Best Tips for Bolusing Abroad

Okay, I’m by no means an expert at this. But I do have some experience under my belt to give a few tips that might help you out. We all know that with diabetes doing the same thing twice doesn’t always work. But over our past few years of travel, I have noticed some trends and find some things more successful than others.

Reading Nutrition Labels

First of all, counting carbs in Europe and other countries is very different than in the US. In the US, the food label shows the nutrition facts per serving or per package. In Europe, almost everything is shown per 100 grams. The first time I read a European nutrition label it was for a little snack bag of chips and it said carbohydrates: 80 g. I was like, NO WAY. And then I realized that it was measured per 100 grams, and that the package was only 20 g, so really, the package of chips only had 16 carbs. So you have to math a little bit more over there.

Image result for nutella nutrition france
Here’s a French Nutella bottle label. On this one it has per portion, but a lot of them don’t so you have to
calculate it out yourself.

Different Languages

If you’ve been diabetic for a minute, I’m sure you know how to read a regular nutrition fact label, so even if it’s in a different language, you can kind of get an idea of which words mean carbohydrates, fat, sugars, etc. based on their location and their values. Here’s a short list of carbohydrate in a few different languages for your reference and entertainment:

  • French = glucides
  • German = kohlenhydrat
  • Spanish = carbohidrato
  • Dutch = koolhydraat
  • Icelandic = kolventi

If you’re not sure which nutritional value is which, you can use Google translate to take a photo of the label and highlight the words to see what they mean. Make sure it makes sense though, because we’ve seen instructions for instant coffee interpreted as “lick the coffee” and an ingredient in yogurt to be “shrimp,” so it’s not a perfect system.

Bolusing for Pastries

Alright. This one, I think I’ve pretty much mastered. (Ish.) What does that say about how many pastries I eat on vacation? 🙂 The biggest thing to take into consideration when bolusing for pastries, is how much fat they have, which will make a difference in how you bolus. Something high in just sugar, like crepes or macarons, you should be able to successfully do a regular insulin dose for. But something high in carbs AND fat, will cause your blood sugar to spike later, because fatty things have a delayed absorption in the body. So things like croissants, turnovers, pastries filled with nutella (yummmmm), and pretty much anything made with puff pastry dough would fall into this category.

What I kept trying (which didn’t work well), is that I would bolus for the large amount of carbs, spike a little high at first, end up going low, treat the low blood sugar, then go high 2-3 hours later. This makes sense, because the insulin works way faster than the delayed absorption of the pastry.

I used paint on the computer make this very non-scientific graph based on anecdotal experience so you can get an idea of how the insulin and the pastry are working in your body.

You can see that the insulin and croissant definitely don’t match. The most success I’ve had with bolusing for croissants is when I extend my insulin. So, instead of giving all of the insulin up front, I give some before eating the pastry, then I give more later. Either way, I recommend doing your initial dose of insulin as a pre-bolus, or about 15-20 minutes early since it takes a little bit of time to start to work.

If you’re on an insulin pump, you can do the extended with a dual wave bolus. It will allow you to choose a percentage of insulin to give NOW, a percentage of insulin to give LATER and a time of how long you want the delayed insulin to be given over. I would recommend 60-75% now, and 40-35% later over maybe 2 or 3 hours. You’ll have to play around with this depending on how your body processes the food and insulin. Oh darn, gotta eat lots of pastries to experiment! 🙂 The nice thing about using the extended bolus feature, is that if your blood sugar goes low or starts to go low, you can turn it off and not give the rest of that insulin.

On our recent trip to Paris, being on injections presented a whole new challenge, because I relied on this extended bolus feature a lot when I use my pump and eat pastries. I found a work around: inject twice. I would still pre-bolus about 20 minutes before eating giving about 75% of the insulin I would need, but then inject the rest about 1.5 hours after eating. It seemed to work pretty well!

One final note: I know that it’s tempting to use yummy treats to treat low blood sugars instead of something fast acting, but I wouldn’t recommend it. Especially if it’s a fatty yummy delicious pastry. It ends up taking FOREVER to bring your blood sugar up, and then kicks in later, causing a spike and is very hard to manage. At least in my experience. (Psst, if you figure out a secret way, please tell me!)

Treating a low with Craisins at the Eiffel Tower.

Good luck with all of your bolusing abroad. If you have experiences different than mine, or any other tips, I’d love to hear them!

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