How much of a 'spike' is okay?

[Adam.froud]

For instance, before lunch today my BG was 6.3. Had my novorapid and a sandwich.

Two hours later I had spiked to 9, but three hours later I was back down to 6.5.

Just tested for dinner and I'm now 5.5.

So, did I not take enough insulin to cover my sandwich? Or because my levels were good in the subsequent hours, did I really take the correct dose?

 

[catapillar]

Seems like you took the right amount of insulin. Experimenting with pre bolusing might help reduce the spike.

 

[Kristin251]

I would say it was the correct dose as more would have dropped you lower later. However the spike to 9 is not something I want to see.

It is said to try not to spike more than 2 points. We also want to keep it below 140 as it is said that's where damage starts to occur.

If i do spike I don't come back down. I think wherever I am at 2 hours is where I'm staying or I continue to rise. No drops odd as that may be.

I have strict goals for myself but many aren't bothered with higher numbers.

 

[noblehead]

Looks like you got the insulin dose spot-on, you just need to work on your bolus timing to reduce the postprandial spike.

 

[Adam.froud]

Looks like you got the insulin dose spot-on, you just need to work on your bolus timing to reduce the postprandial spike.

So if my BG spiked after 2 hours, I guess I should be injecting after eating?

 

[azure]

So if my BG spiked after 2 hours, I guess I should be injecting after eating?

No, pre-bolusing is before eating, not after. If you bolused after, you'd have spiked higher.

If you bolus the correct time in advance you can stop spikes and sometimes actually also reduce your bolus amount a little.

 

[catapillar]

So if my BG spiked after 2 hours, I guess I should be injecting after eating?

At two hours post prandial you will have got the tail end of the blood sugar rise. That's probably the drop from the peak. To see what's really happening to your blood sugar you either need more frequent testing or a spell with flash glucose monitoring.

Injecting after eating will mean your insulin won't start doing anything until after the food is already raising your blood sugar, so it won't help to avoid or reduce a post prandial spike. If anything insulin will be becoming active when blood sugar is high, giving the insulin a harder job to do - swimming against the tide.

If you inject before eating, and experiment with how long before eating to inject for different meals, your insulin will be active when the food is digested - so you'll be ready to start processing the sugar out of the blood and into cells when you eat. It should allow you to reduce the spikes.

 

[noblehead]

So if my BG spiked after 2 hours, I guess I should be injecting after eating?

No before, pre-bolusing is where you inject before you eat, quick-acting insulin's like Novorapid/Apidra take around 15mins before they start to lower bg levels, that is why many of us bolus at least 15-20 mins before eating, the only exception to this is when a meal is high in fat (or low GI) where you would inject just before or after eating.

 

[Adam.froud]

I may be misunderstanding; this was my school of thought:

The mean tmax of novorapid is 1-3 hours, therefore my sandwich spike came right in the middle of the time when I had the most insulin in my body, theoretically.

However, my sandwich was ryebread and has a relatively low GI, producing a gentle curve and peaking at 2 hours.

I took my bolus about ten minutes before eating; so in order to match the rise in BG to the rise in insulin, I would have thought I needed to take it after food consumption?

Blah this is confusing!

 

[Kristin251]

I eat high fat low carb meals and I still perbolus about 10 minutes. However, in the absense of carbs, protein can turn to bs rapidly through gluconeogenisis. I definitely have to bolus for protein.

 

[azure]

If you want to get the 9 down to a lower number, you need the insulin there and working to stop the spike - hence the advuce to possibly bolus a little more in advance

Injected insulin takes a while to get working, even the analogues like Humalog and Novorapid. So you usually need to inject in advance as @noblehead explained.

It doesn't have to be a lot in advance. You could try 15 mins and see how that goes.

My tip is to concentrate on your meter and general principles and remember we're not machines. If it was as simple as calculating and a bit of Maths, we'd all have perfect sugars. The action and onset of insulins is approximate, and we can vary in our response.

I may have said this before, but there is no magic formula to good BS. Just a lot of work and lots of tweaks

 

[noblehead]

However, my sandwich was ryebread and has a relatively low GI, producing a gentle curve and peaking at 2 hours.

Hi again Adam
.
Next time you eat your Ryebread sandwich test at 1 hour to see if your bg levels stays steady but rises and peaks at the 2 hour mark, that's the only way of knowing if the 9 was the peak or your bg was much higher previously and was starting to come down after 2 hours.

 

[Adam.froud]

Success!

Lunch time today I had the same sandwich.

BG was 7.7; dosed my bolus (food and correction) 30 minutes before eating.

1 hour after lunch: 7.3
2 hours after lunch: 6.4
3h: 5.5
5h: 5.1

Cheers guys!

 

[noblehead]

Wow.............well done @Adam.froud

 

[azure]

Well done! Advance bolusing is a fantastic tool!