Do You Eat If Your BGL's High?

[TheClockworkDodo]

Mainly a question for type 1s - if your dinner's ready and you test and find your bgl's well into the teens, do you just add your correction dose to the insulin you were about to have for the meal and then go ahead and eat straight away, or do you inject, leave the meal, keep testing, and eat when your bgl's at a more sensible level? Or something in between?

Not something that's happened to me often - I'm more used to watching my dinner get cold while waiting to stop being hypo - but tonight I was 16.3 😱 I went for a compromise between the two options above - I injected, waited about 15 minutes, and then ate without testing again. Now wondering what I should have done, in an ideal world.

 

[Rosiecarmel]

I just add my correction dose to the dose I was gonna inject for the meal.

Eg. If I'm gonna bolus 6u and need a correction of 4u I'd just inject 10u and eat my meal as normal.

No idea if that's the correct way of doing things but hey ho

 

[Robin]

I will normally go ahead and eat, for several reasons.
1. I cook for the family, and we tend to eat together, so I'd either have to delay everyone's, or let them go ahead with theirs whilst waiting for mine.
2. I tend to do my insulin half an hour before eating, so if I was high, and I'd added a correction dose to it, I should be starting to come down anyway
3. Most meals I have aren't going to spike me upwards dramatically anyway. If I'm eating a lot of carbs, it will be in the form of fruit afterwards, or it will be mixed in with protein and fat to slow it all down.
That's what I do, but this being diabetes, I expect other people will be along in a mo saying they do the opposite - it's whatever works for you.

 

[Pumper_Sue]

The general rule is not to eat if above 8, like @Robin I inject 30 mins before I eat so if I am higher than I should be then the meal is delayed until I reach my target level. Obviously this isn't always practical for other people but as I only have to worry about myself it makes no odds to me.

 

[Rosiecarmel]

The general rule is not to eat if above 8

Oh, I've not been told about this rule. I inject 15 mins before I eat. When I'm eating at friends, or uni, or work etc I don't often know in advance when I'm eating so it can be like ten mins before so I just whack my correction dose onto my bolus dose. I've never had any problems yet

 

[Mini-Vicki]

I try to not eat if I'm above 8, but that's not always practical. If my food is ready to be eaten, or if I'm on my half hour break at work, then I simply haven't the time to wait, so I add the correction on and then check again 2 hours later to see how things are going. If I have the time, I prefer to give a correction and wait.
It takes me 60-90 minutes to get home from work, so I usually test before I leave and then if I need to correct I do so, and by the time I'm home, my BG is at the right level for dinner!
The other thing that I've done before if I'm high is to correct and bolus about 40 minutes before I eat, then I can eat without giving myself another injection. This works for me, but I for others this might be far too soon in advance!

 

[TheClockworkDodo]

Thanks everyone 🙂 It sounds like what I did was probably about right for me. If I injected 30 minutes before dinner I'd be hypo before I started eating! - so I tend to test 5 minutes before and inject while R serves up. Anyway, my bgl should have been coming down after 15 minutes, though possibly not to the extent of being below 8 by the time I started eating. I had a baked potato with tuna and brocoli, so I ate most of the tuna and brocoli before eating too much of the potato, to be on the safe side.

I was 7.7 two hours afterwards, will test again before I go to bed and no doubt find I am 3.5 ... 😉

 

[sunny sanghera]

I tend to wait 15 mins till it comes down abit then start eating or just give the extra insulin and for the food am gonna eat before and eat it quick so my levels don't drop best way to avoid high levels for certain is give a unit of extra insulin as I have done this and ate a big meal and cake after and my levels have been in 4s and 5s but that can be risky of a hypo at same time but it's the High levels which worry me more

 

[trophywench]

I've never had any info not to eat if above 8!

I just add the correction dose to the bolus and go ahead and eat. I don't bolus until I actually have the plate in front of me anyway - and Pete's usually halfway down his by the time I can start eating anyway. He eats his food absolutely red hot - I don't!

 

[mikeyB]

Yup, I just add the correction on to the bolus dose, and like a couple of others have mentioned, I've never been told not to eat with a BG over 8.

 

[KookyCat]

I was told to correct and eat, even when I was experiencing blood sugars into the 20's at the beginning, the DSN talked about correcting and waiting as an option, but then said that more recent research suggests correcting and eating is more effective because the process of eating (chewing actually I believe) releases a hormone that makes the body more sensitive to insulin. For a 16mmol/l level I'd have done what you did, injected a bit ahead of time and then carried on as normal. Anything up to 12mmol/l I'd have done nothing different at all except add a half unit or a unit of insulin to my bolus (1 unit drops me 5mmol/l at least so I'm a cautious corrector). I've often wondered about this actually because my uncle (T1, American, pump, CGM the whole nine yards) waits for his blood sugar to come down, because that's the advice he's always been given, but his hba1c is tied into his premiums for insurance so that may have more to do with it I suppose. I would guess the answer is you do what works best for you, since I don't have many double figures before meals it would be a rare hit if my post meal went very high, but if you get it often, aside from working out why and trying to come up with a more permanent solution waiting for it to come down to avoid the increase is more worth while in terms of overall control.

