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Type 1 Post meal spikes CGM

D

d!cko

Newbie
Messages
4
Type of diabetes
Parent
Treatment type
Insulin
Hi all,

My daughter has T1D for just over 2 years now. We recently started using the Dexcom G5 CGM. Not using a pump so still on MDI of Novorapid and Lantus at night. As we only have half units of insulin to work with I have created a spreadsheet that matches g carbs to insulin amounts. Allowing us to tweak the carbs to match insulin.

Although with the CGM data I'm seeing now what is actually happening every five minutes opposed to BGL snapshots with the meter.

Struggling with 2 things at the moment and looking for any advice!

Firstly breakie, some days she hypos before morning tea. Other times she will stay hyper around 15mmol. I'm assuming this is GI or GL or the carbs having a different absorption profile. I've been using bolus before meal timings to try and ride the wave. But even that seems hit & miss. Any advice?

Secondly around 10pm when dinner bolus has worn off she will start climbing. Not always but most of the time. I thought this was proteins and fats delaying the carb absorption but last night spaghetti Bolognese resulted in a rise from 5mmol to 14mmol. I have her 1U which normal drops her by 5mmol. It didn't even register. So I expect that BGL would have risen further if I hadn't of given insulin. Any tips?

Sorry for the long post!
 
Have you basal tested? Here is a guide on how to do it - https://mysugr.com/basal-rate-testing/ . Lantus lasts about 18 hrs. So evening rises might reflect a lack of basal rather than anything to with the food eaten or the meal time bolus. This can be gotten around by splitting your basal and taking a shot am and one pm.

d!cko said:
I have created a spreadsheet that matches g carbs to insulin amounts.
Click to expand...

So are you actually carb counting and using an insulin to carb ratio? If not you should probably check out ther Bertie course - https://www.bertieonline.org.uk
 
Interesting... Didn't think about the basal wearing off.

Not really basal tested but about a month ago did reduce Lantus by half a unit as was getting hypos during the night well after bolus has worn off. The result was high BGL during the night so think we are about right. Only has 2.5U once before bedtime.

I am carb counting. Use Myfitnesspl and nightscout mainly. I'm keto so counting carbs is very familiar to me lol
 
With ME, I have to count total carbs, not net. Fiber has very little effect on my ratios. This is one time I’m happy to be in the US and have all carbs listed as well as fiber. At DX I was told only to deduct half the fiber, not all. I still need to count it all.

Ex. 5 oz avocado has 12 carbs and 9 fibers. I still have to bolus as if it were 12. The U.K. counts it as 3 carbs. If I don’t take insulin with 1/3 I spike.

Just something to ponder.

And I agree basal has worn off. My 1-2 units are long gone by morning and I need a small bolus an hour or so after bf when I start to get active to stop the morning rise. I can’t take it all with bf or I hypo first. I also need to take it every three hours with a snack or my bolus has worn off by then. The little intricacies....Bolusing 20 min before meals helps ME too as that’s when insulin action starts to work for me.

I am not recommending anything and I am a grown adult, not a child. So just mentioning things you can think about BUT MAKE YOUR OWN DECISIONS please.
 
Kristin251 said:
With ME, I have to count total carbs, not net. Fiber has very little effect on my ratios. This is one time I’m happy to be in the US and have all carbs listed as well as fiber. At DX I was told only to deduct half the fiber, not all. I still need to count it all.

Ex. 5 oz avocado has 12 carbs and 9 fibers. I still have to bolus as if it were 12. The U.K. counts it as 3 carbs. If I don’t take insulin with 1/3 I spike.

Just something to ponder.

And I agree basal has worn off. My 1-2 units are long gone by morning and I need a small bolus an hour or so after bf when I start to get active to stop the morning rise. I can’t take it all with bf or I hypo first. I also need to take it every three hours with a snack or my bolus has worn off by then. The little intricacies....Bolusing 20 min before meals helps ME too as that’s when insulin action starts to work for me.

I am not recommending anything and I am a grown adult, not a child. So just mentioning things you can think about BUT MAKE YOUR OWN DECISIONS please.
Click to expand...
Thanks for the replies. I'll keep logging and watching for patterns. I only change one variable at a time. It's a fine balance but we'll get there. I think the pump will help when we are ready for it.
 
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