# How much carb is in my lunch? (pics included)



## ollie1234 (Sep 9, 2011)

*How much carb is in my lunch? (pics included) Update - why has my BM gone up?*

Hello,

I'm re-learing to count carbs as my knowledge is rusty and not as good as I'd like it to be. Here's a photo of what I'm having for lunch today - could you help me count the carbs?







I've made two ham, mustard and lettuce sandwiches from the loaf. Here's my estimates of the carbs:


Bread (4 slices) = 10g each = 40g
Ham, mustard, lettuce, margarine = 0g (trace)
Tomatoes = 5g
Nectarine = 15g

Total = 60g

Also I'm curious about the bread's GI. It's one of these artisan loaves with seeds in it from a local baker. I would say it's "wholemeal-ish", definitely not white bread but not properly wholemeal either. I estimate it's slow-release carb / sugar (is this called low GI, or high GI?). What do you think? Would you recommend bread like this or would you usually look for wholemeal?

Here's a picture of it:






Thanks!

Ollie


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## Mark T (Sep 9, 2011)

I was wondering if your 10g per slice of bread is a bit high - but it's difficult to guess as those slices are smaller then conventional sliced bread but thicker.  Possibly 10g is OK especially since a conventional sliced bread can be 15g.

I would say that the bread is mid GI at least.  It's much less seedy then Burgen.  I believe Burgen is only just inside Low GI.

Conventional wholemeal and white are usually High GI.

I would of estimated 4g for the tomatoes too - but that's being niggly


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## novorapidboi26 (Sep 9, 2011)

Pretty good counting in my opinion, when it comes to bread I always just use 20g unless its a smaller sliced loaf.........

I wouldn't personally count tomatoes unless there was a substantial amount and spot on for the nectarine...........I would normally use 10g, so 1 unit of insulin.....

As a type 1 diabetic GI inst as important as it would be being type 2 as we can time our dose of insulin with an educated guess.....[BG analysis].....

It seems you are not that rusty though.........

Let us know the results............


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## trophywench (Sep 9, 2011)

Aaargh, French bread.  Some of it is 10g per slice like that, some of it's more.  Never less than that.  We've just had a longish holiday in France so eating bread  like that every day and it was pure guesswork on the bread front.  Never disastrously wrong, though I did do quite a number of later corrections. (i mean on a number of days. not multiple corrections for the same meal, LOL)   So all you can do is test then tomorrow - if it's still edible or the rest of your family haven't scoffed it! - you'll know.


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## ollie1234 (Sep 9, 2011)

Thank you both 

I have some news about my blood sugar... here's the numbers:

1pm (before lunch) 14.4, took 1u humalog correction
2.50pm (just before eating lunch) 8.8, took 7u humalog, ate 60g carbs
4pm (right now) 10.4

(Yes, I had a late lunch today!)

I'm concerned. I thought the 7 units would serve as both a dose for lunch and a correction for my 8.8, I was expecting to be around 6 now, but instead I'm at 10.4.

Wish I had a CGM so I could see if I'm trending up or down... I feel so blind at moments like this.

Could you help me with some practical questions? When should I next test to see the trend? Is 15 minutes long enough?

If I'm steady or trending up, would you take a correction dose? Or should I wait until two hours after lunch, when (I think) I'll have finished digesting and 'processing' the carbs and insulin? 

Any feedback would be greatly appreciated, thanks.

Ollie


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## Robster65 (Sep 9, 2011)

Hi Ollie.

Humalog starts to work after 15-30 minutes and peaks at about 1.5 - 2 hours, tailing off over 3-5 hours, varying from situation to situation.

You need to test before eating, after usually 2 hours to see if you've hit the spike right, but the food can peak after 1 hour or 3 hours, depending on the GI.

One more note, wholeMEAL bread isn't that brilliant. You need wholeGRAIN, which contains the cereal in its husk, and/or seeded, like you're having.

You need to account for the 1u correction dose you took when calculating your ratio for lunch. If you can keep the rise from pre to 2 hours post meal to within about 3mmol/L then you can calc your ratio and keep checking it as you go.

If 1u brought you down that easily, it sounds like you may need to review your basal. It may be a bit high.

Also, your lunch is quite late in the afternoon, which will have an effect.

Otherwise, well done 

Rob


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## RSVP (Sep 9, 2011)

Another quickie

What time did you have breakie? & what was it??

