I love my healthy breakfast: instant oatmeal (20g) mixed with greek yogurt (9g) and 1/2 banana (15g) with cinnamon = around 40-44g CHO.
I wake up at 100 (7am), two hours after my breakfast I am at 250 (10am). But at lunch time (12pm), I am back at 120. I was not aware of that spike until I wore a CGM for a week and noticed that.
How do you handle that? If I take more insulin, I will have a low at noon… Should I change what I eat or should I talk to my doctor to change to a more fast acting insulin?
This is the main reason why I got my daughter onto a pump shortly after diagnosis: the ability to set different basal rates. With long-acting insulin you just do not have this option. If you were pumping, I’d advise you to set an increased basal rate beginning about 1.5 hours before breakfast. With MDI, the only advice I have is to try increasing your insulin-to-carb ratio for breakfast, make sure you’re pre-bolusing, and wait for the curve on your CGM tracing to bend before you begin eating.
ETA: If you are coming back down to 120 by lunchtime, I’d look into nudging up your Levemir dose a bit. I aim for a BG between 90 and 100 for my daughter; I consider pre-prandial BGs higher than 100 sub-optimal. If you don’t already split your Levemir dose, I’d consider this as an option, with going a little higher on the dose that covers breakfast time.
I have to tell you, I find breakfast difficult. I am more insulin resistant and things are often less predictable due to Darn Phenomenon. You might find an alternate would be to consider a healthy breakfast like eggs and sausage which would require a lot less insulin and would have a much more predictable response.
For me, that’s too many carbs for that time of day. I tried repeatedly and unsuccessfully to dose well for an oatmeal breakfast. I limit my breakfast carbs to about 12 grams. Eggs and breakfast meat are easier for me to suppress the post-breakfast spike.
Pre-bolusing is a potent tactic. Your CGM is the best tool to optimize your pre-bolus time. Like someone else already commented, just wait for the CGM line to bend downward before you start eating. For me that takes about an hour in the morning between dosing and my first bite. If you’re lucky, an optimized pre-bolus will cure your post breakfast spike. I suspect that you may have to both optimize your pre-bolus time and reduce your carb load.
You might experiment with swapping the banana for berries. Berries have fewer net carbs and more fiber. Good luck. The CGM is an eye-opener. Pay attention to what it tells you and act on its data.
Another proven tactic you can use is to walk for about 20-30 minutes after eating.
First of all, CONGRATULATIONS!!! I read your profile and you do such a good job with taking care of yourself. It’s inspiring. =) I have a LOT to learn.
I think you are right, it is too many carbs… When I eat a breakfast with less carbs and take the same correction, I do get a better result. I really like your idea to switch the banana for berries. Or maybe I could remove the oatmeal and eat the banana with the yogurt… I will definitely reduce the amount of carbs. May I ask what you eat for breakfast? I’m looking for ideas besides eggs or sausage. I am not very meat friendly in the morning. lol — I read on your profile that you have a low carb, high protein and high fat diet. I have a dietitian, but she doesn’t want to restrict me. I am willing to restrict my diet!!! hehe If you have any resources of where I can find a good nutrition plan, please let me know.
I also like the idea of taking the insulin a couple minutes before I start eating. Like you said “I suspect that you may have to both optimize your pre-bolus time and reduce your carb load.”, so I will try to change both.
A couple minutes before you start eating isn’t “pre-bolusing” in the diabetes sense of the term. At least 10 minutes, but more like 20 minutes up to an hour (or even more) is more like it. Even with pre-bolusing, breakfast is the trickiest meal of the day for most people. Even if you switched to pumping and had an increased basal rate surrounding breakfast, sometimes the only way to fix the breakfast post-prandial high is to have a very low carb breakfast (as many people have already suggested.) One thing that works for at least one person I know is utilizing the Super Bolus technique in which you add the amount of insulin indicated by the number of carbs you plan to eat to the total amount of basal insulin you would otherwise receive over the next 2 or more hours and take that amount up front via pre-bolusing. (Of course, you need to suspend your basal insulin for the corresponding timespan that you used for your Super Bolus.)
I have (generally) adopted a low-carb breakfast (less than 20g carbs) AND pre-bolus as much as an hour before eating. I do wear a CGM, so I wait until I see a clear drop in my BG before eating - however long that takes (what Dr. Stephen Ponder calls “wait for the bend” in Sugar Surfing ). Changing to a pump has been helpful to me overall, has not dramatically helped me with breakfast. I do have a high-carb breakfast approx. once a week – for that, I usually wait a full hour between the bolus and eating – though, depending on how low I am at the start, I sometimes do an extended bolus for that.
