Interpreting rises on a graph

[sgm14]

Anyone care to have a look at this graph and share their thoughts?

It shows my blood sugar levels rising before I have taken my lunch.
Then it shows it rising from around 4pm which again is before my 5.30 dinner.
Then it starts rising again at around 7pm.

I have noticed this pattern fairly often over the last few months and can't understand it,

My first thought was my levels start to rise when the boluses for the meals wears off and would suggest that my basal dosage is too low. But I have been woken up with low warnings during the night almost every night which would suggest my basal dosage is too high.

The figures are not too bad, but from past experience when things like this start happening, they usually get steadily worse and I would like to prevent that happening.

 

[SimonP78]

The problem with basal requirements is that the body doesn't always (often) have a flat requirement, you may well have lower basal requirements overnight vs during the day. The important thing is to remain stable overnight, so this is typically used as the benchmark level against which to decide on basal dosage. It may not necessarily produce optimal results at other times of the day, which means workarounds - either uncovered bedtime snacks to get an upward trajectory which then drops but not hypo level overnight, or taking more bolus dose than is strictly necessary for carbs during the day to drive down what would otherwise be an upward trend.

With all that said, are you sure it's not a case of whatever you've eaten in the previous meal still being digested? Whether this is the case or you require extra insulin during the day, splitting bolus is perhaps an option.

You could also, depending on what type it is, look to split basal and take different doses morning and evening.

 

[Antje77]

What types of meals do you have for breakfast, lunch, and dinner?

 

[sgm14]

The problem with basal requirements is that the body doesn't always (often) have a flat requirement, you may well have lower basal requirements overnight vs during the day.

I'll check this out.

The important thing is to remain stable overnight, so this is typically used as the benchmark level against which to decide on basal dosage. It may not necessarily produce optimal results at other times of the day, which means workarounds - either uncovered bedtime snacks to get an upward trajectory which then drops but not hypo level overnight, or taking more bolus dose than is strictly necessary for carbs during the day to drive down what would otherwise be an upward trend.

It would be less work to increase my basal dose and take some extra carbs to avoid the lows, but I know this would be frowned upon.

With all that said, are you sure it's not a case of whatever you've eaten in the previous meal still being digested?

Unlikely as it happening with all meals and hasn't happened with those types of meals until recently. Also happens with meals where the only real carb content is from orange juice which shouldn't be difficult to digest.

Whether this is the case or you require extra insulin during the day, splitting bolus is perhaps an option.

That might be tricky to get the timing and dosage right. The rise sometimes only starts happens an hour before my next meal time.

You could also, depending on what type it is, look to split basal and take different doses morning and evening.

Basal is lantus.

I am supposed to see my endo fairly soon, so something to discuss with him,

Thanks for the info.

 

[sgm14]

What types of meals do you have for breakfast, lunch, and dinner?

Breakfast was beef sausages and a small glass of orange juice. 10g of carbs for the OJ and in theory there should be no carbs in the sausages, but it does cause a small spike so there may be a few and I guess about 5g.

Lunch was an omelette on toast : carbs 15g

Dinner was a steak with some peas : carbs 9g

 

[SimonP78]

I split Abasaglar which is afaicr biosimilar to Lantus, you may be told that the action of (your) basal insulin is flat, this is not true (as can be seen by Googling for the activity curve of the insulin), splitting it does make a quite significant difference.

I started splitting mine as I was going low overnight post-exercise, but if I reduced the (evening) basal dosage I'd go high the following day. Splitting it works well as I can reduce daytime basal when exercising. This isn't what you will want to do, but I alternatively reduce evening basal if I've had an unexpectedly big day and hadn't remembered to reduce morning basal.

Re your food, while sausages don't have carbs (though protein and fat are both partially converted to carbs when eaten with what the body sees as insufficient carbs) they do have fat which makes digestion slower. As you say the OJ should be absorbed and available very quickly. Omelette on toast shouldn't be overly slowly absorbed, nor should steak and peas.

However, you're very low carbs, which may mean you do need to count the carb conversion content in the protein and fat (both of which are converted over quite a long period of time, which might be the reason why you're getting very slow rises), but I'm definitely not low carb (~260g/day) so I don't have much of a feel for it other than what I've read in various forums. I don't know off-hand quite where the "how much carbs is enough?" breakpoint comes.

Is the low carb eating a new thing? I'm assuming not as you say it didn't happen with those types of meals until recently.

 

[sgm14]

> Is the low carb eating a new thing?

Depends on what you mean by low and new. Average carbs for my meals has been less than 100 for about five years, but current diet started around 8-9 months ago, mainly to try to resolve issues with breakfast. I initially tried sausages on their own but that still caused a rise that needed to be bolused for and so I added the OJ of various amounts. As you say it is hard to know how many carbs is enough, but I figured that my body was happy with 15g at lunch time (which has been the same for years), then it is likely to be happy with 15g at breakfast. And it seemed to work for six months.

However, you're very low carbs, which may mean you do need to count the carb conversion content in the protein and fat (both of which are converted over quite a long period of time, which might be the reason why you're getting very slow rises),

That still would not explain the rises after lunch and dinner, unless you mean it could cause rises even 12 hours after being eaten. If that is the case, then I could try skipping the sausages to see if anything changes.

 

[becca59]

I definitely have problems with the basal differential between night and day. Only a pump would sort it but I’m not eligible. I just do correction doses throughout the day or split my insulin if I have a larger carb meal.

 

[SimonP78]

> Is the low carb eating a new thing?

Depends on what you mean by low and new. Average carbs for my meals has been less than 100 for about five years, but current diet started around 8-9 months ago, mainly to try to resolve issues with breakfast. I initially tried sausages on their own but that still caused a rise that needed to be bolused for and so I added the OJ of various amounts. As you say it is hard to know how many carbs is enough, but I figured that my body was happy with 15g at lunch time (which has been the same for years), then it is likely to be happy with 15g at breakfast. And it seemed to work for six months.

That's fine, sounds like it may well be a change to basal requirements then. Some people report this happens based on the weather/time of year, so it's not uncommon - in the past I've reduced basal by a unit in the summer (hard to know if this is due to more exercise of something else), but I'm currently taking an extra 1U (to make 10U) in the evening (alongside 9U in the morning) as I've been running somewhat high overnight for the past month. I've no idea why - I'm doing much more exercise now the weather is nice (and in fact need to dial back evening insulin post exercise by a couple of units, which I forgot/didn't think I'd need to do last night so ended up repeatedly cancelling my hypo warning and hoping my BG would start rising, which it didn't. You live and you learn!)

That still would not explain the rises after lunch and dinner, unless you mean it could cause rises even 12 hours after being eaten. If that is the case, then I could try skipping the sausages to see if anything changes.

Sort of - fat slows absorption of all carbs, but both protein and some fat are also converted to glucose - all of your meals contain protein and breakfast also has a decent quantity of fat, so I was thinking more along the lines of the fat/protein being converted slowly, however, if it was working fine in the past I'd guess it's more likely a basal requirement change than a sudden change in how/what is digested, though that is only a guess.

Sorry I've not got a particularly useful answer, I think I'd try one of the two approaches I outlined originally assuming it's a basal issue.