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Tuesday, August 3, 2010

Pizza, Beer, and Bolusing

There are certain things that are tricky to bolus for, like anything including a lot of fat or an alcoholic drink.  Loads of fat slows down carb absorption so a delayed bolus is needed, and a drink acts to initially spike BG from the carbs in the drink but the alcohol lowers BG afterward.  Well, combine these two together and you've got a double tricky situation on your hands.  Enter:  pizza and beer. 

We've developed a trend over the last few weeks where we have a set of friends come over on Saturday night and we eat homemade pizza, drink whatever beer is brought by the guests (my favorite is anything Samuel Adams), and play a card game called Phase Ten.  To me, there's no better way to spend a Saturday night than this.  Everyone is talking and filling their bellies, and taking vengeance out on each other whenever someone makes a phase.  My cheeks usually are sore by the end of the night from laughing so much. 

The effect on my BGs, however, is not as nostalgic.  Usually, I like to do a dual bolus for pizza as follows:  3u/slice at 40% normal and 60% square over 3 hours.  Add in beer to this equation and it gets a little complicated.  I don't like to bolus at all for beer because it makes me go low later on, so the initial high correction would result in a lower low--not fun.  So, I'm content to "include" the beer in my pizza bolus even though it's not programmed as part of the carb intake. 

With Constance a part of my diabetes arsenal now, I've been able to spy with more detail what goes on during these fun nights.  I begin my dual bolus as soon as I put the pizza in the oven because it takes about 30 minutes to cook.  Then, when we sit down and start eating, my BG initially spikes from the beer and kind of hovers around my 180 mg/dL threshold for awhile and then it starts to drop about 2 hours later.  My square bolus continues to bring it down for one more hour, bringing me down to a normal number around bedtime. 

But about the time I am in a deep sleep from a full belly and a fun night, I wake up to BZZZZZZZZZZZZ!!!  This is about the time the delayed carbs from the pizza start to kick in, so there's another spike in BG, roughly 6 hours after I've eaten it!  I would have never known this without Constance.  I have heard of other diabetics bolusing for about 10% of their initial bolus after their active insulin is out of their system because of this spike.  Has anyone else ever done this before?  I just can't imagine setting an alarm to take another bolus in the middle of the night.  This would scream future low, to me.  But I certainly don't like spending the night correcting highs after I'm already exhausted. 

NOTE:  I realize this post may bring about some finger-wagging comments.  I know pizzas are high carb, and typically alcohols are no-nos for diabetics.  But I'm a big proponent of living as normal a life as possible.  Anything is possible for diabetics with the right about of preparation and research.  If you choose to abstain for pizza and alcohol, more power to you.  But I'd much rather know how to accomplish these challenges than run away from them. 


  1. Sam Adams is (one of) the best!

    My husband and I used to do Pizza Monday every week, just to make that day a little more tolerable. After 6 or 7 weeks, I finally figured out the carb count in one slice of white pizza and 2 beers.

    It just takes practice -- not finger-wagging!

  2. What about setting a temp basal before going to bed....or a couple hours after you've eaten and drank??? I've done this for high fat indian and mexican food. I've taken a dual wave bolus over 3 hours for the carbs, and then before bed I set a temp basal at 150% for a few hours. I have found that this has stopped the spike that happens while i'm sleeping and my CGM shows a pretty flat line in range. The ratios and what not you of coarse would have to play with. Best of luck to you and cheers to future pizza and beer nights

  3. Lindsay, I think I love you! What a brilliant idea, thanks! This is why I <3 the DOC! =)

  4. When I eat pizza (every Friday at my house!), I will do a combo bolus (25% up front, 75% over 5 hours) and then I will set the alarm to wake me about 9 hours later (after all the active insulin from the combo bolus is gone)and correct the inevitable high that I see. I learned (the hard way) that my normal correction factor is too much for the middle of the night but tweaking it works. The alcohol thing is something I'm too chicken to try but I applaud you for doing it and doing it safely!! If you have more tips on that, send 'em my way!!!

  5. I eat pizza all the time and MORE than my share of all kinds of beers. However, I've learned to stay away from Sam Adams because the carb count is much higher than other beers. I always assume a Sam Adams is a 20g. beer while a beer I've never tried I'll guess half that.. here's a good resource:

    I find that if I have a higher carb beer piled on top of the complications of pizza, it makes it harder to figure out, but if I enjoy my pizza with any of the awesome lower carb choices (Flying Dog, for example), it's all just a little simpler.


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DISCLAIMER: I am not a doctor, nurse, certified diabetes educator (CDE) or any medical professional of any kind. (But I did stay at a Holiday Inn Express!) Therefore, please do not use any of my postings as medical fact. I am simply a blogger expressing my highs and lows (pun intended) with diabetes. For changes in your medication, exercise regiment, or diet please consult a qualified physician.

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My name is Holly and I live in north Alabama with my hubby, two cats, and a dog.