How to avoid spikes after eating

jessie

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275
Type of diabetes
Type 1
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Insulin
Hello,

In the 3 years that I've had diabetes I've never been able to avoid spiking after my main meals. Because my hba1c has so far been quite good at around 5.8 I've not fretted too much about this, but it's more important now that I'm hoping to have a baby at some point in the near future.

I'm quite careful with my diet, my control during the day is fine as I eat minimal carbs. For my evening meal I'll normally have no more than 50g of carbs. I avoid potatoes, rice and pasta if possible but I do eat lots of roasted veg like parsnips, carrots, squash and sometimes a small amount of pulses. This is when I am having the spikes. I appreciate I could cut down on carbs in the evening but I do feel I need this amount. I followed an almost zero carb diet for a while and whilst my control was better and I wasn't spiking, I lost too much weight and I felt really tired and groggy as my potassium was low. It would be nice to just eat a sandwich for lunch without having to worry or fall asleep afterwards!

I do like to treat myself every now and then and if I go to someone's house for dinner I will eat what I'm given and just be careful not to over eat.

My issue is that after eating almost any amount of carbohydrate my blood sugar is spiking, maybe to 10 or 11 after 2 hours. For example I find I can't eat 2 slices of wholemeal bread without this happening, but it's fine if I just have 1 slice!

I take 1 unit Novo Rapid per 10g carbs. I have increased my Lantus but this hasn't helped, if I increase it any more I am prone to hypos in the night. If I increase my Novo Rapid my levels 2 hours after food are perfect but I'll then hypo before my next meal or in the night, I treat the hypo then spike again! Grrrr!

I'm not really sure which way to go now as I don't really want to zero carb if I do fall pregnant... does anyone have any advice on which foods are better for avoiding spikes or do we all react differently?

Thanks and sorry for waffling!

Jessie.x
 

ishjohno

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Hi Jessie

My diet is like yours and I find I spike after eating carbohydrates which I don't normally eat.

I follow the DAFNE rules and use NovoRapid, I find if I know I am going to eat something like a bread or something that I know is going to make me spike I will do 1.5 units of NovoRapid x the total amount of carbs I have eaten i.e. 50g carbohydrate x 1.5 QA = 7.5 units of QA round up or down it's entirely your call. Still check your BG 2 hrs after the meal to see how it is.

Check with your diabetic nurse/doctor/DAFNE team as well :)

Good luck.

Sarah
 

noblehead

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Jessie,

To me it looks like your insulin ratios are out, are you still high 3 and 4 hours after eating?

Nigel
 

jessie

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275
Type of diabetes
Type 1
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Insulin
Hi both, thanks for your replies.

Sarah I took your advice last night and took 3 units of NovoRapid, my meal had 20g carbs in it. After 2 hours I was 8, not too bad but not ideal. When I woke up this morning I was 4.5 so had I taken any more insulin I think I would have woken up really low.

Nigel I think you've tried to help me with this issue before! After 3-4 hours my blood sugar is normally good, 5-7 range.

Unfortunately there are no carb counting courses in my area but I think I would really benefit from one so maybe I could travel elsewhere. Will ask at my appointment next week.

Thanks again,

Jessie. x
 

noblehead

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No problem Jessie! :)

Nigel
 

yipster29

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200
Hi Jessie
I have the same problem!! Limited carbs, same diet restrictions etc and good readings after 3-4 hours, yet spikes at 2 hours!!

I tried increasing Novorapid or Levimir but like you end up low. Another T1 advised I have my Novorapid 5 mins earlier... no more as I risked going low.... so I did this and I've been a little better.

If you get any better advice can you post it on here so I know to try it!!

Thanks :)
 

jessie

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275
Type of diabetes
Type 1
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Insulin
Oh gosh, I hadn't even considered that. I have a really bad habit of taking my NovoRapid half way through a meal, or even afterwards if I'm not sure how much I'm going to eat or if I'm at work and it's 'inconvenient' for me to go off and inject.

I will definitely experiment with taking it before I eat, I may even risk 15 minutes and see what happens. Fingers crossed.

Thanks Yipster :)

PS - will let you know if I hear of any other tips!
 

ishjohno

Active Member
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31
Hi Jess

8 2 hrs after the meal is good, may I ask if you test your BG before your pm dinner and before you go to bed?

DAFNE recommend the following for BG Control:

5.5 - 7.5 mmol/l before breakfast
4.5 - 7.5 mmol/l before other meals
6.5 - 8 mmol/l before bed

If you had tested before bed and it was low you could have eaten 1 extra CP so your BG was reasonable the next morning. It sounds alright in theroy but in reality it takes time and patience to work out yourself what your body likes :D

I think you would benefit from the DAFNE course.....good luck.

Sarah
 

jameshallam

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109
I have similar problems with spikes, esp. after breakfast.
I can be 6 before breakie, take 4 units for 40g of carbs @ 7am.

@9am I'll be up at 13ish, by midday I'll be at about 4-5.
If I up it then I have a hypo!

What I do sometimes is pre-inject for a snack mid-morning. So I inject 5 units with my 40g breakfast. Then at 10am (ish), I test, and if I am on my way down (5-7) then I have a biscuit to tide me over until lunch...

The problems with this method is remembering to have the snack. I have been sidetracked by various things and forget to eat then will have a hypo.

