I'm slightly embarrassed about the question I'm about to ask, but I realize if I don't ask, I'll never learn. My question is about spikes in blood sugar after eating. After most of me meals, I experience a spike in my blood sugars. Sometimes it will spike to about 200 but often it will spike to 250 and above. When I see this spike (either from looking at my CGM or testing my finger), 80% of the time my pump will tell me not to bolus anything, because I have enough active insulin in my system already. And most of the time it is correct, my blood sugar will then drop back down, but not always. I find this incredibly frustrating and confusing to see a high blood sugar but then being told not to give any more insulin. Obviously I don't want to drop low, but I don't want these spikes to occur. Most days my CGM just looks like one crazy roller coaster ride. So how do I get rid of them? Is it a question of food? I know foods like pizza and pasta will spike my bg, but I don't feel like I'm eating extra complex or high sugar foods. Is it a question of how I give my insulin? I usually just do a normal bolus because thats what I was told but should I be doing square or dual? I know these are questions for my endo, but I was wondering about other people's experiences. How do you avoid those spikes??
I don't run into them that much. I look at the 2 hour readings and, if they are higher than I want (I use 120 but that's "ok" in my head but I get nervous as I approach it...), I adjust my ratio to put a bit more insulin on it. Not a lot, like .1 or .2g/ U less. I've tried playing around with square or dual but haven't ever had much luck with those. If my BG gets up above that, like 120 going up steeply on the CGM after a meal, I'll also crank the basal up to 200% regular for a couple of hours. A lot of times, I'll check in an hour and it will be hunky dory or I'll end up turning the basal down to avoid a low but I figure I've saved myself a couple of hours of high. I try to do that as much as possible.
If I'm treating too many lows, I figure the opposite, that my ratios/ rates are putting too much insulin in there and turn them down.
Food definitely impacts blood sugar. If you are eating high carb meals they can be hard to accurately bolus for.
But bottom line, It sounds as if your I:C ratios need adjusting if you are frequently spiking too high two hours after your meals. I would try increasing your insulin by a little. If you are currently using 1:15, try 1:13 for awhile and seeing how that works. Also, many of us have different I:C ratios for different meals. Mine, for example are 1:6, 1:11 and 1:16. Do you have the book Using Insulin by John Walsh?
Also, you might be waiting too long to bolus. Try bolusing 15-20 minutes before eating.
I still hit some higher carb meals, generally in the evenings and weekends but eat mostly the same during the week. I think that helps me keep my settings pretty accurate so that when I let 'er rip, the result works out ok. One thing that amazed me when I switched to the pump was how small adjustments would make significant differences in results. I was all over the place on my homegrown MDI regimen but realize now that a very small nudge can help get me where I want.
Another thing that I do which is not exactly medically recommended is try to aim for 85 for fasting BG. I don't always hang out there but, when I do, it seems less likely to run up to 200+, it has to go farther to get there and all that. I wonder if maybe thinking +/- might have some benefits for a methodology over "hit this number" as the change is the big thing. It always goes up but I try not to go way up.
No I dont have that book, you recommend it? I do have different ratios for different meals but I'm thinking they might need to be adjusted more, thank you.
I read "Pumping Insulin" and "Think Like a Pancreas" by Gary Scheiner and they are both awesome owner's manuals that really will help you figure things out. Ginger Vieira has another book I like called "Your Diabetes Science Experiment" which is also very good and is a bit shorter. I like TLAP the most because that's what I was reading when the light bulb went on in my head but they are all very good and comprehensive books.
I think we do a good job if we can actually figure out the right insulin dose so that we return to a normal blood sugar 3-5 hours after eating. But in order to suppress that spike in blood sugar from eating you need to actually control the profile and timing of your bolus, a very difficult thing to do. We are told that we can just bolus and eat whatever we want, but I think that is just a lie. Sure, you can do stuff like advancing your bolus, doing a super bolus, using an extended or dual wave bolus. But in the end, if you eat a huge amount of carbs, it is going to be really hard to match your insulin profile to that cascade of glucose hitting your system. Your two major options are to cut the carbs or work on advanced techniques to try to compensate for the huge rush of glucose hitting your system.
that makes a lot of sense, thank you. The timing of my bolus is one of my biggest weaknesses, it is usually on the later side so that would help explain the spikes. That probably is a good place to start to see if I can get things to level out.
