spikes

I'm guessing your DSN isn't diabetic? So actually you know a great deal more about the subject than this person does (but not a good idea to say this!)?

The fact is that - depending on what you eat - your blood sugar may spike at different times after eating. The only way you're going to know this is by testing, at 1, 2, 3 or greater hourly intervals, again depending on what you're eating. Different foods affect people differently, and the Glycemic Index is a good starting point for more information: http://www.glycemicindex.com/ But remember it's only a starting point, I have quite different reactions to some of the foods on the list, only by eating and testing will you be able to work out how they affect you.

Another fact is that unless you are really prepared to restrict your carbohydrate intake, you're going to have to live with SOME post-meal spikes. Mind you, this can be minimised with a bit of practice. I had a huge pizza the other night, bg started at 5.8 and for 8 hours following never went over 7.7, just within my personal limit. Nonetheless not too bad for a T1, and it was a HUGE pizza!

Something else to consider is changing insulin to one that better suits your diet and lifestyle. I did this very recently and couldn't be more pleased with the results, although not for the reasons originally intended. Might not be a great idea to scare your DSN too much though...

neededthat said:

i recently bought up the topic a 2 hour testing after meals with my dn, to which i was told i shouldn't be testing then as insulin is still doing its job which i knew.

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Needed,

I have never heard anything so stupid, are you sure she is a qualified DSN?

Of course you need to test after food, it is essential to know what impact the food you eat is having on your glucose levels, there is no other way apart from testing. Only by testing every hour up until your next meal-time can you be sure that you have the correct ratio of insulin to carbs. As Kegstore states, the glycemic index is a excellent tool to understand what impact certain foods have on post-meal bg's. A meal consisting of medium/low gi foods will limit the spikes to which you have been experiencing, provided you have the correct insulin match in place.

I too eat around 100-130g of carbs( most days nearer to 100)eating foods that are lower in the gi table. I have had excellent results to date, and usually stay between 5-7 post-meals, occasionally no more than 8, but pre-meal time I tend to be back down to 5-6, which is where I want to be. More and more diabetics are using the gi/gl approach to manage their diabetes, it is less restrictive than a strict low-carb diet, and I believe much healthier too. By reducing carb intake together with the low gi/gl approach, good control is achievable.

Go back to your diabetes clinic and ask to see another dsn, should this not be possible ask to speak with the consultant, stating that you are not happy with the advice you have previousely been given.

Good luck and hope all goes well!

Nigel

neededthat said:

cheers for the replys i'll look into gi/gl foods, i do test after 2 hours anyway lol, i have had a change of dn as my diabetes care has been moved to a local diabetic clinic since. and what is better the dn is the pump nurse and have enquired about one she dosn't think there would be a problem for me having one i have appointment to see the consultant for a few weeks to see him/her.

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Hopefully you will get a different response from your new dsn. Good luck with everything, do come back to us on your progress.

Nigel

neededthat said:

i recently bought up the topic a 2 hour testing after meals with my dn, to which i was told i shouldn't be testing then as insulin is still doing its job

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Hmmm, makes me wonder why NICE bother issuing recommendations for BG levels pre meal and 2 hours after. Still your DN obviously knows best eh? :roll:

Did her/his wisdom extend to telling you when you should be testing and for what reason? I always thought I was testing pre and 2HA a meal to determine what effect that particular meal had on my bg levels. I am aware that some foods take longer to 'peak' than others but I have only learned that through testing.

They clearly talk fast in order to distract you from costing money and spout a great deal of rubbish in the process. :roll:

Whilst it is good that we have the benefit of the accumulated knowledge of the members of this forum it is appalling when you realise that the vast majority of people with diabetes have not got a clue and are therefore at the mercy of the ‘bean counters’. :shock: :evil:

Hi...I have found this thread really useful..and will pursue teh \Gi.gl approacha bit more.
I wondered though, does anyone know what a non diabetics bg does post meal. I understand that they too will be affected by what they ate, but I seem to remember froma friend who who had gestational diabetes, that anything under about 8 was "normal" after a meal.

Would be keen to know if anyone knows different...as my info is a half remembered conversation a few years ago!

Sugar2,

I am sure that people without diabetes can fluctuate between 4.5-7/8 post meal times. All depends on food eaten and amount etc. I know when I did the DAFNE course, the tutor tested herself 1 hour after lunch and was 7.1, and as she is not diabetic, so it proves that we are all effected by the foods we eat.

Nigel

sugar2 said:

Hi...I have found this thread really useful..and will pursue teh \Gi.gl approacha bit more.
I wondered though, does anyone know what a non diabetics bg does post meal. I understand that they too will be affected by what they ate, but I seem to remember froma friend who who had gestational diabetes, that anything under about 8 was "normal" after a meal.

Would be keen to know if anyone knows different...as my info is a half remembered conversation a few years ago!

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This is from a post I made some time ago
(70-140 is 3.8-7.7mmol/l and is considered the 'normal' range by the American diabetes association and as shown below people were within those bands almost all the time but some did for short times have higher or lower levels)

Continuous glucose monitoring now makes it possible to demonstrate what happens to normal and diabetic peoples BS during the course of the day.

