I’ve heard this mentioned as a blood glucose target, but I can’t imagine being 140 mg/dl [7.8 mmol/l] one hour after eating and 120 mg/dl [6.7 mmol/l] two hours after and not having a terrible crashing low before my next meal. As it is, I’m generally 144-180 mg/dl [8-10 mmol/l] two hours after eating and I’m almost always low before my next meal. (Note: I use an insulin pump, and have a pretty low basal rate–about 6 units/day).
when are you taking your meal-related insulin? I would be disappointed in something as high as 140 mg/dl one hr after a meal. Especially on a pump. If you are that high postprandial, then you’ve got some timing off.
Have you fasted for 24 hr to make sure your basals are right?
are you eating fat or protein along with carbs at every meal? that slows down digestion so the carbs you eat become blood glucose at a slower and steadier pace, which should give your insulin a better chance at matching the speed.
also, with fast acting insulin, usually only about 2/3 of it is used in the first 2 hours, so you still have an extra 1/3 in the 2-4 hour mark. This can make it difficult to both have good 2 hour numbers and keep from going low if you ate a lot of carbs and took a larger insulin dose.
your basal dose is pretty low, but that still doesn’t mean it’s low enough if you routinely have lows between meals. the question is - does your blood sugar go down if you fast for 4 hours? do you have a consistent activity level between meals that makes your blood sugar drop at certain times of the day? if so, you might need to adjust your basal rate.
I feel this is unattainable too, but seems like many here on TuD can achieve it? The only way for me to do so is to literally never eat a carb. Seriously. Not even an apple. I have noticed that bolusing and then waiting 20 mins prior to eating, or even longer if my sugar is a tad high really makes a difference though with the spike. Have you tried that? My endo also suggests not to check at 1 hour post meal, and only to do so at 2 hrs b/c “you will make yourself crazy.” That statement indicates to me that she finds it hard to achieve as well, which only frustrates me more b/c I wonder, how do some people do so? Best of luck to you!
For me it’s all about the timing. I have to bolus at least 25 minutes prior to eating. No matter what my BG is at that time. Some meals I have to wait 40 minutes before eating anything. I will say I have found that the cut off is 45 minutes for me. I have to eat by then or it’s low blood sugar city!! That has helped me a ton with post meal spikes. I have been able to eat 90g and 100g carb meals and never rise above 120. Good luck and keep some glucose tabs close while testing this theory. Do you have a CGM??
I loathe saying “never” about stuff like targets. I agree it’s very challenging but, if you don’t aim at some type of more normalized target it is much harder to hit it? There are several possibilities that it could be with the crashing out. I’ve done that before too and still run into it occasionally but I agree w/ Danny that it’s not unattainable. I think that Gina’s endo is crazy.
Gina, I was taught to only test before the next meal. My diabetes team told me not to test after eating or ‘you will go crazy’.
I also have the problem that OP raised. If I am under those targets at 1 and 2 hours post prandial, it’s hello hypo later. Like Gina, the only way I can stay under those targets is to not touch a single gram of carb. And to be careful with protein too.
OP, it might help to know that the webpage you referenced is written specifically for (early and earlier stage) Type 2s. It isn’t aimed at Type 1s or anybody with no/low/minimal beta cells.
I feel like the people who achieve this are the strict ‘low-carbers’. I am not, so I don’t make those numbers. It’s IMPOSSIBLE for me. Think about it…my I:C ratio is 1:10. So let’s say I eat 50g of carbs. That’s 5 units of insulin. After one hour, I’d still have approximately 3.5 units in me…that’s enough to lower my blood sugar by about 140 mg/dl. If I were 140 mg/dl at that time, I’d be FREAKING OUT. I NEED to be higher at 1 hour. Protein and fat don’t ‘slow things down’ for me like they do for most people, so that suggestion is a moot point for me. I metabolize and digest food very very fast, and always have. So I spike up, then come down with my insulin over the next few hours. But if I were 140 mg/dl at 1 hour, I better have no more than about 1.1 units in me, or I’m going to go low…and again, this isn’t likely as I don’t do ‘low carb’.
