Mystery rise 4 hours after bolus


#1

Type One
MDI Tresiba, Novolog and Novolin R
Female
63 yrs old
No pump possible
Low Carb
Diagnosed 8/2017
Basal at 1.2 units don’t feel I can split that.

I wake up and within an hour I go up 30-45 higher than my norm of 90 - 100.

I bolus.

I have monitored for two weeks at night 3,4 5 am. Just at 5am I see little rises of say 8-10 levels…then bam up 30-40 higher.

After eating (with bolus) I rise right back up to whatever number happened to be with the first morning rise.

The starts to happen 3.5 hours from my last meal and bolus. It happens at breakfast, lunch and dinner…

Maybe my system changed…and I need a bolus after I eat.

I eat low carb and the same meal each day with tiny modifications. I know my numbers and carb counts.

I never had this happen before about three weeks ago. Seeing as I eat the same meal and my numbers were really stable and in range this new spike is strange.

My basal is perfect at night that I am aware of I do random different hour checks. Yes I am a vigilant one.

I just don’t get this new rise and the same rise occurring after each meal?

Looking for possible answers.

Why?

Should I bolus at the rise or before?

Is this what a pump would solve more easily by adjusting?

Honeymoon is ending and this is A possible result part of the dynamic of diabetes life?

Thanks!
Ann

I take Novolin R for meals.
I rarely take Novolog unless I have a really big major spike which with low carb only happens when I try a new food and made a judgement error.


#2

Bingo! Every day can be different when it comes to insulin needs, and bg levels. Welcome to my world of the last 40 years…


#3

I know it sounds like an excuse to be lazy, but sometimes you need to be more forgiving. A number of 145 is a very good number, if you try to have perfect numbers 24/7, you will never succeed, and probably make things even worse and more confusing.

This will always be true, for you and everybody else. It is one of the primary reasons for boluses.

If you are having consistent spikes, it means you probably need to increase the carb ratio for that time of day. This means you will also need to adjust the basal for that time of day. I used to have spikes after breakfast, but once I found the right carb ratio and adjusted the basal, my numbers are much better.

When you eat, you will almost always need to bolus (unless you are literally eating 0 carbs). Doing it shortly before or at the same time as you eat will give the insulin and food the opportunity to work simultaneously, hopefully doing the best job possible of keeping you at reasonable levels.

Most of what I said is probably more appropriate for pump users, but many of the simple statements (you will always need insulin for food, you will never have 100% perfect numbers, etc.) apply to everyone. A pump will definitely not make you have perfect numbers, but it will most likely improve them, because you can enter the insulin any time necessary. Also, if you get a Continuous Glucose Monitor (CGM), you can keep track of your numbers all day & night. This can help you figure out things like what happens overnight, how long does it take for your food & insulin to take effect, are you doing boluses that are too big or small, etc. Some pump/CGM combos also allow the CGM to continuously adjust how much insulin to give you during the day (and night) to make your numbers even better. Using a pump (and for many people a CGM) is almost considered standard for diabetics, so I would strongly suggest talking to your doctor about it. It is a very different way of managing your numbers, but in my (and most other people’s) opinion, also a much better way.