I usually test my BG 2hrs for my postprandials. Today I stayed up late studying for my biostat exam and I was cramming down choco…err,broccoli. A while later and I’m 168mg/dl and I want to eat 19grams of carbs worth of chocolate. So I use my bolus wizard to insure I don’t have any IOB(2.5U, I:C = 1:10) and out of curiosity I set the reminder to half an hour later. My BG now is 194mg/dl. I always have trouble with peaks after sugary foods. Pre blousing is the obvious answer but honestly I’m a bit skeptical of this practice because a lot can go wrong before that and I tend to be a bit forgetful. So how do you manage those peaks? When do you typically have them and how do you define one as acceptable or one that’s a sign of trouble?
I don't want to run up much over 120 so when I hit 110 an hour afterwards, I get a bit squidgy. Usually, at that point, I'll set a temporary basal of 200% normal to sort of anticipate a higher number and, if it doesn't hit, I'm ok w/ like .8 extra. I am sort of into the game of it though?
So that’s how someone scores a 5.5?
I go low whenever I correct. It’s hard to correct with any active insulin in my system because I know it’s supposed to take care of the extra glucose, just not as fast as I would’ve liked it to be.
Doesn’t that worry you? Extra insulin running rampant in your bloodstream?
It depends what I'm doing. I try to eat when I'm around 80 so, if it's 110-120 an hour later, I figure the food is still "deploying" but, at the same time, there's still insulin there too? Like tonight, I ate a bunch of cous cous and chicken but it had spiked right before as I also munched some taco chips, not a ton, but like 6, maybe 15G but I'd bolused for 15G and had munched some cauliflower and a (low carb, like 6G of carbs...) margarita so I was sort of flying around however now, about 2 hours post dinner, I'm tailing off pretty hard and had some ice cream. I'm not doing much, since I worked out this morning but it's sort of dicey. I'd rather treat a low with ice cream than a high with well, bolusing, walking the dog and waiting for it to come down? *munch munch munch*... ;-)
I don't like going over 120 pp either. If I hit 115 in an hour or so, and rising, I'll dose .5u. Not enough to send me that low if I had enough on board to start with, but enough to ensure I'm not gonna go too high. If I end up under 80 I'll have 1/4 tsp of sugar in my coffee or a couple of skittles. My Dexcom makes me feel pretty safe.
140 is my limit. I don't eat any sugar or complex carbs so my limit could be lower but I leave room for the natural sugars fruit and vegetables have,
Have you heard of Symlin? There is a group here on tudiabetes, here is the link, http://www.tudiabetes.org/group/symlin . Its a drug you take before you eat to prevent glucose spikes. it works very well with possible side affects.
Even when I pre-bolus by 20 minutes, I find it virtually impossible not to spike to 180-200 at one hour even only eating 20-25g of carbs. By two hours I'm usually 120-130 (assuming nothing went wrong, like my body deciding to behave as if I skipped a bolus, which happened today with a 229 two hours after lunch), and by four hours I'm down in the 70s or 80s. I really don't know how people can aim for 120 at one hour without going low over the next few.
I might also "cheat" because, at least during the week, I'm an inveterate snacker. I don't eat a huge amount but, if I'm coming up "short" on BG, I'm usually planning a snack (usually about 12-15G of carbs, nuts, carrots, broccoli, maybe cheese if I really want to get crazy...) so if it turns out I only get up to 105-110 and I still have 2U of insulin chugging away at the two hour mark, I dig into some of my snacks, maybe only bolusing for 1/2 of what I'm eating to make up for the carb "shortfall" earlier?
I also sort of use the little bags of jelly beans as a "meter" and, if I'm eating too many of them (> 1/2 bag/ day...) I figure it might be time to turn the basal down a whiff?
You started off at 168 and ended up at 194. That's only a rise of 26. Just think, if you had started out at 80, you'd only be at 106.
That's the key, for me. Not to sweat any arbitrary (and perhaps impossible to achieve especially if I'm already starting out high!) number post-meal, but to be sure that no matter what, I'm back down in an optimal range way before the next meal.
I know there are some folks here who make grand pronouncements about the 1-hour-after-meal number, or the 2-hour-after-meal number, but really, what's the point in sweating those numbers until you or I have the pre-meal numbers under control?
The way I look at it, first things first. The first thing is to make sure that you bolus dose properly matches the meal being covered. If you are down to target in 3-4 hours then you go the first stuff done. Then you can worry about peaks. And matching the timing and profile of your insulin can be hard. If you have chocolate it may hit you as a simple carb all at once or with all that fat, spread out over time. Only testing or a CGM will tell you. And even if you figure it out, you only have so much you can do.
