How to eat out

General
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Full confession here. I used to eat out all the time and while I wasn’t wearing a cgm I never noticed how high my sugars actually spike from it and when I would test 6 or so hours later I’d always be in range so I never thought there was a problem. Now that I’m eating cleaner and wear a cgm I notice it big time. I’ve tried simple hacks but sometimes I want to be able to be lazy after eating some French fries but also not go to 250-300. What has sort of worked is if I eat something out, I take a small walk after and it helps stop the original spike and then I usually elevate some more take another small walk and then I usually land level. Occasionally I will still take a small correction at two hours.

Does anyone have any tips on how to eat out successfully without having a huge spike? I feel like I’ve developed this phobia of carbs (especially carbs deemed “bad”) but every now and then I want ice cream and to not feel bad for wanting ice cream or like I have to workout to enjoy it on the rare occasion I do.

When I eat at home I do prebolus 15 minutes before which has helped tremendously lower spikes but it’s definitely hard to do at a restaurant.

Thanks so much!

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Oh yeah Taylor @Tee25 very simple. Eat blahhhhhh! and probably destroy the very reason you chose to go to a restaurant where you could enjoy different tastes from what you usually prepare. When I suggest we eat out, oh, I long for that pre-pandemic time, it is for a change of scenery, save my wife from preparing one of her really good meals, and for a time to relax and try different foods - carb-counts often not obvious. What helps is I’ve told myself not to feel guilty knowing that I can always correct for carb undercount - made especially easy with the CGM.

A little background first. My usual at-home supper has a carb count ranging from 50 to [occasionally] 80 grams depending on the starch; consists of a main-meal, 8 oz milk, and cut-fresh fruit for desert. At our common eating establishments our sitting begins with a shared intense carb appetizer with wine to sip followed by whatever fits my fancy for an entre - very rarely have desert. I manage insulin by multiple infusion through my pump, often taking a bolus for the appetizer before it arrives at our table. When the main course arrives, I take another bolus just to cover the food carbs - I’m careful bot to include any correction the pomp may suggest due to rising BGL attributed to the appetizer. Two hours after leaving I’ll decide if I need more insulin - I often wait to make a correction for 4 hours.

Experience at often-visited establishments has helped me manage insulin better - sometimes. For instance, one of the appetizers we share is “pub pretzels with heavy cheese dip” - lots of fats with delayed glucose action. My tip here is to take insulin to count for ALL carbs up-front, and deal with the delayed BG rise by adding something to the maim-meal carb count and using an extend pump bolus. Bottom line, we go out to eat for enjoyment, I accept that my BGL may take an excursion - nut I remain cautious and get myself back in-line.

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I’ve got a similar view. I keep my meal size as close to normal as possible, but I don’t hold back from enjoying myself.

A guide (for instance, Calorie King, which is available as a website, a pocket-sized print book, an app, etc.) can help you find the right carb count for what you’re ordering. Although I’ve got issues with carb counting. It oversimplifies things, not just lumping together simple sugar with complex carbs but completely ignoring the calories from fat and protein. That may be part of the issue you’re having.

All our bodies are different. We have different insulin sensitivities, metabolisms, etc. It may take some trial and error to see what works for you.

If taking a pre-bolus helps at home, you can do that at a restaurant, too. If you’re using a pump, you can even just bolus with every course. (Works great at dim sum, where you can assume most items are ~5g of carbs each and just take small boluses as you go.) If you pre-bolus and end up eating more than expected, you can take a little more. Exercise can help burn it off, too, as you said.

But, also, just taking a correction bolus if you see yourself going high is a reasonable way to handle things.

I’m not a Woody Allen fan, generally speaking, but “You can live to be 100 if you give up all the things that make you want to live to be 100” is good advice. As with most things in life, it’s a matter of finding a reasonable workable balance. Don’t deprive yourself, but don’t go too far overboard, either.

Have the fries. Heck, have the truffle fries if you want. Potato is good complex carbs. Just keep an eye on how much you’re having and remember that the oil they’re fried in has calories, too.

If you can do it without making yourself feel overly constrained and disappointed, try to portion things out. 4oz of cooked protein is probably plenty. 60g of carbs is usually a good sized dinner. Have some veggies. Save room for dessert. (Obviously, your particular dietary needs will vary.) It’s okay not to finish the plate. You can enjoy the fries without eating all of them right now. Share with friends or take home leftovers for another day.

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I have an app I use that gives me carb counts for grocery items as well as restaurant meals. The restaurant counts work pretty well for me but that’s not always the case, and if you eat at someone’s home you have to do the best you can and correct later. Those occasional excursions aren’t going to do a lot of harm.
One thing recommended to me when I first started pumping 20-some years ago, was to increase my basal rate a smidge if I’m going to a buffet or will be eating “who knows what.” TBH I’ve never done that so I’m just sharing what I was told. I personally find just 1/10 of a unit can make a big deal when I’m adjusting for background purposes only, but I can’t begin to share any guidance on how to adjust for mystery meals - your doctor or DNE may have some advice. You may still need to take a correction after the fact but hopefully the increase will help you spike less.

