When you split the dose, how big do you make the gap?

[RobertJ]

Recently, I have been having an experience where my levels follow this pattern:

I have an evening meal. I give what I estimate to be 60-80% of the required dose. My BG then doesn't move. It might even go a bit lower.

Over an hour later I think, maybe I don't need to give any more. But then, two to three hours after the first dose it starts rising and it's hard to get it to come down for ages.

I realise this sounds like the pizza/curry effect, but this happens with everything now. Do I just need to be bold and give the second section of the dose even if it's 5.5, on the assumption it will rise shortly? I am finding this difficult to manage because seemingly the required gap between one part of the dose and the next seems to be so big.

 

[Matt2023]

Hi RobertJ,

If I am reading this right and I am sorry if I have not got this right, but you say you eat your evening meal and only take to 60 to 80 % of the insulin required for the amount of carbs you ate. Is that correct?

If it is, I think this is happening because you are only giving 60 to 80% of the actual insulin that you require for that amount of carbs you have consumed.

If you gave the correct does, then you may find that is lasts longer, in the two and three hour period and will not rise.

Just a thought, if I have read your post correctly, if not then ignore this post

Thanks

 

[RobertJ]

Hi RobertJ,

If I am reading this right and I am sorry if I have not got this right, but you say you eat your evening meal and only take to 60 to 80 % of the insulin required for the amount of carbs you ate. Is that correct?

If it is, I think this is happening because you are only giving 60 to 80% of the actual insulin that you require for that amount of carbs you have consumed.

If you gave the correct does, then you may find that is lasts longer, in the two and three hour period and will not rise.

Just a thought, if I have read your post correctly, if not then ignore this post

Thanks

Yes but if I give the correct dose all at the start, I'm guaranteed to go low. But what happens is it stays stable for sometimes two hours, then rises.

This is why I'm asking, how big should the gap be and is the trend I'm describing a normal one?

 

[JAT1]

This is why I'm asking, how big should the gap be and is the trend I'm describing a normal one?

Excellent question ! It is going to be hard to determine. It would depend on the meal - how much food - how much fat and protein slowing down carb ingestion - activity before and after the meal - and so on.

 

[Matt2023]

Hi RobertJ

This is how it happens to me on a typical morning with breakfast, remember though everyone is different and of course what food you eat too makes a difference.

At 9AM I eat 40 Carbs (Corn Flakes with milk for example) for breakfast and I also inject 3 quick acting units to cover the carbs.

The insulin starts to work for me at around the 12 minute mark and the food always starts going in to my system at around the 14 minute mark. So a 2 maybe 3 minute gap between the insulin and the food working.

9 times out of 10 I will still have a spike (Because of the type of carbs I am eating) up to about 9 or 10 but then will come back down to around 6.5 mmol/L an hour and a half later.

My biggest problem is that the quick acting lasts 3 hours and my food only lasting 1.5 to 2 hours, so I have to remember to snack on nuts for example, for the last 1.5 hours that the quick acting is still working for me, otherwise I may have a hypo.

Thanks

 

[EllieM]

Recently, I have been having an experience where my levels follow this pattern:

I have an evening meal. I give what I estimate to be 60-80% of the required dose. My BG then doesn't move. It might even go a bit lower.

Over an hour later I think, maybe I don't need to give any more. But then, two to three hours after the first dose it starts rising and it's hard to get it to come down for ages.

I realise this sounds like the pizza/curry effect, but this happens with everything now. Do I just need to be bold and give the second section of the dose even if it's 5.5, on the assumption it will rise shortly? I am finding this difficult to manage because seemingly the required gap between one part of the dose and the next seems to be so big.

I think it is difficult to make hard and fast rules here, as everyone is a bit different, both in what they eat and in how they digest their food, If your food is being absorbed more slowly than your insulin is acting, for whatever reason, then it makes sense that you have to inject a second dose later.

How confident are you that the delay is because of delayed food absorption, and not, say, insufficient basal?

Have you tried talking to your team for advice?

 

[RobertJ]

I think it is difficult to make hard and fast rules here, as everyone is a bit different, both in what they eat and in how they digest their food, If your food is being absorbed more slowly than your insulin is acting, for whatever reason, then it makes sense that you have to inject a second dose later.

How confident are you that the delay is because of delayed food absorption, and not, say, insufficient basal?

Have you tried talking to your team for advice?

Thank you for reading and responding to my post @EllieM

I don't think it's insufficient basal. In the daytime, my readings stay pretty level once the effect of a Novorapid dose wears off. I think my basal is about right.

I actually went to the diabetic clinic last week but they seemed pretty busy and the doctor didn't appear to be interested in a long discussion. She also seemed totally uninterested in any talk about sport and exercise. The dietician was unavailable and a nurse told me "We'll call you" to make up for it, which I absolutely knew would not happen, and it did not happen.

I am going for a diabetes check-up at my GP surgery next week too, so I think I'll ask the staff about these things there. My GP surgery never seems to be busy, so hopefully I won't be so rushed through the system when I'm there.

