This should be an easy one for someone. I’m on the pump. Two hours after a meal I’m in the 170-185 range and then before the next meal I’m on target (85-100 or so) What do I need to adjust? If I increase insulin to carb ratio and am in target range after meals then I’m low before next meal. I want my post meal BGs to be about 140.
Try bolusing at least 20 minutes before eating. If I bolus 30 minutes before breakfast (my least insulin sensitive time of the day), I don’t go over 120 with my big bowl oat/wheat bran containing 45 carbs. And I end up in target and stay there until the next meal.
I agree… just bolus earlier 
It sounds like your insulin dosages are probably fine, it’s just the timing that could use some change.
I used to be afraid to bolus more than 10-15 minutes before a meal unless I was also including a correction… since using a CGM, I realize now that I can push that to 30 minutes and beyond without any true danger. I get a slight drop within 10-15 minutes, but the bulk of the insulin action takes at least 60-75 minutes to start working. If I can time it so that action hits about 20-30 minutes after I start to eat, it works out much nicer in terms of my BG becuase the insulin matches digestion better. I am getting more and more results from my CGM where you can barely tell I even ate a meal - my goal is to eventually have ALL of my meals stay relatively flat BG wise.
According to my CDE and nutritionist, you should expect a 40-80 rise in sugar levels after meals. It is normal, even for non-diabetics for your sugar levels to rise. Having a flat line 24/7 is unrealistic. One thing you may look at it are your basal rates, and perhaps they need to be slightly higher premeal.
Thanks to all for the suggstions. I’ve tried bolusing about 15 minutes before but don’t do it on a regular basis. I’ll try the 20-30 minutes before and see if that doesn’t do the trick. I’m on the endo prowl mode and hope when I switch to a new one we can visit about a CGM…that’s my next step and I’m excited.
Also, try different kinds of boluses to “stretch” the dose over a longer period of time (and thus work on the slower-to-turn-to-glucose nutrients of your meal, such as protein and some types of fiber).
Pumps feature extended and/or multi-wave bolus features that allow you to give some insulin up front, then program an additional amount to be doled out over a specified time. Here’s one discussion about specialty boluses.
I used to use multi-wave boluses only for very high fat meals such as pizza. But after reading more about the subject from my fellow tudiabetesers, I’m trying them with every meal. So far, my peaks seem to be not as high.
But I also don’t get too upset about after-meal peaks as long as they come down pretty quickly. The ADA says under 180 two hours after the first bite; the clinical endocrinologists say under 140 mg/dl. Although out-of-target peaks aren’t good, it’s also the duration, frequency, and severity that matter. And, like you, I don’t want to drop too low before the next meal! Let us know how it goes!
If you’re consistenly on a downward trend between two particular meals no matter when you bolus or what ratio you use, I’d suspect your basal is too high for that time of day.
Don’t change it until you’re done experimenting with your bolus, though. One thing at a time.
Terry
CGM is the way to go. Timing is the free lunch of bg control. I tried my best with 10 finger pricks a day. Now I prick twice a day (with CGM) and my bg control has drastically improved. People with bad eyesight must feel the same when they get their first pair of glasses. Nothing beats being able to see what’s going on. There might be people out there who can achieve excellent bg control without ‘seeing’ but I am not one of them.
“The ADA says under 180 two hours after the first bite; the clinical endocrinologists say under 140 mg/dl.”
I don’t buy into these lax standards. I believe that these lax standards were ratified so that a lot of people without the right tools don’t give up and throw the towel. Never above 140 and most of the time between 70 and 100 sounds way better to me. But it may be cost prohibitive because all T1s would need a CGM that works for them.
A common sense approach:
If you are producing no insulin…
A basal should keep your blood sugar level in your target range throughout the day.
A bolus should correct for anything you eat and bring you back into your target range.
Keeping these assumptions in mind, to me it looks like your insulin carb ratio is to low ie. you are not taking enough insulin at meals.
But, you basal is to high as it is bringing you back in line by the next meal. (Remember a basal is supposed to keep your blood sugar in your target range throughout the day)
I agree with other posters, timing is a big deal, as well as considering what you ate.
I especially agree with only adjusting one variable at a time. Most literature I have read instructs you to adjust your basal first.
Thanks to all for the great suggestions and encouragement. I’ll start with the timing and see what impact that has. I also know with the change in seasons I need to test my basals…I just hate the process. I was cycling a great deal in the summer and have cut back a bit and replaced it with walking which is just not the same. Regardless of the impact of the timing changes…I still need to test the darn basals.
As always, you guys are the best!!!
Agreed. I bolus at least 15 minutes early now and have had similar results.
I agree. My pre-pregnancy and pregnancy goals have been below 140 at 1 hour, 120 at 2 hours and has resulted in an A1c of under 6. I love it. My blood sugar levels are more like yours on my best days, Helmut. It’s hard, but it feels so healthy.
If it was me, I would increase the meal bolus (ie increase your carb ratio) and decrease the basal rate. Get your 2hour numbers where you want them and adjust the basal to keep them there
Thanks Scott. I am going to increase my carb ratio a little all the way around. I’m just not as active this time of year. But I still need to test basals…which I avoid. I did get a call today that I was accepted as a new patient with an endo that I’ve heard good things about. My appt. is in November. I do fair…I just think the control should be better for the amount of effort I put into it.
Agree w/ timing suggestions…also may try lowering your carb load for a meal…worked for me:) but, very individual response based on lots of things.
Congratulations on great A1Cs, Helmut and MelissaBL. It’s always worthwhile to be champions of safe, tight control. Those CGMs give you both low blood glucose alerts, correct? That makes staying in the safe zone, much easier.
For all those readers with uncontrolled diabetes (medically defined as over 7%; on a personal level, defined by the individual and his/her health care provider), please don’t throw in the towel!
Often, reaching numbers at or under 6% as a type 1 are the result of months if not years of small steps and changes and typically involve insulin pumps and CGMs. Yes, plenty of people do it without those tools. But it’s a lot more difficult.
So I’d like to take this moment to note and show support for everyone fighting the good fight against elevated blood glucose levels, whatever your number.
And thank you for providing that discussion and tips!
A tip of the hat to you Kelly!! I’m really struggling and frustrated right now and I needed your encouragement. No throw in the towel for me.
I’m doing fine, but really think for as much effort that I put into the D that the numbers should be better. The good news is that I’m already doing all those behaviors you would want a d to do. Checking BG, pump, excercise (45-60 min. DAILY!!), etc. When I am home I weigh my food. I used to measure but I think weighing is more accurate.
My old endo wouldn’t get in the trenches with me and help me figure this out. She was OK when the A1C would come in slightly above 7. I got the call yesterday that I have been accepted as a new patient for an endo that I have heard many positive comments about. I’m soooooo excited I can hardly stand it.
I feel great right now, but I can’t wait to feel even better! I know it will take time, but don’t think it will need to be a major overhaul…maybe some tweaking here and there.
Thanks for your kind words. Tudiabetes is such a place of inspiration, encouragement and motivation. Gotta love it!
Looking forward to hearing how the tweaking works for you. Congratulations on your efforts thus far–and thanks for sharing!