Post Meal Spike

[ScottyD]

Hi Everyone,

Things going well here. However, I'm just looking at lowering the post meal spike.

In my first 3 months, I had more things to think about so didn't really bother with addressing this. My A1c after the 3 months was down to 41 so it's really just me now being picky.

I usually have Quaker Oats porridge for breakfast. On my Libre, I've seen a post meal spike going upto 14-16 mmol. I check my actual blood and it's typically12-13 mmol an hour after and then 9-10 mmol 2 hours after.

I read on here that people bolus in advance of their food. What I mentioned above was literally me checking blood sugar, bolusing then eating. For the last 2 days, I've given my insulin approx 20-25mins before I eat. I see the blood go from 5-6mmol upto 9-10mmol and then slowly go back down. I liked what I seen but around the 2 hour mark it's down to 6 mmol again... is this good?

I suspect it is? Basal on my pump is all good and the carb ratio seems to give good results during all meals.

Thoughts would be appreciated!

 

[GrantGam]

Hi Everyone,

Things going well here. However, I'm just looking at lowering the post meal spike.

In my first 3 months, I had more things to think about so didn't really bother with addressing this. My A1c after the 3 months was down to 41 so it's really just me now being picky.

I usually have Quaker Oats porridge for breakfast. On my Libre, I've seen a post meal spike going upto 14-16 mmol. I check my actual blood and it's typically12-13 mmol an hour after and then 9-10 mmol 2 hours after.

I read on here that people bolus in advance of their food. What I mentioned above was literally me checking blood sugar, bolusing then eating. For the last 2 days, I've given my insulin approx 20-25mins before I eat. I see the blood go from 5-6mmol upto 9-10mmol and then slowly go back down. I liked what I seen but around the 2 hour mark it's down to 6 mmol again... is this good?

I suspect it is? Basal on my pump is all good and the carb ratio seems to give good results during all meals.

Thoughts would be appreciated!

Hello,

You'll find the Libre does tend to over-exaggerate highs and lows.

You're on the right lines with the pre-bolusing technique. I'm not a pump user but I find the process is equally as effective on MDI. The amount of time you should leave between bolusing and eating (for optimum control) is entirely individual. It's possible to get it spot on so that you're spike is contained within the target range. But like everything else, takes a lot of practice and might not be exactly the same every time. There are many factors that affect insulin absorption such as temperature, activity, stress and time of day to name a few.

There is absolutely nothing wrong with the small spike you're experiencing with your pre-bolus, sure - it's not ideal but it's a lot lower than many people will experience after a bowl of porridge. If you want to improve further, you can try slowly increasing your wait between bolusing and eating until you're happy with the result.

Regards,
Grant

 

[noblehead]

I've given my insulin approx 20-25mins before I eat. I see the blood go from 5-6mmol upto 9-10mmol and then slowly go back down.

I bolus around the same time for breakfast (porridge with seeds, blueberries and natural yogurt) but some type 1's find they have to bolus more in advance to reduce bg spikes, you could cautiously try bolusing 30mins before and see what results you get.

 

[ScottyD]

Thanks for your thoughts.

I should have made it clearer - I bolus then 25 mins later make my breakfast and then eat approx 30mins later. I check my Libre and it has started to record a downward trend. As you've said, everyone is different so maybe bring it forward 5-10mins? I'm very happy with the spike as it sits between my 5-9 target that I set. It's just after 2 hours being down at 6mmol. I have in my head 7-8mmol might be a bit better.

I'm not dwelling on it, life is too short but just whilst I can, keeping the spike down would be nice. Dinner and lunch don't have such an effect so I don't really bother about those meal times.

Thanks!

 

[GrantGam]

Thanks for your thoughts.

I should have made it clearer - I bolus then 25 mins later make my breakfast and then eat approx 30mins later. I check my Libre and it has started to record a downward trend. As you've said, everyone is different so maybe bring it forward 5-10mins? I'm very happy with the spike as it sits between my 5-9 target that I set. It's just after 2 hours being down at 6mmol. I have in my head 7-8mmol might be a bit better.

