Anti-spike strategy

[vanarchre]

Hey all,

Haven't posted here for ages, but when I have in the past people have been very informative. I had half an idea and figured others must have tried it before so I thought I'd ask.

I know the best way to avoid BG spikes is probably to avoid significant carbs, but I wondered to what extent this might also work. Basically has anyone tried consistently injecting a bit too much insulin in order to avoid the peak? The downside to this would obviously be that you would crash low later, but could that not be countered by eating something a little sugary a couple of hours after the original meal? This could be calculated such that the overall carbs consumed line up with the insulin taken, just with the food split into a 'main' and 'desert'.

Now maybe this just gets too complicated to be worth it with the timing, but I figure someone must have tried something like it so I'm wondering how they got on?

Thanks.

 

[Antje77]

I know the best way to avoid BG spikes is probably to avoid significant carbs, but I wondered to what extent this might also work. Basically has anyone tried consistently injecting a bit too much insulin in order to avoid the peak? The downside to this would obviously be that you would crash low later, but could that not be countered by eating something a little sugary a couple of hours after the original meal?

I do when I'm hoping for a treat later on.
Sadly, it doesn't make the insulin act quicker for me so the spike stays the same, at least for me.
It does work for getting a treat without spiking some time after my meal though, but it takes a very close eye at my BG to get it right.

 

[In Response]

I have found the best way to avoid a spike is to take my levels insulin earlier so that the peak of the carb absorption matches the peak of the insulin potency.

 

[StewM]

Hey all,

Haven't posted here for ages, but when I have in the past people have been very informative. I had half an idea and figured others must have tried it before so I thought I'd ask.

I know the best way to avoid BG spikes is probably to avoid significant carbs, but I wondered to what extent this might also work. Basically has anyone tried consistently injecting a bit too much insulin in order to avoid the peak? The downside to this would obviously be that you would crash low later, but could that not be countered by eating something a little sugary a couple of hours after the original meal? This could be calculated such that the overall carbs consumed line up with the insulin taken, just with the food split into a 'main' and 'desert'.

Now maybe this just gets too complicated to be worth it with the timing, but I figure someone must have tried something like it so I'm wondering how they got on?

Thanks.

It's not so much that your method is complicated is that one wrong move and you could end very hypo very fast. For instance, unexpected physical activity whilst you have excess Bolus on Board could cause your Blood Sugar to plummet rapidly.

If you're looking for other methods of controlling spikes, as InResponse said taking Insulin earlier works for a lot of people. You could also look at the GI of the food you're eating. Not all carbs act at the same speed (for instance Pizza is famously slow). If your Insulin is struggling to keep pace with the food you're currently eating, it might be worth trying lower GI food and seeing what happens (this is was a very common strategy for handling food when Mixed Insulin was the only Insulin available).

 

[vanarchre]

Thanks for the responses.
I should probably explain that I do use the other strategies primarily and have pretty good control on the whole. Most of my diet is low carb and I avoid high GI foods where possible. I also take my insulin in advance of my meal. These certainly help, but I'm trying to gather as many tools as possible so that I can respond to different situations.
Speaking personally, dinner time is when I am most prone to spikes. Taking the insulin in advance helps, but if I waited long enough to completely avoid the spike, I would at times go low before eating.
It strikes me that when faced with a moderate gi/carb meal taking a little more insulin and then having the corresponding carbs a short while after might help. I suppose my suggestion here is really just an extension of the advice you sometimes hear to deliberately eat slowly or save the more carby foods until last. Except that I'm deliberately adding this extra food in to an existing meal.

 

[vanarchre]

But yes, when I said 'complicated' I meant the timing. If you added those extra carbs too late, you would be in danger of crashing. That's why I wondered if any had tried anything similar and succeeded (or failed!)?

 

[NicoleC1971]

But yes, when I said 'complicated' I meant the timing. If you added those extra carbs too late, you would be in danger of crashing. That's why I wondered if any had tried anything similar and succeeded (or failed!)?

The difficulty with flash and cgm is that you can visually see the spike and hence seek to keep yourself in range whereas normal (functional pancreas blessed) do have spikes after a meal. If those spikes are too often and prolonged then that is damaging to both type 1 and 2s obviously but I am not sure if that is what you are talking about? Are you back in range by bedtime or still chasing the high down by waking up time?
The only way I know is to avoid snacks, to cycle/power walk after meal but mainly to avoid carbs over 30g.
If you want to eat carbs perhaps be accepting of the spike but try hard to keep insulin sensitive by keeping muscles and endurance exercise plus low carb to minimise the difficulty of getting the insulin to hit the carbs at the right time. This seems to be universally hard for type 1s even with a closed loop system like mine.

 

[Antje77]

But yes, when I said 'complicated' I meant the timing. If you added those extra carbs too late, you would be in danger of crashing.

What insulin do you use?
When I was on NovoRapid, it was very tricky for me, needing to inject up to an hour before eating (depending on the meal and current BG) if I wanted to avoid prolonged spikes. This greatly increased the risk of getting the timing wrong, so many unforeseen things can happen in an hour!
What also helped a little was taking part of my dose early to give it a bit of a headstart, and inject the rest before eating. That way at least I didn't have my full dose kicking in all at once if I got it wrong or were distracted.

What really helped was changing insulins. I've been on Fiasp for years now, which works much better for me. I've also tried Lyumjev, which worked just as quick (but it stung and I liked my Novopen better than the one for Lyumjev so I stuck with Fiasp).

 

[In Response]

@vanarchre have you tried split bolus? This may overcome the low if you pre-bolus too far ahead.
Are you aware different foods may require different techniques? High fat foods will delay carb absorption so need a shorter pre-bolus time.

 

[vanarchre]

I intended this as a more general question regarding a strategy of this nature, but I can certainly go into a bit more personal detail to explain why I came to it.

I'm aware of different foods needing different techniques. A lot of what I eat is very high fat (nuts, avocados, the classics!) and I will often extend my bolus (on a pump) as I know the rise comes later.

Dinner is my most varied meal. Nothing crazy carb-wise, but sometimes around 40ish grams, and not normally super fatty. The spike is not super high and tends to fall on its own within an hour or two. My doctor's wouldn't care, I'm sure, but if there's a way of improving, that's always good.

Antje's experience does sound familiar. I wonder if Fiasp is the answer.

 

[StewM]

I intended this as a more general question regarding a strategy of this nature, but I can certainly go into a bit more personal detail to explain why I came to it.

I'm aware of different foods needing different techniques. A lot of what I eat is very high fat (nuts, avocados, the classics!) and I will often extend my bolus (on a pump) as I know the rise comes later.

Dinner is my most varied meal. Nothing crazy carb-wise, but sometimes around 40ish grams, and not normally super fatty. The spike is not super high and tends to fall on its own within an hour or two. My doctor's wouldn't care, I'm sure, but if there's a way of improving, that's always good.

Antje's experience does sound familiar. I wonder if Fiasp is the answer.

What would be the purpose of eliminating shallow spikes that resolve themselves quickly?

 

[vanarchre]

What would be the purpose of eliminating shallow spikes that resolve themselves quickly?

Fair question. I'd say that 'shallow' and 'quickly' are subjective terms and a diabetics decision regarding what to act upon is to a large degree personal.
I initially intended for this to be a more general question to maybe avoid a discussion of whether, say, an hour and a half at 9.3 or whatever should be considered an issue.