Meal spikes

[Miss Piggywig]

Can I ask you very knowledgeable people about how long it should take for my food spikes to return to pre meal levels? Should it be within 2 hours or the full 4 hours that the insulin lasts?

 

[Ushthetaff]

it depends on what you are eating ! For example if I eat pasta I have to take my insulin 3 hours after I’ve eaten it otherwise my insulin has “ run out “ before the pasta has taken effect.like all things with diabetes it’s all down to the, individual , generally 4 hrs should see some reduction , experimenting will find out what works for you ,

 

[Olddogandgrump]

Like Ushthetaff says it very much depends. For me a low fat meal, high in simple carbs, will produce a higher shorter lived post meal spike. A meal high in fat or complex carbs it's more of a slow burn. And of course, your pre meal levels, how much insulin you took initially and what your activity levels have been all add to the variety.

Personally (and this is not advice), I check two hours after the meal. If I'm still rising or high and steady and not looking like I'll not be back in range any time soon I take a correction dose.

 

[Juicyj]

I went on the Dose Adjustment for Normal Eating course and was told 3-4 hours, also not to test/correct before then to see if my levels had come back into range, with CGM's we can become too fixated on rising BG levels, but this is where we have to become more relaxed and not obsess over an arrow going straight up, to this point I think CGM's can be anxiety inducing if we let them, we simply just have to acknowledge and be patient.

Different foods will deliver different reactions as pointed out already, fat delays carb absorption so a pizza high can hit you 3+ hours later, whereas a low carb, high protein can cause a steady long rise.

As a newly diagnosed I would write down your BG levels before each meal and to track them on this basis, your insulin requirements will change over the months but this is a good way to chart what's going on against what's been eaten and will help you and your team decide if your insulin doses need adjusting.

 

[In Response]

There is often confusion from people with Type 1 who read the threads about type 2 saying that BG should return to normal after 2 hours.
This is correct if you are using incredibly fast insulin that the human body produces. However, it is not possible to manufacture insulin that works as fast. The insulin we inject to work with the food we eat lasts about 4 hours. If our BG had returned to pre-meal levels after 2 hours, we still have active insulin on board which will drop our levels further.

It is possible to pre-bolus (take your insulin before eating) to reduce the spikes but this requires timing the peak of your insulin profile (Google "NovoRapid profile" to see a graph of the activity of NovoRapid, for example) with the peak of the carb absorption of the food which you have eaten bearing in mind that different food will be absorbed at different rates (which is why we talk about treating hypos with "fast acting carbs" ).

I agree with @Juicyj about the extra anxiety which can come from watching CGMs rise after eating. I temper my anxiety by remembering the amount of active insulin I still have on board rather than stacking insulin and causing a hypo. Taking extra insulin because the graph is rising is dangerous.

 

[CheeseSeaker]

Agree with @Juicyj and @In Response, 2-4 hours generally (unless its pizza etc which can be much longer)

Looking at my graph from yesterday (it was a good one with no odd things messing me about 'for once' ;-) ) I'd returned within 2-3 hours but some times (food, exercise etc) things impact how quick I get back to normal.

Was very much in the 'its not down yet - stick more insulin on-board' camp - but got away from that over the last 12 months or so, and let it do its stuff.

Not easy to do - but pays dividends in the long(and short) run

 

[Miss Piggywig]

Thank you everyone for your replies. I am tracking before meal , carbs, I sulin and after 2 hours. But also noting if it's still rising or falling. I've found a walk after I've eaten really helps bring it down. I'm still learning and taking each day as it comes.

 

[In Response]

Thank you everyone for your replies. I am tracking before meal , carbs, I sulin and after 2 hours. But also noting if it's still rising or falling. I've found a walk after I've eaten really helps bring it down. I'm still learning and taking each day as it comes.

The advice to test after 2 hours is not advice for Type 1. It is advice for type 2.
I would recommend stopping this check and focus on the 4 hour check when your fast acting insulin has finished.
There reason for this is the additional stress you are putting upon yourself which can lead to diabete burnout so early in your diagnosis.
Keeping your BG low after 2 hours is learning to run before you can walk.

 

[Juicyj]

Great point from @In Response this early on in your diagnosis you are going to burn yourself out, try to relax more and let the insulin do it's work, 2 hours is way too early, novorapid duration lasts up to 5 hours, 4 hours is a good check point.

Try to cut yourself some slack, there is a lot to learn and getting used to insulin and your carb response will take time.

 

[Miss Piggywig]

Great point from @In Response this early on in your diagnosis you are going to burn yourself out, try to relax more and let the insulin do it's work, 2 hours is way too early, novorapid duration lasts up to 5 hours, 4 hours is a good check point.

Try to cut yourself some slack, there is a lot to learn and getting used to insulin and your carb response will take time.

Thanks Juicyj, I have tried to relaxed a little and accept it. For the last 2 days I've been in range for an average 75% of the day so I'm taking that as a win.

 

[sninge]

That's a great start miss piggywig, well done.
Just to throw a cat amongst the pigeons.....
Just as everyone reacts differently to food we all also can react differently to insulin!
I take 45 mins-1hr before Novorapid has any effect on my sugars and 1.5 hrs later it will have no effect whatsoever.
How do I know? When my basals are set correctly and I have a high sugar ( food/stress) and correct I can watch this reaction and after 1.5 hrs the sugars will ' never' drop. I may be quite rare, I do not know but its one important reason to get your basals correct before anything, you have to start from a solid place and then you can work out the food/exercise/corrections from there on.
It is going to take some months, you are clearly working hard and doing great but take your time, I promise you that you will never stop learning about yourself/food/exercise and insulin, your pump is your new partner in crime and it will become your best friend. But 100% sort basals out first be confident in them and you will have an easier journey, from there work out your own ' active insulin time ' and it will make carb/insulin doses/timing so much easier to work out!
Good luck and keep us posted.

 

[In Response]

@snige you mention that a correction bolus can take 1.5 hours to work when your BG is high. This is likely to be related to the insulin resistance that comes with high BG.
When BG is “in range” a bolus will usually work faster.
However, if you find a bolus when in range takes this long, it is probably worth discussing with your DSN or endo to trial one of the ultra fast insulins such as Fiasp. Note, these may still take longer to work with a high BG.

 

[sninge]

Sorry I probably didn't explain properly, my insulin works in 45 minutes but after 1.5 hrs it has all been absorbed so no longer brings my sugar levels down.
Wise advice though had it been taking 1.5 hrs to work.