Ok, I hear what you are saying. But we are insulin challenged. The 2 hour pp BG may be abnormal for two reasons: 1. The injected insulin could be insufficient. 2. The food may have too much fat and digest slowly - mismatch of timing of insulin peak and food digestion.
Somewhere between 3- 5 hours, if the BG returns to “normal” - at least the amount of insulin was correct. If BG is still abnormal, the insulin was insufficient for the meal.
I have tested 109 at 2 hours and thought to myself: wow, that’s a great number! I matched my insulin to carbs! Only to find out, 3 to 4 hours later 200+, and I wondered what happened? slow digesting fatty food? or larger than a usual meal? This does occur “often” when I eat rice, steak. It has been suggested by Terry4 to use a little Regular insulin. I brought it up with my endo - he is opposed to this.
(Tonight, 2 hr ppBG 130. 4.5 hour pp BG 146. Took 0.5 unit novolog for correction. Ugh. )
I often inject before my meal, sometimes as much as 45 minutes or more. Which means that 2 hours after the meals is often more like 3 hours after injection. At that point there is little insulin on board. Yes, if you ate a carbfest and went up to 300-400 mg/dl then getting down to 140 mg/dl might portend an oncoming low. But I eat low carb and try hard to match my insulin, so I rarely go over 200 mg/dl. If I am over 140 mg/dl that indicates I had a mismatch somewhere.
And if I have a high protein or particularly fatty meal I’ll split my bolus and worry more about the readings at 3-5 hours.
I use the pump extended bolus for this “steak and rice” scenario. Perhaps experimenting with a second bolus 30-60 minutes after eating might be worthwhile.
What would you have done differently for the situation below? What are your interpretation of the effects of food on BG?
Last Friday for dinner:
I bolused 2 units to cover: one half apple, one half avocado - “appetizer” @ 7 pm
I bolused 3.5 units to cover rice and steak, green vegetables @ 7:45
I bolused 2 units to cover one Haagen Daz ice cream pop. @ 8:30 pm
At 10 pm - BG =109
At 11 pm - BG = 187
At midnight - BG = 205
I went to bed and did NOT take any correction. The next morning 6:30 AM BG = 108.
I have gone to bed in the past with BG’s somewhere between150-220 and next morning fasting BG’s about between 100-135.
I have gone to bed with BG’s 130- 160 and next morning fasting BG’s about between 100-135.
I have not changed my basal quantity.
It seems like whether my bedtime BG is higher or lower, the morning fasting is generally between 100-135. This is different from what I read in Think Like a Pancreas or Using Insulin about basal. It’s perplexing and just one of the odd things that I’ve noticed about my diabetes.
Thanks in advance to all in the community for your patience and understanding. Diabetes is one puzzling condition.
Edited to add: This was meant as a reply to Ih378. Guess I clicked “reply” in the wrong place.
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My interpretation of the above is that the protein from the steak and ice cream take a long time to digest and that the fat in the avocado and ice cream may have slowed down everything.
I’m not on a pump and I don’t like giving more than one injection per meal if at all possible, so I won’t even make a guess as to what you might have done differently for bolus. What I have done differently after a number of situations like this is to move my dinner hour up to 5 PM. That way most digestion of even protein is over before bedtime so I have a better idea of where BG will end up and I can make a correction as necessary based upon bedtime reading. If I have a bedtime snack, I usually make it something with a known bolus amount, for example I need one unit Humalog for one ounce peanuts.
At any rate you ended up approximately where you wanted by morning, I assume, so in the end, all was well with what you did.
Does anyone else experience the same thing as I do? Specifically, even if my post dinner, bedtime BG is “high”, I can still wake up with a not so terrible fasting BG somewhere between 100-135?
(BTW -I was at my in laws. 7 pm was the earliest that I could obtain some food. I ate the apple and avocado to have some food. I was thinking that some of the 2 units could be “pre bolus” for the rice and steak that I ate 45 minutes later.)
If you are high at bedtime and in range when you wake up then that probably means that your overnight basal is a little too strong. You’re on MDI, right? What do you use for basal insulin? Also, how much pre-bolus time did you use for your food at 7 p.m., 7:45 p.m., and 8:30 p.m.? Your higher post-dinner numbers could stem from a time-mismatch between the food and insulin. You didn’t mention your BG number when you started to eat. Starting at a higher number, say > 120, could also be a factor.
I don’t think you are very far off from discovering a regimen that would work for you. The best way I’ve found to dial this in would be to eat the same meal several different times, experiment with insulin dose size and pre-bolus time and keep records.
