Coverage after meals?

I had a discussion with my CDE after reviewing the chart printed from my BG meter. My A1c was high this time (8.0), and after taking a close look at all of my numbers, we’ve concluded that I am correcting my PP sugars too soon. Many times if my CGM gives a high number two hours after eating, I will cover myself with extra Humalog. Many times after, I’m low. She made me promise at my appointment not to treat a high for four hours after I eat. I was very reluctant to agree to this though. The first two nights after dinner, I started noticing a decline after three hours and never needed any extra Humalog. Last night, at the three hour mark, my sugars seemed to be holding strong at 230, assuming I wasn’t going to see much of an improvement in one more hour, I took 1 unit of Humalog. 40 minutes later I was at 60. I was so mad at myself for not waiting, as I’m sure it would have come down on it’s own. My question is, if you need coverage after a meal, how long do you wait to take it?

Hi Tiffany,

It is normal for meals to cause a spike in blood sugar post-meal. My doctors always have me check 1-2 hours after a meal, but never give a correction, and then again 5 hours after my pre-meal injection. Now, the huge rises that you are having are likely caused by the foods you are eating. I’m guessing you’re eating meals that contain any kind of grain, starchy veggie, or fruit… all which cause blood sugar spikes. Even though your blood sugar can come back down because you are dosing correctly, it can still be very dangerous to your body to have those highs at all.

I eat a diet free from grains and sweet foods (just meat, fat, non-starchy veggies), and only experience a rise of about 20 mg/dl an hour after eating. So, pre-meal could be 80, 2 hours post meal could be 100, and at the end of the 5 hours I could be back at a nice 80. If I’m wrong about what you’re eating, I apologize for all the details. It’s just that I used to eat like that, and had numbers like that - always up and and down. Since changing my diet over 2 years ago to eliminate anything that causes a blood sugar spike, my numbers have been great. Definitely read Dr. Bernstein’s book The Diabetes Solution if you haven’t already. Hope this helps.

I do correct after two hours, because the more time we spend over 140, complications can begin to accumulate. However, it’s important to know your correct ISF (how many points one unit of insulin lowers your blood sugar) and to take into account insulin on board. So if I’m at 160, with my particular ISF which is 1:45, and I took 3 units for my meal, at the two hour point I still have a unit on board which should lower me to about 115. (I use a 3 hour duration, some people use more) No need for correction. If you haven’t already, keep records and test your ISF until you are reasonably sure of it and always count your IOB.Though I have to say 230 to 60 after the 3 hour mark seems a lot!

Humalog has a duration of action of 4-5 hours. Walsh in Using Insulin suggests that a good rule of thumb is that 20% of the total dose of Humalog (Novolog) is used each hour after injection. This means that 2 hours after your meal, you could have more than half your insulin still on board (IOB). Altho am cautious about corrections with IOB, I correct at 2 hrs if I am over 140 mg/dl. But I follow a low carb diet and seek to almost never need to correct. Constant correction suggest a need to change your carb bolus.

Last night I had a six inch sub (on wheat) from Subway and an apple. I eat pretty healthy, but I do eat carbs. I’m just not sure how to avoid the spikes while eating carbs. I don’t want to sit high for three to four hours, but don’t want to crash from treating a high too early.

Oops, I meant to reply to you, but it posted above. :slight_smile:

Whole grains and fruit cause blood sugar spikes. You don’t need them, they’re not healthy (yes, even though tv commercials and doctors and nutritionists will push for them) and you can avoid blood sugar rises by omitting them. I really encourage you to read Dr. Bernstein’s book - he explains it all. Also look up information on a paleo diet, but be sure to omit the fruit. They’re basically the same, though Dr. Bernstein’s book spells it out so nicely for us diabetics. There are a million other great reasons to eat this way as well which you’ll find in paleo books. Best of luck.

Tiffany I have to agree with joeynicole. I have always been taught to take a bolus shot two hours after eating to correct any high sugars. But I too seem to run into trouble with that. It’s hard enough taking the correct amount of insulin morning noon and night and then through in corrections shots. It stresses me out! I think you will be fine.

