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Post meal spikes

emmarw

Active Member
Messages
31
Type of diabetes
Type 1
Treatment type
Insulin
Hi,

Having received such good advice on my last question I though I'd try another. I am trying to get my postprandial spikes down. They aren't too bad between 8-12 but I've tried no/low carb, and am currently exploring low GI, but just wondered if anyone had any ideas. Also trying to increase my insulin sensitivity with more exercise........this is an ongoing challenge! My Hba1c is 42, so pretty good, but can always be better.

Thanks

Em
 
How long after eating are you testing? Most non diabetics can have a spike a hour after eating. Leave your testing till two hours.


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I've been messing around with this for most of last year as I was diagnosed with type one in early 2013. I made this account just now to post about this but I saw your thread so I'm just gonna put down everything I've learned here.

I guess I should mention I'm 20 years old, male 5'8" using Novorapid and Levemir just in case it matters to anyone. So I got really into lowering my Hba1c for obvious reasons, when I was diagnosed it was something like 16 in the old conversion which is roughly 151 in the units you're familar with. I tried going low carb I was eating less than 70 carbs a day not really sure how well that went but my blood sugars rarely went above 9mmol post meal and sat around 4-5 most of the day. My most recent Hba1c was 5.1 or a 32. So I'm sticking with that kind of diet.

Things I've found through my own trial and error and research (currently doing Bachelors in Applied chemistry and have easy access to and poured through scores of peer reviewed studies,). Hopefully this helps you out a bit so you don't have to start from scratch

- The GI index is lousy at best. It can be a decent guideline but for the most part it sucks, not accurate and there is far too much error varying from individual to individual. Not to mention it does not apply at all when you start to mix foods. Some countries have removed the GIycemic index from food labels as it was evaluated as being too misleading.
(http://ajcn.nutrition.org/content/98/2/269.abstract)

- Wholegrain is mostly a gimmick when it comes to slow releasing sugars and using the lousy GI index that most companies do makes it even more misleading; I tracked my blood sugars every half an hour after eating various foods and found that my sugars would peak at 13-14 with all wholegrain breads and cereals. They just don't work. Even with the high amount of fibre(possibly due to most of the fibre being insolube as opposed to soluble fibre?).
If you've ever studied metabolic biochemical reactions you know that a high surface area to volume ration like a powder reacts quite quickly and readily as opposed to larger volume solid pieces and when we really get down to it bread and other wholegrains are ground into fine powders and once in your stomach they disperse very quickly and you get the sugar spike. I have however found some success with whole oats but anything less than that such as quick oats or cut oats seem to behave more or less terribly.

- When I was first diagnosed my cholesterol was dangerously high even though I never ate high fat foods etc. Most people have the misconception that saturated fat causes heart disease when in fact having a higher on average blood sugar causes cardiovascular disease, anyhow I eat a high fat diet now and my cholesterol levels have been fantastic better than average in fact. So that heart foundation tick you see on many food products is pretty much bogus.
(http://ajcn.nutrition.org/content/early/2010/01/13/ajcn.2009.27725.abstract)
(http://onlinelibrary.wiley.com/doi/10.1111/j.1445-5994.1994.tb04444.x/abstract)
(http://www.ncbi.nlm.nih.gov/pubmed/11584104)

- There have only really been a couple of carbohydrate sources that I've had that have ever kept my postmeal levels fairly even and they include only blueberries, black berries, uncut rolled oats and legumes. Lentils are far superior than all of them. I usually sit at 4.1-5.5 before meals after eating about 300g of lentils as I do everyday for dinner my BS levels go from 4.1->5.0->6.0->5.5->4.x over four hours. The other foods go as high as 7-8 at around 2 hrs post meal and come back down.

I've just realised how much I've written so i guess I should stop here! Sorry for the poor formatting I just kind of dumped thoughts out as they came to me, I've tried to cite a few journals but I'm not familiar with this forums formatting options so they're just printed links.


EDIT: If anyone wants to know what my meals typically look like during the day or any other info I'd be happy to keep posting here.
 
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One of the things that helped me improve my postprandial bg readings was injecting 10-20 mins before eating. The idea that QA insulins can be given just before or after eating is totally wrong, if you look at the profile of insulins such as Novorapid and Apidra you will see they only begin to work 15-20 after injecting, also where you inject plays a big part in how fast the insulin is absorbed as insulin works fastest when injected in the stomach and least when you inject in the legs or bum, if you read Gary Scheiner's book he discusses the timing of injections.

The only time I do inject just before I eat or thereafter is if my bg is say in the low 4's or the meal is high in fat.
 

I followed this advice from noblehead before and it works


Blogging at drivendiabetic.wordpress.com
 
hale710 said:
I followed this advice from noblehead before and it works


Blogging at drivendiabetic.wordpress.com
Click to expand...


In as much as this is good advice, if you are not sure how much carb you are going to eat in the meal, then how can you bolus in advance? You would have to make a calculated guess at best or dish up the food, bolus for it and then wait 15-20mins before eating it. You would possibly have to adjust the carb ratios as well I would think.
 
