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The 2-hour post food level???

A

Age_wills

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Hello all,

Just wondered if anyone else is experiencing the same as me:
I'm type 1, have been for 5 years, I use Lantus and Novorapid.

Basically, my diabetic nurse, all the books, GP's,etc say that you want a low (4-7) reading pre-meal and then you should aim for between (7-10) 2 hours after eating. I've been calculating my carb-insulin ratio (did a carb-counting course) and if I get my 2hour level to around 10 or under, I will have a hypo about an hour later as my blood sugar level keeps on falling.
For example, if I'm 6 before eating, I eat, insulin, then 2 hours later I'm at say 9, after another 1/2 an hour I'll be at say 5 and then around 3/4 hours after eating i'll be low (under 4).
I don't think it's my background insulin as overnight if I go to bed on around 7 it won't really change during the night (if anything it'll go up a bit!)

Just wondered if anyone else experiences this? If I take less Novorapid then after 2 hours my levels will be higher - maybe over 13 or something (it'll still come back down after 3/4hours) but I'm told that you want to aim for a level between 7 and 10 2 hours after eating?
I'm a bit perplexed to be honest! I know that Novorapid stays in the system for around 4 hours but how can I get a good post meal 2 hour level and not have to have a carb snack 3 hours after eating to top up, or go hypo?

All thoughts, experiences suggestions welcome!!
thanks
Adrian
 
Hi Adrian, unfortuntly I haven't got advice but I wanted to say this is exactly what I experienced before going on the pump. I was on Humalog and Lantus and found my Humalog to last around 4-5 hours so if I was in range at 2 hours I would be hypo by 3 hours. Also my lantus kept me stable at night just like yours. I don't know how on earth you get in range without going low so i wanted to say it's not just you as it puzzles me too. Hope you find some help.
 
What are you eating when you go hypo 3 hours? Maybe you need slower release carbohydrates so they wouldn't be all used up by then.
 
Hi Adrian,
I used to have pretty much the same problem as you but this used to only happen to me at lunchtime. This is when I am at my most insulin resistant, so before I changed my diet and was eating as I used to pre diagnois (sandwiches, pasta, jacket potatoes etc), I required a fair old amount of insulin to cover. I would be fine at the 2 hours post prandial mark, very pleased with myself and then drop like a stone at the 3 hours pp mark. Disaster. This was happening on a daily basis and got me very down. Now however, I eat a low carb lunch which requires a very small dose of Novorapid and bingo, problem solved. The hypos have stopped. Not sure if this will help but it certainly has worked for me. Good luck!
 
Hi again, thanks for the responses

I always have a bowl of bran flakes and a yogurt for breakfast so maybe I could try something that has a slower release, maybe porridge (although I thought bran flakes was a fairly slow carb-release food?)
Now that you mention that it only used to happen to you at lunchtime Lizzie makes me think maybe it only happens to me with breakfast as generally my evening meal is not too bad, although sometimes experience the same thing that happens between breakfast and lunch.
I'm quite a slim and tall person so maybe it's something to do with my metabolism?? Does this affect sugar levels/insulin absorbtion??
 
The problem you describe is what I seemed to find when on lantus and Novorapid pens. Now I have switched to a pump I am starting to see that I probably need to minimise the amount of carb I eat for a meal, particularly lunch and supper. Try limiting your carb intake and see if you can get an improvement.
 
This used to happen to me, until I started bolusing before I ate instead of afterwards. I started bolusing 5 minutes before I ate, the spike got less but it was still there, so I moved to 10 minutes, and now 15. That basically eliminates the big spike and then plummet afterwards.
 
This happens to me quite a lot...

I went on DAFNE (a carb counting course in the UK) and they basically told me not to test 2 hours after eating - because the insulin for my food would still be working - so even if i was high, there was nothing to i could do about it (i.e. i shouldn't take a corrective dose).

When I explained to them, exactly what you have... this was the conversation:

DSN: "Well don't test after two hours, then you won't get a high results. Wait until your next meal and then test"

Me: "Even if I don't test, I will still have dangerously high blood sugars for a period - is there nothing I can do about this"

DSN: "No"

Not exactly the best of news, but it understand it is going to be difficult to mimic the body's natural insulin response using an inject (or combination of injections).

My advice from my experience would be that choosing the right food. Eating fatty foods helps (as fat slows down the metabolism), although the DSN was a little shocked when i said i do this! If i have a sausage roll with a sandwich for lunch my bloods are generally better.

Exercise helps massively. If I have a game of squash before lunch, i will use less insulin for my lunch, and also my BG will generally sit at a lower level (around 5-8 after eating instead of 9-13).

The other thing i do quite a lot is delaying eating part of my lunch - but inject for it.
So I take enough insulin for a sandwich, crisps, banana and a biscuit. I eat everything but the biscuit straight after injecting and then have my biscuit two hours later.
This tactic tends to work quite well - unless a) you are hungry and want to eat all your lunch straight away or b) forget to eat the biscuit (in which case it will be hypo o'clock)!

If anyone else has any ideas on this I would also like to know!

Cheers,
James
 
James - that's the exact same conversation I've had with specialists. And no conclusion was reached in my case either.

I like your ideas on how to get around it. Another one I like is a protein shake with the meal. If eating a relatively low carb meal, the relatively high protein content provided by the shake allows your bg level to be more acceptable at 2 hours, without shooting through the floor after 4.

I'm not advocating lo-carbing; I eat in the range of 170-250g on average.

But, there is is one breakfast shake that I take that, whilst on a continuous glucose monitor, gave me results between 4 and 7 for the WHOLE 4 HOURS after breakfast. Amazing. I didn't find another food with that profile during my CGM time. If all foods could be constructed with that exact same make up, it'd be easy.

Having said that, a low-carb, mid-protein meal isn't always the preferred option according to my specialists... or it wasn't until I showed them the packaging. Anyway, you have to find what works for you I guess. I'm a veggie, so dedicated lo-carbing isn't for me... just can't eat that much cheese and eggs.

Sam.
 
emm142 said:
This used to happen to me, until I started bolusing before I ate instead of afterwards. I started bolusing 5 minutes before I ate, the spike got less but it was still there, so I moved to 10 minutes, and now 15. That basically eliminates the big spike and then plummet afterwards.
Click to expand...

That's really interesting Emm! - as well as what I was recommended to do when I first became diabetic. I may try it again. The only problem is remembering to eat having injected. :oops: So easily get side tracked.

Sam.
 
I have to say, it's re-assuring to hear that others have been experiencing the same problem!

I have always injected NovoRapid after I have eaten, as I always thought that it was a bit risky to take a load of insulin and then have something that could prevent you from eating so that you'd crash soon after, but I guess if you're 100% sure that you're going to eat then it's ok.

I'll try taking my morning novorapid at different times and see if that affects it - but like James says, it's frustrating to have high readings 2 hours after that you can't really do anything about. At the moment I'm just having to remember to eat something around 10.30-11am to stop me crashing - I guess it's the only time i can eat something with carbs and not have to inject!
Every cloud....

Thanks for your responses!
 
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