How do you feel about the initial spike after food

I already have diabetic complications and was diagnosed with that a month after the diabetes diagnosis, I don't like being over 9 at all but sometimes it cant be helped, say if you are trying something different I usually inject the same amount of time as I would a tested meal as I don't know how I will react but if the spike is too big but I came back down I'd try it again but pre bolus by a bit longer, I worry about my levels a lot though and the DSN's have been trying to get me to relax more so I would say I spiked at 10.2 last week after a meal I eat all the time, I wasn't too bothered, what you have to remember is we are doing a job that our body should do naturally so we may spike higher then drop to normal, lately I was told not to worry 'too' much about short term spikes and that I should only worry about the long term problems if I was spending any length of time high x

Joe it really depends on how high you are going. Everybody, even non diabetics will get an elevation in blood sugar after food. Obviously the pancreas then releases insulin to deal with the excess glucose. If we are able to mimic this as much as possible then we reduce the risk of damage. When first diagnosed I was very strongly advised against what was then described as 'chasing the gauges' which in essence was an obsession with following food immediately with insulin and then having to have more food to compensate. The low carb principle however adds a whole new dimension with rises in blood sugars after food not now necessarily being quite so strong.

Personally I really enjoy carbs and could not see myself going without them. Having said that insulin affords me the luxury of not having to go without them. The high fat low carb thing that some diabetics adopt, particularly type 2's makes me really respect them for it. I personally lack the willpower. If it's any consolation to you I have gone over 30 years without complications and have never denied myself food of any type.

JoeT1 said:

Yeah, I get that. I'm also lowering my carbs to a certain extent. I went very low, but then figured that the protein is raising my levels when carbs are low, so have gone more with 20-30g of carbs per meal.

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I do not like seeing high spikes ever. Hence I eat vlc, not just low carb, and I don’t get spikes but I do bolus for half my protein.
I am also extremely sensative to carbs in the morning. And no matter what I eat for bf I need a small bolus an hour or so after to stop the morning rise.

Have you tried injecting earlier to reduce the spike?
Different foods take different lengths of time to be digested for different people. Using the Libre you can get an idea of how long each food type takes to have an affect on your BG and take your insulin that much time earlier than you eat.
Following ocassional use of a CGM, I have worked out how much earlier to take my insulin for some meals I often eat and, when I can, I inject early. It is usually about 30 minutes early. But I don’t get hung up if it’s not convenient.

JoeT1 said:

It really is great to see a comment like this. Sometimes it gets incredibly frustrating, seeing a rise in an evening when it's been good during the day, or a low in the day when you thought you got it spot on. I think a major thing i need to work on is accepting that it's not going to be 100% all the time, i'm not going to be in the range 4-7/8 all the time. I always try to perfect what i'm doing, but it's something I need to let go of.

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No 2 days are ever the same for any of us. An identical meal eaten 3 days running while being extremely tedious will invariably give 3 different sets of blood sugar results after eating it. This is why I never understand some doctors telling diabetics to test at the same time every day. Personally as long as I am testing and making adjustments then as much as I am able I am mimicking a healthy pancreas.

I think this is a useful article for those worried about seeing spikes on CGM - https://www.ncbi.nlm.nih.gov/pubmed/28763121 -the risk of complications is calculated by your hba1c, not any individual blood sugar reading and not any individual spike - we just don't know what the impact of a spike is, we only know that prolonged highs are bad. The fact is, when DCCT risk curves were produced no one was using a CGM so wouldn't have been especially aware of post prandial spikes.

It's interesting that you've raised this, as I have just started using the Libre. I'm half way through my first sensor.

Since diagnosis 3 yrs ago, I have been waking up, testing, eating a cereal breakfast, driving to work and testing again at my desk, approximately 2hrs after eating.

My blood glucose has usually been below 9mmol when I retest and I have been under the illusion that I have doing really well. The libre has shown me that 4 times this week my blood sugars have gone from a fasting level of around 6ish, to over 14mmol and back down to below 9mmol by the time I get to work.

This morning I had some time to experiment. I injected as normal in my leg and used the Libre to see when my blood glucose started to fall. I was amazed to discover that this took over 1hr. When I saw the drop start, I had my normal breakfast and then only went to 8.7mmol.

The Libre has been a revelation to me already.

Through finger pricking every 15 min I discovered I never drop unless I eat. I boluses every hour for 4 hours without food and didn’t budge one bit
Now I prebolus 20 min and eat a low carb bf and stay even but need to bolus an hour later to stop the morning rise. And I can’t imagime if I got up and started moving around! I tend to sit and hang on my iPad for an hour after bf catching up. As soon as I move around I start rising.

The two times I didn’t eat as soon as I got up ( for fasting bloods) I spikes like a maniac until I eat. Silly diabetes

urbanracer said:

I was amazed to discover that this took over 1hr.

