High in Mid-Afternoon.. HELP!

My sugars have been high in the mid-afternoon for about a week now. I took a pattern management class recently, and we have changed my insulin dose about 3 times since 2-25. It is still high. I dont know what to do! Do I still change it even more? When changed it last time, I was low before lunch… ugh! So… now what!? I don’t want to get low before lunch because then I will be late for lunch and then I wont have a spot in the lunch room- boo- hoo): Any advice?

What you need to first figure out, Julia, is if your highs are caused by bolus or basal. Have you done basal testing? Even without basal testing, you can look at the patterns and see which is causing the highs. When do they occur? You said mid-afternoon, so I’m assuming you are talking about 2 hours after lunch. That would mean your bolus is too much and you need to reconsider you lunch I:C ratio. If it is now 1:10, try 1:9, etc. If you are fine, though 2 hours after lunch and then go high before dinner than you need to tweak your basal dose. Assuming you are on MDIs you want to tweak it by one unit and then sit with that for 2-3 days before you change another unit. But first you need to clarify which you need to tweak: basal or bolus.

Wow! What does all that mean?!? I dont have a pump yet so I’m not sure what basal and bolus means, so… What does MDI mean? Sorry I wasnt clear(: LOL! Maybe if you could explain it in syringe terms, I would understand(:


MDI= Multiple Daily Injections (taking lots a manual injections daily). You didn’t mention what type of insulin you are taking. But, in shot terms…Basil insulin would be like taking NPH, Levemir, and Lantus (the long acting insulin). A Bolus would be like taking Humalog, Novolog, or Apidra for handling meal carbs (fast acting). If you are high you could take a Bolus correction shot (small one) depending on how high you are. Maybe you needed more insulin for your lunch meal if you take shots then. Or better yet, if your blood sugar is below 200 go for a 20 min walk. Recheck Blood immediately after your walk. Ken

I seem to need to adjust my carb ratio at lunch. A little bit of extra insulin then seems to help keep things smooth? If you’re not sure about the terms, it might be worth it to take the time to read up on stuff, “Think Like a Pancreas” or “Using Insulin” are really good owner’s manual kind of books that can help you understand both the terms and what’s going on?

How much did you change it by? A couple of extra units mid morning might help you along and keep it on a more even keel. It does generally take a couple of hours for your insulin to kick in, which would explain the highs after lunch.

Mine is the same after breakfast. I can be normal or near normal before breakfast but within 20 minutes of eating a slice of brown toast I can go to 28mmols!! But if I was to take insulin a couple of hours early, it would stay within reasonable limits after breakfast. I realise that we are all different but it is worth a try. Are you pumping or injecting?

Things change a lot in the early days! As Zoe said, first determine which insulin needs to be changed – are you taking a basal AND a short acting or just one of them? Being high after fasting, like in the AM or very frequently throughout the day, is usually a sign that the basal/long-acting needs to be changed. A high up to 3-4 hours after a meal usually means that you need to change the short-acting insulin. But when you say that increasing the dose brought you low at lunch it almost sounds like you’re just taking a long acting insulin (lantus/levemir)? If that is the case then it may be time to add a short-acting insulin and you should discuss that with your doc.

Good luck! Doses do change throughout your life, but it’s usually worst in the first year or two after diagnosis.

OK! Thanks for the info!
In the morning I take 2 humalog and 19 humalin at 5:30. I eat 60 carb breakfast. Around 9:30 I eat a 15 g snack, then at noon I eat a 60 g lunch, but sometimes I cut it to like 45 or 50 because I really dont want to be high. The doctor told me not to change my meal plan… oops! I dont change it everyday, but you know, I dont want to be really high.

A couple suggestions, Julia. First of all humalin is an older insulin. You might want to ask to be put on one of the newer basal insulins (long acting) such as Lantus or Levemir. Second of all 60 grams is an extremely carb-heavy meal. Many of us can’t handle that many carbs for breakfast and it is a guarantee of being high. 60 grams is to me a lot for lunch as well, but some people do successfully eat that amount. I would suggest a doctor who was more flexible about meal plan! Or a Dietician, Diabetic Educator who will work with you. I would be very surprised if you could cover 60 grams of carbs with 2 units of Humalog. I would suggest, rather than a fixed dose of 2 units that you learn how to do an insulin carb ratio. Such as 1 unit for every 15 carbs (that is an average, yours might be more or less). If your I:C ratio were 1:15, that means you would take 4 units for 60 carbs, not 2. It is much better to figure the bolus (mealtime) insulin based on what you are actually eating. I suggest reading Using Insulin and finding an endo who is willing to work with you on a more up to date regimen of insulin use! Your doctor is doing you a disservice, imho by giving you out dated regimens and telling you to “stick with it” despite the resulting highs! You also want to learn to “correct” highs. Read the book.

Which is the slow acting insulin? I think that one could go up a couple of notches.

Do you inject for lunch as well?

You might do well to halve the fast acting one at breakfast and inject the other half at lunch. That might be helpful.

