Pizza is notoriously hard to bolus for. The fat content in the pizza usually delays the effect of the carbohydrates on blood glucose. Pizza also tends to have a high number of carbohydrates, especially if it’s the thick crust type of pizza, like pan pizza, or rising crust pizza.

I often buy thin crust pizza because it has less carbohydrates so I can bolus less and am less likely to get high blood sugar from it. However, last night I proved that it’s possible to eat rising crust pizza without my blood glucose going too high!

Top Tips for Eating Pizza

• Choose thin crust pizza if you are following a low carbohydrate diet.
• Look up the number of carbs for each slice. Check out the nutrition panel on the box if it’s a frozen pizza, or search for the nutrition information online or using an app like CalorieKing.
• If you’re cutting the pizza, look at the serving size beforehand and cut the pizza so that one slice is one serving size, or one slice is a half of a serving. It makes the math easier!
• Eat salad, veggies, or a low carbohydrate snack with it.
• Check blood glucose about 2-3 hours after, and dose more insulin if needed. Pizza with a lot of crust may cause your blood glucose to rise later.
• Have something sugary on hand, like lemonade, regular soda, candy, glucose tabs, etc, incase the insulin makes your blood glucose drop before the pizza carbohydrates makes your blood glucose rise. It can be hard to get the timing right and there is always the possibility of going low.
• If you have an insulin pump that offers the “dual wave bolus”, learn how to use it, as it may work well for foods like pizza that have a high fat content.

Count the Pizza Carbs

If you are eating store bought pizza, check out the “Nutrition Facts” label on the box. The pizza I ate last night was a frozen Digiorno Pizza. It said that 1 serving size is 1/6th of the pizza and that the total carbohydrates per slice is 38 grams. (I subtract the fiber count of 1 gram from the total carbohydrate count of 39 grams.)

Bolus for the Pizza

I am using an insulin pump that has a bolus wizard. I just put in the number of carbs and it calculates the amount of insulin required.

Cut the Pizza based on the Serving Size

The pizza box says that 1 serving is 1/6th of the pizza, so I cut the pizza into 6 slices. It can be hard to get the slices to be all the same size, so you may need to eyeball whether you’re about to eat a bit more or less than the serving size.

Low Carb side dish

While technically you could just eat 2 or 3 slices of pizza and bolus for those 2 or 3 slices, that would require a higher insulin dose… However, this is riskier because if the insulin starts working before the pizza carbs start working, you could go low… Additionally, later on, you could end up higher and need to correct. It’s just harder to control blood glucose when eating a high number of carbohydrates. If you’d like to learn more about how it’s easier to manage diabetes with a low carbohydrate diet, read about The Laws of Small Numbers.

Therefore, I try to limit the number of carbohydrates I eat at one time. It just makes my life easier. So, if I’m going to eat something high in carbohydrates like rising crust pizza, then I’m going to balance it with salad or vegetables or cheese snacks or something else low in carbohydrates.

Plus, salad is good for me 🙂

Pizza’s Effect on My Blood Glucose

I use an insulin pump with a CGM, so I can see a graph of my blood glucose on my insulin pump. Below is a graph showing when I administered the insulin for my pizza dinner. As you can see, about one hour after eating, my blood glucose rose, but still remained in range.

Delayed Effect of Pizza

It wasn’t until 3 hours later that my blood glucose went into the high range. I had to do a correction bolus to get it to go back into normal range.

Because of this delayed effect, I try to avoid eating pizza and similar types of meals too close to bedtime because I need to be awake to administer the correction bolus. Otherwise, the pump will wake me up in the middle of the night…

Helpful Links

• Calorie King – Online database to look up the number of carbohydrates in the pizza! Includes specific pizza brands like Domino’s, Pizza Hut, Round Table, Papa Murphy’s, etc, as well as averages. Whether you are eating at a restaurant or home made pizza, you can use this site to estimate the number of carbohydrates in a slice of pizza.
• The Laws of Small Numbers – Diabetes Solution by Dr. Bernstein. Explains why managing diabetes using a low carbohydrate diet makes life easier. After reading this, you may decide to skip anything other than thin crust pizza!