Vital Points for Pesach

The following is a list of important issues relevant to changes in insulin regimens, which are necessary to accommodate the irregular schedule of Pesach (Passover)

Please remember that any change in regimen should be discussed with your health care professional. If you have any questions, please feel free to call or email the JDA at: nechama@jewishdiabetes.orgor call 718-303-5955.

1. This year Erev Yom Tov (the eve of the holiday) comes out on Friday- Saturday the 18^th – 19th of April 2008. It is usually a bit of a hectic time with last minute preparations for the holiday and the Seder. Early Saturday morning (check exact times with your local Rabbi for specific time) all chametz (unleavened bread and any food made with unleavened bread flour) has to be out of the house. Therefore, there will be only a limited amount of carbs that one will be able to eat. It is also forbidden to eat Matzo until the Seder (which is on Saturday night after sundown); so again throughout the day there will be only a small limited amount of carbs. (In our other articles there are many suggestions and tips) Discuss this with your doctors. For those on the pump there are many people that have specific Shabbos basals that are based, in part, on the fact that one moves around less and eats more on Shabbos. It is advisable to stay on the regular basal for Friday and Saturday and to set a specific basal for the Yom Tov days and switch to that basal on Motzoei Shabbos. Again this should be checked with your Rav & health care professional. Keep in mind that this year it is three days (outside of Israel and two days in Israel)

Those that take their doses based on insulin to carb ratio would continue covering as usual, allowing for adjustments in choice of carbs and the sporadic eating schedule of a very hectic day. Those not on pump therapy, and/or those that do not cover all meals with injections and take long acting insulin (NPH or Lente) in the morning) that covers lunch and snacks, or Lantus on both Friday and Shabbos nights should discuss the need for possible changes in their doses with your health care team.

2. Dinnertime will be considerably different than a normal night or even a Shabbos night meal. The Seder, as well, starts later than a normal Shabbos meal. Actual eating at the Seder starts even later. It is necessary to discuss with your health professional a reduction in the usual dinnertime dose, and the amount needed to cover the Seder meal. (Those that are on NPH or Lente should probably have a snack at the usual dinnertime, to keep you going until the meal is served). Those on Lantus would take their normal dose at the normal time.

3. On the Seder night, take your long acting insulin at the SAME TIME you would take it on any usual day. (Please note comments by Dr. Jovanovic below)

4. The short acting insulin (administered before eating), or bolus should only be taken at the time of washing for the Matzo, unless there will be a significant delay (such as large Sedorim with many people present, in which case it should be taken right before eating). However, if one uses grape juice for the first cup, he/she should figure the amount of carbs, and cover with insulin before drinking. We drink the second cup before eating the Matzo, so it may be a good idea to cover that cup and the Matzo together.

5. Those that will be drinking wine with high alcohol content for the four cups should be very careful about hypoglycemia, especially for the first cup, since one has not yet eaten. (As explained in our Purim issue, alcohol inhibits the liver from producing glucose, if one has not eaten and there is no circulating glucose there is a greater risk of low blood sugar.)

6. Those that use potatoes for karpas can cover for it together with the insulin taken for Kiddush. Keep in mind that one is NOT supposed to eat an entire kezayis (allotted amount) of karpas. One kezayis of karpas is 1oz. of potatoes, which contains 4.2 grams of carbs. [Only those with pumps, which deliver by a tenth of a unit, will be able to handle this correctly].

7. The Seder is a long meal and Matzo may be digested (and converted to glucose) at a much slower rate than bread or Challah. It is therefore advisable to discuss with your doctor: a) combining a normal and an extended bolus (Square wave) for those on the pump, b) Those that cover meals with short (fast) acting insulin (Humalog or Novolog), should discuss either an addition of regular insulin (that will last longer than the Humalog or Novolog alone) or taking an additional dose midway through the Seder.

8. Some pediatric Diabetologists recommend administering Humalog or Novolog (short/fast acting) insulin for young children, who are picky eaters, AFTER they eat, when it becomes clear how much they have actually eaten and how much coverage they need. The Seder is a typical example of the need for this flexibility, since it is so late at night, and many children may eat very little. (If your child is a picky eater this might be a good time to discuss this option with you health care team for all year round).

9. Make sure to check your BG before going to sleep; there may be unexpected results. If the BG is high and you plan to supplement with extra insulin, make sure you have taken any previous insulin doses into account. This rule applies if it is less than 3.5 to 4 hours since the last time Humalog or Novolog (fast acting) was administered, or if it is less than 5 to 6 hours after you took Regular insulin. Please keep in mind that introduction of additional bedtime insulin doses should be done with great caution, and follow up tests MUST be performed overnight to ensure that hypoglycemia doesn’t occur.