As a moderately active, not sedentary, adult, can you avoid blood sugar spikes of 180 to 200 at the one hour mark after a 60 gram carbohydrate meal? If so, what techniques do you use? (a) prebolusing? (b) overbolusing? (c) superbolusing (d) slight exercise after eating, such as a walk? I am assuming the meal does not contain sugary foods, yet does contain a starch, such as rice, potato or pasta, along with protein and a small amount of fat.
Ideally we would avoid a spike by accurately counting carbs and using an accurate carb to insulin ratio.
Pre-bolusing always helps me. Overbolusing and superbolusing risk a low. A post prandial walk certainly can’t hurt and it’s good for your piece of mind and digestion, diabetes or not.
If you’re constantly or frequently spiking after meals I would focus on testing my carb:insulin ratio first. Once you’re sure that’s correct, work on getting an accurate carb count.
Terry
If the suggestions that Terry gave you haven’t worked, there’s an injectable that can be used to help with meal spikes called Smyllin. I am talking with my endo about it at my next appointment. I wish mine were only the 180-200 mark… I’ve hit the 300-400 mark pretty regularly after a higher carb meal. Pasta and potatoes wreck havoc on my BGs.
I’m on a pump and CGMS and it’s been great to follow and use the information that I have to make sure my I:C are correct. I’ve prebolused for meals and postbolused for meals and I haven’t really noticed much of a difference.
I hope you can figure it out!
Liz
People using pumps might have different answers, but for me rice and cereal are just impossible, and I stay away completely. Pasta isn’t much better and I eat it rarely (only when I’m out at a restaurant somebody else picked and that’s all they have on the menu I can eat). I generally find that once I get up much over 50 carbs, all bets are off and my normal I:C ratio is inaccurate. I don’t low carb it, but I do stay clear of that dangerous level and avoid foods I know I can’t control.
Obviously you need to have the correct amount on insulin based on your starting sugar and carb intake but the timming can be critical as well. If your eating higher glycemic carbs you may want to wait a little longer before eating. I eat cereal all the time unless I’m a little elevated to begin with. Strangly In the morning even if I am in a target range of 85 to 100 I still wait at least 40 min before eating. I think our bodies either use Insulin different or we metabilize food differently in the AM as opposed to the rest of the day. FWIW I eat fairly high carb meals compared to most diabetics I’ve been in touch with. I am usually at very min 60 grams per meal which IMO for an adult male is really nothing. I’d bet most males not watching any kind of diet eat 150 to 200 carbs per meal.
Rice, potatoes, pasta are basically sugary foods, hence the problem. They start digesting as soon as they contact the enzymes in saliva.
It’s possible, but quite difficult to achieve consistently. One problem is that larger insulin doses don’t act predictably. As we all know, ratios are far from perfect. The more carbs/ more insulin, the greater the chance for errors in either direction.
Prebolusing helps depending the person’s digestive rate & how sensitive/insensitive they are to rapid acting insulin. Overbolusing isn’t a good plan.
Others may have a different experience, but taking a long walk doesn’t do much to lower highs for me.
Used to prebolus with Novolog. With Apidra, it is risky. Did not realize this until she was on cgms and would sometimes drop in the first 45 minutes of a bolus. Overbolus we do use for dinner and when she is home – just a slight overbolus – then when we check at the 2 hour mark or 2.5 hour mark, cover the remaining insulin on board. This works. One thing I have not reliably tried is the superbolus. Tried once or twice and did not work.Bummed that superbolus can also make you go low. ICR is correct carb count correct, but the correct dosage will result in a spike of sorts, i.e., with 3.5 to 4 hour duration 200, 160, 120, 80. Or it could be 180, 150, 110, 70, but I can’t get a one hour spike under 180 usually. When she is an adult, I know she can use carb restriction if she wants to, and I’m assuming from looking through the Tu boards that low carb diets work well. Maybe put the Dexcom on and prebolus for some foods, but not others…
Pasta has always been a nightmare for her, including Dreamfields, which causes lows then extended highs. We switched to Quinoa Pasta (in turquoise box). This one is mixed with corn flour. Some quinoa pastas may be mixed with rice or other grains. Strangely, this pasta does not cause a spike for her at all; in fact, it causes lows so we give 20 free grams of this pasta, give 60 grams and charge 40 grams. And she still needs rescue carbs sometimes at two hour mark. Not sure if this is true for everyone but for her it is a miracle food. Her old CDE gave us this tip.
I think so too. But eventually it will catch up with them. 60 grams, 70 tops is what we aim for at dinner. She eats 40 for breakfast and lunch, not hungry and won’t eat more than that. Even with the 40 grams, I think there is a one hour spike regardless of what she eats.
