How do you correct post meal spikes?

Type 1 and LADA
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I’ve been correcting post meal spikes aggressively with insulin. Once it reaches over 180 (10 mmol), i inject 1.5-2 units and turn my basal up like 130% for 2-3 hours. It’s always stubborn to come down - if it doesn’t start trending down by 40 mins, I give a bit more insulin. Yes this may be stacking, but its done in a planned way. The only thing is I find myself constantly crashing low once it starts falling.

I can’t seem to get a steady landing. Could it be the additional basal that’s sending me crashing? Do you correct with both a bolus and a basal?

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You are stacking…not a good thing, whether it’s planned or not. We have a tendency to want to “rage bolus” trying to get our numbers down faster. But if you are crashing, it is stacking because you have ended up with too much insulin. And it catches up to you and you crash.

It really does seem harder to get down numbers once you are high. I would work on your timing of prebolusing more. For my “normal” food I have a tendency to take a half dose a half hour before I eat and the other half when I eat., This allows me to adjust that second dose to what I actually ate. It can vary, if it’s high fat I might wait until I eat, If it’s fruit I might even time my prebolus earlier. It can also depend on what I am starting at. If I am starting at 70, I am not as likely to prebolus as early.

I chalk up most of my mistakes to improper timing. Sometimes it’s forgetting to bolus for an add on. But usually it’s not waiting the full half hour to eat, or forgetting to prebolus, and my meal is ready type thing and I decide to eat anyways. I will pay a price in higher numbers for that.

I just don’t reach 180 with prebolusing and meals. Now, not eating and DP and FOTF will catch me at 160 too often than I’m happy with.

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I wait out my prebolus as long as I can and I still spike. When I say as long as I can I mean to the point where my sugar goes into close to hypo territory while I’m 10 mins into eating. I have to shut off my basal iq every meal time because it kicks in and cancels my extended bolus.

I know some people would tell me low carb is the way to go but at the moment I’m not quite there yet.

I hate battling a high blood sugar, takes forever to come down, even sometimes when I’m aggressive with insulin it would take me a good 3-4 hours before it falls back into range.

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Wouldn’t doing an extended bolus be considered stacking to some degree? I find stacking to be a necessary evil with high fat meals, I really don’t see any way around it.

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Post-meal spike corrections are just plain tough to get right. Over correction and stacking are hazards. That often leads to swings in BG going from hyper to hypo and back to hyper – not good.

I know you are looking for immediate short-term tactics to address post-meal spikes and I can suggest a few of those but I think you should also consider the overall context of these spikes.

I’ve found that the best tactic is to prevent these spikes and that is not always easy. As a group we are keenly focussed on blood sugar levels and that is understandable. In this case we might be better served if we also consider insulin sensitivity.

Many of us struggle with dawn phenomena and the feet on the floor (FOTF) effect. These are situations where the body resists the typical action of insulin due to other factors like an increase in cortisol secretion and/or signaling that provokes the liver to release an inappropriate amount of glycogen.

I delay my first meal to mid-day for this reason. This may not work for everyone but it’s been a good tactic for me as a T1D. I still, however, must take actions everyday to increase my insulin in the morning to hold my glucose closer to normal.

This means increasing my pump basal rate from the more usual 0.3-0.5 units/hour all the way up to 1.4 units/hour from 6:00 a.m. to 1:00 p.m. It also means delivering a 1.5 unit bolus when I arise each day just to counteract a rise due to FOTF. Your needs, of course, will vary.

In addition, I often add one 4-unit cartridge of Afrezza when my BG starts to rise through the 110 mg/dL level. Afrezza shines in this situation due to fast-on, fast-off action and rarely over-corrects into hypo territory.

What can you do to increase your insulin sensitivity so as to minimize post-meal spikes? Exercise, even relatively light exercise like walking, timed to occur when your meal insulin dose peaks is an amazing way to limit post-meal spikes. For me, this is about 60 minutes after the meal insulin dose.

I choose to limit carbohydrate consumption for this very reason. I know about and respect others diet choices but this tactic works dependably well for me.

Fasting provides another tool to increase insulin sensitivity. If you struggle with post-meal spikes often for the same meal each day, why not just skip that meal one day and see what happens?

Another factor that increases or maintains good insulin sensitivity is getting a good night’s sleep. Most people who regularly enjoy good sleep go to bed at the same time every day. Our bodies like this regularity and it is reflected in insulin sensitivity.