For me, lunchtime is by far the most predictable and easy time of the day – Ideally, if I’d plan most of my daily carbs for lunch, I’d probably never see the other side of 150! (Today’s lunch: Lamb burger with a bun and fries (ok, I splurged) – took 10u and peaked at 150.)
For breakfast I usually eat scrambled eggs, a sausage patty, and 1/2 of one side of an English muffin. Eggs are a staple for me; I don’t know how I would eat without them. Have you tried full fat Greek yogurt? I know one cup only contains 9 grams of carbs.
Check out Fraziska Spritzler’s web site. She’s a Registered Dietitian, Certified Daibetes Educator and is known as the “Low Carb Dietitian.” She started experiencing some blood sugar abnormalities a few years back and overhauled her way of eating as well as her professional recommendations about food. She doesn’t have diagnosed diabetes but was probably headed down the path to type 2 when she put the brakes on that. She eats a wide variety of food but keeps the carbs low. She has lots of great ideas about easy to prepare food. I’m sure she has some ideas that could help you.
Be prepared for most dietitians to bad mouth the low carb high fat way of eating. There is plenty of controversy over it and I found Franziska’s position enlightening. Most dietitians want diabetics to eat 100’s of grams of carbohydrates each day. They have no idea how hard that is to dose insulin for that carb load. Mega carbs = mega insulin doses = mega mistakes. Smaller insulin doses means smaller mistakes and much less drama.
I say the best thing someone with diabetes can do for themselves as far as eating is to use their meter and post-meal readings to inform what they should eat, what they should avoid, and what they should limit.
A few minute pre-bolus time will probably not make much difference to to your post meal blood sugar level. You want to try to match your insulin action profile with your food metabolism profile. Waiting for the bend on your CGM is one way to do that.
Yes, I use a pump. I find it’s a wonderful tool to help control my blood sugar but I value the CGM as the most useful tool. For almost every meal I take an immediate insulin dose to cover carbs and then an extended dose over 2-4 hours to cover the protein and fat.
@rgcainmd mentioned the “super-bolus” concept, something only pumpers can do. I think it’s a good idea. A super-bolus is nothing more than borrowing from the next few hours basal and delivering that upfront before eating and then turning off the basal rate to pay back that insulin. It just switches the timing of the insulin not the total amount. I use this method for breakfast as well. It all sounds more complicated than it actually is.
Looks like everything has already been well explained by @Terry4, @rgcainmd, and @Thas, so I’ll just restate the same from personal experience: when I started using CGM I was also very surprised by the high spikes (>200) after what I thought were ‘normal’ breakfast choices (around 50g carbs). I first found that CGM-guided “waiting for the bend” pre-bolusing helps a lot, bringing the spikes to well below 200. I was also surprised by how it can take considerably more time (half an hour to an hour) to see any insulin action in the morning than later in the day. I have since reduced my breakfast carbs to about 20-25g at most. In combination with the CGM-guided pre-bolusing, my post-breakfast spikes are now below 140, usually well below 140. I have to admit it took me some time to figure all this out on my own - should have just posted a question on TuD . It’s pretty amazing how much one can learn from people on this forum!
If I really wanted to have that higher-carb breakfast, here is what I would do: (1) super-bolus, borrowing from 2 hours of basal ahead (this requires a pump), (2) wait for the bend, (3) eat all except the banana, (4) wait for the BG curve to reach a peak (which should be less than 140) and start trending down, (5) eat the banana, (6) expect soft landing back to the starting BG.
An additional suggestion: substitute steel-cut oats for instant oatmeal. Steel-cut oats are the least refined and have more soluble fiber. You can make a big potful at the beginning of the week, then measure and rewarm a portion each morning. This might work better for you.
My BG will normally peak to over 200 if I eat more than about 25 carbs for breakfast or 45 carbs for lunch or dinner unless I super-bolus for the amount I eat initially, then save part of the “meal” for a snack two to three hours later. High GI carbs are worse this way, but it is a problem with low GI foods, too.
Before breakfast I often bolus for 32 carbs, but only eat about 24 at the meal and save the rest for later. For lunch and dinner I most frequently bolus for 56 to 64 grams carb, but eat only about 45 and save the rest for a snack. That’s the only way I can eat up to about 160 grams of carb a day and maintain my A1c between 5.5 and 5.9.
