The Accidental Bolus


I celebrated my 42nd birthday yesterday. I don’t usually like birthdays, at least not my own, but this one was low key and quite pleasant. Celebrations started the night before, when Jessica and I went out to dinner for the first time since her birthday eight months ago.  My birthday morning started a little later than most running days. I let myself sleep in until 5:00am and went running with a friend at 6:00am. We ran eight miles at a comfortable pace and I was back home by 7:30am.

The rest of the day was uneventful except for a few birthday emails, texts and phone calls. I don’t know why but I wasn’t reflective or depressed this year as I usually am on my birthdays.

PizzaWhen it came time to decide about dinner Jessica suggested I give myself a break “Let’s order pizza,” she said.   “It’s been so long.”

I hesitated. It has been more than a year since I went paleo, and gave up dairy, grains and potatoes.  And much longer since I’d eaten pizza or any carb based meal.

“I won’t try to talk you into it,” Jessica said, “but I think you deserve it.”

It didn’t take much convincing.  We ordered pizza from a good place which makes very thin crust brick oven pizza. Shortly before the pizza arrived my mother came over with a very good bottle of wine to make the evening perfect. When the pizza arrived I checked my blood sugar (97). Before bolusing, I tried to estimate how many grams of carbs I was going to eat. I had no idea. I estimated 100 grams of carb in the few slices I intended to eat. But Jessica said “no way maybe 60.” I compromised and punched 80grams into my bolus wizard. (Thanks Medtronic, I love this feature.)

I ate the pizza and enjoyed it so much. I had forgotten how much I like it (love it). The whole meal was great – just pizza, salad and a fantastic bottle of wine. It was a perfect birthday dinner and I‘m happy Jess suggested it. When it was all over, and hour and a half after I bolused, my blood sugar was 191. I took a correction bolus.  At 11:30 p.m., my blood sugar was 264. I was a little surprised but decide to correct it again using the bolus wizard and went to sleep.

When the alarm went off at 4:01 I was dazed. The late night of wine and pizza had taken its toll and I had to drag myself out of bed. I imagine that had I not agreed to meet up with some friends for a serious six mile tempo run, I would have just taken a day off.

I checked my blood sugar (181), got dressed and had some coffee. At 4:30am my blood sugar was 166. As I always do, I plugged the number into my pump but instead of cancelling the bolus, I accidentally took 1.3 units of insulin. The second I did it, I realized what I’d done.   But tired as I was, I didn’t even think of disconnecting.   Instead I just said “shit” out loud and ate a handful of grapes.

At 5:30am despite the accidental bolus, I was a perfect 140. We started to run at a slow pace. I felt sluggish and tired which I thought was a very normal state to be in after sleeping four-and-a-half hours and eating pizza and drinking wine. But after a mile-and-a-half warm up I checked my blood sugar. It was 61. I took a gel and continued to run, delaying starting the 6 mile tempo run for a few more minutes. A half mile later I tested again.  This time I knew I was low. I could feel it.  I had no energy and was weak. My blood sugar was 49. I took another gel, said goodbye to my friends and started to walk back towards my car. I tried to run a little more but just couldn’t.

Walking back I thought to myself, this is why I don’t eat pizza anymore.

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Scott K. Johnson
11 years ago

Sounds like your birthday was a mixed bag!  Yay for the good – boo for the accidental bolus.  Isn’t it crazy how something that seems so little, taking that little bit of insulin, can mess up your routine so much? 
And it’s a hard balance to find.  If my blood sugar is too high before I play basketball, I feel like crap and my performance sucks.  But if I take just a *tiny* bit too much to bring it down, then I crash hard, and can’t play because I’m low.  We’re so dang finicky sometimes! :-)

Jane Kokernak
11 years ago

I wouldn’t be surprised if the wine contributed to the low BG and compounded the effect of exercise on your BG the next morning. I first learned about alcohol’s temporary effect on BG (it usually causes lows) at a patient education program at the Joslin Diabetes Center a few years ago. You might try doing a Google search for alcohol, Type 1 diabetes, and hypoglycemia. And like Matt T., I am a frequent user of the square wave bolus on the pump, when indulging in high-fat foods or even high-fiber ones. I want to spread out my bolus whenever I… Read more »

11 years ago

Happy Birthday, Michael! I’m a T1 who just turned 43. I agree with Matt and when I partake of the “doughy disk” (rarely) I dual square for at least an hour usually moving 50% out. It helps, but not completely. Pizza, white rice, and pasta get me every time.

Elizabeth Snouffer
11 years ago

Michael,  Happy birthday!  Sorry it was so tough. Your story is familiar and is also why I have eliminated pizza and other high carb foods for the most part, which is not something I believe every T1 has to do (do they know how lucky they are?).  I make up for it by ordering or preparing salads with mozzarella (di bufala), rocket, tomatoes, and a little pesto (or just olive oil) and all those tastes collapse my pizza desire!  Then again, I love salads – so I never feel cheated.  I am so sorry you had such a terrible night,… Read more »

Catherine Price
11 years ago

No. I just bolused regularly. I don’t usually eat this kind of food.

Matt M.
Matt M.
11 years ago

Did you use a square for the pizza, in addition to an initial bolus? I find that taking about 25% of my calculated bolus for pizza (or burger and fries), and spreading that portion over about 3 hours helps a huge amount with post-fatty-meal glucose rise.

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