Question: Is pizza incompatible with diabetes?
Answer: Absolutely not
The real question is how do I manage to incorporate pizza into my diet without experiencing marked hyperglycemia?
The “pizza” food group is often a staple in the lives of many children and adolescents. Some of my colleagues have even referred to it as evil! However, I prefer to refer to pizza management as a challenge and thus try to include it in meal planning in moderation. Pizza is a complex assortment of fat, protein, and carbohydrates (carbs). As such, despite coverage with either fast or rapid acting insulin, blood sugars are often elevated several hours after pizza parties. The goal is to perform “damage control” in order to avoid having high blood sugars all day or night.
Suggestions for Pizza Strategies
1. All pizzas are not equal! It is important to realize that different brands have differing combinations of fat, protein and carbohydrates. Indeed, apps that can be downloaded to computers and mobile devices such as the Calorie King can provide carbohydrate counts for all the different brands of pizza (e.g. Domino’s, Pizza Hut). Use this information to help you estimate as best as possible the number of carbs per slice, etc.
2. There are many algorithms for estimating carbs based on thickness of the pizza crust. Ask your diabetes team for their favorite.
3. Match your insulin regimen to accommodate the pizza.
For those patients on conventional split mixed insulin with NPH/Regular or rapid acting (humalog, novolog or apidra) 2 or 3 injections/ day, time your slice(s) with a meal such that the rapid or fast acting insulin will coincide with the carbohydrate excursion. However, be prepared for higher blood sugars even 3-4 hours later due to the fat content slowing digestion. Be prepared to possibly require more rapid or fast acting insulin later to lower blood sugars.
For those patients on basal/bolus insulin via multiple injections, one might try to use a combination of rapid and fast acting insulin (analog plus regular) in order to cover the immediate rise of blood sugar after pizza ingestion and then the slow rise in glucose several hours later.
Patients using insulin pump therapy may employ the same strategy as those that are on basal/bolus therapy by using a “combo” or extended bolus feature of the pump. This strategy allows you to give a certain amount of insulin up-front and the remainder over 2-4 hours based on what actually works. Many choose to determine the amount of rapid acting insulin required based on carb counting and give 50 percent up front and the remainder over 2-4 hours. The key is to experiment with varying percentages and hours to extend based on experience with different pizza brands. (33 percent up front and 66 percent over 2- 4 hours is another popular stratagem.) Keep trying to see what is most effective.
4. Keep in mind that it is still likely that you may have to give another correction bolus 3-4 hours after enjoying that pizza!
5. Keep records of the different combinations employed with the varying pizza brands so you do not forget.
6. Moderation is essential.
7. Ask your diabetes team for other ideas and share them with one another. Indeed, I continue to learn new successful strategies from my own patients who like to experiment.
Lastly, feel free to send your pizza stories and strategies so that our mydiabetescentral community may enjoy, share, and learn.