BG spike after meal then hypo's 2 hrs later

[Janelle123]

Hi,

I have been trying to work out a way to eliminate the spike after a meal without going low a couple of hours later.

For example, last night pre-meal I was 5.8. I had 50g of carbs and took 4 units of Novorapid (carb ratio is 1:12 - I think). 1 hr later I was 8.5, which was ok I guess but would prefer for it to be under 8.0. 2 hrs after my meal I was 4.0 so I had a biscuit with 10g of carbs. 20 mins after that I was 3.7 so had another biscuit, then 20 mins after that I was 3.4 so I had a small glass of lemonade.

I guess the obvious answer is that I took too much insulin but if I took any less then surely I would have had a high reading 1 hr after my meal? How do I eliminate a high reading after a meal without going low a couple of hours later?

TIA

 

[urbanracer]

I'm on mobile so can't do too much. But type Novorapid Profile into the forum sesrch bar for an interesting thread from the past which explains how Novorapid works over time.

 

[Lazybones]

This is purely a calculated guess, but have you considered that the rapid drop 2 hours after eating a meal (containing carbohydrate) might have resulted in what is commonly know as reactive hypoglycaemia. I know that your a Type 1, but they also can suffer with this as well as us Type 2's. It's where the body draws glucose rapidly from the bloodstream to such an extent that it drops down below the starting B/G level that was prior to taking in that meal.
The trick here is to ensure that the carbohydrate content in the meal is combined with fats and is ideally of a low GI/GL or medium GI/GL food choice so that the initial high peak is avoided. You can find out more on Reactivve Hypoglycaemia here on this site.
Hope this info is of some benefit to you - All the best - Lazybones

 

[Heathenlass]

It sounds to me that your ratio for that time of day is too high, if it's happening consistently. If your dose was lower, you wouldn't see a significant change in your post meal reading, but later on it would be more even. A lot depends on the content of the meal, not just the carb count. For example, if it is mainly starcy carbs, the initial action of the Novorapid would deal with this quickly, but then continue to work on glucose that essentially isn't there. Result - hypo.

Unless you are actively testing for a spike in an unfamiliar food, one hour post prandial may be too soon to test, a more accurate picture of how you are doing can be gained from a two hour test. In the example you gave, at 2 hours it was 4.0 which to me indicates too much insulin, therefore your ratio is likely to be incorrect. Have a word with your HCP, but you could try altering your ratio to 1:15 and see how you get on ? Just go by the two hour test to evaluate .

Signy

 

[dannyw]

Hi Janelle, assuming your basal is correct, your ratio for this meal is probably wrong. Either that or you miscalculated carbs ? Try same meal again, 1 unit less but inject 10mins earlier ( to avoid spike ).

 

[noblehead]

Do some basal testing Janelle before looking at your I:C ratio:

http://www.salforddiabetescare.co.uk/index2.php?nav_id=1007

To reduce postprandial spikes try injecting 10-20 mins before you eat, QA insulins such as Novorapid and Apidra take around 15 mins before they begin to work.

 

[CarbsRok]

Either your ratio is wrong or the timing of your bolus, or both.

 

[IanD]

I'm T2 only on metformin, but I can reproduce those figures delayed by an hour if I have a low fat cereal breakfast. A one-hour spike around 14, 2 hour 7-8 & 3 hour 4-5, though I don't then hypo.

I followed the Diabetes UK, NHS diet for 8 years from diagnosis & complications were becoming serious. With advice from a T1 on this forum, I switched to a low carb, increased fat diet. My readings immediately improved & complications were gone in 3 months. Seven years on my health is excellent, readings are normally 5-9 - rarely above 9, & never below 5.

Not being T1, my suggestions may be suspect, but many on the forum, both T1 & T2 have found a low carb/increased fat diet beneficial for control & health.

I suggest your problem is relying on carbs both as a main b'fast & as correction for lows. Carbs are digested quickly - as you have found - whereas proteins & fats are much more sustaining.

IMO 1 hour readings ARE significant, as they show the immediate effect of your food/insulin metabolism, while the 2 hour readings suggest that the insulin is too high. If you reduce the insulin you are likely to get a high 1 hour reading, with resultant complications, but still be low &/or hungry after 2-3 hours.

@daisy1 has a post of general recommendations including diet, that I'm sure you will find helpful.

 

[Janelle123]

Thanks everyone. I think I might try a low carb diet after all the good things I have read on this forum.

Trying to work out a carb ratio probably isn't helped by the fact my basal dose isn't correct but unfortunately I can't do half a unit... I take 19 units of Lantus and am often low during the night and throughout the day. I take 18 units and wake up with high BS in the mornings and need to take multiple correction units throughout the day. Thankfully I will be getting a pump in 6 weeks and will be able to fine tune my basal rate!

 

[donnellysdogs]

Also.. Treating a lowish level then a low with biscuits isn't right... You then went on anc had lemonade. You would have been much better treating the low reading with sugar drink, or your hypo stoppers first ...

 

[Janelle123]

Also.. Treating a lowish level then a low with biscuits isn't right... You then went on anc had lemonade. You would have been much better treating the low reading with sugar drink, or your hypo stoppers first ...

I guess I'm naughty in the way that I use my dropping blood sugar levels as an excuse to eat the things that I like. I usually only resort to lemonade and jelly beans once I'm under 3.5ish.

 

[donnellysdogs]

I'm sort of the same in all honesty but I have maomi pinballs as my hypo stoppers and they are my treat as well because biscuits, cake etc do nothing for me at all!
Don't blame you, but not really the best way to treat a hypo....

 

[noblehead]

Thankfully I will be getting a pump in 6 weeks and will be able to fine tune my basal rate!

That is the beauty of a pump, I have 5 different basal rates, two of which are through the night

 

[crashinduction]

Hiya. I had this issue recently. I'm on a pump and was loaned a CGM. I found that giving the bolus early did the trick. It's a concept (on a pump) called a "super bolus" - Google it. It's not quite the same in a MDI but the idea is the same.
Obviously, make changes gradually and test regularly but this seemed to work a treat for me.
I turned postprandial highs then later hypos into BM's of 5-7 with small peaks of upto 8-9 after a meal.

 

[donnellysdogs]

@janielle123
You
Need to approach pump switch over logically.
If you are going to adjust your carb eating do that sooner rather than later...do regular testing with all meals and find the spikes and drops...lowering carbs should reduce spikes..
Have a go at some basal testings.. Even during the night for the last month before the pump.
Record everything down.. Your foods, your routines.. Ie weekends may vary greatly to weekdays.
(I have profiles for weekdays and weekends).

The more you help yourself now doing all of this will make pump switchover easier...