Hello,
I’m new to the forum and was diagnosed with T1 4 months ago. My question/issue is that all too often I have a normal starting blood sugar, then eat (a non-fatty/non-pasta meal) and bolus. At 2 hours post meal, usually have a good reading of 140 or less. But at 4-5 hours post-meal, I’ve risen up to 200. To my knowledge, I have no other health issues, I run 3 miles 3 times per week and I work out on weight equipment 4 days per week. To my knowledge, I have no other issues, no stomach or bowels issues. Any ideas why this could be happening and what to do?
If the meal is not high carb/high fat causing a delay in spike, than my guess is you need more basal for those time periods. In general basal affects the "in between times" as well as fasting numbers. I would raise your basal rate for the time zone two hours before the period where you see the rise.
Thank you, Zoe…I will have to try that. I did re-test my basals last week by fasting through all 3 meals and my results for that were all right between about 85 and 110, so I was thinking my basals were fine, but I’m just not sure what else it could be other than that.
I'm not sure what a non-fatty, non-pasta meal exactly is. Is it a big old hunk of lean protein? Is it rice? If you just eat protein, you should expect that it will digest over a period of 3-5 hours and if you don't bolus for protein it you may well get exactly the sort of response you observed.
You didnt mention the times you work out. Working out on weights could be raising your bg’s.
It doesn't seem to be correlated to working out on weights. It happens on running days just as much as weight days. It happens with a tuna and cheese sandwich, with Cheerios, foods that shouldn't be doing this whatsoever, so I'm perplexed.
I agree with Brian, if they’re high protein meals, you might want to try an extended bonus, of you’re on the pump that is, or at least blousing for protein.
It might also be that your carb ratio is a little bit off. I was very surprised that when I started pumping, I learned that very small adjustments could make a big difference between flying up to 180-200 and being more where I'd want to be.
I'm on the pump and also now considering the Dexcom CGM because of this issue, but my 2 hour post-meal readings are almost always below 120, but if I check it after 3-4 hours, then they're up to 160-230 which makes no sense because each meal is typically about 75-85 carbs, maybe some protein and fat, but nothing "substantial". I'm talking about meals like rice, cereal, granola bars, yogurt, tuna, etc.
75-85 carbs is a lot for a meal. I find it hard to reliably bolus for anything in excess of 50 carbs. Also, many of us have a hard time reliably bolusing for cereal or rice. I cannot eat either of those foods at all anymore.
Hmmm--okay, maybe it's the number of carbs...I hadn't thought of that. In the past, I was told only 100 or more carbs at a meal would require an additional extended bolus, but maybe I need an additional extended bolus for anything over 50 or 60 since my meals are typically 85ish--it MUST be that b/c I sure can't think of anything else since I know my basals are correct. For cereal or rice, I bolus about 20-25 minutes prior to eating and that seems to work as long as I do it that far ahead.
This happens to me too.. I spike up 3-4 hours after a meal.. I have tried a lot of things but there is really no way to control it for me other than to test a lot and when I see the rise I take more novolog & or exercise to stop the spike. My spikes are usually in the 150-170 range. We raised my basal but this has made me go more hypo most of the time, I think, but has not stopped the spikes.. raising my morning basal did stop most of the am spikes(knock on wood) :)
I'm no expert on the mechanics of the body, so I may get the some of the following details twisted, but I worked with Gary Scheiner (the author of Think Like a Pancreas) and he suggested that it could likely be that since the stomach can only churn so much food at a time, if I'm eating more than it holds and churns at one time, this is likely the cause of the spikes since the major effect of the insulin is gone during the first 2 hours, but if the stomach is still processing the remainder of the food, then glucose is going to keep rising as the insulin wears off. That kind of follows what Zoe said above too. Gary said we could try to increase the bolus amounts then use a combo bolus, but sometimes I just don't know which exact meals will need this and which won't, and like meee's post said, I don't want to go hypo, so I think I may just get the Dexcom G4 on and watch the trends and re-dose as necessary to cut the late spikes. It's not really an option for me to eat much less than 70-80-90-100 carbs per meal (I work out a lot), so I suppose this forces my hand towards the CGM--and we all need to get used to CGM anyway because the artificial/bionic pancreas requires it, and that's only a couple years off--yay for all of us! :-)
I find cereal to be the worst food when it comes to controlling blood sugar. I tried everything i could when i was first dx'ed so that i could eat cereal, including buying the 'healthiest' cardboard tasting cereal from trader joe i could find. It still shot up my blood sugars. Bottom line, every cereal out there is processed to the max and loaded with sugar and diabetics should really think long and hard before eating it.
