I've tried to research this but haven't gotten the answer I am looking for. What is considered an acceptable random blood glucose level for a diabetic person (T1 & T2, if there isn't a difference)? By this I mean a test done at any time of the day whether you've eaten prior or not.
I've changed the dosage of a medication I'm on (cymbalta, was 20, now 30 mg 2x a day) and have noticed that since then, my bg levels have been a lot more undpredictable -- higher highs and lower lows. In particular, I've had to up my basal insulin a unit or two because my morning readings have been higher than they should be for me, and I've been feeling more fatigued than not on most days.
I normally eat breakfast and then a mid-morning snack. My diet has been consistently the same since I was diagnosed in June and by bg levels are good. As I'm trying to pay more attention to what is happening lately, I've noticed that the last two days after I've eaten my mid-morning snack, I've felt extremely tired, even dizzy and have trouble focusing my eyes. Today, I tested my blood and found that about 1 1/2 hours after the snack, by bg level had risen to 174. Is that ok for a diabetic person so soon after eating? Because it did not feel ok for me...
The blood glucose is highly dynamic so you can not ignore the glucose intake. A healthy person can produce 20 units of insulin per hour. The synchronization between digestion and insulin secretion is orchestrated in a way that a level below 140 mg/dL is very likely achieved within the 1 to 2 hours after the intake of carbs. In the morning the numbers of a healthy person would be below 90 mg/dL and this is also true for the day while fasting.
A spike of 174 mg/dl at the 1 1/2 hour mark should be addressed - at least it can be tried:
how long do you wait between injection and eating. It might be a good idea to wait some minutes (5-10 minutes for example).
what type of bolus insulin do use? There might be a faster brand.
do you think something has changed? The end of the honeymoon phase for example!?
For cymbalta I found this information:
Nausea, somnolence, insomnia, and dizziness are the main side effects, reported by about 10% to 20% of patients.
Well I inject 4 times a day (3 for meals, one for basal/night time), and that is also when I usually test, unless I’m feeling weird. Like today. So, I use Humalog and inject literally right before the meal. I don’t inject before snacks. My mid-morning snack is 15 carbs and a bit of protein.
I wonder about the honeymoon phase, or perimenopause around the corner, or just plain annoying female hormones. Things were fine however until I started the higher dose of cymbalta, i.e. my bg levels were pretty predictable.
Any other thoughts based on this additional info.?
If you are somewhat petite, you may rise 5-10 mg/dl per gram of carbs, so 15g mid morning snack could raise you 75-150 mg/dl. So unless you still have some bolus insulin on board, you may end up depending on you basal to “cover” the carbs and that may be why you are seeing those higher numbers. I kinda agree with Holger, it is probably better in the long-term to try to target keeping under 140 mg/dl between meals, and you will feel better. Any chance you would consider just a protein snack? How about a handful of almonds?
It is also possible of course with the medication that your morning basal requirements are higher or that you are more insulin resistant in the morning. You would normally observe that with a higher average morning fasting number and higher after breakfast number. Are they consistently higher? If so, then you may want to make some adjustments.
If you raise a med and you have some of the symptoms of side effects, it often means you are reacting to that drug.
I agree with everything Holger has said.
Concentrate on getting the basal at a level it does not change when it is 4 hours after a meal.
Then test yourself to learn when your bolus insulin starts acting (if you’re unsure). Get your blood sugar above 140 and give yourself 1 unit. Test at 15 min, 20 min, 25 min, 30 min., 35 min. and learn how much before a meal you need to give your bolus. Timing your bolus to be very effective to keep your blood sugars as even as possible.
And do write down everything with the time of day.
It’s great that you’re paying attention to your symptoms. Tell these to your doctor - by phone. He may want to change the dosage.
A non-diabetic will not change his blood sugar when he eats - only small increments, since insulin comes quickly. A diabetic may spike after eating any carbohydrate at all. That spike may be within the hour and last until the insulin finally starts to act.
Honestly I wouldn’t mind just eating protein. The length of time between breakfast and lunch is not that extreme (I’m not eating breakfast at 5:00 am), so I think I could well survive on that. I’ll give it a try.
I’m pretty certain now being on this dose for more than 2 weeks that it’s raising my basal requirements. The thing is, even in that I can fluctuate a little. I can take the same amount of basal, say 8 units, and wake up one morning with 76 and another morning with 101. This with the same things I always eat. This is perplexing because prior to that my numbers were a bit closer together every day and I could easily adjust the basal with consistent results during the insulin resistance time of the month (prior to period) to normalize my bg to where it more closely matched the other 3 weeks of the month. Now I’m totally confused as to what that meter is going to say from reading to reading!
I don’t have dawn phenomenon, and my morning fasting and before lunch numbers have not been higher all the time, or matched in being high.
Thanks for the info. about 140 between meals. I thought that 174 was what was making me feel drugged…
Thanks for this, Leo2 – I will give it a go and see what happens. Haven’t tried this particular experiment before.
I’ve been told that Humalog when taken before a meal takes a couple of hours to really kick in. I’ll have to verify that with testing on me, but it feels about right. Sounds then that the basal will have to be helping more than it is. Argh… I hate to be upping insulin because of meds, but I guess I have to see about it at the least…
Capri- Humalog only takes 15-20 min to kick in. That’s why you shouldn’t take it till you are really ready to eat. I occasionally have taken it after ordering in a restaurant, and the food took a little longer than expected to arrive, and I had a low.
Ok, that’s confusing. Maybe I got it wrong. I’ll have to do the test that Leo2 suggests and find out for sure what the deal is. I think I was thinking of the fact that a test should be done 2 hours after a meal… Oh, my brain is fuzzy lately!
On that note, I’ve done the same thing, but felt the low coming on in the restaurant about an hour after I took it – but that’s because I took it before instead of after ordering and the food took forever to come. Since then, I always take it right after ordering.
I am a big fan of NovoRapid because of the waiting problem in restaurants. I can just shoot and eat. Some experienced that Apidra is even faster than NovoRapid. So the insulins are there - you just have to find the right one for you. All it needs is an open minded endo and one vial.
Just my experience, but Apidra works fastest for me. But, timing of doses to meals really is an art. Takes a lot of experimentation to find the timing that best coincides with your digestive rate, as well as the particular meal. Yep, there are no constants.
What you might have read is that Humalog, like most raid acting insulin, peaks in two hours. Hence, the test two hours after meals guideline.
Ask your endo for samples.
I’m small & slender. Carbs hit me fast. One carb raises my BG 10 pts.
Never seen this. When I was diagnosed I was just shown how, took the box home, took the pen out, and started injecting. Gotta look for this chart now, see if I still have it lying around somewhere.
Yeah- I never really looked at those charts until a few years after diagnoses. Now I read owners manuals for everything, even kids toys.
But really Caprifoglio, you really are doing a great job after just being diagnosed so don’t be so critical of yourself. The learning never stops.
You are kind. I’m just impatient with my body. Always have been. Maybe I’ve been made to pay my karmic debt by being born into the body of a woman.
I do appreciate your encouragement. I think everyone who comes to this site gets inspired to do the best they can, and that says a lot about the support we all give one another, doesn’t it?
Still, I prefer the Ikea"international" instructions because they are mysterious and anyway temporarily, leave things to the imagination. (Now you can envision what misshapen furniture I can build in my mystery mode, lol)!