If anyone on DR. Bernstein wants to shot me some adive on how to stay in the 80-90 range consistently I would love to hear it. I am doing Bernstein for close to 4 months now and thought I had it figured out, but now am having an awful time staying between 100-200!

Thanks for your support Yolanda - sorry if I’m sounding harsh Tiffany - I just am so irritated with all the bad nutrition info I am seeing on TV these days :frowning:

Yolanda - if you’ve got the food part down, it’s just a matter of insulin. I had the same issue going from pump to injections - I started eating low carb when I was on the pump, and then going to injections suffered high blood sugars for awhile until I could figure it out. My husband even talked to Dr. Bernstein on the phone, who motivated me to re-read his chapter on insulin and be my own doctor. It worked. You will get there!

No, it’s not harsh at all. I just don’t know if I could follow a diet that eliminated grains and fruit. I choose not to eat nuts because my son has a severe allergy, and I’ve read there’s a lot of emphasis on nuts. It completely makes sense, I just don’t know if I could make it on that diet. There has to be a way to maintain good readings while eating carbs.

I don’t eat nuts either - I don’t like they way they are pushed in the paleo diet… they contain a lot of antinutrients. I get my fat primarily from animal fat (from good-quality meat) and some avocado, some coconut products. I used to never think I could eat like this either. I was raised Italian on homemade pasta, pizza, and bread, bread, bread. And on top of all that, I ate a ton of fruit on a daily basis. I feel much, much better now that I eat just meat, fat, and veggies. I no longer have allergies, acne, or headaches. I lost weight and am stronger… yadda yadda yadda… And my blood sugars thanks me for it. Just food for thought.

With Apidra I know it’s basically gone within 2 hours, so I would go ahead and correct, but that was definitely NOT the case for me with Humalog or Novolog. Humalog seemed to have an action curve much more like regular insulin for me and I was often seeing the effects 6-8 hours after an injection, and Novolog often hung in there to surprise me 4-5 hours after injecting… which is bad when you assume it’s all gone at 3 or 4 hours, and have a surprise low just 20-30 minutes later.

However, I can say that Apidra with all of it’s speed doesn’t often provide very good meal coverage for me as a normal bolus since it’s just too fast - I was having problems going low 30-45 minutes after eating, so I combo bolus almost everything now with my pump. When I am on MDI, a combo of Apidra + R works nicely.

Can you give me examples of what you eat throughout the day? Also, what do you do when your family or friends go out to eat? I know there are usually salads on most menus, but what would you eat at a mexican food restaraunt, for example? How many grams of carbs do you eat on a daily basis?

We correct 2 hours after meals. I would look harder at your ISF/Correction factor…lowering that number would prevent lows. I’m a bit confused - your CDE should be looking at ways to lower your A1C…waiting longer to correct after meals means you are out of range even longer.

You also need to check what your Duration of Insulin Action is set on your pump…this impacts how much insulin you get for corrections too.

Tiffany –

Humalog had a long and unpredictable tail for us, which is why we switched to Apidra. Apidra is faster acting and very predictable, at least for us. It’s duration of action is about 2.5 hours. Humalog was 4 hours for us. If you can’t get things leveled out after adjusting ISF and DIA, this might be something to talk to your endo about.

8:30am Breakfast: 4 eggs, 4-7 pieces of bacon, coffee w/2 oz of heavy (grass fed) whipping cream
2:30pm Snack: grass-fed beef jerky or leftover dinner protein, 1-2 ounces of raw cheese
6:30pm Dinner: steak & asparagus / pork chops & spaghetti squash / skin-on chicken thighs and roasted broccoli / grilled sausage and peppers / taco lettuce wraps topped with cheese and guac…

This works well for me, as I wake with a big appetite. My husband isn’t as hungry when he wakes and typically just has coffee w/heavy cream, and then has a big lunch and the same dinner as me. My breakfast is loaded with good fats, and keeps me full all day. It’s convenient as well as satiating! When we work out more often, we’ll both add a bit more protein and fat during the day, just according to our hunger.

