After Meal Spikes

Need suggestions, please. I’ve been on an insulin pump since September, 2010. All of a sudden in the last week, the amount that my blood sugar rises after meals is much higher than before. My post-prandial numbers are fine, under 140. It’s just that the rise in my blood sugar in response to food is higher. Before, it usually didn’t rise higher than about 150. Now it goes as high as 180 or 190. My food choices have remained the same. Can I adjust something to reduce the height of the rising? I’m afraid if I increase my basal rate, I’ll just go low before the next meal. If I change the carb ratio, it seems like I would go low at the two hour mark or shortly after. I will say that here in South Louisiana, it’s been really hot the last week, but I thought insulin needs went down in the summer?

It sucks that things have changed, but its part of the disease. Just when you think you’ve got a handle on this, something happens.



If you change your insulin to carb ratio do it very gradually, and only a small amount at a time to be safe. I had to do this recently, after an illness. My ratio went up and has not returned to my previous “normal”. My diabetes nurse advised me that this is pretty common with type 2, as your pancreas wears out and you lose the last of your remaining beta cells, or your insulin resistance increases, or a combination of both.



Your blood sugar could be lower between meals anyway. 140 is high enough to develop complications down the road. Organ damage starts when blood sugar goes over 140. So while its higher, (just after your meal), damage is occuring. Its best to keep your blood sugar under 125, or possibly lower, if you don’t have any heart problems. Its not something all of us can achieve, but its something to aim for if you can.



You could try increasing your mealtime insulin just one unit at your largest meal of the day, which for most would be supper and see how that goes for 5 or 6 days. You may need to increase it for all meals, like I did, or just the one. Check with your doctor first of course. You should monitor very closely. It can take 4 days to a week for changes to really make an impact, so go very slowly. Changes are cumulative, so the true impact can’t be known for a while.



One other thing to consider is the possibility of an infection. Infections can raise blood sugar. If there is nothing obvious, could you have an abcessed tooth, or gum infection, or even a small boil. Anything like that can have a affect.



Also, check your insulin. If it got too hot, it may have lost some of its effectiveness. Extreme cold can also affect it and freezing ruins insulin. Consider using a fresh vial or cartridge just to be sure that its not your insulin, before making any dose changes. If a fresh vial doesn’t make any difference, then you may have a hidden infection, or your diabetes has advanced and your ratio needs to be changed slightly.



One other thing, open a fresh vial of test strips to test for a day or two and see if the numbers are the same. If you have testing solution for your meter, use it to make sure your meter and test strips are fairly accurate. If they are, then try fresh insulin, if neither makes any difference, talk to your doc about making changes.



The other thing that can help of course, is to reduce your carb intake, which is what I’ve had to do. Walk more too if you can.

Thanks so much for the information and feedback. Interestingly, I saw my Endo last week and though I was excited about my last A1c (5.8) she was worried and not happy. It’s been under 6% for the last 9 months since I’ve been on the pump. I’m having lows the hour or so before each meal. We have now reduced my basal again, because she thinks the spikes, even in reaction to food, are because I’m rebounding from the lows before the meal. I didn’t think the lows were that bad. They are usually in the low 70 - low 80. Of course, I have had a few in the 50-60 range, but those aren’t the norm. Well, we reduced my basal, completely across the day from 1.4/hr to 1.3/hr and no more spikes. I’m still having some lows, before lunch and dinner, but they aren’t as low. Maybe between 78-85. I have to fax her my numbers next Tuesday. My guess is she will reduce the basal again just a little.