Testing after meals

[catsbd]

I have never tested after meals. But I think in order to improve my hba1c which was last time 80, I think looking more carefully at what my blood sugars do might help? I follow DAFNE.
I always test before meals, varied tesults no pattern as such. Today I had for breaky 1 grilled egg, 2 bacon, some baked beans (not measured) and 1 slice toast. Blood sugar before breakky was 12.1 which I took 1 unit for and 4units for beans n toast. 2 hrs latermy blood sugar is 15.
My question is, do people do correction doses if high 2 hrs after a meal or is it best not to? I know I need to keep testing b4 and after and to try to eat balanced meals ( am trying to lose weight). I dont really know how my insulin levels are with different foods, cept chinese takeaway which endz up with high bg no matter what I inject!


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[JustDomUK]

My DSN told me that the rise after food should be around 2.8 mmol two hours after eating with Humalog. Of course this is entirely dependent on the type of carbs you've eaten. If fasting the rise should be within 1.5mmol for four hours. I don't know if this helps you but I would also be checking how much your insulin brings you down as you might have to adjust it for the different times in the day. E.G my bloods drop by 1.8mmol in the morning with 1 unit of insulin as a correction but in the afternoon it drops 2.3mmol with 1 unit. Is your basal correct?


As a side note Ive just begun a lower carb diet and have found my insulin requirements have dropped dramatically. This has enabled me to lose weight. My blood sugars have also stabilised and my rise after meals currently is less than 2.8. In fact it doesn't go above 7mmol unless I have eaten something that spikes me.


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[mo1905]

Don't do a correction 2hrs after a meal as there will still be insulin working. If you need to do a correction, do it at the next meal.


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[Rachyroo]

I'm having the same problems, my blood was 8.6 had cereal and 7 units of humalog, my blood lifted to 20.2 after 2 hours but had dropped to 8.9 after 4. If I do a correction dose of 1 unit it drops 4mmol but never do correction dose in between meal times.


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[noblehead]

I have never tested after meals. But I think in order to improve my hba1c which was last time 80, I think looking more carefully at what my blood sugars do might help? I follow DAFNE.
I always test before meals, varied tesults no pattern as such. Today I had for breaky 1 grilled egg, 2 bacon, some baked beans (not measured) and 1 slice toast. Blood sugar before breakky was 12.1 which I took 1 unit for and 4units for beans n toast. 2 hrs latermy blood sugar is 15.
My question is, do people do correction doses if high 2 hrs after a meal or is it best not to? I know I need to keep testing b4 and after and to try to eat balanced meals ( am trying to lose weight). I dont really know how my insulin levels are with different foods, cept chinese takeaway which endz up with high bg no matter what I inject!


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Well despite your bg reaching 15 you only had a 3mmol rise after breakfast as your pre-prandial reading was 12, if 12 mmol is normal for you first thing in the morning then I would suggest you do some basal testing throughout the night, it might be the case that your basal insulin is running out or the dose needs increasing, however it could also be DP.

I would definitely test your bg postprandial to get a picture how your levels rise and fall after food, if you find you are spiking think about giving your insulin a head start over your food and inject 10-20 mins before eating, I do this myself and have noticed a big improvement in postprandial spikes. You may also want to look at choosing foods that are lower in the Glycemic Index or add some good fats to your food which helps delay the absorption of the food, reducing the amount of carbs will also work but if you decrease them by too much you will need to start account for the protein & fat on your plate.

There's an excellecent book you should read called Think like a Pancreas by Gary Scheiner, he has loads of useful info and advice to control diabetes well and it's not too difficult to read.

As for corrections, I rarely do them unless I know my bg levels won't be in range before I next eat, insulins like Novorapid and Apidra peak at around 2 hours after injecting but there's still around 20-30 left and can keep working for a further 2-3 hours (this is certainly so for Novorapid) so taking a correction dose can lead to hypo's, plus when you correct between meals there's a tendency to stack insulin doses which can lead to hypo's after you next eat, once you establish good control you'll know yourself when and when not to correct.

I find Chinese food fine but do have to split my insulin dose due to the fat content of the food, I had two such meals over the Christmas period and rather enjoy a take-away as a special treat.

Good luck and hope you get on top of your control!

 

[catsbd]

How do I work out my ratios of insulin? Is it just trial and error? My morning high of 12 is typical if I have eaten late the night before. No matter what insulin I inject for the foods. If I dont eat after 7pm then blood sugar is around 4 to 7 next morning. I think I will do a run of 3am testing. Low carbing might be a way for me to get better control snd lose weight. You'd think after 40 yrs being type 1 I'd have got the hang of it by now.
I've got Think Iike A Pancreas on my kindle, I did start reading it a little.
To me, there are so many variables (diet, exercise, life etc) that I wonder if I'll ever have good control.


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[noblehead]

Insulin ratio's can vary throughout the day so can be different from breakfast to dinner. The following website is a course similar to DAFNE and will advise you on working out insulin to carb ratio's:

http://www.bdec-e-learning.com/

If your bg is fine if you don't eat after 7pm then don't eat, I have my dinner around this time but don't eat again till morning, I did use to eat supper once but stopped when I decided to lose weight.

