Meal plans, and lack thereof.

There’s a laundry list of questions us folks with diabetes get asked: “Are you allowed to eat that?” “Did you eat a lot of sugar as a child?” “Does the pump control everything for you?” These would all make the Top Ten list for most annoying and probably the Top Ten for most frequently asked.

Last night I got a question though that I have had many times before, but much less frequently than the usual suspects. This question was in response to me explaining the difference between Type 1 and Type 2 diabetes, and saying that Type 1s like myself must always be on insulin because we don’t make any:

“So does that mean you have to eat at certain times?”

I always find this one tricky to answer. Back when I was diagnosed in 1992, the answer to this was essentially “yes.” You were dependent on a sliding scale of Regular insulin, NPH, and a meal plan. So yes, meals were dictated by insulin on board (or not on board for that matter) and what “exchanges” were due at that time (remember meal “exchanges!?” They were so carb heavy all the time! I would NEVER eat like that these days).

But ever since I went on a combo of Lantus and Humalog back in….2001 I think it was? And then on the pump in 2008, there’s really been no rules about when I have to eat. If you’re basals are running right, you should actually be able to skip a meal without going low, and of course you can bolus on the fly for an unexpected snack or meal.

That being said, there’s one exception to this world of freedom we live in with insulin analogues and pumps: Low BGs. If you’re low, you definitely HAVE to eat right that second.

So it’s actually kind of complicated to answer the question “Do you have to eat at certain times?” The short answer is no I guess, since I’m on the pump and can adjust according to my schedule. But I’d hate to answer that question that way for someone and then grab a cupcake out of their hand because I got low and suddenly the answer was “yes, I absolutely need to eat at this specific time RIGHT NOW.”

Ah diabetes. Never a straightforward answer…except to the question “do your beta cells work?” That one is just a firm “no.”


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There’s still a 4hr’ish window that the bolus is working while on the pump. I find if I try to keep meals that far apart and limit snacking to coffee it is far easier to see the problems with carb ratios/basal rates. Then again, sticking to that isn’t always easy.

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