Spike round 2 !

[PG1759]

So I posted on here a couple of weeks ago regarding spikes after meals. My bolus/fast acting ratio is correct as most days I'm there or thereabouts the same at each mealtime interval.

I've tried injecting early like half an hour before ( I'm using apidra) and tried different sites like my arm. which I've never used before. Nothing has worked

I eat pretty well and eat at the same times each day.

It seems my blood sugar always wants to go to 12-13+ each day regardless of how low or high I start meals !?

A few questions for anyone who might be able to help:

1. I have confused myself in all of this recently regarding low and hi gi foods and the timings of bolus. What's the textbook time to inject ? If the food is low gi meaning it's released slower then should I be injecting later or earlier ?? ( sorry)

2. I'm really interested to know what people with tight control of there levels go to after eating ? Do you stay within normal range ?

3. Sometime back I was on more background insulin and I reduced it over time to stop me dropping all the time. It was deemed I was in a honey moon period and it could be reduced. Well my current basal is 8 units in the morn (lantus) and on tests I have ran with no food in me this seems to be correct( I.e I'm not going high or low)
Could I be in a honeymoon period still given the fact I'm spending 3 hours after each meal time running between 13 and 11 mmol ??
Should I increase my lantus ?

Sorry for all the questions. Any advice would be very welcome...

A confused newby !

 

[Emmotha]

Hi,
I'm commenting to bump the thread as having exactly the same troubles (as point 3).
Hopefully someone will give you some info soon

 

[AndyOD]

So I posted on here a couple of weeks ago regarding spikes after meals. My bolus/fast acting ratio is correct as most days I'm there or thereabouts the same at each mealtime interval.

I've tried injecting early like half an hour before ( I'm using apidra) and tried different sites like my arm. which I've never used before. Nothing has worked

I eat pretty well and eat at the same times each day.

It seems my blood sugar always wants to go to 12-13+ each day regardless of how low or high I start meals !?

A few questions for anyone who might be able to help:

1. I have confused myself in all of this recently regarding low and hi gi foods and the timings of bolus. What's the textbook time to inject ? If the food is low gi meaning it's released slower then should I be injecting later or earlier ?? ( sorry)

2. I'm really interested to know what people with tight control of there levels go to after eating ? Do you stay within normal range ?

3. Sometime back I was on more background insulin and I reduced it over time to stop me dropping all the time. It was deemed I was in a honey moon period and it could be reduced. Well my current basal is 8 units in the morn (lantus) and on tests I have ran with no food in me this seems to be correct( I.e I'm not going high or low)
Could I be in a honeymoon period still given the fact I'm spending 3 hours after each meal time running between 13 and 11 mmol ??
Should I increase my lantus ?

Sorry for all the questions. Any advice would be very welcome...

A confused newby !

I believe that not one person in this community has total control of their BG.
But here is my best advice, please try not to concentrate on the spike lets say before my meal I am 6 after 1 hour if I test I am almost certainly 10+, but the insulin and food always absorb at different rates.
After two hours normally (with me I am back to being 5 or 6,7 or even 8).
To be as honest as I can injected or pumped insulin will NEVER mirror a pancreas.
I would like to add that the odd spike will always occur whatever you do.
The risk of complications in Diabetes (I would say) are caused by long term high BG ( I won't put a number on it or everyone will try to limbo under it) and we are all different.
Avoid the highs and avoid the lows this is the secret.
If you go to sleep at (lets say)16 and wake and its (lets say) 22 then you'll get problems.
It is sustained high or low sugars.
I stand to be corrected, but after 42 years and a BG management course, I like to think that I've learnt something about Diabetes Mangement.
I would say that if your BG levels are generally single digits and occasionally you get to 13 - you have very good control.

 

[PG1759]

I believe that not one person in this community has total control of their BG.
But here is my best advice, please try not to concentrate on the spike lets say before my meal I am 6 after 1 hour if I test I am almost certainly 10+, but the insulin and food always absorb at different rates.
After two hours normally (with me I am back to being 5 or 6,7 or even 8).
To be as honest as I can injected or pumped insulin will NEVER mirror a pancreas.
I would like to add that the odd spike will always occur whatever you do.
The risk of complications in Diabetes (I would say) are caused by long term high BG ( I won't put a number on it or everyone will try to limbo under it) and we are all different.
Avoid the highs and avoid the lows this is the secret.
If you go to sleep at (lets say)16 and wake and its (lets say) 22 then you'll get problems.
It is sustained high or low sugars.
I stand to be corrected, but after 42 years and a BG management course, I like to think that I've learnt something about Diabetes Mangement.
I would say that if your BG levels are generally single digits and occasionally you get to 13 - you have very good control.

That's a really interesting way of looking at it, thanks. I think if I was high for an hour or so after I wouldn't be as bothered but with me its 3 hours after. As a result I spend circa 6 hours of my working day being high, which in turn will raise my hba1c.

Do you think my basal could be increased ? Would it help ?