Oooo thanks for all those replies, I think I might try the inject 15 mins before and see what happens. I test 1 hour after- on advice by DSN as trying to conceive so important to track when it is highest and lower it! Eat about 100g of carbs a day and use carbs and cals ap so can predict the amount in a meal.
Omar101, wow lots of info there, may take me a while to digest it all!!! (no pun intended) my cholesterol is also slightly raised, so Im trying to lower it with diet and exercise, tried eating porridge for b.fast with whole oats, but got huge spikes from that so back to multi grain bread. Its amazing who different people are and what they can tolerate.

Thanks everyone
 
as others have mentioned, get your insulin in well before actually eating, this will let the insulin get going and be ready for the glucose from your meal.....

its all about trying to match the insulin action to the digestion action............you might find you need more or less time for different meals, so experiment......

I personally have went up to 45 minutes, now I am 30 minutes for all meals......
 

I have the same problem with porridge, so, if I'm not at work, I have porridge then go for a half hour run or cycle, half an hour after eating. Today before porridge 5.8, after my cycle (40min.), 5.4, before lunch 5.9. If I'm working, I bolus half an hour before the porridge and it keeps the spike down.
 

I use this at home where I know my portion size etc. not practical out and about always! But at home and at work to some extent it is a useful tip


Blogging at drivendiabetic.wordpress.com
 


If your not sure then yes it's best to wait for the food to be served and then bolus, I would do this when eating out in a pub or restaurant as portion sizes can vary. At home I know in advance how many carbs I'll be eating as I'm either cooking the food or my wife is and she weighs my food before serving (pots, rice or pasta etc) so injecting ahead isn't a problem.
 
I did have a go at bolusing for 10g carb in advance but when sitting down to eat, I forgot that I had already done part of the bolus and bolused again for the whole amount and then went a bit low 2hrs later so you've got to keep your wits about you especially with a pump

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Hi all, been reading this very interesting link, I'm a bit confused, I take Novarapid , and my dn said to inject 5 mins before food, which I've always done, as I was worried I might have a hypo, if I didn't get food into me quickly enough, now today, I was out shopping with a friend, we had lunch on the go, I only eat a half an egg sandwich( don't usually eat bread) and a bottle of water, I gave myself 8 units, when I got home and tested my BS was 10.8, I thought I was more than covered for the carbs, any answers anyone,
 

Depends upon what your bg was before your lunch and how soon after eating you tested your bg, might also be you underestimated the carbs in the sandwich despite only eating half, either way if it's a one-off I wouldn't be worrying too much about it.
 
Ooo ve

Interesting and lots to look into. I looked at GI to help with the post meal spikes probably about 10 years ago, but I think I read stuff about low GI to mean that you should eat more wholegrain food and I took that as more unprocessed whole grain food (so not ground down grains)…so I have a granary bread, one of the really seedy sorts and that seems to stop me peaking so high after food. Like you, for me proper porridge (not ready brek) is the one that works best for me in the morning producing the least highs afterwards (depends on whether there is a morning phenomenon going on in there or not - this morning - without the old morning bounce in the rise in my sugar was about 1.5mmol - I have cgm so can see it all). I also find pasta seems fairly stable afterwards for me. Beans, lentils and pulses - makes sense that they burn slower too. The Canadian article didn't say that GI was a waste of time for diabetics (it was more positive than that), just for non-diabetics and when companies label their foods as it can be misguiding. Try bulgar wheat for your post meals…that is the only food that I need to inject as I eat it or I go hypo after! - but I know we are all different and our bodies can behave differently (wish I liked lentils!). Your control is amazing and I do think that diet is a big area that gets missed out in teaching us lot to manage our diabetes - they show you how to count carbs and give insulin but it is way more complicated than that - so do keep writing as I am interested, I want to look at fat and proteins and how they effect blood sugar too - but not really done much digging on that yet.

Completely with everyone on trying to inject earlier - I inject between 15 and 20mins before I eat which does help to stop big peaks and is probably the easiest thing you can try to do.
 
For anyone who cares to know and would like to critique:

I've kind of been playing around with numbers and average blood sugars in the past few days, since I have a bodybuilding lifestyle and I've maintained my lowish carb diet to mainly lose weight (I've cut to about 9% bodyfat). I'm planning on bulking up and adding mass very soon and as most people know to lift heavy and add mass effectively one should consume a higher amount of carbs.

I'm planning on consuming st least 200-250g of carbs a day, now to mitigate the spike that these carbs will cause; whether they are fairly slow releasing or not(I haven't personally experimented with the difference in bs spikes of eating 30g vs eating 100g of the exact same carb in a sitting.) I want to try implementing an "intermittent fasting" type of approach or at least play around with it.

Basically this entails eating all my carbs for the day either in one meal or within a 4(maybe 6) hour window and eat protein and fat only meals for the rest of the day as normal. What I hope this does is give me one spike and then flat bs levels during the entirety of the day. As opposed to having 3 or more carb filled meals resulting in multiple spikes and insulin shots during the day.

