whatever, when I actually give 50/60% upfront and the rest over the next 2 or 3 hours, depending on how much fat is in the sauce, topping, accompaniments.  Not too much hassle - hence I continue to do it purely to avoid any of that.

Occasionally yes I do pig out, not necessarily on pasta etc - and yes I do always have to pay for it with the higher BG for too many hours - but there you go - we all have to live with it and I honestly only do it occasionally!


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## everydayupsanddowns (Jan 22, 2019)

HOBIE said:


> This is the pumping Post. You could not do this on injections ?



I used to use split doses all the time on MDI @HOBIE - I'd dose a proportion of the full amount up front, and then bolus the remainer after 2 hours or whatever. 

I like the automation of dual/combo wave boluses, but it requires a slightly different approach as the extended/square part of the dose starts trickling in straight away (so effectively the doses are less spread apart).

How many times have to experimented with the 3hrs vs 3.5hrs @Sprogladite? It just sees too small a difference to me to actually *cause* a hypo if all other things are equal, and I wonder if it was a one-off and caused by something else entirely? 

Like TW my best success seems to come from limiting the carb load of pasta to around 60g CHO (then including 10g or so for the sauce). Actually pasta treats me pretty kindly. Though bizarrely spaghetti behaves completely differently to all other shapes and needs less up front. 

My standard go-to split is 60:40 over 2 hours. Works for most of the 'tricky things' for me.


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## trophywench (Jan 22, 2019)

Mmmm, spag.  It will get better coated in sauce than bows, shells etc and therefore the carbs will hit slower.  Even when you've mixed larger shapes into the sauce well - each bit has a greater proportion of uncoated pasta - the insides of each piece - than half a dozen strands of spag.

Probably!


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## RoyalBlood (Jan 25, 2019)

What are you having with your pasta? Cheese sauce like macaroni cheese for example? Or something else with a high fat content?

If the above is true, this issue is likely with fat rather than carbs and is something I experience.

Solution? Dual wave bolus to deal with the immediate DIA (3 -5 hours) and then a temporary basal overnight. All trial and error though I'm afraid.


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## Sprogladite (Jan 28, 2019)

RoyalBlood said:


> What are you having with your pasta? Cheese sauce like macaroni cheese for example? Or something else with a high fat content?
> 
> If the above is true, this issue is likely with fat rather than carbs and is something I experience.



It's usually tomato based sauces so that's not the issue - I actually find things like macaroni cheese a lot easier to bolus for, but don't want to put cheese on everything! Lol. At the moment I am finding the easiest thing to do is bolus as I have been and then do an additional correction bolus of about 1.6 units after the extended bolus has finished.  My levels start rising around an hour after the extended bolus finishes so I had tried extending the dinner bolus out for longer, but ended up hypoing!  Maybe my body is just weird lol


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## RoyalBlood (Jan 28, 2019)

Sprogladite said:


> It's usually tomato based sauces so that's not the issue - I actually find things like macaroni cheese a lot easier to bolus for, but don't want to put cheese on everything! Lol. At the moment I am finding the easiest thing to do is bolus as I have been and then do an additional correction bolus of about 1.6 units after the extended bolus has finished.  My levels start rising around an hour after the extended bolus finishes so I had tried extending the dinner bolus out for longer, but ended up hypoing!  Maybe my body is just weird lol


What you're experiencing is something I encounter too.

If I had a sandwich for lunch and bolused accordingly, I'd be back in range as normal - no dramas. Have the same sandwich just before bed and it's a different story. I have seen the CGM graphs in which my BG will rise and fall as normal, yet slowly creep up in the hours following.

I think part of the reason for this (what you're experiencing) is in how the body digests and processes CHO and other foodstuffs during sleep. It's very much different to during the day. Also, there is the matter of being sedentary whilst sleeping (obviously) - so what may be an ICR of 12:1 during the day with a full bolus upfront, could be a 6:1 ICR when you're idle/sleeping with a combination bolus. Trial and error sadly.

If I want steady overnight BG's (who doesn't!?) I try to avoid ANY food four hours before going to bed. For obvious reasons, this isn't always possible - but it gives the best results. Going to sleep with no bolus on-board or food digesting will give you a head start wrt stable BG's. Sure you can tinker, adjust and adapt all sorts of fancy bolus profiles and ratios for each meal. But IMO, it's too much effort especially when considering that diabetes is a non-linear beast with countless external factors impacting how your BG reacts to each meal and situation. Also, depending on how close pasta in tomato sauce is to your heart, it might be easier to prevent the problem rather than cure it. i.e. omit it from your diet or don't eat it before bed. I know it's not the answer to your problem, but remove the root cause and there won't be a problem to solve...



Sprogladite said:


> If i treat the hypo I'm back in range for bed, but I then shoot up again, again seems to start at around midnight.


I'd ignore any BG data post hypo; and not use that trend to amend basal rates, bolus profiles, etc. Everything goes out the window post hypo and what you may have experienced there is a normal rebound rather than anything to do with your meal.


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