Hi, I just started insulin few days ago but after reading several books on diabetes including Bernstein I’m now confused and need some clarification. I’m on very low doses of Humalog (2 units before meals) and trying to cut my carb intake to 40g per day. My endo tells me to measure 2h post meal but then I read I should measure 1h post meal. The problem is sometimes when I measure 1h after meal it seems ok like 130 and then I measured again after 2h and it was 180. And sometimes its 130 after 1h and 90 after 2. I have only 100 strips for a month to test at this time so I’ll appreciate an explanation on which time is best.
The standard advice always given is measure your blood glucose two hours after eating. But, that’s also typically designed for people eating a higher carbohydrate diet.
Everyone has a slightly different way their body seems to metabolise fats, protein and carbohydrates. So my advice would be at the start measure more often. You may actually want to measure every hour post meal up to 4 hours for a week, and see if you can establish some kind of pattern. You will eventually start to understand how different foods impact you, and can reduce your testing to maybe two hours post meal.
A lot of people on Tu use a continuous glucose monitor, so they see the pattern all the time. I personally don’t. I only measure one hour after meals to see if I have a spike higher than I would expect or want after eating something new.
However, when I’m eating what I normally eat, I usually do 2 hours post meal. I also often check my blood sugar at the peak of when my rapid acting insulin will have flattened out. For instance, I know that Novorapid for me at the two hour mark has essentially stopped the bulk of its impact on my blood sugar levels. Given this, I use the two hour post injection rule, as this lets me know if I need to give more insulin or not. As I understand it Humalog has a similar action time to novorapid, but keep in mind this can differ for each person! So again, your really need to collect some data and look at it and see what’s going on.
That has been established for myself by a lot of trial and error.
It’s also important to remember that you need enough data to make some broader generalisations. For instance, you will always have days or meals when your blood sugar does not do what you thought it should do, but you should try to find the patterns within a week or month worth of data. At the start again the more you test the easier it is to establish these patterns, once you have a better understanding of how your body deals with the food and insulin you can reduce your tests.
In my opinion though, it’s not a one person fits all rule with testing and it comes down to a lot of different things.
It also depends on how strict you want your control to be?
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I really like the advice @Donman90 has written above. I know you are concerned about conserving test strips but that is not a healthy influence on your behavior. If you’re driving a car, you sure as heck want to see the path you car is driving. Using test strips and/or a continuous glucose monitor acts as our vision to guide our diabetes journey.
As a new person using insulin you need to test a lot so that you can learn how your body responds to insulin, food and exercise. This is not a short term project! It will takes weeks, months, and years to learn how your metabolism works. I’ve been using insulin for over 32 years. I fingerstick check 8-15 times each day. I also wear a continuous glucose monitor. This intense regimen has taught me a lot about how my metabolism works.
I’ll let you in on a little inside knowledge of living well with diabetes. You may not like it but it’s the solid truth. Just when you think you have this insulin/food/exercise game down, something changes. You start getting very different results. This happens. Diabetes is dynamic, not static.
Welcome to the world’s least desirable club! I’m glad you’re here. Peer support is an incredible asset, especially with diabetes. Learn all you can, pay attention, stay motivated. You can live very well with this disease. A lot of it is up to you.
A big congratulation on limiting your carbs. It took me 28 years to figure that out and it improved my life immeasurably!
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One further thing I would say, and this is probably dependant on your personality, but it’s important to try and find some enjoyment in managing your condition. I strangely enjoy working through my blood glucose data, working out what I did wrong, looking for patterns. It’s a challenge undoubtedly, and I wish I didn’t have to do it. I can’t change the fact that I do have to do it, but I can change my attitude towards it. I’m probably lucky in that I’ve developed an inherent interest in the condition and how my body works. But if you can do that, even at a base level it makes this whole thing much more workable.
I spent years just cruising through, never really thinking a lot about what I did and just following the broad recommendations. But if you really want to have tight control it’s about having some agency for your own condition, that means sometimes actually justifying to your health care team why you do certain things. You’ll have days that frustrate you to no end, and days that you just can’t for the life of you explain why your blood sugar did what it did. But, when you get that day where all your blood sugars are right where you want them, and all that hard work you’ve been doing with monitoring your sugars and diet and working out insulin regimes finally pays off! That is a moment you should rejoice in! Certainly I do, and when I have those days I always express my pleasure with someone in my life, particularly if it’s someone who knows the work that goes into it. Because in the end thats what keeps me working at it.
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It’s great when things go well. You know how hard it is to align all the various forces in play. When you get a sideways glucose trace for hours on end, especially when sleeping, I give myself credit and I take pleasure in that fact. If you’re going to play the game you may as well be good at it.
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Thanks for the encouraging advice. I know I’m still a rookie at this but I have another autoimmune disease RA and I’m still digesting the thought that I now have a second one. I’m also taking care of a 4 month old baby so getting all this new knowledge together is hard :-)I’m still making my own insulin as I have perfect fasting bg with no insulin injections and if I followed Bernstein’s carb approach I probably wouldn’t need insulin shots for now. But since I’m nursing I need to eat and with 40-50 grams of carb I needed some additional help from insulin. I will try to get more strips so I’m not stressed every time I need to use one.
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Hi Pat34
It’s hard getting this Dx, either as an adult or the parent. IMHO you don’t have enough test strips … I’m fairly new to this as well and I test frequently as I have other conditions that impact my sugar levels ( I can go from 60-400 in 20 min). I’m not sure if you are in the US, but until my Dr. gave me more strips I used the ones from Walmart. the meter and the strips were fairly inexpensive and I still use my meter at night … note I did testing with the Walmart meter AND my One Touch, they have always been pretty close within two or three points…
YOU need to work with your Dr to get with a certified diabetic educator who is familiar with type 1. They should be working with you to help get you stable and work with your particular situation.
