Question of delayed post meal spike

[Bluemarine Josephine]

Hello everyone, I hope that you are all having a great day!

According to guidelines, (which are getting stricter and stricter) post-meal blood sugars should be less than 6.7.

Let me tell you what happens in my case and, please let me have your insights.
I am quite active during the day.
I am on a low carbohydrate diet and I love it because it gives me better glycemic control.
I run on basal insulin and metformin pills because my active lifestyle and consistently low carbs diet compensate for the bolus (so, I bolus every now and then when necessary to restore the balance.)
I am on a prolonged honeymoon period for the last 3 years.

Lunch-time blood sugar level of 6.1
Very low carbohydrate meal (salad and 100 grams of protein) – no bolus
2 hours after meal, blood sugar level: 5.1

Not so bad.
Theoretically, all the digestion process has finished by 16:00 and whatever sugar spike should have happened by then.

Yet, around 16:00 the rise starts…
In between 16:30 – 18:00, my blood sugar, slowly and gradually starts to rise and can reach anywhere up to a 9, 10 or even 11.

By Dinner-time it is back to a relatively normal-ish level.

If I bolus after lunch, by 15:00 hrs I will reach too low and will have to treat so, I find it un-necessary to bolus as, additionally, my Novorapid will not cover the rise which starts around 16:30 onwards (Novorapid will be redundant by that time).

What do I do to prevent this late afternoon spike? Any suggestions?
By the way, this happens only after lunch. I do not have the same effect after breakfast or dinner.
Does anyone know why this happens?

Thank you so much
Regards
Josephine

 

[tim2000s]

@Bluemarine Josephine 6.7? That is a new low. It is lower than even non-diabetics reach post eating!

What you haven't given us is your timings for breakfast, lunch and dinner. Those could be quite important.

The rise you see late in the afternoon is likely to be your liver generating glucose and this could simply be because you are short of the required energy. You may be able to stave it off by eating something like nuts mid afternoon.

 

[slip]

When and how much Basal do you take?

 

[tim2000s]

And as @slip says, how do your basal timings work?

 

[Bluemarine Josephine]

@Bluemarine Josephine 6.7? That is a new low. It is lower than even non-diabetics reach post eating!

What you haven't given us is your timings for breakfast, lunch and dinner. Those could be quite important.

The rise you see late in the afternoon is likely to be your liver generating glucose and this could simply be because you are short of the required energy. You may be able to stave it off by eating something like nuts mid afternoon.

Hello, thank you for your reply.
The American Diabetes Association (ADA) guidelines advise lowering A1C to below or around 7%” and postprandial (after-meal) glucose levels to 180 mg/dl ( 10 mmol) or below. But new research shows that these glucose levels damage blood vessels, nerves, organs, and beta cells.

An article analyzes at what blood glucose level organ damage starts. Post-meal blood sugars of 140 mg/dl (7.7 mmol) and higher, and fasting blood sugars over 100 mg/dl ( 5.5. mmol) can cause permanent organ damage and cause diabetes to progress. Glucose can also start killing beta cells at levels below 140. One study found that people with fasting blood glucose from 110–125 (within the official “prediabetic” range) had already lost up to 40% of their beta cell mass.

Great news…:-(

Regarding your question,
Breakfast is at 07:00
Lunch is at 13:00
Dinner at 19:00

Do you think that a mid afternoon snack might help?

Regards
Josephine

 

[himtoo]

Hello everyone, I hope that you are all having a great day!

According to guidelines, (which are getting stricter and stricter) post-meal blood sugars should be less than 6.7.

Let me tell you what happens in my case and, please let me have your insights.
I am quite active during the day.
I am on a low carbohydrate diet and I love it because it gives me better glycemic control.
I run on basal insulin and metformin pills because my active lifestyle and consistently low carbs diet compensate for the bolus (so, I bolus every now and then when necessary to restore the balance.)
I am on a prolonged honeymoon period for the last 3 years.

Lunch-time blood sugar level of 6.1
Very low carbohydrate meal (salad and 100 grams of protein) – no bolus
2 hours after meal, blood sugar level: 5.1

Not so bad.
Theoretically, all the digestion process has finished by 16:00 and whatever sugar spike should have happened by then. because the lunch meal consists of 100 grams of protein( and fat if it is cheese) the rise in blood sugars will be delayed - i would suggest to about that magical 4pm time that you mention.
perhaps taking a small bolus at 4pm could prevent the rise from happening between 4-7pm

Yet, around 16:00 the rise starts…
In between 16:30 – 18:00, my blood sugar, slowly and gradually starts to rise and can reach anywhere up to a 9, 10 or even 11.

By Dinner-time it is back to a relatively normal-ish level.

