Help - big long lasting spikes ( even with stacking lots of insulin )

Grumpy Porridge said:

it seems to be putting insulin after eating fatty sweet foods especially just suppresses the blood sugar rather than eliminates the spike?? Do I have to keep stacking every couple of hours for say 6+ hours ?! Help !

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I've found that fatty food can very much delay the absorption of carbs, and it then definitely kicks in later - depends what it is as to how long it takes, so I need to split my insulin for fatty stuff.

Grumpy Porridge said:

Also . My basal
Is 14. Maybe that is too low for me . How come on here I’ve seen people say their basil is something tiny like 5?? Mine might meant to be 15-20 for all I know . Why do I need a big amount like that ?? Does that point to insulin resistance??

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Everyone is different, I've seen amounts from about 5 to about 70 for the basal amount for T1's on here, it will require doing a basal test that I'm sure some others can link/explain.
Until your basal is right, it can be tricky to work out your proper carb ratio. But since I believe you have not too long been diagnosed (I think) your basal rate and carb ratios may still be changing anyways (or not)

The advice from DAFNE is not to stack insulin, as it's dangerous. Starting out, you are supposed to give yourself the calculated insulin before your meal and wait 5 hours to check it. You will spike if you eat normally, as unlike normal insulin, injected insulin will not match the food you are eating and will take 5 hours to return to pre-meal levels. Corrections should be given with your next meal and only if your levels haven't returned to premeal levels. The 2 hours you mention is for type 2 diabetics, not on insulin.

If you are eating high carbs and have insulin resistance you will need more basal insulin than someone like me who is not.

Grumpy Porridge said:

Also I’m bad at maths . How on earth do I figure out my insulin to carb ratio : S

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If your ratio is 1: 5
Divide your total grams of carbohydrate by the 5 in your ratio.
For example, if you eat 40 grams of carbs. 40 divided by 5 = 8 units of insulin

ert said:

The advice from DAFNE is not to stack insulin, as it's dangerous. Starting out, you are supposed to give yourself the calculated insulin before your meal and wait 5 hours to check it. You will spike if you eat normally, as unlike normal insulin, injected insulin will not match the food you are eating and will take 5 hours to return to pre-meal levels. Corrections should be given with your next meal and only if your levels haven't returned to premeal levels. The 2 hours you mention is for type 2 diabetics, not on insulin.

If you are eating high carbs and have insulin resistance you will need more basal insulin than someone like me who is not.

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Hi ert, you make such a good point. So much is made of this 2 hour target (which is important of course for many) but as you say injected insulin does not work as efficiently as your own. My Consultants & team stress that you should not rush to do a correction immediately after the 2 hour mark as the insulin will still be working for up to 5 hours. If you do a correction too soon then you are taking a risk for hypos which then require carbs so up you go again. They also said too many corrections throughout the day can have the opposite effect, ie, your body thinks it's going low too fast so it compensates by releasing yet more glucose and yep, up go the readings, the yo yo effect if you like. Obviously there will be times when your levels might be so high or for a prolonged time, when you do need a correction but that is different to using corrections constantly between meals.

So much conflicting advice. All I was told by my consultant was that she was happy for me to correct after 2hrs. I only tend to do this in the evening & usually wait 3 or 4hrs.

Regardless I find it’s easier if I’m a bit predictable in meal patterns. Grumpy porridge you could try meal planning with your mum, practice carb counting including your post meal treats / snacks & see what carb to insulin ratio gets better results.

It might be a bit boring but a couple of weeks for eating similar things at similar times will help you puzzle things out.

TashT1 said:

So much conflicting advice. All I was told by my consultant was that she was happy for me to correct after 2hrs. I only tend to do this in the evening & usually wait 3 or 4hrs.

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Hi Tash, I think that's because we are all so very different and one size does not fit all. The advice they give is quite generalised but obviously what works well for one might not work for another. If your corrections work for you then that's all you need to worry about, nobody else matters. It seems from Grumpy though that what he is currently doing isn't working so of course he will need to find a strategy that works for him. Correcting after 2 hours is not 'wrong', in fact for you it's right if it works. x

Grumpy Porridge said:

Also . My basal
Is 14. Maybe that is too low for me . How come on here I’ve seen people say their basil is something tiny like 5?? Mine might meant to be 15-20 for all I know . Why do I need a big amount like that ?? Does that point to insulin resistance??

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As others have mentioned, your basal requirements as well as correction factors/ICRs are unique to you and can be influenced by a very wide range of factors, not limited to your age, sex, time of the month, weight and muscle/body fat composition, amount of regular exercise, also split of exercise by intensity and duration, sleep patterns, mental stress, all medications, dawn phenomenon, ambient temperature, seasons, T1 honeymooning status (sporadic production of your own insulin), what insulins you use, and any infections, illnesses.

