I'm slightly embarrassed about the question I'm about to ask, but I realize if I don't ask, I'll never learn. My question is about spikes in blood sugar after eating. After most of me meals, I experience a spike in my blood sugars. Sometimes it will spike to about 200 but often it will spike to 250 and above. When I see this spike (either from looking at my CGM or testing my finger), 80% of the time my pump will tell me not to bolus anything, because I have enough active insulin in my system already. And most of the time it is correct, my blood sugar will then drop back down, but not always. I find this incredibly frustrating and confusing to see a high blood sugar but then being told not to give any more insulin. Obviously I don't want to drop low, but I don't want these spikes to occur. Most days my CGM just looks like one crazy roller coaster ride. So how do I get rid of them? Is it a question of food? I know foods like pizza and pasta will spike my bg, but I don't feel like I'm eating extra complex or high sugar foods. Is it a question of how I give my insulin? I usually just do a normal bolus because thats what I was told but should I be doing square or dual? I know these are questions for my endo, but I was wondering about other people's experiences. How do you avoid those spikes??
I don't run into them that much. I look at the 2 hour readings and, if they are higher than I want (I use 120 but that's "ok" in my head but I get nervous as I approach it...), I adjust my ratio to put a bit more insulin on it. Not a lot, like .1 or .2g/ U less. I've tried playing around with square or dual but haven't ever had much luck with those. If my BG gets up above that, like 120 going up steeply on the CGM after a meal, I'll also crank the basal up to 200% regular for a couple of hours. A lot of times, I'll check in an hour and it will be hunky dory or I'll end up turning the basal down to avoid a low but I figure I've saved myself a couple of hours of high. I try to do that as much as possible.
If I'm treating too many lows, I figure the opposite, that my ratios/ rates are putting too much insulin in there and turn them down.
That's a good idea to try with the temp basals, definitely something I don't utilize very often. Thank you!
Food definitely impacts blood sugar. If you are eating high carb meals they can be hard to accurately bolus for.
But bottom line, It sounds as if your I:C ratios need adjusting if you are frequently spiking too high two hours after your meals. I would try increasing your insulin by a little. If you are currently using 1:15, try 1:13 for awhile and seeing how that works. Also, many of us have different I:C ratios for different meals. Mine, for example are 1:6, 1:11 and 1:16. Do you have the book Using Insulin by John Walsh?
Also, you might be waiting too long to bolus. Try bolusing 15-20 minutes before eating.
No I dont have that book, you recommend it? I do have different ratios for different meals but I'm thinking they might need to be adjusted more, thank you.
I read "Pumping Insulin" and "Think Like a Pancreas" by Gary Scheiner and they are both awesome owner's manuals that really will help you figure things out. Ginger Vieira has another book I like called "Your Diabetes Science Experiment" which is also very good and is a bit shorter. I like TLAP the most because that's what I was reading when the light bulb went on in my head but they are all very good and comprehensive books.
thanks, I will definitely look into those
I still hit some higher carb meals, generally in the evenings and weekends but eat mostly the same during the week. I think that helps me keep my settings pretty accurate so that when I let 'er rip, the result works out ok. One thing that amazed me when I switched to the pump was how small adjustments would make significant differences in results. I was all over the place on my homegrown MDI regimen but realize now that a very small nudge can help get me where I want.
Another thing that I do which is not exactly medically recommended is try to aim for 85 for fasting BG. I don't always hang out there but, when I do, it seems less likely to run up to 200+, it has to go farther to get there and all that. I wonder if maybe thinking +/- might have some benefits for a methodology over "hit this number" as the change is the big thing. It always goes up but I try not to go way up.
I think we do a good job if we can actually figure out the right insulin dose so that we return to a normal blood sugar 3-5 hours after eating. But in order to suppress that spike in blood sugar from eating you need to actually control the profile and timing of your bolus, a very difficult thing to do. We are told that we can just bolus and eat whatever we want, but I think that is just a lie. Sure, you can do stuff like advancing your bolus, doing a super bolus, using an extended or dual wave bolus. But in the end, if you eat a huge amount of carbs, it is going to be really hard to match your insulin profile to that cascade of glucose hitting your system. Your two major options are to cut the carbs or work on advanced techniques to try to compensate for the huge rush of glucose hitting your system.
that makes a lot of sense, thank you. The timing of my bolus is one of my biggest weaknesses, it is usually on the later side so that would help explain the spikes. That probably is a good place to start to see if I can get things to level out.
When I changed my timing - waiting 15 min after bolus, it was a big help. Also, eating the proteins/salads first, then the carbs helped out.
More recently I started checking BG/CGMS 1 hr before meal, and may pre-bolus .5 - 1 unit if BG is >120, but the disadvantage there is to not get distracted ! But if plans change, I can eat a small carb snack to cover it. If timing is good, my BG is usually around 80 when I start the meal, and the 2 hour spike < 150.
I've found for me, I can handle higher carb meals for breakfast and lunch better than I can dinner. And forget eating anything carby late at night. Right now I'm having a lot of gastroparesis issues, go figure my A1c is right at 6 and I'm having more problems with gastroparesis NOW than I ever had when my A1c was really high. But I've been using my dual wave bolus a LOT lately and avoiding eating high carb meals.