A recent pilot study, ( it was aimed at developing a methodology to answer the question 'what is normal glycemia? ) 'included 32 subjects, non diabetic by all criteria, their mean HBA1c was 5.3%.
The subjects wore a monitor for 30 days.
The mean BG was 102(+,- 7)
maximum 186 (+,-20, )
minimum 39 (+,-13.)
The subjects stayed within a range 70-140 for 93%( +,- 5 %)of the time
They were over 140 for 4% (+,-4%)of the time
When over 140 they were only at that level for an average of 0.7 of an hour (range 0.4- 1.4 hrs)
They were under 60, 1% of the time (range 0-4.4%)
(all figures mg/dl divide by 18 to get mmol/l, I hope that I've got the figures right but you cancheck them yourself if you want to )

The BG profiles over the day were much flatter than a comparison set of insulin treated diabetics. There is one graph which really demonstrates the difference between a normal person with an HBA1c of 5.1% and a diabetic with one of 7.3%
http://professional.diabetes.org/Conten ... 0401-P.pdf

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phoenix said:

A recent pilot study, ( it was aimed at developing a methodology to answer the question 'what is normal glycemia? ) 'included 32 subjects, non diabetic by all criteria, their mean HBA1c was 5.3%.
The subjects wore a monitor for 30 days.
The mean BG was 102(+,- 7)
maximum 186 (+,-20, )
minimum 39 (+,-13.)
The subjects stayed within a range 70-140 for 93%( +,- 5 %)of the time
They were over 140 for 4% (+,-4%)of the time

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Interesting stats phoenix, higher than I have read in other posts on the forum.

Thank you!! That was interesting. The thing I found most surprising was the amount of time none diabetics were in their "higher BG" zone. It is good to know what to aim for. My diabetes team, probably for nice, if misguided reasons wouldn't tell me this, saying, you are a type 1, you can never achieve this. OK, so they may be right, but I am not going to get depressed about "failing" but celebrate getting close! (If I ever do!)

Thank you for the information

Hi, I've had type 1 for just under a year now, and add i love this site.

most of the time my bg is ok , my first blood test at Christmas was 5.7, so i was very happy with that.
My question is, when after two hours you test yourself and it is higher, do you do a correction then or wait until later, say the four hour period to see if it comes down? and if you do wait , are the sugars doing you damage for those few hours before it comes down.

sunflower333 said:

My question is, when after two hours you test yourself and it is higher, do you do a correction then or wait until later, say the four hour period to see if it comes down? and if you do wait , are the sugars doing you damage for those few hours before it comes down.

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It depends on what insulin you are on, and to a lesser extent what you ate that caused the spike. I am unlikely to correct at 2 hours unless I have a very good reason. A temporary excursion into the "danger zone" is probably not going to cause too much harm, but anything you can do to reduce this exposure has to be a good thing.

thankyou kegstore

I'm on Novorapid.... 2/3 units for breakfast, 3/4 lunch and about 5 units for dinner (my worst time )

and 8 units at night Lantus.

sunflower333 said:

thankyou kegstore

I'm on Novorapid.... 2/3 units for breakfast, 3/4 lunch and about 5 units for dinner (my worst time )

and 8 units at night Lantus.

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so if I get this right you're on basal/bolus, which means ignore the Lantus (your basal) and focus on the NovoRapid.

I was on NovoRapid for about 5 years, and have to say I never liked it very much, it always seemed very slow to kick in when I wanted (or needed) it to, but it also hangs around for quite a while which limits the correcting you can (or should) do early on. Occasionally it sent my bg plummeting into massive hypo territory for no discernible reason so I was very glad to change quite recently, my overall experience with it: erratic (and that's being very kind).

Although these timings will vary from person to person, NovoRapid starts working 15-20 minutes after injecting, peaks at around 90 minutes and can still be around 4-6 hours later which as I said limits your correction options before then. Are you carb counting, do you know your insulin/carb ratio and correction sensitivity? You need to take these factors into account and may need to do some experimentation with small correction dose numbers and monitor the results.

Another thing to throw into the mix - for the ultimate confusion - is the GI of what you're eating. Lower GI foods such as pasta, pulses and rice take much longer to raise bg levels - although again this varies between individuals - so you have to spread your dosage over a number of hours. Easy on a pump, less so if not.

So lots of variables to take into account, my advice would be to change just one thing until you get the result you're after, then move onto the next. Hard work, but definitely worth it.

sunflower333 said:

Hi, I've had type 1 for just under a year now, and add i love this site.

most of the time my bg is ok , my first blood test at Christmas was 5.7, so i was very happy with that.
My question is, when after two hours you test yourself and it is higher, do you do a correction then or wait until later, say the four hour period to see if it comes down? and if you do wait , are the sugars doing you damage for those few hours before it comes down.

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Sunflower,

The recommendation is that you don't do corrections between mealtimes. So say you had your breakfast at 08.00, then 2 hours later were a little high at 9.5 say, what you should do is ignore this and test again before lunch, should you still have a high reading then have your food and include a correction dose with your normal insulin.

A correction dose of 1 unit of quick acting insulin such as Novorapid is suppose to lower blood glucose by 2-3mmol/L, so I would include a correction dose here of 1 unit. Do bear in mind though, that this is a rough guide, as you are recently diagnosed, and may still be in the honeymoon period, you may only need 1/2 unit to have the same effect.

The only way of knowing how to do correction doses is by trial and error. It is important that you start at the lowest dose possible and test accordingly, only by testing your bg will you know that you have it right. In the event that you are experiencing frequent high on the 2-3 hour mark, it means that you have not got your insulin to carb ratio correct, so you need to look at your previous meal and work out where you went wrong.

I wouldn't worry to much about the occasional high whilst you are trying to overcome this difficulty,I am sure it won't take long before you are on top of things again.

Nigel

thankyou for your kind replys.