Going low after eating

I’m just totally puzzled by this…

V’s numbers lately (not real numbers, he’s not even this perfect)

Before eating: 100; 2 hours after eating: 80; 4 hours after eating: 175

Shouldn’t they be more like:

Before eating: 100; 2 hours after: 140; 4 hours after: 100

He used to only get morning lows… Now, bless his heart, he’s added afternoon lows to the picture.

And often the low numbers dip into the 50 - 60 range, and the highs can go above 200.

He’s Type 1 with no pancreas, so he has to take ensymes to digest.

Has anyone else had this rollercoaster?

Any thoughts on how to fix it - other than test constatnly and adjust?

Yes, I know the pump would be lovely, be, let’s assume that’s not an option at the moment.

He takes about 38 units per day - 12 Lantus at night and 8 in the morning; the rest meal boluses. His night time readings are pretty steady.

Thanks for any help

And Happy Thanksgiving to the Canadians!

Hi Katie,
almost every diabetic I know has rollercoaster days, that’s just how it is, even if you’re in good control.
Does V count carbs? Because it sounds like he needs to adjust his insulin/carb ratio and take less insulin to cover his carbs. This also works without a pump. Our insulin requirements can vary over time and are influenced by things like weight, level of activity, new meds, stress and hormones. I’m constantly making small adjustments because of this.
Hope you get this figured out,
Kat

We do count carbs and are pretty careful. He is just consistantly high at noon. If he took more insulin for breakfast, he would drop even lower at the 2 hour mark. So then I think he should take more Lantus… But then he goes low after lunch so that can’t be it. He takes 5 units for 130 carbs at breakfast and 4 units for 75 carbs at lunch (and 4 units for 50 carbs at night, but that seems okay)

As soon as we think we have the answer it goes other way.

Wow, 130g of carbs for breakfast is a lot. What is he eating? This might be your problem. If I eat a lot at once, especially things that are high in protein or fat my numbers will steadily rise for a few hours, even if they are good two hours after eating, because digestion takes longer. And if his digestion is delayed (because of the food, or maybe because he has no pancreas) he will go low after eating, because even if you counted all the carbs correctly, they simply haven’t reached his bloodstream yet when the insulin peaks. And that makes him low and then high later on.

So my suggestion is to see if a lighter breakfast with less carbs helps or taking his insulin 15 to 30min (maybe more, you’d have to experiment) after eating to give the carbs a headway. And if those problems remain, he could try switching to an insulin that is a bit slower that the one he’s currently using.

Hope you get it sorted out,
Kat

Hi Katie,
I have questions to consider, but they are not going to result in a final answer.
The Lantus seems a bit topsy turvy. Yes it does peak 5-6 hrs after taking and so it may causing the low in the afternoon.
But then why isn’t it peaking during the night, if you give it at 10 pm, say, why isn’t it giving a low at 3am?
So the Lantus at night should remain - unless the 50-60 you are talking about starts in the early early morning.
Could the Lantus in the morning dose be too high when added to the evening dose? What are the blood sugars (without the meals interfering with the readings)? Is the Lantus resulting in a nice even across-the-hours 100? That’s what you want to see. No lower. Even if you have him fast a while to learn this, take one day and skip breakfast. Take a second day and skip lunch. Take a third day and skip supper. Learn what that lantus is doing.
Now to the next consideration.
The number of carb grams V is taking results in 1020 calories out of what calorie total diet? Could his protein be raised so he is not taking such a load of carb grams in the morning? Or, does he need 4 meals a day rather than 3? Digesting that load takes real time for his system. In fact, MY system would be totally overloaded. He is overloading HIS system. :slight_smile: LOL
The real problem, Katie, is getting this down to manageable chunks so you can test it out. Digesting all those carbs takes time. Trying to find out what V’s blood sugar is without the meals takes time, too. Take one problem at a time: work out the Lantus problem first. Then reduce his carb grams in the morning. Give him a 2nd meal about 11 am, say. give him a 3rd meal about 4 pm, say. And voila, 4th meal at 8 pm. Divide those carbs in the morning between the first two meals. See if his system handles it easier. THen you’ll be ready to tackle his long digestion, if it’s that.
I’m celebrating Columbus Day for today. And I’m a bit discobabalated cause I’m over in MI for a long weekend closing up a vacation place. It’s COLD here - down to 30s and 40s. Horrible. Not what we usually have here. Stay warm.

I agree with Kat, that’s a lot of carbs for breakfast, and if some of them are fats that could account for the late rise in blood sugar. I also think if he is going low like that 2 hours after eating he is taking too much insulin. Then the insulin wears off and he jumps up from the excess of carbs and fat four hours later. I think he should experiment with his I:C ratio until the results look good as well as consider lowering his intake of carbs and slow digesting fats.

His br5eakfast is orange juice, a bowl of cereal (Bran Flakes) with 2% milk, raisins, 1/2 banana, 2 slices whole wheat toast with peanut butter. He’s always been a big breakfast eater. He normally injects after he eats breakfast - just before for the other meals.
We’re restoring an old farmhouse, so he is working all day - today he took down a tree, Sunday he hung wall paper - so not always the same type of work, but busy. We have 3 meals and a snack - plus, afternoons when he’s usually low he nibbles on cheese and / or a hard boiled egg. His total calories are probably 2700 - 3000.