 

[EllieM]

I am going for a diabetes check-up at my GP surgery next week too, so I think I'll ask the staff about these things there. My GP surgery never seems to be busy, so hopefully I won't be so rushed through the system when I'm there.

I'll be honest with you and say I suspect that your GP won't have the specialised T1 knowledge to help you, but some GPs are informed about T1 so I'll hope to be surprised on that.

Can I ask how long you've been T1?

 

[RobertJ]

I'll be honest with you and say I suspect that your GP won't have the specialised T1 knowledge to help you, but some GPs are informed about T1 so I'll hope to be surprised on that.

Can I ask how long you've been T1?

I've had type 1 for 20 years and three months. I used to think I managed it well but then last summer I found out I was not managing it anywhere near as well as I could have been, and so I became a born-again diabetic in August 2022.

 

[Deleted member 45091]

Hi Rob, with my issues IAM far from the perfect diabetic. And only been on this basal bolus regime around 2 years myself. But as an idea couldnt you try planning your meals out for the whole week. Wright the foods and carbs you eat etc take the right amount of bolus to start. And see what happens with your sugars etc. If you start to dip lucazade is my choice to boost me back up. But you may find certain meals you can take the bolus in one go, some you may have to split. Or with some meals you may find taking the insulin after you've ate works. Just an idea.

 

[Deleted member 527103]

When splitting the dose, make sure any correction component is up front.
Likewise, if under target, make sure any deduction is considered with the initial dose.

As a result, the split depends not just on what you are eating but also on your current BG.

 

[hellobear007]

I have the exact same problem... jence why i am still awake at 2
45am ( although I'm finally headed in the right direction)

see attached CGM graph. I ate where the red arrow is. I gave my full dose plus 10 % ( I'm playing around with ratios and stuff to try and find a solution ) ... as you will see I was stable for around 2 hours then a rise of over 5mmol. Even 250% temp basal won't fix it.

The meal was not high in carb and I accounted for fat and protein.

Regular occurrence here. My basals are fine too. I have basal tested a ton these past few weeks.... as long as I don't eat, I'm fine LOL

If I figure it out I will let you know!

Let me know also If you find a solution

 

[Sailorlad]

I am 1;1 ratio during the day, but evening dinner, if no activity happening, I am 1.8:1, so for dinner i take half the dose, then an hour later the other half, if its pasta i wait two hours for the second dose, works well for me, and yes, even if im at 5mmol i will take the second dose, if i took the whole dose in one go, i would run low in an hour.

 

[JMoli]

Totally relate! Seems to be trial and error, make notes of certain meals and how it affects you maybe, sometimes there can be a pattern. I stumbled upon 45 minutes after the first bolus for anything breaded (and then the ‘’rules’’ changed of course) Seems to be different for all of us but very envious of anyone that only needs a single bolus. Pasta is impossible for me, the second bolus can be six hours later. Same with noodles. I find the evening meal the hardest to get right

 

[Hopeful34]

It's rice that I can't get right. Have tried all ways and still either hypo or go high. First time after switching on control IQ on tslim pump it was a dream, stayed in range all eve. Thought brilliant, but since then it's never worked again. Sigh!! My old DNS said that type 1 diabetics usually have one food that they have a problem with. Rice is definitely mine.

 

[ert]

Recently, I have been having an experience where my levels follow this pattern:

I have an evening meal. I give what I estimate to be 60-80% of the required dose. My BG then doesn't move. It might even go a bit lower.

Over an hour later I think, maybe I don't need to give any more. But then, two to three hours after the first dose it starts rising and it's hard to get it to come down for ages.

I realise this sounds like the pizza/curry effect, but this happens with everything now. Do I just need to be bold and give the second section of the dose even if it's 5.5, on the assumption it will rise shortly? I am finding this difficult to manage because seemingly the required gap between one part of the dose and the next seems to be so big.

I always split my fast acting dose for my meals and give the first and start eating after my blood sugars start falling (by 0.3 mmol/l), and the second as soon as my blood sugar starts rising.

 

[RobertJ]

I always split my fast acting dose for my meals and give the first and start eating after my blood sugars start falling (by 0.3 mmol/l), and the second as soon as my blood sugar starts rising.

That seems sensible enough, but how long does it usually take for your blood sugars to start rising? I seems to be experiencing the "pizza effect" with every meal now and it can take three hours for the rise to happen. This means when I am getting ready for bed my high glucose alarm goes off and I have to figure out what to give. It's not the ideal scenario for going to bed.

 

[ert]

That seems sensible enough, but how long does it usually take for your blood sugars to start rising? I seems to be experiencing the "pizza effect" with every meal now and it can take three hours for the rise to happen. This means when I am getting ready for bed my high glucose alarm goes off and I have to figure out what to give. It's not the ideal scenario for going to bed.

There is so much variability in dosing that there is no set formula for timing doses other than following my blood sugars rising and falling.