Managing Your Blood Sugar Over the Holidays

While the holidays are a time for celebration for many, they can be quite a challenge for people with type 1 diabetes (T1D). Blood sugar management can get a bit chaotic when your daily routine is disrupted (e.g., eating a large meal that takes longer than usual, drinking more alcohol). However, everyone should be able to celebrate with their loved ones without feeling guilty. Remember that even if you temporarily experience more blood sugar fluctuations than usual, this will not affect your health in the long term. 

If you or your child are living with T1D, there are a few strategies you can use during the holidays.

Routine is everything

While you’re enjoying some time off, your activity level, mealtimes and stress level might be different than usual. This change in your routine might affect your blood sugar levels. Here are a few helpful tips.

• Try to stick to your usual meal schedule. When you’re planning on eating a big festive dinner, you might be tempted to skip lunch. However, this will likely mess up your blood sugar management in the afternoon and after dinner, and it could lead you to ignore your hunger and satiety signals. 
• Make room for physical activity. Why not take your guests on a walk after dinner? Not only will it be fun, but it will also help to lower your blood sugar.
• Keep a closer eye on your blood sugar. The best way to manage your blood sugar during the hectic holiday season and make the necessary adjustments is to monitor your blood sugar levels even more closely. Continuous glucose monitoring (CGM) systems (Freestyle Libre, Dexcom) let you monitor your blood sugar discreetly and watch for trends while you eat, so you can more easily assess the situation.

Understanding the impact of large, prolonged meals  

Holiday meals are often heftier and longer than usual. This means that their impact on blood sugar levels can be harder to predict and last longer. 

One of the main challenges will be evaluating the meal itself and its carb content. If you’re in charge of cooking, you can make your calculations ahead of time and enjoy your time with your guests at mealtime. If not, don’t hesitate to ask your host what ingredients they used and whether you could see the labels of any prepackaged foods they might have used. At any rate, your estimations won’t be as accurate as usual, and that’s completely normal. Remember that your blood sugar levels are affected by many factors (e.g., meal that is high in fat and protein and longer, desserts with a high fat and sugar content, alcohol consumption). You might have to let go of your blood sugar management expectations and just enjoy the time spent with your friends and family. 

Here are a few tips to help minimize the impact of holiday meals: 

• Use your insulin-to-carb ratio. Your ratio helps you to determine how much insulin to take depending on what you eat and give you more flexibility at mealtimes. If you don’t use ratios, you could discuss it with your healthcare team and consider how to determine your insulin-to-carb ratios based on a method that we developed for the Support training platform.
• Determine the right time to inject rapid-acting insulin. Certain insulin pumps have a feature to extend a mealtime bolus if a meal is longer than usual or high in fat (called extended bolus, dual wave or square wave). This feature lets you administer part of a bolus at the beginning of the meal, and the remainder over a set period of time. 

This feature helps to avoid early hypoglycemia (when the insulin action starts before the glucose hits the blood stream) as well as delayed hyperglycemia (when the insulin action is over while carbs are still being absorbed). 

If you don’t use a pump, you can still use this method manually by taking a partial bolus (e.g., 50% of the dose) at the beginning of the meal and the remainder later (e.g., one hour later, but be careful not to forget it!).

• Keep the amount of active insulin in mind. Rapid-acting mealtime insulin lasts for about four hours. Keep in mind that if you correct high blood sugar within four hours of taking an insulin injection, you risk stacking insulin and going into hypoglycemia due to taking too many boluses close together.
• Alcohol: to bolus or not to bolus? In general, carbs from alcohol are not considered in bolus calculations. If you consume an unusually large quantity of alcohol (more than three drinks), watch for hypoglycemic episodes in the following hours.

The holidays last only a few days; try not to feel guilty if your blood sugar is higher than usual. This won’t affect your health in the long term. Just enjoy the celebrations!