It’s Complicated

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English: A pizza from the oven. Français : Une...

(Photo credit: Wikipedia)

Nothing beats a fresh slice of pizza.  Pizza combines all of my favorite things: crusty bread, spicy tomato sauce, loads of veggies and meat,  melted cheese.

But since pizza is not only full of carbs but also literally dripping with fat, eating a slice has gotten…complicated.

A large amount of fat in a dish delays its effect on blood sugar. A slice of pizza may have 40 carbs, but if I take a dose for 40 carbs immediately before eating I’ll end up going low. In fact, once I went low while eating a pizza crust. I’m still trying to figure that one out.

A few hours later, however, my blood sugar will start to climb as the rich, carby goodness I consumed finally hits my blood stream. While on injections, the only thing I could do was split my insulin dose in half and take two shots. (Ew.) My insulin pump has a more elegant solution: the combo bolus.

A combo bolus allows me to split an insulin dose in order to obviate the effects of high-fat, high-carb foods. I can take a little insulin up front, right before eating, and stretch out the rest in mini-doses over the course of a few hours. But a combo bolus is a bit…complicated.

First, I have to decide how much insulin to take up front. Do I take half of the dose? 60%? 40%? It’s different for each food. I can determine if  I took the right amount up front by checking my blood sugar two hours after eating. If I went up about 30 points, I’m golden. If I went up more than that, I needed more insulin to start. If I went up less, I took too much insulin. Of course, this assumes that carb counts for the slice were accurate. If I get twitchy about how a pizza is cut, that’s why. If I start rifling through your trash looking for the pizza box so I can figure out the circumference of the pizza, that’s why.

But the initial dose is only half the battle. I then need to determine how long I should stretch out the rest of the dose. Two hours? Three hours? If I don’t stretch out the dose long enough, I could end up going low and then going high a few hours later. Stretch it out too long and I could be high for a few hours and then go low. And then there are the times when, without thinking, I correct a high blood sugar while a combo bolus is still active and then I go low just as I’m about to go to sleep.

The biggest struggle? Once I finally figure out how to time the perfect combo bolus for a slice of pizza I HAVE TO REMEMBER IT. This fact frustrates me the most, since I figured out how to dose for a slice of pizza over the summer and cannot for the life of me remember how I did it.

If I opt for the salad at your party, it’s not that I’m a health nut. Pizza is just too complicated.

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About Nel

As a graduate education student, I've come to the conclusion that teaching requires an addiction to caffeine. My favorite caffeinated beverages are coffee, tea, and diet Coke. And when I was diagnosed with Type 1 diabetes in January 2012, I also came to the conclusion that living requires insulin. I blog about my busy life juggling graduate education courses, a teaching assistantship in my University's English department, and my recent type 1 diabetes diagnosis the The Clumsy Juggler. I do not live in New York City.

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