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Help with breakfast: Porridge

JJO

Well-Known Member
Messages
68
Type of diabetes
Type 1
Treatment type
Insulin
Hi all.

So i've been struggling for years to eat a decent breakfast, following the normal LADA pathway of being misdiagnosed a t2 for years, carb cutting to keep BS normal but failing as my pancreas gives up the goose, DKA then insulin....

I appreciate that porridge isn't ideal but since i've started insulin (10 days ago) I figure I should be able to have a bowl of porridge with a known carb load (weigh the ingredients and sticking exactly to the recipe and keeping a record on whats happening with my sugars.

Current treatment is;
2g =Metformin (1g BD)
15u Levemir (once a day) taken with breakfast
5u Novarapid x3 (with each mean)

I also understand the value of a LCHF diet, and whilst I haven't got sub 100g per day, i'm getting closer to it. I also appreciate that for many people a bowl of porridge for breakfast is just a bad bad idea / impossible, so I will expect to hear some of those comments but i'm really trying to make this work.

My DN suggested that I just take 5u on insulin with each meal, but clearly that doesn't work if i'm having zero carbs. But likewise if I know i'm going to have a bit more carbs then I need to calculate. For lunch and dinner 1u/10g of carbs is working really nicely to keep the rest of my days BS normal.

My 7 day average (only been using the MySugar App for four days though so only a 4 day average!) is 6.5mmol/L with a standard deviation of 2.1. Whilst that may be too high for many, I'm quite happy with that (my 30 day average pre insulin was 9.8mmol/L) as a starting point. I know it needs more work, but one thing at a time. If I try to change too much I won't know what's working!

There is 44g of carbs in my bowl of porridge. I do put a little bit of real butter to add a little flavour...
Day 1: Pre porridge = 7.7mmol/L, 5u of insulin and 2hrs post is 10.8mmol/L
Day 2: Pre porridge = 7.8mmol/L, 7u of insulin and 2hrs post is 10.9mmol/L
Day 3: Pre porridge = 8.0mmol/L, 9u of insulin and 2hrs post is 8.9mmol/L

So I do see three problems and my main question is to do with the last.
1. Photo attached below, so apologies for any typos or poor layout!
2. I'm freely acknowledging that my fasting morning BS is both high and increasing slightly. I will keep monitoring this, but my DN also recommending that my pre bedtime BS be more than 8 and if not for me to have a snack before bed. This is one area I will need ongoing work with but I'm not going to make adjustments to my levemir just yet (10 days into insulin).
3. Should I keep increasing the nova to get my post breakfast a little more normal? Does that ratio of 1u/5g carb seem high? Or is that normal?? Is morning insulin resistance a 'thing'?



Many thanks for all your suggestions.

Josh (and kittie)
 
For being just 10 day on insulin you seem to have a very good grasp on things. As for your porridge I guess the questions would be how much insulin are you comfortable taking just so you can eat it and how high are you comfortable with your bs numbers? After you answer those questions you will have those answers.

FOR ME PERSOANLLY, I like to keep bs and insulin low and am willing to adjust my diet to do so but we are all individuals with different goals.
 
@JJO Great record-keeping and 'experimenting' there

Many people here eat a reasonable amount of carbs. I personally eat anything from 150-200g, and eat cereal, bread, pasta, etc in moderate quantities

I have cereal every day for breakfast and my 2 hour BS is within range. This is my experience so I'm giving it as an example only: I need to bolus further in advance for breakfast than for any other meal. When I was on Humalog, I bolused something like 40mins in advance. That was so the insulin had a chance to 'get going' and because I have Dawn Phenomenon so my blood sugar can go up in the morning even if I don't eat.

If I bolused just before my cereal, my 2 hour BS could be as high as 10 or 11, but bolusing more in advance gives me a 2 hour BS of below 8 and normally around 6 very roughly.

I'm going to tag @noblehead because I think he has porridge a lot. I have it occasionally as I prefer granola or muesli. But when I do have porridge, I weigh my oats, work out the carbs and bolus in advance (I found the best time by carefully and cautiously moving my bolus). Many people find 'proper' oats are better for their blood sugar than highly processed hot oat cereals.

If I was you, I'd carefully continue your bolus amount experiments (and I'd use a half unit pen for flexibility) but before doing that, I would try the same bolus but a little earlier to see if that helps before looking at more increases.

