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Eating Out (Pub Grub)

This short article presents a common scenario to navigate when eating out.  It is infrequent but not impossible to find any item on the menu that has been explicitly provided for someone on a low-carb diet, not to mention keto! 

Most restaurants now cater for vegetarian and vegan lifestyles, and gluten-free is commonly seen.  There are rarely options for people with Type1 on a ketogenic diet, mainly because it is rare.  Most people with Type 1 will choose any item on the menu if they are DAFNE trained, as they will be used to carb counting and estimating insulin boluses on a high-carb diet the same as everyone else. So you can see that it is likely that as a person with Type 1 diabetes on a keto diet, you will need to learn the skill of choosing food when out. 

Eating out can be a social event, and many people prefer to fit in with a group.  Not wanting to stand out is essential for some people. 

As a general rule, most menus come with bread, rice, pasta, or chips, which, of course, should be avoided as all of these foods are laden with carbs. Children’s menus can be worse than those intended for adults in this respect.

Be cautious when ordering sauces or dressings, as many contain refined carbs such as glaze or thickeners.  Gluten-free offerings might be something to look for in sauces, but they cannot be relied on as many sauces and dressings use sugar. 

Puddings or sweet choices are out. You might feel that the often outrageously priced cheeseboard is worth it.  Otherwise, tea and coffee are good choices.  It is surprising how many people opt for this when they realise it can replace puddings. 

If you prefer to stay incognito in a group, order chips, bread, and puddings and offer them to others. You will be very popular as other diners will likely fight over them. 

Make sure that you have remembered to take your insulin.  Make sure also that your pen has sufficient insulin to cover your meal.  It will happen that you forget!  Also, even though you are in an eatery, the meal might arrive late, so have some glucose tablets available, just in case.  Needles do break so it is a thought to have a spare one handy. Practical tip; if you are carrying both basal and bolus cartridges you can use the needle from the basal in an emergency. Pumps are less troublesome in this respect.

This menu has a vast range of choices.  It is the sort of menu you will find in those often town and city-based pubs that promote ‘grub’ or ‘proper food’.  Usually well priced for those on a budget, and traditionally large portions that will fill you up. 

The Situation

You are with a group of six friends who prefer a pint and some food to celebrate a birthday at lunchtime.  This pub was chosen for the party.  You get to your table and take a look at the menu.  Forget the drinks this time; you are the driver and are choosing water. 

Take a look at the menu.  There are two pages.  Find the items on the menu that will be the most keto-friendly.

This is not a good menu if you are keto. But it is a common menu type in a pub. In these situations, compromise will be needed. The likely candidates are:

Salad with a separate side dressing.

Burger minus bun and chips.

Chicken wings, but check if they are breaded,

Some restaurants will replace carbs for a side salad for free, some will charge. It can get expensive.

With all of these choices, you will have to avoid the sauces for the chicken wings, and it would be prudent to ask for your salad dressing to be served separately so that you can assess the sweetness and adjust accordingly.

So, there are options. That is a good start. These are the sort of options you will encounter just about everywhere. Sometimes fish is available that is not battered. Removing carbs will allow you flexibility in timing your bolus rapid insulin injection or timing your bolus with a pump.  Because of the protein in the meal, you might find that you get a delayed and steady rise in glucose that starts a couple of hours after eating.  The bolus dose will need to be estimated and timed to cover this rise.  You are looking for your now usual flat trace despite the challenge. On a keto diet like this, your insulin volumes will be small and your margin of safety against estimation errors improved. Compared to the high carbohydrate food you were previously eating, the improvement is that you have none of the anxiety of giving yourself a relatively large bolus injection, and then the food arrives late and you find yourself eating some glucose to counter a hypo.  Remember that modern rapid insulin is designed for a high-carb diet and will be active within 30 minutes of injection typically.  

You have successfully navigated the meal, but it doesn’t end there!  Your insulin effect will last a few hours, typically 3 hours, but it varies with individuals and types of insulin. Some people are choosing so-called soluble insulin, which has a later onset of action but a longer duration.  You are a Type 1 for at least three more hours yet. 

When you choose your bolus dose, you will, of course, have had thoughts about the hours following your meal. 

Are you walking or resting in the afternoon?  Walking would be best, but your group might prefer to rest.  So, you will need to be alert to two possibilities, your glucose might go down, or it might continue to rise.  It might, of course, remain flat, which is the desired outcome. 

Make sure you carry insulin for a small correction bolus and your glucose tablets, just in case you have a hypo on the walk.  It is six times less likely than with a high-carb low-fat diet, but the risk of hypo is still ever-present.