Also, you don’t have to do “eggs” or a typical breakfast for breakfast. It just so happens that bacon and eggs is my most favorite meal ever so I eat it every single day. Don’t be afraid to grill up a nice steak for breakfast - protein is protein. Another great idea is to make twice as much dinner and eat the leftovers for breakfast. Tonight, I’m making a double batch of tacos and I’ll probably eat the leftovers as my snack tomorrow afternoon.

As for eating out…

Mexican restaurants are great - order the fajitas and have them hold the tortillas. I also have found great slow-roasted pork at mexican places - again, hold the rice & beans and get another veggie, like asparagus as a side. At Chipotle, I get a fajita bowl w/the veggies, choice of protein, cheese, lettuce & guacamole. If I’m really hungry I’ll order double meat.

You can also order burgers without the bun, sub a side salad for the fries. All restaurants have some sort of protein and all you have to do is ask (usually!) to get what you need. Never be afraid to ask for double meat if they don’t have a veggie side for you or if the protein portion is too small.

My husband eats the same way I do. My parents do as well, so going to there house isn’t an issue. My in-laws are trying to eat this way, so they keep good options when we eat together. It did take everyone awhile to come on board, so in the beginning I would eat what they had, and my blood sugars suffered for it. I decided for my health that this was no longer an option, and they all understand now.

I do shy away from dinner at friend’s homes as it can become really awkward if you deny all their side dishes and dessert. We suggest getting together for a happy hour or dinner out so I can be picky with the waiter instead :slight_smile:

I eat 8-12 grams of carbs per day, typically just at dinner. Have tons of energy. Do crossfit workouts 3x/week. Life is good!

I have lots of super low-carb recipes on my blog, if you visit my profile there’s a link there and you can search by “recipes.”

That’s funny that you mention this because I just got scolded by my endo for doing this! The four hour time frame is a good time to wait, or you can drink lots of water and try to exercise instead of correcting right away. Right now I try to take the dog for a nice long walk after a carb-loaded meal or hit the gym. If you are carb counting, it is dangerous to “chase your numbers.” I hate being high so it’s tough not to do this sometimes. A few nights ago I was 120 2hr post meal and then shot up to 200 and stayed there for about 4 or 5 hours, not responding to any corrections. Finally I was back to 127 and had a snack and went to bed (and covered for its 15g). I woke up at 1am at 44, then over-corrected (because I felt like death) and woke up high again. See, it’s a bad cycle!

I’m not currently on a pump. However, I did fill out the paperwork to get the process started for an OmniPod. I also agree that waiting four hours to correct a high is a bit odd, but my experience has been that when I correct at the two or three hour mark, I always drop. Because the drop is so rapid, like it was last night, I felt it was low before my CGM ever gave me an indication that it was heading in that direction. It read 180, but I tested at 60. Maybe 10 minutes later my CGM was indicating a rapid drop. It seems like it’s about 15 min or so real time.

I’m not sure what else to try. I just ate lunch and I had a chicken burger with a slice of cheese on one piece of bread. Total carbs was 20. I would have like to eat something else with it, but all we have is fruit. I need to grocery shop tonight. :slight_smile: For those that eat the lower carb diets, you don’t worry about spilling ketones in your urine?

Well, when you burn fat your body generates ketones. That is not DKA which happens at highly elevated bood sugar levels. And low carb does not just mean meat, you can eat all kinds of veggies. I love all kinds of green veggies. Stock up on all those veggies, just skip the starchy ones.

ps. I think your lunch choice was great. I find that the (low carb) wraps can also work out well.

Hi Tiffany -

I eat 160 or so net carbs a day and maintain an A1c under 6 most of the time so that it is possible to eat carbs including whole grains and fruit and still have ok numbers. Going low carb does wonders for some people but it isn’t the only way to go.

If you are running high for 2-3 hours and then going low at around 4 hours, it might be that your basal is set too high and your insulin to carb ratio is set too low. In that situation, you would spike after meals and then your basal would gradually cover the carbs at 4-5 hours. Have you done any basal testing? If you don’t eat, your basal insulin should keep you within a +/- 30 point range. If you are going down more than that, you are taking too much basal and you probably can improve your control by reducing your basal and taking more rapid with meals.