# Pasta hypo's and highs



## Rosie.H. (Oct 6, 2009)

Hi, i have a query over eating pasta.  My son's insulin regime has been changed from twice daily mixed to separate multiple injections, no problems there, goodness knows why we didn't do it before.  however he ate pasta before with no problems, as long as it was followed by something sugary.  now with injecting the rapid only he has a hypo before bed and the pasta seems to kick in in the middle of the night and wakes him up.  it has done this twice now, both times he woke around midnight with readings around 20.  we have had no other problems with other food.  having looked up about the GI this would account for it, but the DSN said this shouldn't make any difference and the cause of the high was a rebound from the hypo and not the pasta.  we didn't over treat hypo's as 20 mins later he was about 7mmol.

Has any found any problems with pasta.  i dare not feed ethan any more pasta as i hate correcting in the middle of the night.  I'm totally confused about the GI and how it can work with rapid acting insulin.  Does anyone have any ideas?  Rosie


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## Adrienne (Oct 6, 2009)

Hi Rosie

As per normal the 'patient' is right and the DSN is wrong.   This is not from a rebound but definitely from the pasta.

Eating pasta when not pumping is a trial.   Its a trial on a pump as well though but manageable.

You will see a spike after about 4 to 6 hours with pasta.   On a pump we can do a special type of bolus where the insulin gets spread out over a few hours.    On MDI (multiple daily injections) it is much harder.   Some people actually do a split dose of the novorapid, ie give some immediate and then another injection about 2 or 3 hours later.    This seems to work.  We never did that as I didn't really know what food did until we pumped.    

Most people however don't hypo immediately after they just start going up and really spike as you have found.

So combat the hypo you could try injecting in a different place and after you eat.    The pasta will have started working way before the insulin if you inject after and hopefully this may sort that problem out.    If you inject into the tummy then for pasta don't.   The tummy is the quickest acting place, for pasta try the leg or arm (not sure if too skinny for the arm).  

Just some suggestions and I hope one may help a bit.


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## Adrienne (Oct 6, 2009)

If forgot to say about the GI diet.   On mixed insulins then the GI diet is really the only way to go.   However on MDI it is not.   The levemir or Lantus glargene (whichever you are on) is the background rate and in theory this should cover a full 24 hours (they don't by the way - most people end up having to split levemir but not generally lantus).    The NR deals with food.   It lasts approximately 5 hours in your body with a peak at about 3 hours - this is obviously not definite as everyone is different, just a guide.   If pasta peaks 6 hours later then you only have a dribble of NR left, not enough to cover the spike.    

If you have religiously tried to follow a GI diet then you can rethink things again.

I personally found that a non low GI diet was best ie aim for medium GI food.   Porridge is very low GI, even on a pump we can't have that.   It seems to shoot my daughter up to the 20's and leave her there for about 8 hours.    For others its different.

Try wholemeal pasta.   I don't know whether you are into this wholemeal stuff, I'm not.  I can't stand brown rice so have basmati as that is the best for diabetes after brown.  I do however love the taste of wholemeal and I think that helps a little on the spike as well.


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## Rosie.H. (Oct 6, 2009)

Thanks for that, i thought i was going a bit mad.  i think i will just take pasta off the menu for a while, and get the cook books back out to find a replacment.  i had the diet sussed for the mixed but it just doesn't work the same for the MDI.  thanks for the tips greatly appreciated.  Rosie


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## Patricia (Oct 19, 2009)

Hi Rosie

I was away when this went up, sorry...

We have major problems with pasta, but on MDI found two things:

1) my son always hypo-ed if we injected for the whole carb content with the pasta. And then he was high the next morning.

2) we managed things okay if we split the dosage into 1/2 when he ate, and 1/2 two hours later. He was still a little high in the morning(12 or something), but didn't hypo and didn't spike to 20...

He is now on a pump and we have now discovered more firmly that he spikes with pasta six hours after eating it. On the pump we dribble 80% of the dose in over six hours (with another two hours after that of 'trailing' insulin, as Adrienne mentions, to mop up the spike).

Another suggestion made by one of our consultants was to raise the nighttime levermir by a unit on pasta nights...This would have worked for us ONLY if we hadn't given the full carb counted dose for the pasta initially, as otherwise E would have hypo-ed. It always seemed a bit random to us to try to arbitrarily determine how much NOT to dose for in novorapid using this method...but it may be worth a try?

We also encounter something similar with rice, which seems to have an even longer time digesting than pasta...In the last few days we have come to think it's around 7 hours, with another two hours 'trailing' to mop up...Again, on MDI my son always hypo-ed with a straightforward novo dose for the whole thing. We split it half and half with two hours between, and managed much better....

For split doses though we did find the necessity of 'checking' the second dose irritating: we felt we always had to get up at the peak of the second dose to make sure that he wasn't reacting unexpectedly to it. Sometimes this would be quite late!

Saying that, we continue to do this with all the long insulin dribbles on the pump, so that's just the way it is!

Good luck with everything.

Patricia


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