Who doesn't sometimes need help navigating life with diabetes? That's why we offer Ask D'Mine, our weekly advice column, hosted by veteran type 1, diabetes author and educator Wil Dubois.

This week, Wil offers a sweet nugget of truth about whether PWDs (people with diabetes) should forgo that so-desired dinnertime dessert when blood sugars are high. You know you're curious...

{Got your own questions? Email us at AskDMine@diabetesmine.com}


Leslie, type 1 from Colorado, writes: I read someplace if your blood sugar is too high (say, over 150 or so) you shouldn't eat. You should try to bring it down, then eat. Well, what if you're at dinner, munching judiciously along, and you check your blood and whammo! It's 245, you're in the middle of the meal and still hungry, and the dessert you brought to the party is what you've been waiting for all night? This just happened to me last evening. When I saw the 245 I thought, now I have to take insulin and go back to the table and sit there with my hands folded while everyone finishes up? Are you kidding me?? Forget that — I'm still hungry. Forgo dessert?  No f*ing way, I brought that friggin almond cake here and I can't wait for a piece. So, I took insulin, went back to the table and enjoyed my meal, figuring I would probably die of kidney damage or some other dire thing as a result of my "crime." But you know what? At that moment, I didn't care. Was that so wrong?

Wil@Ask D'Mine answers: Oh yes. Oh so wrong. Wrong in that the perverted universe, and a little bad information, put you in that situation in the first place. You most likely read the "don't eat over 150" advice here, and I couldn't disagree with the authors more.

Actually, to be fair, that information isn't so much bad as out of date. Well, more than out of date. Moldy. Like cheese that is waaaaaaay beyond its sell-by date. This is one of the unfortunate things about the internet, nothing ever goes away. This "advice" to not eat over 150 comes from an article that dates from 1994.

For perspective, the first "modern" analog insulin was introduced two years later in '96. So the "advice" given in the article pertains to old-fashioned "R" insulin. Just to remind everyone how far we've come, consider the following: The onset of R is somewhere between half an hour and an hour. The onset of modern analogues is 10-15 minutes. The peak action of R is between 2 and 4 hours. Analogues peak in 1-2 hours. R lasts up to 8 hours, analogues are effectively gone in 4. So as you can see, Leslie, it's a whole 'nother ball game nowadays.

My point is that this might have been good advice 20 years ago (although I'm not sure I'd agree); but it sure as hell isn't good advice now. The thought behind it, no doubt, was to try to head off trouble at the pass. If you are high and your insulin is slow, adding more carbs could potentially turn a garden variety high into a crisis. Maybe.

The author's worry is about diabetic ketoacidosis, or DKA to its friends. This is the classic "diabetic coma" that's usually only a threat to type 1s like us. It's a slow-motion emergency that left unchecked can kill you. If you were actually starting to go into DKA, eating more would be a bad idea. Especially if your insulin is slow to get on the job. But no one goes into DKA at 150. It generally starts north of 300, and it requires you to be above 300 for hours to start. Should you not eat at 300, then?

Maybe. Maybe not. I wouldn't eat cotton candy north of 300, but I wouldn't say you shouldn't eat anything. Of course, it depends how long you've been north of 300, too.

Really, the only time I would say you should return to the table and sit with your hands folded in your lap while everyone else finishes up is if you're north of 300, have been for a while, your stomach is aching, and you've got ketones in your blood or urine. At that point you should probably avoid eating like hell. You're starting to go into DKA.

Come to think of it, in that situation you shouldn't be sitting calmly at the table. You should be drinking tons of water, taking insulin into your arm with a long needle, and having a loved one drive you to the ER, while you are on your cell phone making sure someone at the party saves you a piece of the friggin' almond cake for the next day.

Another thing to consider about the modern world, and when to eat and when not to, is that carb and insulin "stacking" is much safer nowadays than it was back in them days. You can shovel a fair amount of food down your gullet so long as you bolus for each round. Pumps allow you to do this with quite a bit of safety with their insulin tracking software, and folks on shots or pens can use an insulin tracking app. Of course, D-folks outside the USA can track their insulin on their meters.

Now... moving on to the next place the universe bit you in the ass: For God's sake don't check your blood sugar in the middle of a meal! Even the authors of the 150 nonsense didn't intend for you to do that. They only wanted you to delay eating if you were elevated before you started eating. It's common for many people to "spike" as they start eating, or shortly thereafter. So stick to the judicious munching and leave the friggin meter in your purse in the middle of the meal.

Beyond that, let's consider your 245 mg/dL... well, how much insulin did you take before you started eating? If you counted your carbs right and took the right amount of insulin, if you stop eating and sit at the table with your hands folded you are quite likely to kill yourself. Look, you took a set amount of insulin to soak up a set amount of carbs. If you stop the carbs half-way through you can't take the insulin back. It will keep working. You'll have a spectacular low downstream if you only eat half of what you intended. (This is the special hell D-Moms get to live with every day—will the kid eat her whole meal?)

And lastly, on guilt and living in the moment: Diabetes is a disease, not a religion. One crime, one sin, doesn't send you to diabetes hell. The trick is to be "good" in our blood sugar control most of the time, and to balance that with all the joys of life. By God, you waited for that almond cake all day. You wanted it. You deserved it. You should have it. (In moderation.)

The only thing you did wrong was to torture yourself unnecessarily with visions of dialysis and other dire fates.

So, in the future, no guilt, my dear. Let us eat cake.


This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.


This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.