I'm not dwelling on it, life is too short but just whilst I can, keeping the spike down would be nice. Dinner and lunch don't have such an effect so I don't really bother about those meal times.

Thanks!

No problem

It's also worth noting that your Libre will be lagging behind your actual BG level by as much as 15 minutes, so you should be cautious if you're extending your wait between bolusing and eating any further. Something as daft as taking time out to answer the door or the phone when you're eating, could result in a hypo. And a possible rebound high that may be worse than the spike, etc, etc...

Seems like you've pretty much got it sussed though' let us know how you get on

 

[ScottyD]

That's a brilliant point regarding the Libre. So I guess that suggests bringing it forward would be a reasonable move.

It's nit picking but all helps into the future I guess. I sat there watching that Panorama programme scanning my arm every 5 minutes....haha!

Cheers again and I'll let you know!

 

[GrantGam]

That's a brilliant point regarding the Libre. So I guess that suggests bringing it forward would be a reasonable move.

It's nit picking but all helps into the future I guess. I sat there watching that Panorama programme scanning my arm every 5 minutes....haha!

Cheers again and I'll let you know!

The Libre can lag as little as 5 minutes but that's just dependent on you as an individual I suppose. I'd stick with what you're doing but use your BG meter to see what value you're really at, it could be very close - likewise a good bit off.

Scanning the sensor is addictive!

 

[misswhiplash]

Thanks for your thoughts.

I should have made it clearer - I bolus then 25 mins later make my breakfast and then eat approx 30mins later. I check my Libre and it has started to record a downward trend. As you've said, everyone is different so maybe bring it forward 5-10mins? I'm very happy with the spike as it sits between my 5-9 target that I set. It's just after 2 hours being down at 6mmol. I have in my head 7-8mmol might be a bit better.

I'm not dwelling on it, life is too short but just whilst I can, keeping the spike down would be nice. Dinner and lunch don't have such an effect so I don't really bother about those meal times.

Thanks!

Personally, I don't think 7-8 is EVER better. Those are potentially damaging levels (though obviously not a necessarily huge problem if not prolonged). Why would you prefer that? Are you worried about dropping later?
I aim to be between 4 and 6.8 as much of the time as I can - obviously it doesn't always work out, but I definitely wouldn't adjust anything to make it deliberately higher.
(Also - yay to libre and prebolusing - that stuff changed my life )

 

[ScottyD]

Personally, I don't think 7-8 is EVER better. Those are potentially damaging levels (though obviously not a necessarily huge problem if not prolonged). Why would you prefer that? Are you worried about dropping later?
I aim to be between 4 and 6.8 as much of the time as I can - obviously it doesn't always work out, but I definitely wouldn't adjust anything to make it deliberately higher.
(Also - yay to libre and prebolusing - that stuff changed my life )

With my job being an airline pilot - and the UK being only one of three countires allowing diabetes into the flight deck, I have certain limit to contain my blood sugar levels (5-15mmol). Lower than 5 and higher than 15 requires action and I'm just wanting to keep in the range and add a mmol or so onto the lower end of 4mmol so I don't dip below 5mmol. I've been doing that and an A1c of 5.9% resulted so I'm well within a range of keeping complications at bay best I can... Thoughts are appreciated however, sadly my job has now become a bit of a balancing act!

 

[Flakey Bake]

I agree with everything people have said so far. Bolusing in advance is good, but insulin will only achieve so much. Maybe you need to look at the food as well. I am massively insulin resistent in the morning and I find that traditional poridge (made with oats, water and a small amount of milk, no sugar) gives me a massive spike (>15mmol). However the same amount of oats eaten with and apple and full fat greek yogurt (so more carb than just porridge) has a much lower spike (spike of around 10 mmol). I think eating some fat with the carby oats helps to level things out. Maybe worth a try?

 

[ScottyD]

I agree with everything people have said so far. Bolusing in advance is good, but insulin will only achieve so much. Maybe you need to look at the food as well. I am massively insulin resistent in the morning and I find that traditional poridge (made with oats, water and a small amount of milk, no sugar) gives me a massive spike (>15mmol). However the same amount of oats eaten with and apple and full fat greek yogurt (so more carb than just porridge) has a much lower spike (spike of around 10 mmol). I think eating some fat with the carby oats helps to level things out. Maybe worth a try?

