highs to lows in less than an hour - what could be going on?

[the_anticarb]

Has anyone experienced this? A few times now I have eaten my breakfast, injected my novorapid and then done the one hour post test and it's been 11/12. Then an hour later it is in the 2s and 3s. I am pregnant so I know that is upsetting the apple cart but has anyone got any suggestions for how to combat this? It's like the insulin just isn't working to cope with the amount of food I am eating (not massive amounts of carbs, eg 40g carbs - 2 slices of toast) but then suddenly it does manage to find its way into my cells and i have overdosed!

Getting conflicting advice from the pros re whether to have one big meal/two little/inject for some of it/all of it/inject half an hour beforehand/ don't inject half an hour beforehand- which makes me think they don't actually know the answer

So wondering if anyone else been thru this and can tell me what is going on

Ta

 

[sugar2]

Re: highs to lows in less than an hour - what could be going

No they don't know I am afraid...it is all trial and error in this situation. I found the onjecting earlier helped a bit...but not too earlier of I just hypoed befoe teh meal rather than after. It all depends on what you are eating...fat will make it all go in slower etc. This is a pro pump situation...you can give bolus's in different profiles, that can help with this.

ANother of those wonders of diabetes and pregnancy I am afraid!

 

[jopar]

Re: highs to lows in less than an hour - what could be going

it's caused by missing timing the injection, the food is hitting they system before you insulin is kicking in, you may also have your ratio's out as well which would explain the hypo along side basal rates out..

I would try injecting before breakfast, see what happens it may be wise to use a lower ratio's to balance out a bit so that you don''t hypo before it kicks in..

I would also check that your basal is correctly set, so you rule out added background to quick as a problem..

It may be that if you are having breakfast a slightly different times you made need slightly different tactics...

It's a case of trail and error, in the main to find out if you need to inject before, or even split the injection, and then which one is better when you are eating at what time..

A good investment is Think like a pancreas or Using insulin's by John walsh, John Walsh also does a book could pumping insulin which is know as the pumpers bible so if you get a pump it's a must have

 

[the_anticarb]

Re: highs to lows in less than an hour - what could be going

Thanks jopar, I'm pretty sure the basal is correct as I'm taking my lantus dose at night and testing on waking and it's around 4.5-6 which is what it is supposed to be according to the docs.

But I've had to increase my nightime basal dose from 4u before pregnancy to 18u and it may go up even more before the birth.

How soon would you inject before breakfast? I am on a massive dose in the morning now a 7:1 ratio up from 1:1 before pregnancy. So don't want to miss time it and go hypo before I eat.

I have found a lower carb/smaller breakfast to be better to manage the highs but still need to inject on that ratio even with, say 20g carbs, to get the post meal high under the target for pregnant ladies which is 7.8

I don't think my insulin profile is working the way it did before I was pregnant, have tried having carb snacks around 10-15g two hours after meal as mop-up snacks but still going hypo several times a day, reckon the basal dose although right for the fasting reading, may be too strong later in the day as it lasts 24 hours (plus I have another basal dose of 12u lantus at 8am) this is why the pump may be better for me what do you think? I understand you can vary the basal dose much more on a pump wheras with lantus you're stuck with the injection for 24 hours?

ta

 

[phoenix]

Re: highs to lows in less than an hour - what could be going

Getting conflicting advice from the pros re whether to have one big meal/two little/inject for some of it/all of it/inject half an hour beforehand/ don't inject half an hour beforehand- which makes me think they don't actually know the answer

Anti carb, I know absolutely nothing about pregnancy and diabetes (long past that when I became diabetic) but I had a look at the John Walsh pumping book about pregnancy.
He has a plan which divides calories into 18ths with carbs forming 40% of the total calories (he says to have individual advice on the number of calories needed and that they increase by about 500-1000 calories by nine months.
He divides the day into small meals and snacks.
2/18 of the carbs are eaten at breakfast,(time of high resistance for many pregnant women)
1/ 18 for midmorning snack
5/18 for lunch
2/18 mid afternoon
5/18 dinner
2/18 after dinner snack
1/18 bedtime snack
1/18 works out at 19g carb on a 1600 calorie diet, 20g carb on a 1800 calorie diet, 22g carb on a 2000 calorie diet, 30g on a 2800g diet etc

I'm not certain (thinking back into the depths of time) that I would have found such a prescriptive regime easy to follow but I do think that the concept of planned, counted carbs in small(ish) doses is a good idea. Instinctively it seems more sensible to plan in those snacks, rather than have to eat them when you deal reactively to a hypo.