Stress is another factor that we can manage. Higher stress levels increase cortisol which drastically raises insulin resistance. We can do many things to manage this stress every day: meditate, exercise, pray, sing, play a musical instrument, eat every meal in conversation with your immediate family (no screens!), engage in any creative pursuit and breathing exercises. Regular, as in every day, stress relieving practices will increase insulin sensitivity.

It’s not simple but our bodies are complex organisms. If we pull back and consider the larger context, we can often discover more remote factors, when combined, will give us the results we want.

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@Baddog40 Stacking to me is adding extra insulin so you end up crashing. But not splitting the dose up you need as you need it? And yea it’s easy to stack when trying to figure out how much you need along the way for the higher fat meals because it’s hard to know. So I end up “stacking” sometimes too.

All very good points @Terry4

Here are just some other suggestions to try to figure it out. If you are dropping by the time you eat, take less as a prebolus and take more with your meal or some at a little less time before your meal? Try splitting your doses more? It might be some of what you are eating is outright digesting slower. It kind of sounds like you need some of the earlier dosing moved to later. I commonly will take some a half hour later or extend my second dose over the next hour if it’s high fat.

Higher fat foods delay carb absorption and cause insulin resistance. I eat them anyway but I change my dosing so some hits later. And a lot of my food is guessing so I adjust along the way. Taro burger buns and donuts, bought vegan pesto salad or vegan pasta primavera with veggies??? So it takes some trial and error and adjusting along the way.

We all can be so different and it is really trying to figuring out what works for you so it takes experimenting to see what works. It can be very frustrating to figure out. And so many things can change it. So forgive your mistakes and chalk it up to trying to figure out something that isn’t a straight line in the sand. Sometimes it’s easier to fold on certain things. I too skip eating in the am.

PS I need to get some Afrezza! I tried Fiasp and it worked great for a few shots and then it was like water.

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The problem with making sensitivity factor strong means that if I’m under my target BG, it will bolus less than I really need to compensate for the IOB.

I actually exercise after breakfast and find this have better control on my post breakfast spikes. I try to but sometimes with meetings and it getting dark early makes it hard to always fit an exercise session in.

But some very good points in your post. Thank you.

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Great suggestion, I didn’t think of this. Always thought if I didn’t have enough insulin up front , when i spike, it will just get higher. I may give this a go.

Yeah Fiasp for me also like water after like a week.

I was just wondering whether when people are fighting a high, do they turn on their temp basal in addition to a bolus? I wonder whether if I just bolused and left it at that, would my landing be much steady.

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I hardly ever use the increase in basal at all. My basal rates vary all day, so it’s too hard to keep track of what that increase would be? I’d much rather just give myself a dose and know exactly how much and when it was given.

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What sort of foods cause this behavior? Like, is this a constant problem or just for meals heavy on the carbs, like pasta or breakfast cereal? Could you solve your problem by adjusting the composition of your plate?

The funny thing is, a lot of people complain about high fat/high protein meals, because they’re so hard to bolus for… But I think that’s my sweet spot. I rarely ever eat carbs anymore without fat and protein to balance the meal out and slow the carb absorbance down.

For instance, evil lives in those colorful breakfast cereal boxes. Pour it in a bowl with milk, and there’s no hope in taming my BG. So I just don’t do it. It’s one of those weird comfort foods I crave when my husband is traveling for work, though. Thankfully, I can exorcise the demons by swapping the milk with full-fat Greek yogurt. THAT spike I can easily tame. The carbs absorb more at the pace of my insulin. It also helps me portion control the cereal, because I’m filling up on the “stick to your ribs” yogurt, instead of eating half a box of cereal because I’m still hungry after the first bowl of empty calories… And a bowl is already several “servings” worth.

If we’re having waffles, I usually serve them with a buffet of condiments, each quarter-piece getting it’s own treatment. I usually chuck an extra egg in the batter, then eat 1.5 waffles, and enough pieces get cream cheese or peanut butter to make it all manageable. Just a dab of butter and syrup wouldn’t be manageable for me at all.

(No, those aren’t typical. Usually breakfasts consist of some sort of egg dish with toast, sweet potato, tortilla, or fruit.)

Same rules apply to dinner. The meat and veg are the stars of the show. Pasta, rice, bread, potatoes, and other starches get a smaller corner of the plate. There’s usually a condiment or sauce containing fat. The combination is a slowly absorbing meal that is easy for me to bolus for, but still satisfies my carb addiction.