I'm not sure if you make your porridge with milk or water, but I always use full fat milk on my cereal as I think the fat helps.

Yes, morning insulin resistance is a thing, and pretty common too. Don't be freaked out if your morning ratio is higher than your other ratios. The correct amount of insulin is the amount that works for you.
 
JJO said:
Should I keep increasing the nova to get my post breakfast a little more normal?
Click to expand...

I wouldn't be doing that, it's maybe the case that porridge isn't a suitable breakfast for you, but if say you were to inject 6u for a meal using a 1:10 ratio and your bg was high 2 hours postprandial (but back within range before you next eat) then that would mean your I:C ratio is fine but you need to work on your bolus timing (or look for an alternative meal).

On a morning I bolus 20mins ahead for my porridge, I use jumbo porridge oats but add a little fat to the meal in the way of seeds,natural yogurt and also add a small handful of blueberries. my bolus dose on average ranges between 4.65-5.45u when my fasting bg is in range and my 2 hour postprandial levels are nearly always within my bg target range, if they weren't then I'd work on the bolus timing or ditch the porridge altogether.

btw @JJO, don't use the oats like Readybrek, they are highly refined and tend to spike bg levels quite quickly.
 
Thanks @Kristin251 @azure @noblehead

Thats all very helpful and every time I post a question on one thing I learn something completely new!

I honestly didn't know that you can alter timings of the insulin or that it would have an overall effect. Really opens my eyes. More things to experiment with, which is great because I do enjoy the experimentation. Sadly though I'm a little stuck. I still haven't found a good breakfast to have and i'm back at work tomorrow.

I work in the operating theatre 0730-1730 with unpredictable and sometimes non-existent breaks during the day so was hoping to have this sorted by then. Being relieved mid operation is not a suitable practice

I'm still having hypos in the afternoon (4-5 hours after breakfast, just before lunch). It doesn't help that I'm having late breakfasts and even later lunches. I guess thats what you were referring to @noblehead regarding the increases of insulin vs timings and i:c ratios.

My plan to cope with my first week of work is to slightly lower my basal (as suggested by my DN) and do what I know kinda works with my breakfast. I think I'll try the 20mins early on a 7u insulin for the porridge and see how we go.

In the very short term I'd (as well as my DN and my patients) prefer to err slightly on higher side of normal than the lower.

I'll keep you posted as i get more data, and thanks again to all those who have (and will to come) helped me!
 

Thanks for this @Kristin251, I'd love to have a relatively normal breakfast option. I'm hoping I won't eat this everyday forever but for 4 years i've essentially been skipping breakfast or eating a cooked breakfast. Neither are perfect. I'm not happy with 10's after breakfast especially if i'm also having hypos later in the same day.

If I can work out how to safely eat porridge then that's one meal that I can put a tick box and in the arsenal for breakfasts. Equally, as you say, if I can't, with help, get my BS to comfortable levels despite every effort then I'll happily give up the porridge idea and move onto the next thing to try. Not quite ready to knock it off though till I've tried every avenue.

I'd love to be able to have a varied diet for breakfast, porridge seemed to be better than the muesli morning so thought I'd work through it. I do appreciate though that both are high carbs.

Thanks for your on-going support.

Josh

*Edited to add an apology about an apparent abuse of commas in that comma filled paragraph, I'm never sure when a comma is correct or not ... did I just misplace another comma?*
 
@JJO, bolus timing can make a big difference to postprandial bg levels, there's a chapter on this in the book Think Like a Pancreas, however the author wrote a good on-line article called Strike the Spike which briefly discusses it and here is a quote from it:

Time your bolus insulin properly. For people who take rapid-acting insulin at mealtimes, the timing of the bolus can have a huge impact on after-meal blood glucose levels. Boluses given too late to match the entry of glucose from dietary carbohydrates into the bloodstream can produce significant blood glucose spikes soon after eating. A properly timed bolus, on the other hand, can result in excellent after-meal control.

http://www.diabetesselfmanagement.c...blood-glucose-management/strike-the-spike-ii/

Good luck for work tomorrow and hope all goes well.
 
