Quick Quiz – Meal Matching for Insulin Users

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1. When a type one is eating in a restaurant it could be risky to do one of these…
a) Inject your regular insulin right after ordering.
b) Inject your rapid acting insulin right after ordering.
c) Ask for vegetables instead of potatoes or rice with the main course.
d) Tell the waiter you are diabetic and need food right away if you have been waiting for a time or feeling low.

2. For insulin dependent diabetics they should avoid large amounts of alcohol at one go because…
a) It will make them fat.
b) It causes acute peripheral neuropathy.
c) They will lose their inhibitions and eat sugary food too.
d) It can suppress gluconeogenesis and give severely low blood sugars.

  1. Type ones need to consider extra insulin when the protein portion to be eaten amounts to…

a) One pound of meat.

b)The size of a man’s palm.

c) The size of a woman’s palm.

d) The size of a boiled egg.

  1. Three of these methods can effectively cover protein for insulin users…

a) Using a single injection of rapid acting insulin such as novorapid/novolog or humalog.

b) Using a single injection of regular acting insulin such as Humulin S.

c) Using two insulin injection of rapid acting insulin separated by a length of time. (split bolus technique)

d) Using an extended bolus of rapid acting insulin in a pump.

  1. Ways of extending the length of time an insulin is active also helps to cover three of these foods such as…

a) Pizza

b) Lasagne

c) Mashed potatoes

d) Chicken korma.

  1. You are using rapid acting insulin to cover your meals. Which three of these techniques could be appropriate around mealtimes?

a) If your blood sugar was low you could take the appropriate amount of glucose and delay your meal till your blood sugar was back to normal….

b) If your blood sugar was low you could inject 15-30 mins after starting to eat.

c) If your blood sugar was on target you could inject 15-30 minutes before eating.

d) If your blood sugar was high you could inject 15-30 minutes before eating.

  1. You decide to have a high carbohydrate dessert to celebrate your birthday. What three measures could you take to minimise adverse effects on your blood sugars?

a) Eat it early enough in the day when you can exercise vigorously after eating and have plenty of time to check your sugars and correct accordingly.

b) Add a little more insulin than the carb count and your insulin sensitivity would suggest to compensate for the relative insulin resistance caused by high blood sugars.

c) Add lots of unsweetened heavy/double cream to the dessert to slow the blood sugar spike down.

d) Take the amount of insulin you think you will need but induce vomiting to prevent it digesting fully.

 

Have you got it?
1. B is unduly risky. Food tends to arrive 20-40 minutes after ordering and you may be putting yourself at risk of a hypo by injecting a rapid acting insulin too soon before the meal. The waiter is there to help you. Ask if you need anything done specially for you.

2. D is correct. Insulin users in particular should always be moderate about their drinking and eat slowly releasing carb or protein with drink to avoid delayed hypoglycaemia from alcohol. A and C apply to some extent too of course. Prolonged heavy drinking can cause peripheral neuropathy.

3. C is correct. This is around 3-4oz (apparently!) Other visual clues are the size of a deck of cards or a quarter pound burger.

4. BCD are correct. A single injection of rapid acting insulin will tend to spike too early and could give you a hypo soon after you start to eat. It will have stopped working before the protein has been digested so will give you higher sugars a few hours after the meal.

5. ABD are correct. These have a high fat/protein content and digest fairly slowly. Mashed potatoes on the other hand are converted to sugar very quickly.

6. BCD are correct. With high blood sugars you do need to bring them down for optimal control before eating. Otherwise you would be starting off a meal with a degree of insulin resistance which then tends to require a disproportionately high amount of insulin to sort out after the meal is eaten compared to the levels needed to reduce a high-ish blood sugar before the meal is eaten. You don’t need to correct for low blood sugars with glucose though. Just eat earlier and time your insulin a little later…

7. ABC are correct. High carb treats can be enjoyable. To eat them very sparingly will enhance the sense of specialness and need not damage your health. The problem of course is if you can’t stop once you start or you eat them too frequently. Some people are best to avoid them completely.

Vomiting to control your blood sugars, your weight or anything else is a very bad idea. It plays havoc with your teeth, blood sugars and metabolism.

Unfortunately diabetics have a higher rate of eating disorders such as bulimia and anorexia than the general population. Sometimes the pressure to be thin can feel so great that insulin injections can be missed so that the calories are passed as sugar in the urine. Life threatening complications such as diabetic ketoacidosis can result. Rapid development of complications such as proliferative retinopathy can appear in a fraction of the time they would with just “average” control.

If you think you could be developing an eating disorder please seek help from your doctor or diabetic clinic. You need expert psychological help and they can get this for you.