EVERYTHING spikes me! Help please.....

[Indy1282]

As title....

Even foods with no/small amount of carbs. I am eating low carb but to be honest i am starting to get really frustrated and fed up. I eat less than 20g carb with a meal, take 4 units ( i am 1:5 ratio ) pre bolus depending on where my sugar is and BOOM spike after, nearly every single time.

I spent ages doing low carb baking - i made some biscuits that were 1g carb each so i shouldn't have even need to bolus. I ate 2 , BS before was 6.4 two hours after 11.2!!

I really do not get it. All my DSN says is that i need to take more insulin to cover it but really?? So i should take 2 - 3 units to eat something that has 1g of carbs.

The other day i had 10 almonds, which are supposed to lower your BS if anything - BS| went up 4mmol after eating them.

Please - can someone help or at least tell me i'm not going crazy???

 

[Matt Cycle]

Hi Indy and welcome to the forum. 🙂 Sounds like a very difficult situation. What insulin(s) are you using? Have you been diagnosed long i.e. is this a recent phenomenon?

 

[Indy1282]

Its a pain....

I was diagnosed on 1st Feb this year, on my birthday!

I take Abaseaglar and Novorapid. I used to have good control but in the last few weeks its just been a complete nightmare - i make the effort to eat low carb to keep sugars down but when they spike after its so frustrating.

I can eat a chocolate muffin ( with insulin ) and spike less than if i eat a low carb biscuit ( also with insulin )?? Its almost a joke between my partner and i that my body seems to respond better to junk food than cutting the carbs 🙄

All i want is to be able to eat fairly normally and keep my BS in range. My last HB1AC was 7.5% which my DSN says is good control, but i know it isn't as i have been spiking between 15 - 22mmol after some meals.

 

[Matt Cycle]

Your ratios do seem quite high but one of the often quoted phrases regarding T1 and insulin use is 'you need what you need.' I wouldn't worry too much if you're using more insulin as long as you're not hypoing all the time. Has your DSN ever mentioned the possibility of insulin resistance?

 

[Sally71]

Do you come down again after the spike? If so have you tried injecting earlier (e.g. 10-20 minutes) to allow the insulin to get going before you eat? If you don't come down again then maybe your DSN is right and you do simply need more insulin. Your ratios do change from time to time, they don't stay the same forever. Don't get hung up on how much you need, everybody is different and you need however much works for you.

 

[Indy1282]

Your ratios do seem quite high but one of the often quoted phrases regarding T1 and insulin use is 'you need what you need.' I wouldn't worry too much if you're using more insulin as long as you're not hypoing all the time. Has your DSN ever mentioned the possibility of insulin resistance?

Yes we did talk about it and I have been prescribed Metformin to take along side my insulin.I know I should just take more insulin but theres more risk of things possibly going wrong- I try to stick to the rule of small numbers.

I'm trying to lose weight and talking more insulin wont help that. I think I'm just really annoyed that I am trying really hard to keep healthy and it seems all in vain p

 

[Matt Cycle]

Yes we did talk about it and I have been prescribed Metformin to take along side my insulin.I know I should just take more insulin but theres more risk of things possibly going wrong- I try to stick to the rule of small numbers.

I'm trying to lose weight and talking more insulin wont help that. I think I'm just really annoyed that I am trying really hard to keep healthy and it seems all in vain p

That sounds like a difficult situation. I can understand why people try to stick to Bernsteins law of small numbers but in my experience taking more insulin to cover whatever carbs you've eaten and reduce your blood glucose levels shouldn't make you increase weight. If you don't mind me asking what were the circumstances of your diagnosis - did you have the classic 4 T symptoms?

 

[trophywench]

I'm wondering about that choice of basal insulin, what the medical reasons are for that choice instead of one of the more common ones - insulin resistance is one of the possibilities and if you are IR then your bolus doses will also be a lot higher than someone that doesn't have it - but only you can determine how much extra you need by treating yourself as a scientific experiment at mealtimes using your meter and responding to the results.

 

[Robin]

I'm wondering about that choice of basal insulin, what the medical reasons are for that choice instead of one of the more common ones

Abasalgar is a bio similar Lantus. (but cheaper!) It’s now the first choice basal in our CCG area (Oxfordshire).

 

[Indy1282]

I was in hospital for 4 days with DKA. I'm not putting on weight which is good but not losing either! I think I just need to take more insulin I guess - I was high 2 hours after lunch so corrected, then at 5PM before leaving work I was 5.4mmol - now dropped and at the beginning of hypo si must have over corrected. Still learning I guess!!!

 

[Indy1282]

Abasalgar is a bio similar Lantus. (but cheaper!) It’s now the first choice basal in our CCG area (Oxfordshire).

I didn't get a choice! Just given this basal at hospital.

 

[Robin]

I didn't get a choice! Just given this basal at hospital.

I meant, the CCGs choose it and impose it on the patients, on cost grounds, not that the patient gets a choice!

 

[Pigeon]

Hi Indy, did you know fat and protein can affect bg too? They eventually get converted to glucose, I found the clinic gloss over this but it's a big thing for me. Have a read of https://www.google.co.uk/url?sa=t&s...FjAIegQIBhAB&usg=AOvVaw2FeM9rDrtYbf97Vm9cfNEc or Google Total Available Glucose. If I have a low carb meal but protein to compensate, I have to dose for the protein. Eggs, peanut butter, cheese all have this effect. Similar if I have a meal with a lot more meat than usual, E. G a barbecue I dose for the meat. The spike is later than with carbs, and so on injections I'd take an extra dose 2 hours after the meal. It seems very counter intuitive and scary at first, but I experimented E. G. With a slice of toast 2u would do me, the same toast with zero sugar peanut butter needs 4u, so the fat and protein were the only logical cause, when it happened again and again. Hope that helps!

