BG levels raising fairly sharp after Novorapid wanes

[Kuba85]

Hi,

Last few days we have experienced a situation with our daughter (5yo; CGM no pump), where her novorapid is finished after the meal and the BG levels increase fairly quickly right after that.

Yesterday we ate lasagna which I understand would benefit from double bolus, but we will do that once we get on the pump. Today we had dark sourdough with avocado so nothing fancy/long absorbing I don’t think.

One possibility I can see is that basal insulin is touch low. But, if we increase that, then we would likely hit a hypo - our ratios for bolus look pretty good as we end up around ~6-7, 3 hours post the meal. But from that point the chart moves upwards (today moved to 11.6 within 40 mins).

Another is that the food we eat is too low GI, I think. So the BG chart is smooth but bolus is dealing only with the carbs absorbed in the first 3 hours and then insulin is missing.

Our ratios are 1:12, 1:17, 1:17 and 1.5 Levimir in the morning and evening.

Anyone had similar experience?

 

[sgm14]

Diabetes is complicated and some foods are difficult to handle and what may be difficult for one person may not be for another person.

When I first started on insulin I assumed (based on what I was told and read and also from my sister's experience) that you had one carb ratio.
Then I discovered that some people have a different carb ratio depending on the time of day.
Then I discovered that some people (like me) can have a different carb ratio depending on what the meal is. As an example, my breakfast carb ratio is either 1:2 or 1:4 depending on what it is.

And as you have discovered, some foods can cause double spikes.

The problem you are seeing isn't uncommon and there isn't one way of handling it. Some people prefer to double bolus - some people prefer not to pre-bolus, but let their BS rise a little and then take more insulin and others just prefer to avoid those types of food altogether.

And the other thing to remember is that there are a lot of things that can affect your blood sugar and so you need to look for patterns that repeat rather than make assumptions based on one meal.

 

[SimonP78]

Also remember that basal requirements are not constant, so with MDI it's usually a case of tuning for overnight (or whenever one sleeps) and potentially needing to fix how this affects other times with extra bolus/food/ratio tweaks during the day. There's also the possibility to split basal, depending on what type it is if the difference in requirements is very pronounced, though this tends to be a bit of a try-it-and-see experiment and a pump will allow much more flexibility in any case.

With that said, it does sound like in this case a second bolus would potentially fix the problem (due to speed of digestion/quantity of food to be digested/changes in insulin sensitivity) - presumably you did a correction dose? Did this bring her back to the desired level?

 

[Kuba85]

Thank you both.

Correction - yes, we gave her an extra unit and it helped to bring it down to about 9.3->. Rest we addressed by giving the dinner insulin in a decent advance of the meal itself. Again, if we had a pump, I would just press a button and do it. As we have the pen for a few more weeks, I am trying best to calibrate her so that we minimise the number of injections needed.

Variability - yeah, feels like either we will go mental trying to get it always smoother and within the range, or we will give up at some point trying the perfection (we have stayed ~80% in the range since she came home but some vol looks too high).

We tried to move onto all low GI alternatives of the foods we were eating. But in a hindsight I think that’s not always desirable. This is because it feels like some foods are affecting her even after the rapid dose is gone.

Tonight we ate (in this order) cauliflower, grilled chicken, standard pita bread and a peach for dessert. We brought her down from that elevated 9.3 level to about 4.5 and she did not have the spike after NovoRapid stopped working. The level is touch low ahead of going to sleep, but I can work with this by relaxing the ratio a touch / or seeing how she does overnight with Levimir.

So for the moment, may switch some foods around (dark brown sourdough to dark sourdough, no lasagna) and see how she responds and whether we still have double peaks. The pace of increase post novo rapid finishing (from exit level of about 7 to 13+), was just too high to me to indicate this could be driven by other factors (she was not stressed, not sick, not exercising).

 

[Bill G]

Hi,

Last few days we have experienced a situation with our daughter (5yo; CGM no pump), where her novorapid is finished after the meal and the BG levels increase fairly quickly right after that.

Yesterday we ate lasagna which I understand would benefit from double bolus, but we will do that once we get on the pump. Today we had dark sourdough with avocado so nothing fancy/long absorbing I don’t think.

One possibility I can see is that basal insulin is touch low. But, if we increase that, then we would likely hit a hypo - our ratios for bolus look pretty good as we end up around ~6-7, 3 hours post the meal. But from that point the chart moves upwards (today moved to 11.6 within 40 mins).

Another is that the food we eat is too low GI, I think. So the BG chart is smooth but bolus is dealing only with the carbs absorbed in the first 3 hours and then insulin is missing.

Our ratios are 1:12, 1:17, 1:17 and 1.5 Levimir in the morning and evening.

Anyone had similar experience?

I don’t think since brexit this year novarapid is the same sometimes good but it seems to go off quicker it should have peek reactions of 3 hours but then Carry on for 2 hours keeping level