Need quick tips (high after meals, on target before next meal)

Replies to This Discussion

Permalink Reply by Kimberly on October 7, 2009 at 1:56pm

Try bolusing at least 20 minutes before eating. If I bolus 30 minutes before breakfast (my least insulin sensitive time of the day), I don't go over 120 with my big bowl oat/wheat bran containing 45 carbs. And I end up in target and stay there until the next meal.

▶ Reply to This

Permalink Reply by Sarah on October 7, 2009 at 2:01pm

I agree.. just bolus earlier :) It sounds like your insulin dosages are probably fine, it's just the timing that could use some change.

I used to be afraid to bolus more than 10-15 minutes before a meal unless I was also including a correction.. since using a CGM, I realize now that I can push that to 30 minutes and beyond without any true danger. I get a slight drop within 10-15 minutes, but the bulk of the insulin action takes at least 60-75 minutes to start working. If I can time it so that action hits about 20-30 minutes after I start to eat, it works out much nicer in terms of my BG becuase the insulin matches digestion better. I am getting more and more results from my CGM where you can barely tell I even ate a meal - my goal is to eventually have ALL of my meals stay relatively flat BG wise.

▶ Reply to This

Permalink Reply by MelissaBL on October 7, 2009 at 7:09pm

Agreed. I bolus at least 15 minutes early now and have had similar results.

▶ Reply to This

Permalink Reply by KiwiRox on October 7, 2009 at 2:13pm

According to my CDE and nutritionist, you should expect a 40-80 rise in sugar levels after meals. It is normal, even for non-diabetics for your sugar levels to rise. Having a flat line 24/7 is unrealistic. One thing you may look at it are your basal rates, and perhaps they need to be slightly higher premeal.

▶ Reply to This

Permalink Reply by Brenda on October 7, 2009 at 2:14pm

Thanks to all for the suggstions. I've tried bolusing about 15 minutes before but don't do it on a regular basis. I'll try the 20-30 minutes before and see if that doesn't do the trick. I'm on the endo prowl mode and hope when I switch to a new one we can visit about a CGM.....that's my next step and I'm excited.

▶ Reply to This

Permalink Reply by Helmut on October 7, 2009 at 4:33pm

CGM is the way to go. Timing is the free lunch of bg control. I tried my best with 10 finger pricks a day. Now I prick twice a day (with CGM) and my bg control has drastically improved. People with bad eyesight must feel the same when they get their first pair of glasses. Nothing beats being able to see what's going on. There might be people out there who can achieve excellent bg control without 'seeing' but I am not one of them.

▶ Reply to This

Permalink Reply by June English on November 1, 2009 at 7:54pm

Helmut
,
Which CGM are you using, that you can get by with two finger stick BG's per day. I'm guessing it's the Navigator. Am I right? I wear the MM, and LOVE it, but it cannot replace finger sticks!

▶ Reply to This

Permalink Reply by Helmut on November 2, 2009 at 4:57am

June,

I use the DexCom 7+.

▶ Reply to This

Permalink Reply by Kelly Rawlings on October 7, 2009 at 2:39pm

Also, try different kinds of boluses to "stretch" the dose over a longer period of time (and thus work on the slower-to-turn-to-glucose nutrients of your meal, such as protein and some types of fiber).

Pumps feature extended and/or multi-wave bolus features that allow you to give some insulin up front, then program an additional amount to be doled out over a specified time. Here's one discussion about specialty boluses.

I used to use multi-wave boluses only for very high fat meals such as pizza. But after reading more about the subject from my fellow tudiabetesers, I'm trying them with every meal. So far, my peaks seem to be not as high.

But I also don't get too upset about after-meal peaks as long as they come down pretty quickly. The ADA says under 180 two hours after the first bite; the clinical endocrinologists say under 140 mg/dl. Although out-of-target peaks aren't good, it's also the duration, frequency, and severity that matter. And, like you, I don't want to drop too low before the next meal! Let us know how it goes!

▶ Reply to This

Permalink Reply by Helmut on October 7, 2009 at 4:42pm

"The ADA says under 180 two hours after the first bite; the clinical endocrinologists say under 140 mg/dl."

I don't buy into these lax standards. I believe that these lax standards were ratified so that a lot of people without the right tools don't give up and throw the towel. Never above 140 and most of the time between 70 and 100 sounds way better to me. But it may be cost prohibitive because all T1s would need a CGM that works for them.

▶ Reply to This

Permalink Reply by MelissaBL on October 7, 2009 at 7:12pm

I agree. My pre-pregnancy and pregnancy goals have been below 140 at 1 hour, 120 at 2 hours and has resulted in an A1c of under 6. I love it. My blood sugar levels are more like yours on my best days, Helmut. It's hard, but it feels so healthy.

▶ Reply to This

Permalink Reply by Kelly Rawlings on October 9, 2009 at 1:05pm

Congratulations on great A1Cs, Helmut and MelissaBL. It's always worthwhile to be champions of safe, tight control. Those CGMs give you both low blood glucose alerts, correct? That makes staying in the safe zone, much easier.

For all those readers with uncontrolled diabetes (medically defined as over 7%; on a personal level, defined by the individual and his/her health care provider), please don't throw in the towel!

Often, reaching numbers at or under 6% as a type 1 are the result of months if not years of small steps and changes and typically involve insulin pumps and CGMs. Yes, plenty of people do it without those tools. But it's a lot more difficult.

So I'd like to take this moment to note and show support for everyone fighting the good fight against elevated blood glucose levels, whatever your number.

▶ Reply to This

• First
• Previous
• Next
• Last