If I bolus after lunch, by 15:00 hrs I will reach too low and will have to treat so, I find it un-necessary to bolus as, additionally, my Novorapid will not cover the rise which starts around 16:30 onwards (Novorapid will be redundant by that time).

What do I do to prevent this late afternoon spike? Any suggestions?
By the way, this happens only after lunch. I do not have the same effect after breakfast or dinner.
Does anyone know why this happens?

Thank you so much
Regards
Josephine

answer in blue inside your post

 

[tim2000s]

An article analyzes at what blood glucose level organ damage starts. Post-meal blood sugars of 140 mg/dl (7.7 mmol) and higher, and fasting blood sugars over 100 mg/dl ( 5.5. mmol) can cause permanent organ damage and cause diabetes to progress. Glucose can also start killing beta cells at levels below 140. One study found that people with fasting blood glucose from 110–125 (within the official “prediabetic” range) had already lost up to 40% of their beta cell mass.

Great news…:-(

Whilst this is damning, it holds true for all people. It's not particularly new news. Essentially, it comes back to one of two things. You can either live your life in such a way that you try to guarantee (and you may not be successful) that you limit complications and have a long life which you may have to restrict things to do or you can enjoy life, accept that maintaining the levels being described can be difficult and require intensive focus and know that maybe your life will be shorter, but there are plenty of people out there with Hba1Cs around 7% that haven't suffered complications. Put it another way. You live and you die. There are plenty of ways to do both!

The statement about Beta Cell mass is kind of irrelevant to most T1s. They've already been destroyed by that nasty auto-immune attack. No need to worry about bg levels finishing them off! Not so good for T2s, but again, also known about for a while.

It's possible you are seeing the liver doing a glucose dump late in the afternoon. Given you are on Tresiba, it is unlikely to be the basal running low. The only way I can think of to stop that is to either inject additional insulin around about the time the increase happens or to eat something and see if it stops it.

Do you really eat 100g of protein, or do you mean 100g of meat (which would be around 22g of protein).

 

[Bluemarine Josephine]

Whilst this is damning, it holds true for all people. It's not particularly new news. Essentially, it comes back to one of two things. You can either live your life in such a way that you try to guarantee (and you may not be successful) that you limit complications and have a long life which you may have to restrict things to do or you can enjoy life, accept that maintaining the levels being described can be difficult and require intensive focus and know that maybe your life will be shorter, but there are plenty of people out there with Hba1Cs around 7% that haven't suffered complications. Put it another way. You live and you die. There are plenty of ways to do both!

The statement about Beta Cell mass is kind of irrelevant to most T1s. They've already been destroyed by that nasty auto-immune attack. No need to worry about bg levels finishing them off! Not so good for T2s, but again, also known about for a while.

It's possible you are seeing the liver doing a glucose dump late in the afternoon. Given you are on Tresiba, it is unlikely to be the basal running low. The only way I can think of to stop that is to either inject additional insulin around about the time the increase happens or to eat something and see if it stops it.

Do you really eat 100g of protein, or do you mean 100g of meat (which would be around 22g of protein).

You are correct for asking, let me clarify please, it is overall 100 grs of meat.

 

[tim2000s]

You are correct for asking, let me clarify please, it is overall 100 grs of meat.

Okay, so 100gr of meat shouldn't, normally, result in gluconeogenesis if you are taking bolus insulin at lunch time, however, if you are only operating with basal insulin, as @himtoo mentioned, it is highly likely that this is a result of eating the protein with no insulin. The delay is substantially longer than I have experienced with this though.

Essentially there are two strategies available. Either take a little before your glucose levels start to rise, or take it just after you eat. Account for ~50% of the protein as though it were carbs. That should help.

 

[jimmax]

Hello everyone, I hope that you are all having a great day!

According to guidelines, (which are getting stricter and stricter) post-meal blood sugars should be less than 6.7.

Let me tell you what happens in my case and, please let me have your insights.
I am quite active during the day.
I am on a low carbohydrate diet and I love it because it gives me better glycemic control.
I run on basal insulin and metformin pills because my active lifestyle and consistently low carbs diet compensate for the bolus (so, I bolus every now and then when necessary to restore the balance.)
I am on a prolonged honeymoon period for the last 3 years.

Lunch-time blood sugar level of 6.1
Very low carbohydrate meal (salad and 100 grams of protein) – no bolus
2 hours after meal, blood sugar level: 5.1

Not so bad.
Theoretically, all the digestion process has finished by 16:00 and whatever sugar spike should have happened by then.

Yet, around 16:00 the rise starts…
In between 16:30 – 18:00, my blood sugar, slowly and gradually starts to rise and can reach anywhere up to a 9, 10 or even 11.

By Dinner-time it is back to a relatively normal-ish level.

