If my pre-meal blood sugar is fine, but my post-meal blood sugar is high, what do I do?

"Take a bigger bolus" is the obvious suggestion, but even with post-meal high blood sugar, I'm generally low before my next meal, and my basal rate is quite low (ranging from 0.100 to 0.300 during the day).

I always wait 20 minutes between bolusing and eating. Should I wait longer?

Advice, please!

Tags: advice, after meal, basal rate, before meal, high blood sugar, insulin pump

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I think what you are describing is similar to what some of us call the "rollercoaster". Except in some ways, your situation is simpler, because you aren't doing the correct with insulin-go hypo-eat and go high again cycle, you're just doing the hypo part of the cycle :-).

If your threshold for "high" is too low, it's easy to end up rollercoastering. e.g. I think that's high, but it's only high because the insulin already on board isn't absorbed yet, but because the number looks high I take a correction, then not only the correction kicks in but the insulin previously on board kicks in as well. Then I go hypo, I correct the hypo, I might overcorrect the hypo, lather rinse repeat.

And then to top things off, if the cycle is repeated a couple of times, the repeated hypos mess up my hypo sensitivity, then boom I'm in the ER with glucagon.

OK, it's not always that serious, but it's seriously wearing and not fun. Sometimes the best thing to do is just relax the standards for "high" a little bit, back off on doses just a little bit, and not get to a pattern of hypos. I know that's an anathema for those here who believe a single reading of 140 means doom and gloom, but seriously, it's no fun to believe in the doom and gloom all the time, occasional high numbers haven't put me in the ER yet (30 years in) but I have been to the ER several times (once with a lights and siren ambulance ride that I regained consciousness during!) with hypos. I'm not saying that we need to be deathly afraid of occasional hypos, they're going to happen, but if they are happening regularly then seriously, it's time to back off on the doses (either basal or bolus or both) just an eensy bit. OR, and this may or may not be possible for you, bolus the way you are now, but make the meal a little smaller and eat a snack later on to avoid the hypo. Others will tell you the snacking is absolutely verboten but really it sure beats the regular hypos.

Moving the bolus earlier, I'm not a big fan of, because I've had hypos during the meal as a result. If you are using the fast acting stuff (e.g. novolog or humalog) I find it hard to bolus more than half an hour before a meal without having to have a snack before the meal, or aborting the meal for a high-carb hypo correction, kinda defeating the purpose.

Hypoglycemia is not the problem--it's the post-meal highs. I'm not taking corrections, yet I still go low later, which I why I said "take more insulin" is not the solution to my problem. And boy, I wish it were 140 mg/dl [7.7 mmol/l] I was worried about.

OK, I was equating "low" with "hypo". Maybe they don't always mean the same thing :-)

But I would not sweat the after-meal highs too much.

If you are never having hypos before or during meals, you probably could bolus a little earlier. It makes me nervous because I know that's resulted in hypos for me.

And Humalog is the fast-acting insulin as far as I'm concerned! Maybe you aren't old enough to remember good old Regular :-). I regard Humalog is the instant neutron bomb in comparison.

You're right--regular is before my time. My diabetes was diagnosed just after Humalog came on the market. So, lucky me, I guess. ( :

I woke up at 143 and stayed there for hours today... too big of a chicken to correct it as it was hovering just under 150. My insulin pen does not do 1/2 units.

Finally in the afternoon, it dropped to 100 of it's own accord..

Can you get some insulin syringes that do allow for 1/2 units? You can always draw insulin from the insulin pen with a syringe.

Also, if your I:C is like 8:1, then you could eat 4g of carbs to offset the extra half unit. Just about perfect for a Dex4 tab. I actually use smarties, 6 g per roll, about 0.4 g per tab.

LOL, I totally didn't think of that. Yes, I could get ahold of syringes that would do that!

Post meal highs mean certain foods produce that high. Check out which foods are producing the high and get rid of them.

I have an absorption problem in the evening. I bolus for dinner and get low within an hour. Then my blood glucose gets really ghigh about 4 hours later. Some of that is from slower absorption of the food after having diabetes a long time.

I use a square wave bolus at night and it really seems to work well. My problem is different than yours, but theYou could try a dual wave: give some at mealtime, and the rest an hour later.

Your basal rates are really low. I basal 12.1 units over a 24 hour period and thought mine were low.

Regarding Novolog -
I recently switched to it after 15 years of Humalog, due to insurance company making Novolog the preferred brand. I found it does work quicker, and I actually had to reduce my basal and bolus by about 10%.
With Humalog (and pump), I would have it in the pump for 4+ days (against recommendation) and found less consistent results after 3 days. With Novolog, it says it can be used up to 6 days in pump, and I find more consistent results for 5+ days.
I wish I had switched sooner !

Regarding post-meal highs -
especially breakfast, I determined that simply getting up and having caffeine (no carbs) would raise my BG. So you may want to check your BG immediately on waking, then again just before breakfast to see if you have a non-carb related rise. It wasn't that my basals were off, because if I awoke at different times, the same occurred. So I either add small correction to my meal bolus, or do a small bolus when rising, (I also have CGMS which helped me to recognize this scenario).

Another suggestion is to include more protein/fat with your 15 carbs at breakfast, and if possible eat the protein/fat first. For breakfast, I usually have a smoothie, with about 40 carbs, but it is mixed with fats and protein. With humalog, I had to consume it slowly to match the slower time for Humalog to kick in. But now with Novolog, I need to finish it more quickly, or extend the dual wave bolus. My CGMS was also helpful in recognizing this, but frequent BG testing can also help analyze what variations would work.

Another factor that works for me is a small amount of exercise in the morning (10 min), that seems to make the insulin more responsive (maybe increases circulation, or reduces insulin resistence ?).

Everyone is different, so experiment with different combinations and find what works for you !

So glad the rising BG just because of getting up (at different times) isn't just me. It happens if I nap, too. I've learned to bolus a small amount as soon as I get out of bed.

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