With my method I don’t peak nearly as high as if I ate the entire amount at once. However, there is the risk of going hypo between meals if I get distracted and forget to eat my snack on time. The timing changes depending upon what bolus insulin I’m using, too, as the duration of action is an hour or two different between Apidra, Humalog, and Novolog for me.
The length of time I need to allow between bolus and eating varies with insulin brands, too. I tested Humalog and Novolog to find that my BG hadn’t dropped a single point in 30 minutes after my bolus. In one test it hadn’t dropped in 40 minutes, but in a second test it dropped a few points in 40 minutes. Apidra is supposed to start acting faster, so I’ve been on it for a year before I had occasion to test that. With a FBS of 159 yesterday, I felt it was safe to test. My BG dropped 37 points 30 minutes from bolus with the same number of units of insulin. Each person is different, though, but as a whole Apidra seems to act faster for most. For me, Novolog is the slowest.
I actually believe that our tastes can change and adapt. I would encourage you to broaden your aperture about what you can eat for breakfast. Try some different things and see if you can develop a taste for them. If you don’t want eggs or sausage then have cheese, avocados or even fish (I like british style kippered herring). You can eat nuts or a granola made from low carb ingredients (available in many markets). Or a homemade or store bought low carb granola bar (like the nature valley sweet and salty). Or low carb muffins made from flax, almond, coconut or other low carb flowers. Or low carb pancakes made from cream cheese or ricotta (like crepes). Or chia pudding made from chia seeds and whole cream. Just some ideas.
I don’t see 120 after breakfast with carbs as a result to be avoided at all. That’s pretty good and very much mirrors BG levels of people without diabetes. Although I will not eat bananas under any circumstances, a tightly controlled move to 120 seems pretty commendable to me. I like stuff that isn’t carbs quite a bit but like carbs too and would consider a 100-120 spike to be very well controlled.
I handle it by reducing the amount of carbs I have for breakfast. A English muffin is 26g of carb. Add some bacon/sausage, egg and maybe some cheese to balance it out.
FWIW, I have a high carb breakfast that involves a banana nearly everyday (I only miss if I am out of bananas). I figure each whole banana is between 24 - 32 g carbs (based on size and ripeness - the more ripe, the more carbs). I expect a huge rise in BG and because of the variability of carbs in them, and the variability in me, I sometimes have to do a correction bolus/add in a glucose tablet or three. (I have a hearing/vertigo issue that I manage with banana consumption.)
So, the biggest thing I do is what’s called a pre-bolus. If I wake @ 100, I bolus, wait 15 minutes and then eat the banana. Recently, I have been using my pump to help decrease the rise and later correction by using an extended bolus of 0.5U over 1 hour. If I were on MDI, I would consider taking that 0.5U about 30 minutes after I started eating the banana.
Of course, the CGM is a tremendous help here. If I am trending up during the 15 minute lag between bolus and eating (right pointing arrow, but numbers rising), I will delay eating for at least 5 additional minutes. Likewise, if I wake @ something below 83 and/or I’m trending down (right pointing arrow, but numbers falling), I will eat the banana within 5 minutes of bolusing.
Oh, the joys of being your own artificial pancreas!!
BTW, if I were in your situation and consistently returning to 120, I would give a little more bolus - but(!), I would start with increasing the pre-bolus time.
This is a first for me. Is it about potassium? There are other low carb foods that are high in potassium. Dark leafy greens, mushrooms and avocados are high in potassium.
It’s not about potassium. There’s something else in bananas, I can’t remember the details, but I had an allergist recommend bananas when I was having more severe tinnitus and dangerous vertigo episodes. When I have tried going more than about two days (mostly when traveling), the ringing increases.
FWIW, I consume a significant amount of [quote=“Brian_BSC, post:18, topic:50061”]
Dark leafy greens, mushrooms and avocados
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Thank you so much for your suggestions - very thoughtful, as always!
Oh, and just FYI here’s a shot of my CGM from this morning: woke @ 102, bolused 1.5U for 28g carbs guesstimate @ today’s banana, plus 0.5U over 1 hour. Hmmm … it was not very ripe, so maybe I should have bolused for 24g carb - since I am trending down @ 2 hours post prandial and didn’t get much of a rise.
Okay then, onto my 52g carb cereal and milk! I am bolusing less and eating immediately …
(P.S., low alarm set @ 65, high @ 190, because I had a LCHF meal last night and was running higher than normal @ bedtime. I took appropriate actions - increased basal rate - but, didn’t want to hear alarms as my BG came down over several hours)
. It’s pretty amazing how much one can learn from people on this forum!