Oh let’s talk about pigging out today shall we? Ok good.
It’s a few months now since the Fembot became a permanent fixture on my being after ditching the injections in favour of the Omnipod pump. After getting to grips with how it all works on the most basic level, for the most part my insulin-punctuated life has carried on much the same – testing, dosing, prescriptions, hypos (although noticeably less), frustrations, elations, constant surprises on behalf of my body and its torrent of hormones that continue to defy my logic and emotional rationale.
For the last month or so, now that my body is no longer wondering what on earth is going on with this new foreign object that’s attached itself, I’ve been exploring the more intricate diabetes management life on the pod offers. After 18 years on injections, I’d got to the point where we were pretty sussed; apart from the odd unsightly bruise, me and my Novopen were pals for the most part. It was good control but it was vague in its approach – a guesstimate here, a little correction dose there, and my body responded in kind. The pump however, is a precise piece of equipment that likes to deal in the minute – an increment of 0.2 delayed by 30 minutes to run over the next four hours to the nth percentile. Once the basics of pump basal and bolus were solid and ticking along fairly merrily (after a bit of a tricky time when it came to tackling meals initially), the space in my brain dedicated to the diabetic part of being me has been freed somewhat to explore these more subtle tweaks, allowing me to have more stability than ever before. That’s nice isn’t it?
I was intrigued to test this out with the most gluttonous of Sunday lunches last week. I’m a fairly healthy human for the most part, but when I give in, foodwise, it’s serious business. What better situation to test the more complex intricacies of my Fembot’s capabilities than a traditional roast, which for many non-type 1s is just a glorious feast, nostalgic of home and reeking of relaxation. For me however, this type of food indulgence is an absolute minefield. Christmas was entirely hazardous – runs on both Christmas and Boxing Day morning couldn’t keep me out of the high teens for the majority. I was interested to see if me (and my body) had got more of a handle on things and if not, well I was entirely willing to suffer the consequences for two hours of culinary GORGEousness (geddit?) offered by the delightful people at The Ginger Pig in Brighton. Pig is right. I was ready and wearing my loosest jersey dress.
Myself and Ian had popped to Brighton for a little escape and some sea air on the Friday. Two days of glorious and not entirely unhealthy food (think local produce, sharing plates, NOMNESS) had been navigated without serious injury, helped along by an increased effort in the gym over the previous couple of weeks. My body was ticking along nicely and handling all the tapas I was gleefully throwing at it.
So upon sitting down at the Ginger Pig and perusing the menu, my eyes widened. This was serious Sunday business. We’d accidentally on purpose slept in and missed breakfast, having eaten late the night before and being fully aware of the fats and carbohydrates that were imminently upon us. Testing before I ordered told me that my bloods were at 5.1. Lovely.
I couldn’t come to such a lovely pub/restaurant like The Ginger Pig and worry about making the ‘healthy’ choice – life is for living. I opted for a starter of cured duck ham, then we went the whole hog (hello pun) and chose the sharing main – two types of lamb (I was a veggie once!), roast potatoes, cauliflower cheese, kale, gravy… you know, the full works. AKA heaven.
After I’d ordered and kinda sorta had an idea of what I was about to consume, I knew the way forward was a split bolus dose. This is something that I never really needed to explore fully on MDI – I’d tend to just inject and then eat, potentially checking an hour or so later incase I’d got it all a little wrong. But since switching to the Fembot, the delayed sugar spike that results from eating a combination of fats with carbs has been hugely pronounced – I can now be hypo straight after a big dinner only to shoot up into the high teens a couple of hours later. This is an entirely unpleasant experience and one I was keen to avoid here.
So I diligently figured out that most of the carbs would come later in the meal. I decided, with Ian’s reassurance, to bolus for 50g carbohydrates, not being entirely sure of what my starter would consist of, nor how many roast potatoes I would devour subsequently (read: have the opportunity to devour before Ian stole the remainder). I chose a 40-60% split, delayed by an hour. The precise nature of the doses on pump is still blowing my mind a bit – with injections the closest I would ever get is a 0.5 unit dose, and that’s without accounting for me not quite injecting right, removing the needle too quickly, etc. You know with the pump that you are getting EXACTLY that 3.05 units direct into your system.
