High glucose 3 hours after meal

Hi @Spablauw_

Have you done a basal tes to rule out a basal issue?

Spablauw_ said:

Hello,

I'm having problems with my BG after lunchtime
Before lunchtime I'm around 90 mg/dl
And I eat around 80g carbs (brown bread with low GI) I take around 4 units of insulin and then I'm around 100 1,5 hour after my meal but then my Bg start to rise a lot.

If I don't inject a correction I go all the way up to 240 mg/dl

I tried injecting after my meal because I thought that because I am eating slow carbs with some fat (cheese, peanut butter...) that it might take a while to digest but even if I inject after my meal it still happens..

Does anyone has a solution for this?
I'm on pens so a dual wave bolus will be difficult or I will have to split my insulin and take 2 more injections a day (I have the same thing during dinner) but I'd like to avoid that..

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Are you counting carbs for your fillings also?

I'd make 80g wholemeal bread (certainly the varieties I've tried) to be about 5 slices. How many slices are you having - are you sure your carb estimates are accurate?

Is your I:C ratio accurate?

Apologes for all the questions

Spablauw_ said:

I haven't been fasting but I know that if i go asleep I wake up at about 30 mg/dl less than the the BG I went asleep with

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A basal check isn't just a night-time test, to see if your bg levels rise in the afternoon (in the absence of food at lunch) just do the basal check, as your using mg/dl units have a look at the following which explains how to go about it:

http://integrateddiabetes.com/basal-testing/

Spablauw_ said:

I actually weigh the bread on a scale, I always take 140g of wholemeal bread and one glass of milk which makes 80g of carbs

My I:C ratio is maybe even too low, today I was at 80 mg/dl pre meal and 75 after my meal with hypo symptoms so I took 2 dextro tablets.

About 1,5 hour after the hypo I was on 158 and rising (I don't think that could be because of the 2 dextro I had to take...?)

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Does the bread have any nutritional information on the packaging? Your carb counting could be well off (even when weighing) unless you know exactly what's in it: flour content, sugar, etc.

Interesting what you said about the hypo. Have you heard of rebound hyperglycemia before? It's possible that you're dipping low either as a result of too much insulin at meal times; or because you're taking too much upfront with regards to the glycemic load of the carbs. When you dip to a hypo state, your liver can dump a lot of glucose from it's glycogen stores into the blood stream and send your BG through the roof.

Do you have full hypo awareness? It's possible that you may be dipping just low enough to cause a liver dump without realising. Best way to find out would be to test every 15 minutes after a meal for a few hours; bit of a pain - but it should let you know if you're going low.

Unfortunately, our basal requirements are not level throughout the day. Hence one of the benefits of a pump is the ability to adjust basal throughout the day. Sure, with injections, there is not so much control. However, there is some. For example, you could split your basal. So it could be worth checking.
As @GrantGam mentioned, it could be your i:c ratio. Just like your basal requirements, this can vary at different times of the day so, just because it works for breakfast, does not, necessarily mean it works for lunch.
The other thing I wonder is whether the rise has nothing to do with your food. For example, do you walk/run/cycle the work more in the morning? Do you do weight lifting (or other resistive exercise) in the afternoon? Or do you do always have a very stressful meeting after lunch? This could affect your Bg and you just have te be aware and adjust your injections accordingly; maybe with the correction you mention or maybe by increasing your lunchtime bolus if you know you have a tough meeting soon.

Spablauw_ said:

I don't see the point of basal checks in the afternoon since I can't change anything. My basal insulin is right for the night...

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Don't know which basal you take, but the timing of the dose and sometimes spitting the dose (if using levemir or lantus) can keep your bg levels on an even keel throughout the day.

Spablauw_ said:

I don't think that is the issue, sometimes I'm on 120 after meal and I still rise.

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If you've confirmed that's not the case (through testing) then I'd suspect you may have a basal issue and suggest a basal rate test, as suggested by @azure and @noblehead.

What fillings are you having in your sandwich? Fat can often cause a delayed BG rise - so if you're having things like mayo, cheese, etc - then you might want to look into that as a potential cause. There's also the milk, which naturally has a fat content, especially whole milk.

Spablauw_ said:

I don't see the point of basal checks in the afternoon since I can't change anything. My basal insulin is right for the night...

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You could possibly consider splitting your basal into,two injections if you find its ok for the night but wrong for the day.

I have a pump and I can now see that my basal needs vary hugely over 24 hours.