Jan,
I haven’t been able to avoid spikes at one hour unless I eat 6-22 grams and prebolus by 20 minutes. I think it’s all individual. Obviously I can’t eat 60 gram carbohydrate meals. I trim my meals and eat 4 a day. Exercise, not just a walk, has to be intense to affect my BG.
i assume you go to the gym? thats the only reason i can see its needed to eat 60 carbs… and if thats the case i suggest working on your bolus if you have to give it earlier or what not but if it is for the gym id suggest eating high protein, med carbs, med fats protein is the muscle builder otherwise id say cut out some of the carbs down to like 30 or 35…
I am receiving information I had already suspected from following the Tu boards for awhile; that to avoid spikes carbs must be restricted; in some instances, drastically so. Not just a question of using the glycemic index and eating healthy carbs. Perhaps it would be healthier for my niece to eat more small meals throughout the day (though endo disagrees strongly with this). As it is, she does 40, 40 breakfast and lunch and we can control the dinner spike by overbolusing which works for us since we know how to compensate with Ex-carbs at the two hour mark so she does not go low. It will be up to her to decide if she wants to go on a low carb diet when she is an adult. With the exception of using Symlin, which can cause nausea and lows, and experimenting with superbolus more, seems there is nothing more I can do at the moment that I have not already tried. Can reduce to 40 grams if we give another meal; have not tried that. Seems like there is no easy answer.
I am a caretaker asking for a child. Gym every other day at school and she is quite active. She is very thin, in the 20th percentile her entire life. I may experiment with throwing an extra meal in there and do 40 with an early dinner as well, with an extra 40 gram snack following later in the evening. She already won’t eat more than 40 grams for breakfast and lunch (her choice). So may try 4 meals of 40 grams each… Getting some good ideas here.
I bolus about 15-20 mins before I eat so the insulin has time to catch up to the food. Also with a 60 carb meal with lots of pasta, I make sure I am having a lot of protein with the meal as that reduces the spike. Seems to work well for me. If I had just a bowl of pasta and no chicken I would hit 200. For me, the dietician said I must have protein/fat with eat large carb meal.
you are doing quite well and it’s awesome to see a caretaker putting in so much effort!!! there are many D who don’t put in this much effort for their own health. so thank you!
in answer to your original question, i think that this post is around where i’m at. i try to keep carbs to 40 or fewer g/meal unless i’m planning more activity than my usual run. i’ll then add fruits through the day. i’ll prebolus 25% of the total about 15 min before eating and administer the remainder at or following the meal. if i’m consuming something on the sugary side like corn bread i’ll probably prebolus 40-50% of the total. but i have not used Apidra and am not sure about the safety of that.
I am also wondering if the spike is less once you reach adulthood. I remember clearly, at 8, her spike was higher than 200 at the one hour mark, more like 230 hour 1, 200 hour 2, 160 hour 3, etc but we used Novolog which has a 4.5 hour duration for her. Initially, she needed to be 200 at 2 hour mark. Now if she spikes to 180 at the one hour mark, she will not be low hour 4. If she spikes to 150 at one hour mark, she will need rescue carbs or go low. It is possible spikes will improve further but I can see carb load at each meal will have to be considered. I think pedi endos should be more truthful on this issue and perhaps suggest more mini meals. Though any extra meal will add a two hour period out of range. So choose your poison.
Jan, if you are caring for a child then I don’t think the question you asked is going to help you much.
Personally, I don’t think a “moderately active” adult needs to be eating 60g of carbs per meal in the first place. I think Brian touched on that.
If you’re really serious about tuning your carb intake to your activity level then your carbs should ne doing two things, providing fuels for your workouts and daily activity, and providing a glucose source to rebuild your depleted glycogen stores after workouts and daily activity. Simply put, avoiding spikes is a difficult thing to do if you’re not burning through the sugar you are eating, one way or another.
As a “unusually acitve” adult on 60+ g of carbs a meal, I think postmeal spikes above 140 can be avoided consistently enough to warrant increasing your carb intake to fuel your actitivy. I still miscalculate a couple times a week and I do have to employ a whole grab bag of techniques depending upon the situation. But, as an adult, it’s very manageable.
I generally agree with what Alan said about being on a pump versus MDI, except for one thing. The ability to adjust basal rates on the fly is a complete and life altering game changer. I don’t have to limit my workout times to post meal, or spike my BG to high levels before heading to the gym anymore. I don’t have to worry about overnight lows after working out in the evening anymore. After 3 weeks on a pump, I’ll never go back to MDI if I can help it.
If you’re caring for a 10 year old, however, I don’t think any of this is really applicable because it does take a lot of micromanaging and strict adherance to diet and routine.
Superbolus is the one thing that I have only tried once or twice; have never kept trying this; have not got the hang of amount to give upfront, etc. Super may just be the way to go. Will need cgms to experiment with the supers, definitely. And it may vary by food. I had thought, in theory, superbolus should work.
While there are steps that mitigate the spike from a higher carb meal, I do think limiting your carbs gives you a much better chance of reducing your meal spikes than anything else you can do.
I limit myself to 80 carbs a day, my spikes seldom reach 140. Other than meal spikes, most days I don’t reach 115 or go below 70.
An insulin pump is a fabulous tool!
-Lloyd
I prebolus and overbolus. My breakfast is the highest carb meal of the day: Half a bagel with lots of cream cheese and a little sugar free marmalade. About 40 carbs. On most days my BG stays under 120, always under 140. I backfill with some fruit at the 1.5 hour mark.