Very high glucose after meals: it's getting me down...

[gorman100]

Hey

New member here, but longtime lurker...

I've been a T1 diabetic for the last 18 years, and I've always had reasonable control, but in the last few months things have just gone off the scale for me. I'm not sure whether it's as a result of me noticing more about my readings, or some external factor (stress?) but I'm constantly finding that after meals I get very, very high glucose readings. These are sometimes followed by very low readings.

Take breakfast as an example. I went from 4.6 this morning at 6 am, to 16.3 at 8 am, then by 10 am I was teetering at 4 (and I could feel myself dropping further). Sometimes my levels will go as high as 18!

I don't know if this has always happened, largely because I noticed this change when I started on the Freestyle Libre. However, because that isn't always reliable, I always finger-prick test very high or low readings (and usually find - although not as high - they are still well out of acceptable range).

I should add that I'm carb counting, and I am very sensitive to insulin. I've discussed it with my diabetes clinic (and just done a carb counting course, in fact, so I think I'm doing everything right), and the general consensus seems to be "Well, you HB1AC is ok, so don't worry about it". But I am worried, and it isn't right to be going this high 2-3 times a day...

The issue is how to control this? Even adjusting my insulin by, say, 1 (or 1/2) unit will result in a nasty hypo at the 3-4 hour mark. I've tried using basal/bolus in different combinations, but none of that seems to help.

Would a pump be the answer? I've also been reading about Fiasp insulin, but the comments have all been a bit mixed

 

[KK123]

Hi Gorman, it makes my blood boil to hear you were told not to worry about it because your hb1ac is ok!! It is not ok for you to have to put up with those high numbers followed by low numbers. I have no idea what you should do and i am sorry about that but others who know more will reply soon.
How can you do normal daily stuff worrying whether you are going to fall to the floor or suffer from a hyper from hour to hour. Your insulin levels are clearly not right somewhere along the line and your so called team of 'experts' should be helping you.

 

[Deleted Account]

I have no silver bullet but I have a few thoughts
- you mention breakfast, does this happen with other meals or could it be a dawn phenomenon thing?
- have you tried taking your bolus earlier so that the peak of your insulin absorption matches the peak of the carb absorption?
- the drop at 3 - 4 hour mark may be due to too much bolus ... which you are taking to try to address the peak.
- are you doing anything else which can impact your BG such as exercising a couple of hours after eating?
- have you done a basal test to discount basal from the equation?
- which fast acting insulin are you taking and have you tried any other? You mention your concerns about Fiasp: there are others available which may suit you better
- a pump could help if your basal requirements differ throughout the day
- a pump could help if you need to taper your bolus over a longer period but it sounds as if you want the opposite

Sorry if you have already tried/thought if these.

 

[Juicyj]

It's amazing how using a libre can suddenly open a can of worms/provide further enlightenment on your results, I know the high readings on my meter are generally out by up to 3 mmol/l so personally I don't try to panic too much.

However I agree with @helensaramay ... Have you every tried pre-bolusing for food, you can do this say up to 20 minutes before you eat which will help reduce the spike ?

 

[Juicyj]

Also another thought @gorman100 Have you checked your injection sites, if you've got scarring there it would delay the absorption, so good rotations and new sites if possible, try not to get down though, there will be a solution

 

[Scott-C]

Just a thought, @gorman100 , but I'm wondering whether you pre-bolus?

It made a huge difference for me injecting about 10 to 20 mins before the food, to let the insulin get to work before hitting it with food, otherwise the insulin is going to be playing catch up.

Might explain what's happening with you: just speculating here, but maybe you're injecting about the same time as eating, maybe you're taking a larger dose than you otherwise would have done so as to try to pin the high rises, but the food is still digesting and running ahead of the insulin, hence the rise, then once the food is digested, the insulin is still working hard but with little food left to deal with, hence the hard drop.

Like I say, just speculating based on limited info but it suggests a timing issue might be worth considering.

If you're using libre, there's a gig called "waiting for the bend" : inject and wait till you can see the line starting to inflect downwards. Can be tricky to do with the reader graph alone because of the way it is averaged, but a few extra scans, or turning it into cgm with a blucon transmitter and xdrip+ makes it easier to see because of the 5 min dots. After a bit of experimentation, you'll generally be able to tell what the optimum pre-bolus timing is.

Or maybe depends on the food - I'm not a low carber by any means, but some foods like breakfast cereals will just not work for me so I avoid them.