Behold, starter. Oh it was a dream. And not too heavy. But wait, there’s more… so much more…
And here is the real deal. Proportion of potato to my hand should give you some idea.
We went in. I’ve definitely had bigger meals in my life, but I didn’t need a bite more. It was an outrageous roast by anyone’s standards.
One hour post-bolus and I was 8.1, just as the suspended 60% was ready to roll. I was feeling good. And full.
Then – dessert.
We rarely eat pudding, mostly because we’re embroiled in an intense savoury love affair. But again, it was a special occasion (Sunday’s count under ‘special’, right?) and when in Rome…
Oh hello, apple and rhubarb crumble.
This is the ultimate in nostalgia for me – I had both a cooking apple tree and a rhubarb plant in the back garden when I was a kid. Our freezer would be stocked for the year with bags of sliced apples, and Mum’s sharp apple sauce was one of my favourite parts of the Sunday roast.
It had to be done. And so it was done.
I waited until the pud came (so I could assess its size!) and tested again – 8.1. I bolused an additional 2.3 units, which was less than I needed to cover the pud, but I knew I would suffer if I bolused too quickly as the remaining 60% of the initial dose had just entered my system. What can I say, it’s a complicated relationship guys.
Oh hello, heavenly, red wine, delicious food and wonderful company induced state of haze. That’s the real triple threat right there guys.
By the time we were on the train back to London (having nearly lost the taxi door to the brutal storm that had took hold while we were obliviously tuck away in our cosy corner of greed), my blood sugars had started to climb – I’d hit 11. It was tiny bolus PLUS temp basal time, knowing from previous experience that if I did nothing I would hit the high teens and stay there. Two units plus a temp basal of +50% over three hours, please and thank you. Sounds a lot but that was an increase from 0.5 units/hour of basal to 0.75 units/hour of basal. Hardly major doses. I still don’t quite believe that such tiny doses can have any effect whatsoever, but they do. Boggled.
An hour and a half later, back in the warm and dry in London, and I tested at 8.6. I couldn’t *quite* believe that for all that food I hadn’t hit the teens. I eat a lot, but I eat very very well and this kind of food is all but coma-inducing for me. Somehow I was, thus far, coming out of this feast unscathed.
I bolused a small amount as we decided to snack a little on veggies and hoummus – neither of us had room for actual food – and by bed time I was 4.9. PERFECTION. This might sound a little low to go to bed on, but it’s a case of me knowing my body and knowing that I often get a blood sugar spike the night after an indulgent day. We both slipped into a beached whale kinda sleep. And I survived! 9.2 the following morning was entirely acceptable thankyouverymuch.
So there we go. It may all seem a bit of a breeze, and to be honest I surprised myself here. I’m putting it down to fluke this time, but I know I made some – gasp – educated decisions. I also know, wholly and undoubtedly, that if I ate like that every day I would need a lot more insulin to cope. I also know that if I hadn’t been kicking serious ass in the gym that week, I also wouldn’t have coped quite as well. This disease is an absolute mathematics minefield, but if you know you’re going to eat like this and splurge (as you absolutely bloody should), there are things you can do help yourself. I wouldn’t want to eat like that every day because I’d be asleep 80% of the time if I did. But it was an entirely perfect, glorious and gluttonous Sunday feast. Three courses – sugar, fats and carbs. And they say type 1s can’t eat stuff.
And if you’re ever in Brighton on a weekend and are after something a little bit special, I urge you to check out The Ginger Pig. It was relaxed, busy, yet entirely special. It felt like an occasion and had we not had a train to catch, I could have spent the entire day holed away out of the rain. Just make sure you book – the deliciousness here is no secret. Well done piggies, well done.
How do you cope with heavy meals like this? As I said, split boluses are a fairly new thing in my life – any other hacks much appreciated, as I’m quite partial to a roast potato or two…