I am trying to prevent a spike after breakfast. I normally take 2U for 30g C in the morning for my breakfast which consists of 1 cup yogurt+berries+fruit. I also normally have a 50% increased basal 6-8 am but did not today, as I am trying to move away from using basal to compensate for food. Today I took 1U of insulin at 5:40 am, BG 85, then ate an hour later, BG 65, and arrow trending down. 20 minutes later, BG began to rise, and when I saw the double arrow up, about 30 minutes after finishing my breakfast, I took another 1U. BG continued to rise for another 1/2 hour, and I took another .5U, BG 151. BG then begain to drift downward over the next 2 hours, and now I’m at 92.
My question is, what is the best way to prevent the spike in the first place? Should I have taken the full 2U for the breakfast at 5:40 am? Or should I take an extended bolus, 1U upfront, and 1U extended over two hours? I frequently have this problem. I’ve inserted the xDrip+ image for this scenario below. It’s from a few minutes ago, as now my BG is 92, but steady. TIA!
Almost certainly not the kind of answer you’re interested in, but I’ll share it anyways (for completeness)
Maybe try a lower-carb breakfast? I, like many others, am very “carb-sensitive” in the morning and have high BG after eating even nominal amounts of carbs. My solution has been to delay eating carbs until later in the day. I often have my supplements (only calories from oils), coffee with cream, and nuts for breakfast (usually a handful of mixed nuts, about 28g). All told, I usually have less than 10g of carbs before noon, about 1/3 to 1/2 of which is dietary fiber.
I eat fairly low-carb (60-80 grams net per day with 30+ grams of fiber), but the bulk of those carbs are eaten for lunch (about 1/4) and dinner (about 2/3). Since I exercise in the afternoon, I can generally eat a significant amount of carbs for dinner without unduly affecting my BG.
Thanks for this excellent advice, though as you guessed, not exactly happy to hear I should reduce my breakfast! I like nuts, too, but they do cause my BG to go up pretty rapidly as well. I’m a vegetarian (except I eat some dairy and fish), and I usually skip lunch. Breakfast is a pretty important meal for me because I usually run mid morning or lunch time so I need the energy or I can’t finish the run properly. I think the morning carbs are probably closer to 20g (1/3 cup yogurt=9g, 2/3 cup berries, apple, banana, etc.=10 - 20g) most days but I calculate it as 30g because of the spike I get. I suppose I could try to distribute the breakfast over a longer time period but that would be difficult to do!
Yes, I, too, eat fairly low carb, generally under 60g, though I am not a fanatic about counting as you may have guessed! I usually just eye ball it. I don’t include dietary fiber either as I was told it does not get metabolized.
Dinner is mostly lots of low-carb vegs, tofu, small amount of high carb-vegs like sunchok, potato, and maybe two ravioli/pasta w/ cheese / mushroom, and 2-3 oz of salmon or other fish. Those high-carb items are probably my biggest problems w/ spiking after dinner. All told, I usually take 2U for dinner and calculate it as 30g. I have been getting spikes 3+ hours after dinner though, so I am trying to find a better method, maybe using extended bolus for dinner instead of increased basal that I currently do.
Last night went pretty well. No spike whatsoever because I did not eat the high-carb vegs and pasta, and only took 1U of insulin. I guess it is Trial and Error…;(
You got it, that’s the only solution. You might try varying your breakfast and then testing to see how you respond. My body got used to exercising while fasted (i.e., before eating at lunch) pretty quickly. It felt terrible for the first couple of weeks, and then my body figured out it was fine, and now I regularly exercise (cycling or weightlifting) without having eaten yet.
Regardless, one of the things with diabetes is that I have to test, test, test and vary my routines to figure out what works. What works for me is not always going to work for someone else. I take ideas from others and then try to figure out how they can be applied in my own life. For me, cutting early day carbs, adjusting to exercise without carbs, and finding ways to manage the exercise-related highs and lows has been a long (but very useful) process.
Many yogurts and berries have high glycemic loads. My BG spikes in the same way when I eat those foods.
I’d recommend eating something w/ a lower glycemic index…say oatmeal w/ no added sugar or a 100% sprouted whole grain bread w/ butter. If you don’t mind fish or tofu for breakfast, that’d certainly do the trick.
As for insulin, I’d recommend taking the entire 2U upfront.
Breakfast is notoriously difficult - this is the time when my I:C ratio is most aggressive, and when it takes the longest time for insulin to do anything. Sometimes I just skip breakfast, sometimes I eat low carbs (and still have to bolus for protein/fat). But, here is an example of what I’d typically do for a breakfast with some carbs (25 g in this example): about 30-45 minutes before the meal, I give about 50% of the insulin required in the form of a standard bolus, and I also start an extended bolus for the rest. In my case, the extended bolus is done automatically by Loop high-temping, but a similar extended bolus could certainly be done manually. In the graph below, green is bg, blue bar is bolus, red bar is when I had carbs (25 g), and the light-blue is the temp basal issued by the Loop, with the highest level being 2.5U/h.
Yes, this forum has been so great for useful ideas. I know all will not work for me, but all are helpful in understanding what can happen.
Man, I don’t know I can run without having eaten! That is a challenge. I ran yesterday, my third day of fasting, and actually had to stop and walk half way through for about a half hour to recover, before running again. That might just be fasting though. Funny, but yesterday I hardly had an exercise high, maybe the walking, or fasting? Just went from a low of 57 at the completion, to a high of around 94. Somewhat of a spike, but within range. Usually I’ll go up immediately after the run, and then sometimes go down a few hours later. I wouldn’t cut the exercise though because overall it helps to keep my BGs down. When I sprained my ankle a while back and couldn’t run for 4 weeks, I had to triple my insulin intake just to attempt to stay in range.
