Breakfast sugar spike.

[johngers72]

I have just started using the Freestyle Libre2 a couple of days ago.
Monday to Friday , when i'm at work, i have muesli with blueberries for breakfast and have done for months now.
When i did my sensor scan at lunchtime today it showed that my levels shot up to 20 after eating breakfast but came back down just as quickly and at lunch my reading was 5.3.
I was a bit shocked at how high i'd gone. I have read , many times, that muesli is a good breakfast choice for type 1 so is the rise a normal occurrence ?
Any feedback appreciated.

 

[Martin62]

Some mueslies are quite high in sugar and then you have the blueberries to factor in as well , I have a low sugar granola for my breakfast which doesn't spike me too much.
Saying that though although your levels spike quite high it is only for a short while , and back in range quite quickly so I wouldn't worry too much.

 

[rebrascora]

It is likely the timing of your bolus insulin. How long do you prebolus for breakfast?
I used to need to give my Novo(not so)Rapid 75 mins head start on breakfast to prevent me spiking up to 15 every morning. I now use Fiasp which is a bit quicker and I just need 45 mins, so I inject as soon as I wake up, get up and use the bathroom, get washed and dressed, make a coffee and breakfast and sit down to drink my coffee and catch up with the news before I eat breakfast. 45 mins or indeed 75 mins is excessive and some people would hypo in that time..... and if I wake up in the low 4s I need less time but mostly 45 mins is spot on for me and I only get a very slight rise. You might just need 25mins or 30 mins, but basically, if your levels are spiking high but then coming back down into range before lunch it is because the glucose from your breakfast hit your blood stream before your insulin and you need to give your insulin more of a head start, so that they hit the blood stream together. Experiment by increasing it by 5 mins each day from where you are now until you reach the point that it lowers the spike to where you want it without causing you to hypo before or whilst you eat.
I would be surprised if you are actually going as high as 20 because Libre tends to exaggerate once you get above 10 but even spiking to 15 every day and coming back down is not ideal and if you can fix it by taking your insulin a bit earlier, it can really make a significant difference to your BG management, but also to how you feel. I am guessing you have got used to it but I used to feel rotten going up to 15 and then crashing back down to 5. Now I drift up to 7-8 and then drift back down again and having so much less variability in my levels makes me feel a lot better.

 

[Inka]

I have just started using the Freestyle Libre2 a couple of days ago.
Monday to Friday , when i'm at work, i have muesli with blueberries for breakfast and have done for months now.
When i did my sensor scan at lunchtime today it showed that my levels shot up to 20 after eating breakfast but came back down just as quickly and at lunch my reading was 5.3.
I was a bit shocked at how high i'd gone. I have read , many times, that muesli is a good breakfast choice for type 1 so is the rise a normal occurrence ?
Any feedback appreciated.

Try gradually moving your breakfast bolus earlier in 5 minute increments. Finding the sweet spot for your bolus should help reduce the spike. As Martin says, you could also try a different muesli or granola. Some are better than others. Homemade muesli with big, chewy jumbo oats can be good too as the proper oats are usually absorbed more slowly.

 

[everydayupsanddowns]

I swore off all breakfast cereals some time ago as I could never get them right. But I had a bowl at lunchtime the other day and was able to stand on my chair and shout. "I am a diabetes GENIUS!" to no one in particular (apart from the confused dogs) as my guesstimate of timings was spot on.

Leaving a gap between dosing and eating can be a really powerful strategy, but be careful you don't over-do it, as it can take a little while for the food to get going. It's like one of those clips of Pele hoofing the ball into a big open space for no apparent reason, when suddenly, completely out of shot someone comes haring in and blasts the ball into the back of the net.

It's judging the movement of all the variables to perfection that makes it so tricky!

 

[nonethewiser]

Without prebolusing can easily get into double figures, you have to allow time so insulin starts to work as rebrasco says above.

In range my breakfast prebolus is up to 20mins, that's for bowl of porridge which have most mornings.