As for trying low-carb, I think you should give it a go and see if it improves matters.

 

[catsbd]

Ta for the link. X


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[SamJB]

If you don't test after meals, you won't know if you've given yourself the correct amount of insulin. As for correction doses, you need to be careful unless you are tightly controlled and confident that it won't cause a hypo. Personally, if I'm > 7mmol/l two hours after eating, I'll give myself a correction dose because I know 1 unit of Novorapid will drop my levels by 1 unit. I wouldn't necessarily recommend this for now, but if you're in double figures 2 hours after eating, a correction dose is probably a good idea.

Fast acting insulin is designed to last in your bloodstream the same amount of time as pancreatic insulin, so you should aim for consistent readings before and after eating to within 15% of each other (or around 1 mmol/l).

 

[Daibell]

Various points. First if your weight is too high you must reduce your carb intake e.g. no toast or beans for breakfast. You probably have some insulin resistance which makes it more difficult to control your levels and get the insulin units right. Your info and post doesn't make it clear whether you are on a Basal/Bolus regime or mixed? It may not be easy but are you trying to get your fasting blood sugar between 5 - 7mmol where you can? You must test before and after meals for a while to enable you to get your ratio right for carb counting. With regard to DAFNE these courses can vary greatly and some of the NHS advice from what I hear isn't the best (that's being polite). In particular there can be little guidance to keep your carb intake down. This you must do to get the weight and blood sugar more balanced; don't be tempted to eat too much and just match with the insulin. Sorry if that sounds a bit harsh and I'm guessing but set a target of, say, 150gm/day and see how you do. BTW, I agree that you shouldn't do a correction doese only 2 hours after an earlier dose

 

[smidge]

Hi CatsBD!

I've just been on a DAFNE course and I was shocked by the amount and type of carbs that course participants were being encouraged to eat. The trainers brought biscuits and chocolate in for us, we went out for a meal that involved huge portions of chips, pies, burgers and jam doughnuts. We had a buffet involving sausage rolls, bread rolls, crisps, cake etc and we were told not to test after meals - you'll see if your insulin dose was correct by seeing what your next pre-meal figure is. Absolute tosh! If you want good control of your BG, you must test 2 hours after your meals to see what the effect of that meal and the insulin dose you took was. I promise you my BG have never been so badly controlled as they were for the whole of last week - I was seeing double-figures every day. Most well-controlled Type 1s reduce their carbs to considerably below the 'normal' carb intake. Some of us reduce them further. How low you take them is a matter of personal choice and how consistent your BG is.

I do correct if my BG is high at two hours, but I take a lot of things into account before I do it e.g. how much active insulin I have on board, what food I ate and when the sugar from t is likely to be released etc. Get your BG lower and more consistent before attempting corrections.

Incidentally, DAFNE also taught that you don't need to take vegetables, beans and pulses into account when bolusing - unfortunately, many of us find that this is not the case and we DO need to jab for those or our BG will rise too high. Specifically, we were told to jab only for the sauce on baked beans - not for the beans themselves (so the 'of sugars' part rather than the 'total carb' part) - I can't speak for anyone else, but I have to jab for the 'total carb' content of baked beans as I do for any other carb. They also said you don't need to jab for any snack with 10g carb or less in it - I certainly DO need to jab at that level or my BG will rise by around 3mmol.

Take care

Smidge

 

[SamJB]

Smidge, that is absolutely astonishingly bad advice from the DAFNE course. No testing after meals? No blousing for carbs in veg? A carb is a carb is a carb, doesn't matter if it's in a spud or a lettuce leaf, it all adds up!

Truly shocking!!!

 

[Picci]

Hi CatsBD!

I've just been on a DAFNE course and I was shocked by the amount and type of carbs that course participants were being encouraged to eat. The trainers brought biscuits and chocolate in for us, we went out for a meal that involved huge portions of chips, pies, burgers and jam doughnuts. We had a buffet involving sausage rolls, bread rolls, crisps, cake etc and we were told not to test after meals - you'll see if your insulin dose was correct by seeing what your next pre-meal figure is. Absolute tosh! If you want good control of your BG, you must test 2 hours after your meals to see what the effect of that meal and the insulin dose you took was. I promise you my BG have never been so badly controlled as they were for the whole of last week - I was seeing double-figures every day. Most well-controlled Type 1s reduce their carbs to considerably below the 'normal' carb intake. Some of us reduce them further. How low you take them is a matter of personal choice and how consistent your BG is.

I do correct if my BG is high at two hours, but I take a lot of things into account before I do it e.g. how much active insulin I have on board, what food I ate and when the sugar from t is likely to be released etc. Get your BG lower and more consistent before attempting corrections.

