Care to settle an argument for me?

Question

Here's the scenario: You're at a restaurant, and you've just ordered a stromboli. Everyone knows the portions are always different wherever you go.
I say you take some insulin, 5-7 units while you wait to see how big the portion is, that way the insulin has the 15-20 minutes to work while the meal is cooking, and the initial high isn't as drastic.
My friend here says you wait to see the portion size before you take any insulin that way it's only one shot.

What do you say? Am I right? How do you usually handle this situation?

Well, yes, it's a given that you always shoot up BEFORE you eat. The argument, however, is whether you get a jump on the insulin before the meal gets there or do you wait to see the portion.

We've both been diabetic since we were six years old, so the fact isn't an issue, the question is about timing and technique.

Thanks though!

Answer 1

I select alternative #3. I check my sugar level and take my shot before I enter the restaurant. When the meal arrives I eat that portion that is allowed in my diet. If its one of those slow restaurants or a bad day, I eat one of the chocolates I have with me. I can't remember the last chocolate I ate and I have been doing this for 39 years. The only time I take extra insulin is Thanksgiving and Christmas, but on those occasions I only eat what my adjusted diet allows. I also love Italian foods the day after.

Answer 2

You are both right. Techically, giving your insulin some time to work *will* help reduce any spikes. Giving *some* insulin is not a bad idea *depending on the food and context*.

HOWEVER, the problem is that if you inject ANY fast acting before the meal is in front of you (even 15 minutes early), you could have a dangerous low blood sugar. If:

-The meal is late
-The meal is served with a creamy (fatty) sauce that slows down absorption.
-Some foods are low GI, which means they raise blood sugar slowly.
-Some people have a diabetic complication called gastroparesis, which can slow down digestion.
-Your blood sugar is already close to being in the low range.

Any or all of the above can cause serious low blood sugar if the new rapid acting analogues (i.e. Humalong, Novolog/Novorapid) are used before the meal is eaten.

Note that as a safety precaution, the makers of these insulins say this should never be done. But I think "never" is a questionable concept.

For instance, you might want to give a little insulin 15 minutes before you have something like chocolate milk or candy (assuming your blood sugar is not already on the lower end of normal).

But you would *never* want to do this when you are not in control of your food, like ordering at a restaurant. Especially if the food in not high GI (high glycemic).

Another thing to watch out for is bolusing (taking insulin for food) and then getting distracted forgeting to eat. This can be VERY dangerous, and is not likely to occur if you only take your insulin when your food is in front of you.

I think that "mini-bolusing" can be done *depending on the situation*, and is generally safer with a pump. With a pump, you can see how much insulin was given and when (how much is still in your system), you can give very small amounts, and you can turn down your basal rate if needed.

If you do choose to "mini-bolus", make sure you always have some fast acting sugar right in front of you if you need it.

Answer 3

Ive been a diabetic on insulin for 38 years.
I have had the same problem as you,given my insulin,then waited for my tea to arrive,and waited,and waited,eventually having a "hypo" and ruined my meal.Now I give myself my insulin as soon as I've eaten,that way I can alter it,depending on the meal size,if needed,and if the meal takes a long time to arrive,no hypo.
It works for me;0)

Answer 4

Go ahead and get some insulin on board!
Especially for a carb giant like stromboli.

Really, one thing we are seeing with the increased use continuous glucose monitors is how important it is to give the insulin before eating. This action alone can drastically improve A1c.

Answer 5

i would take it after you've seen the portion...unless you've been to that restuarant before and ordered stomboli before

i actually take my insulin after i'm done eating. my primary physican (who also happens to be type 1 like me) said that when u take it before then you have to eat everything you took for....what happens if you get full when you're only half done with your meal? you'd end up with 1 or 2 extra units that you dont need causing a low later.

Answer 6

My wife was a diabetic. When we went out to eat, she always took her insulin before we left home. Hope this helped you.

Answer 7

That all depends on the person who taken the shot, if you don't mind taken 2 shots if that be the case or if your one who only wants to do it once then wait. So your both right if you look at it both ways. Myself personally I wouldn't take a shot until after the fact.

Answer 8

An easier way would be to ask the waiter/waitress how big the portion is when you order.