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Is a spike of 12.5 for a short period ok?

O

O_DP_T1

Well-Known Member
Messages
459
Location
United Kingdom
Type of diabetes
Type 1
Treatment type
Insulin
So today the strangest thing happened came back from training with BG at around 6 and stable, had 50g carbs and a chicken breast with salad carbs in the form of sweet potato and took my NR about 15 mins before food as usual, as it was not a particularly hard session I decided not to reduce my NR dose so took it as usual.

Check BG after 1hr 12.5 ***!!! usually it would be 8-9 tops
Check BG after 1.5hr 10
Check after 2hrs 6.5

This is unbelievable, does this kind of time out of range seem ok? I'm abit worried I've seen some real unstable results over the past couple of weeks my time in target has gone down about 10-15%.

Any one know why/how this happens and how to stop it?
 
O_DP_T1 said:
So today the strangest thing happened came back from training with BG at around 6 and stable, had 50g carbs and a chicken breast with salad carbs in the form of sweet potato and took my NR about 15 mins before food as usual, as it was not a particularly hard session I decided not to reduce my NR dose so took it as usual.

Check BG after 1hr 12.5 ***!!! usually it would be 8-9 tops
Check BG after 1.5hr 10
Check after 2hrs 6.5

This is unbelievable, does this kind of time out of range seem ok? I'm abit worried I've seen some real unstable results over the past couple of weeks my time in target has gone down about 10-15%.

Any one know why/how this happens and how to stop it?
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I'm not an expert and I'm sure others will be able to give better guidance, but my BG would spike like that if I ate 50g of carbs at a single sitting. I aim to keep my carbs under 30g a day. We are all different of course.
 
This is not that unusual. What is unusual is seeing it because we don't normally test 1 hour after eating.
You are seeing your carbs get into your blood stream before the insulin starts working.
Some carbs react quickly and some carbs act slower - this is indicated by the glycaemic index.
If you are able to do the testing (or try a Libre) you can learn which food spike when and adjust when you take your insulin so the insulin peak matches the peak from your carbs.

I often eat 50g or more of carbs in a meal and have found, for example, pasta reacts quickly whereas chocolate reacts slowly. So I take my insulin 15 - 30 minutes before eating pasta but once I've finished the chocolate (if I remember to stop eating chocolate ... nom nom nom)
 
I do have a Libre and tbh since going on the MDI I check every hour 2 hours 20 mins or whatever takes my fancy. Usually sweet potato does not spike me like that, this caught me off guard tbh.
 
The important part is that you injected to cover the intake of food and got back to your starting point after 2 hours. A small amount of NR insulin would still be active for another couple of hours and possibly slowly reducing your blood sugar further.
 
O_DP_T1 said:
Yes but I bolused the correct amount for it as usual. But didn't get the usual outcome.
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I'd file it under the category of SRSH - Sometimes Random Sh*t Happens.

We want predictability, so it's always tempting to think that X u will work in relation to Y carbs the same way every time.

But it's not like you're measuring those two things on their own on a precise set of scales. There are things shoogling the table.

Think about it - as soon as you put the same amount of food and units in your body, they're both subject to lots of variables which mean it's highly unlikely they'll pan out the same way two days in a row.

A few examples:

In a non-T1, most insulin is sent straight to the liver to tell it to suck up excess glucose. Most injected insulin ends up nowhere near the liver. Some of it gets destroyed while it's floating around the body before it can do anything useful. You may think, ok, injected 10 u two days in a row, but that doesn't mean 10 u ended up working on those two days in the same way.

Other things like digestion affect it. Say you had 50 g of sweet potato two days in a row. Maybe the 50 g on day 1 had been cooked longer than day 2, or you chewed it more. Either would make it turn into glucose quicker than day 2, with consequences for how rapidly it's absorbed.

There's just so many variables involved in how the same dosage and carb amount will be processed from day to day once they are put into a very complex chemical/biological melting pot, it's inevitable that there will be unpredictability. We cannot possibly account for these all the time, we can't even measure most of them.

It's surprising that we get even close to achieving a reasonable balance most of the time.

That's why I'm reasonably relaxed about the occasional 11 or 12 spike - it will happen from time to time no matter what. It even happens to non-T1s from time to time, so, while I'll spend a lot of time avoiding it, I'm not going to beat myself up about it if it happens occasionally.
 
Dexterdobe said:
I'm not an expert and I'm sure others will be able to give better guidance, but my BG would spike like that if I ate 50g of carbs at a single sitting. I aim to keep my carbs under 30g a day. We are all different of course.
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The OP's T1, so the rules are very different - we can play with insulin.

There's a little trick called pre-bolusing and, with cgm, "waiting for the bend".

It involves injecting a while before the meal to give the insulin time to get to work lowering levels a bit before the food hits it. With cgm, you can watch the trace to see it starting to trend down.

Get it right and you have a gentle inverse spike going down then up.

Easier to see with a picture. In the screenshot below, I'd taken a small 1u shot about 16:30 to pin a small rise I normally get when heading home, so it was starting to tail down, then a 9u shot just before 18:00 for tea of 75g carbs about 30 mins later. Net result is a glide down to almost 4, a bit too close for comfort, a 20 min pre-bolus would have bern sufficient, normally do that, maybe getting my tea ready just took longer that night, then about 30 mins later it wanders back up to around the 6 mark. Rinse and repeat for a 24 g supper with 4 u to cover it. Each blue dot is every 5 mins so it can be very useful for figuring out timings of carb absorption rates and insulin action to make more informed choices on matching patterns. Of course, there's still many days where it ends up a mess!