 

[karen8967]

hi gormon this has been happening to me big rises after food but low or back in range by my next meal time .i am halve way through carb counting course but know how to carb count and my ratios are right .i was on apidra for bolus and would try injecting 10/15 minutes before a meal i tryed splitting injection half b4 and half after but nothing worked i had my apidra changed to fiasp 2 weeks ago and i have found that although still getting a rise after food its nowhere near as bad as it was .i myself would try the change of insulin but its completely your choice i do hope you get sorted soon

 

[dancer]

@gorman100 my blood sugar used to jump to mid to high teens 2 hours after breakfast. At one point I was told that if I didn't test, I wouldn't know I was that high (not exactly helpful!)

I am also insulin sensitive, so tend to go low if I pre-bolus (you might be more successful).

When I went on the pump, the same thing was happening, so I was told to bolus and also use a temporary increased basal for 30 minutes. This worked for me so, if you've tried everything else, why not ask your team if you can go on the pump.

 

[gorman100]

Thank you all for the helpful replies.

@KK123 - thanks for the support! It's nice to know how other diabetics feel about this, and I am not alone in my reaction!

@helensaramay and @Scott-C - it happens all day sadly, but especially after breakfast and lunch. I just tried, as a possible solution, injecting 10 minutes before lunch. That isn't really practical for me, because of my work, but I tried anyway. And guess what? I went into hypo about 10 minutes after I'd finished eating! My levels have went up at all...

@karen8967 - thanks for the very good suggestion; I think I will ask about Friasp

@dancer - okay, that's encouraging: I think that I will try for that. It's what I thought might help, because it'll give more control

I'll keep you all posted, and thanks again for listening!

 

[Tabzmcfc]

Hi @gorman100
I had exactly the same problem and changed to Fiasp. After a couple of weeks my readings were much better. I'm a libre user too. It's worth a try. Good luck.

 

[Wurst]

Perhaps I missed something but what are you eating for Breakfast and Lunch ? I can't tolerate carbs until evening time when I'm more sensitive to insulin and generally can eat what I want (in moderation).

For Breakfast/Lunch I stick to very low carb meals and generally have a very flat BS profile throughout the day/night.

 

[gorman100]

Perhaps I missed something but what are you eating for Breakfast and Lunch ? I can't tolerate carbs until evening time when I'm more sensitive to insulin and generally can eat what I want (in moderation).

For Breakfast/Lunch I stick to very low carb meals and generally have a very flat BS profile throughout the day/night.

Sure, I forgot to add the most relevant part!

Breakfast is usually 1-2 Weetabix, or brown porridge. No sugar, literally splash of milk (enough to make the Weetabox wet!). Typically that sends me high, then low within an hour.

Lunch is single brown bread sandwich (usually with cheese), sometimes also a packet of crisps. That generally causes the same...

I've been in contact with my clinic again, who have suggested pre-bolusing. That does seem to have an effect, but it's really difficult for me to do while working. This week already, I've had two hypos as a result of not eating before my sugars drop rapidly.

I'm getting so much contradictory advice from the clinic though. I just did their diabetes refresher course (carb counting, insulin ratios etc) and the advice was really clear: what whatever you like, provided you take the appropriate insulin. Then when I start questioning my levels, the advice instantly becomes "Oh, I wouldn't eat that..." The Weetabix in particular has met with some disapproval!

 

[Wurst]

Breakfast is usually 1-2 Weetabix, or brown porridge. No sugar, literally splash of milk (enough to make the Weetabox wet!). Typically that sends me high, then low within an hour.

Ever tried low carb alternatives for breakfast / lunch ? That would stop the spikes, I tend to eat chicken strips for breakfast / lunch and i'm flatlining all day long. Boring I know, but better then rollerocasting blood sugars.

 

[phdiabetic]

Hi Gorman, it makes my blood boil to hear you were told not to worry about it because your hb1ac is ok!! It is not ok for you to have to put up with those high numbers followed by low numbers. I have no idea what you should do and i am sorry about that but others who know more will reply soon.
How can you do normal daily stuff worrying whether you are going to fall to the floor or suffer from a hyper from hour to hour. Your insulin levels are clearly not right somewhere along the line and your so called team of 'experts' should be helping you.

Totally agree with this! Once, shortly after I was diagnosed, I sought help for a problem where I would wake up normal then get up to 10-11 during the morning. It was unrelated to my breakfast. I was advised to just ignore it and correct at lunch time! Hello, I don't WANT to be high, it's unpleasant, I want to fix this! I think medical people tend to ignore you if your hba1c is good because you are probably one of the better patients anyway, so they see less of a problem. They are also used to seeing bad numbers from other patients, so their perception of "normal" diabetic numbers can be a bit off.