 

[noblehead]

1) Have a look at this article wrote by Gary Scheiner (Think like a Pancreas) who has some useful information on reducing postprandial spikes:

http://www.diabetesselfmanagement.com/articles/high-blood-glucose/strike-the-spike-ii/all/

Injecting half hour ahead should be more than enough to cover most meals and not get a spike like what you see, I wonder if a change of your fast-acting insulin might be the key to controlling your spikes, for example some people find that changing from say Novorapid to Apidra works and vice-versa, as I say maybe something you might want to consider.

2) I don't have 'tight' control, I try to stay below 9mmol postprandial wherever possible and get dow to around 7 two hours postprandial, in most cases I achieve this but it's been hit & miss of late as I've been having a few insulin absorption issues.

3) I don't very much you are still in your Honeymoon period with those levels, if you say your basal is fine when you do a fasting check then that is not the cause of your high bg levels after food, you should not increase basal insulin unnecessarily as this will lead to hypo's, especially so when you don't eat as in missing a main meal.

 

[PG1759]

1) Have a look at this article wrote by Gary Scheiner (Think like a Pancreas) who has some useful information on reducing postprandial spikes:

http://www.diabetesselfmanagement.com/articles/high-blood-glucose/strike-the-spike-ii/all/

Injecting half hour ahead should be more than enough to cover most meals and not get a spike like what you see, I wonder if a change of your fast-acting insulin might be the key to controlling your spikes, for example some people find that changing from say Novorapid to Apidra works and vice-versa, as I say maybe something you might want to consider.

2) I don't have 'tight' control, I try to stay below 9mmol postprandial wherever possible and get dow to around 7 two hours postprandial, in most cases I achieve this but it's been hit & miss of late as I've been having a few insulin absorption issues.

3) I don't very much you are still in your Honeymoon period with those levels, if you say your basal is fine when you do a fasting check then that is not the cause of your high bg levels after food, you should not increase basal insulin unnecessarily as this will lead to hypo's, especially so when you don't eat as in missing a main meal.

Thanks. I would be happy with readings under 9 within 2 hours of eating.

Is my basal dosage still quite low though ? When I was diagnosed 6 months ago I was on 20 lantus. I do agree I think increasing it wouldn't give me better 'control' but it would probably give me better readings... Like you say though that comes with a risk and a lot of chomping on dextrose between meals !

 

[noblehead]

Thanks. I would be happy with readings under 9 within 2 hours of eating.

Is my basal dosage still quite low though ? When I was diagnosed 6 months ago I was on 20 lantus. I do agree I think increasing it wouldn't give me better 'control' but it would probably give me better readings... Like you say though that comes with a risk and a lot of chomping on dextrose between meals !

Everyone's basal dose is different and there not as set amount, although they do say your basal insulin should make up around half of your TDD.

Sorry for yet another link, but the following (again by Scheiner) explains the role of basal insulin and why it is important to get the dose right, if your experiencing difficulties at the moment don't forget to get some input from your diabetes care team, they may see things we don't see.

http://integrateddiabetes.com/basal-testing/

 

[AndyOD]

I think that I maybe overreacted with my earlier response and also I have a second thought.
I remember when I sometime had forgot and done what maybe others have done,

i.e. go into auto-pilot and done my basically dose normally 10 units with food, and not thinking that maybe I was
having pavlova for desert, in the first hour giving myself the rest of my insulin this has (in my experience) a multiplying effect on the insulin (so be CAREFUL) i.e you give yourself a basic dose just before eating, then an hour later a bit more and watch the levels it gears the effects of the insulin.
p.s. please forgive my earlier response I get worked up sometimes when I don't understand and jump to conclusions.
p.p.s. Always don't be afraid to experiment and as my Father always used to say you can always give yourself more insulin = you can't put to little in, only too much.

 

[Diamattic]

This might matter-
I was told by my doctor that a ratio isn't necessarily a fixed all day thing, and some people have a ratio in the morning, and then afternoon and dinner they have a different one, and even a third one at night. This is due to how the body processes things differently throughout the day.

So maybe your one of those people, maybe you need to lower your ratio for whenever it is your spiking?

Typically if I'm eating high GI foods I try to bolus earlier because I know my food will spike 45 minutes or so after eating and my insulin spikes 2 hours after taking it haha

Low GI foods you can take like right at or even maybe after eating because they might not spike for 3 hours.

It's all trial and error. I'm actually avoiding low GI foods right now (PB is killing me! Lol)

But if I so it right my BS only goes up 2-3 mmol/l after eating, so from 5 to 8 then back down to 5, sometimes it's 5 to 10.5 then back down haha but it's 90% of the time back to 5 or 6 after 4 hours so I am happy.

 

[AndyOD]

Thanks. I would be happy with readings under 9 within 2 hours of eating.

Is my basal dosage still quite low though ? When I was diagnosed 6 months ago I was on 20 lantus. I do agree I think increasing it wouldn't give me better 'control' but it would probably give me better readings... Like you say though that comes with a risk and a lot of chomping on dextrose between meals !

