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Blood glucose levels after meals

Discussion in 'Type 1 Diabetes' started by Lydiagoodman93, Dec 9, 2018.

  1. Lydiagoodman93

    Lydiagoodman93 · Member

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    hi all,

    Bit of a strange one but I need some advice as I’m very confused. I’m newly diagnosed and still figuring out my levels and my insulin, I cut out carbs for the most part and found my levels easier to control and more consistent, then my diabetes nurse told me that I cut too many carbs from my diet and to take less insulin when I do eat them... so I did and my levels shot right back up. I get severe spikes after I eat most carbs no matter how much insulin I take (although haven’t been taking over 8-9 units as over that seems a lot?). Can anyone tell me how they keep their BG levels consistent and low? I’m so confused.
     
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  2. DCUKMod

    DCUKMod I reversed my Type 2 · Master
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    Hi there, @Lydiagoodman93 - I'm not T1, so won't comment, but I wonder if my colleagues, @Jaylee or @Juicyj are about.

    Good luck with it all.
     
  3. Antje77

    Antje77 LADA · Moderator
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    If I ate a slice of bread/apple/whatever yesterday, and I shot way over the mark I just try the same food today and see if it's better. If I still go way high, and not towards hypo 4 hours or so after eating I'll take some more insulin for the same food tomorrow.
    If I do tend towards hypo after 3 to 5 hours but still go high first, I can choose to take my insulin longer before food (pre bolus) or I may decide my insulin can't handle this particular food so I'll try half a portion next time.
    As long as you are not going hypo I don't see why you should lower your insulin dose.
     
  4. EllieM

    EllieM Type 1 · Well-Known Member

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    In the long term. as a T1 you should be able to end up with an insulin to carb ratio so that you know how much insulin copes with how much carbs eg 1 unit of insulin might cope with 10g of carbs, or it might only cope with 2g: people's bodies really do vary that much. (And as if it doesn't make it worse, people's insulin to carb ratio can vary with times of day and exercise, as well. :)).

    How much is a severe spike? Your DN is probably worried that you will get a severe hypo, which is why she's telling you to up the carbs. There are a small but significant group of T1s who get extremely good blood sugar results by going very low carb, and you can go that route if you want, but the medical profession as a whole don't tend to recognise this option yet, so you have to get support from the other people doing it.

    As to the answer to your question, I don't keep my blood sugars consistent and low all the time, but I do it enough of the time that I've lasted 48 years without any significant complications (background on again off again retinopathy that hasn't yet required any treatment). It also means my diet isn't particularly restrictive (no sticky sweet desserts but I can eat most other stuff in moderation) and if I want to eat chocolate almonds on Christmas day I can inject for it.
     
  5. kitedoc

    kitedoc Type 1 · Well-Known Member

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    Hi @Lydiagoodman93[/USER], First of all, a big Welcome to the site. As a T1d for 52 years, not as professional advice or opinion:
    When newly diagnosed I found it took a while for me to make sense of what was what.
    Not all carbs are the same in the way they affect BSLs, some cause blood spikes more readily than others even though they may be labelled as having the same grams of carb in them. And yes, your observations about lower carb content of a meal leading to lower after meal BSLs are spot on, provided one allows for the type of carb also.
    If you look at mendosa.com, (an American site complete with American spelling)!! Home page and at definition of Glycemic Index (GI) and Glycemic Load (GL) and then look at Glycemic Values you can see how certain foods compare in the effect on BSLS. Take for example 'Cereals' down the list aways, and compare oats to other cereals and also oats with water and Oats with milk (a little further down). The inclusion of extra fat (as in the milk) lowers the GI value, that is the rise in BSL is moderated by the fat in the milk.
    Also if you google "pictures of insulin profiles" and look for the brand of short-acting insulin you are prescribed you can see when (on average) your insulin starts to work, when it reaches its peak of effectiveness in lowering BSLs and how long it lasts.
    The general aim, as I understand it. is to ensure the peak of insulin's BSL-lowering effect matches or preferably precedes the BSL rise and peak. So not only is it a matter of 'matching up' the peak of insulin and BSL but ensuring there is sufficient dose of insulin to deal with the BSL. So timing and amount. To 'hit the BSL nail' at the right time and with the right amount of force.
    If insulin peaks too late for example the BSL from the meal goes higher than acceptable and if subsequently the insulin dose is increased the insulin might cause a fall in BSL some hours after the meal. The BSL was hit too late and then too hard!!
    Understandably most of us tend to stick to the same sorts of foods for our meals so that the BSL rise and the effect of insulin we take can best keep BSLs within range. Although we are adventurous at times!!
    That at least is the theory !!