Now… About the getting him to fast part… Not a chance. Obviously I can get him to do the overnight part, but a daytime fast? Yesterday, I ‘made’ him not eat after lunch - all the way until 7:30 in the evening. Usually, I don’t get the chance because he has lows…

But thanks for all the tips and advice. I have 3 months worth of records, now… I’ll take your tips, the records (and a bottle of wine) and closet myself somewhere to see if I can figure something out.

Any one of those things, alone orange juice, raisins, 2 slices of toast, cereal, would put me through the roof, Katie. All together would probably make me hit 300. ::: shudder::::. He can eat a big breakfast if he likes, but one that is more carb friendly. I enjoy omelettes with lots of vegies and cheese (I’m vegetarian but if you add meat it won’t hurt the carb count) and ONE slice of toast with the peanut butter. If he is eating that kind of carb laden breakfast and then injecting AFTER he eats, it is no wonder his numbers are climbing. I would suggest finding a better breakfast and then injecting 15 minutes BEFORE. And then play with the I:C ratio so you don’t go low and then high. I definitely find Bernstein too extreme (FOR ME, other people say it works great for them), but his “principal of small numbers” makes a lot of sense. The less carbs you are trying to cover, the less insulin you need, the less room for error.

He injects after because if he injects before he goes very low very quickly. As it is he is usually low 1 1/2 - 2 hours after breakfast - before the high. He’s tried having eggs… Just a faster low before the high. If he injected 15 minutes before - I shudder to think where he’d be…
Maybe some cheese instead of the rasins… Just not on the cereal ;-))

I can see there won’t be a fast! With no fast, we assume the lantus is keeping him even all day. You’re really great the way you work at this! I can see, too, that his activity is enormous. It isn’t a desk job by any means. That kind of activity will make anyone go low.
The cheese and egg are not going to raise his blood sugar, as you well know but the protein will go to glucose over time.
How about heading off the low by your taking him glucose tablets or your equivalent after 20 minutes work - and every 20 minutes? I’m not thinking here of food, but of glucose. I don’t think food at this point will prevent the low due to the slowness of digestion. But straight glucose, not going through digestion which is so slow, would likely prevent.
My thrust now is: Let’s get at this by learning what’s needed in glucose for 20-30 min physical activity. An hour later test. See if he needs more or less glucose than whatever you gave. And make it a repeated test. That way you’ll know exactly what’s happening, e.g., prevention or no.
When I’m into major physical activity I like to first take something fast acting plus something that will stick with awhile. Around here I use an Adkins protein bar one time with a peanut butter Nature Valley bar every 30 min. when doing work like that. But you’re going to have to figure out your own glucose/protein power combination, how much and how often, testing to figure it out. At this point I’m concerned a low not get ahead of you! Obviously food would be too slow acting.
Not being anything but persistent, I had a third and fourth consideration to follow up, but after hearing what he’s doing, he’s going to go low with the activity, and you’re going to help prevent lows with every 20 minute glucose - and testing to nail down how much. If you give food, you’ll have highs later and for one afternoon of work, hey, maybe he’ll be willing for the glucose!
There’s no question the glucose from food is not processing normally: digestion is slow. Pulling him out of a low may be slow, so don’t use food; use glucose…
Cheers! I’ll bet your place is getting to be a work of art!

I didn’t look at treating the lows that way. He has a cereal bar because he needs the carbs to work - but he should have the glucose first - then 1 cereal bar. Not 1 cereal bar followed by another because it didin’t raise the low. I knew we were, somehow, contributing to this roller coaster… Thanks for helping me figure it out.
Now, If I could only get him to plan his day.
It’s usually like this:
Me: What are you going to do today?
He: Stain and varnish the new doors.
15 minutes later I hear the chain saw…
Me: What happened to the doors?
He: It’s so nice I thought I would take down a tree / do firewood / trim the hedges / and so on.

He’s lost enough this summer - I don’t want to make him give up his fun / spontenaity too.

Thanks for your help. It’s another day, we’ll see how this one goes.

I know how it goes. We’re doing trees here in MI, too. As you know, Katie, it’s only one problem you tackle at a time!
When you tackle the prevention of low by glucose you are also going on a roller coaster, but hopefully over a couple trials, you’ll get it minimized.
Remember, in the background, that Lantus is working.
If glucose does not stay around long enough to minimize the low long enough, test and give some more.
For 175 lbs, 2.5 grams raises 10 mg/dl.
If he weighs 35 lbs more, then use 3 grams for a 10 mg/dl raise.
For 35 lbs less, 140 lbs, give 2 grams for a 10 mg/dl raise. And figure it from there mathematically.
You must have a marvelous record you’re keeping! And what a book you can write!

We don’t have glucose - for some reason the doc’s didn’t think he needed that. French doctors probably think why waste the opportunity to have real food?
Anyway, I found some sugar-coated fruit jellies at 10 carbs each that seem to work pretty well - he can cut them in half (he won’t, but he could), Today we’ve kept him betweein 75 and 95 which is really good (other then the morning 168 which came down to 94 right after breakfast)
I just have to learn to accept that it can’t be perfectly controlled and that X isn’t going to work the same tomorrow as it did today.
And, it’s about keeping the numbers under control - not about how you do it… So… instead of pumping insulin to keep him steady we’re feeding sugar…

Thanks again…

At the moment he’s hauling the last of the tree branches to the recycling (the ones not good for firewood)

Ah! why not! Ask the pharmacien what they have for glucose tablets - about 2 grams, 4 grams apiece. You may avert going high when you have something that’s really small glucose.
Sounds great what you’re doing, Katie.