That’s sorta what the automated systems do, butt it’s a strategy better employed to avoid the high in the first place. Once you’re already high, and thus insulin resistant, I think basal adjustments are fairly futile. Have you ever figured out what your correction factor is at different BG levels? It sounds to me like you’re being too tentative with corrections. I correct sooner and more aggressively.

Unfortunately, Basal-IQ doesn’t suspend insulin until just before you head low, so it may not be able to counteract an aggressive correction on its own. That would be a good time to use the temp rate setting. Once you’re back in range, you can better evaluate how much extra insulin you have on board, and it’s it’s too much, set a reduced/stopped basal rate.

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I’m struggling with post dinner BG and I can’t seem to put my finger on the problem. I’ve done my basal testing so I think my basal is correct for that duration. The behaviour im seeing after dinner is either if I have dinner at 6:30, I seem to either crash around 8:30 to 9:30 pm (without correction) or go high (about 170mg and won’t come down). There is no consistent behaviour!

I’m not eating anything processed or super sweet. 1/2 cup cooked basmati rice, veggies and some protein (maybe tofu and meat), some clear broth and an apple. For this I do an extended bolus of 40g carb. Nothing in the meal is out of the ordinary and not super sweet. My meal is like that most nights except protein changes. BG mostly goes up post dinner (70% of the time) but there have been many occasions where it went down so I’m nervous about increasing my bolus or making my isf stronger. It’s when it runs high, I try to correct with a bolus and a temp basal and I find myself in hypo state before midnight. I can’t establish a consistent pattern of my BG post dinner and I’ve been trying for several weeks now.

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I don’t mean to pre-empt @Robyn_H’s response as I’d also like to read her analysis.

Are you keeping a journal as you try to entangle this contradictory-at-first-glance situation? Writing stuff down and persistence almost always pays off for me.

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Tedos, I eat a lot of very healthy vegan carbs and while I eat lots of quinoa and potatoes, I can not eat rice at all unless I want to give extra insulin.

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Rice is a game changer for me as well.

When I eat an apple, I generally pair it with peanut butter, to help slow the spike.

What of exercise? After you eat, do you exercise or take walks?

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Rice is a problem for me as well, it’s very hard to manage for some reason. Lately I have been having a little more success with dosing for it but I just have a tendency to stay away from it.

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If I’m uncertain, I over-bolus and take the single post meal low. Its just simpler.
I just ate rice with a bunch of sweet and sour sauce. The data is totally flatline, which means a low is lurking in my future…but I avoided any spike.

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Rice is one of those things I haven’t figured out how to bolus for. I do still eat rice but I might only eat it once a month and just take the high BG that comes from it. For me I get a sharp spike and either a sustained high or a sharp drop, however I am not likely to actually go low even with a correction.

I guess I would try making the rice digest as slow as possible by adding a fatty mixer in to the rice (butter might work) and taking a separate dose of insulin as I start to eat for the remainder of my meal.

Also don’t wait until you go low before eating your meal, that just makes your body desperate for any glucose it can get as fast as it can get it. I will prebolus but only so far ahead and if my BG is already where I want it to be then I cut my prebolus time down to about 15 minutes or less so I don’t go low while eating.

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Thanks for that. Basmati rice is supposed to be much less carby. Rice is a staple in the family, half a cup is actually not very filling but that’s as much as I can take without upping my insulin. A lot of the times basmati makes my sugar go low too. Because of the inconsistency of either extreme high or extreme low, I haven’t been able to put my finger on it.

There must be other variations, but I simply can’t tell to the best of my knowledge. The only thing is hormones but then I don’t ever get to the bottom of it and I can’t even predict when it goes in which direction.

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I realize cauliflower rice is not the same, but have you tried mixing some basmati rice with cauliflower rice? For me for example, when I am making a chinese style stir fry, I was used to brown rice with it, but I ended up stopping rice with it altogether. But when cauliflower rice came along, I started using it with my veggies and I was delighted. Spritz some soy sauce on it and I felt like I had rice to mix with my veggies. I look forward to just eating it with some soy sauce on it. It doesn’t work for everything. For instance I make a rice salad with brown rice, peas, grated carrots, grapes and mayo, but I found mixing half lentils half rice and I still get the same flavor, less rice and more protein. I have been having much better success with dosing for it with some tweaks sometimes…

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I’m not sure why you just wait it out a bit? Stop being so aggressive.