Screenshot_2017-12-01-00-06-27.png
 
Hhhhm thanks for these tips very useful does that not mean though some days we taking 5 shots plus. I have a libre rather then a Dexcom but i get what you mean.
 
hi @Scott-C that is fascinating! I wish I could monitor like that but I don't need to and can't justify the cost. It must be so useful to you.
 
O_DP_T1 said:
Hhhhm thanks for these tips very useful does that not mean though some days we taking 5 shots plus. I have a libre rather then a Dexcom but i get what you mean.
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Depends how the day is going, some days I don't need any inter-meal corrections, some days I do. Injections don't bother me, so it's not a big deal. If one is needed, I prefer to do it to pin a developing rise before it goes out of range, rather than having to save the correction till a meal shot by which time it might be well out of range. I just feel more in control gently steering it even if it means a shot or two extra.

The screen shot is from libre, not dexcom. I've got a transmitter called blucon from www.ambrosiasys.com, set up about a year ago by an ex-Abbott employee, on top of the libre sensor, it reads it every 5 mins and bluetooths it to an android app xDrip+ which is an open source app originally started as dexdrip by people who felt that the official dexcom app was a bit basic. I've been using the set up for 5 months. It's reliable. I bolus from it. You can calibrate to iron out sensor inaccuracies. It has hypo/hyper alerts. The blucon was a one-off cost of 95 quid, just need to replace the cr2032 battery every couple of weeks. Not waterproof so need to take it off for showers but no big deal seeing as it's giving me dexcom style cgm for £95.
 
archersuz said:
hi @Scott-C that is fascinating! I wish I could monitor like that but I don't need to and can't justify the cost. It must be so useful to you.
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It certainly is. After 30 years on strips alone just seeing tiny little snapshots, the last 18 months with cgm has been a revelation - I can now see the full picture in real time and proactively take small steps to stay in range instead of retroactively using a sledgehammer to force it back in.

I've been really lucky. My local NHS area, NHS Lothian, in Scotland, has had the foresight to see that libre engages us, encourages us to improve control, gives us more peace of mind, and reduces longer term the cost to the NHS of treating complications, so they decided a couple if weeks ago to give it on prescription to any T1 who wants it. Difficult to say from their published material but there seems to be scope for insulin dependent T2s getting it too. In a few years, cgm will be standard, and I think it's only a matter of time before others follow Lothian's lead.
 
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O_DP_T1 said:
does that not mean though some days we taking 5 shots plus
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I usually inject 7 to 10 times a day, and more often when having long stretched out meals. I don't want the hassle of a pump, but I do like reacting quickly to changing bg and I don't mind injecting.
 
Scott-C said:
The OP's T1, so the rules are very different - we can play with insulin.

There's a little trick called pre-bolusing and, with cgm, "waiting for the bend".

It involves injecting a while before the meal to give the insulin time to get to work lowering levels a bit before the food hits it. With cgm, you can watch the trace to see it starting to trend down.

Get it right and you have a gentle inverse spike going down then up.

Easier to see with a picture. In the screenshot below, I'd taken a small 1u shot about 16:30 to pin a small rise I normally get when heading home, so it was starting to tail down, then a 9u shot just before 18:00 for tea of 75g carbs about 30 mins later. Net result is a glide down to almost 4, a bit too close for comfort, a 20 min pre-bolus would have bern sufficient, normally do that, maybe getting my tea ready just took longer that night, then about 30 mins later it wanders back up to around the 6 mark. Rinse and repeat for a 24 g supper with 4 u to cover it. Each blue dot is every 5 mins so it can be very useful for figuring out timings of carb absorption rates and insulin action to make more informed choices on matching patterns. Of course, there's still many days where it ends up a mess!

View attachment 25472
Click to expand...

I find the timing of 'the bend' to be mostly reliable but I was seriously thrown by it 1 day last week. I normally inject my pre-breakfast bolus about 50 mins before eating, where I normally see the bend. For me, I am usually around 6mmol and falling slowly when I start to eat and I go up again before I set off to work in the car. I am so used to this that I no longer check my glucose level during the 50 minute period between injecting and eating. So I was quite surprised to be sensing an impending hypo within 30 mins of injecting. Sure enough, the Libre indicated my blood glucose was just above 4 and falling rapidly. Hadn't done anything different that morning, and normal service has now been resumed.

It's a game innit.
 
Scott-C said:
That's why I'm reasonably relaxed about the occasional 11 or 12 spike - it will happen from time to time no matter what. It even happens to non-T1s from time to time, so, while I'll spend a lot of time avoiding it, I'm not going to beat myself up about it if it happens occasionally.
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Does it really matter what YOU think about it though. Isn't it more relevant what your body does about it?

Nobody has ever told me what the graph of blood glucose over likelihood of complications looks like.

My assumption: nobody knows.
 
NoKindOfSusie said:
Does it really matter what YOU think about it though. Isn't it more relevant what your body does about it?

Nobody has ever told me what the graph of blood glucose over likelihood of complications looks like.

My assumption: nobody knows.
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You're missing the point I was trying to make. I'm not saying being at 12 is fine or poses no problems. Of course, it's much better to be in range, but the complexities are such that an excursion from time to time is inevitable despite best efforts, so there is no point in grieving about it too much. I don't think the occasional excursion for short periods does that much harm - the body repairs itself. When people are burned out and spend days/weeks on end in the teens, now that's a problem. I'm not interested in charts and statistics. All I know is that I've been doing this for 3 decades and have no complications, which stands me in good stead for the next 30 years.
 
Scott-C said:
. All I know is that I've been doing this for 3 decades and have no complications, which stands me in good stead for the next 30 years.
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Way to go @Scott-C , 40 years here and sometimes there's no second guessing it. Correct and move on, there are more things to do than sit worrying.
 
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