Lately seems that after I take my CHO and Insulin at meals, 1 hr after meals my BS come down nicely to around 80-100. Then after 1.5-2 hours they start rising again to around 200 and stay there for another hour or 2. I am Type 1 non-pump. Not sure if is timing of meals and insulin or if I have delayed absorption? High fat? I have increased my protein intake at meals which may be a factor? Cant seem to get them down and stay there till next meal? Any suggestions?
Thank you
There are meals, especially high protein meals, where good old fashioned R (Regular) insulin is a better match than the fast-acting analogs.
While I only use the fast-acting analogs today, I miss how good a match old fashioned R insulin was to some foods e.g. pizza.
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If you aren’t going to switch to pumping, one option is to take 2 boluses but you can NOT wait until you see your post-meal spike occur, or it will be too late to fix, as well as lead to a later hypo. It’s so much easier on a pump as you can do an extended bolus.
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Since you have increased your protein intake that will often delayed absorption and glucose rises that you describe. If you were on a pump, I would recommend experimenting with extended boluses.
For people who use multiple daily injections, MDI, you could consider trying some alternate insulin. Are you using a rapid acting analog insulin like Novolog or Humalog? Those formulations match reasonably well a diet weighted toward carbohydrates but do not cover higher protein or fat content very well.
You may want to experiment with using old fashioned Regular like Humulin or Novolin. These are much less expensive formulations and can be picked up at Walmart without a prescription. Regular insulin has a slower onset and peak and last a few hours longer than the rapid acting insulin. You may find that some combination of the rapid acting and Regular might be the answer for you.
Dr. Bernstein in his book, Diabetes Solutions, provides a full description and discussion of this topic. This is done, however, in the context of low carbohydrate eating. The concept still holds with higher levels of carb consumption. He also recommends, in some eating scenarios, the use of the intermediate duration insulin, NPH. This insulin can be tricky to use but can be used strategically in certain eating situations.
Good question and good luck!
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Thank you.
I did pick up his book however have not read it yet. I currently am using Novolog. I am finding mod protein with my normal carbs are ok. When I introduce more fat and protein is when I find this trend. Is it possible to wait till almost done with meal before injecting? Maybe split injections to 1/2 at meals then the other 1/2 after meal? Thoughts?
Thanks so much
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Thanks Dave
Thanks Tim
What if I had a protein snack or good fat snack between meals. Trying to get in additional kcal. Have had a 7# wt loss in a year or so and already BMI is 21. Cannot afford more wt loss. Ideas. Would like to gain weight. AM eating 90gm CHO each meal already. Metabolism is high and runs in family so challenge to keep weight on. Exercise regularly.
TIA
When you think about it, we can only control two aspects of insulin delivery: dose size and timing. What I would suggest is use the same meal and try altering various factors. You could play with prebolus time, split doses and timing. Keep a notebook and you will eventually come to some customized conclusions that work for you.
Once you’ve perfected one meal, you then have a template to discover the solution for other meals. I realize that our bodies can change some from day to day and also at different times of day, but you will learn the rough outline of your personal metabolic needs. Personal experimentation is a potent technique often overlooked. Don’t shortcut writing stuff down — it’s a forest and trees thing!
Please report back your progress or lack of progress. Good luck.
Thanks for the suggestions. I have only been at this for about 1.5 yrs. Gets frustrating when I see it over 200. Usually 80-150 regularly. Over think at times as well. A1C is 6.4 and would like it lower. Trials and tribulations. I just hate the lows or when BS drops fast. Feels yucky.
As @Terry4 suggested you might try
using several different mealtime insulins. This may seem complicated, but wanting to share to help.
I use Humalog, Regular (purchased at Walmart), and Afrezza. Because I eat relatively low carb–which means more fat and protein–I mostly use R for large meals. If I’m eating a meal more heavy on the veggies and without too much fat or protein, I use Humalog. (I also use Humalog daily for feet on the floor and sometimes for corrections.) I use afrezza rarely (samples from my Doc). I love it for corrections (much faster than Humalog) and for rare cheat excursions. I would love to use more often, but ins doesn’t cover afrezza and it’s pricey!
When I use R for a protein heavy meal, I find that dosing just as I eat or even AFTER I eat works for me, but every body is different. For ex: Today I had 3 eggs with mushrooms and avocado. I bolused R just as I sat to eat. I find R matches how I eat much better than H.
I hope something here may be helpful to you!
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Very frustrating to see high numbers and to think you did what you should and it still happens.
High protein with little carbs drive my blood sugar up and not right away. I made that mistake when I bought some vegan high protein low carb drinks thinking what a great hardly bother snack, boy was I wrong. I had a heck of a time trying to figure out dosing for it and just aren’t drinking them anymore. For my higher protein with normal carbs I don’t seem to have an issue, for a higher fat meal I just take part (usually half or a third) of my insulin when I eat with an extended bolus.
So the best way I can say is a second or even third shot after you eat. The trick is figuring out how much and when.
My A1C dropped with a pump and my first CGM (Libre) and then dropped more with a Dexcom. The tools we have available really do help manage our numbers better.
Being able to respond with small amounts of insulin as needed with a pump and being able to read your numbers constantly with a CGM, and then being alerted to your numbers going north or south before they get out of range are game changers!
Thanks Karin
Thank you Marie. I have CGM Dec. I find Days 1and 8-10 my CGM reads are off so am afraid to switch to pump. I take small Amy’s now 1:30 so 3 units at meals and 6 night of Toujeo. So pump would be very small amts. Thanks for the input
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Afraid to switch to a pump because of CGM accuracy for some days? I can’t follow the reasoning. I switched to a pump years ago when just doing finger sticks and it was the smartest thing I’d done. I had to dump my dipstick of an endo who wouldn’t authorize a pump. The new endo immediately Rx’d a pump. Soon after, I got my first Medtronic pump, and thru frequent testing I was able to set the correct basal rates in quick fashion and then refined them over the course of about a month or so. Frequent testing was something I had been doing for many years. When I got my CGM 2.5 years ago, I was still testing, on average, 17x/day. A CGM is a godsend. But having a pump is also a godsend. Do not fear a pump!!
Thanks Dave. What I mean is that at times my CGM could be off 20-40 points and then would be afraid the pump would over correct for a false high reading. This happens during the first day of a new CGM sensor and the last 2 days. My Dexcom sensor appears to never last 10 days. Get on average 8 days out of the session. I will get “no reading” errors or “calibration errors” which then will not communicate with the pump…correct?
I really appreciate the information and confidence in a pump. My A1C currently without pump is 6.4-6.5. Would like to be around 6.0 however may risk hypo.
Brett
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If you are afraid of a pump correcting a “too low” or “too high” not all pumps auto correct. I only know my Omnipod but I enter my Bg number to decide on a bolus, but I can enter in any number I want or skip entering a BG altogether for a bolus. And I can just give myself insulin with no other numbers entered at all if I wish.
This happens to me, too, often but not every sensor. Have you tried different sites for the sensor? I finally moved the sensor to my upper, back of arm and find the sensor lasting closer to the full 10 days now.
I agree with you, on the first day readings can be off which can really make using the pump in closed loop very difficult. I’m usually 90+% in range, but on day 1 of sensor when readings are off, my time in range plummets to 60%! Of course, this is because the readings are inaccurate! I haven’t yet decided how to handle this. Maybe it is better to go open loop on day 1 and revert to finger sticks!
Got it.
TY Marie
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I don’t have my CGM connected to my pump, I don’t trust a CGM that much. 