So I'm a relatively new Type 1, (10 months in as of tomorrow)and for the past few months I've been having issues with blood sugar spikes about an hour or two after eating. Lately it doesn't even seem to matter if I eat a pretty low-carb meal in one sitting, whether it be just one 18g piece of bread or an 11g cup of applesauce, I always seem to shoot up into the 250s (mg/dl) within the first couple hours after I eat. But after 3 or 4 hours, I'll be at an acceptable level. I've tried adjusting my insulin to carb ratio so that I'd be taking more insulin, but then I just spike after an hour and end up low later. Upping my basal rate seems to help the spikes but then my fasting levels wind up low.

I've been told a ton of different things regarding this issue; that spikes don't matter as long as you end up at a good level or the opposite that spikes are really a cause for concern. Does anybody have any experience with this kind of thing or suggestions on how to deal with it?

Tags: 1, post-meal, spikes, type

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hi carly. how far ahead of your meal do you take your isulin? have you tried taking your insulin a bit earlier? i try to leave 25 or 30 minutes between insulin and meal. it seems to work better for me than the 5 to 15 minutes the cde advised.

I agree with pancreaswanted. If you return to target properly at 3-4 hours after a meal, then the total bolus was right on target. A spike (or even a low) indicates a mismatch in the timing and/or profile of the bolus. Depending on the meal, you may want to inject 15 minutes or more before the meal (fast acting carbs) or even after them meal (low carb, mostly protein fat).

But most important of all, I would tell you to not sweat the small stuff. None of us are perfect, we are just human. Just being able to count your carbs and bolus the right amount is a good standard. Many people might even tell you to not test at 1 hour.

ps. If you are eating "only" bread or "only" applesauce, that is not low carb, it is a small portion, but not low carb. A cup of cottage cheese with a few blueberries, that is low carb.

What insulin are you using? If your meal is spiking before your insulin you might try what pancreaswanted said and give it more lead time. Or you might ask your doctor to change to Apidra which acts a little faster and has a quicker peak than Novalog or Humalog.

In addition to prebolusing, you might consider using the "super bolus." (Just do a search here on the site).

In addition to trying to manage the insulin you might try to eat more fat and protein with your carbs. Adding a couple of tablespoons of peanut butter to the slice of bread or eating a chunk of cheese with an apple (rather than a cup of applesauce) will make it easier for the insulin to catch up.

I would suggest testing at 2 hours as oppose to 1 hour for a more accurate measure of how your blood sugar is reacting to food. Better yet if you're so inclined one day, test every hour after you eat and track over time how much your blood sugar is going up/down and around what times they do so. Do this once in a while just to get an idea. But yes, if it comes back down to a normal level 3-4 hours later you're doing a good job, as the insulin is typically the insulin's active time.
Also keep in mine some foods will take longer to spike than others, particularly food with high fat content.

Carly, If none of the above timing adjustments work to keep you from spiking, then reduce the bread carbs to what does not spike you. There is low carb bread out there in some communities.
Insulin does not cover everything for everyone and many of us choose to eat low carb because of this. Some have reduced their fruit considerably.

Another issue you may want to consider is the glycemic index of your food: http://en.wikipedia.org/wiki/Glycemic_index. You know this idea in concept: For instance, which food digests faster applesauce or broccoli?

I have found that bananas are a poor food choice for me due to their carb content and glycemic index. An average banana is 25 carbs and peaks at about 40 minutes for me. It is too slow for me to use as a correction and it is too fast for my insulin (that peaks at 2 hours) to accurately match. Applesauce and many breads are the same for me, they could be the same for you?

I try to eat foods that are low or moderate on the glycemic index as they match my insulin's activity better. This reduce the post paradinal spike and the 3-4 hour lows.

Another thing to consider is the amount of carbs you eat per sitting. I do my best to not eat over 35 carbs/meal. You sound more insulin and carb sensitive than I am and may do better being even more restrictive?

Good luck, we all go through these problems from time to time.

I'll echo the sentiments of the people here, you should take your insulin earlier to counteract the spikes. Also try adding more fiber and some fat into there as well. If I eat just a piece of bread that's 18g of mostly all carbs. Now if I eat said bread with some egg whites, or some turkey sausage it absorbs a lot slower.

Another question, what is your level going into these meals? Are you starting at 75 and spiking to 250? Or are you at 160 and spiking there?

That's a tough issue. I can relate. If I take 8 units and eat a pc of toast (18carbs) with peanut butter (7carbs) my blood sugar will spike between 170 to 250 while driving to work then will drop low after the long walk from upper parking lot to shop floor, requiring a juice (18 carbs). I've tried half pc of toast and the second half 90 minutes later; that helps but what a pain... I just bought a recumbant exercise bike off craigslist; the idea is wake up take 2 units then spend 20 minutes pedaling followed by 20 minute shower then bolus another 6 units and eat the toast w/peanut butter. The insulin pump makes multiple bolus much easier. Good luck.

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