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 think I'm going to try the 2/3 before and 1/3 after and see how it goes and then eventually try to give it all before. That way I can ease into the transition knowing that if I don't eat what I thought I would, I'd still be okay. Thank you everyone for the advice and suggestions
The beta cells will inject the pro-insulin directly into the portal vein. In comparison the absorbtion in the top layers of the skin is very slow. To inject before the meal - perhaps with some additional time on top - makes sure that the insulin has been absorbed partially when the glucose from the digestion hits the blood stream. With the older insulins like Acctrapid I had to wait 15 minutes or longer depending on the BG. For that I had a wrist clock with countdown timer. Coming from these times it was a great relief to switch to NovoLog and to just inject before the meal. If my dosage is greater than my appetite which happens rarely I will make sure to get all the carbs necessary - by drinking juice instead etc.
Are you going to bolus twice or do a dual wave with 2/3 of the insulin up front and 1/3 over the next hour? If split you insulin that way you'll have an easier time fine tuning.
very very good list of suggestions! once again, I m amazed by the helpfulness of everybody!
My son can have up to 30 carbs in a setting without too much spike usually. However, sometimes his BG will briefly spike and then come back down even when only eating 30 carbs. The best method to avoid this for him is to bolus 15 minutes before eating, as others have suggested (he is on Novolog). If you are on humalog, you may only have to wait 10 minutes. I'm not sure about other insulins, but a quick search will give you their action times.
I don't remember the blogger, but someone recently did a "self-study" on doing a 15 to 30 minutes walking after every higher carb meal and indicated that it lowers the amount of his post meal spike. I think he indicated a 20-30 point flattening of his overall BG levels.
I was wondering if the bolusing after eating might be an "artifact" from when reberman was younger? I know parents sometimes do that to avoid kids not eating as much as the parents guessed they would and perhaps a habit like that would linger on if things were working ok? I think that most of the adults I've encountered seem to pre-bolus to give the insulin a head start. If post-meal bolusing were a plan, it might offer a great opportunity to try something new and get a significant improvement fairly quickly, at the cost of breaking a habit. Which, of course, can be very challenging.
I find that post meal blood sugar spikes are unavoidable...but I will correct a high BG as soon as detected and if I can predict a high BG I will correct it before it happens.
Excellent question and answers, I struggle as well.
So I just had this same discussion with my physician as it seems regardless of what I eat, I spike to these levels too after a meal.
1. I asked her what I should spike to as a diabetic after a meal - she said 180.
2. I am on humulin and really all insulins even humalog has a delay before it kicks in. In my case with the humulin, its usually 60-90 min, so I see this spike on my CGM.
3. Obviously, simple vs. complex carbs effects this, but I see the spike a lot no matter what as well.
I am fine except for those spikes....GAHHHHH!
Your doctor is giving you the ADA line: 180 is not fine! Studies have shown that damage can accumulate with sustained highs over 140, so that is a more reasonable pp goal. Having said that, spikes cannot always be avoided, and the key, as John says, is to correct promptly. However, if you are seeing a pattern of pp highs, than you are not using enough insulin and need to tweak your I:C ratios.
My physician is a life long T1D. Its not an ADA feed I think she wants it below 180 too - spike be gone!