Yes, I agree, I monitor with my CGM, but not so much with finger sticks unless I know the sensor is noisy. Maybe I should try to alter my breakfast food content… another trial and error task…
I always eat plain, Fage Greek yogurt, non-fat or regular, it depends on what is available. I always put fresh berries, or whatever fruit I have in it to make a full cup. So no added sugar or anything else. But obviously the berries and fruit are having a drastic effect. I hate to give them up though! I love tofu and I eat it regularly for dinner. Maybe I will try substituenting SOME of the fruit with a lower glycemic index food.
So, here’s what I’ve found about exercise highs. Stress hormones released during exercise cause the liver to dump glycogen shortly after I start exercise. Cycling does this for me, weightlifting does it, running does it, but walking/hiking/etc. does not. A certain level of intensity is required. Two things I’ve found to help with this:
really low-carb eating (like 30g net per day for me) depletes so much liver glycogen that I don’t have any to dump when I get stressed (so, no or minimal dawn phenomenon and little or no exercise high);
and using 30g of resistant starch half an hour before exercise (no idea why this works, but it really does work for many T1s).
The misery of exercising before eating diminished after a couple of weeks: my body figured out how to “free” enough energy (presumably from fat metabolism) to make it no more or less difficult than exercising after eating. I can’t eat really low-carb or I lose weight uncontrollably, so that doesn’t work as well anymore. My solution has been to use resistant starch before exercise (to dampen the high) and eat more carbs than normal after (in order to blunt the low). It’s a balancing act!
That’d be where I would start in your shoes. Many of us have found chia pudding (check out the food section) to be particularly useful. I often do a chia pudding, pecans, frozen blueberries for late breakfast or lunch. Almost all the carbs in chia are fiber, and I’ve found it to work very well for me.
I eat Stoneyfield full fat plain yogurt all the time with little sweetener and a splash of vanilla extract. If I have them, a few strawberries or blueberries. 1 cup of the yogurt has 12 grams. If I get the prebolusing correct, it doesn’t spike me and it’s filling.
Thank you! I know you are on the closed Loop so it won’t exactly match what I need to do on the OmniPod. As an example, would I want to set extended duration be 2 hours, since my graph shows about a two hour window, from bolus to max BG, or maybe 3 hours? I know when I take the full amount up front (pre-bolus that is), I will go low before I begin to rise from the food. It usually keeps my from going too high, but I experience the awful low, too. I usually pre-bolus about 30-40 minutes before eating, but my uploaded graph shows close to an hour today because I was trying to see if that would make a difference, together with taking a 1/2 insulin at pre-bolus, and the remaining later when I started to go high. It didn’t work, obviously:(
Thanks. That is quite similar to what I’m eating, but I suspect I’m eating a larger quantity of fruit. The yogurt only makes up 1/3 cup, and the fruit 2/3 cup. I really want to keep fruit in my diet for the nutrients, and plus, I love it!
That is a great suggestion. I have had chia seeds before and they are delicious but as seeds, not very filling. I will check out the recipes for the chia pudding. Another task of trial and errror:)
Count me in as a fan of chia pudding for breakfast. I make mine with chia seeds, cinnamon, vanilla extract, melted butter, walnuts and berries. The amalgamation of all these ingredients slows down any rise due to the berries. My after breakfast CGM will often range from non-detectable rise to a BG bump that climbs to 120 (6.7) and then gently falls.
@Trying, I like Fage plain yogurt, too, but I prefer the full-fat version. I find the fat slows down and blunts the carb spike. I also find fruit like bananas and apples much harder to eat with regard to spiking than blueberries, raspberries, blackberries and strawberries. The berries contain a fair amount of fiber that also slows down the carb absorption. I don’t eat my first meal until late morning and if I want to blunt a post-breakfast BG spike, I’ll simply go for 30-60 minute walk. For me, I find walking combined with the insulin peaking can effectively pull down any trending spike.
Yes, I saw you mentioned resistant starch in another thread. Something like u-cann?? I am seeing that advertised a lot on Social Media but haven’t tried it.
I don’t think I would be comfortable 30g or less per day. I don’t want to give up running or other intense exercise either, so it is the resistant starch, and the balancing act, and help from this forum! I eat very little after a run. Maybe a few pecans or other nuts but that doesn’t seem to bother my energy level. I hate the idea of taking a bolus/correction after I just spent all of my energy getting rid of excess glucose!
U-cann is one that many people have used, although I haven’t tried it. I use Bob’s Red Mill Unmodified Potato Starch myself after reading about it on Peter Attia’s blog. I have to admit, it took me a while to get the guts to actually take 30g (suspended in cold water) of “starch” before exercise. Seems insane and suicidal.
However, what it actually does is blunt the exercise BG spike for me. I’m not willing to say it is universal, but I don’t think any of the resistant starch in BRM potato gets converted to blood glucose for me. And why it blunts liver dumps is a bit of a mystery, but it certainly works. I especially use it before HIIT, which raises my BG like nothing else in the world.
I mix up potato starch and use to wash down my bed-time pills. Potato starch is resistant starch as long as it’s not cooked. I buy Bob’s Red Mill potato starch.
Thank you!