Acceptable Post meal spikes

This is a good question. Your numbers are conservative. I've read that for older people, a higher number may not only be acceptable but preferred; reason being possibly that seniors become less hypo aware.

Distroyer said:

Hi All.

I am new in this forum and this my second post. I do apologies if this question has already been raised and discussed.

I got diagnosed with Type 1.5 in April 2021. Since then I am only Basal insulin (Lantus) and Metformin. I do have Nova Rapid with me as well by don't use it often because I get hypos.

I get after meal spikes up to 10mmol sometimes even 11mmol. Even when I take Bolus insulin sometimes I get this spikes. I then go for a walk or do some physical work and after couple of hours it drops to 6.5 and stays like. This has been the case for past 6 months now and even after this by last 2 Hba1c were 45 and 43. I have asked about the spikes to my doctor and also Nurse and they saying it fine. Your Hba1c result are very good and you dont need to worry about it.

During my research on internet I get mixed opinions some says 10 is fine and some say it should not go 7. I am confused now would like some of your thoughts opinion on this. I don't want to risk any complication by continuing this practice.

Thanks

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Hi I get spikes after certain food and was told the same by my nurse, my HbA1c was 42 -48 at the time. Now for some reason it’s crept up, due to high BG when ill I think and just needing more insulin as I progress through honeymoon phase ; they are more bothered about the spikes now! Last HbA1c 60. I haven’t changed anything, but have been ill quite a bit this last year. I can often spike up to 12-13, which I don’t like as my vision goes blurry and if I am supposed to be working I struggle even to see the laptop screen. I find going for a walk really helps and maybe in your case try some Novorapid with a certain meal that spikes you which should help keep you steadier.
I eat low carb to try and reduce this exact problem. But sometimes I can eat something and be fine, go up to around 8 and back down, I feel that’s normal my nurse tells me even non diabetics would have that. Other days I can eat the same low carb thing and spike up to 13, then I have to stop what I am doing, go for a walk. It can be very disruptive and I have accepted that some days things just don’t work out. Maybe because there are so many other factors involved, weather, stress sleep …it all impacts on how your body reacts that particular day. I did switch to Fiasp for my bolus for this exact reason and in the main it has helped stop the spikes. I can’t find a definitive answer about spikes either (Dr Bernstein very helpful though I like his book and YouTube videos) but my nurse always says man made insulin is not the same as the insulin your pancreas produces and it will never be perfect. Don’t beat yourself up trying to get it spot on all the time but if you are spiking regularly and having to stop what you are doing to try and sort it out maybe talk to your nurse about introducing some of your Novorapid ?

There are some graphs on the internet from people without diabetes.
Their levels go over 9.

In my mind, if a full functional pancreas that has very little else to do can go that high, I have no concern if my manual pancreas which I operate on top of a full life goes up to 10 sometimes.

Distroyer said:

Thanks for your thoughts @Hertfordshiremum. Well when I get spikes I dont get any symptoms or may be I am not feeling them that much and so that is not my concern. I am just thinking if I get these spikes is it doing any internal damages which I am not aware or now but will show up in the future.

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I have had the same thoughts which is why I persuaded my diabetic nurse to give me Fiasp. It works a lot quicker than Novorapid and therefore is far better at stopping the spikes. I pointed out I couldn’t have a low carb lunch stopping me working in the afternoon and needed something different despite a very good HbA1c at the time.
They seem very focused on HbA1c whereas I agree with you, I am more concerned about the range.

My diabetes consultant spent years trying to persuade me that brief excursions over 10 were nothing to worry about. I can't say I'm comfortable with it and do my darnest to not go over 10, but I still get cross with myself. I think the truth is no one really knows what harm is done by brief spikes, maybe even higher than that, if it is for 30 mins maybe an hour say once every day or two.

It's a bit of a qualitative call. How hard are you going to try and what cost the enjoyment of life. It's your choice.

Not much help - sorry!

barrym said:

My diabetes consultant spent years trying to persuade me that brief excursions over 10 were nothing to worry about. I can't say I'm comfortable with it and do my darnest to not go over 10, but I still get cross with myself. I think the truth is no one really knows what harm is done by brief spikes, maybe even higher than that, if it is for 30 mins maybe an hour say once every day or two.

It's a bit of a qualitative call. How hard are you going to try and what cost the enjoyment of life. It's your choice.

Not much help - sorry!

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That is a really good point. Brief spikes for 30mins to an hour are much more acceptable than spikes well into double figures that takes hours to go back down.

barrym said:

It's a bit of a qualitative call. How hard are you going to try and what cost the enjoyment of life. It's your choice.