You can regularly move your bolus to 15 minutes before the meal, I often do that. But the downside is that you need control over your food, if your meal is delayed at a restaurant, that is bad news. If you are high (as you were), you can often move up your bolus to give the correction part time to work (I presume your 2.5U also included a correction). You could have actually bolused perhaps 30 minutes ahead of time, that would have allowed time for the insulin to bring your blood sugar down before you ate. There is also a technique called a superbolus that can be used for foods that have a very sharp peak, like candies and bread, but it only really works with a pump.
I don't routinely test for peaks. I just do first things first. Life is already mess enough. I may mess around a bit with timing, but I don't worry about the details. In the end, if you get the total bolus correct and you return to a normal blood sugar in 3-4 hours you will be fine, even if you went a bit higher for a short period of time.
I have not had a A1c over 5.7 in 4 Years and my average is 5.2 My goal is to stay between 90mg/dL and 140mg/dL 90% of every day. I do have BG over 140 but I watch my CGM and correct as soon as I see a problem. There are also times when my BG spikes to 180 / 200 but quickly falls back in range with no correction needed. There are no set rules and every day is a new opportunity. My pump target is set at 90-110 and I have very few excursions below 70mg/dL.
After spending most of my adult life with the Bete's I have found my best option is to start everyday fresh and
just take what works best for me and stick to my rules. I have many days where my BG is flat and then usually
a day or two of not so good results..I have compiled years of pump and CGM data that shows this pattern
and have no clue what causes it but I have no issues with my control it's good enough and I already do not have enough time to finish my Bucket List.
I do the "superbolus", cutting the basal back too sometimes. Taking the same amount of insulin "up front" can make sense in a lot of situations? Sometimes for "bumps" that seem to be moving towards running higher, I'll turn up the basal instead of a correction bolus? Maybe it's the same general effect, .5U-1U more or so but spread out and, if the original bolus "catches up" and I notice my BG dropping on the CGM, I just cut it off?
I guess this "fiddliness" may be why I don't talk all that much about the specifics of what I do, since there are a whole bunch of different things?
That was an irregular reading. Usually my Pre-meals are lower than that. I see what you mean by having a different-lower- peak have I started with a reading more normal. But I did take a correction for it.
This is all so very interesting. Seeing that I own a pump and a CGM, I have the ability to zoom into my readings in order to overcome those peaks. That though wouldn't mix well with my finals.
So when I LATER start studying those peaks, the first step would be getting my premeals under control. I've already seen past sensor overlays and my endo thinks the problem is carb-counting. So naturally I have to review my information. What comes after that?
I have a minimed. Which only offers the three basic boluses. The superbolus is a feature of the Animas I believe. Though I could mimic its action by depleting my basal and increasing my bolus, it all seems a lot of work to me. Maybe after my finals.
5.2, very impressive! congrats on your awesome A1C( That should be made into a card!)
You can see here:
my sensor overlay from a while back. But I usually have the same pattern. Those rises are all after meals. Would you correct those? or wait for the insulin on board to take its action?
My latest is 6.5. Good but I can do better. I believe I will achieve a lower A1C that once I get rid of those wretched peaks.
You have a minimed too, right? Do you find it too much of a hassle to do so? Do you have any graph or data showing that? I'd love to see one in action.
My endo once told me that I could do a temp basal if I'm high and about to have a meal. But that doesn't help with the peakedness afterwards though, does it?
The thing is, at one hour I wouldn't expect the correction to be "done".
When I take insulin with food I can have some expectation (or maybe just a hope!) that the food and insulin will get absorbed about the same time and spread over a few hours.
But when taking the correction, the correction is ALWAYS lagging unless I want to wait several hours for it to actually be "done".
To top it all off, eating and bolusing at the same time as a correction, means a sizable dose, and we know that sizeable doses take longer to absorb than more miniscule doses.
Yes it is frustrating. But I wouldn't want to layer an unrealistic expectation for correction kicking in, with an additional expectation for a number at one hour, and then on top of that expect that large bolus+correction to kick in quickly. I just think that having all that line up correctly, is very unlikely. Not trying to lower anyone's standards, just that's a hard combo.
That makes sense, A correction-on its own- would take quite a while to be consumed( About 4hrs). Its not reasonable to expect the BG to go down after an hour. When you throw in the carb factor its almost impossible! Which leaves us with pre-bolusing again.
I don't really look at it as a hassle. I look at logging as a hassle so I don't have any sort of ledger of what I've eaten or not eaten to compare it to, just the regular reports? I just want them to be flat and, if they aren't, I fix them?