Huh? Are you suggesting, latvianchick that she only take one unit to cover 60 carbs at breakfast? Very few people have 1:60 carb ratios! What she needs to do is figure out her insulin carb ratio to know exactlyhow much insulin to take to cover the carbs at each meal, and not just take random doses. Then she need to be prescribed an actual long-acting insulin, which Humalin is not, before she can worry about increasing doses. Personally I think a “pattern recognition class” if that is what it sounds like is getting ahead of yourself. The first thing you need to do is figure out the basics such as insulin carb ratios, and then worry about looking for patterns and fine tuning/tweaking doses. You can’t run until you walk.

I agree w/ Zoe on this! When I got my pump in 2008, the doc and/or SalesNurse said that Humalin N had only a 53% chance of peaking when it’s supposed to which, in retrospect, made a lot of the rollercoastering I experienced during that time (20 years!) make sense. Except it’s not really that much fun while it’s going on?

I take Humalog (fast) and Humalin (slow) at 5:30 in the morning. Yeah, I will take the Humalin up 1 unit tomorrow. I dont inject at lunch, just at breakfast, dinner, and bedtime.

Julia, you need to talk with your doctor, or find one who is willing to help you, which this one doesn’t seem to be. Why do you not inject at lunch? If you are eating significant carbs, you need insulin to cover it. Of course you are high mid-afternoon! I can’t recommend too much you need to get on a REAL long acting insulin such as Lantus or Levemir, which will allow your to have your numbers more stable before meals, waking and bedtime. You also need to learn your insulin carb ratios to bolus before EVERY meal. Please read Using Insulin and get more information about how it all works. Your doctor can’t be with you all day and you need to understand more about dosing so you don’t have dangerous lows and highs that lead to complications.

You also might want to work with a Diabetic Educator or Dietician. Your doctor is telling you to eat 60 grams of carbs for breakfast which is a lot! Then he tells you to eat 60 grams for lunch but not take any insulin??? If I did that I’d probably be in the 400s!

I take lantus before I go to bed, but I will ask the endo next time about taking lantus instead of humalin. They recently told me that humalin is an old insulin, but what can I do, I’m only 13! Most of the other kids my age that go to my doc take humalin, soo… I like the idea of an I:C ratio. Next time I will ask. At dinner I eat 75 grams and take 4 units of humalog. I’m very active, so I guess it takes a lot of carbs to fuel me up. I am always hungry, so maybe thats why they put me on a high carb meal plan. I am a growing teen, what can I say (;

Thank you so much. It sounds like you really know what you are talking about.

I didn’t realize you were 13, Julia. You might want to check on the Teens with Type 1 Group on here to talk to other kids your age who are dealing with all of this as well. I also have heard adults who went to diabetes camp when they were kids and when they were a bit older became counselors at diabetes camp and said it changed their lives being able to hang out with other type 1’s!

Ok, I’m confused, now, Julia! You take Humalin AND Lantus?? That doesn’t make a lot of sense to me. You might want to ask your parents if they can take you to another endo, as I’m not sure this guy is the best at helping you learn how to manage your type 1!

Yeah, insulin carb ratios are great because they help you take the right amount of insulin for what you are actually eating. How does it work when you take the 4 units for the 75 gram dinner? If you are in target range (say under 140) 2 hours after dinner than that means your I:C ratio for dinner is about 1:19. One unit of insulin for every 19 carbs. If you are too high after dinner than you might try more like 1:18 or 1:17. Once you know your insulin:Carb ratio than you can eat a little more or less and know how much insulin you need, so if you know how to carb count you don’t have to eat the same amount every day. Most of us find we have different I:C ratios at different meals. My I:C ratio for dinner for example is 1:18, very similar to yours. But my ratio for lunch is only 1:8 and for breakfast (when many of us are at our most carb sensitive) is 1:7. That doesn’t mean yours will be the same. We are all different and the only way to find out is to just keep “wiggling” the numbers by a small amount until you find the ratio that keeps you in target 2 hours after eating.

I am going to a diabetes camp this summer. OK, I take humalin and humalog at breakfast… humalog at dinner… and lantus at bedtime. Got it? I am not high after dinner, Im usually between 80 and 140 after dinner. I dont have an endo in my hometown, we go to corpus. Thats what my regular doctor recommended, but the one he wanted me to go to retired, so we ended up with the new. I really like her. She seems to put diabetes in a simple term, to where I understand it, and when we need to move up a step, then we will.

Nope, can’t say as I do get it about taking both humalin and lantus, but there must be some reason for it! That’s great that you are in target after dinner, so now you know your dinner I:C ratio is 1:19! I’m glad you like your endo and feels she explains things well, that’s really important. I think it can only help if you learn more on here and then bring your questions, ideas to her. You sound like a bright motivated girl and it’s great if she recognizes that! I definitely would ask her about taking a bolus insulin at lunchtime which would probably solve your problem of being high in the afternoon.

That’s very cool you’re going to diabetes camp this summer! I’m sure you’ll have a great time.

I suspect the arrangement is to cover lunch w/ the Humalin to avoid shots at school? In some places that can be a bit more of a project so I could maybe see doing that but it’s pretty hard to get great results with that? I always took an extra shot of R @ lunchtime though.