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Stephen Ponder's book Sugar Surfing is pretty good for getting the most out of cgm. It's on kindle.

He calls that drop after a shot "waiting for the bend", proof that insulin has started working, so less of a spike in response to food. Bit trickier to do with a libre graph because the graph is made up of 15 min averages, easier with cgm because of the 5 min dots.

The other big revelation with libre is just how little sugar is needed to tail off a pending low. I've had many occasions where I've seen a slow slide on the graph, which might eventually end up as a hypo. As little as 3 to 5g will stop it. It's extraordinary watching the graph just level out in response to such a small amount, instead of having to hammer it with 10 to 15g after getting into hypo territory.

I reckon I've learned more about T1 in the last year with libre than I did in the previous 3 decades, so have fun with it!

JoeT1 said:

This is an interesting point @Scott-C

I have noticed I have been going into the hypo region, at possibly 3.7-4.0, and knowing that the food I have is digesting, I am weary of throwing in a large amount of carbs to treat, for example I took some lucozade yesterday, along with one 4g glucotab, when, I actually think 1 4g glucotab, or possibly 2, would have covered it and brought me nicely back up to 5-6mmol, rather than the unknown of possibly going to 7-8mmol

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I need very few carbs to stop the drop. If I’m 2 hours away from insulin I use the ‘one carb raises me about 5-7 US mg/dL. However if insulin is still on board then it’s more like 10 mg/dl. I used to always over treat. Soma few raw veggies or a scoop of avocado does the trick. And for me, being vlc, a bite of protein or half a hard boiled egg works.
I base it on how long ago I took insulin and where I’m at but haven’t really over treated in a long time.

JoeT1 said:

This is an interesting point @Scott-C

I have noticed I have been going into the hypo region, at possibly 3.7-4.0, and knowing that the food I have is digesting, I am weary of throwing in a large amount of carbs to treat, for example I took some lucozade yesterday, along with one 4g glucotab, when, I actually think 1 4g glucotab, or possibly 2, would have covered it and brought me nicely back up to 5-6mmol, rather than the unknown of possibly going to 7-8mmol

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One of the things which really surprised me was how little glucose is in our blood.

Say you're at 5, multiply by 18 to convert to US mg/dl, 90, convert to g/l, that's only 0.9 grams per litre, typical person has about 5 litres of blood, so a grand total of only about 5g if you're stable at around 5.

Maybe explains why such small amounts can have such a big effect if you're holding relatively stable with maybe a slow downwards slide.

DAFNE's take on it is that 10g will raise by 2 to 3.

Of course, if it's a rapid plummet, all bets are off!

JoeT1 said:

That's interesting @Kristin251

So, you base it on how long ago you took the insulin? For example, I tend to go a little low after about 3-5hours after taking the insulin, so, if after 3 hours, I see i'm heading south...if it were you, you'd take on a small amount of carbs? Rather than if it were after an hour, you'd take a little more...

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This is hard to answer as I’m vlc and only take 1/2-1 unit per meal. With such small doses I run out of insulin around the 2-3 hour mark depending on the time of day. I usually stay very steady with the half unit but if I take 1 I can drop. If I’m dropping before 1 hour I eat a little , not a lot. If I’ve dropped at the two hour, but not too low, I just ride it out as the peak is gone and I’ll start rising shortly. I discovered I start rising at the 2.5 hour mark and need to inject or ill keep climbing. So I inject and eat a small snack. I do this 5 times a day. It of a nuisance but so is my stomach so it all works out.

How high are you spiking at the one and two or three hour mark? Have you tried prebolusing? I know it takes about 20 min for my insulin to start working so I prebolus 20 min even for a vlc hf meal.
I can’t take all my insulin at one time to cover me for more hours as I will hypo first so I just eat small meals and bolus more often. I rarely have fluctuations and if I do they’re nothing of concern. I guess it’s my version of the pump. I also continue to rise until at least noon no matter what I eat so I need a small bolus an hour or so after bf.

So for you, how fast and high are you going? Do you prebolus? Do you see the same trend later in the day or maostly in the morning. ? Mornings are a bi*ch.

Hi @JoeT1,

Great thread.

I agree with all of the approve, particularly what a revelation the Libre is which highlights spikes that would normally be masked with standard testing.

I get very frustrated when I see totally different outcomes from the same routine but truth this is the reality so try not to be too hard on yourself if you spike or are just running high for no apparent reason. Last week I was posting about too many hypos this week I've been running high constantly (possibly due to stress or hormones).

You asked about the damage and I think for me the damage of not being aware and therefore taking any kind of corrective action is a high HbA1c (with it's own complications) which I've been stuck with for quite a while without a clue where I was going wrong. So where possible I'd suggested trying to make tweaks and substitutes for foods that really don't work for you if you need to but if your HbA1c is good don't be too concerned.