Help! spiking 5-6 hrs after eating and resistance!

First time poster here. Im desperate for some help.
Me: 50+ y.o. with LADA (1.5) for about 16 years. First few years easy to manage, last year very difficult

  • Dexcom 6 for about 6 mo, pretty amazing I think
  • Long: Lantus 24 u at night, was never too sure about long acting in general, but sugars a bit more variable during day without it, so I’ve stuck with it. Usually in my gluteus nowadays
  • Short: Humolog vial with needles, I found the fast acting pens to be difficult as I was never sure how much the pens were giving me. I rotate around my abdomen, could be an issue…
  • Status HgBA1C is around 8. could be better, could be worse I know.


  1. For a few months now, my sugar will slowly creep up 200 or more points SLOWLY 4-6 hours after I eat, let say a meal with 30 -45 grams of carbs. It doesnt happen every night either, but “most” nights. I think its more common with a fatty or greasy meal, like a restaurant, but can happen sometimes with a home cooked healthy meal like grilled meat, veggie and a sweet potato, and a small chunk of dark chocolate (like tonight!). My new Endo is thinking could be gastroparesis and will be seeing a GI soon. My previous Endo thought I was giving too much dinner insulin, going low, then having a glycogen release, but Im not going low, and if I do I dont have a surge unless I overtreat my low, which Im aware of. Any thoughts? We eat around 6 pm and at 11, 12, 1 AM my sugars at at 300-400, which makes NO sense!! The problem does not seem to be as bad for breakfast (yogurt and coffee) or lunch (salad or protien bar)

  2. Also recently, chasing the high sugars with insulin seems to be more difficult then just treating a regular high sugar. I am giving 4-5 unit boluses 3 or 4 times at to bring it down. Using carb counting/adjustment ratio, that is way off for me, I shouldnt have to give my self 15 units to bring me back from 300 to 150, should be more like 5, and its seems to take more like 2+ hours for fast acting to kick in which is oddly long. Is this a related issue? Or a separate issue like abdominal scaring, resistance, etc?

Sorry for the long post, but Im trying to watch my sugars with the dexom and carb count my meals and the normal rules are not applying and Im scared. Thanks!

If that were me, that would mean my basal (long-acting) were either not enough or had worn off before the made-up “24 hours” it was pretended to last.
I know they claim Lantus can be a once a day dose, but I am 100% positive (and managed to convince my Dr also) that I only get 18-20hours out of it, and when it wore off, my BG would creep up and up and up- which rudely coincided with dinner time- and trying to fix my post-meal high by changing my insulin:carb ratio for dinner was ineffective at best and often caused ugly swings (low then high because I had to treat the low but still hadn’t addressed the underlying issue).
Especially if its only a problem after dinner, it might be worth playing with either the timing of your Lantus so if it is wearing off, it wears off a time that doesn’t coincide with a meal or bedtime. I had dramatically better luck splitting my Lantus dose in half and taking it at 9am and 9pm, even though thats not the official “rules” about how it should work. I am however extremely comfortable adjusting my own doses/ratios/regimens and monitoring to see how -or if!- the changes work, and then readjusting as needed. (I have also switched to Toujeo in the last year or two, and it is WAY more stable for me than Lantus was and my life is all the easier after the switch.)

If this is more common with high fat/high protein meals you can also look into dosing for fat or protein in addition to carbs. Its a little more complicated, but for some people it works really well. The Juicebox Podcast has a few episodes that cover how and why that works, might be worth looking into.

And its SUPER NORMAL to need more insulin (by ratio) to bring down a 300 than to correct a 200 or so. In a really rude feat of biology, being high causes insulin resistance which makes the high harder to bring down which just makes everything a little more challenging. I probably add 20% to the straight math of correcting a 250+ for myself, and if Ive been there for a while Ill start with at least 30% more because I know that for me, the longer Ive been high the more stubborn it is and the more insulin it will take to correct. Without a CGM I’d be more hesitant to do that…

And, I might offend people by saying so, but an A1C of 8 is… your business! Sure, we could all try harder and do better and all that jazz, but studies show that even with an A1C in the solid 7s, we’re statistically not likely to suffer serious complications. If you’re doing what you can with the tools you have and managing to live a life that’s also otherwise okay, you’re doing great! Don’t apologize to anyone or beat yourself up over not having perfect results!

A few other bits though, because diabetes is complex and theres never just one thing dependent on one other part…
Site rotation is good for so many reasons! You’ve got arms and legs for a reason, so spread the love and jab them also.
Your carb:insulin ratio can change throughout the day, so if you’re using the same ratio for every meal, it would be very reasonable to have to adjust that up or down for different time periods. I think a higher ratio in the morning is more common, but theres sure no hard and fast rule that precludes anyone from needing more insulin for lunch or dinner than for the other meals.
Basal is just an amazing tool! Get a copy of Think Like A Pancreas by Gary Scheiner for a lot of good info on why you should love it but also how to teat your dose(s) and see if you’re on the right track.

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I’m going basal is too low (need to increase Lantus dose).
Or, perhaps split the Lantus dose into 2 seperate shots with 2 different dosages - like one in the morning and a different one at night. But, since your mornings are OK, then I’m leaning torwards slowly bumping up that Lantus dose from 24 to around 30 - but do this slowly (1 unit per day, maybe) so that if it is gasteoparesis, you don’t overdose. You should see improvement within the week. If not, then maybe is gasteo. The leap to gasteo seems like a large leap in reasoning, though.

Your correction short acting dosages to bring you down from those highs should take 4 hours, NOT 2 hours. Correction is different than meal time insulin. Mine take about 4.5 hours.

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I would definitely split the Lantus dose. I always did and didn’t have a problem. Also lowering your fat intake will decrease your insulin resistance. You might want to look at the Mastering Diabetes website which is run by two type 1 diabetics who are both very intelligent. They are experts at lowering insulin resistance.

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I had similar issues a long time back and the only way to correct for me was to go to 1 meal a day at lunch time. If I eat dinner, then same will happen to me unless I take fasting acting insulin every 2 hours subsequent to meal to keep blood sugar from rising. So if I have to have dinner at 6PM due to a family or business gathering, which I pre-bolus fast acting Humalog for about 15 minutes in advance of meal, then I need to take additional insulin at 8PM, 10 PM and if it was more than a light meal, then also at midnight, 2 AM and 4 AM. I stopped Lantus a few years back because it was causing me daily nightime lows so only use fast acting insulin and I am on MDI (multiple daily injections).

The amount of insulin to take every 2 hours will need to be determined using your Dexcom unless you know your I:C ratio

Two things I noticed—- you say this happens at night—- eating your last meal of the day earlier before your body goes into evening mode and your digestion and metabolism slow down can help

Also you nailed it— it happens more with greasy fatty foods

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My thoughts are it could be any of these- you need more basal, you need to eat less carbs per meal and smaller meals with less fat, you need to eat more, a snack at night with correction as well when needed. 8 is not good, you are getting damage so it could be gastroparesis or other digestive issues too.

Once bg goes over 200 it usually takes a bigger correction and longer to get it down, and your bg will bounce around more for several hours after.

There are a lot of other things that can affect bg, it can spike for hours and crash unexpectedly according to how your body is using the insulin in the mix with hormones, illnesses, sleep, food, activity and so on. And each day can be different.

I recommend a pump for issues like these because it gives you real control of your basal that you will never have with mdi. Some people say they are more stable on the newer long acting insulins so you could try them as well.

You you do a miss a meal basal check?

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