Replies to This Discussion

Permalink Reply by Michelle Forsman on April 17, 2010 at 12:58am

I never check one hour after eating, but if I did, unless I ate zero carbs, I would expect my BG to be in the 250-300 range. 2 hours after is when I am supposed to check and then, all my docs (primary. endo, gastro, etc.) want it to be 180-200. Remember the bolus insulin you take when you eat stays on board for 4 hours after you take it, so if you brought your BG down to the 100-120 range after an hour or two, you would bottom out before the 4 hour life of your bolus ended.

Michelle
Western Washington State

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Permalink Reply by Zoe on April 17, 2010 at 6:29am

Doctors that state that two hour readings should be 180-200 are responding to very out of date and dangerous ADA recommendations (which were actually under 180, not 200). Damage begins to accumulate at 140 so letting your blood sugar regularly go to 180-200 is asking for complications.

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Permalink Reply by DiabeticRadio.com on April 17, 2010 at 3:57am

Hi OmniTamer,

There are many things that could be a factor, this includes the type of insulin, and even brand. I do not recommend that you test an hour after you eat UNLESS you are experiencing symptoms of a hypo. For many diabetics, after 1 hour is when your sugar peaks! You must understand that for many of us (depending on what's eaten), our bodies are still digesting, hormones are high (which raises sugars even further) within an hour. This is why health care professionals/ADA recommends to test 2 hours after eating. If you try to correct before 2 hours, you can run the risk of having lows later. After 2 hours an acceptable range is less than 150-160. The only exception to the rule, is unless you are an athlete, doing extreme sports. then I can see you testing every hour (because you are performing strenuous physical activities, which of course lowers your sugars)

Second, I agree with your doctor's suggestion 100-140 mg/dl. When your out and about, you should always have a cushion to prevent severe lows. Remember that when you are walking, thinking moving, your body is using the insulin 24/7 to get it's energy to do what it needs to do!!

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Permalink Reply by rick phillips on April 17, 2010 at 3:57am

Different people have different reactions to food. My BG rises very quickly after eating and hovers at about the 250 mark, unless it does not. I do not think there is a set answer, for every time I have gone way high, I have also gone way low. unfortunately I have never found a good answer to keeping it low all the time. The more fiber you eat, the less influence food will have, but by the same token, some days a bunch of fiber works against me.

My best advice is to ride the wave and think about it in terms of a steep learning process. . Everyday I try to learn what the ins and outs of BG control are. I have been tyring ot figure it out for 35 years, no luck so far,

rick phillips

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Permalink Reply by Tim on April 17, 2010 at 4:38am

250 and 300 are definitely high... but that doesn't mean you never get there.

I think some folks view bg target goals differently than me. My goal is roughly 80 to 120... if I end up at 133 in the morning do I think myself a failure? Not at all! I came remarkably close to the goal. And the morning number is the hardest for me hit.

If you're high-carb school lunches all the time those are really hard to deal with. I'm not saying they're "good" or "bad" just that they will be among the most challenging meals you ever have to deal with in your ENTIRE LIFE. After you get out of school, and you're allowed to actually *pick* the food you want to eat, you can do a lot better. When I got out of high school and in college, and I was actually responsible for choosing my foods, I did so much better so much of the time.

If I'm at 200 an hour after a meal and then back to 100 two hours after the meal I don't feel bad. I notice it, yes... think that maybe I can take my insulin a little earlier next time I have that meal, sure.

Keep in mind that they're all numbers to HELP you. They're not numbers to act as judges on you or some impossible bg standard.

Don't see how you needing contacts has anything to do with after-meal bg control. Going nearsighted is not a complication of diabetes!

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Permalink Reply by mother4peace - Christine on April 17, 2010 at 7:56am

This is such excellent advice. I ave found that if I also keep my meals under 45-60 carbs my control is far more superior than when I don't.

I also test frequently...between 7-10 times a day. I regularly test in pairs with meals...before I eat and 2 hours from after the start of the meal. You can learn a lot about how your body responds to different foods at different times and under different circumstances.