There are plenty of quick protein options for BF such as hard boiled eggs/ egg salad, lox/ smoked salmon, left over protein and veggies form dinner etc etc. I think the biggest problem with porridge for BF is we are most insulin resistant and volatile in the morning. You may do better eating porridge later in the day. Of course if you eat less carbs at BF you will need much less insulin but I think you already know that.
Have you tried a small snack such as a few nuts a few hours after you eat BF to avoid a hypo? This was the problem I found with carbs at BF. I would go high and then hypo. I do much better without the carbs. I was always chasing my bs.
Timing your insulin differently can do great things. Many do find bolusing
early helps a lot. I have always been very low carb so I only bolus 5 min early. It is said insulin can take more than 15 min to start working but I would think that would depend on our individual size, amount of fat on our bodies etc.

Good thing to error on the side of caution until you find out what works

You're doing amazing well figuring all this out. Koodos to yiu
 
@noblehead thanks for that, really helpful. I have the book Think like a pancreas and will endeavour to read it soon. Sadly got exams to prep for, but they get done next week so .... will have more time then (so long as I pass!)

@Kristin251 Nuts do sound like a good idea. I shall stick some in the work bag for tomorrow!

I shall let you know how it all goes tomorrow!
 
I have porridge oats with xylitol, berries and Aplro Soya Light milk every weekday morning. I take 2.5 units as soon as I wake up and eat my porridge 30 minutes later. This amount of insulin (and the timing) took some trial-and-error but this regime now keeps my blood sugar completely flat. As @azure said, for many people (me included) it is necessary to pre-bolus further in advance for breakfast. On mornings when I wake up late and don't allow sufficient time between taking my bolus and eating my porridge I can quite easily spike by 4 or 5 mmol (and that's with the honeymoon period helping me out, so could be a lot higher...).
 
@pinewood that's really helpful!

Thanks for that! Will inject before I shower and get dressed and keep a track of timings etc. Will post when I have some data!
 
@JJO Just a word of caution - bolusing before a shower or bath can make the insulin be absorbed faster. If you're only talking about a very quick shower, you might be fine, but just bear that in mind and be aware of the potential to drop more quickly.
 
JJO said:
@pinewood that's really helpful!

Thanks for that! Will inject before I shower and get dressed and keep a track of timings etc. Will post when I have some data!
Click to expand...
Good luck! Be careful the first time you do it as your mileage obviously may vary! Keep some sugar handy in case...
 
@azure thanks. Did not know that about the shower thing. I mean it makes sense when you think about it but I hadn't.

Okay. I'll have a rethink as I definitely don't have a quick shower, it's part of my morning routine not to! Might have to get up a lot earlier!
 
Okay new plan

Get up early enough for shower, inject after shower and I'm going to use just 5u and do that 20 mins before porridge.
 
Hi. Carb counting is essential for anyone on Basal/Bolus and I've never understood why nurses don't start most people on it; mine did. Carb counting should help reduce or even stop the hypos. I have cold muesli with milk 'stewed' oats as in porridge is not the best form of oats.
 
@Daibell thanks! Yeah not sure I understand why she didn't start me counting. But mine not to reason why, but I've started counting.

I'm sure it'll start coming a little more naturally soon.

If others are able I'm sure I can crack the porridge situation soon, at least before my patience leaves me!
 
So quick update! Day 4 today, have reposted the full information, but only day 4 is new information.

There is 44g of carbs in my bowl of porridge. I do put a little bit of real butter to add a little flavour (and use full fat milk for the fat)...
Day 1: Pre porridge = 7.7mmol/L, 5u of insulin and 2hrs post is 10.8mmol/L
Day 2: Pre porridge = 7.8mmol/L, 7u of insulin and 2hrs post is 10.9mmol/L
Day 3: Pre porridge = 8.0mmol/L, 9u of insulin and 2hrs post is 8.9mmol/L
Day 4: Pre porridge = 6.6mmol/L, 5u of insulin 25 mins before and 2hrs post 7.4mmol/L

Still felt a little low BS wise so grabbed a starburst (4g of sweetness!) at 5hrs post porridge. But overall I fell this is a big success! My BS 5h45mins post porridge and 45mins post starburst was 4.7!!! Also on a reduced dose (13u instead of 15u) of levemir this AM because it's my first day back at work!

Will repeat tomorrow to confirm but will drop to 4u instead of 5u because I did need a pickmeup which I need to try and avoid.

Many thanks for all your help so far. Will post again tomorrow and let you know how the porridgate is going.

Josh
 
Oh did mean to say that was attempting to try the 20 minute post porridge mark, but clearly underestimated the rubbishness of the electric hob of where I was staying vs the gas hob at home, hence the extra 5 minute delay...
 
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