Def great reads! I also am an advocate of low carb. The lower the carbs the less insulin you have to take, the less mistakes, and best of all no blood sugar roller coasters.
I've found for me, I can handle higher carb meals for breakfast and lunch better than I can dinner. And forget eating anything carby late at night. Right now I'm having a lot of gastroparesis issues, go figure my A1c is right at 6 and I'm having more problems with gastroparesis NOW than I ever had when my A1c was really high. But I've been using my dual wave bolus a LOT lately and avoiding eating high carb meals.
I got in the habit of bolusing right as I finish and sometimes I forget and I end up bolusing 10-15 minutes after I'm done. It sounds like if I can switch and remember to bolus before I eat, it will make a difference. Probably easier said than done since I'm so used to doing it after, but I'll for sure give it a try. I guess I always just worried what if you end up eating less than you anticipated but you already gave insulin
our beta cells do not produce insulin (surprise). Actually they produce pro-insulin that will dissolve to amylin and insulin. The amylin will slow the digestion down so that the insulin can unfold its activity before all the carbs hit the blood stream. We T1 diabetics have no amylin thus we always digest with full speed. Our insulin also has to get from our skin to the blood stream. This combined results in huge spikes.
The possible strategies:
-you can inject symlin with every meal. This is the synthetic counterpart to amylin. The drug comes in a pen.
-OR: inject and wait 10 minutes before you eat. Here the problem is that the pump is actually distributing the dosage over time (in contrast to one injection with a pen). So waiting might be less effective for pumpers. Give it a try.
-OR: try different brands of analog insulins. Individually some people find Apidra faster than NovoLog and NovoLog faster than HumaLog. Find your personal favorite by getting samples from your endo - a very valuable experience in my opinion.
-OR: try to eat slower food (lower glycaemic index)
The older we get the slower the digestion. In other words time will normalize the situation to some degree ;-)
thank you! this is very valuable information. Sampling different insulins is something I never thought to do but I'm going to bring it up at my next appointment.
you could also eat one table spoon of apple cider vinegar on top of the meal. This has the potential to prevent that the carbs will be fully absorbed. But this might be kind of gross.
No need to be embarrassed about asking questions. Our ability to continue to learn is our single best tool to manage BGs and deal with the complexity of T1 diabetes.
Here are the things that I do to combat post-meal spikes:
1.) I use food labels and/or a digital scale to calculate the actual carb content of my meal. An educated guess is OK for once in a while dining out but swagging at home buys you a ticket to ride the glucocoaster.
2.) I follow a lower carb diet, about 50 - 100 grams per day. I didn't do this until last year, my 28th year as a T1. It has had a dramatic positive effect on my control.
3.) I always bolus at least 15 minutes before I eat at home. I push that to 30 minutes or more if my sugar is higher. I watch my BG on my CGM and confirm with a fingerstick so that I don't end up hypo as I start to eat.
4.) I exercise every day. I walk 40-60 minutes per day. Walking after you eat does wonders for post meal BGs; my walking rate is at a comfortable pace. I can easily hold a conversation at the speed I walk. Use your meter to advise you on post meal exercise timing.
5.) Since I don't consume a lot of carbs, I bolus for fat and protein using a combination (dual-wave) bolus. I take some insulin right away for the carb content and some insulin over time for the fat/protein content.
6.) The best meal dose will not control your after meal BGs if your basal rate is not matched well to your personal needs. I recommend Gary Scheiner's Think Like A Pancreas protocol for setting up a good basal rate.
7.) Test. Test. Test. And write stuff down. Keeping a written log, at least while you're making changes will keep you from chasing your tail! With all the factors that affect BGs, it can get very confusing in a hurry.
Good luck to you. You are asking the right questions.
My son can have up to 30 carbs in a setting without too much spike usually. However, sometimes his BG will briefly spike and then come back down even when only eating 30 carbs. The best method to avoid this for him is to bolus 15 minutes before eating, as others have suggested (he is on Novolog). If you are on humalog, you may only have to wait 10 minutes. I'm not sure about other insulins, but a quick search will give you their action times.
I don't remember the blogger, but someone recently did a "self-study" on doing a 15 to 30 minutes walking after every higher carb meal and indicated that it lowers the amount of his post meal spike. I think he indicated a 20-30 point flattening of his overall BG levels.
