Sudden rise in BG after 2 hrs of meal

[haider]

Hope everyone is fine. I am type 1 since 2006. My BG been Ok last couple of years but from last 3-4 months I am struggling. My BG reading is not great at the moment. I always struggle after evening meal. Couple of times during the nights its been between 15 - 23 :cry:
Mostly after 2 hrs of meal its below 10 but after that it shoots to 15-17.
I am taking Lantus 24u and Novorapid 3 times.

I will appreciate if anyone can help me here.

Many thanks in advance
Haider

 

[hanadr]

I'm not a T1, but married to one and i'd start by examining what's in the meals.

 

[timo2]

Hello haider,

It sounds like the problem might be with your Lantus. If the dose is ok (waking sugars on target), then it's most likely down to a tired injection site.

Better site rotation and perhaps splitting your Lantus dose (and injecting it twice a day) might be a good idea.

Regards,
timo.

 

[hanadr]

I had another thought on this Possible gastroparesis. Stomach not empttying immediately.

 

[janabelle]

Hi, Lantus is notorious for causing poor BG control & a lot more besides. I had 4 1/2 years wondering what was causing my constant fluctuations, and unpredictability in my control from day to day. Since getting off the stuff,and changing to Hypurin Porcine, I have consistent, predictable control.

Examine your meals by all means, but you'd be wiser to examine the Lantus! You can look on the Sanofi Aventis website to see how inadequately tested this drug is, a worrying read I can assure you.

Many people have problems with Lantus, including suffering debilitating side effects, as I did.. A lot of these side-effects ,including the unpredictable and poor BG control,can occur up to a year and a half,or even longer, after patients are put on Lantus. However the clinical trials on type-1s were done over a maximum period of 28 weeks, not nearly long enough.
Jus

 

[kewgirl]

Hi Haider

Sorry to hear your BG levels are not good at the moment.

At first glance it might be carbohydrate/food related however……..

Novorapid is by its name & nature a very very rapid analogue – sometimes it is almost too efficient that despite its duration being 2-5 hours sometimes its actually “spent” 2 hours after a meal thus when the carbs hit the blood stream there is effectively no Novorapid left to do its job. Additionally sometimes Novorapid can last 2 hours, sometimes 5 – again often no rhyme nor reason why & each day it can be different.

Lantus analogue in some diabetics a very unreliable basal (background) insulin - as you might already be aware – there is good documentation to identify that only 50% of Lantus is actually absorbed on the day it is actually injected, a further 25% is absorbed the following (thus with the Lantus you inject on day 2 equals 75% in total) and finally where does the remaining 25% go to – unknown! (Source IDDT). Thus at any one time some diabetics in effect are only getting 75% of the 100% of Lantus injected.
Timo & Janabelle have both made very good additional comments re Lantus.

What part of the day do you inject your Lantus?

Then there is the complexity of our biorhythms and when our bodies are at their most efficient in dealing with carbohydrates – the added challenge with diabetes is our bodies are already challenged trying to deal with carbohydrates.
It is well known that many diabetics cannot tolerate too much carbohydrate in the morning/for breakfast – but some diabetes find evenings as equally challenging.

Are you taking any other medication with/near your evening meal that may cause BG spikes?

Switching to animal insulin, human synthetic insulin or another analogue (short acting and/or basal) may significantly improve your control.

You’ve identified that something is not right.

This is where you have to play detective to try and suss out what’s happening!

Hope you get things sorted.

Best wishes

Txx

 

[haider]

Thanks everyone.
I am taking Lantus at night time between 9 - 10.

I thought you might be able to help me here, mostly if I check my BG after 2 hrs its OK, but then I eat something to avoid any hypo can this be a problem as well?

What would you normally do if after 2-3hrs of meal your BG is between 4.5 - 8?

From my understanding Novorapid can last upto 3-5hrs.


Other problem is NIGHT time I always struggle with my BG. If my BG before BED is between 11-12 then my morning reading is OK otherwise its high.

Last night I reduced my Lantus to 20u and in the morning it was 9.4, before bed my BG was 8.0 and I had a cup of milk and one dried Fig before bed.

