I have a quick question. I feel silly asking after having this stupid disease for 17 years but here goes…
I have heard people mention that they check their sugar and it’s say over 200 and then it’s I’m so hungry but I can’t eat or my husband was wondering why dinner wasn’t ready and I told him it’s because my sugar was 230 and couldn’t eat yet…why is that? My experience with doctors has been horrible until recently and I feel i missed out on a lot of helpful info while I struggled with this and awful doctors.
If my blood sugar is high at dinner time, I just take the appropriate dose for the meal plus the excess glucose, then wait about an hour for the insulin to get underway. If you just eat right away when your blood sugar is 200, you might as well pour it down the toilet, since your body can’t use food unless there is insulin to allow it to be metabolized.
It can be quite irritating when you’re hungry but the blood sugar is high, but since hunger depends on more things than blood sugar, such a disconnect is possible.
@phillips4adventure - Although we do not eat a low/no carb diet, on occasion we will reduce or skip the carbs. If the BG is running very high then at times, we may decide it would be more appropriate to have a meal consisting of calories obtained from protein and fats and entirely skip the carbs.
Certainly everybody would like to have BG that are always in a good range. But often times something happens where it spikes out of control. Sometimes we know what caused it so we can prevent an occurrence and sometimes we are left not really sure. From a T1 point of view, the solution is always the same - insulin. But as you say, waiting for the insulin to work can take time - hours. And knowing how much insulin is of course where it gets tricky and is very individualized.
For example if 250 BG and ready to have dinner of hamburgers, an option might be to have the burger but skip the bread/bun where the majority of the carbs are. Perhaps pass on the fries and have a side of broccoli instead.
At times we have switched dinner plans and decided to have a veggie filled cheesy omelette with a side of bacon or sausage. Breakfast for dinner is sometimes fun.
Some people will certainly push the NO CARB lifestyle as the best approach entirely for all meals everyday. That is an option for some people. We find it to be a helpful tool which we use at times but do not use that as our overall dietary approach.
I dose for the food I will be eating, plus I would add another five units to cover the excess that I am starting with. Who wants to not eat? That isn’t fair. And it isn’t necessary either.
I would agree that we also sometimes do that. However we have found that if starting at a high number like 200 or 250 and then eating a good amount of carbs and bolusing at the same time that the food will hit first (ie - well before the insulin has had time to kick in) and we could easily end up in the 300 or 400 range. At that high of BG sometimes we find it very difficult to get back down and it could take quite a bit more insulin and basically most of the night trying to get back under control.
It is great that it works for you at high numbers to just be able to bolus and eat.
Unfortunately as you know everybody is different in this regard.
It is good to know different options available so each person can determine what course of action works the best for themselves.
I eat very few carbs. I just can’t do them. My meals usually consist of a protein of some sort and then a big salad or a large helping of cooked veggies. With that, I am actually able to eat and correct at the same time.
The biggest reason I don’t eat right away at over 200 is that if I don’t knock it down, I’ll stay high a long time. So if I’m 200 or higher I will give myself a dual wave pre-bolus and add a unit or two to the total. I’ll give myself 70% now and 30% over the next half an hour or hour.
So, I take it. And I wait about 20 minutes before I eat. If I’m still not moving then (my CGM is not starting to point down, I’ll wait maybe five minutes more, cancel the second part of the wave and reenter the square wave with a bit more insulin.
The biggest breakthrough in my Type 1 is to always pre-bolus. The dual wave on my pump is a close second.
If I’m 90, I don’t have to.
If I’m 120, I wait 5 minutes
If I’m 150, I wait 10 minutes
If I’m 180, I wait 15 minutes
Over that, at least 20 minutes
I adjust how many minutes based on where my number falls.
I am experiencing “the prebolus breakthrough” these days! I’ve been doing it for only about two weeks, but I can’t believe the difference it’s making. It matters a lot to me right now too, because I’m pregnant. Yeah prebolus!!
If find that the maximum my blood sugar will decline with any amount of insulin is about 40 per hour, or 60 per hour if I bolus to such an extent that the blood sugar will be too low later on. This is because the cells only need so much sugar for their metabolic processes, and there is a limit to how much they will take in even with insulin to carry it across the cell walls. This can mean a three-hour wait if it is very high.
