Sunday, August 13, 2006

Sunday Blunder

I made a big mistake this morning.

Every Sunday before church I run through the old Del Taco for my one "bad" breakfast each week. Mon-Fri my breakfast is one packet of plain old Oatmeal with 2 packets of Splenda and a little pat of "I Can't Believe it's not Butter!" (BTW, that is not just a clever name! How do they do it!?!)

So this morning I checked my BG, 157 (had a bad low of 42 last night and over corrected but not horrible). I said 157 out loud so I would not forget. Packed up the care and headed for Del Taco. I pulled into the Drive thru.

"welcometodeltacomayitakeyourorder?" the distorted, noncaring, young voice spews.

"Yeah, I want the Bacon and Egg Quesadilla meal with NO SAUCE and a macho DIET coke."


"um, yeah. that's it"


Get the grub. Go to the park. Park the car. Eat the grub! MMMMM Bacon!

We had a great day at church. This week was Vacation Bible School so the kids were up in front singing and doing these sweet little dance moves. It was so much fun. We had a lot of visitors at church so that was cool and the band received a bunch of very nice compliments. A very good way to start the day.

After church we went to lunch at Panera Bread for a friends birthday. I check my BG before we go inside. 327. woah, i have not been that high in a long time. What is up with that??? My BG's have been great! Oh crap....

Iforgottobolusforbreakfast! (That was Del Tacoian)

I felt like such a dummy. That was a first for me so lets see how the rest of the day goes after that.

Master P gave me a mega bolus. We just got back from lunch and man am I tired.

Should I have waited to eat lunch later when my sugar was normal? I didn't know exactly how to handle that. I would really love some direction from the OC.


Scott K. Johnson said...

Hey man, no biggie. Stuff happens, and you deal and move on.

I got a kick out of your drive through voice! That's so how they are! Amazing that anyone can make out anything.

I recently forgot to bolus for breakfast too - first time I've forgotten to bolus in a LONG time (like, many years).

If it happens often, then you need to figure out a way to not let it happen so often - but if it's just a freak occurrence, then don't worry about it!

I wear a Cozmo pump, and there are optional alarms that you can program to help you catch those missed meal boluses. These alarms are set such that if there is no meal bolus between 7 AM and 9 AM (for example, times can be configured however), you get an alarm.

I don't use them though because my "normal" meal times are not normal at all. It's also not usually an issue for me (forgetting boluses).

There is some information out there that says even one missed meal bolus per week (or is it month?) can have an impact on things. So, again, if it happens often, dig into it. If not, chalk this one up to experience.

As far as to eat or not to eat when high - there's going to be a lot of personal opinions on that one.

I know that there are many people who will not eat until their BG's are back to normal.

Personally, I eat and add my correction bolus into the meal bolus. It might not be the best choice, BG wise, but I have trouble avoiding food and that whole "not eating until later" thing (which causes me a significant amount of trouble most often).

There are times when your BG is high but you HAVE to eat something - remember when you were spilling ketones that one time? Ketones are a by-product of your body turning to other sources for energy - so to prevent more ketones you have to eat something (assuming your insulin is getting into you properly) - whether you're high or not.

I'll be watching the comments to see what others have to say - I'm interested in this as well.

Caro said...

Yeah, this definitely happens. There is a part of me that sort of thinks it's a good thing. It means we're not totally obsessed by either diabetes or our pumps. But the resulting high... that sucks!

As for the waiting before eating - do you have the 4th edition of Pumping Insulin? If so, a great visual answer to your question is on page 160.

Basically, the longer you wait to eat, the lower your blood sugar will be before the carbs start to raise it again, and the more insulin will already be active to combat that raise, so the lower your 'peak' will be.

I think this is altogther more significant if you are often high before meals, because then by eating right away you would be getting high peaks frequently, with an obvious deleterious effect on your overall control.

If you are very high, you need to remember that you will also be more resistant to insulin than if you were lower, so any boluses you take may be less efficient at controlling a post-prandial spike anyway.

Generally I try not to eat when my blood sugar is over 200. If I know I will be eating I take a bigger than needed correction, knowing that some of it will be offset by carbs later.

I do eat though if not doing so would spoil enjoyment of something. So if I'm out with friends at a restaurant or at a dinner party I'll juts try to get the bolus in as far ahead as I can. Likewise if I know there is no way I will be able to eat later if I skip now. So in your situation here I would have taken a bigger than suggested correction right there in the parking lot - adding on what I knew for certain would be needed for carbs later - since that would be as far ahead of food as you could get it.

Hope that helps in some small way!

Kerri. said...

What kills me about this - aside from the fact that your drive-through people talk in the same, smushed together way that the RI drive through people talk in - is that I did exactly the same thing this afternoon.

Boiled water for my afternoon oatmeal. Stirred it up. Ate it. Worked on an article. Noted that I had a headache and felt sick to my stomach. "Hmmm..." thought Kerri. Tested. 313 mg/dl. Checked pump. I did not bolus for my oatmeal. I let 33 grams of carbs have their way with me.


(Also, when I wrote "33 grams of carbs" the first time, I originally wrote "crabs." It struck me as the funniest typo. 33 grams of crabs, beating the living shit out of me. But I digress... yet again.)

Minnesota Nice said...

At least with the pump you can check and see if you've bolused.
With MDI, I sometimes forget five minutes after I've injected whether I've done it or not. (Really makes me feel old). But, within an hour I usually have a pretty good idea whether I did and then have to scramble and act accordingly.
Oh by the way, the absolute best thing for my diet was having the Panera Bread in my heighborhood close - way too many temptations.
Have a good week ahead.

George said...

I do not think this will be a problem I hope! I am just taking a second before that first bite to think about the bolus.

I do believe I have the 4th addition of PI so I will check that out!

Thats a coinkydink! Crabs! LOL

My MDI days were filled with that feeling of, did i just take a shot or not? I remember trying to find a fresh red spot on my stomach hoping I could "see" my shot!

Thanks guys, It's good to not feel alone.

julia said...

O and I did this the other day. Got a bagel at Dunkin Donuts (same smushed together voices up here in Massachusetts, too) and two hours later, she's nearly 400. We looked at each other and said, at the same time "No bolus for the bagel." I let her eat anyway, just let the pump figure out how much she needed and checked her every hour for the next three. It happens.

I suppose you could stick a post-it note to your forehead. That might help. ;)