Struggling post lunch highs

The_Dog_Lady said:

I have been having problems with my sugars post lunch for the past few months. I did a fasting bloods from 12pm - 4pm my sugars were perfect 5.2 - 5.6. my diabetic team have told me to give my insulin 15-20 mins before I eat or try extending my insulin over a 15 minutes time frame before eating. Nothing is stopping my sugars from rising up to 14 an hour and a half after eating.
My carb ratio is currently 1 unit to 11g of carbs. My diabetic team are not happy about me changing my carb ratio too much as when they calculate what my ratio should be it comes out as 1:15g.
I did try having my insulin an hour before eating, my sugars were stable ( freestyle libre graph showed this ) but yet again 1 1/2 hours after eating my sugars peaked in the mid teens.
Having tried everything my team have told me I at a complete loss as to what to do, any ideas?

Dog Lady

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Hello @The_Dog_Lady

You're using the Libre which should make solving this a lot easier.

-What are your BG's like 4 hours after finishing your meal?
-What bolus insulin are you using?
-Is this happening with all different foods your having for lunch or just a specific meal?
-How are you counting your carbs and are you confident you're accurate?

Post-prandial spikes can be a disaster, and most of us find that taking insulin in advance of starting your meal and choosing lower GI foods work well.

The_Dog_Lady said:

Thanks replying to me.
My spikes are always 1 1/2 hours after I have started my meal.
I'm on the accu chek combo pump so am on novorapid - I did find eating 20-30 grams of carbs did not give me a huge spike but that's gone this week. I usually only have 30-40g of carbs for lunch.
I have been using the app myfitnesspal. I am even carving for my carrots and tomatoes when I have a salad. Even if I have bread etc where I know the carbs are accurate I still get the dreaded spike.

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That's no problem Oh, and a warm welcome to the forum - I've only just noticed that these are your first posts - apologies!

So where are your BG's 4 hours after eating?

If your BG's are in range 4 hours after eating, then your carb counting is accurate and the spike is likely caused by the GI of what you're eating. There are ways round this though, such as to increase the time between bolusing and starting your meal. I am on MDI, but the principle is the same and as an example; I need a 35 minute pre-bolus for bran flakes. If I was to eat a sandwich for example, I'd still need to wait about half an hour before starting eating - for the best results.

Your other options are to substitute what your eating for something with a lower GI: wholemeal bread instead of white, sweet potato instead of potato, etc. Things like sweet potato can actually require a bolus after eating, or in your case a multi-wave/dual wave/combo bolus due to the slow rate at which the carbs turn to glucose. Excuse my pump terminology; I can't guarantee it's accurate!

Then there is the addition of fat to dampen the spikes, although I'm not a huge fan of this method. So you could add some cheese, mayo, nuts, etc to whatever you're eating. Even olive oil on your side salad can potentially make a difference.

I find that I can minimise spikes massively if I bolus in advance, and that's pretty much the only technique I use. Sometimes it's really difficult to entirely eliminate post-prandial spikes; but remember that non-diabetics get them too - so don't be too hard on yourself. The important thing is that you're back in target at 2 hours and remain there

Also have you confirmed the Libre read out against a BG test with your meter? I have found that at highs and lows both tend to be exaggerated somewhat.

If you are guaranteed to eat at a set time you could increase your basal 2-3 hoyrs before that 11/2hr peak but... and a big but ... you are tied to the eating times then.... and you must eat on time... you dont have to increase it hugely... eg

I always needed more basal before tea on a pump. (Cant do now I'm back to mdi) that allowed my tea not to spike me. I always ate at the same time ish.. within 30 mins but I needed to adjust two hour block..

Split your bolus. 1/2 then 1/2 one hour later. Low doses more often works for me. Cover spikes late and stops lows

Kristin251 said:

Split your bolus. 1/2 then 1/2 one hour later. Low doses more often works for me. Cover spikes late and stops lows

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1/2 one hour later is not going to be at peak working for 2 -3 hours so according to OP and her rise timings its not at the right time.

Agree food and carbs can affect rises but the OP looks like trying on that..

It is normal by the way for peaks to be higher at 1-2 hours.. but with a pump this should be more manageable.

With a name like that I've got to comment! LOL

As most have already asked we really need to know what your 4hr mark level is like. If that's back to normal then the dose is correct so it has to be down to timing, how about trying FIASP?

Not wonderfully practical but it seems that Novorapid works best if injected about 45mins before eating a main meal as this gives it a kick up its rear end. I couldn't be bothered to do that simply because I never knew what the carb content was going to be until I saw it on my dinner plate and it would have made life difficult for me serving food for my OH to eat and me waiting 45mins before I could eat.
What I ended up doing was adjust the basals a bit more (the Combo has 24 time slots) so although this makes eating of food within set times, this wasn't that much of a problem as it was the effect that insulin had on controlling my bg that mattered and not what insulin combination I was using. Sadly pumps don't work miracles so it's best not to get knickers in a twist. I never used the hospital carb ratio of 1u to 20g because it just wasn't enough so my friend advised me to use my MDI ratio of 1u to 8g and test bg levels every 2hrs and adjust as I went along. This worked much better and I started to enjoy using a pump.
I now use a different pump and still adjust the basals as I need to. I will most likely change to Fiasp next year so thst will be a different ball game for me to play with. Until that time comes, I will just eat a low to moderate amount of food every day as that helps pumps work a bit better without all the other faff. I use dexcom sensors and an app that I can enter my food, insulin and it picks up the Dexcom data and guides me when my levels will drop and also tells me how much carb I will need to eat and at what time. Brilliant.....yes it most certainly is!

I always take my novorapid via my Insight at least 30mins before I eat, if my BG's are slightly higher then 45mins. I always use multiwave bolus too normally set for me to 1hr 15mins but extend this depending upon the food I'm eating.

I do not eat bread anymore as whatever system I choose for bolus, or bread type I choose, I always go high after eating bread.

Hi there had very similar issues when I used Novorapid was pre bolusing upto 45 mins in advance for some meals and still had very high post meal readings at the 2 he mark especially at lunch times. Since changing to Fiasp my post meal readings have greatly reduced and now pre-bolus between 5 to 15 mins on average before eating (pending on the GI value of the food). Still need to pre bolus slightly more in advance for breakfast prob down to the fact that as soon as I put my foot to the floor in the morning I start to rise but can live with that

The_Dog_Lady said:

My carb ratio is currently 1 unit to 11g of carbs. My diabetic team are not happy about me changing my carb ratio too much as when they calculate what my ratio should be it comes out as 1:15g.

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The only way you are going to find out if you need a different carb ratio is to try it and see for yourself. It's your pump your body your decision Your team should not be adjusting your pump that's down to you.

Another option is to bolus 30 mins before you eat and see if that helps.

CarbsRok said:

The only way you are going to find out if you need a different carb ratio is to try it and see for yourself. It's your pump your body your decision Your team should not be adjusting your pump that's down to you.

Another option is to bolus 30 mins before you eat and see if that helps.

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Totally agree that it's your call on ratios. Before switching to pump to cope with DP my breakfast ratios were 3u:10g and 1:1mmol correction which seemed crazy but mostly worked. Everyone's different. Provided you're careful and do enough testing when you make the change and have hypo treatment ready, go for it! If it works you can then let your team know it works... they should be pleased you're working to improve things yourself.