Queries & Mysteries

[LionChild]

I cant quite understand the following:
I am on a very low carb diet, mostly salads, with fish, chicken or eggs etc. and only need 1 unit for each meal usually, and 3.5 units each day for Long acting levemir.
Yet it is clear when I have something like half a shop bought lasagne which is about 46 carbs, (in total, so actually I have half the lasagne (23 carbs), with plate of salady stuff), that I need around 5.5 units for that which would seem to indicate (from what I have read on line), that my carb-insulin ratio is higher than is average? It looks from this, and from the 40 grams of porridge I had earlier today, which apparently is 36, carbs, that the 5 units of insulin was not enough because, after 20 minutes on my bike, this still went up to 10.1.
I know there is this 'rule' that it is after 2 hours of eating that the measure is significant, but does this rule mean that what happens after less than 2 hours, is not relevant? (unless of course you have to treat a hypo?)
When the doctors talk about 'complications' if your blood glucose goes high (and maybe stays high for say 40 minutes or so), what then is the indication if BG goes high within say, half and hour of eating?
Also, there seems to be so many things to take into account when assessing how much insulin is needed? GI, GL, carb count, exercise, stress, etc etc.... All this 'does my head in'! It seems all the official accounts of how to manage this condition rarely tally with my own experience!
My A1c was last time, 42, and my average Libre readings are about 6.7. The doctors are very impressed, saying the figures look like I do not have type 1 diabetes at all....
But although these figures are encouraging, it is clear to me that if I were to have more carbs, that ratio would shoot up! So although the doctor is impressed with my figures, those figures are only good because of the low carb diet, and in fact I seem to still need a fair amount of insulin for food other than low carb.
By the way, last time I visited the hospital I was told there was still a fair amount of insulin being produced...not using the blood C-peptide test, but the urine, implication one. (if you know what I mean?)
Any comments would be welcome. Thank you.

 

[ert]

The two-hour rule doesn't work when you're injecting insulin as unlike normal insulin, injected insulin has a fixed curve which doesn't match what you eat. If you're eating normally then you will spike your BS's but they should return to where they started 4 to 5 hours afterwards. On DAFNE they say only test your blood sugars before eating and 5 hours afterwards and ignore the spike.

As you're still producing a fair amount of insulin, you only need small doses of extra insulin, and your dosing can vary on a daily basis. It's important to follow the numbers, and not be afraid to split your fast-acting doses if your BS's are running lower,

 

[LionChild]

The two-hour rule doesn't work when you're injecting insulin as unlike normal insulin, injected insulin has a fixed curve which doesn't match what you eat. If you're eating normally then you will spike your BS's but they should return to where they started 4 to 5 hours afterwards. On DAFNE they say only test your blood sugars before eating and 5 hours afterwards and ignore the spike.

As you're still producing a fair amount of insulin, you only need small doses of extra insulin, and your dosing can vary on a daily basis. It's important to follow the numbers, and not be afraid to split your fast-acting doses if your BS's are running lower,

Thank you Ert. So this would seem to mean that I am overly concerned when it spikes at 30 minutes after a meal......So I am making this harder work than it needs to be? This might also indicate that my actual ratio might well be more like something like 1:10, insulin to carbs after all...?

 

[ert]

Thank you Ert. So this would seem to mean that I am overly concerned when it spikes at 30 minutes after a meal......So I am making this harder work than it needs to be? This might also indicate that my actual ratio might well be more like something like 1:10, insulin to carbs after all...?

Even people who are no longer producing their own insulin can have a different carb ratio for every meal, as they experience IR due to hormones or insulin sensitivity due to being active. I am more IR in the morning, or when I have my first meal of the day, and hardly need any insulin at night-time.
The medical professionals say to eat normally and ignore the spikes, as they aren't for an extended period of time. I eat low carb, for me, so I can dose less insulin, not have to deal with so much variability from spikes, and lose weight. My DN doesn't promote my choice but works with me.

 

[LionChild]

Even people who are no longer producing their own insulin can have a different carb ratio for every meal, as they experience IR due to hormones or insulin sensitivity due to being active. I am more IR in the morning, or when I have my first meal of the day, and hardly need any insulin at night-time.
The medical professionals say to eat normally and ignore the spikes, as they aren't for an extended period of time. I eat low carb, for me, so I can dose less insulin, not have to deal with so much variability from spikes, and lose weight. My DN doesn't promote my choice but works with me.

Thanks again Ert. I can see you really know what you are talking about! What then is the point of the diabetic nurses and consultants encouraging a 'target' for BG, in my case between 3.9 and 10mmoles when it is pretty obvious that if I were to eat normally, there is very little chance of my staying within that range, and even on my salady regimen, sometimes I go above, inevitably during that period of time you mention of 4-5 hours after eating....?

 

[In Response]

Different foods spike at different times. Those of us taking insulin know this because we use fast acting carbs to raise our blood sugars fast when we have a hypo.
As @ert mentioned, injected insulin peaks at a fixed time. Some f us try to match the insulin peak with the carb peak. We do this through pre-blousing and sometimes, double blousing when we eat food with a long digestion rate such as pizza or curry.
If you don’t do this, as you have seen, you may see a peak blood sugar after eating. My understanding is trying to avoid the post meal peaks is ideal but ideal is not always possible.

 

[LionChild]

Different foods spike at different times. Those of us taking insulin know this because we use fast acting carbs to raise our blood sugars fast when we have a hypo.
As @ert mentioned, injected insulin peaks at a fixed time. Some f us try to match the insulin peak with the carb peak. We do this through pre-blousing and sometimes, double blousing when we eat food with a long digestion rate such as pizza or curry.
If you don’t do this, as you have seen, you may see a peak blood sugar after eating. My understanding is trying to avoid the post meal peaks is ideal but ideal is not always possible.

Thanks, 'In Response', but I have never heard this expression, 'pre-blousing'. What does it mean?

 

[In Response]

Thanks, 'In Response', but I have never heard this expression, 'pre-blousing'. What does it mean?

Pre-blousing is taking your bolus injection before eating.
The usual advice is to bolus 15 minutes before eating but some of us find our insulin takes longer to start working so we inject earlier. To make things more complicated, some people experience insulin resistance at certain times of the day (most commonly morning) so they may need to inject earlier at these times.
This allows us to match the carb digestion peak closer to the insulin peak.

 

[MangosteenElbow]

Agree with above when I was MDI but, there's more ...
Multi injecting for a meal added to woes around injection sites and regular adjustments.
It gets more complicated if exercising intensely, or for extended times, or both.

The feature on my pump for extending the bolus has been very helpful. It's arguably more beneficial to me than the CGSM in.the pump unit because it actually helps reduce "time under the curve", not just show it.

Keto has reduced spikes and insulin needs to about 18% pre keto, and I'm exercising roughly 5 times more, with so many good flow on effects.

Each to their own, it's a journey, helped by learning from our peers.

 

[Cal M]

The two-hour rule doesn't work when you're injecting insulin as unlike normal insulin, injected insulin has a fixed curve which doesn't match what you eat. If you're eating normally then you will spike your BS's but they should return to where they started 4 to 5 hours afterwards. On DAFNE they say only test your blood sugars before eating and 5 hours afterwards and ignore the spike.

As you're still producing a fair amount of insulin, you only need small doses of extra insulin, and your dosing can vary on a daily basis. It's important to follow the numbers, and not be afraid to split your fast-acting doses if your BS's are running lower,

Thanks , this may have answered my question on bg testing with basal insulin. Not done a Daphne course and all other forum members seem to prefer testing 2hours after meals. 5hours makes more sense, I can review my Bg test on that basis.