Dim Sum: Ding Dong Diabetes

IMG_0113Dim sum is a tradition in my family, which is strange seeing as we are not Cantonese, don’t speak Cantonese, and my father won’t use chopsticks. Growing up near Boston, we would trek into Chinatown and feast on delicious pastries filled with barbecued pork or red bean paste and dumplings with delectable seafood or vegetables. Over the years, I’ve enjoyed dim sum in many major metropolitan cities. Still haven’t made it to Hong Kong, which is dim sum Mecca, but that area is on my bucket list.

It’s a social experience that I encourage everyone to try at least once; think of it as brunch, which is always best with friends. You’ll often see large multi-generational families talking animatedly around circular tables as mountains of steamed buns are snapped up and devoured.

Those Carts Hold Secrets

Popular dim sum restaurants will have women bringing carts piled high with steam baskets, their treasures hidden under lids. You peer into each cart as she grabs the knob, unveiling the dish. If you want what’s inside, it is plopped (often unceremoniously) onto the table. If not, the jarring clang of the lid signals an opportunity passed to try chicken feet or tripe. (I’m adventurous; I’ve tried chicken feet, but I still haven’t checked tripe off my bucket list. Tripe is way, way down on my bucket list.)

Before the server leaves, she will mark a ticket on your table, signifying what you purchased. At the end of the meal, it’s tallied and you pay for what you ate. It can be inexpensive if you only order a few dishes, but often, you’ll find you want to try just.one.more.thing… you know how it goes. I usually end up paying a lot more than intended, and I’m not just thinking about money.

Dosing Dim Sum Disasters

It’s not surprising when I tell you that dim sum is hard to dose insulin for. Lots of rice, rice flour, syrups, and sugar glazes. Some items are steamed, some are fried. I have learned, over the years, on dim sum days, my blood glucose management is going to be tricky.

Pre-pump and pre-CGM days, we did a lot of extra shots and extra blood glucose checks. I’ve tried pre-bolusing, extended boluses, temp basals, and know what I’ve learned? Every dim sum meal is different. Some meals I’ve totally owned and others have sent my blood glucose level soaring, despite a huge push of insulin well before I dug into those steam baskets of yummy.

Sunday was one of those days. John, The Kid, and I trekked out to dim sum in our city. Before we even sat down, I had pre-bolused several units and then set an extended bolus. Throughout the meal, the sound of laughter coming from our table was punctuated with the beeps of my pump as I added a unit or two of insulin, calculating how many carbs were being ingested.

Ding Dong: Diabetes!

ring-my-bell-belle-de-jour-1181765-639x871Dim sum was delicious, but less than an hour later… Ding dong: diabetes! My CGM notified me that my blood glucose level was rising (thank you, double arrows, I already knew), but I had so much insulin already on board that I was afraid to rage bolus and bring it down. For the first time in a long time, my meter spit out a 392 mg/dl. Sigh. I guzzled water, checked for ketones, and watched the CGM for any sign of a down arrow.

That down arrow took its own sweet time showing up. By bedtime, I was back in range, but I cursed the dosing failure.

Do I regret eating dim sum? Nope.

Will I eat dim sum again? Yes.

Will I try a different tactic dosing my insulin next time? Yes.

Do I wish that my pancreas still worked? Yes. Every day. 

Does anyone have suggestions for dosing for dim sum? I’m all ears… (but no chicken feet or tripe…) I’d love to hear your experiences!

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  1. Ding dong made me laugh. You make this so much fun. I mean I know high BG is not fun, but it’s fun to read your story!

  2. Dim sum and other grazing-type of eating is this for me: pre-bolus before first 30g cho. Then I usually put on %110 increased basal for the duration of eating and do micro boluses every 30 mins. I usually cap out around 220mg/dcl and come down a bit due to the micro boluses not being able to pool.

  3. At FFL Gary Schiner recommended we try raising basal rates for high fat/ sugar restaurant meals, rather than dosing for all the carbs. I’ll have to check my notes on the exact method, but I hadn’t heard that before.

    1. 40-60% increase for 4-6 hours after the meal (Just looked in my notes :))

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