 

[Bloden]

I do exactly what you did, Juliet. 🙂 If it's breakfast or dinner (never at lunch) I inject 15 mins before eating. Not eating isn't an option I'd ever consider!🙄 I love my food.😛 And I deffo give myself a correction dose.

I like the idea of Sue's 'never above 8' rule but it just wouldn't be practical for me.

 

[Sally71]

We've never been told not to eat if high, pump anyway just adds on correction dose to the bolus, so we just do that and get on with it!

 

[TheClockworkDodo]

Interesting to see the mix of advice (or lack thereof) people have been given about this.

Jenny - snap! R has often finished his dinner before I start mine. Partly because he wolfs it down hot without pausing for breath, but also because I am too often hypo just before meals and have to sit about twiddling my thumbs and waiting for enough blood sugar to eat 🙄

Anything up to 12mmol/l I'd have done nothing different at all except add a half unit or a unit of insulin to my bolus (1 unit drops me 5mmol/l at least so I'm a cautious corrector).

Also snap! And I think this may have been the third time in six years my bgl's been over 12 just before a meal - the second time being the previous day, when it was about 13. I'm pretty sure I know exactly what caused it - I have found the second food that is a no-no for me because of my diabetes - the icing sugar in the carrot cake I had for lunch.

The first food I couldn't eat was eggs and I can eat all sorts of other sugary stuff with no problem, just a tiny bit of extra insulin, so this was more surprising than most diabetics would expect! And knowing me, it may still turn out to be not the icing sugar but the cream cheese ...

 

[Sals75]

I have just been reading your comments about correction doses. Never heard of them before now. I've only been on insulin since 19.11.16 and am on Apidra before each meal alongside Lantus. My BG levels are mostly high, for example yesterday I was 11.6, 13.8, 18.7, 22.2. These readings are very normal for me; I rarely go below 10. My insulin units have all been put up this week due to my levels so hoping they will start to come down. Is this normal this early on in the life of a type1?! Will I be taught about correction doses?

 

[TheClockworkDodo]

It does normally take a while to get your levels stable, but all the same those are a bit high, Sals - if the increased insulin doesn't mean you have lower readings within the next few days I'd talk to your DSN about putting the doses up a bit more, if I were you. It's sensible to give it at least four days after increasing Lantus before you change too much else but I wouldn't wait much longer than that before getting on to them.

Yes, you should have been told about correction doses! Has anyone mentioned sick day rules to you? Or told you how to test for ketones? If not, then again, I'd have a chat with your DSN. They should be able to work out how far one unit of insulin brings your blood sugar down and let you know, so that you know what to do if you are ill and your blood sugar is too high and you need extra insulin. They may be waiting until you've got your levels a bit more stable, but all the same, it's information you should have asap, just in case. Basically a correction dose is the amount of insulin you take if, after the Apidra has stopped working (I don't know what the timing is with Apidra but with my fast-acting insulin that would be about four hours after injecting) your level is still too high, or if you're ill and your level is too high so you need extra insulin. I don't know how to work out what yours should be though, you really need to talk to your DSN about it.

I'm assuming here that you have a DSN (diabetes specialist nurse) - if you were diagnosed at your surgery and haven't been referred to a hospital team yet because they've only just worked out you're type 1, please ask your surgery to refer you to a hospital DSN as soon as possible, you will need to see one!

 

[missclb]

Like most folks here, I used to just add a correction dose onto my bolus, but I'm currently trialling not eating until the bolus (for food + correction) has reduced my levels to a number I'm happy with. It seems to working better for me, as it avoids a higher spike, post-food. Although I do have to be mindful about what I'm eating and how quickly or otherwise my BG will rise.

 

[Lilian]

This is what I was told. If between 7.8 and 10 wait half hour after bolus to eat. If between 10- 11.1 wait 45 minutes before eating if more than 11.1 wait at least an hour. If still too high then lower carbs. If 4.4 or lower bolus after eating 15 minutes especially if it was a low carb meal. If not certain of carbs or if adding more carbs not counted for, or a prolonged meal, bolus can be split. Bolus actually performs better in smaller doses rather than large so splitting would be better anyway. This is for type 2. I would not know if it also applies to type 1 or any of the others. Bolus loses about 20% an hour so if having snack or meal less than 5 hours after previous bolus take into consideration how much is left.

 

[TheClockworkDodo]

Thank you both, that's interesting. I suspect the general idea of waiting for a bit, and also of waiting longer the higher you are to start with, would apply to type 1s and other types, Lilian, but probably not the length of time or the very specific numbers you've been given. Like most things it seems to be a case of trial and error. I'm so insulin sensitive that I suspect even if my bgl started at 16, if I waited a whole hour after injecting I'd go so hypo I'd wake up in hospital! But the principle of the thing is useful to know 🙂

 

[Lilian]

I am quite the opposite to you Juliet, but then you are type 1 and I am type 2, which is typically insulin resistant and I am extremely insulin resistant and carb sensitive. More so in the mornings than the evenings.