Can you help me figure out why I am having low blood sugars after eating doughnuts?

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Can you help me figure out why I am having low blood sugars after eating doughnuts?

Question:

Hi!  I am hoping you can help me figure out how to best bolus for a Krispy Kreme doughnut.  It's one of those "delicacies" I was shunned from when first diagnosed. But the advent of insulin pump and other technologies changed the thinking about this kind of "total avoidance" of sweets.  Granted, I don't eat doughnuts often. But, I have noticed that when I do, I always have a low blood sugar not long after eating (sometimes VERY low!).

Thanks,

Brandy

Answer:

Brandy--

I'd like to provide some personal history to shed some light on your situation.  I was 8 years old when I was diagnosed with diabetes and it was a very long time ago (1968). Every morning that I can remember before going to the hospital my mom gave me a brown sugar cinnamon pop tart with a large amount of melted butter on top. I loved that food.Well, upon returning home from the hospital and beginning my new life with Type 1 diabetes, there would be no more brown sugar cinnamon pop tarts. Instead, I was allowed to have an egg, 2 pieces of toast, a glass (small) of orange juice, and a cup of milk. That was the first of many disappointments in my new life.

When my family travelled to see my grandmother, we stopped by the Krispy Kreme shop on the way home. I had to smell those doughnuts all the way home not allowed to have one while my sisters and brothers ate them. That was how life was back then and pretty much remained that way until after the DCCT. If I wanted those “sweet delicacies”, I would sneak them and back then we didn’t do blood sugar testing and I only took one shot a day so gosh-only-knows what my blood sugars were doing. After the results of the DCCT were presented at the ADA meeting in 1993, diabetes management drastically changed for the better. The possibility that we could have those evil sweet foods became a reality if we took the adequate amount of insulin.

I started giving presentations in 1995 about carbohydrate counting and how to take your insulin based upon an insulin-to-carbohydrate ratio. I bought a box of brown sugar cinnamon pop tarts and made a slide of it as well as the nutrition information. This was how I started my presentations on carbohydrate counting and for the first time since 1968, I had a brown sugar cinnamon pop tart with melted butter. At the time, it seemed a lot smaller than what I remembered! But I took my insulin based upon the 27 grams of carbohydrate in that pop tart and waited to see what my blood sugar did. The carb counting and my insulin to carb ratio worked! Yea! Brandy’s experience with her Krispy Keme doughnut was a little different. I have 2 thoughts on this. The first goes back to something I alluded to in another question about every individual’s glycemic index. What I mean by that is that I believe that some foods may make my blood sugar rise higher than they make my friends blood sugar. Why? I don’t know except that we are each individuals and our bodies are different. For example, I have to take insulin for peanuts while some people do not but I have learned that each small handful requires 0.5 units The other possible explanation for Brandy’s experience is the fat content in the Krispy Kreme. A KK doughnut has 22 grams of carbohydrate and 12 grams of fat and 200 calories. If she took her insulin guessing that she needed a little more because of the glaze on the doughnut and took it all before eating the doughnut, that may explain the crash right after eating when what she may have needed to do was take insulin for the 22 grams but throw in a little extra extended out over an hour or two. Fat takes a little longer to get digested and some people need insulin for fat. For pump users, you can use your extended or square wave bolus. My other question would be also in this particular case, how did she treat her low blood sugar and did she overtreat by eating too many carbs?

The idea to get out of all of this is that there truly is no forbidden food but just the challenge of figuring out (if you have type 1) how much insulin you need and how does it need to be delivered. Keep in mind that everyone may have their own glycemic index and that high fat foods may wreak havoc and require creative insulin adjustment but know that it can be done!! FOOD Glorious FOOD!!