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Post breakfast high and then low

Kelsie

Kelsie

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144
Hello, I have been type one since July 2013 and have had pretty good control of my diabetes with carb counting etc. my brother is diabetic too so that helps :) anyway, for breakfast I have porridge with blueberries and blackberries and is 40g of carbs therefore I have 4 units of insulin. But I've had this ongoing battle where my sugar levels rocket to 12-14 two-three hours after breakfast. But within the space of an hour tops, I then drop to 4 and below. At first I thought I needed more insulin but my sugar levels always drop before lunch as my job is relatively active (sports masseuse). I also can't have less insulin at breakfast as I would be even higher! It's annoying as I feel headachey from the high and then have to have a snack without fail about 11/11.30 to prevent me from going low. I have heard of dawn phenomenon but why would I go low after within an hour? It's super annoying and baffles me, is there something completely simple I'm missing? Does this happen to anyone else? Thanks in advance!


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Used to happen to me, I needed more basal, less bolus. Extra basal stopped the highs after breakfast but without the quick action of bolus causing a low. Only problem was extra basal caused hypos in the night. So, got the pump, so I could program the extra basal in the early morning hours and up to breakfast, then had less through the day/night. Was the only way round it really without having extra quick acting for breakfast,but relying on a mid morning snack to stay steady after.

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Is your basal dose working OK? What time(s) do you take it and how much?

If your basal is definitely fine, try dropping your insulin:carb ratio slightly to 1:9. And perhaps skip the porridge with fruit as you may be having a very individual blood sugar reaction to it.

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brett said:
Used to happen to me, I needed more basal, less bolus. Extra basal stopped the highs after breakfast but without the quick action of bolus causing a low. Only problem was extra basal caused hypos in the night. So, got the pump, so I could program the extra basal in the early morning hours and up to breakfast, then had less through the day/night. Was the only way round it really without having extra quick acting for breakfast,but relying on a mid morning snack to stay steady after.

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Basal is 4 units at 9am and 4 units at 9pm (less at night if I exercised in the evening which is 5 times out of 7 so only 2 units instead). Exactly Brett-it's an ongoing battle! Ha. I have experimented with basal as advised by DSN but then had troubles with night time hypos so the dosage I'm on now is correct. I am at mo just relying on my snack as I'm a gym instructor too so am always on the go hence why I'm on small doses compared to the average diabetic. I can't skip my porridge and fruit-it's too yummy plus blueberries are my brain food! Ha.


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I have similar problems.

Lie ins this holiday weekend have emphasized to me how my BG climbs on first waking. I guess it's some version of the dawn phenomenon but my CGM clearly shows that it starts when I wake. Yesterday I woke up, made a coffee took it back to bed & in within half an hour increased by more than 2. Coffee ( a little milk & a sweetener) doesn't usually affect me & the increase began before I drank any. This was a particularly big increase but I always see it to some extent.

I would suggest taking your breakfast bolus earlier, at least 20 minutes before eating (unless you are low) perhaps even 1/2 an hour. This means the insulin is active as you start to absorb the food. Difficult on a busy work day morning I know.

I wouldn't suggest skipping breakfast but perhaps you could reduce the size of your portion of porridge? 30 or 20gm of carbohydrate would be a lot easier to deal with. Your bolus dosage would need to be reduced accordingly. I went from 2 slices of toast to one (15gm) & it helped a lot.

I find that a walk soonish after a meal also reduces the size of the post meal peak. Would it be practical to walk to work?
 
The fact that after about 3 hrs your levels are good suggests the amount of insulin is probably correct. It may be the timing of it. Try taking your QA insulin around 20mins prior to eating to try to counteract the high.
 
If you are experiencing hypo symptoms and your basal is correct then reduce your insulin:carb ratio slightly.

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Thanks guys :) I have got into the habit of taking my nova rapid ten mins before eating so I will try as you guys suggested and take it had hour before and see if that helps with the three hour post high-fingers crossed!


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I don't mean to sound mean but I'm glad someone else has this problem!! I thought I was being mad. I have the exact same problem and it gets more pronounced at certain times of the month. I tried injecting up to 45 mins before breakfast but that didn't help much. I also increased basal but that sent me low overnight. The only way I can improve it is by eating a low carb breakfast, something like Greek yogurt and berries. I miss my porridge and cereal too :-(


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Do as Dune Plodder suggests and take your insulin well ahead of your breakfast to give the insulin a head start on your food getting digested, as said 20 mins would be fine, to avoid having a snack later on in the morning you will need to reduce your breakfast insulin dose if your certain your basal insulin is set at the right dose.

I eat porridge every morning and inject 10-15 mins before eating, to slow down the absorption of the oats even more I add seeds (linseeds, pumpkin & sunflower) to the oats as they cook and a few spoonfuls of natural yoghurt, seeds are really nutritious and with a handful of blueberries thrown in you have a truly heart healthy breakfast.

Try it, if it doesn't work then sadly porridge might not be suitable for you.
 
Kelsie said:
Thanks guys :) I have got into the habit of taking my nova rapid ten mins before eating so I will try as you guys suggested and take it had hour before and see if that helps with the three hour post high-fingers crossed!
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If that doesn't work you could possibly experiment with using Humalog rather Novorapid. For me Humalog is quicker acting, with a shorter onset time, more rapid peak action, and more rapid end of action.
However changing insulin is not to be undertaken lightly as you will have to go carefully and check all your ratios again. You could maybe try it just for this one meal (porridge and berry breakfast).


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Hello, improvement has been seen! :) :) I have since been taking my normal nova rapid insulin 45 mins before eating and my 3 hour post meal readings are now between 7-10.... yay!!! Much better than the 14+ readings I was having! I still have a snack about 11.30 of about 20-25g carbs to prevent the low due to my job but am super happy with the improvement. Thank you all :)


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