# burger king/McDonald's?



## breeze (Sep 27, 2013)

Hello! I think I should start by saying that we know how bad these foods are for you and it is very rare that we eat them, but it does happen now and again. 
Last night my husband (he's the type 1 diabetic) had a burger king on his was home from london. We have only just started pumping (on wednesday) so have been put on a ratio of 1:15 (was on 1:10 with injections). He did 6 units at the time to cover 97g carbs (I think he slightly miss calculated and thought there was 90g). He has been ridiculously high all night. We have been awake almost every hour doing tests, giving more insulin, doing a set change, giving insulin with his pen, etc. He has just tested at 6am and found he is still up at 22! He's ignored his correction ratio of 1:3 which has done nothing all night and just gone for 6 units.
Has anyone got any advice at all?? Can we blame the burger king? Or is something else going on here? Why would it stay so high for so long? Does anyone else have this problem from this type of food??
Thank you!


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## LeeLee (Sep 27, 2013)

As a non-injecter I'm not an expert in these things, but going by other posts on this forum, I suspect the answer is that the high fat content slowed down the release of all those carbs.  Others have reported this effect with pizza in particular.  I hope he's OK soon.


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## breeze (Sep 27, 2013)

Ah yes I hadnt thought of that! We do have the same trouble with pizza but that usually involves a hypo just after the food when the insulin kicks in. That didn't happen this time. Could certainly account for why he has been so high for so long.
Thank you


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## Northerner (Sep 27, 2013)

breeze said:


> Ah yes I hadnt thought of that! We do have the same trouble with pizza but that usually involves a hypo just after the food when the insulin kicks in. That didn't happen this time. Could certainly account for why he has been so high for so long.
> Thank you



I believe pumps allow insulin to be spread over a longer period in order to cope with problematic meals like this e.g. half the insulin up front then the remainder spread over several hours. Might be worth asking in the pumping forum. Having said that, it's strange that the corrections and set change didn't seem to have much effect. Did he actually change the insulin in the pump - could be that had become compromised for some reason, but I would have expected the pen injection to work (unless the pen insulin was out of date/also compromised!).

What was his level before the meal?


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## pav (Sep 27, 2013)

While not on insulin and can't stand burger king / Mc'Donald's etc, I found that burgers send me hypo if I am not careful, though the bap element would send me sky high.

Was there any sauces applied to the burger causing a miss calculation of the carbs, as these could be laden with sugar increasing the BS levels even more.


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## AlisonF (Sep 27, 2013)

It makes me smile the way everyone makes an excuse before admitting to occasionally eating fast food 

So, one day, following a major earthquake when no other food was available I had a McDonald's. I also had one when aliens stole my fridge. Every time I.found if I bolussed for the stated carbs id go hypo. They have the complete opposite effect to pizza on me.

I do wonder whether its more case that your hubby's new ratios aren't quite right and perhaps the BK is a red herring. How's he been with normal food you eat all the time?


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## ypauly (Sep 27, 2013)

What was in the meal? and what was on the nutrition sheet?



ETA
The nutritional info is usually on the back of the tray liner/paper


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## DeusXM (Sep 27, 2013)

There's a few things going on here.

Firstly, yes, the fat content can cause these things to hang around. 

Secondly, the stress of having all this going on will pump up insulin resistance, so it's likely he may need more insulin anyway.

Thirdly - going from 1:10 to 1:15 is a big leap. I don't know enough about transitioning from MDI to pump but I would be very surprised if I had to change my ratios that much. 

Fourthly, it could be a set insertion issue, and finally....

...could be his basal rate is set completely wrong.

The context of the food is largely irrelevant so I wouldn't get too worked up about that.


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## Redkite (Sep 27, 2013)

Firstly, is your husband sure of his carb count?  Burger King and McDonalds both supply their nutrition breakdowns for their menus (McD's is on the back of the paper sheet they line the tray with).

If his ratios have been working ok with other foods, they shouldn't be the problem.  We do find that fast food and other high fat foods need more insulin.  My son would bolus upfront for the entire amount of carbs, and then set an increased temporary basal rate at about 150% for 5-6 hours.  But we have arrived at this method after much trial and error, and since I get up during the night to test his BG, I can keep an eye on the outcome.

The other possible problem could have been a cannula issue.  Any BGs over 17 at bedtime and we correct by injection to be certain the insulin is going in!  Once the BG has reached those sorts of levels, we find he gets some insulin resistance, and the normal correction factor is inadequate for a while, so add 25-50% more to the correction amount.


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## breeze (Sep 27, 2013)

Thank you all so much for your replys!  Lots of brilliant info as always. I will be reeling all of this off to him when he gets in.
I think a few of you have hit the nail on the head. After lots more tests today it seems that his levels must be wrong. He has just managed to speak to his pump nurse and she has suggested changing the ratio again. He has also had another kinked canula today which hasnt helped (i'll be off to the pumping forum about that one).
Oooh he's just walked in so I'm jusgoing to read these replies to him!


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## Lauras87 (Sep 27, 2013)

I agree with what the others have said.

I'm new to pumping too & when I've had the oh hell my bloods are over 18 situation, I know my corrections will be wrong. My DSN said what ever it tells you to give as a correction put an extra 2 units on to beat the resistance.

Has your OH been given the sheets to basal text?


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