The high before lunch could be due to lack of quick acting insulin on board?



sarah


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## everydayupsanddowns (Sep 9, 2011)

I'd rteckon the count was pretty good Ollie. But I would suspect that bread would be quite fast acting for me. I no longer consider 'brown' to be safe - let alone brown-ish  Not that I don't still make those food choices, I just factor them in to later results



ollie1234 said:


> 1pm (before lunch) 14.4, took 1u humalog correction
> 2.50pm (just before eating lunch) 8.8, took 7u humalog, ate 60g carbs
> 4pm (right now) 10.4
> 
> ...



What is your insulin sensitivity generally? How much would you expect that 1u to bring you down over it's 4h duration? My guess would be around 3-4mmol/L for me depending on how accurate my basal that week. My problem is that insulin activity rarely seems to be very linear. Sometimes I get a fairly steady activity over 4 hours, other times after 2h it seems pretty spent.

Your 14.4 to 8.8 is quite a lot in the first 2 hours, and the initial 1u may have nearly done its work (smaller doses tend to have a shorter duration). And of course either/both of those levels might be out by meter innacuracy of 10-20% 

I think the 8.8 to 10.4 (at just over 1h after eating) is driven by the rapid-ish absorption of the food. The 7u will only just be getting going and still has 3hrs or so to run. 

If you are concerned I'd say test again at 5 and see how things are faring.


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## Robster65 (Sep 9, 2011)

@ Everydayupsanddowns .. Spot on.

Rob


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## ollie1234 (Sep 9, 2011)

Wow, thanks everyone. I'm so grateful for all of your kind words and consideration 

I had late start today (I have a day off work!) so I had a lie in until about 10.30, breakfast at 11.37 (3 slices of the same bread, toasted with marmite, plus a cup of black coffee). I've been using the Diabetes Diary iPhone app and have recorded everything so far:






@Robster65 I think you're right that my basal is a bit high, I keep having hypos at night. Going to drop the units by 2 to 18 and record my before bed and morning readings tonight.

I see that some of my ideas about insulin and food carb absorption are off. I had been told that lispro acted immediately and was absorbed within 30 minutes.

There's a lot to think about here...

Edit: just did another test, 10.1 at 4.54pm. Thought my sugar would have come down a bit by now but on reflection I suppose the insulin and the food are both still being processed.


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## Robster65 (Sep 9, 2011)

That's really informative Ollie.

I've never tried to do lie-ins that late, so not sure whether it affects things. I tend to stick with routines as much as I can. A hangover from the old days I suppose.

The hypos at night do suggest a basal overdose. Unless you're eating late and over injecting the bolus. But try the basal first.

It looks like you're rotating your injection sites nicely. Just watch for fat build up. 

Your test at midday was around the peak of your humalog action and possibly your breakfast absorption. The 1u correction will have acted in conjunction with the breakfast dose. Something to be wary of when correcting. It can stack up and cause hypos later.

I'll leave it there for now from me. Too much at once could be bad. 

Rob


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## everydayupsanddowns (Sep 9, 2011)

Ahhhhhhhhh! It all becomes clear!

That overnight hypo may well still be messing you about. (causing your liver to drop in glucose from its stores)

I would just ride out today until you liver has calmed down a bit 

Oh... and if you've got the blue Autopen24 that only does 2u increments I'd suggest you pop to your DSN and ask for a green one. Still horrid, but at least you'll get 1u doses (a smaller max dose, but that won;t worry you looking at your suggested change). I often found 2u was too much change and just caused other problems


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## ollie1234 (Sep 9, 2011)

An update - at 5.54pm my blood sugar is now 5.9! Finally coming down.

Going to try to keep it steady through dinner.


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## ollie1234 (Sep 9, 2011)

Another update - feeling a bit funny at 6.30, took a reading at 6.40 - 3.3.

I had the possibility of a hypo at the back of my mind when I got that 5.9 result. I've also done some light exercise today (a few pull ups, sit-ups and shoulder raises with dumbbells).

I've eaten one finger of a kit-kat bar and another nectarine, I estimate 20g total.

Highs and lows today, hmm. Heading out for dinner and a drink with friends. Wish me luck for tonight and tomorrow!

Thanks again for everything, it's been incredibly supportive to get all this feedback throughout the day. You are all so amazing


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## novorapidboi26 (Sep 9, 2011)

might want to think about having something quicker absorbed than that for a hypo, but you may find this out for yourself...........


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## everydayupsanddowns (Sep 10, 2011)

I'd agree with NRB Ollie. I used to use chocolate, even though I knew it wasn't very quick acting, but having switched to fruit pastilles (or skittles or locozade for nasties) I found my awareness improved. Partly because other work began to reduce the total number of low-level dips, but also I think, because I spent less time in low numbers. It also helped prevent overtreating as the response/rise was always quicker and I didn't feel the need to reach for something else after 10 or 15 mins.

