Highs after the peaks

[Dan87]

Hi all,

I take Novorapid as my fast-acting insulin and been having a couple of problems lately as follows:

2 hours post lunch - level is 5.8 - check level again 2 hours later - level is 7.7 - all I've had in that time is fruit-flavoured water, containing sweetener
2 hours post breakfast - level is 8.0 - check again 3 hours later - level is 9.5 - all I've had in that time is a cup of tea with a normal amount of milk, 1 tablet of sweetener

I should point out I'm very sedentary in this time, sat at a desk. I have tried to cut down snacking lately, and avoided snacking in the two scenarios above, could that be the issue that my body was expecting insulin in between? Is the reading 2 hours after the meal a bit of a false narrative, as the insulin 'peaks' after around 90 mins-2 hours, and the later reading 4-5 hours after the meal is the more accurate one all along? Is it the lack of exercise in this period that is the problem? Lastly, is the sweetener in the drinks causing the problem? Never thought of it as a problem before.

Dan

 

[azure]

What are you eating for breakfast and lunch?

 

[AndyS]

Just to bang the usual drum. Have you checked to make sure that your basal insulin is correct?

Also I find that 2 to 3 hours can be a little soon for me and gives a skewed view on what is going on since you still have a couple hours of active insulin on board at those times. Do your levels come back down to where you expect them by the time you get to the next meal?

/A

 

[Dan87]

What are you eating for breakfast and lunch?

Breakfast - 2 pieces of 50/50 bread with low-fat butter and crunchy peanut butter, small glass of cranberry juice

Lunch - sandwich (normally chicken, tomato and mayo or cheese, tomato and butter), often with crisps

Just to bang the usual drum. Have you checked to make sure that your basal insulin is correct?

Also I find that 2 to 3 hours can be a little soon for me and gives a skewed view on what is going on since you still have a couple hours of active insulin on board at those times. Do your levels come back down to where you expect them by the time you get to the next meal?

/A

Pretty sure my basal insulin is correct, when I exercise in the evenings I sometimes have to drop my basal insulin by 1 to prevent hypos the next day at mealtimes even when keeping to my normal 1-10 ratio for levemir-carbs.

No they don't come back down before the next meal, after being fine 2-3 hours after the previous meal they have then risen before my next meal.

 

[Diamattic]

You mentioned only two hours post, and four hours post. How do you know two hours IS the peak?
With only two data points it looks as if you sugars are just going up from 5.8 to 7.7, which just tells me you didn't bolus correctly :/

Try again, but check before the meal, then every hour for 4-5 hours and see what you are getting. Sometimes i find if i inject too long before eating the insulin brings me down for the first hour and just shifts my peak, combined with high fat or protein meals i end up with my peak at 3 or 4 hours in and usually have to inject more to avoid sitting at the four hour reading.

2 numbers isn't really enough in my eyes to actually know where your peak is.

EDIT - Depends on the sweetner you are using, some do contain forms of sugar but in very small amounts and it MAY increase your levels if you use lots or are sensitive. If also MAY be that your basal rate is two low and your bolus brings you down but the basal cant hold you there. If you are on MDI its a bad situation because some people require multiple basal rates ie - higher in the day, and then low at night and as such they go high or low since they are only covering 1 of those needs instead of both.

 

[Dan87]

You mentioned only two hours post, and four hours post. How do you know two hours IS the peak?
With only two data points it looks as if you sugars are just going up from 5.8 to 7.7, which just tells me you didn't bolus correctly :/

Try again, but check before the meal, then every hour for 4-5 hours and see what you are getting. Sometimes i find if i inject too long before eating the insulin brings me down for the first hour and just shifts my peak, combined with high fat or protein meals i end up with my peak at 3 or 4 hours in and usually have to inject more to avoid sitting at the four hour reading.

2 numbers isn't really enough in my eyes to actually know where your peak is.

EDIT - Depends on the sweetner you are using, some do contain forms of sugar but in very small amounts and it MAY increase your levels if you use lots or are sensitive. If also MAY be that your basal rate is two low and your bolus brings you down but the basal cant hold you there. If you are on MDI its a bad situation because some people require multiple basal rates ie - higher in the day, and then low at night and as such they go high or low since they are only covering 1 of those needs instead of both.

Thanks for the reply.

I guess it isn't the peak after 2-3 hrs then, but having a snack like fruit and some insulin would keep me in range (4-7) until my next proper meal. I only tend to inject 10 mins pre-meal as my novorapid starts working after about 15 for me.

The sweetener for the water was definitely sugar free so I think it's unlikely to be the cause.

I can't up my dose of basal insulin as occasionally I hypo in the morning, sometimes I have to drop my dose by one even, if I am exercising more than usual. Is splitting the basal insulin an option?

One thing I have wondered, I've read that bolus insulin should only kept for 28 days then discarded, I often keep mine much longer. Could that be a problem?

Dan

 

[tim2000s]

I can't answer for Levemir, but if Lantus is your basal insulin you absolutely need to change it every 28 days. Many of found it doesn't last that long. I used to have to change it after about 21.