It looks like you have access to a Libre which is excellent helping to understand how your personal BG levels respond to food and insulin, but can be influenced by all the above. Being able to monitor your BG levels in almost real-time is very informative, but can also feel overwhelming. Please do not beat yourself up by failing to immediately achieve perfect BG control - very hard for T1s and can take a long time and much experimentation to work out the regime that is most effective for you personally.

Some suggestions -

For treating hypos use pure dextrose (glucotabs/liquid dextrose only) - easy to find at most pharmacies and much easier to know precise glucose dose administered. Much "cleaner" solution than sweets, orange juice, biscuits, etc, which will have lots of fructose and other ingredients that do not directly impact BG levels but may increase insulin resistance. Also in my experience, glucotabs are NOT moreish, so harder to create over correcting, yo-yo patterns.

Focus on specific meal times, try to avoid snacking, especially in the evening. Constant grazing is known for increasing insulin resistance. If possible exercise after eating, even if just a walk. Now is a good time of year to get into this habit.

Your diet sounds refined carb heavy, even for a non-diabetic. Take control by actively researching lower carb, better incorporation of healthy protein/fat into your diet. Sweet talk (pun intended) your Mum to join this exploration if she is the main cook. My personal favourite is dietdoctor.com. You may be surprised how easy it is to lose your sweet tooth.

Hang in there!

Correction dose timings will also depend on the type of bolus insulin used. 5 hours maybe ok for something like Humalog but Fiasp only works for about 3 hours.
@Grumpy Porridge I fully support Type 1 diabetics eating as many carbs as they want to. However, if you want to try and pin down your carb ratio I agree with keeping meals simple and repetitive for a couple of weeks. The amount of pure sugar eaten following your high carb potato and beans tea will have made this very difficult. Choose the potato and beans and one sweet item. Write down the amount of carbs in all 3 food items eaten and then work out how much insulin you will need on the ratio you are using. Test 2 hours and 3 hours later. If too high your ratio or timing may need altering. The same with a low. Eat the same meal again with some adjustments if needed. It will take work but the effort will pay off in the long term.
You also need to be doing basal testing both during the night and day. This can only be done by fasting and monitoring that line on your Libre. Every bodies needs are different, do not fall into the trap of comparing your doses with others. You are unique!

becca59 said:

Correction dose timings will also depend on the type of bolus insulin used. 5 hours maybe ok for something like Humalog but Fiasp only works for about 3 hours.
@Grumpy Porridge I fully support Type 1 diabetics eating as many carbs as they want to. However, if you want to try and pin down your carb ratio I agree with keeping meals simple and repetitive for a couple of weeks. The amount of pure sugar eaten following your high carb potato and beans tea will have made this very difficult. Choose the potato and beans and one sweet item. Write down the amount of carbs in all 3 food items eaten and then work out how much insulin you will need on the ratio you are using. Test 2 hours and 3 hours later. If too high your ratio or timing may need altering. The same with a low. Eat the same meal again with some adjustments if needed. It will take work but the effort will pay off in the long term.
You also need to be doing basal testing both during the night and day. This can only be done by fasting and monitoring that line on your Libre. Every bodies needs are different, do not fall into the trap of comparing your doses with others. You are unique!

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I take Fiasp. Fiasp begins lowering glucose in 15-20 minutes, has a peak glucose-lowering effect in about 1.5-2 hours, and returns to baseline glucose-lowering within 5-7 hours after dosing. Hence why on DAFNE they recommend not dosing again 5 hours after taking Fiasp to avoid stacking insulin. I know a lot of people take correction doses during this window, but a lot will hypo or overcorrect a downwards fall with sugar and spike again (which is what is happening with @Grumpy Porridge's graphs.) I only hypo once every couple of months and run my blood sugars between 4 and 5 as I stick to this rule and avoid stacking. It was the most important take-home lesson I learnt on DAFNE.

I was advised that stacking was fine provided you took into consideration insulin on board (IOB).
Despite the profile of fast acting insulin usually being a front loaded spike lasting 4 or 5 hours, the calculation fo IOB is simpler and more conservative - assume the insulin is used linearly. So, if you assume it lasts 4 hours, IOB after 1 hour is 3/5, after 2 hours is half and after 3 hour sis 1/4.
Pumps and some meters do this calculation for you.

My blood sugars only come below 10 prior to eating my next meal. Novarapid is too slow. Had my 2nd jab the other day and my Lantus isn't making any difference or the Novarapid. Been taking huge correction doses recently with no effect.