Thank you all for responding. It makes more sense to me now why people wait. I guess having your sugar at a normal range before piling on more sugar is easier to control instead of treating a high than pouring on the sugar and treating that too.
Yes and I find that the insulin required to move your BG down 100 points is just not the same when going from say 350 to 250 as compared to maybe going from 180 to 80. For us, 100 points is NOT 100 points. I don’t claim to understand, I just know to get a 100 point decrease when in the 300 or 400 range it will take more insulin than to get a 100 point decrease when under 200.
Sometimes we just go with “the way it is” and stop trying to figure out the “why” of it.
When I was a kid, I didn’t eat above 200. But, now, since I use sliding scale insulin, I just increase the amount of insulin I take at mealtime. I might wait longer to eat, after dosing, and give the insulin a head start on bringing my numbers down.
Are you on manual injection insulin with a syringe? What insulins do you take?
If I’m above 200 (11.1) and my recent BG history tells me I’m becoming more insulin resistant, then I will often skip a meal. (Yes, T1Ds can be insulin resistant.) For me, fasting is a dependable way to decrease insulin resistance. I also find that bringing down a 300-400 (16.7-22.2) BG is much harder, takes more insulin, than say something under 200 (11.1).
I’ve found that eating a lower carb diet (<75 grams/day) has diminished appetite extremes. I believe carbs have an addictive quality – the more you eat, the more you want. I don’t feel deprived much when I skip a meal due to high BGs. If I still really want to eat, I eat a handful of nuts or a couple tablespoons of peanut butter.
It really depends on the situation. If I’m high and it’s really necessary to eat, say because we’re dining out or we have company and everyone is sitting down at the same time, then I will calculate the amount needed to just correct the high, add in what the meal calls for, and do it as a single shot. If it’s really not necessary to eat at the moment, I will just correct the high and wait til later to bolus and eat. No fixed strategy. Circumstances dictate.
Tim35 makes a good point, which is that the responsiveness of blood sugar to insulin varies with the level of blood sugar, which makes diabetes an extremely difficult disease to manage. For me, one unit of insulin usually equals 20 units of blood sugar on the American scale, but if my blood sugar goes above 200, the excess glucose seems to earn ‘interest’ and require much more than just one unit per 20.
@Tim35 I think not knowing WHY is the hardest art for me. I have always felt the need to know why in any situation and with diabetes there seems to never be a why.
@mohe0001 Currently I am on the medtronic insulin pump with humolog. Ive had a rough summer and was rationing insulin but I saw my doc and we are working together to get back on track. Lack of funds is making it difficult and even with insurance its still almost impossible. But I do better on the pump than injections.
The most important aspect is knowing how to manage and treat.
Knowing the “why” of it is secondary but certainly when you understand the “why” of the various situations then it helps you better with the managing and treating.
The reality is sometimes you do know the “why” and sometimes you just have to let the “why” slide you by and stick with treating.
After a certain time, a pre-bolus becomes a very aggressive correction. I sometimes just recognize that I will have to bolus AGAIN for the meal. So, functionally, I am actually waiting to eat anyway.
OK, so when I changed to a pump, most recently, it helped improve BG. People have suggested that the tiny, little doses of insulin that the pump injects get absorbed and processed faster by our bodies. That’s opposed to a large syringe injection of medication that can kinda pool under the skin and take much longer to absorb. That falls in line with my experience. However, it still takes a while, sometimes a long while, to bring those ‘sticky’ high numbers down - roughly 4 hours. Although, it might be quicker on a pump. Its always preferable not to go high in the first place. Highs are tenacious. They are harder to treat than lows (in my case, but some people, obviously, really struggle with lows). Some people also argue that delivering smaller dosages via the pump, like under 6 u, gets absorbed faster. So, that’s something to investigate in yourself.
Medtronic IS the least expensive pumping option that I know of (compared with Omnipod) because more of the pieces fall under the ‘durable’ medical device part of insurance billing. We ought to do some investigation, on your behalf, to see about lessening the burden of cost. What state are you in, if you don’t mind me asking? I’ll google. I’m sure that you have done that, but it’s a good learning experience for me, too, to see what diabetes resources are out there. I have to think there is something…
