Hi
@Fenn, If you look at the BSL ranges quoted on the Home page for Type 1 diabetics (T1Ds) the accepted range for after meals (> 90 minutes, but usually measured at about the 2 hour mark) is higher than the pre-meal and fasting range.
This suggests that a rise in BSL after a meal is usual or physiological (that is, it is part of our usual non-diabetic human condition). Yes, as diabetics we try to avoid that rise going over a certain limit.
But if we try to have enough insulin to prevent any rise there is a risk that the dose of short-acting required would drop our BSL later on to hypo levels.* It comes down to trying to match the individual effect of one's injection of short-acting insulin (plus some of the long-acting insulin also present) on the rise in BSL and pattern of subsequent levels.
When I was on MDI there were several options I would use to try to keep my 2 hour after meal BSL within range:
For a before meal BSL in normal range:
a) eat less carbs in the meal and avoid quickly absorbed carbs in particular, also having some fat in the meal seemed to help, I assume, by slowing the time between the meal being in my stomach and then entering the small intestine where the carbs would be broken down to glucose and absorbed
b) increase the short-acting insulin dose (as you suggested) hoping that it will be effective in its strength and timing to keep the 2 hour and subsequent BSL in range (but note above *) or discussing with DN or doctor whether there was a better short-acting insulin and avoiding injecting insulin persistently in the same spot but keeping in general to the abdominal area where insulin seems to be most rapidly absorbed, remembering also that the insulin to carbs ratio in the morning may not be the same at at lunchtime or in the evening.
c) alter the timing of when injecting short-acting insulin and when food is eaten, say from immediately before food to 1/2 hour, ? 3/4 hour, ??1 hour before. Advice from one's DSN or doctor would be important in this endevour.
For a before meal BSL above the normal range:
1) i would eat even less carbs and more protein and fat
2) include a correction dose of short-acting insulin and add say 20% extra if that BSL was > 10 mmol/l
3) wait a bit longer between insulin dose and the meal.
Having written this it is as much an art as a science. If I had exercised the day before, my breakfast dose of insulin is more effective so a little less was better. There were differences in my insulin's effect in cold compared to hot weather.
And I have learned there is the effect of our bowel bugs on the way we respond to intake and absorption of food and subsequent BSLs that result. see openaccessournals.com Microbiome-based approaches for treatment of diabetes editorial Knip M and Siljander H Diabetes Management 2015
I always try to remember that I am like a pilot trying to keep flying within two levels of altitude when for a non-diabetic these manoeuvres are on autopilot, one that has been perfected over thousands of years and stays that way (in most persons)!!
Yes, closed loop insulin pumps have gotten closer to the ideal and there are nore radical solutions such a pancreatic transplants etc but all have drawbacks!!
Best Wishes and be kind on yourself in the process !