From a *very* rough mathematical standpoint where a bs spike is up to 14mmol/dL either from a less than desirable carb source or from the sheer volume of carbohydrate and average fasting bs are within 4-6 (so say an average of 5). And an average bs spike lasts about 2 hours. A 24 hour day of bs levels gives the averages:

1 carb meal with 2hr spike:
((2x14)+(22x5))/24 = 5.75mmol/dL average blood sugar; which gives an a1c of 5.3%(http://professional.diabetes.org/GlucoseCalculator.aspx)

versus

3 carb meals with 2hr spikes:
((6x14)+(18x5))/24 = 7.25mmol/dL average blood sugar; which gives an a1c of 6.2%

and best case scenario keeping spikes below 9mmol/dl (very doubtful):

1 carb meal with 2hr spike:
((2x9)+(22x5))/24 = 5.33mmol/dL average blood sugar; which gives an a1c of 5.0%

worst case scenarios:

1 carb meal with 4hr spike:
((4x14)+(22x5))/24 = 6.9mmol/dL average blood sugar; which gives an a1c of 5.9%

3 carb meals with 4hr spikes:
((12x14)+(24x5))/24 = 9.5mmol/dL average blood sugar; which gives an a1c of 7.6%

Of course this bit of arithmetic is all very rough and doesn't account for differences between individuals, accidental over/underdosages of insulin and any other kind of mishaps and unforeseeable events which do often occur with bs management. I'd like if someone could give a critique of this or some of their own experiences with this kind of thing.
 
Love the maths I guess I am your 3 carb meals with 2 hr spikes less than 14 and I think my HBA1c from my averages should be low 6's maybe into the 5s….I am not spiking as high as 14 after meals then I do try and eat pastas and avoid really high sugar stuff and mash, and inject about 15-20mins before I eat…so my spikes are 8/9/10, sometimes negligible and then on the odd occasion at that 13/14 level (my sugar level since being on cgm rarely goes over 11 now). So as you said the other stuff is probably what adds quite a lot to our HBA1cs - how much were you going to allow for it. It would also be lovely if our insulin doses were static but I find that it can change fairly regularly, but then I also what to stay on top of any changes so once I see a pattern I start reacting to it…and I guess that comes into all the other bits - would you add 10 or 20%.
 
Glad you enjoyed the post, I went with the spike of 14 because of either the portion size required to eat 250g of carbs in one sitting or simply the quality of carbohydrate that would allow you to eat that much in one meal.

That kind of meal plan obviously isn't for everyone and is a very bodybuilding/macro-counting oriented approach to minimising average blood sugar while maximising carbs consumed. The most efficient balance for a low Hba1c would be to eat low carb with all carbs in one meal ie: the best case scenario.

I feel the margin of error would be impossilbe to calculate without the statistical data of a few thousand type 1 diabetics and seeing as most don't eat like this and have a largely varying diet of different kinds of carbs/fibre and eating habits the error could be greater than 50%. A better way to look at it would be that the above calculated average blood sugars are the absolute minimums(best) blood sugars you can achieve with your particular kind of meal plan where the lax in your own discipline or other unforseeable complications account for any higher average levels.

I know from my own experience of eating only 70-100g of carbs a day, about 30-50g each at breakfast and dinner (2 meals) with only meat, cheese and leafygreens at lunch my fasting blood sugar was around 5 and post meal was usually at 6-8(avg 7) at 2 hours so mathematically: ((4x7)+(20x5))/24 = 5.33mmol/dL which translates to a theoretical Hba1c of 5.0% and my actual Hba1c was 5.1%!!! thats an error of only 2% (I did have the odd hypo and the odd hyper)
So I imagine with very consistent control you could easily see an error of only 10%

So I'm going to try replicate my last Hba1c with 1 meal of high carbs; allowing for a higher spike of 9 which conveniently gives the same result
1 carb meal with 2hr spike:
((2x9)+(22x5))/24 = 5.33mmol/dL average blood sugar; which gives an a1c of 5.0%
Click to expand...

But like I said this kind of thing isn't for everyone, I know there are those who struggle to keep their levels below even 8 or 9 due to other complications. I imagine that this fasting approach could help those who are stuck at Hba1c's of 6 or 7 who need that extra little change to join the 5% club. Or for bodybuilders and athletes who need the high carb count but don't want to damage their bodies just to achieve it.

EDIT: formatting
 
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I'd suspected this as a lot of people on the LCHF diet are finding that their lipid levels are good. Personally I feel that it is high BG levels that are the culprit. This is when Diabetics have an advantage over non-Ds. There are an awful lot of people going about with too high BG levels and might never know it.
 
Hi Omar 101, just been reading your reply,a bit complicated for me with all the maths, and not being a bodybuilder, and being a female, I would like to know what foods you are eating, I am on low carbs, I try to keep them below 50-70, I give myself 1 unit of Novarapid to 10 carbs, but it doesn't seem to keep my BS down, so I am now experimenting with 1 unit of NR to 5 carbs, see if that makes a difference, like you, I love lentils, in fact any type of beans, but, I would be interested to know what your diet consists of, as your levels are excellent
 
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