Replies to This Discussion

Permalink Reply by diabud on January 15, 2012 at 2:52pm

I have a similar problem with moderate intensity exercise. The only thing I have worked out with it is to bolus less fore a meal before exercising and/or eat a snack on my way to the gym (granola bar usually). This way I avoid post-exercise highs and mid exercise lows.

Rose

Permalink Reply by Debbie on February 4, 2012 at 2:05pm

I have these unexplained highs 3-6 hours after I eat if I eat something like chicken wings. I think it's the fat in them that causes this. I eat very low carb and loosely follow Dr. Bernsteins diabetes solution. however, being a woman in my 40's I find that hormones play a HUGE roll in night time highs. not sure how that works for men....but it may be something to look into. at night sometimes, I'll wake up to my high alarm going off. I haven't eaten in many hours so the only explanation is hormones. arghhh. frustrating as I try to do everything right like you!! this is what is working for me, I set my high alarm at 110 now....anything over 110 gets a bolus. my last A1C was 5.6 so it's working for me. perhaps set tighter perameters on your pump like i did? I also bolus for TAG (total available glucose), so many are taught to just bolus based on carbs, this does not work for me. even fat and proteins turn to glucose in your body eventually,just at a smaller rate. so it only makes sense to bolus for all of it. this has made a huge difference for me and is keeping my A1C at 5.6 so I'm happy with this protocol. I hope this helps. this disease is very frustrating, and I feel your pain. I just also want to mention that I workout regularly also and find that exercise skews things as well. when I lift weights (my passion) my BG levels sky rocket, but cardio brings them back down...so now I lift first and finish with cardio to bring my levels back down.

Permalink Reply by Doug H on February 6, 2012 at 10:07am

Thanks Debbie. A1C of 5.6. Thats fantastic. The good news is that I am starting to see positive results from some of the changes I have made since this post. I like the idea of tightening my target range more and more over time and bolusing when outside that zone. I have been doing this and have brought my upper range down from 250 to 180 so far. much more to go clearly.

I too have been finding that protein only meals / snacks are leading to highs 3-6 hours later. Since you are following Dr Bernsten type low carb diet, what Insulin ratios do you typically use when you only ingest protein or protein and fat during a meal? Do you bolus normal or do you do a dual wave to account for slow digestion of proteins?

Permalink Reply by Debbie on February 6, 2012 at 11:30am

I almost always do a dual wave bolus. I give , for example, 2 units immediately to cover the carbs and another 2 units over a duration of 1.5 to 2 hours to cover the later proteins/fats. it's not always perfect, my ratio is 1 unit per 8 gr. of carbs, and then I take the ounces of protein and figure up an approx amount of insulin to give for that. everyone is different. I find I require more insulin than a lot of people. some take 1 unit per every 15 grams of carbs, and I take one unit per every 8 grams. you just have to find what works for you!! I NEVER allow my glucose to go above 140...EVER!!! I'm a bit OCD , ha ha....and get frantic when I see it rising!! that's why my high alarm is set at 110 and my low at 65, I really try to keep it within those parameters. My A1C at diagnosis was 14.9 (nearly dead)....so I've come a long way and found Dr. Bernsteins books very helpful. I dont follow his plan to a T, as I found I was getting highs due to all the protein hours later....so I've found what seems to work for me which is lots of lower carb plant based foods and some lean proteins. I never eat anything that contains flour or sugar....so I eat no bread at all...but that's ok....I don't need it!! :)

Permalink Reply by JohnG on February 8, 2012 at 5:17am

Hi Doug

If you are having trouble with protein it could help for you to try TAG. Protein eventually turns into sugar

it just happens hours after a standard bolus has ran it's coarse. Protein converts to glucose at a rate of

about 2.5 to 1 (40%) 10g of protein = 4g of sugar...YMMV  This is a well known fact but when food

exchanges and carb counting started to be the preferred way to calculate a dose of bolus insulin  our diets where 50+ percent carbs and only about 20 percent protein. The medical profession decided we would only be off 20% if we did not include protein in our bolus calculations. This was good enough for insulin therapy in those days.

When you bolus using the TAG method you are doing a bolus for the Total Available Glucose in your meal. I think there is a TAG group on TU, I have not been active on the forum for about a year. When I tried to go low carb it did not work and my BG was unpredictable and all of the protein and fat just put my BG on a long slow boil... As soon as I started TAG my A1c started dropping and my bolus calculations where more predictable.

Someone in the TAG group posted a good bolus calculator if you cannot find it email me and I will send

you a copy of the Excel file  I have used in the past.

 

Years ago I asked a Doctor what can I eat and he looked at me smiled and said if it tastes good spit it out!

 

 

Permalink Reply by Tracy on February 7, 2012 at 6:47am

Thank you Doug for starting this thread. I started doing square/ dual bolus after each feeding and I find it helps a lot for me too.

Permalink Reply by diabud on February 21, 2012 at 11:58am

Hey Doug, How is it going? I just had my first A1C under 8 since I was a kid: 7.7! I know I still want it to be better but it feels like I broke an invisible wall. Hopefully I can keep the trend going.

How I did it so far: Still no Dexcom (fighting the insurance fight), but I did do extensive basal checking. I basically spent a few weeks skipping meals every time my BG was below 250 and found my basal was way too aggressive in the afternoon. I have been trying to cut down on carbs per suggestions here and also to write more things down.

Thanks everyone for the suggestions so far! Keep 'em coming.

Permalink Reply by Doug H on February 21, 2012 at 6:06pm

Hey Dbud. Nice going on the A1C improvement!! 7.7 is a great step in the right direction!! These types of positive changes need to come in bite sized chunks to be sustainable. Keep it up.

My progress was really going well until I got some flu / bug that has been going around here. Knocked me out for almost two weeks. Really hard to keep BGs in line with few exceptions during this time. Need a better sick day mgmt plan for future reference. Good news is I'm almost done with this thing and looking forward to getting back to normal / more active routine. I've got an endo appt in one month so I have time to drive my A1C down towards my goal.

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