Many thanks
Haider

 

[timo2]

Hello Haider,

Novorapid will have done its worst after 2-3 hours, so you'll need to be careful with any corrections made then. If you need to correct a low at the 2-3 hour mark, use small amounts of glucose rather than anything slower acting. By mid-evening, both your Novorapid and your Lantus will be tailing off, so your blood sugar will be more sensitive to any carb eaten, making it very easy to overcorrect a low sugar.

I'd have to repeat the recommendation for a split Lantus dose. Until your basal rate is sorted, your blood sugars will continue to do slightly strange things at certain times of day.

Good luck,
timo.

 

[haider]

Hello,
Hope everyone is doing fine. Sorry for late reply.
There is something funny going on here. Even though I have switched from Novorapid to Humalog and from Lantus to Levemir. I am still having the same problem. I am unable to get my morning BG right. I have to wak up during night to make the adjustments.
I was wondering there might be something wrong with CARBS calculation.

Could anyone please suggest me the effective way of carbs counting espacially in INDIAN foods.

Another thing do I have to split my Levemir?

Many thanks.

 

[janabelle]

Haider,
Some people don't get on with synthetic, especially analogue insulins. I'm not usually so blunt on this forum, but you've been struggling for a long time and high BGs are doing you harm; so as an experienced user of alll types of insulin over 21 years, I would advice you to get off long-acting analogue insulin altogether. There are other varieties of insulins available, the misleadingly named "human" insulins, or animal insulin-which is really insulin A full list of medications is available on this website.
You are not on insulin, long-acting analogue insulin is **** for a lot of people. They are marketed as a 24 hour basal insulin; from the recent postings on this forum and my own awful experience, it's obvious that's not the case. Patients are being advised,when these insulin analogues appear not to work, to split the dose; why don't docs do the right thing and get patients off it while there's still alternatives available :evil:
You could ask for a pump, pump users seem to get the same stability that I've achieved on animal insulin-the rogue insulins are Lantus and Levemir. The sooner these are binned the better off we will all be.
Sorry for the wee rant Haider, but that's the best advise I can offer. Let me know what you think
Jus

 

[barkbark]

As hanadr said in the first reply, I believe you should be looking at what you are eating and understanding how that impacts your body prior to thinking of changing insulin etc. You mention Indian foods, which from experience do exactly what you say if eaten in the evening as unless you are staying away from Indian breads, which are very high in slow acting carb's, your rapid acting insulin is used up before the food itself starts moving your blood sugars up, resulting in a slow but firm increase of blood sugars through the night. If you count the carb's in say a naan bread or smaller roti you will be very surprised at the carb' content and specifically how much insulin you will need over a good 4 to 8 hours to balance it out. An easy way to start getting an idea of the carb's in a naan bread or the like if no other options are available to you is go to Tesco and see what one of theirs contains (it is on the packet). Not totally accurate but at least gets you moving in the right direction.

 

[lilibet]

HI

Firstly make sure your basal is down to pat - without it being sorted your ratios for carbs will be seriously out of wack. My initial basal seemed absolutely fine but my ratios were HUGE for 20g carb etc so I put my basal up and its now 6u per day higher but my ratios are much healthier

Secondly, indian food or any fat heavy food is notorious for a slow rise so you think the first two hours is looking great but after that its a horrible rise. The best way to tackle this is to either not eat it, or take your insulin later.

If my bg was at 4 two hours after taking fast acting, I would prob have a 5g cracker or something, to avoid possible hypo. If it was around 7 or 8 I would feel ok about leaving it. It will depend on you and your body.Novo does its worst/best in two hours for me, but it will drop a wee bit over the next two hours so I usually know by the two hour point if I will be ok

In terms of setting ratios, its meant to be back at what it was after 4 hours ,ergo the ratio is right. In doing this, I would avoid fatty slow rise foods if you can until you get a notion of whats happening cause if you are eating later, and it continues to rise during the night due to insufficient meal time insulin then it will 'set' your numbers higher (if your basal is ok)
You really are better to do one bit at a time -basal first, then ratios

Also, in terms of overnight testing - ensure that ALL novorapid is out of your system before bed, test and then eat nothing (as long as you are safe numbers) The morning number will show if its not right. Too high, you need more Levemir. Too low,you need less.

Some like to see a pattern for a few days before making changes, to avoid reacting to the inevitable diabetic gremlins (ie when the moon is in Jupiter) :roll: