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Why does my evening meal keep making my blood sugars unstable?

Introverted_And_Proud

Introverted_And_Proud

Well-Known Member
Messages
61
Type of diabetes
Type 1
Treatment type
Insulin
Dislikes
Warm weather, insects
So, this is a bit of a weird one that I've been dealing with for a while now. Not sure if anybody could help me with it, but figured it was worth a shot. For context, I am a Type 1 diabetic who uses Novorapid and Tresiba insulin. I also suffer with IBS-C (this is semi-relevant).

Two days a week, I always eat the same evening meal: fresh stir-fry chicken (0g of carbs) with 200g of Aunt Bessie's roast potatoes (36g of carbs) and 100g of frozen bag broccoli (3g of carbs). When I inject for this meal, I always do it right before eating. And every single time, within 30 minutes to an hour of injecting, my blood sugar levels will drop continuously, usually for up to an hour in some cases. Sometimes, my levels will stop above 4mmol - 5mmol, then slowly start to rise until they reach high levels by the time I go to bed. Other times, however, my levels will go below 4mmol, forcing me to take hypo treatment. The hypo treatment kicks in quickly within 10 to 15 minutes and puts my levels in the green. But from there they keep rising and wind up going too high after around two hours have passed.

Now, the strangest thing is this is the only meal where I have this particular problem. The other evening meals I eat throughout the week never do this. My levels are usually quite stable with them. And some of the foods I've listed above I also eat with other evening meals (i.e. broccoli and potatoes), yet they haven't caused the same issue. Furthermore, I don't think this is being caused by me accidentally injecting into a muscle. I admit I am underweight for my age and have minimal body fat, but I don't usually feel any pain or bleed when I inject. So, this has certainly left me scratching my head and looking over my Libre data to try to figure out the cause behind this strange pattern.

I came up with the following theories:

Maybe I'm injecting too much insulin?

Could it be my digestion is slower on certain days or at certain times?

Perhaps my IBS isn't reacting well to certain foods I'm eating and delaying the carbs reaching the insulin?

Is the protein affecting my digestion?

Is it the combination of what I'm eating?

So, I tried the following solutions in attempt to rule out the cause:

Reduced my Tresiba dose; no change.

Increased my Novorapid carb-to-insulin ratio to inject less insulin; sometimes it steepened the drop and increased the rise, other times the outcome didn't change.

Ate meal on different days and/or at different times; no change.

Ate chicken an hour after the carbs; no change.

Swapped out broccoli, chicken and potatoes one at a time for alternative and IBS friendly food options to rule out the culprit; no change.

At this point, I am absolutely stumped. I keep feeling like I'm doing something wrong and I'm always on edge when I have to inject. Has anyone else encountered a problem similar to this and possibly might have any other ideas of what could be causing it?
 
Hmm, that is strange.

It sounds a bit like this meal is mimicing "the pizza effect" for you, but I have no idea why.
Is it worth experimenting with splitting your insulin dose and having half at the normal time and the rest a couple of hours later? (ie doing some sort of delayed bolus?)

I suspect it would be worth having a chat with your diabetic team/endo to see if they have any helpful suggestions, and the possible relevance of the IBS.

Good luck. I would be very interested to read about any conclusions that you come to, as I occasionally have a similar issue, but am not organised enough to have identified a particular food culprit.
 
I agree with EllieM that it sounds like this meal is having the Pizza effect for you. A split dose could help with this. Or you could try injecting after the meal. I have a similar problem with certain types of bread. If i inject before eating or just after I finished my bloodsugar stays at the same level or drops at first and then rises a few hours later. So with this particular bread I wait until my levels start to rise and inject then.
 
I'd agree with @EllieM and @ViktoriaM that it's the "pizza effect" and the fat in the roast potatoes that are slowing the carb absorption - as a type 2 I have no idea how you would combat that with your insulin dosage, but I'm sure that there are much more knowledgeable folk than I here
 
@EllieM @ViktoriaM 'Pizza effect'. I didn't know it had a name. I'm glad I'm not crazy and that it is a known problem. That article was quite informative, I must say.

I had considered injecting after eating due to my suspicions it was a digestion delay issue. I am going to have the meal again tomorrow, so I think I'll try that first for a couple of weeks and see if it makes a difference. Then switch to a delayed bolus if it doesn't. I am due to see the diabetes nurses in under a couple of months, so if my situation doesn't improve I'll try bringing it up then. Thank you for the suggestions, though. :)
 
Just wanted to update this thread regarding how the past week has gone so far since injecting after the meal, because... Well, it's certainly been interesting.

Before I do, though, I wanted to clarify from my initial post that I no longer use roast potatoes with the meal. I've had to stop because the oil I cook the potatoes in kept giving me IBS cramps post-meal. I now eat Uncle Ben's wholegrain rice with it, which has been better for my gut, but made very little difference with my blood sugars.

Day 1, Week 1: I was experiencing a bout of insulin resistance that day, so when I began the meal my levels were at around 10mmol. I waited for my levels to start rising before I injected, which was around 20 minutes. For the first 40 minutes post-injection, my levels shot up pretty quickly. They stopped at around 15mmol - 16mmol, then dropped. After around an hour, they stopped at 9mmol, then gradually rose again. Four hours post-injection, they were back at 15mmol. But again, I suspect I was experiencing some insulin resistance that day, so it's difficult to say what was happening then.

Day 2, Week 1: My levels were at 9mmol when I started eating. Once again waited until my levels started rising before injecting; 20 minutes again. 30 minutes post-injection my levels rose to 13mmol - 14mmol, then dipped. They dropped for over an hour and a half. Two hours post-injection, my levels were at 3.8mmol (confirmed on meter). Took hypo treatment. Four hours post-injection my levels were 12.3mmol. Not as bad as last time, but still high.

I was planning on doing a third attempt today to kick off Week 2, but I've noticed I've now got a bout of increased insulin sensitivity going on so I'm going to abstain just in case. But one thing I have observed so far from these two attempts is that my levels start to rise pretty quickly within the first 20 minutes of eating. I initially thought the delay in rising was down to the food not digesting fast enough. Yet it seems I was wrong. The insulin appears to be causing my levels to stay put initially, leading to the drop after 30 minutes or so. So, perhaps my IBS wasn't affecting me like I thought.
 
Hi
Seasoned pro here 50 years injecting...
Monday to friday i am active with around 18000 per day.
I eat at 6pm and often take my insulin after i've eaten as all the activity affects my sensitivity.
Weekends i am generally a lazy article and if i have a carb heavy meal i often split the dose of novorapid.

If i get it wrong and start rising i go for a stroll.
If dropping i'm well used to eating jelly babies and munch through either 3 or 5.

IBS can be mistaken for coeliacs disease and/or bile acid malabsorption and i only know this because i'm coeliac and have BAM this is just a left field thought.

I wish you well

Tony
 
Tony337 said:
Hi
Seasoned pro here 50 years injecting...
Monday to friday i am active with around 18000 per day.
I eat at 6pm and often take my insulin after i've eaten as all the activity affects my sensitivity.
Weekends i am generally a lazy article and if i have a carb heavy meal i often split the dose of novorapid.

If i get it wrong and start rising i go for a stroll.
If dropping i'm well used to eating jelly babies and munch through either 3 or 5.

IBS can be mistaken for coeliacs disease and/or bile acid malabsorption and i only know this because i'm coeliac and have BAM this is just a left field thought.

I wish you well

Tony
Click to expand...
See, this is the problem for me with this meal. Because it doesn't seem to matter what I've done throughout the day, or what time I eat at, or what day I eat on, or whether I inject before or after the meal, or what dose I take. The reaction to the meal is usually the same. The only difference is when I inject it after the meal, the rise delays the drop for a while. I wouldn't mind the drop as much if it stabilised in the good ranges or didn't send my levels through the roof after treating a hypo. But it's just bizarre how erratic they act with this particular meal but not any of the others. Especially compared to the meal where I eat actual pizza, because I don't have the 'pizza effect' happening with that one ever. Yet a supposedly healthy-ish meal does? Doesn't make any sense.

I've been diagnosed with IBS-C since I was 17 years old, four years before I had my Type 1 diabetes diagnosis. I don't recall if I was ever tested for coeliac or BAM as part of the list of diseases they ruled out during the tests the doctors did. But my symptoms have never mimicked either disease from what I know of. Furthermore, this meal doesn't have any gluten food in it, and I haven't noticed anything off when eating other meals containing gluten. So, I suspect whatever is happening to me might not be a digestive related issue, as previously thought. I appreciate you sharing your thoughts, though.

I think this is probably an issue I'm going to have to have a long talk with the DSN about in over a month's time, because it's driving me crazy. That, and maybe considering the possibility of finding a different meal to replace it. I'd rather not, but I'm very concerned this is going to cause my diabetes management problems further down the line.
 
Introverted_And_Proud said:
maybe considering the possibility of finding a different meal to replace it. I'd rather not
Click to expand...
You've already swapped the potatoes for rice so I'm guessing the part of the meal you want to keep is the stir fried chicken and the broccoli? Having more of that and less of the carb components could make dosing easier, I know it does for me. Maybe add in a second vegetable or salad instead?
 
Antje77 said:
You've already swapped the potatoes for rice so I'm guessing the part of the meal you want to keep is the stir fried chicken and the broccoli? Having more of that and less of the carb components could make dosing easier, I know it does for me. Maybe add in a second vegetable or salad instead?
Click to expand...
I did actually try adding carrots to the meal once when I was still having potatoes with it. It worsened the drop in my levels, believe it or not. o_O Though, I will add that I didn't tweak the amount of carb I was consuming, so it's hard to say what happened there.

I do agree with you on consuming less carbs, though. I have done basal rate tests to doublecheck my Tresiba isn't causing this problem, and from what I can tell, my levels don't drop by much if at all with Tresiba on its own. It only seems to happen when injecting fast acting insulin. The carbs are definitely the primary culprit in sending my levels all over the place. Eating less of it would likely stop my levels going too high after 2 - 4 hours. Whether it would stop them dropping is another thing altogether, but I won't know until I try, right? Next week, I'll cut back on the rice and maybe increase my broccoli intake a little to make up for it, see if that makes a difference.
 
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