It may not be a bad idea to eat more protein and healthy fats(olive oil, avocadoes, coconut products), and less carbs like rice and bread. This would definitely help the blood sugar, and beneficial to overall health in general.
You can eat less carbs than that in a day and maintain your exercise regimen. I workout quite often, sometimes burning up to 2000 calories per day with biking and calisthenics. i eat less than 100 carb/day, and am in far better shape than when i pounded down the carbs pre-diabetes. Check out this website www.marksdailyapple.com and it will show you what it means when your body learns to burn fat for fuel instead of sugar.
I eat ALOT of meat, vegetables, salads, nuts, seeds, etc, especially on my heavy biking days, and my insulin action seems to match my digestion perfectly, as my blood sugar very rarely even reaches triple digits.
I am also looking at getting a cgm, but just because I'm a control freak and want to know exactly how my bs responds when i start exercising and between tests so i can maintain that coveted 83 reading for as much of the time as possible
I eat a large breakfast and have discovered that I have to defer about 16 carbs (1.35 units) of the bolus until 2-2.5 hours after eating. I'll take that extra bolus even if I'm below target when I test at 2 hours. I had always assumed that the reason was that the meal also includes a lot of protein and fat but maybe it's just the amount of food.
Wow–less than 100 carbs per day? No thanks! That’s like 1 smoothie’s worth of carbs per day which is so miniscule–up until diagnosis 4 months ago, I was probably eating 600 carbs per day, so going down to around 300 carbs a day now is about all I can handle. I think I’ll just do like ‘young at heart does’ and bolus more a couple hours later.
It occurs to me that perhaps the "culprit" here might be protein? Approximately 50% of protein will convert to carbs and, FWIW, it's a bit more labor intensive and slower so perhaps that would be in line with the evidence of the later spikes with what seems to be a great 2 hour result. If the meals are substantial, there could be quite a bit of protein involved that could be covered?
Ok, so when you a meal your stomach will hold the meal and the valve (pyloric sphincter) will open and shut releasing measured amounts of food into your digestive system. When you eat a large meal, this slowed digestion may take place over longer periods of time. Other things that can slow your digestion include fat and protein. So yes, you could use a combo, extended or dual wave bolus for this.
Another think to remember is that if your insulin profile is not matched and your "peak" insulin misses your "peak" blood sugar, you can have a dose mismatch because the missed insulin is at least partly wasted.
And while I realize you may be working out, you are not Michael Phelps. Many of us have concluded that while carbs provide easy energy, excess carbs have the adverse consequence of making our blood sugar harder to control. Humans work perfectly fine using fat for energy, but you need to adapted to burning fat as opposed to carb adapted. Being newly diagnosed, things may well be easy for you. Maybe life will be wonderful and you can keep this up. But for many of us, it is hard.
Hey acid rock, I thought protein only converted to carbs in the absence of carbs…and that if you eat a decent amount of carbs along with the protein, then the protein never converted to carbs? However, I can see how if you eat both protein and carbs with a meal that constitutes a “big meal” where the stomach is overfilled, more insulin will be needed later once the rest of the carb portion processes through the digestive system…ugh so much to think about! Will be glad when the bionic pancreas is here in a few years–it will take all this calculation nonsense out of the equation!