Bolusing for Burgers
One of the observations that Dr. Right made when reviewing my data last week was that I would often have stubborn-highs in the time between dinner and bed. Not spikes, but plateaus; the kind that hover in the 220 mg/dl range and don’t seem to budge. No matter what.
I had suggested that my basals might need tweaking. When I set my original basal rates years ago, my lifestyle was thus: sit motionless on the train and at work all day, run around like crazy with my son at home. That pattern was my regular weekday routine for years. Over time, “train” changed to “car” and “son” changed to “sons”, but the routine was the same.
Lately, my job has become much more rigorous. Instead of working at a desk, I’m in the field, on my feet and active all day (sporting a temporary basal and fighting lows). By the time I get home, I’m physically drained so I do nothing – especially when three hours of playoff hockey is on the tube. The answer should be that the lower evening basal, optimized to the high-exercise evenings, is no longer right. Right?
My correction boluses have been a couple of units – and they’ve also seemingly been useless. So if I doubled, or even tripled, my evening basals, it still wouldn’t be enough. (It might help, but this is where the don’t-try-to-fix-too-many-things-at-once rule comes into play). Instead, I was told the following. First, increase my sensitivity aka correction factor.
Second is something I had never in my 31 years of diabetes done: bolus for protein.
I suppose that, in my attempts to do better, I’ve been trying to curtail the high-carb, spike before bedtime dinners. As a result, I’ve had more protein, and that’s kept by BG’s stubbornly high all through the night. Protein metabolizes slower than carbs, but some of it does ultimately turn into glucose. He told me that I need to bolus for the protein.
After taking the regular carb bolus, I should bolus the equivalent of 10 carbs for every three ounces of protein – and extend (square-wave) it over three hours. That seemed logical, but a bit excessive. Does this mean that every meal will have the net effect of being increased by about 10 carbs? Eventually, we agreed to try 10 carbs for every 3 ounces AFTER the first 3, over 3 hours. Sounds like some complex 401(k) match formula of days past (my current job’s 401(k) match formula, by the way, is easy to understand: it’s zero.).
Since I’m not yet able to bust-out the smart-scale that Leah “Lovehatediabetes” mentioned on Saturday, I’ll be using the rule of thumb that three ounces is about the size of the palm of your hand – another reason life would be easier if I had more than two hands! But for this meat-eating carnivore (redundancy intentional, for emphasis), the plan seems to make sense. Still, it’s too soon to tell if it will work.
Extended bolusing for protein: such an odd, but sensible concept. Something you just can’t do without a pump. Have you ever heard of such a thing?