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I completely agree with this.
I am sure if I lived in a bubble did the same exercise every day and ate the same diet every day, my diabetes manageemnt would be much better but my quality of life would be much worse.
With Libre, I can quickly spot and react to going high but that doesn't rule out double figures, it minimises the time I spend there and I am happier with that than bubble living.

It is about balance and as we are all difference the correct balance is very personal. Some find their mental health is more affected by highs and some find their mental health is more affected by obsessing over their numbers.

EllieM said:

I think the data just isn't available yet.

For a long time, doctors had to work with hba1cs, and they discovered that a T1 hba1c of 48 (or so) seemed to lead to better results for complications like eye disease etc. Very low hba1cs are frowned upon as they are often associated with hypo issues.

Now we have cgms but they haven't been around long enough for the long term studies to exist, So the jury is still out. But remember the many T1s who were diagnosed 50 or more years ago didn't have glucometers for their first decade, so you can be pretty sure we were spiking like mad then.

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I think the myth of HbA1c as the definitive tool it once was is well and truly blown.

My consultant (again) pestering me about persistent 'lows', to which I replied "my HbA1c is good though" just reminded me that it is just a clever, weighted average, and that there would be corresponding 'highs' to get the HbA1c in a good place.

I agree the data for what damage is done but short spikes isn't there yet, what is short? what is spike? Again my celebrated consultant now looks solely at Time in Range, and has persuaded me to set this at 4.5-10.0 as the current realistic target for a T1 to aim for without having to risk the known damage of numerous hypos.

Distroyer said:

Hi All.

I am new in this forum and this my second post. I do apologies if this question has already been raised and discussed.

I got diagnosed with Type 1.5 in April 2021. Since then I am only Basal insulin (Lantus) and Metformin. I do have Nova Rapid with me as well by don't use it often because I get hypos.

I get after meal spikes up to 10mmol sometimes even 11mmol. Even when I take Bolus insulin sometimes I get this spikes. I then go for a walk or do some physical work and after couple of hours it drops to 6.5 and stays like. This has been the case for past 6 months now and even after this by last 2 Hba1c were 45 and 43. I have asked about the spikes to my doctor and also Nurse and they saying it fine. Your Hba1c result are very good and you dont need to worry about it.

During my research on internet I get mixed opinions some says 10 is fine and some say it should not go 7. I am confused now would like some of your thoughts opinion on this. I don't want to risk any complication by continuing this practice.

Thanks

Click to expand...

Injected insulin does not match the food you are eating and follows a fixed curve over 4 to 5 hours, so if you eat normally, you will spike. On DAFNE they teach you to ignore the spikes.

EllieM said:

Not disagreeing with you at all, but how long ago did you do DAFNE? Pre or post cgms?

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Post CGM's. We all had them on the course.

Postprandial Glucose Spikes, an Important Contributor to Cardiovascular Disease in Diabetes?

"short, intermittent bursts of hyperglycemia may have detrimental effects on several organ systems including the vasculature and the hematopoietic system collectively contributing to the state of elevated CVD risk in diabetes"

Ten years ago for me. Full time user. Carb counting & MDI after less than 6 months. Tried like hell to manage on exercise alone, and was doing upwards of 3hrs a day, but finally realised the way it was going.

I do sympathise with people with busy lives though, younger folk, mums, busy careers etc. Asa retired old git, I can obsess all day about it - and do! It must be a massive job for most.

Good luck.

Distroyer said:

Hi @barrym, @Hertfordshiremum, @Bubbleblower
I find easy to manage my diabetes on low carbs and occasional Bolus insulin. I have been reading about other type 1 diabetes and struggle they have to put up with managing sugar levels. Thinking about it stresses me out and gives me anxiety and not able to enjoy my current life styles.

Want to know from you guys - how long you been since diagnosed with LADA and are you fully insulin dependent now.
Thanks

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Hi Diagnosed nearly 4 years ago. Very similar to you for the first year, increasing insulin gradually, still in the honeymoon phase. I find exercise really helps I also eat low carb. Everyone is very different so try not to compare or worry. Most useful thing my nurse said to me is not to think of insulin increases as a negative thing. We need it and you take what you need. Last couple of years much less stressful. Sounds like you are doing great to me.

I was diagnosed for LADA in September 2020, but I prefer the term NIRAD, Non-insulin requiring autoimmune diabetes, as it used to be called. According to several studies wether you will need insulin in the future is dependent on GADA titers.
You can drastically lower these titers by using 4000 IU of vitamin D a day.