I just would like to point out that I am “in” the Flatliner’s club and the majority of my posts are not flatlines. Also, I do not eat a low-carb diet.
However, posting and discussing what works and what doesn’t with other people who “get it” has improved my blood sugar SIGNIFICANTLY! (It’s also improved the way I mentally deal with diabetes, but that’s a different subject). And there is no pressure within the club to conform to one management style over another.
Anyway - all this is to say that it is not an elite club of perfect diabetics! It’s a group of diabetics who want support as we try to figure out how to manage this beast
I frequently post on the Flatliners Club Group and I eat no where near low carb. I am eating approximately 280 carbs/day. Lately I have been achieving 1-2 days a week where my CGM does not read over 140. The amount of information that you can learn from the CGM is unbelievable. There are 2 things that I use to greatly reduce my PP spikes: premeal bolus timing and glycemic indexes.
With the CGM I am understanding the importance of timing premeal boluses. For my normal lunch (80 g Carb) timing is key. Through trial and error I have learned to prebolus lunch by 13 minutes. I also adjust that timing up and down 1-2 min per 10 mg/dl off of 100 mg/dl (along with bolus correction). I will start my PP spike at about 80 minutes after start of lunch and hit the celing about 100 minutes after lunch. If everything is planned right I do not exceed 120 mg/dl, yesterday I spiked at 118. I believe there is some synergy at play when you time your bolus and meal correctly which leads to a “normal” PP spike.
My insulin does not work fast enough for high glycemic index foods. I had to stop eating bananas for breakfast as my PP spike was begining at 45 minutes and climaxing at 65 minutes. That was just too fast and difficult for me to cover correctly with humalog. I prefer low glycemic index foods when possible, or more low glycemic mixed with less higher glycemic carbs for a meal.
Other tips are using the dual wave bolus (medtronic). I use this for high fat/protein meals and to time the delivery of my insulin better. I am still working on dual waving, but have borrowed many principles from TAG (Total Available Glucose).
I certainly do not always bolus correctly for a meal , but it is possible to keep your PPs below 140 while eating a good amount of carbs. That being said, it is also more difficult to limit PP spikes while eating more carbs.
I’m hoping to get pregnant, and aiming at as close to normal BGs as possible: not higher than 120 an ahour after eating. THAT is pretty hard, and I often don’t manage it, but I feel pretty good if it’s under 130.
My CDE said that I would probably have to snack between meals. She didn’t explain, but here’s how I understand it: i keep my I:C ratios so that I don’t spike. 1:10, most of the day. That is more insulin than I would be taking if I was only aiming to not break 160 (and, indeed, the dumb dietician I went to was so surprised that a skinny thing like me needed that much insulin that she started saying I was type 2. Whatever.) BUT: that much insulin does lead to increased risk of lows about 2 hours after eating, at least when I’ve taken a high dose for something sort of high carb. Here’s the trick: don’t wait until you go ACTUALLY low, just nibble on something. A cracker or two. 2 skittles.
This is not treating a low, it’s preventing it. I try to kind of coast along maintaining my levels, “topping up” a bit with sugar a few hours after meals. (Kind of like maintaining the right buzz at a long party…) So I end up eating candy, but it’s not a big deal. Is 10 skittles a day going to make you fat? Nah.
I don’t do low carb, but I also won’t eat something with more than 30g if I have to do something important afterwards.
I’m doing 140 or lower one hour after meals and am on MDI without a CGM. I’m 6.5 months pregnant, so this is a must. I don’t go too low too often afterwards. But, then again, due to pregnancy, I’m also eating way more often than I would have if I weren’t pregnant. So, it’s possible. If you had asked me last year if it was possible, I would have laughed in your face and said NO. But… it is. I’ve even proved myself wrong.
Type 1 for 13 years- 10+ BG tests per day, 20+ MDI per day, no CGM, no pump
not so I am not a low carber - moderate would be more accurate. Do I meet the goals evry day - no but do I try every day - Yes. If you believe the goal is unobtainable, you will not try and you will not meet it. Some things that I have found to help:
eating a low glycemic index meal
eating in moderation 25 to 50 carbs per meal works for me About 120 per day
Fine tuning and testing basal rates
using Metformin helps reduce my peaks and level out highs and lows
Using the CGM to monitor things real time
this one may sound crazy, but it really works. 4 Teaspoons of Lemon juice in a glass of water - I add a lil sugar free sweetener. The lemon juice lowers the glycemic index and further reduces the peaks and valleys and helps level things out. I understand that Balsamic vinegar has the same effect.
I USED to be a low-carber. Now that I’m 6.5 months pregnant, I eat whatever my baby needs. Any given meal I can eat from 30-90g carbs. Which is not low carb by any means.
I used to be low carb. After baby is born, I will likely go back to that because it was just easier. But, my post prandials are close to 140 and 120 after one hour… that’s after a 90g carb lunch. I’m on MDI and do not have a CGM. My I:C is 1 unit per every 5g of carbs. So a 90g meal will cost me about 20 units of insulin (depending on fat content).
I rarely go above 120 PP if I don’t eat something like potatoes. Whole grains and dosing 20 min before I eat keeps the spikes from happening and the come down steady. I sit usually between 70-85, so that also make a difference for what is considered high.