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Thank you! This is all helpful. So not being judgy here at all but if you guys see spikes on your dex and you just ride it out and the let the high happen? I used to have a better mindset around it and like it was mentioned above you really only do live once and I have to be able to enjoy whatever every now and then. I just have this weird anxiety about going super high after meals which I didn’t used to have ever since being on a dex. Yesterday I tried an extended bolus for a cheeseburger and estimated 57g of carbs for that and about 10 fries. About 2 hours after I started spiking hard so I bolused (okay by my endo to do at the two hour mark for 1 unit if over 200 or 2 units over 3) and went for a half hour work. It helped tremendously but I was also disappointed that I caved and went for a walk. I want to not feel guilty again. I know one high 200 or 300 here or there won’t kill me or wreck my control it’s just been hard for me to get back to more of a laid back mindset around highs.

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Hi @Tee25 it’s been a long time since I used the term “guilty”. I try not to as it is a word used to describe possibly a morally inconsistent behavior and diabetes isn’t like that for me.

If I bolus and I see a way high reading on dex? Yes my first reaction is how much iob and can a walk around the block help. See I don’t need to gain any more weight and so I prefer to add some activity. If a gonk wakes me up at night and I see a 150 on dex, I’ll correct and go back to sleep.

I eat ice cream and enjoy a cheeseburger and I eat Halloween candy with my son. These don’t cause guilt unless i want them to. A high or low is just feedback and you can use any or all tools, like sugar, insulin and exercise to get the result I want because I want it for me. I don’t know if this helps, but good luck :four_leaf_clover:

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Some people bolus when they start eating, so they can gauge whether they’ll eat everything, etc. others bolus in advance, which is fine if you don’t drop fast. I like to bolus about 15 minutes before I start eating whether at home or out, to give my insulin a bit of a head start. Depending on my BG at the time I might bolus 20 or 30 minutes before but I know my body.
I’m wondering what you consider “high”? Some people don’t want to go much above 150 and consider 180 high, while others may go a little above 200 for a short time before coming back down. What’s your high?
BTW, there is a factor called the glycemic index. Two foods may have the same carb count, but those on the high end of the index cause BG to rise fast, while those on the lower end raise it more gradually. A good guide to good carbs: The glycemic index - Harvard Health

I first learned about it several years ago and thought I read that including low GI foods with high GI ones may help “balance them out.” I did a little searching online but wasn’t able to find that documented - you might discuss it with your nutritionist. There are online guides available that show you the counts of many foods.

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Good question. For me high would be anything 230+ 2 hours after eating(if I’m at home and know 100% the carb count then I consider anything over 180 high at the two hour mark). Yesterday for example freaked me out because sugars were relatively good and then at about the 2 hour mark I went from 190 to 245 fairly quickly. I do typically still prebolus when I can when eating out and start with veggies and things first so I can eat the carbier stuff later too. And if I do multiple courses I always take insulin for apps when eating those, insulin for the meal etc.

The GI index is always helpful but it still can’t make it work with me for eating out.

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Taylor @Tee25 , I certainly see spikes after some meals, and when I see those spikes [just as when I see BGL going too low] I open the picture-book of what I ate and the insulin I took, and insulin timing, and try to determine if I miscalculated. If it was an obvious undercount in my carb count WAG I will take additional insulin within two hours to correct my error; another thing I consider is the food type. I generally wait about 4 hours before a correction-bolus. As you have already figured out, some foods push your BG high quickly, but if you counted the carbs correctly, your glucose level will be back where you want it four hours later.

We all know that our BGL is affected by way more than foods consumed, activity level, and insulin administered. Adam Brown at diaTribe Foundation has published a sheet “42 Factors That Affect Blood Sugar” [you can download a PDF]; some of the 42 can raise BG, some lower BG and others can go either way. Right after publication, a bunch of Medalists [all people living with diabetes for more than a half-century] were critiquing the list and decided that there are more than 100 factors affecting BG. Unless you regularly eat at restaurants and the experience is new to you, excitement or anxiety about eating “new foods” might affect your BG.

And, like @Joe, “guilty”, along with bad BG and good BG, are not in my diabetes vocabulary. When it comes to matters about MY choices for food and later I see a BG reading of 350, “stupid” might be the word I apply to either my food choice or how I calculated the necessary insulin.

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Taylor @Tee25 As others have said essentially life happens sometimes you guess right and others not so well. My sugar tends to plummet if I take my insulin in advance of eating so I usually wait until the first course comes out take a look and guess carbs then bolus for that. If I decide to have that dinner roll I will add a bolus for that amount of carbs, when the main course comes I will then bolus for that. A few hours after eating I will look at my numbers and the insulin on board and adjust as necessary. either with exercise or insulin. It generally is a good idea to avoid to many carbs, but you have live and do what makes you happy. I love a good crusty bread more than most desserts so will usually have that roll and skip the dessert…

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