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Post prandial blood glucose rise as a missed complication

M

Maundown

Member
Messages
8
Hi
I have type 1 diabetes and am managed well with CSII and CGM. I exercise well and I eat OK. Christmas is always an issue!!
I have developed, over the last 2 years, a significant postprandial (after a meal) rise in my glucose. I can't prevent it. I bolus 20 mins before I eat. If I go longer I go hypo before I eat! I still get the rise to around 9-10mmol/L an 30-60 mins after the meal. I can't bolus more as it will make me hypo later. I just have to wait for it to come back to my usual (5-7mmol/L).
There is a drug in US called Symlin (www.symlin.com) that could manage this. I want to try it but it is not available in UK. The company who produce it in US (Amylin) are not big enough to trial it over here. Anyone got any ideas how I can get it and try it out? :)
Does anyone else have postprandial hyperglycaemia? Is it an issue (yet)?
Thanks
 
Re: Post prandial blood glucose rise as a missed complicatio

What bolus are you using? some are faster than others... you could try Apidra I have found this to be the best at managing +1 hour spikes as it has real kick between +45 - +90 mins.

Secondly you could look at the type of carbohydrate you are eating and replace fast acting carbs with slower release carbs.. or you could look at the balance between carbs and fat in the meal.. higher fat meals tend to slow the processing of carbs.. just replace 2.5g of carb with 1g of fat... so if you cut 25g's of carb you would add 10g's of fat...
 
Re: Post prandial blood glucose rise as a missed complicatio

Many thanks. Congratualtons on your HbA1c. Very impressive. Mine are usually in the low to mid 6s.
Yes, I do use Apidra in the pump. I use continous insulin infusion via a pump. The bolus I use depends on the time of day and is, of course, related to the CHO load. I try to balance fast and slower acting carbs and try for lower fat as the complications of higher fat content are discouraged.
 
Re: Post prandial blood glucose rise as a missed complicatio

To be honest I don't know of many people that even test at that point after a meal. Since most people also don't have any access to a CGM they won't know what their level is at 30min post prandial. The evidence from the DCCT suggested that lower risks were from having lower HbA1cs and that it didn't make any difference how that was achieved (whether it was lots of spikes, or a flatter profile ; the post prandial readings in that study were taken at the 2 hour point)
Have you experimented with using dual wave boluses, varying the amount you give 'up front'?
 
Re: Post prandial blood glucose rise as a missed complicatio

Well, for example, pregnant women should monitor +1h pp levels, so I don't think it's quite that rare.

As for the spikes, you could try foods not quite as low in fat (fat slows the absorption of carbohydrates) but since the glucose released by the liver when eating may be the issue here this may not work (thus the Symlin hormone approach).

I'd suggest, and I expect that I'll one of small minority to do so, to speak to your consultant about this.
 
Re: Post prandial blood glucose rise as a missed complicatio

Hi

I also use a pump. Although I've done a bit of basal testing what I have done to make my bg levels balance out every 2hrs is alter my basals and alter my carb ratios. Ive deliberately altered my lunchtime 12pm, 1pm basal to be higher to cope with the rise up in bg. Ive also adjusted the carb ratio too. The drawback is that I do have to remember to eat within certain time frames but that's no big deal to me as I eat my lunch at lunch and eve meal is nearly always around the same times as well.
Some of basal rates are higher and some of them are lower. It all comes alright on the night :) .......

If you dont want to do that, then you could look at some other forums which mention the use of the Super Bolus.
 
Re: Post prandial blood glucose rise as a missed complicatio

It would be interesting for people to record a pre-meal glucose and again 60 after completing the meal, just to see what happens. If you don't test you don't know! Those with CGM could just look at the trend but do the test anyway to be more accurate and up to date. Worth a small trial and see what we get?
 
Re: Post prandial blood glucose rise as a missed complicatio

I typically get 6.5ish mmol/l one hour after a meal, and only very rarely above 7.8 mmol/l after 1h.
 
Re: Post prandial blood glucose rise as a missed complicatio

Wow, lucky you. Something is not right with me. Might mean a trip to see the consultant as I know more than my GP! It's a real pity that the NHS is cutting back on diabetes services at the hospital and pushing diabetes out to community care ie GPs. Good luck.
 
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