Miscalculating Carbs

March 10, 2014By 1 Comment

 

japan-plastic-foodWe’ve all done it.  Your stomach is grumbling as you patiently stand in line at maybe a Starbucks or Chipotle or any given grab-and-go shop.  You scan the food display case, the menu and the other diners’ plates as they walk by.  You decide on your meal of choice, estimate the carbs and take a bolus while you anxiously move to the front of the line.  But then you order and forget to actually order out loud the items you were salivating over in your brain.  You realize after your done scarfing down your meal and as you hurry back to work that you probably took way to much insulin for what you actually ate.  Oh crap, now you have to find room in your stuffed belly for more carbs/fast acting sugar.  And now your late getting back to work.

I will absolutely never forget one night at diabetes camp, when I was about 10 years old.  My counselor woke me up in the middle of the night and told me to grab my pillow and follow her to the infirmary.  As if I were in a dream or on the movie set of Willy Wonka and the Chocolate Factory, they had me sit in the infirmary office and brought me a tray with donuts, ice cream, cookies and pudding.  I quickly rubbed my eyes to clearly see what was in front of me.  The nurse then told me they were reviewing the charts and noticed I was given too much insulin at bed time.  Before I could dig in, they had me check my blood sugar to confirm what they all assumed would be very low.  I was 260.  I corrected with an injection in my leg, waved good by to my tempting treats and was sent back to my cabin.  Are you serious!!

There’s miscalculating carbs, misjudging the amount of food your going to consume, or being given false estimates on the amount of carbs in an item.  How is a person with diabetes supposed to do their job then?

Over the weekend, I had the pleasure of being one of the speakers at the Boston JDRF T1D Symposium.  I thought it was so cool that at lunch, they had the carb content listed for the food items available.  This only made sense given that there was a room full of diabetics there.  I am unclear as to who calculated these carb amount, whether it was the convention center kitchen or an actual dietitian, I’m not sure.  In the middle of the meal, one of the attendees/speakers who was also an endocrinologist came up to the podium to announce that the mini cupcakes which were listed to have 67 grams of carb in them did indeed NOT have that many carbohydrates. She chuckled and told parents to give their kids another cupcake if they had already bloused.  While this was a fun idea for the kids, to get to eat another cupcakes and help prevent a severe low blood sugar, what is a parent of a child with diabetes or an adult with diabetes supposed to do in every-day life if they’ve accidently taken too much insulin?

Here are some tips:

  • As soon as you know you have over-bolused, check your blood sugar to see where it is at and either consume some juice or other fast acting sugar if it is low or just wait if it is normal or high.  Wait about 15 minutes and check again.  If it has dropped, it may be a good idea to treat with some fast acting sugar.  There really is no hard and fast rules here.  You just need to check your blood sugar more frequently over the next couple of hours to see what it is doing and act accordingly.  It is funny how sometimes even though you know you have over-bolused, you never actually end up having a low blood sugar reaction.  This may be because you had more fat in your meal then you realized which will help keep you blood sugars higher for a longer period of time until the insulin has worn off.
  • Consider putting on a reduced temporary basal rate on your pump.  Consult with your doctor or CDE for what this might look like, i.e. possibly bump it down to 80% for a 2 hour period depending on how much you over bloused.
  • If diabetes is new to you, it’s not a bad idea to call your nurse practitioner to get her thoughts on what you should do in this situation.  Don’t panic, just check your blood sugar often, about every 15 minutes.
  • Keep track: Write down in your diabetes notebook what you think happened.  Did you overestimate carbs?  Did you accidentally put in too many carbs in your pump?  I have even seen  people make the mistake of putting their blood sugar on the screen that asks for carb amount on the pump, resulting in a huge over-bolus.  A blood sugar of 180 and 180 grams of carb is a HUGE difference when it comes to your pump determining your correction dose.
  • If you are on injections, same goes for you as far as just checking your BG’s more frequently.
  • As far as choosing what to eat when you have determined you have over-bolused, try not to get out of control and binge on everything in site.  Consider that you will probably just need either fast acting sugar if you are already low at the time of realizing you have over-bolused, or, a snack that has some fat in it, like peanut butter crackers if you are not currently low but anticipate dropping over the next hour or so.
  • If you believe that the carb content on a restaurant menu or a website is false, do some research.  Reach out to the manager and ask them what company they use, software or person to determine the carb content of any homemade meals.  The larger restaurant chains do use sophisticated nutrition software and professionals, so your less likely to see mistakes there, but the smaller locally owned places may just use estimates.

Sometimes we just can’t avoid or predict what our food or our insulin is going to do to us.  There are a lot of extraneous factors such as illness, physical activity and length of time someone takes to consumes a meal that can play a role.  Worst case scenario, you get a ‘get out of jail’ free card and you can happily treat yourself to a second mini cupcake.

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  1. Danielle says:

    Thanks for writing this article Regina! I hate when this happens to me, a frustrating time this happens is when I have decided a sweet treat is ‘insulin worthy’ , pre-bolus, and then get to the front of the line and they are ALL OUT! Now i have to order something, that i am not as interested in eating, just because i already bolused, UGH.

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