Registered Dietician and Medtronic Diabetes Educator, Sandra, was diagnosed with type 1 diabetes at age 8, and her husband at age 11. It wasn’t until she became a Certified Product Trainer, training people with diabetes on the use of insulin pumps and continuous glucose monitors, that she really found her niche. With each person she’s worked with, she’s enjoyed forming a support group and passing on education. This growing network enables her to share an emotional bond that only a person living with diabetes can pass to another person living with diabetes. Today, Sandra shares her personal meal time tips with us that help her manage her glucose levels, especially during the holidays, which you may find helpful as well!
How are we going to make it through the holidays this year without experiencing the dreaded high blood glucose blues? Holidays are meant to be time spent with family and to relax. Don’t fall into the dreaded clutches of high blood glucose and let diabetes keep you from enjoying this time! While most people have to sleep off their turkey and stuffing on Thanksgiving, many people with diabetes are sleeping off their high blood glucose. Don’t panic! Here are 5 diabetes meal time tips to help manage your glucose levels this holiday season.
- Take a walk.
Did you know that when you exercise after taking a bolus it could help your body use the insulin more efficiently, therefore lowering your blood glucose faster? This also means you might need to take less insulin to lower your blood glucose after a big meal.
- Spend your carbohydrates wisely.
Think of it like a bank account. You can “spend” your entire carbohydrate allowance on stuffing and mashed potatoes, or forgo the potatoes and spend more on extra turkey and vegetables. Choose your favorite carbohydrates to eat and be sure to also have plenty of veggies and protein.
- Eat your veggies first.
Vegetables are very low in carbohydrate and high in fiber, and will help to fill you up, not to mention they are full of vitamins and minerals. As a dietitian, you know I was going to get that one in somewhere.
- Use the Dual Wave bolus for meals higher in fat.
The Dual Wave bolus consists of a normal bolus, followed by second wave of insulin, which is delivered in a square over time. The Dual Wave bolus should be used for high fat, high carbohydrate meals. This includes fast food, and meals that are common in many Mexican and Italian style restaurants here in the United States. Often times, it also includes holiday meals. Whenever we eat foods higher in fat, it takes our bodies longer to digest those foods. Therefore, we do not need to take the bolus all at once, but to spread the bolus out over time to mimic the time that it is taking our bodies to digest the food. You may need to increase total amount of bolus delivered since insulin is delivered in two waves and some of the fat will break down into glucose. You can use your continuous glucose monitoring (CGM) and blood glucose meter to monitor glucose levels and to determine the total amount of insulin and percentage split to cover the meal. I typically add 25-30% of total insulin to the bolus amount to account for the higher fat. For example, if my Bolus Wizard recommends for me to take six units to cover a high fat, high carbohydrate meal, I would add two units to the total, making it eight units.
When setting a Dual Wave bolus, take a blood glucose reading, and enter your current blood glucose level and grams of carbohydrates you are going to eat into the bolus wizard. Then, there are two decisions to make.
- What percentage do I want in the first wave of insulin vs. the square?
Your insulin pump’s default setting is a 50/50 split, meaning 50% of the insulin is delivered in the first bolus, and the remaining 50% of insulin is delivered in the square wave bolus. You may adjust your Dual Wave bolus split depending on your current glucose level and target range. For example, if your blood glucose is in target range, you may set your Dual Wave bolus to a 60/40 split, having 60% of insulin delivered in the first bolus, and the remaining 40% of insulin delivered in the square wave bolus. If your blood glucose is above target range, you may adjust the split to 70/30 or 80/20, so 70 or 80% of insulin is delivered in the first bolus, and the remaining 20 or 30% of insulin is delivered in the square wave bolus. Whatever setting you choose, the pump will automatically do the math for you.
- How much time do I want to spread this bolus over?
Typically you will set this between 2 and 4 hours. The heavier the meal, or the more fat that is in the meal, the longer you will set the time duration.
5. Separate the meal from the dessert.
Instead of eating in one large sum, eat your dessert separately from your meal. This will help to spread the carbohydrates out throughout the day. It is easier on your body and blood glucose if you eat several smaller meals, than to eat one large amount of carbohydrates at a time. And with pump therapy, it is easier to bolus again later for dessert than if using injection therapy.
Be sure to talk to your healthcare team before using a Dual Wave bolus so you can work together to find the best settings that work for you and your diabetes management.
For more holiday tips and seasonal stories, visit The LOOP Blog. Have any diabetes management meal time tips you’d like to share? We’d love to hear them in the comments below!
[For important safety information about Medtronic devices, please visit medtronicdiabetes.com/important-safety-information]