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Post Meal Readings

mo1905

mo1905

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4,334
Location
Cambs
Type of diabetes
Type 1
Treatment type
Insulin
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Rude people !
Hi all, I'm T1, basal and bolus. Still probably in honeymoon period as fairly low levels. I have pretty good control over BG levels, or so I thought. I have always been advised the best readings to get are before meals. This made up 90% of my readings and generally good, between 5 & 7 or so. Out of curiosity, I've recently started taking readings 2 hours after a meal and they're generally over 10. I was a little surprised as I thought they would have dropped by then. Any thoughts or is this normal ? Many thanks, Mo
 
I don't know if it's normal but in generally the same. Quite high (8s or 9s usually) 2 hours after but down at around 5 immediately before I eat. I guess it's to do with the GI of the food maybe?
 
for a type on on mdi usually aim for a 7~8 post meal reading, on pump maybe 6~7. This is so you can have a small drop down to 5~6 before next meal with the remaining qa left. The main one I think is the morning reading as this will make up nearly 50% of your hba1c (usually 7~9 hours sleep). hope this helps

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You could try injecting 10-20 mins before eating to see if this helps with the postprandial spikes, I do this with most my meals now and found it makes a hell of a difference in my bg readings, Gary Sheiner discusses this in his book Think Like a Pancreas.
 
Thanks for replies. So Brett, when you say "aim for 7-8 post meal readings", how can I do this ? I inject as per carbs. Should I increase dose or is it the food that I'm eating ? This is happening over a range of meals so it's not just the odd spike. Also, should these post meal readings be taken 2 hrs after ? I wonder whether it could be as Hale sggests and something to do with GI of certain foods ? Thanks, Mo
 
Hi mo, mixture of the two, higher the gi food higher you willbe of course . If you compensate for a high gi meal with extra insulin then you would probably hypo in hours 3~4 due to the extra qa so would need a small carby snack to maintain. Harder to achieve those levels on mdi I know. With a pump if 5 units was not enough for a meal but 6 too much I could try 5.3 which can't be done on mdi. When on mdi I would have to bolus extra to have good post meal readings but know I would need a snack two hours after , not ideal if dieting but I'm still trying to gain weight, just a bit more though. Very hard balancing act but made alot easier by the pump would never give it up lol.

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I went on the dafne course and we were told to only test before meals, however my pre meals and post meals can differ quite drastically! I try and aim for post 2 hour between 5-6.5 and have a biscuit to prevent the low before my next meal.

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Mo, sorry meant to say I also carb count so with my pump it is often giving me .3 or .4 in addition to full units.

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Re: Post Meal Readings - a condundrum

I had two weetabix, banana and milk for breakfast (no dietary suggestions from anyone please as I'm comfortable with my regime).

My pre-breakfast was 5.0 and two hours after 8.5 (higher than last time. Within 5 minutes it was 7.8 and one hour after that (including dog walk) 3.6! I usually start hypoing at 3.9 when I'm walking, but I am sat on my butt doing nothing and feeling ok (energy burning rate I guess).

No wonder so many of us are confused or struggling with the guidelines & testing and what they are really telling us!
 
Hi gezza, very similar breakfast to what I have but also find I would need a snack 2 hours after. If I was to go got a walk afterwards I would have a larger snack or if within 2 hours I was walking an earlier snack. Like me you are probably insulin sensitive which is greatly exaggerated by the smallest bit of excercise causing quick drops. Either bolus less for breakfast and go for a walk before 2 hours, or bolus same and have a snack before walk 2 hours plus after bolusing.
Planning and adjusting is a great help and will soon find what works for you. Keeping a record also helps.
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Thanks for all replies so far. Indeed, not an easy balancing act. I thought this diabetes thing seemed a little too easy lol !


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I too am very insulin sensitive. I walk my dog after work everyday, and I find that between the concentration involved in driving home to get the dog AND the effort of walking (not that brisk I might add!) can drop me quite suddenly. And this is 5-6 hours after lunch! I always take a snack with me for the walk and it's my opportunity to have my something "naughty" of the day.

Less bolus at lunch would mean very high BG at work..... I tend to involuntarily nap in meetings when that happens haha 3 year waiting list for a pump...... I can dream of it for one day!

But Mo, I only test 2 hour after a meal if I've been unsure of the carb content and want to ensure I'm not plummeting! Or if I'm jumping in the car etc generally I just test before meals as a T1
 
Same here Hale. I generally only test prior to eating. Not sure why I started testing after but the high numbers surprised me a little. I wondered how much of my day am I running with high BG readings without me knowing about it ! I worry about possible complications ! I guess we all do ;-)


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If you want to know what the highest level your BG reaches after meals is, test about 75 minutes after you start eating.
The 2 hour reading will tell you if your BG has dropped back to baseline. I think the top of the spike is a more useful reading for people using minimal medication or diet. the 2 hour figure would help an insulin user get the dose right.
Hana
 
I thought that with DAFNE and carb counting, you can pretty much eat what you like ! Seems not to be the case, I'll have to start being a little more watchful with food and note which foods still cause high readings 2 hrs later. At present, seems like all of them lol !


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Mo,
If you look at fig 2 on this link you can see how the action of injected rapid insulin is very different from that of natural insulin . http://www.uspharmacist.com/content/s/126/c/20874
Endogenous insulin has already done it's job by 2 hours so it's a different scenario for someone who isn't relying on injected insulin. At 2 hours rapid insulin is only just beyond it's peak action, as Brett pointed out you don't want to be too low at 2 hours because the bolus insulin still has a way to go.

If you started from a lowish level and it's back to pre meal at 2 hours you could be hypo by 3 .

The target I was given when I was first diagnosed was around 50mg/dl (2.7mmol/l) above the starting level at 2 hours. I certainly don't always manage it.
How high you go with any given meal, is obviously dependent upon where you started (and whether you've recently exercised). The content of the meal (ie type of carb, amount of fat etc ) also influences how quickly glucose levels rise and how long they stay risen for. I find that higher fat tends to result in longer, later, rises for example and that for a very low carb meal I have to give a higher insulin dose than I would if I just took the carbs into account.
(I think sometimes it's a bit of an art rather than a science, you get to know that you might need more or less than the nominal carb count for certain meals For others you might inject a bit earlier (as Nigel mentioned) and sometimes you might even split the dose)
 
Well put phoenix. As you pointed out carb counting does help to give an estimate then adjust it up/down depending on excercise before/after, illness, any insulin left, level before you eat, fat/protein content. Over time its easier to adjust by a percentage depending on those factors. The science bit.

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brett said:
Hi gezza, very similar breakfast to what I have but also find I would need a snack 2 hours after. If I was to go got a walk afterwards I would have a larger snack or if within 2 hours I was walking an earlier snack. Like me you are probably insulin sensitive which is greatly exaggerated by the smallest bit of excercise causing quick drops. Either bolus less for breakfast and go for a walk before 2 hours, or bolus same and have a snack before walk 2 hours plus after bolusing.
Planning and adjusting is a great help and will soon find what works for you. Keeping a record also helps.
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Click to expand...

Hi Brett, thanks for that. I usually do have a mid-morning snack and mid-afternoon one, but I got up late so the whole day was shifted. I should have said I am T2 diet only and I though a bolus was a dance!! :crazy: I do keep records as I can transfer my Accu-Chek stuff to my PC and use the free software that came with it.

I guess what was behind my post was the fact that we are told to test exactly 2 hours after and yet my bG dives pretty soon after that. I suppose the 2 hours is approximate as we are all different?
 
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