Ah interesting! I shall see how that works out with myself and see what I get.

I had a look at 'Think like a Pancreas' and the bit on timing your bolus suggests for moderate GI foods to bolus around 10-15mins before. It's in line with what I'm thinking.

 

[himtoo]

@ScottyD
you have more than my total respect for what you have achieved.
First -- I would be honoured to be a passenger on a flight you were in charge of.

one of the things I have learned in my 44 years as a type 1 is that different foods affect me differently -- even the same foods at different times of day.

have you tried adjusting meal times and / or for example -- eating a snack upon waking ( to help with DP - dawn phenomenon)
and eating breakfast an hour or more later -- to see if that helps the whole spike thing you are experiencing.

also -- remember you are still fairly new to this whole D thing -- and you can only learn as you go through each day -- just so totally amazed you are "in the sky " -- well done you !!!!!!!!

 

[ScottyD]

Thanks so much @himtoo! Really appreciate the kind words!

So happy the way things have changed in aviation - just been offered a new job with BA and a friend of mine has just passed his captaincy interview with easyJet. Never been happier with life and that's now with diabetes coming along for the ride!

I've noted my DP and it rises from 4/5 to around 7? My pump seems to have that under control with the settings I have. However, like you said, I'm still new so that could be totally wrong? My diabetes care team are amazing and they have been awesome getting me back flying. I have discussed many things with them and the DP things seemed all okay, would the snack be a good if the DP seems okay? I was at a 3 monthly pump group run by the NHS in Scotland and we just discuss sick day rules, carb counting, exercise, alcohol etc. Really just refreshing everything that you were taught at first diagnosis and I asked about post meal spikes. They said really it's not a worry if it's coming back down within my insulin's active period - which it is. I'm very conscious of not getting hooked up on it all and it always being on my mind.

As you said, every day is different but always similar enough to draw comparisons... It's easy sitting in a seat all day at work so my sugars seem to stay relatively steady. With different start times for work (4am wake-up through to afternoon starts) my breakfast time does vary but I get similar results. The 4am wake up is where I don't bolus early as I just want my bed but the rush to get to work on time and the walk to the airport from the car park always brings that down nicely anyway.

Any other thoughts always appreciated but it's really just a nit picking question all of this!!

 

[himtoo]

that is what is so great about this forum.............. a place where we can read, interact , and learn from other people's experience and apply it to how we live.

if your DP is staying at or rising to around 7 in the morning , you sound as though the settings are pretty spot on.

 

[ScottyD]

that is what is so great about this forum.............. a place where we can read, interact , and learn from other people's experience and apply it to how we live.

if your DP is staying at or rising to around 7 in the morning , you sound as though the settings are pretty spot on.

That's perfect, thanks! Still honeymooning for sure so it's something I'll keep an eye on.

Yeah couldn't agree more. I've got loads of little tips off here and other threads have got me thinking about new ways to keep things in check such as this post meal spike malarky! That think like a pancreas was also a recommendation by loads on here which has made for good reading - I do wish he left the complications section to the end of the book!!

I found a NHS letter confirming what I'd donate should I no longer be around. Pancreas was of them - you have to laugh right? Keeping the spirits high!

 

[slip]

can't help or give any further tips but reading this thread just wanted to say sounds like 'you have control' over the big D just don't expect autopilot to keep you on the straight and narrow though - we all have to keep working at it constantly.

 

[ScottyD]

Hahah! Autopilot is a diabetics best friend...

We do play 'guess Scott's blood sugar' with the libre. I've lost to much money with betting on it!

 

[DunePlodder]

Have a look at this page describing "eating soon" mode
https://diyps.org/2015/03/26/how-to-do-eating-soon-mode-diyps-lessons-learned/
The essence is that it helps enormously to have some insulin on board which is already "active" when you eat. This can be a minimal amount which you injected much earlier.
I'm experimenting with it at the moment & getting some good results.
Perhaps not suitable when you are flying though!