Incidentally, DAFNE also taught that you don't need to take vegetables, beans and pulses into account when bolusing - unfortunately, many of us find that this is not the case and we DO need to jab for those or our BG will rise too high. Specifically, we were told to jab only for the sauce on baked beans - not for the beans themselves (so the 'of sugars' part rather than the 'total carb' part) - I can't speak for anyone else, but I have to jab for the 'total carb' content of baked beans as I do for any other carb. They also said you don't need to jab for any snack with 10g carb or less in it - I certainly DO need to jab at that level or my BG will rise by around 3mmol.

Take care

Smidge

Oh Smidge I totally agree with you. I was diagnosed 35 years ago and was taught 'counting carb exchanges'. DAFNE is nothing new however, I did the course out of curiosity. They told me to test my background insulin by having a carb free lunch, salad, lentil soup etc and not have any quick acting!!! I argued saying I'd go sky high, but they insisted I try it out. Just to prove them wrong I did as they said and was 20mmol by 5pm. (at lunch time I had been 5.5mmol.) NOTHING is carb free, I follow a very low carb diet ( no starchy carbs what so ever ) and have quick acting for everything that passes my lips, including a handful of cherry tomatoes. If I don't my bgs will rise. I test how my background works by skipping lunch completely and that is the only way. I cannot believe they say you don't have to have insulin for pulses!!! Mad

 

[CollieBoy]

Having read your course ordeal,Smidge, i preferred it when DAFNE was one of "The Broons" in "The Sunday Post"
I couldn't have kept quiet in that debacle and would have been "asked to leave".

 

[smidge]

Smidge, that is absolutely astonishingly bad advice from the DAFNE course. No testing after meals? No blousing for carbs in veg? A carb is a carb is a carb, doesn't matter if it's in a spud or a lettuce leaf, it all adds up!

Truly shocking!!!

Oh that was only the tip of the iceberg of bad advice, Sam. I think I'm traumatised by it LOL.

Seriously, I'm determined to do something about it but I don't know what yet. I'll start a new thread on the subject of DAFNE later if I get time rather than hijack this one, but if you want to read more about my week from Hell, I gave daily updates on another forum - diabetes support forum . org (all one word but I can't give the url or write it properly as this forum is a bit silly with things like that and blanks it out!) It was beyond shocking!

Smidge

 

[desidiabulum]

Oh that was only the tip of the iceberg of bad advice, Sam. I think I'm traumatised by it LOL.

Seriously, I'm determined to do something about it but I don't know what yet. I'll start a new thread on the subject of DAFNE later if I get time rather than hijack this one, but if you want to read more about my week from Hell, I gave daily updates on another forum - diabetes support forum . org (all one word but I can't give the url or write it properly as this forum is a bit silly with things like that and blanks it out!) It was beyond shocking!

Smidge

Hi smidge - why don't you run it as a daily thread here for a week, just changing the dates but having the same content? No one could object, and given how central DAFNE is to NHS plans for managing type 1 it is really important to get this in the public domain as widely as possible.

 

[noblehead]

Smidge, that is absolutely astonishingly bad advice from the DAFNE course. No testing after meals? No blousing for carbs in veg? A carb is a carb is a carb, doesn't matter if it's in a spud or a lettuce leaf, it all adds up!/quote]


Absolutely right Sam, a carb is a carb and it will raise bg eventually. I've just had my Sunday roast and although I weighed and calculated the potatoes, yorkshire puds and gravy on my plate I still did a rough calculation for the veg, if I didn't there's a good chance my postprandial bg would be high.

Oh that was only the tip of the iceberg of bad advice, Sam. I think I'm traumatised by it LOL.

Seriously, I'm determined to do something about it but I don't know what yet. I'll start a new thread on the subject of DAFNE later if I get time rather than hijack this one, but if you want to read more about my week from Hell, I gave daily updates on another forum - diabetes support forum . org (all one word but I can't give the url or write it properly as this forum is a bit silly with things like that and blanks it out!) It was beyond shocking!

Looking forward to what you have to say Smidge, I'm gonna bet that it's different to the many 100's of positive posts we have had about the DAFNE course over the years

 

[inhil1982]

I always correct my sugar levels before food, adjust me levels to danfe targets and then for the carbs I eat. Wait 5 hrs later so there is plenty of time for the insulin to completely work and then check my sugar level. Hope this helps

Ian

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[kkkk]

I've just started on CGM, (and am on 2 basal injections and then bolus for meals). I have noticed something similar with my sugars after breakfast, and despite having porridge and waiting in-between injecting and then eating it I do have a bigger spike after my breakfast than I do at other times of the day, so I am figuring I need a pump to help correct that. I will have a play with reducing my carbs at breakfast too and see whether that makes any difference. However I have that same issue that if I correct I would be hypo, even on one unit, as after that peak my sugars are down and normally mid-4s ready for lunch….so even though I don't seem to have a dawn phenomenon I wonder whether something happens in that first bit of morning when I actually get up and moving, whether my liver gives me an extra spike then to 'help' me get moving .

 

[inhil1982]

Kkkk- During the day it seems like your background insulin is too high because its only there to keep you sugar level stable, not lower it. The morning problem might be down to your sugar level dropping during the night and your liver kicks in the back up sugar? I would differently look into you background insulin.
Hope this help your sort this problem out

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