 

[Kaylz]

I was in hospital for 4 days with DKA. I'm not putting on weight which is good but not losing either! I think I just need to take more insulin I guess - I was high 2 hours after lunch so corrected, then at 5PM before leaving work I was 5.4mmol - now dropped and at the beginning of hypo si must have over corrected. Still learning I guess!!!

when you say you were high 2 hours after lunch, how high were you exactly? I'm almost 2 years in but would still never correct 2 hours after a meal as there is still insulin on board so would see how I was after 4 hours when that lunch dose should in theory be used up OR just correct with my next meal, this may be why you are close to a hypo because you 'rage bolused' as its sometimes referred to while the insulin you had on board hadn't quite finished its work yet x

 

[Pumper_Sue]

Hello Indy and welcome to the forum.

Firstly you need to check your basal insulin by doing a basal test.
As you eat low carb I would suspect you need a lot more basal to soak up the protein and fat you are eating. The point being proved when you didn't eat low carb 🙂

Are you also bolusing 15/20 mins before you eat? This does make one heck of a difference as to whether you spike at meal times as well.

As you are also so newly diagnosed, I would also suspect your honeymoon period is coming to an end thus you will soon start to see your true insulin needs without your pancreas having it's last fling and splutter before it packs up.

 

[Indy1282]

Hi Indy, did you know fat and protein can affect bg too? They eventually get converted to glucose, I found the clinic gloss over this but it's a big thing for me. Have a read of https://www.google.co.uk/url?sa=t&s...FjAIegQIBhAB&usg=AOvVaw2FeM9rDrtYbf97Vm9cfNEc or Google Total Available Glucose. If I have a low carb meal but protein to compensate, I have to dose for the protein. Eggs, peanut butter, cheese all have this effect. Similar if I have a meal with a lot more meat than usual, E. G a barbecue I dose for the meat. The spike is later than with carbs, and so on injections I'd take an extra dose 2 hours after the meal. It seems very counter intuitive and scary at first, but I experimented E. G. With a slice of toast 2u would do me, the same toast with zero sugar peanut butter needs 4u, so the fat and protein were the only logical cause, when it happened again and again. Hope that helps!

Yes i know about protein and fat raising my BS so i bolus for half the amount of protein in my meal, as it releases more slowly.

 

[Indy1282]

when you say you were high 2 hours after lunch, how high were you exactly? I'm almost 2 years in but would still never correct 2 hours after a meal as there is still insulin on board so would see how I was after 4 hours when that lunch dose should in theory be used up OR just correct with my next meal, this may be why you are close to a hypo because you 'rage bolused' as its sometimes referred to while the insulin you had on board hadn't quite finished its work yet x

Eg. If before my meal i was 6.5mmol i would take the appropriate insulin to cover both carbs and protein then 2 hours after i could be 12mmol or over. I have tried testing after 1 hr, 2hr, 3 hr and 4hr with various meals and they do eventually go down but i would nearly always need to do a correction at some point.

 

[Indy1282]

Hello Indy and welcome to the forum.

Firstly you need to check your basal insulin by doing a basal test.
As you eat low carb I would suspect you need a lot more basal to soak up the protein and fat you are eating. The point being proved when you didn't eat low carb 🙂

Are you also bolusing 15/20 mins before you eat? This does make one heck of a difference as to whether you spike at meal times as well.

As you are also so newly diagnosed, I would also suspect your honeymoon period is coming to an end thus you will soon start to see your true insulin needs without your pancreas having it's last fling and splutter before it packs up.

I have done a basal test already, more than once, and i know how much to take to keep me at a steady level throughout the day and night.

I also pre bolus for meals, timings depend on where my BS is at the time. I.e if 'in range' i would bolus 2 - 10 min before eating and if they are higher then i will pre bolus up to 45min before eating.

 

[Pumper_Sue]

I also pre bolus for meals, timings depend on where my BS is at the time. I.e if 'in range' i would bolus 2 - 10 min before eating and if they are higher then i will pre bolus up to 45min before eating.

Perhaps this is your problem then.
You need to be consistent with your timing as Novo takes 15/30 mins to actually start working. Have you been shown how to adjust your insulin for correction dosage? Knowing your carb ratio as well as your correction factor is very important , also if eating high fat or a lot of protein many people find they have to split their bolus.

Having diabetes is probably one of the most frustrating conditions to have so plenty of trial and error is the norm.
Do you have the same carb ratio for all of your meals? If you do then perhaps have a look at this aspect as well as many type 1's tend to have different ratios throughout the day.

 

[Indy1282]

Perhaps this is your problem then.
You need to be consistent with your timing as Novo takes 15/30 mins to actually start working. Have you been shown how to adjust your insulin for correction dosage? Knowing your carb ratio as well as your correction factor is very important , also if eating high fat or a lot of protein many people find they have to split their bolus.

Having diabetes is probably one of the most frustrating conditions to have so plenty of trial and error is the norm.
Do you have the same carb ratio for all of your meals? If you do then perhaps have a look at this aspect as well as many type 1's tend to have different ratios throughout the day.

I know that Novorapid takes 15/20 mins to work but I cant pre bolus for the same time for all meals. If I am in range and I pre bolused 30min before eating I would hypo before eating, if I was too high 30mins would not be long enough!

I know my correction dosage and I have different ratios for morning, lunchtime and evening meals.

I also do a split bolus if needed