I’m not a strict low-carber. I eat all sorts of crap and drink V8 so I don’t get scurvy. That being said, I am pretty dull during the week, eggbeaters w/ minced bacon, toast (1x 12G slice) and V8 for breakfast, cheese and maybe some mini pretzel twists (like 3-4, about 10G of carbs all together…) mid AM, 1/2 Peanut butter sandwich and Propel for lunch, maybe a couple more pretzels and then some more cheese for lunch, this about 5 days/ week when I’m at work. Our office location sucks as there’s not a good restaurant within 10 minutes of the office and it’s big enough that it takes 10 minutes to get to your car which doesn’t leave a lot of time to eat. I have cereal maybe 2x days/ week, if I’m running a lot, on days I have a long run planned.
In the evenings however I will eat 50-70G, sometimes more carbs for dinner. A lot of times, I’ll overbolus and have a couple of beers to smooth out the BG curve and fight off the crash. Or dessert. The days are a bit dull but I like my job and get a lot done just working through lunch. One weekends, I tend to eat more.
I think it may be more helpful to know what those achieving those flat lines are doing(pre-bolusing, changing basal rates throughout the day, food choices etc.)? More so then just pictures of it, no?
Not me, I eat pretty much whatever I want. Before I went on a pump more than 15 years ago I was considered “brittle” and more than 1 doctor felt I wouldn’t live to be 35 (I’m 44 and healthy now).
check your basal rates by fasting either 12 or 24 hr. Do this a second time a month later. Try to keep activity moderate for this day
accurately calculate your insulin/carb ratio. Consider also calculating protein if that’s what you need.
figure out what timing you need.
for me… I’ve found I don’t absorb more than ~3u very well or consistently. My ratio is 8:1 - so if I want 40 g carb for lunch = 5u. I would take 2.5 u 30 min before eating and the remaining 2.5u as a square wave for that 30 min.
If I was having a lot of fat or milk (ie a latte, don’t know why skim milk affects me that way, but it does), then the square wave would be over 1 hr.
this really does work. The specifics will be different for different people, though. The specifics are also different later in the day for me - if I eat anything after 6:30, I need a long square wave component (>1 hr).
I think the danger many of us get into is reacting rather than being proactive - after the bg gets to 140 then you take a little bit of insulin, rather than doing what needs to be done up front. I know I’m guilty, especially with a CGM.
LOL, I agree! That’s the intent of sort of part II there.
By being conservative, I can set ratios pretty accurately, since I’m consuming similar amounts of carbs at the same time most days. That way it’s pretty easy to tell if my ratios are working or if they get out of whack? When they need adjustment, sometimes, I’ll push all 3 up or down 1G/ U and see what happens and then the numbers will get a bit out of whack for a couple of days and settle down. A lot of it is just that it’s easier to eat that stuff during the day instead of going out, eating garbage or even eating healthy. Peanut butter feels good, although my boss was like “that’s all you eat?” but I don’t need a ton, just enough to stay smooth.
At the same time, the efficacy of my insulin doses is pretty clear too. By not eating a ton, if it gets “out of whack” if floats up but doesn’t usually go >140 as I’m not eating all that much. My main problem in the evening is that I tend to run down but I’m usually lounging around then anyway. I guess I sacrifice some diversity but if somebody says “let’s go to [insert restaurant]” I will usually go, unless I’m busy? Having good data, in turn, has been very helpful to sort of turn things around and exercise a lot, which produces a lot more endorphins for me even than cheese fries. Even with bacon bits.
Re rates, I have a basal bump in the AM to cover DP but that’s about it. I used to do a bump from 12:00-2:00AM but that seemed to miss the spikes that started so I hit the spike w/ an increased rate. I also bolus .3U manually before I hop in the shower and let it soak in while I do that and let the dog out. I hardly ever have DP issues. Getting the day off to a good start makes me a lot happier than I was when I was at 250-300?
