The Integrated Diabetes Services team (IDS) recently decided that we are going to challenge ourselves once a month with foods that can be tough for people with type 1 diabetes to consume and manage their blood sugars after.
The idea came about thanks to a new high protein kellogs cereal-Gary ate it and had beautiful blood sugars following. I on the other hand shot up to 270. If you don’t already know, we all live with type 1 too. Additionally, we are all utilizing hybrid closed loop systems (5 loopers and 1 Control IQ).
Following the challenges, we’re posting the strategy we used and our dexcom graph to show how it worked. You’ll also notice the impact of stress and life events that we’ll note in the background story. The first challenge was honey nut cheerios and the second was pizza(see results below).
Follow along here on our thinking like a pancreas blog page or on social media platforms:
Feel free to join in our challenges or make suggestions on what meals you would like to see us do. The point is to have fun and hopefully learn too!
CHALLENGE #1: honey nut cheerios
Cereal is tough and leaves many with a skyrocketing bg (we’ve all been there too). The team did pretty well overall and we all had a good time doing it.
Strategy order is as follows: Kristen (Control of study does not have T1D), Gary (loop), Jenny (loop/autobolus branch), Alicia (Control IQ), Annette (Loop/autobolus), Dana (Loop/autobolus), and me (Kathryn, loop/autobolus).
Kristen(control): Honey Nut Cheerios caused the most prominent spike since inserting the sensor Friday.
Gary: Ate at 8. 15 min prebolus. Got a little unexpected physical activity around 9am – the bottom fell out from the case of soda I was carrying into the office, so I had to chase the cans that were rolling all over the parking lot. What fun. I also take a GLP1 receptor agonist (ozempic) once weekly. It has a slight effect to delay gastric emptying. Loop helped too.
Jenny: My strategy was 30 min prebolus with the simple sugars in that first bolus and a 1 hour absorption time.Then when I ate I bolused the other 2/3 of the carbs and started eating right away. I think I dropped because of the bike ride with my boys which was a bit more brisk than planned.
Alicia: Half hour prebolus 1% lactose free milk. I meant to do a 50/50 over 30 min but forgot.
Annette: I did a 20 minute prebolus and was busy around the house cleaning.
Dana: I added almonds for protein and took 20 min prebolus. Would skip that much time if I ever eat this combo again. Definitely took a nosedive afterwards and had to treat it.
Kathryn: I did a 30 minute prebolus and dropped to 61-was still hungry after 1 cup of Cheerios so added a banana with no prebolus.
CHALLENGE #2: pizza
We planned for 2 slices but some of us went for a third. I have to say- I don’t think pizza counts as a challenge for Gary because he eats it quite often. Jenny’s kids on the other hand didn’t even know what Pizza Hut was! If you choose to manage your diabetes with MDI we provided tips in here for you too by popular demand.
Strategy order is as follows: Gary (loop), Jenny (loop/autobolus branch), Alicia (Control IQ), Annette (Loop/autobolus), Dana (Loop/autobolus), me (Kathryn, loop/autobolus), MDI.
Gary: Went into dinner a little high due to a late afternoon snack. Had 3 large slices just to even the playing field (and because it was really good), plus salad and strawberries. Bolused for 1 slice just before dinner, then did 5k run 20 min after dinner. Dipped at the end of the run and had a few pretzels, and bolused for the remainder of dinner. Raised basal by 40% for the next 8 hrs, which may have been slightly too aggressive, but woke up in the 80s (blood sugar, not the decade… although that would have been cool too).
Jenny: I went to the park with the boys before dinner, BG was on the trend down after the park and into bolus for pizza.Ate about 6:15, bolused for 1 slice at dinner time and had salad with veggies and vinegar with the pizza.Then once Bg started a slow climb (about an hour after 2 slices and salad) I bolused for the second slice.I had taken a bike ride in the afternoon with the boys – pulling the burley behind, so didn’t use an override for the overnight knowing I was already more sensitive and expecting the pizza and exercise to even each other out. Graph high bar is 140, went to bed at about 120 on the rise but with Loop Auto Bolus I left it alone. Wake up was BGwas 92 (12 hour graph is 120 top bar). “Not too bad for pizza!”
Alicia: I bolused for 75% of carbs with a 50/50 over 2 hours. Then 2 hours later delivered the last 25% over an hour 15 minute prebolus. Turns out pizzahut hits a LOT faster than my normal pizza so I needed more up front. I had chicken on our pizza (Asher’s favorite) I was starting a bit high from a mid day set issue, but couldn’t give dinner the longer prebolus I’d have liked. I was also running my “control iq high” profile with 50% higher basals.
Annette: My backstory is a little complicated; I’ve been very active this week and swam 1.5 miles the morning of the pizza test, but I’ve been dealing with some higher numbers the last few days due to pre-menses and a small infection. After waking up at 200 the morning of the pizza challenge I made some changes to settings knowing that things might get rocky. I started the challenge a little low, probably from wrestling 3 kids into the car to go pick up the pizza. Tried to do a pre-bolus but ended up dropping into the 60s so I started eating after only 5 minutes. Things were very up and down for the next few hours and I ended up having a little juice a few hours after the pizza, and increasing my ISF as that was one of the settings I’d changed in the morning but realized it was too aggressive. As I went to bed things leveled out pretty well and I had a great night, letting Loop take over. The high alert on my graph is 150.
Dana: Here’s my full on pizza adventure! Started a little bit lower using my Loop premeal setting. I was planning to meet friends out for a socially distance glass of wine and I had the pizza before I left. I took my insulin about five minutes before starting to eat and extended the food absorption 3 1/2 hours… I think I over estimated the carbs in the pizza because I was looking specifically for smaller pieces than the nutrition information allotted for on the Pizza Hut website! So my BG dropped a little bit around 4 hours after my meal and I was able to have a dessert – eating dinner so early made me hungry for more pizza. But sadly my family didn’t leave any leftovers so I was stuck with peanut butter in a crisp bread! Kept pretty steady overnight which was a win: Dana 1 vs Pizza 0…for now!
Kathryn: I used my loop premeal setting for a 70 pre pizza bg. Then I did a 5 minute prebolus. I used the “pizza” food type in loop for my bolus(4 hour absorption time), bolused for 80% upfront, and turned on a 30% basal increase. I started to trend low around 10:30 so I turned my basal increase off before going to bed. I guess I started rising almost immediately after falling asleep-loop was helping me out- woke up to the high buzz (high is at 150, tapped 197), and turned my basal increase back on-then was trending in the high 60s prior to breakfast. Definitely learned a lot and pretty confident I’ll nail the Pizza bgs next time (so grateful to be learning from the best!!)
PIZZA AND MDI Strategy
PIZZA AND MDI Strategy: With any slowly-digesting meal, those on MDI have several options:
1. Switch to Regular insulin for that particular meal (same dose, taken just prior to meal) 2. Delay the dose of rapid-acting insulin until after the meal 3. Split the dose of rapid-acting insulin: 50% just prior to the meal, 50% 1-2 hours after the meal
To deal with the delayed effects of a high-fat meal, it’s a little more difficult. Raising the dose of long-acting (basal) insulin will affect insulin levels for at least 24 hours, when you only really need an increase for 6-10 hours. There is the option of taking a small dose of NPH insulin after the meal to offset the delayed/additional rise caused by large amounts of dietary fat.
Kathryn Gentile is a clinical exercise physiology student from Lancaster, PA who is pursuing her Master’s degree and also working towards becoming a Certified Diabetes Educator. Additionally, she is an ACSM-CEP(clinical exercise physiologist), Certified Personal Trainer, and Certified Sports Nutritionist.