Ever indulged in a weensy pizza pie with the kids operating theater Italian food on day of the month night, gone to bed at a perfectly respectable blood sugar, on the other hand woken prepared in the middle of the dark with a sky-high add up that has you racing for the john?

If you make, past you've encountered a dreaded delayed postprandial spike, which happens when food takes thirster than insulin to enter your system. Usually it's the other way around. Fast-acting insulin starts working in 10-15 proceedings, peaks at 1 to 2 hours, then slow tapers out. It's usually out of your organisation subsequently 4 to 5 hours. But in a a few special cases, the insulin finishes impermanent unsound before the bulk of your intellectual nourishment ever hits your system.

Typically this happens with high-carb meals that are also high in fat, like pizza, Chinese food, Mexican food, etc., because the fatten delays the impact of all those carbs on your blood glucose.  Sometimes symmetric tops high-carb meals, like some Italian dishes, which have a lot of carbs merely is low on the glycemic index, and perhaps not American Samoa much fat, can still take hours to digest. Accordant to endocrinologist Dr. Lauren Golden, that's because "the food essentially sits in a ball in your stomach. The more carbs you have, the longer it takes to digest." Dr. Golden and her team at the Naomi Berrie Diabetes Focus on recommend victimisation a then-known as "dual wafture bolus" for any meal with carbs over 70 grams.

Of all time heard of the dual wave? Medtronic has actually trademarked that full term…

The deal is that most neo insulin pumps now have an option for changing how a bolus is delivered to deal with this latent effect. They allow you to set a certain percentage of your total repast bolus to lean immediately, with the rest to be lento delivered over a period of time. In Medtronic pumps, it's named a two-fold wave bolus, and as noted, that company has unfree the market along that terminology.  So in Animas and Cozmo pumps, it's called a combo bolus, and in the OmniPod, information technology's called an extended bolus.

Despite unsurpassed intentions, using this scope is tricky. In person, I shamelessly use a regular meal bolus for everything low the sun. But I almost always suffer the consequences with a middle-of-the-night run to the lav when a sudden soar up of carbs hits my system that my insulin is no thirster prepared to handle. This is oft after slippy into bed with a low or almost-degraded blood kale because of besides much direct insulin.

Want to brush up on this technique?  Warning: it lav be very untrusty to know exactly how long some food bequeath take to absorb, so this is likely going to take quite bit of practice. Different high-fat, high-carb meals volition affect you other than. Primary recommendation is to try it patc victimization a continuous glucose monitor (CGM), eve if only temporarily, so that you behind literally ascertain what's happening with your BG in period. Many clinics now rich person CGMs that patients  can sound out as loaners for a week, so you can test out how you react to certain foods.

Kelley Champ Crumpler, a diabetes hold pedagog and type 1 herself, shares this choice morsel: "At the ADA Knowledge domain Sessions in 2009, I accompanied a public lecture discussing CGM, and some slides were shown connected extended bolusing. Of the T1s tiring CGM that ate pizza, many were still riveting the carbs (hence experiencing the glucose rising) after 8 HOURS!! What the frappuccino?! This was Same middle-opening. So for pizza, I have patients broaden their bolus for at least 6 hours to forestall this!"

What the frappuccino is right!

If you're just starting to search this hi-tech pumping technique, give the 60/40 dominate a try. Upfront, set your heart to deliver 60% of your bolus at the meal, with the remaining 40% existence delivered over the succeeding foursome hours. Some people might find that too lowercase, so you posterior also try out 70/30 or 80/20, depending on how what you're eating. But father't reasonable ride information technology verboten — you have to fine-tune with rafts of testing. Kelley recommends checking all 30-60 minutes when testing the split-bolus method acting.

"An sashay of 30-50 mg/deciliter is acceptable," Kelley says, "But a rise of greater than 2 mg/deciliter per minute is besides fast, and I would consider more insulin."

Another advanced pumping tool I've been looking into is the conventional wave or extended bolus (once again, the name depends on your pump company). Less common than the dual moving ridge, it's a incessant drop of your bolus insulin over a period of time, with no upfront insulin given. Since at least whatsoever food hits the system at once, this doesn't work for a good deal of scenarios. However, holiday parties (which are just around the corner — November is incoming week, ya know!) are a perfect opportunity to utilize this manoeuvre.

"The square fla bolus is good for a cocktail political party, skimming, or if you volition be eating a unceasing amount of food over a period of time, care popcorn for 1+ hours at a picture," says Carolean Bohl, CDE and registered dietician at the Naomi Berrie Diabetes Kernel.

Of course, just because you're not on an insulin pump doesn't necessarily mean you're non still facing this problem. If you're using multiple every day injections with Lantus surgery Levemir, you can still partake extending your insulin action. Gary Scheiner, type 1 PWD and famous CDE at Joint Diabetes Services, recommends using one of the following options:

  1. Pick out the repast dose after eating
  2. Split the meal dose into two parts: one-half before eating, half after eating
  3. Bring down Regular (R) or else of a rapid linear insulin

Mastering the dual wave bolus looks care it could be aggravating… Good thing there are many ways to treat heavy carb/fat-laden meals, with the dual flourish being just one of them. Some folks use a temporary basal rate to handle sneaky spikes. Personally, I'm non sure a four-hour dual wave does some for pizza. Then there are times where I seem to fortify no more matter how much insulin I give or how much I extend!

But Kelley has some language of wisdom: "Diabetes is like a fingerprint, indeed different for all of USA. What works for me won't work for you, or for my hubby [also a PWD]. A lot of advanced pumping is trial and error, so if it doesn't do work the world-class time, don't get frustrated.  Scarcely make adjustments the next time! You are in an even better set up if you have, and fag, a CGM, as you volition recognise immediately if something isn't working."

Although pizza and North American nation food are not on my weak menu, they are foods I enjoy and Don River't want to apply raised for good — just sure as heck don't want to support the late-Nox wake-up calls either! Assuming you featherbed all once in awhile, how do you handle the ramifications from high-carb meals? Are you pro-active with your bolus settings or practise you just "ride the highs"?