Do you use the '15 rule'? (15g cho, 15 mins, test again)


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## ollie1234 (Sep 10, 2011)

Thanks for the tip about faster acting sugars, that sounds really good. I'll get some lucozade for the future. 

I did the 15 rule - 15 minutes later my blood sugar was even lower (2.9), I ate two fingers of a kit-kat (15g). Next test was half an hour later and 6.4.

I've been doing lots of tests again today (Saturday) and thinking about what I eat. I feel really motivated to learn about how diabetes, carb counting and my body are working, it's great to be thinking about it this much. Here's my readings for both days (the Diabetes Diary app is really useful):






And a graph of the last 24 hours:






I have mixed feelings about today and would really appreciate your feedback again.

I think the adjustment to 18 lantus worked well, I went to sleep at 8.7 and woke up at 5.8, that seems good.

I seem to have taken the right doses (6) for breakfast and lunch as I stayed at a steady 6. Although I am pleased with the results I would like to understand why I got them; how could I have had the carb counts right if taking 6 units for 30g and 6 units for 45g both kept me steady? 

No pic of breakfast but here's a pic of my lunch - would you say these sandwiches were 45g? 






I was thinking that each one was a quarter, so half a slice of bread. 4x 1/2 slice = 2 slices. 2 x 15g = 30g, plus 15g for both the fillings and for some of them being white bread. This is a bit of a fuzzy way to add them up - could you improve on it?

Also this wasn't an entirely steady 6 as I went hypo (3.1) at 6pm. I drank a can of coke, which I read as having 30g carbs (all sugar) on the nutritional information on the can. Intuitively I'd expect coke to have more sugar than that; does it, or did I read the numbers correctly?

With hindsight I wish I'd just drank half the can (15 rule again) as I went hyper (9.3) 45 minutes later.

I also don't understand why I didn't go hypo in the morning but did after lunch.

Dinner arrived at 7.20pm (I've been out all day), I ate 3/4 of a pizza then about another half a pizza (I got greedy, there was free pizza!). The pizzas had quite thin crusts so I thought their carb counts would be quite low (I estimated 50g for 3/4 of a pizza), but looking at my sugar levels afterwards (9.1, then 15.5) I think I got this very wrong. Here's a picture of 3/4 of a pizza, how many carbs would you say it had?






I took the 2 units at 9pm to correct for the high blood sugar - do you think this was the right thing to do? Also is there anything else I can do (other than just a dose) to bring my levels back to normal as quickly as possible, or do you just have to wait it out?

Finally I just did a test (10.30pm, 15.3). How am I doing at managing this hyper? Should I just wait?

Thanks for reading!

Ollie

Update: tested again at 11.20pm, 14.4. Been hyper for three hours, since 9pm. 

I'm thinking that as I ate dinner around 8pm, it will have stopped being absorbed by now, because 11.20pm is 3hrs 20mins after eating, and (as I currently understand it) food is absorbed for up to 3 hours.

This means (again, as I understand it) that my sugar level shouldn't go up any more. My last dose was the correction at 8pm, that will have effects for three hours, so at 12 midnight it should have run it's course. If I test again at midnight then I should get a result that shows me the final results of dinner, my dinner dose and correction dose. 

At that point, if I'm still around 15 I might take one more correction unit (risking a night time hypo, but hopefully just bringing me down to a better level for the morning). I'm also going to take my night time bolus now. 

Phew, there's a lot to think about sometimes, isn't there? I'd really appreciate some feedback on how I'm thinking it through - it's great to learn how to manage this properly.


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## RSVP (Sep 10, 2011)

Pizza is renowned for causing problems  We just don't there.

Insulin requirements vary at different times of day Rob has 1 unit to every 9 grams carb at breakie but 1 to 12 grams come teatime. This is different for everyone. 

We also found that having our main meal at Lunch helped as the body processes food easier. For Rob it seems to sit all night causing fluctuating blood sugars if we do it the other way round.


Jelly babies are quick an easy for hypos 3 = 15 gram of carb and are easily stashed in pockets saves carrying oodles of stuff round 


I'm sure others will be along with further pointers Ollie, I can't really advise on the hyper it will be the pizza no doubt. Over nights are tricky for treating hypers as I'm sure you know the yo yo effect can (treat a low and end up high and vice versa) come in to play  



Take Care

Sarah


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## Robster65 (Sep 10, 2011)

Hi Ollie.

Something to try and keep in mind while you're getting things stable.