If I bolus after lunch, by 15:00 hrs I will reach too low and will have to treat so, I find it un-necessary to bolus as, additionally, my Novorapid will not cover the rise which starts around 16:30 onwards (Novorapid will be redundant by that time).

What do I do to prevent this late afternoon spike? Any suggestions?
By the way, this happens only after lunch. I do not have the same effect after breakfast or dinner.
Does anyone know why this happens?

Thank you so much
Regards
Josephine

Hi,
the complete solution to this is a pump if it is affordable. Too expensive for me.

My solution to this exact same problem is to go high carb for lunch with a small serving of protein. I eat only high carb vegetables and take about 10u of bolus insulin. This is enough insulin to see me through to 18:00 (The larger the dose, the longer the action). I'd prefer to have a low carb lunch but I've had to settle for this.

My low carb evening meal works exceptionally well (salad vegetables and meat).

 

[RuthW]

An article analyzes at what blood glucose level organ damage starts. Post-meal blood sugars of 140 mg/dl (7.7 mmol) and higher, and fasting blood sugars over 100 mg/dl ( 5.5. mmol) can cause permanent organ damage and cause diabetes to progress.

I'd love to see a link to this article.

["Aye, we're all DOOMED, doomed ah tell ye, doomed". I mean, if non-diabetic blood sugars "cause permanent organ damage", there ain't no hope at all for anyone. Link, or it didn't happen.]

 

[Bluemarine Josephine]

I'd love to see a link to this article.

["Aye, we're all DOOMED, doomed ah tell ye, doomed". I mean, if non-diabetic blood sugars "cause permanent organ damage", there ain't no hope at all for anyone. Link, or it didn't happen.]

Hello and thank you for your comment.
I have not managed to find the exact article but, I found this (which advocates the same thing...)
Prepare yourself mentally and emotionally...

P.S. I consider 4.6 a mild hypoglycemia - I feel dizzy and funny at this number. Apparently, this is where we should be...

 

[Bluemarine Josephine]

Hi,
the complete solution to this is a pump if it is affordable. Too expensive for me.

My solution to this exact same problem is to go high carb for lunch with a small serving of protein. I eat only high carb vegetables and take about 10u of bolus insulin. This is enough insulin to see me through to 18:00 (The larger the dose, the longer the action). I'd prefer to have a low carb lunch but I've had to settle for this.

My low carb evening meal works exceptionally well (salad vegetables and meat).

Thank you for your comment.
I feel very insecure to use big industrial doses of insulin and then "feed the insulin dose".
I have never tried what you sugget so, I might be wrong but, I suspect that very high carbohydrate meals and high doses of insulin are risky because it is so difficult to predict the outcome of such huge doses. The range of blood sugars, upwards or downwards, is great and this can become risky...

 

[RuthW]

Seriously, I have almost 50 years of T1 behind me. Bernstein and his ilk only surprise me in their arrogance towards other doctors. He criticizes other doctors on the grounds of mere hearsay. Any doctor and any diabetic who does not have some kind of cognitive deficit or personality disorder understands that when a diabetic comes to you running a BG of 250, first of all you ask them to bring it down to 200. Then you ask for 180. Then 160, and so on. There are both clinical and socio-psychological reasons for this. I am really sick of the doctor-bashing on these boards and by people like Bernstein. First of all, there are threads on here by people with T1 who refuse to take insulin for WEEKS, let alone be ready to engage with this kind of advice. Secondly, Bernstein has a private practice. He only sees engaged and motivated diabetics. Thirdly, a video of some bloke chatting has no scientific grounding. References mean everything. Properly researched and referenced papers. Not some guy's anecdotal experience.

 

[Bluemarine Josephine]

Whilst this is damning, it holds true for all people. It's not particularly new news. Essentially, it comes back to one of two things. You can either live your life in such a way that you try to guarantee (and you may not be successful) that you limit complications and have a long life which you may have to restrict things to do or you can enjoy life, accept that maintaining the levels being described can be difficult and require intensive focus and know that maybe your life will be shorter, but there are plenty of people out there with Hba1Cs around 7% that haven't suffered complications. Put it another way. You live and you die. There are plenty of ways to do both!

The statement about Beta Cell mass is kind of irrelevant to most T1s. They've already been destroyed by that nasty auto-immune attack. No need to worry about bg levels finishing them off! Not so good for T2s, but again, also known about for a while.

It's possible you are seeing the liver doing a glucose dump late in the afternoon. Given you are on Tresiba, it is unlikely to be the basal running low. The only way I can think of to stop that is to either inject additional insulin around about the time the increase happens or to eat something and see if it stops it.

Do you really eat 100g of protein, or do you mean 100g of meat (which would be around 22g of protein).

"You live and you die. There are plenty of ways to do both!"
Thank you for this. It sums it up and I really needed it! <3