 

[gorman100]

Ever tried low carb alternatives for breakfast / lunch ? That would stop the spikes, I tend to eat chicken strips for breakfast / lunch and i'm flatlining all day long. Boring I know, but better then rollerocasting blood sugars.

I think that I will definitely try this. Out of interest, if so have have chicken strips, do you count those carbs at all? Because chicken has carbs in it, but only a low amount - my clinic tends to encourage not to count very low carb items such as nuts or chicken on the basis that the background insulin will catch that...

 

[tim2000s]

What you're seeing here is the NHS advice tied to real world experience.

In the morning, physiologically our bodies try to produce glucose to get us up and out of bed. This means that we are less insulin sensitive and carbs are more likely to make us high. Add to that that breakfast cereals in general cause a fast upward effect (Weetabix most definitely and porridge for most people too, regardless of sugar) and it can be very hard to manage them.

What most of us eventually learn is that our numbers tend to climb after carbs (quite a lot in many cases) and that while we **can** eat what we want (as per the advice) and take insulin for it, how we **manage** the insulin around that is really important. And in order to make that easier, many people just reduce the amount and types of carbs they eat.

Both the meals you describe for breakfast and lunch for me would need a 20-30 min pre-bolus. The other thing to check is that your I:C ratio is really correct. For many of us, that can vary throughout the day, so you might need to check that and factor it in.

 

[gorman100]

Totally agree with this! Once, shortly after I was diagnosed, I sought help for a problem where I would wake up normal then get up to 10-11 during the morning. It was unrelated to my breakfast. I was advised to just ignore it and correct at lunch time! Hello, I don't WANT to be high, it's unpleasant, I want to fix this! I think medical people tend to ignore you if your hba1c is good because you are probably one of the better patients anyway, so they see less of a problem. They are also used to seeing bad numbers from other patients, so their perception of "normal" diabetic numbers can be a bit off.

Thanks for the support! Yes, I agree: but the HB1AC is only part of the story, which I don't think non-diebatics really appreciate. The headaches, the dissociated feeling, the mood swings... I think the NHS takes the view (and perhaps not everyone, but largely) that this is about keeping us functional, rather than keeping us optimal.

 

[gorman100]

What you're seeing here is the NHS advice tied to real world experience.

In the morning, physiologically our bodies try to produce glucose to get us up and out of bed. This means that we are less insulin sensitive and carbs are more likely to make us high. Add to that that breakfast cereals in general cause a fast upward effect (Weetabix most definitely and porridge for most people too, regardless of sugar) and it can be very hard to manage them.

What most of us eventually learn is that our numbers tend to climb after carbs (quite a lot in many cases) and that while we **can** eat what we want (as per the advice) and take insulin for it, how we **manage** the insulin around that is really important. And in order to make that easier, many people just reduce the amount and types of carbs they eat.

Both the meals you describe for breakfast and lunch for me would need a 20-30 min pre-bolus. The other thing to check is that your I:C ratio is really correct. For many of us, that can vary throughout the day, so you might need to check that and factor it in.

Absolutely. The pre-bolusing is actually helping quite a bit, but the balance is hard to get right: in the middle of the day, I struggle to accomplish a 15 min wait, and sometimes waiting an extra minute or two can lead to a hypo. The advice I think I'm getting from my clinic is very "one size fits all", which is fine, but will always need to be adapted to individual needs.

 

[Juicyj]

Hi @gorman100 I agree with Tim about the carb effect at breakfast, I have a higher insulin/carb ratio for breakfast than any other time of day, I also use the libre and when I eat more than 10g of carbs in the morning I can see the arrow just heading north for 1-2 hours before falling again, it's dis-heartening of course to see it, as your then into mid morning before levels can come down, so mornings I either have greek yoghurt with blueberries, low carb high protein bread which is 9g of carb for 2 slices and lots of butter or bacon and eggs, in doing this I have a much smaller spike. I have to eat in the morning, call it habit but would never touch cereals again now knowing what I know now.

 

[Wurst]

I think that I will definitely try this. Out of interest, if so have have chicken strips, do you count those carbs at all? Because chicken has carbs in it, but only a low amount - my clinic tends to encourage not to count very low carb items such as nuts or chicken on the basis that the background insulin will catch that...

It varies for me , depending on exercise levels. I tend to keep an eye on things via the libre and inject if needed. DP initiallly confused me as it believed it was the chicken raising my BS. Some people are hit with the protein spikes. I'm not impacted by this but it's something to watch out for. Overall can virtually flat line all day by staying away from carbs until the evening.