Post Prandial Readings High After 3-4 Hours

Afternoon all. New member and figured I'd dive in with a question thats been bothering me. I'm a type 2 on insulin (lantus and Novolog) and have been working to get my BG under control. I've had pretty good success the past three months due to some lifestyle changes. The problem I am facing is that when I eat a meal, we'll say hot dogs, I'll give myself some novolog right before I eat to counter the carbs. At the 2 hour mark my BG will look pretty good (not great), but after 3 or 4 hours, its much higher. Should I be taking my Novolog after I eat?

Blood glucose results that are 3-4 hours after a meal are technically not post-prandials unless you eat a high fat/high carb meal like pizza where the spike occurs much later. Taking your Novolog before you eat is good and I would suggest you doing it 15-20 minutes before especially if the 2 hour number is "not great". This gives the insulin time to work.

So highs that you experience 3-4 hours+ are due to insufficient basal insulin. So you might want to try increasing your Lantus dose by a unit, splitting the dose, or tweaking the timing to see if you can get numbers down for those in between times such as waking, in between meals and bedtime.

Its funny you mention pizza asthat is when I have issues as well. Splitting my Lantus doe hasn't worked for me, as I used to do it, and it was terrible. I'm currently taking 50 units at around 7pm every day which leaves me at about 90-110 for my fasting BG when I wake up.

So let's assume that my BG before I eat is 110. I then eat two slices of pizza, juice up with 18 units of Novolog, and after two hours my BG is 134. 2 hours after that my BG is now 200. So you think I should be adjusting my Lantus to assist with keeping this down, or both Lantus and Novolog? The "combo meals" with fats and carbs (pizza, hot dogs, etc) are what really get me confused.

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hi Stavs, welcome again here.
Pizza is really difficult for me, and I'm on a pump and can do fancy boluses that are supposed to take care of the infamous "pizza effect". Here's a discussion I found on it, with a lot of really good ideas for those on MDI as well as pumps

Thanks! I will check that thread out. Dinner is my one "free meal" that I allow myself, and thats typically where my carbs come in. The rest of the day its a couple carbs here and there from my protein shake, fruit or nuts, and for those I don't need to bolus as they have no real effect on my BG due to the low amounts.

I think this has to do with your bolus not your basal. This happens to me too sometimes.You can try dual wave bolus for things like pizza, in other words at the 2 hour mark, or when you see you start to rise you can do another novolog bolus and or exercise to stop the spike.

Now that you've shared a bit more, I agree with meee (that sounds funny!) that it is, in fact, the bolus. Personally, I find those meals incredibly problematic, even with a pump that makes it easier. Sometimes I get it right with a combo bolus, more often I don't. So I make those kinds of foods an infrequent thing

I don't know what the rest of your diet is like but I eat about 50 grams of carbs per day. Because I eat "low" carb, I also add insulin to cover the fat and protein in my meal. The insulin to cover the fat and protein is delivered over a two to six hour period by my pump.

If you were to skip a dinner and your blood glucose remained flat then you could conclude that your BG rise when you do eat is due to an inadequate meal bolus. I'm not on multiple daily injections but if I were, I would be tempted to try adding NPH insulin to a meal of pizza.

lol... I'm not sure why I chose meee for my name here, it does create "funniness" :)

Hi Stavs,

Being insulin resistant and eating hard to dose for meals is not likely to bring you much success. I wouldn't consider any meal a "free" meal. If eating pizza or hot dogs has you hitting 200 regularly, you might want to treat them as rare treats and not as a regular meal option.

One way of dealing with a meal that hits your blood sugar at 3 or 4 hours is to take a second hit of insulin at two hours even if your blood sugar is OK. I wouldn't do something like that without getting a lot of help at first from a CDE on carb counting, logging meals and results so that you understand patterns and being willing to use a lot of test strips. It's an intensive technique and you might just want to modify your diet rather than work that hard just to enjoy a few foods.


While others have suggested that meals like pizza may have slowed digestion, there are other things that could be going on. I find that meals that are very low carb and consist of protein and fat still cause a blood sugar rise, but the rise occurs over a longer period of time, perhaps 3-5 hours. I follow a low carb diet and bolus counting for half my grams of protein as carbs.

The second thing which could be affecting you is gastroparesis. You have had D since 2002 and have had a high enough blood sugar that you may have this complication which leads to problems with digestion. Do you think you might have gastroparesis?

I just read what that was. In looking at the symptoms, I don't think it's something I have. I never even heard of that before, but not something I would want either! LOL

Just a question about your Lantus dose at 50u????? I didn't realize people could use that much? Are you a larger person? How much Lantus do people use? I am using 12u every morning.
Sorry to ask an OT question, but your post just really shocked me.
Thank you.

I often questioned that myself! I actually just upped it to 55u per day which is giving me a fasting BG of 85-95. I'm fairly big. I'm about 5'9" and 226 now, was 238 2.5 months ago.

The OP is Type 2, mekamom. Type 2's take significantly larger doses than Type 1 because of insulin resistance. Insulin resistance means the body doesn't efficiently use insulin so more is needed.

Thank you for explaining.