If you can try and stick to some kind of routine time-wise. I notice you inject your Lantus at different times (11pm, 2am). It's meant to last 24 hours but doesn't in meveryone. Mine wasn't lastign the course, so I had to split it. If you inject at 11pm one night and 2am the next, it's going to be running out and overlapping at different times, which will confuse your bolus calcs.

Also, things like pizza might be best avoided until you understand things better. The fat in the cheese delays absorption for hours potentially and then the white bread base fires through to spike you late. You'd be better with a low to medium GI meal with less fat in it. Just for now while you're sorting things out.

I've always found that a structured day works best for me btu realise not everyone can or wants to do it. But without a semi-routine for a few days running, you'll struggle to find patterns you can adjust for.

Rob


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## ollie1234 (Sep 11, 2011)

I've set an alarm for 11pm each day, I'm going to aim to take my lantus regularly at 11 from now on. I can see how that's an 'easy win' and will make everything else less complicated. My daily routine does vary quite a bit, switching to regular hours for everything would be too big a jump right now but I'll keep it in mind and see where I can get more easy wins on this front.

Having a main meal at lunch is an interesting idea... also avoiding pizza and going for simpler foods appeals to me a lot right now, it's another way to make things more understandable.

Thanks again for the kind words and advice


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## trophywench (Sep 11, 2011)

High fat plus high carb is still a nightmare for me even with a pump.  So that's most things with rice, most things with pasta, most things with a jacket spud.  (I have butter on them too, whatever I slop on top)  I still eat em to be sure - but the ruddy spike can be anything up to 6 or 7 hours later - after I'm already in bed.  PITA.

I wondered why you had 30g carb to treat a hypo, it only needed to come up c 1.5, cos you weren't even THAT hypo ....  LOL we've all done it.

I always count a slice of bread from a large sliced loaf as 20 - unless I'm only 4ish pre meal.  That's because the packet says +/- 17 or 18g a slice.  definitely not as low as 15.  Some browns can be as high as 23g but if you don't have the benefit of the packet of course it's harder.

You need to know exactly what carbs and insulin do to your BG.

Soooo take a day when you haven't had a hypo in the last ?12 hours.  You haven't had a bolus or eaten for at least 4 hours.  Eat exactly 10g of fast acting carb (you can have it in coke or eh a digestive biscuit, whatever) and test as many times as yer like for as long as yer like up to say, 3 hours to see what it does.

Then another day do the opposite,  same thing but your BG needs to be high enough so the 1u of fast-acting ain't gonna send you hypo and wreck the experiment.  Take the 1u and test, test test!

BUT - have you tested your basal yet?  the information about the 24 hours is correct - but how long is it actually lasting, for you personally?  see

http://www.diabetes-support.org.uk/info/?page_id=120

and also

http://www.diabetes-support.org.uk/info/?page_id=408

but the latter is only the theory.  Lantus can last anything from ?18 to ?36 hours ......


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## Pumper_Sue (Sep 11, 2011)

Hi Ollie,
Just a few pointers for you if I may 
1st if you are above 14 then most would have insulin resistance. So would need more of a correction dose. IE, 15% more insulin.
If you haven't done so invest in a good carb counting book and a set of scales plus a calculater if your maths are not good.
Weigh all foods untill you know what it looks like on your plate. So when out can guestimate easier. 

But first of all though you do need to sort out your basal insulin (long acting) Because if thats wrong so is everything else.

Also do remember that many people also have a different carb ratio for each meal time.
Hope that's of some help to you.


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## everydayupsanddowns (Sep 11, 2011)

Hi Ollie

First of all congrats on your logging, recording, questioning and enthusiasm. If you carry on like this you will *certainly* get your control whipped into shape. Now the hard bit- it's not going to be a quick fix. You may have to slog away for several months, possibly longer. And there may well be times in that period where you think it is impossible. But many folks around here, myself included, have taken steps to improve control from what they thought was OKish to 'not bad, almost there really' (this is, I think, about as good as it ever gets)

Haven't looked at your numbers in detail, but one other 'rule of thumb' that might apply to you is to do with portion sizes. It seems up to a certain point, ratios work reliably. After that you may find they stop working so well, even when you count accurately. That point seems to be approx half your weight in pounds as grams of carb. 

So weight: 160lbs - anything under 80g CHO should be fine. But larger meals may need extra insulin on top of 'standard' ratio, and this larger dose may need to act over a longer period (as you found with pizza, sometime stuff takes ages to digest). You can spread the action by splitting the meal dose (say 60:40 or 70:30) with some before eating, the rest after. 

There's a whole lot of experimentation to get that to work well too!


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## ollie1234 (Sep 11, 2011)

I've been learning so much from you all over the last few days 

I want to write a quick summary to help these lessons stick.


