We try to live a healthy lifestyle. I watch what I eat. I am conscious of what I feed my family. It is the way I have always been—before and after diabetes.
My children are now adults with their own minds and their own tastes. They enjoy treats that cause my arteries to convulse in sympathy. My son, with type 1 diabetes, will also enjoy treats that have more sugar than some might think possible for a person with diabetes. He just deems them bolus-worthy and moves on.
Having type 1 diabetes means that he produces no insulin of his own. (Unlike someone with type 2 diabetes who often has some insulin production but the body is not using it properly) If he eats any food that has any caloric value, he must match that food with insulin. Sounds simple right? It isn’t.
Sometimes you will make a mistake and give too much or too little insulin for a meal.
He makes mistakes. When he does, his blood sugar levels will either spike really high or drop really low. If he is high, he will need more insulin. Should he drop low, he will have to find more fast-acting sugar to eat right away. Despite that fact, as we said, some foods are just bolus-worthy! They are worth the math and the work that goes into figuring out how much insulin he will need to enjoy them.
If you don’t have type 1 diabetes, you probably don’t think about this. The reality is that many people living with diabetes don’t either because it is part of their lives. As a mother of a child with diabetes, I do think about it.
He boluses without a second thought
One morning, many years ago, I was sitting at the table enjoying my morning coffee. My son had eaten his breakfast. I gave him the carb count for his meal and he bolused his insulin through his pump. As he got up from the table to put his dishes in the dishwasher, he spied the box of Timbits on the counter from the night before. His hand darted into the box and he popped a little morsel into his mouth. I yelled out to his back “Don’t forget to bolus for that!”
It hit me then…he could not just walk by and grab a snack. He had to give himself insulin for each piece of food that touched his lips. This wasn’t the first time that this fact had hit me but it broke my heart a little bit more.
As I said, for my child with diabetes it was such a natural act. He simply grabbed his insulin pump while grabbing his doughnut hole and bolused what he needed.
Living with diabetes isn’t just about figuring how many carbohydrates are in a doughnut hole and delivering some insulin. You must also consider things like fat, protein, physical health, stress level, and activity level.
Some meals are just bolus-worthy no matter how much thinking is involved
Now that my son is a young adult living on his own, his bolus-worthy treats now tend to involve fast food meals. He once sent me a picture of his meal and asked me to help him to figure out how much insulin he would need.
I asked him what his blood sugar level before his meal. He had been high and made a correction. We totaled up the carbohydrates in the meal. We then considered the high-fat content. Fat would mean that it would take longer for the carbohydrates to be used. We would need to prolong the delivery of the insulin rather than cover the entire meal right away.
After a bit of back and forth, we decided on the correct amount to cover the fat, the high, the protein, the activity level, and the carbohydrates in the food. Time and blood sugar checks would tell us if we made the right guesses or not.
When you live with diabetes, counting carbohydrates and all that goes with it is just part of your day. You don’t think a lot about it. For those of us who don’t have to watch every morsel that passes our lips, the process is awe-inspiring. Imagine if you had to decide if what you wanted to eat was worth the hassle and the thinking involved just to enjoy a treat?