The evening started off normally enough. It was spaghetti night—also known as “let’s see how many carbs we can fit on one plate.” It’s one of the few meals where there are never leftovers. Peyton can eat through multiple plates of spaghetti without even blinking, and Owen likes to follow in his brother’s footsteps.
Owen had his usual serving, inhaled it like a competitive eater in training, then asked for another. His blood sugar was 160 and stable. I already had the combo bolus running and hesitated, because I knew this could end with me canceling the combo and restarting it—a giant pain. But he was hungry, so I said yes. He happily dug into Round Two.
Ten minutes later, his phone buzzed. Double arrows down—and he was already at 127. I checked his pump and felt my soul try to exit my body: over 4 units of insulin on board. All of it meant for the spaghetti. All of it apparently on a lunch break.
Cue: slow panic loading… 40%… 60%… 110%.
So what do you do when you have that much insulin on board, the food isn’t hitting yet, and the blood sugar is dropping above 100?
Here’s the deal: when BG is above 100, trending downward, and you’ve got a ton of IOB, your job is to stop hypoglycemia before it shows up to the party uninvited. Even if you know the food is coming, you can’t rely on it. Spaghetti likes to take its sweet time.
That’s when you give a small amount of fast-acting carbs—not the usual full 15 grams. Start with 5–10 grams: just enough to tap the brakes without launching straight into the classic diabetes roller coaster of “treat the low, now you’re 300.”
That could be:
- Two glucose tablets
- 4 oz of juice
- A few sips of regular soda
Then you recheck in 10–15 minutes to see if things are improving. If you’re on an automated pump, it has probably already suspended basal insulin, but you still have to treat the downward trend.
Use small treatments—because the spaghetti will show up eventually, like your kids finally coming downstairs after you yell it’s dinner time… again.
Not every educator would agree with this; others might rely on the 15 grams right away. You have to do what you feel comfortable with.
I sprinted to the cabinet where we keep treatments… or where we should keep treatments. I hadn’t bought glucose tabs in a while because we were still living off the massive pile of Halloween candy—the kind of stash that could sustain a small village.
I told both boys this was serious. They were playing on their phones, and when I asked them to stop, they immediately… ignored me. Shocking. I realized this was going to be harder than I thought, and in my panicked state, I could feel myself starting to lose my composure.
I asked again, and my oldest looked offended that I dared interrupt whatever Very Important Pixel Task he was completing.
“Come on, Dad, it’s not my problem.”
Peyton cares deeply for his brother, so I chalked that response up to autism, not apathy. I tossed him the bag of candy and asked him to find some Skittles or hard candy.
With where Owen’s blood sugar was—and how much insulin he had active—every instinct in my body wanted to give him a handful of candy. I knew that wasn’t the right move, but fear doesn’t always care about logic.
I helped Owen unwrap two Starbursts and had him eat them. There was no need for him to go through the same trauma I was experiencing for the next 10–15 minutes, so I told them both to go back to their phones.
Thankfully, Owen’s blood sugar leveled off after the second small treatment. Crisis averted. I’ll call that a win in my book, and let’s just close the book for today. Parenting is glamorous.
In Short
If blood sugar is above 100 mg/dL, trending down, and there’s a boatload of insulin on board, treat early:
- Take 5–10 grams of fast carbs.
- Recheck in 10–15 minutes.
- Increase to 15 grams if the drop is rapid or symptoms appear.
Hope this helps the next parent experiencing a spaghetti-induced near heart attack.