This is a little aside, but one thing I have learned since having a CGM is that testing, no matter how often you do it, is just a brief snapshot in time. Test a little earlier or a little later, and you can get different results. This has really amazed me since I have readings every 5 minutes now. So, someone who tests at 1 or 2 hours and gets good results may still be spiking later, and never know it, even if they check often. This happens to me a lot, especially with meat, cheese and hummus. I am great early on, and then spike, and go back down later. The spike can occur several hours later. Even if I were testing hourly, I would have no idea this was going on, as I might go from 120 to 180 and then back to 110 within the time between finger pricks. I used to test 10x and realize now how much I was missing.
I love my CGM for this reason and I think everyone who can get one should give it a go. But I also have to warn people, “Flatlines” on CGM’s can be real or very deceptive. Yesterday my BS stayed between 67-77 for more than 4 hours. I suspected that this was too good to be true and in fact it was. I tested and my actual BS was 63 points higher. This frequently happens to me, this was on day 2 of my sensor, but it often happens toward the end of my sensor life, and is how I know to replace it. It gets somehow “stuck” on a lowish reading, usually in the 60’s or 70’s (stuck within a range, not on one specific number) Also sensors sometimes will show a spike, but it may not be as high as my meter says it is. I recently had a reading where my sensor stopped climbing but my meter showed a reading 100 points higher. I think when this happens, my BS has gone up and then back down quickly and the CGM doesn’s always keep up.
In short, depending on what you eat, your spike might come much later than 1-2 hours. Or it may come at 30 minutes after a meal. And, the CGM is a great tool, but sometimes it does not catch highs very well and flat readings are not always true. In my experience, sometimes yes and sometimes no. .
The same thing happens to me at lunch, if I have a 140 at the two hour mark. I will totally bottom out 2 hours later, and I cannot lower my basal any lower as I have it set for 00.00 from 1:00-4:00, very frustrating.
To the original poster - I totally agree with what you are saying. What I did was increase my insulin to carb ratio and then I was low at 2-3 hours but I would top out at 130. Now, knowing that I will be low at 2-3 hours I have a nice 10g carb snack after meals to balance the remaining insulin, like an apple, orange, crackers to avoid the low that I know is coming.
I am using 150 units via pump daily and adjusting at one point I was using 400units daily.
I freaked one EC out by letting him see me use 80u of Apidra w/o eating. There are some of us that have a heck of a resistance and elevated A1C’s and stay on it but go no where.
I also love my CGM, but if I got those results on day 2 I would be calling for a replacement sensor I am on day 18 and spot on! The spikes out of nowhere are frquently a sign of a dead sensor. Which CGM do you use. I have the Dexcom 7 plus and it is my best buddy!!
I keep my after meal BG spike below 120 mg/dl. My BG would go too low if I would not eat a snack 2 hours after a high carb meal. So what? I don’t consider this a penalty. I always look forward to the snack. I get the best of both worlds: BG under 120 mg/dl and a snack.
dickengel-
I have the MM and the sensors don’t last as long as Dex. Not by a long shot. Approved for 3, the best I have gotten is 6. Very different system!
I would still call and ask themto replace it only 2 days - they charge somuch theyshould work as advertised. I have had a couple dex sensors that messed up before the promised 6 days and I call and they will replace no charge
I am no expert in flat lining, but I have noticed, especially at breakfast, that I need to take the bolus before I eat (i.e. 10+ minutes) and I feel a lot better. At the moment I’m not a big fan of testing after meals either, because I’m still trying to get the 3-4 hours after results correct (basal rates, carb ratios etc.) and I don’t usually correct, so I don’t see the information as so important. If I don’t have time to bolus before I eat, then I live with the consequences, or correct and am prepared to eat something more later before I get a low blood sugar. And all of that said, for me it depends so much on what I eat. E.g. pure bread/potatoes vs. pizza. Some foods just get absorbed more slowly. There was a comment in here about being afraid of having an ‘OK’ blood sugar shortly after you eat, because it implies a hypoglycemia is coming. I wouldn’t 100% agree - if it was a single scoop of ice cream, then I would agree, but if it was a larger meal that your stomach is still getting through, then you might be in a ‘perfect balance’ of food absorption and insulin activity. Its really hard (for me a nightmare still), but I think the trick is to balance the food/type of food and the time you take the insulin.
I was on the Dex for about 3 months to learn my spikes and rhythms and it really does teach a lot about BG. But the variances and alarms just drove me crazy. I am seeing much better results without the CGM as I’m a bit obsessive about things like that. I almost went NUTS one day because the CGM wasn’t responding (I had taken a Tylenol). I thought I was going to die. That’s when I figured I’d better stop depending on the Dex so much. I disconnected and haven’t looked back.
I’m glad you’re learning from it. I learned a whole lot from using one for even the short 3 months.
Sorry to hear the u gave up on the CGM - Thats like driving with blinders on - its worth figuring out the peaks and valleys and after just three months i’ll never give up my dex, as i get to know myself better, the dex does not beep at me near so much but when it does, I know something needs attention!
Am I correct that your BG then keeps dropping – it wouldn’t settle at that 120 or close to it? It sounds to me like you need some kind of adjustment. I’m wondering if you increased your basal rate a bit, then you could lower your carb to insulin ratio and might have a more consistent level after you eat. I find a lot of this is true guess work – but that’s what I would try.