 

[aboz]

Re: highs to lows in less than an hour - what could be going

How high is your bs before you have breakfast ? check this first you may need to adjust your evening medication. :?: :?

 

[moonstone]

Re: highs to lows in less than an hour - what could be going

I'm no expert, I'm less than 3yrs in and haven't been pregnant, but I went on the DAFNE course and that rang a massive bell - it sounds exactly like what they said would happen when you're injecting into a fatty lump that's been caused by using the same injection site for so long. Could you try to use a different area and see if that helps? Basically they said the insulin sits in the fatty bit (called a lipo I think), making you feel high after eating, and then it randomly comes out all in one go and can cause unexpected hypos. I'm sure there are other potential reasons too, however, I have to say that was the exact scenario they painted for the lipo thing.

 

[the_anticarb]

Re: highs to lows in less than an hour - what could be going

Thanks all

Aboz - my morning reading is coming in at between 4.5 and 6 and I eat breakfast about an hour after I get up usually.

Phoenix - It does make sense to load my carbs towards the end of the day, I am going to try and have a low carb breakfast (20g or so) and moderate carb lunch, I don't like the idea of injecting these massive doses in any case, as I think is causing a kind of novorapid traffic jam in my system. Doesn't seem to matter whether i eat low gi or high gi, the insulin in the morning is just not doing it's job. It doesn't seem to work properly til about 2 or 3 in the afternoon when a 2:1 ratio seems to be effective.

Moonstone - I like the theory but don't think this can be it, as i do vary my injection sites but don't get this problem later in the day and I'd see this happen every time I injected in that site if that was the case. No, it's definitely the pregnancy which is at the root of it, but two months to go and then I can hopefully go back to some semblance of normality.

I think i'm going to do two things a) eat a lower carb breakfast, and have a snack mid morning which I don't inject for (as the night time basal is so high, will make me hypo before lunch if I don't)
b)see about going on a pump which will mean I am not committed to the basal rate for 24 hours as I currently am with lantus.

The other thing I thought I could do was to do some exercise after breakfast, not really possible whilst I am working but I finish work at christmas (hurray!) and then I'll have a lot more control over when /what I eat and when I test.

 

[iHs]

Re: highs to lows in less than an hour - what could be going

hello AC

In MHO one of the best ways to control bg levels no matter what insulin regime is used, is to eat 'little and often' and test frequently. I always question the eat 3 meals per day and don't snack.

Novorapid is known for having a delayed onset of action but when it does start to work, it has a sting in its tail and can cause hypos. Loads of people have found this trying to eat high carb meals with Novorapid and get worried because of the high spike and then the massive drop. At best, bolus insulin will last for about 4hrs before it starts to tail off. When very fast acting bolus insulins come to market like Biodel, then it will be a different ball game but until that time, we all have to manage as best we can.

If you weren't pregnant you could possibly try Apidra which has very fast onset and a much shorter duration. Other than that, carry on the way you are or try a pump.

 

[the_anticarb]

Re: highs to lows in less than an hour - what could be going

quick update - Still happening despite low carb breakfast! Had small 10g carb piece of toast today with cheese and ham, injected on a 7:1 ratio so 7g novo, the one hour post meal reading was 7.9 (so just outside the limit) then down at 3.4 90 mins later. Can't reduce my basal any more as I'm only just making my fasting target of below 6. I give up!!!! But thanks for everyone's replies