Welcome to club…it’s a GREAT group here
Also, when I was diagnosed, I used the intensive insulin therapy site …it helped me understand how to set my levels.
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Thanks for the link to the UCSF diabetes site (University of California San Francisco). It’s been a while since I’ve visited and it has developed into a great patient resource. I agree, this is an excellent site to educate a new (and not so new) diabetic. I encourage readers to check out this site. Learning about diabetes is a life-long process.
A dear friend’s endo once told her, “If you can figure out the ‘why’ in 10 seconds or less, great. Otherwise correct and move on.”
As mentioned, there will be times when you just won’t be able to puzzle out why it’s not following the expected pattern. It’s nice to know the reason why, but getting the level where it needs to be takes priority. Eyes on the prize!
And, sorry about the RA. As you undoubtedly know, having one autoimmune disease places you at elevated risk for additional ones. Diabetes with RA is, unforunately, a not-uncommon combination. @Rphil2, one of our senior members (and a dedicated blogger), is in the same boat.
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Hi Pat34,
Sorry that you have had to join our club, but glad that you have found Tudiabetes! The great people here were so helpful to me when I was diagnosed!
And congratulations to you that you have already read a number of books about diabetes! It’s great that you are motivated to learn!
It will make your life a lot easier if you can get more test strips (obviously), if there is a path for you to convince whoever you need to that you need them to test sufficiently. Hope that is possible!
If not, if you can afford it (and are in the U.S.) I’ve liked Walmart’s Relion tester and strips and they are relatively inexpensive.
Best wishes as you figure out what works best for you!
marty1492
I live in the US now but I got here 8 months ago so I’m still confused about the insurance issues. I turned to my doctor about the strips and she helped me to sort it out and I now have 200 strips per month so I got straight to testing several times a day- 1 hour, 2 hours and 4 hours post meal just to check how is my body responding to insulin and what I eat. I really try to cut my carb intake to 40-50 grams per day. With such carb limit I’m basically within 80-120 range all day long with small doses of insulin.
I know that this is honeymooning but with LADA I can’t be sure when it ends right?Either way I want to be ready and have best knowledge how to cope when things get rough.
The usual curve of BGs after a meal is that is that it peaks after one hour and stabilizes after two hours. Exceptions are found if you have had a meal with low GI carbs like squash or beans or high in fat like a big mac, which delays the conversion up to three hours However as a general rule most diabetes support professionals recommend checking two hours after eating.
I’m still trying to get my finger around the 40 (40-50) gram a day diet that has been mentioned by several, especially when nursing a baby?
Doing 30-45 carbs a meal is hard. 1 slice of bread 13 gr. 1 apple 15 gr. 1 glass of skim milk 12 gr. oops I’m over and didn’t have anything on my bread or had lunch or had dinner.
If I only could do that I would be slimmer.
Keep testing as you must establish a “curve” to see how you react to insulin, food intake, and exercise.
It’s pretty difficult, if not impossible, to follow a low-carb (LCHF) lifestyle, either 40-50 grams of carbs per day (or even 30-45 carbs per meal, which not too many people on this Forum would call “low-carb” because that would equal a minimum of about 90 carbs per day) without eliminating bread, pasta, and rice. There’s always Dave’s Killer Bread - Powerseed Thin Slice, but even that is still 11 grams of carbs per slice. A LCHF diet is very doable and delicious when you emphasize the protein and healthy fats (butter, cream, olive oil, coconut oil).
I had to completely give up bread, pasta rice and other grains to achieve the 50 grams a day goal. I rarely had 50 grams a meal even without diabetes but still I had around 100 grams per day when still healthy. Giving up grains and deserts was the most difficult part for me but I substitute regular bread with Wasa crisp bread once a day (14 grams carb per 2 slices). Deserts are now on the table since I discovered almond and coconut flour. You can find tons of recipes and they almost don’t touch my BG when adding Stevia or Splenda. I substitute potatoes for caulliflower puree. Pasta for zuccini I simply put the sauce over and enjoy it. I eat a lot of proteins(meat and cheese) and healthy fat (olive oil, avocados). All of this requires more time for preparations and money too as almond flour is quite expensive but I see nice results so I stick to it. There are many websites where you can find great low-carb and paleo recipes.
Unfortunately I do have my downtimes and eat a piece of bread or half a cup of rice to thai food…and then I get 200 reading after 2 hours 
It then motivates me to get back on tracks. I don’t want to shoot more insulin to cover that because I just don’t know my body and its reactions well yet.
Agree with the above. To maintain a true low-carb diet I have to pretty much avoid white stuff altogether. I mean, I could eat one spoonful of rice, but what’s the point?
That is what I said, but good luck in less than 50 a day and yes you you can do a LCHF diet but a 6’1" man with an even slightly overweight BMI (say 200 lbs) could not live on 40-50 gr.
Oh, I do just fine on 30 to 45. But as mentioned, it means eliminating bread, rice, pretty much any form of starch at all.
This is simply untrue. Anyone can live just fine on 40 to 50 grams of carbohydrates per day if they are eating enough kcal of healthy food.
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Good luck doing that but as per the below and many other articles I couldn’t.
A typical ketogenic/low-carbohydrate diet might contain 0.5 g/lb (~1 gram/kilogram) of carbohydrate. (This is still more than what you are talking about, assuming you weigh around 100lbs/45kg) An average moderate carb diet (such as The Zone or Duchaine’s Isocaloric Diet) might contain 1 g/lb (~2 g/kg) of carbohydrate or slightly more. (This is what I do)
So I keep doing what I have done for over 47 years and besides having diabetes am as healthy as any other 63 year old and can run circles around many as I have fuel(crabs) in my body.
Thanks,
E-J
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