My endo described the carb counting and calculations for insulin dosage as biology and not just mathematics. There is so much to factor in when figuring your bolus as you have described above. A person's diabetes is very individual and to figure it out you have to test, record, analyze, and repeat.

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Permalink Reply by Kelly Rawlings on April 17, 2010 at 7:09am

American Diabetes Association guidelines are under 180 1-2 hours after the first bite of a meal. American Association of Clinical Endocrinologist guidelines are under 140 2 hours after the first bite of a meal.

Under 140 can be quite difficult to achieve without dropping low within 4+ hours (when action of bolus insulin should be gone, depending on your body), but is not impossible. Basically, you need to figure out what you can achieve and be happy with and how much time, effort, and cash you want to invest in the process.

I'm a long-time PWD who is OK with 180 every once in a while--especially if I'm back in range by the next meal. Yes, damage does occur when levels are high, but it also matters how long they are high (and how severe the ups and downs). For me, smoothing out drastic swings has been more important for improved A1Cs than worrying too much about the ocassional high--but your mileage may vary :-)

Keep in mind, both sets of guidelines are general to cover all people with diabetes--longtime type 1s on MDI, those on pumps, newbie type 2s, etc. That's a huge spectrum of people, years with diabetes, body weights, activity levels, insulin production, other types of gut hormone production or lack thereof, menstrual cycles, etc. So, individually, we each really need to establish, with the help of a health care pro, an individual target range.

The numbers can be a bit tricky if you start a meal already out of range. Some people correct until back in target, then bolus and eat. Others correct and bolus at the same time. Another number I look at is attempting to achieve an increase of no more than 40-50 mg/dl from a meal, no matter the starting blood glucose.

Best wishes. Glad pumping is going well for you.

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Permalink Reply by Stephen Gilbert on April 17, 2010 at 9:00am

Thanks everyone. I forgot to include that my Novolog only works on me for 2.5-3 hours, and all of my bolus calcs work off of that.

It's looking like i should aim for about 140-180 at this mark, and then somewhere around 140 at the two hour mark?

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Permalink Reply by DiabeticRadio.com on April 17, 2010 at 11:22am

Yes.... That sounds about right.. However, still talk to your doctor because it maybe slightly different depending on how physically active you are at a given time. In addition, if you are more physically active @ a given time, dosages may have to change to compensate for heavy physical activity.

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Permalink Reply by Gerri on April 17, 2010 at 12:05pm

Timing of bolus is as important as dose. Trying to get the peak of insulin to jive with the food peak takes a lot of testing, but it's worth it. No hard & fast rules since we all react differently to food, insulin & rates of digestion vary. I did a ton of testing at 1, 2 & 3 hours trying to figure it out.

I aim for 140 & under at 2 hours.

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Permalink Reply by dep on April 17, 2010 at 8:04pm

That is crazy high. You really should not expect to move more than 30-40 points over your baseline. If you stay at 80 or 90 pre-eating you should be expecting 120-130. If you are at 120 then 160 would be OK but you might consider taking it down to target a bit lower.

There are a couple of things you can do. You can take your insulin earlier (20-30 min before eating) as long as you don't crash. Better, you can eat less carbs in a given meal. Many people are going to be hard pressed to stay down eating 60+ carbs at once. When you get to 80 or 100 carbs your BG will be high no matter what.

So, bolus earlier and eat less!

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Permalink Reply by Stephen Gilbert on April 17, 2010 at 9:33pm

Thanks. :)

I usually try to aim for about 60ish a meal. I usually have a 65-75 carb breakfast, and then whatever crap the school throws at me (I HATE school lunches, i have so many presets for them building up in my PDM), and then dinner is usually pretty lean at 40carbs or so.

Tonight we had Pizza, so i got to play with the dual wave bolus setting for my Omnipod... kinda went okay... until the third hour afterwards, then i shot up to 320 before i could get my insulin to start working on me. I'm still in the "Well, how do i use THIS setting" stage... i just HATE spiking up that high after any meal, or anything, because my hyper awareness kicks in at 180ish, and when i get THAT high, i feel pretty bad.

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