 

[johngers72]

It is likely the timing of your bolus insulin. How long do you prebolus for breakfast?
I used to need to give my Novo(not so)Rapid 75 mins head start on breakfast to prevent me spiking up to 15 every morning. I now use Fiasp which is a bit quicker and I just need 45 mins, so I inject as soon as I wake up, get up and use the bathroom, get washed and dressed, make a coffee and breakfast and sit down to drink my coffee and catch up with the news before I eat breakfast. 45 mins or indeed 75 mins is excessive and some people would hypo in that time..... and if I wake up in the low 4s I need less time but mostly 45 mins is spot on for me and I only get a very slight rise. You might just need 25mins or 30 mins, but basically, if your levels are spiking high but then coming back down into range before lunch it is because the glucose from your breakfast hit your blood stream before your insulin and you need to give your insulin more of a head start, so that they hit the blood stream together. Experiment by increasing it by 5 mins each day from where you are now until you reach the point that it lowers the spike to where you want it without causing you to hypo before or whilst you eat.
I would be surprised if you are actually going as high as 20 because Libre tends to exaggerate once you get above 10 but even spiking to 15 every day and coming back down is not ideal and if you can fix it by taking your insulin a bit earlier, it can really make a significant difference to your BG management, but also to how you feel. I am guessing you have got used to it but I used to feel rotten going up to 15 and then crashing back down to 5. Now I drift up to 7-8 and then drift back down again and having so much less variability in my levels makes me feel a lot better.

I'm not on any bolus insulin. Since diagnosis i have been on 10 units of Levemir twice a day and 500mg of Metformin twice a day.
Had my yearly bloods and diabetic nurse appointment 3 weeks ago and my pancreas is still producing insulin i was told. Just not enough to cope on its own obviously.
I previously had overnight oats as a breakfast but with the Metformin i found it was playing havoc with my digestive system so i stopped eating that.
Is the Freestyle Libre 2 as accurate as the finger prick and test strip? I have just started using it so still learning.

 

[rebrascora]

That graph is showing you that you now need some help from bolus insuin.

Libre is reasonable accurate in range, but not as reliable as finger prick tests. Once you get above or below range ie below 4 or above 10 the recommendation is to double check with a finger prick before taking action.... unless you obviously feel hypo. So those of us who use quick acting (bolus) insulin would be advised to do a finger prick test before calculating a correction dose when out numbers are above 10 because Libre can read higher at high levels and lower at low levels. This is partly because it uses an algorithm to extrapolate previous readings in order to predict your current reading in order to try to overcome the time lag between interstitial fluid which is what Libre reads and blood, which is what a BG meter reads. It all sounds pretty complicated and I suppose it is but once you get used oi the implications and limitations of that algorithm and how it impacts the Libre readings, then you learn when to trust the Libre reading and when to double check it.

 

[johngers72]

That graph is showing you that you now need some help from bolus insuin.

Libre is reasonable accurate in range, but not as reliable as finger prick tests. Once you get above or below range ie below 4 or above 10 the recommendation is to double check with a finger prick before taking action.... unless you obviously feel hypo. So those of us who use quick acting (bolus) insulin would be advised to do a finger prick test before calculating a correction dose when out numbers are above 10 because Libre can read higher at high levels and lower at low levels. This is partly because it uses an algorithm to extrapolate previous readings in order to predict your current reading in order to try to overcome the time lag between interstitial fluid which is what Libre reads and blood, which is what a BG meter reads. It all sounds pretty complicated and I suppose it is but once you get used oi the implications and limitations of that algorithm and how it impacts the Libre readings, then you learn when to trust the Libre reading and when to double check it.

I was high again this morning after breakfast then 6.6 at lunch. Two hours after lunch I was 7.2 and just before my evening meal I had gone up again, according to the Libre, to 8.1 so I did a finger prick test and I was at 6.0!!!
The diabetic nurse and the consultant told me I don’t need to be taking Novorapid YET as my levels are pretty steady and my hba1c was 45 last month.

 

[rebrascora]

I tend to only compare Libre readings and finger pricks when Libre shows my levels have been steady for the last half hour or so. If levels are or have been rising then Libre can easily overshoot a bit. The difference between 6 and 8 isn't desperately bad, but if the disparity become any greater then I would ring Abbott and report it. Generally they require 3 readings and paired finger prick results where the Libre arrow was horizontal and there was a difference of more than 2mmols between Libre and finger prick. Obviously the above was 2.1 mmols, so just over that threshold, so keep an eye on it.

Sometimes taking a small amount of insulin before each meal can help to preserve your remaining beta cells, which are clearly struggling to cope with meals judging by those spikes in readings. Your body is eventually managing to bring your levels down again by the next meal though which I am guessing is why your diabetes team are reluctant to add bolus insulin yet. It really should not be for you to adjust your diet to try to lower that spike, but for them to give you the tools to manage it... ie Bolus insulin.