I don’t think she’s crazy at all. she’s actually awesome! Maybe she simply recognizes the control freak in me, and the fact that I’m fairly new to pumping, and recently working to figure out crazy insulin resistance and type 2 medications in addition to insulin for that. That I’m also crazy hard on myself. Maybe she simply recognizes that one more thing on the plate will shatter it… I’m stoked some are achieving these goals, and I’ll bet that as they figured their body out and how it works, they ate a carb restricted diet perhaps? Or have been on a pump for their entire diabetic life? Or don’t have issues with insulin resistance? That their D is as manageable as mine once was? That they have a secret weapon they aren’t sharing with us? I have an appt with the CDE/Endo Friday. I will re-assess of course. Maybe now she wil have a different opinion. Maybe now is the time. I will also simply try to wait longer prior to eating after bolusing as Will D mentioned and see what that does. I’ve also decided to not eat carbs for a while to try to get things sorted. We will get there, Lila and I. To those who are already there, good for you!!
Good points Kari! That is part of the reason I was told one hour also wouldn’t work. That if I was that low at 1 hour, I’d be bottomed out at 2. As mentioned above, I have an appt Friday, and will re-assess with my endo. Maybe I’ll magically never want to eat a carb again, as that could be a solution??
I don’t want to oversimplify something that you might already have considered, but to me if you are crashing low before your meals your basal (no matter how little it is) is still too high…at least for those “time zones” when you are going low. On the other hand if you are generally from 144-180 two hours after eating your boluses are not high enough and/or not given early enough before the meal. (I go for 20 minutes unless I’m low; some people do it earlier, you will have to experiment to see what’s right for you.
If you don’t test after eating, how do you know if the foods you ate and the insulin doses you took were successful? Also, how would you know to correct for a high or treat a low if one occured?
I agree w/ Zoe on that. I don’t just want to know the number, I want 2 points so I can know the rate of change in my BG. This seems to be the most useful part of the CGM and, at least the way I use it, I can tell after lunch if it’s going 110-119-132, it is increasing the delta and I’ll revisit the carbs and maybe consider a CB. If it’s 110-114-118-120, I can chill out. I didn’t test that crazily w/o a CGM but the data is there, in your blood, for the taking.
My daughter is definitely not a low carber by any stretch of the imagination. She usually boluses first as much as possible and waits 10 minutes normally, or a certain amount of time if she is higher than target. I have her CGM set to go off as high at 160, and she usually doesn’t hit anywhere near that number. I have never bought into the idea that you have to go high in order not to go low at 3 or 4 hours. I am not saying that she has perfect control, in fact right now things are really wonky and I am not sure why, but it is not meals that are causing the spikes. I suspect it is an increase in her thyroid meds.
One thing that I think a lot of people miss, is that some foods should have an extended bolus. If we didn’t have her using this for low glycemic foods, she would certainly have lows followed by highs hours later.
Zoe and Acid, I only said I was taught not to test 2 hours after eating. I never said I followed their advice.
I think the OP brings up a valid point - that for some people, if they are ‘on target’ at 2 hours post meal, they will be below target maybe 4 hours post meal.
The biggest problem for me is that Novolog/Novorapid takes two hours to work. I am aware that I have a problem with insulin timing and have been trying to sort it out, but it seems to require more complicated algorithms than I can muster. Despite this, I have a fairly decent A1C. I would obviously like to join the flatliners club but I don’t think that will be possible in the near future!
I have an appt with the CDE/Endo Friday. I will re-assess of course. Maybe now she wil have a different opinion. Maybe now is the time. I will also simply try to wait longer prior to eating after bolusing as Will D mentioned and see what that does. I’ve also decided to not eat carbs for a while to try to get things sorted. We will get there, Lila and I. To those who are already there, good for you!!