Has there ever been a food more beloved and yet more challenging for people with type 1 diabetes? Something about that high-carb/high-fat mix makes pizza both incredibly delicious and incredibly difficult to control blood sugar!

Here at T1D Exchange, we’re always seeking a better understanding of everyday practices in type 1 diabetes, with an eye toward improving outcomes. We asked Dr. Howard Wolpert, a senior physician and director at the Joslin Institute of Technology Translation for advice.

Here’s the advice he gave:

-If you are on a pump, start by covering the carbs in the meal upfront using your usual insulin-to-carb ratio, and give an additional 30% extended out over 2 hours.

-If you are on shots, give a bolus immediately before meal (also calculated using your usual insulin-to-carbohydrate ratio). Take another about 60 minutes to 90 minutes after the start of the meal, amounting to about 30% of the pre-meal dose.

-Experimentation and reviewing CGM patterns can help you nail down the correct dose. If you run high in the first 60 minutes to 90 minutes, next time you have pizza try more insulin upfront.

-If you’re going high after 90 minutes, take more insulin for the 2-hour extended bolus or your 2nd bolus.

Here is what people with type 1 diabetes had to say in two polls on T1D Exchange Glu:

You can download a PDF about this subject here.

Blood sugar management varies from person to person. Please consult with your healthcare provider before making any major changes in insulin therapy.