    Because each of us is different we each need to work out the timing of our insulin effect and of food. (the insulin profiles are averages and you will notice that some GIs of food have a range, e.g. Rice porridge 78 (+/- 9).
    Of course sticking to low GI (<55) and GL (<10) is ideal for the theory. And with insulin, some of us inject short-acting insulin and eat straight-away, others find they need to wait say 30 to 45 minutes after injecting insulin before they eat to ensure the insulin's peak effect arrives in time to meet the rising BSL from the meal. Lots of finger-prick BSLs needed and/or use of a BSL monitoring device like the Libre etc.
    The other tricky bit is that our bodies do not always react to insulin uniformly throughout the day. On an insulin pump, my insulin dose to carb quantity is different between breakfast and my evening meal. And as a male I can only relate that reading about cycles indicates the need for many lady diabetics to raise their insulin doses as period time approaches and during this time.
    I know the above is a lot to take in but also read in the Home page of this site under Type 1 diabetes about the 'honeymoon period' or time, where in the first months ? year or so on insulin there may be some residual insulin produced by the pancreas, not sufficient to avoid use of injected insulin but sufficient to lower insulin doses and provide some leeway in getting does of insulin and food amounts to balance out BSL-wise.
    Please re-read this post if you need to. Keep asking questions. We have all at some stage asked the obvious or simple questions, only to discover that every question and answer is valuable to someone. Rome was not built in a day nor was the Oracle of Delphi always super quick in answering!!
    Try to develop some self-humour about your situation. It helps to carry you over the rough patches.
    I used to call injection time, "javelin practice" and I have some funny hypo stories or cautionary tales (which were embarrassing at the time). A lady with diabetes has her hubbie and son bet on what her before dinner BSL will be and the loser does the washing up!
    And we all make mistakes along the way - that is how we know what might work (or not)
    Please keep posting !!!:):):)
    IMG_3067.jpg

    It is all about balance
    PB200052.jpg
     
    • Like Like x 1
    #5 kitedoc, Dec 10, 2018 at 1:53 AM
    Last edited: Dec 10, 2018
  6. Jaylee

    Jaylee Type 1 · Moderator
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    Hi @Lydiagoodman93

    What insulins are you prescribed?

    Long long time sice I was diagnosed, however. At a guess. What maybe happening is the "honeymoon" period where yer pancreas is still producing its own insulin in fits & starts for a while before the final burn out?

    Having said that, & hopefully assuming you have been put on MDI (basal bolus insulin regime with a long working profile & short acting insulin for the meals.)
    Whatever your diet. (Though personally as an LC'er myself, I wouldn't mess about with low carbing till the honeymoon is over.) the basal (long acting.) needs to be looked at before wondering what went wrong with the injections for meals...
    https://mysugr.com/basal-rate-testing/
    The foundations need to be solid, before building the rest. :)

    Hope this helps.
     
    • Agree Agree x 1
    #6 Jaylee, Dec 10, 2018 at 7:20 AM
    Last edited: Dec 10, 2018
  7. Juicyj

    Juicyj Type 1 · Moderator
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    Hello @Lydiagoodman93

    It's early days so at this stage try to focus on keeping a good routine and regular testing, record your results though as time moves on you will need to adjust your insulin/carb ratios regularly with your DSN, in time you will learn to adjust yourself.

    At some stage you will have the opportunity to join DAFNE which is Dose Adjustment for Normal Eating - a week's course on the NHS which will help empower you with support and knowledge to manage your T1, also grab a copy of 'Think like a pancreas' written by a type 1 and a good guide to help you along the way.

    I know how it felt early on in my diagnosis about achieving 'perfect numbers' this for me was unachievable, instead I focus on managing day to day and keeping as close to my target as possible, if I get double figures I correct and move on but I don't become fixated with numbers any more, my HbA1c is a good guide to tell me if i'm on the right path and I get this done every 3-4 months to track my progress. I don't sweat the day to day numbers any more for this reason as otherwise it can be over whelming coping with this as well as everything else you have to deal with. We are all here to help support you, so lean on your online team to help you along :)
     
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