I would proceed with a basal test first for this period first to make sure your basal insulin doesn’t confuse analyzing your prandial insulin dosing. It appears to me that your basal insulin is doing some bolus work while you sleep. Your body, of course, doesn’t care if you delivered basal or bolus insulin but figuring out your meal insulin is complicated if the basal is doing some bolus work.
I thought about the basal possibly doing some bolus work. It’s more likely that my liver may dump less sugar if my bedtime BG is high ( my pancreas may secrete insulin erratically/unpredictably too). I’ve noticed that my body seems to “adjust” and “like” morning fastings generally between 100 to about 135 ish regardless of my bedtime BG. If the basal were set too high, I would often have low morning FBG, or low middle of the night readings (I’ve never had either low FBG or low 3 AM BG) I’ve had bedtime BG 133 and FBG 133; bedtime BG 205, FBG 108. I will try to keep better records. It’s puzzling. Has this happen to anyone else? That is higher or lower BG, the morning BG is always about the same.
(These BG were while using Levemir. I just began to try Tresiba. I do know that it may take a while to figure out the correct Tresiba dosage too. So I’ll do my best to keep records and analyze the data.)
Hi All,
Looking for a little assistance in trying to figure out whether bolus timing or quantity need adjustment. The following happened.
1 pm - BG 122 before lunch
4.5 units Novolog prebolus by about 15 minutes
Lunch: Rice, milk, carrots, walnuts, chicken, green vegetables 1 small square of dark chocolate
I understand liver dumping to be more prominent in T2D than T1D. I think your gut instinct is more material than how I framed things. What do you think is worth trying?
I’d say your bolus quantity was perfect.
To avoid the higher spike soon after eating, you can wait a bit longer, or start eating the lower carb foods first (meat, green vegetables), or both. I watch my dexcom, and often it takes 30-45 min to see a down trend, but varies on many factors.
I avoid rice, carrots. They shoot up my BG too fast, no matter how long I wait.
Many doctors would say Perfect ! No change at all, since you got back into range and leveled out 4 hours post meal.
Honestly, I wasn’t thinking about changing anything major. I could try avoiding the situations (eating out, eating at relatives…etc) However, that begins to affect my quality of life. At home, I will try to pre bolus and eat the carbs at the end of the meal and try to err on the side of slightly more bolus than less. It is easier to correct a mild low than to correct a mild high between 150-200. I’m on MDI so the 0.5 unit correction is often rather inaccurate; not to mention it could take a long time.
Well…I was thinking similarly to what you said, that at 4 hours or so, I was level and decent near 100. The only concern would be the rise to 206; how long did it last? I do not use a CGM. I did use it but for a variety of reasons, I do not want to continue using it.
If it were me, knowing my response to a meal you described, using Novolog insulin via pump, I would have been 250+ by 1:45 or so, maybe still rising or getting flat at that level, before the drop to 200ish by 3-3:30.
I often include more fats to slow things down a bit, and limit the peak to 160 or so, and can add more insulin via pump with a square or dual wave.
I also starting using Afrezza last year, so if I used that, it would be another story!
I often have a rise to over 200 when I eat rice, too, even though the bolus I take with the meal is adequate to bring my BG down eventually. I do now sometimes skip rice entirely, even though I might make some for my partner. When I do have rice I normally weigh my portion, limiting my serving to 2.5 or 3 ounces at the most.
Another thing I do when having something like a carrot-raisin salad is to save part of my meal (in this case the salad) for a snack a couple of hours later, even though I’d bolused for it in the meal. That way the BG from the rest of the meal is coming down closer to pre-meal level before I eat the salad. It works for meals eaten at home, but of course might not be appropriate when eating as a guest somewhere. Frankly, using this trick of saving part of my meal for later is the only way I can manage eating 120-150 grams of carb daily without having my BG go over 200 postprandially almost every day.
Your prior to eating and 5 hours post eating are about +43 points.
8:15 number is good.
10 pm high - slower digestion from the fat from salmon and eating rice last.
If it were me (and I managed things very tightly), I would have done a correction for the 107 (because my target is 70 - 90), this would probably mean that I would end up lower at 5 hours.
Else I would say 1 or 2 more units of insulin for that meal, depending on your carb & protein: insulin ratios - to try to get pre and post numbers closer together.
Alternatively, I would have done a cautious correction at 10 pm if I found I was that high 3 hours after eating. For me my insulin really does not have much impact beyond 2 1/2 - 3 hours so i am very comfortable adjusting at that time.
