So mom’s blood sugar was out of control after surgery due to an infection which she was treated for at the hospital with antibiotics ( she stayed here for abt a week). When she came home, her blood sugar readings were a lot better. That lasted about 3/4 days?
1 unit per 10 grams of carbs on humalog and 16 units on Tresiba ( prior to surgery, it was 24/25 which worked wonderfully).
A week later. Mom’s blood sugar is AWESOME SAUCE 2 hours after meals but a huge QUESTION MARK 4 hours after meals?!
Disclaimer: The following is not medical advice, as I am not your mother’s physician, nor have I examined her.
If a PWD’s BG is fine 2 hrs. after a meal but high 4 hrs. after, that’s an indication that the basal insulin dose should be increased (or, much less likely, that this represents a spike due to the meal having a high fat content). If it were me, I’d increase basal insulin by no more than 2 units every three to four days in order for things to “settle out” before making any further adjustment(s).
There are also two reasons that your mother could be having a rise at 3-4 hours. If she is eating meals that are low carb, high fat or contain significant amounts of protein and/or fat then the meals may be slowly digested and absorbed over 3-5 hours. The second reason might be gastroparesis which is characterized by slowed stomach emptying and often accompanied by nausea, bloating and even vomiting.
So, the obvious culprit is an increase in basal needs. The other possibilities, such as a slow-digesting meal rich in protein and fat, and/or gastroparesis, are also very possible suggestions. If she had gastroparesis I would assume she’d go low before eventually going high, because her premeal insulin might kick in before the food is digested. But, I could be wrong and probably gastroparesis can manifest in a lot of ways.
If it’s just about the content of her meal being very rich in fat/protein, the easy way to test the difference is to serve a meal with the same number of carbs but, say, twice the protein and fat on one day at the same time versus another and see if you still see a pronounced spike 4 hours later. If you do so only on the high-fat/high protein day I’d suspect its’ the food, which may need an extended bolus or a follow-up shot like an hour or two after the meal. If you see the rise no matter the meal, it’s more likely to be a basal issue.
Practically speaking, I have trouble being a purist about what’s basal and what’s bolus because my son is ALWAYS snacking and we use the same insulin for both. But since you’re on MDI, it’s definitely worth figuring out.
So glad to hear your mom is doing well after surgery. She’s lucky to have such a wonderful daughter looking out for her!