If you KNOW you will remember to have a snack, then it's not a bad method...

Personally I wouldn't inject 15 mins before... Maybe if I was a little high before hand, but not if I was within targets.
 

jessie

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275
Type of diabetes
Type 1
Treatment type
Insulin
Hi Sarah,

I do test a lot (my poor fingers!) - including before my evening meal and bed, and I guess I could cope with being a bit low at bed time and having to snack. I would then worry though that it will drop low again during the night. You're right, it does take a lot of patience which I seem to lack a little ;)

James, my doctor did once advise me to try your theory, take a little more insulin and snack more... it works well when you have the opportunity to graze! But like you say not always possible if you're in a meeting, driving, or out and about etc.

Soooo, think I have concluded:

• Take a little extra insulin when eating certain carbs
• Take insulin 5 or so minutes before eating
• If increasing insulin, graze between meals and before bed!
• Do a carb counting course

Just had a thought - Yipster - do you have a half unit pen? Those half units can make all the difference!

Thanks all.

Jessie. x
 

Paul J

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Hi,

I have found that eating few almonds per day ( about 25g) helped to stabilise my sugar levels,and reduce the spikes,just watch the calories!

Paul
 

yipster29

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200
Hi Jessie

2 things..... 1st my DS told me NOT to take as much as 15 mions beforehand as you risk going hypo after meal, she said just the 5 mins and it has helped reduce my spikes!

2nd... yep half unit pen, loads more accurate :-D
 

dectjoh

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53
Yipster29 - What make is your half unit pen? This sounds just the ticket for me - my insulin to carb ratio is very low (1 unit : about 40g in the morning) and therefore having to take whole number doses is a right pain! Tracy
 

iHs

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dectjoh said:
Yipster29 - What make is your half unit pen? This sounds just the ticket for me - my insulin to carb ratio is very low (1 unit : about 40g in the morning) and therefore having to take whole number doses is a right pain! Tracy

Hi Tracy

There are currently 2 pens that will deliver insulin in 0.5u. Novopen Junior and Echo pen for Novo insulins and Lilly Humapen Luxura HD for Lilly insulins. Aventis and Workhardt cartridges will also fit in the Luxura HD pen although the insulin pen needle needs to be attached to the pen first before screwing the pen together to allow a small stream of insulin to come out.

The Echo pen is available in Europe but am not sure whether it's made its way to the UK but do ask about it as it also has a memory function :)
 

the_anticarb

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Hi Jessie

If you fall pregnant you will need to keep it under 7.8 after meals, I find the only way to do this is to inject a lot and then have a mop up snack before my next meal to mop up the excess insulin - about 15-20g carbs works for me (sometimes - bg's very unpredictable during pregnancy especially towards the end with hormones flying about).

If I want a bigger snack than this I take 20g off the carb total and inject for that.
I wouldn't recommend low carbing during pregnancy, I started off doing this but was advised it could affect the growth of the baby and you'll find it hard to keep yourself from getting too hungry. Also when I had morning sickness I completely went off all foods except plain starchy things like bread and rice.

So you'll probably have to become a dab hand at dosing up your bolus, ok in first half of pregnancy but not so easy when ratios start spiralling upwards in the final months.

It's a bit hit and miss to be honest, often you can't do right for doing wrong.

Think we are all different in terms of which foods spike and which don't, often things that I woudln't have expected to spike me do, such as porridge and wholemeal bread, so I just tend to go on the total carb content now and inject novorapid to cover it, then test an hour later and correct any highs/lows. I'm coming to the end of my pregnancy now and whilst it's not been a barrell of laughs it is do-able.

Good luck
 

Lucie75

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I'm opening myself up for being shot by saying this, but please don't get everything out of proportion with your control before a planned pregnancy. You have excellent control anyway (I don't think I have ever had an HBA1C below 6.6. You must realise that while it is preferable to have good control before pregnancy and during the first trimester, the pregnancy itself will vastly alter how well you respond to insulin. Your consultant will be on top of this throughout your pregnancy and your control will probably remain good (if you follow the advice). I was always advised to stay within certain parameters with my bg before and after meals, but when I got myself worked up about higher than ideal bg readings the reaction from my consultant was that the odd high reading won't make any difference whatsoever.

By the way, my control wasn't as good as yours but both my babies were in the 7lb range at birth, and had no 'defects', so please don't worry.

Ok - shoot me now.
 

the_anticarb

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Just wanted to add Jessie, I have been experimenting with pre injecting this week to avoid those spikes, as I am in the last stages of pregnancy my insulin resistance is sky high! I have been pre injecting 10 units 10 mins before the meal (at the moment this is the mimimum I'd take with a meal) then if I need to inject any more I do this at the end of the meal. It is sometimes hard to predict how much I will eat as my stomach is all squashed up now to accomodate the pregnancy and my appetite is erratic!
So far, not too many problems and I wish I had thought of this earlier as it does seem to avoid the spike. However I do test before I eat and if I'm really low say in the 4s then if I'm having a low GI meal this may mean the insulin works before the food so I might not do it then, or only take 5u.
Its a fine art trying to match the action of the insulin to the action of the food, and I'm not sure that once my insulin resistance goes post pregnancy I'll need to do it, but it is working for now

AC