From what you've said the basal is fine the problem is around food. Question 1. Does your BG increase before you eat - try and test literally the second before you eat after your dose of insulin - as the cause could be an anxeity around eating for fear of spikes which will introduce fight or flight autonomic response and our old friend glycogen.
Question 2. What is the profile of the high is it linear or does it gradually increase- the reason I ask is that the food types if mixed i.e. all the sugary stuff last will produce uneven BG.
The trying to mirror the pancreas is a good idea once again thinking about it overnight it might be an idea to think how the pancreas waits until there is an increase in BG before it releases insulin but I would say that is a retrograde step. I tend to eat fruit first then the other food the reason being when the insulin goes in it takes 20 mins or so before it starts to work then the fruit sugar is hitting my system just as the insulin starts to get into it's stride. The other food takes longer to digest also generally has less glucose in it.
Hope this has helped.

 

[PG1759]

Everyone's basal dose is different and there not as set amount, although they do say your basal insulin should make up around half of your TDD.

Sorry for yet another link, but the following (again by Scheiner) explains the role of basal insulin and why it is important to get the dose right, if your experiencing difficulties at the moment don't forget to get some input from your diabetes care team, they may see things we don't see.

http://integrateddiabetes.com/basal-testing/

Thanks for the link. When you say it should make up half do you mean add all you bolus together (average) per day and then give half that in basal ?

 

[PG1759]

From what you've said the basal is fine the problem is around food. Question 1. Does your BG increase before you eat - try and test literally the second before you eat after your dose of insulin - as the cause could be an anxeity around eating for fear of spikes which will introduce fight or flight autonomic response and our old friend glycogen.
Question 2. What is the profile of the high is it linear or does it gradually increase- the reason I ask is that the food types if mixed i.e. all the sugary stuff last will produce uneven BG.
The trying to mirror the pancreas is a good idea once again thinking about it overnight it might be an idea to think how the pancreas waits until there is an increase in BG before it releases insulin but I would say that is a retrograde step. I tend to eat fruit first then the other food the reason being when the insulin goes in it takes 20 mins or so before it starts to work then the fruit sugar is hitting my system just as the insulin starts to get into it's stride. The other food takes longer to digest also generally has less glucose in it.
Hope this has helped.

Blood sugars don't increase before o eat. I always test the moment before I eat. I had found when I injected early that they hadn't moved either way in a half hour period... Absorption issue ?

In relation to your second question. If it helps I eat at 1pm everyday and by 1:45 to 2pm they start to climb. This then goes on and by 3pm they are generally at their peak- usually around 13-14. They often stay between that figure and around 10-11 before dropping from 4.30 onwards.
I eat granary bread (sandwich) crisps and a yoghurt ( low fat) .... That's it everyday. No snacks in between and I still struggle !

 

[AndyOD]

Do you know the sugar content of the yoghurt ? Try eating it first. The sandwich and crisps will delay the effects of it.

 

[PG1759]

Do you know the sugar content of the yoghurt ? Try eating it first. The sandwich and crisps will delay the effects of it.

The total carb content is 13.0 and I'm guessing the sugar content will make up most of that.

 

[AndyOD]

Did u fancy trying the split injection if you don't want to change the food ordering.
Let us know if there's any effect of either. I think the absorbtion is not an issue if you've been changing sites as much as u previously mentioned.

 

[PG1759]

Did u fancy trying the split injection if you don't want to change the food ordering.
Let us know if there's any effect of either. I think the absorbtion is not an issue if you've been changing sites as much as u previously mentioned.

As a guideline what would you suggest on the split timings ? I.e. How long after / before eating ?

 

[donnellysdogs]

Thanks for the link. When you say it should make up half do you mean add all you bolus together (average) per day and then give half that in basal ?

TDD - total daily dose still varies with different people, frame sizes, eating carbs etc. My dosage works out at 40% bolus 60% basal. Others work at 50/50 and others at 60/40 or 30/70.

So you should not go changing your basal to match your bolus amount. You need to increase or decrease your basal with basal testing...and then work out what your basal/bolus ratio is... This helps at times of eating more.. Say christmas... If you bolus more during xmas day, you may find that your basal needs to go up too...

My pump is switched to 250% temporary basal rate running for christmas.. As my bolus is increased so much.....

My ratios for every mealtime is different....

 

[AndyOD]

Did u work out the iu/weight to give yourself a insulin sensitivity number. So in total you're eating 13g + 15g + 30g for the samdwich = 58 g.

 

[AndyOD]

Ok so I found a calculator on the internet converts g of glucose so not 100% accurate to moles 58g = .3 moles remember the ave person has 5 litres of blood and .3 × 1000 (remember milimoles)/ 5 litres = 64 mmols/ litre possible for a 100% efficient conversion which isn't the course.

 

[AndyOD]

Lots of assumptions here but lets say your digestive tract is 15% efficient and out of the 64 mmols available you get 9 into your blood, so no injection starting at 8 mmol/litre, you would end up being 17.