Test up to 8-10 times a day and record everything (that app is great for this, I feel this change has gelled quickly for me)
Take the bolus injection at the same time each day (makes so much sense, alarm now set for 11pm every day).
15 rule for hypos - 15 units, retest in 15 minutes. 
Lots of fat and carb together make for difficult meals with spikes and delayed reactions.
Humalog takes 30mins to take effect then lasts for 1-3 hours (handy graphs). This is really good to know, I had been going on old and incorrect information that humalog took effect immediately and worked for 30 minutes.
Testing before a meal, then 1, 2 and 3 hours after lets you see the full effect of the food and insulin (pizza or fatty + carb heavy foods excluded!)
Insulin ratios break down with large amounts of carbs. I'm going to aim to eat low-med carb meals (up to 60g) to work out my ratios.

I seem to be around 1u : 5g carb for breakfast based on today and the last two days. 

This sounds really high, I'm concerned I might have insulin resistance. Although I feel really good to be doing all of these tests and all of this thinking (it's good to be getting in control), I'm also feeling really anxious about the damage I might have done so far and what kind of shape my heart's in. I'm seeing my doctor on Tuesday, can I ask for a 'heart check up' or something to get a picture of what condition I'm in?

@trophywench I like your two experiments, definitely going to try these soon. I'd love to work out my ratios. 

It's good to be building up all this data, I used my records from yesterday to consider how much insulin to take with breakfast today.

@pumper_sue, is insulin resistance something that I either have or don't, or can it be temporary? You talked about having insulin resistance if a result was above 14, did you mean I might be resistant temporarily, while my blood sugar was high, or in general?

@everydayupsanddowns thank you, it's really good to hear that. For years I've felt that the hospital would just criticise and tell me I'm never doing anything right, but actually I think the goal is 'good enough'. It really got to me over the years... anyway, very grateful to hear you say it now and perhaps I can rebuild a useful relationship with the doctors when I next visit. 

Ollie

p.s. blood sugar has come down since last night, going to test again 2 hours after breakfast to see if it's lower. Breakfast was 150g of 2% fat yogurt (at 8g carb per 100g, so 12g) plus a nectarine (15g), then a black coffee around 11.30 (no carbs - does coffee have an effect on blood sugar?).







p.p.s. yes, another lie in! Back to work tomorrow so will have a more regular routine.


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## Robster65 (Sep 11, 2011)

Hi Ollie. 

Just a quick note. You mention your bolus at 11.30pm. The lantus is the basal and the humalog is the bolus. They're only words but can make a big difference if someone thinks you're meaning the other 

Also, humalog can start to act a lot quicker (10 minutes or even less) for some people, depending on where you inject, how low you are, how much exercise you've been doing, temperature, phase of the moon, inside leg measurement, etc.

Don't take what we say as gospel. What t does for us may not be what it does for you but you need to do the testing to work it out, so use what we say as a guide only.

I mentioned resistance to my DSN and she said T2s have resistance, T1s have sensitivity. I'm not sure what she meant by that and don't necessarily agree with her, but I think there is a difference. Insulin resistance is seemingly caused by fat round the organs. Sensitivity can be affected by all the above things listed for timings, and more.

But the higher youare, the harder it seems to be to bring it down. Unless you inject a correction, wait maybe half an hour, then go for a brisk walk and it can plummet like a stone.

Again, you need to find out what happens for you at different times.

Looks like you're getting there. The breakfast sounds healthy enough and the night time high was a lot lower.

And you don't need to test any more than you feel will give you the right info. If you can get away with 5 times in a day, then that's enough. But right now, more seems to be needed.

Rob


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## Pumper_Sue (Sep 11, 2011)

> @pumper_sue, is insulin resistance something that I either have or don't, or can it be temporary? You talked about having insulin resistance if a result was above 14, did you mean I might be resistant temporarily, while my blood sugar was high, or in general?



The higher your blood sugar ie, over 14 the more insulin you need to correct, this is called insulin resistance. So if it's a rare occ then it's temp 

Have you thought about having a set amount of carbs at each meal time and sticking to this until you have sorted yourself out? You might find it easier this way.
But as already been said you must sort out your correct dose of long acting 1st. You are wasting your time if this isn't right.
Humalog for your info also works a lot longer than 1-3 hours.


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## ollie1234 (Sep 15, 2011)

Hi everyone. After about a week of starting to monitor seriously I've posted a follow up with my diary, it's in this thread here http://www.diabetessupport.co.uk/boards/showthread.php?p=289923

Just wanted to let you know.

Ollie


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