No carbs eaten, but blood sugar rises, it’s making me think I’m going mad!

[Kearnspaula]

Help, I’m trying to go back to basics, getting my head around GI! Aswell.

Lantus taken each morning at the same time, 8am, blood sugars are in range until mid afternoon when they drop off, so I have 10g carbs, stable until teatime, eating carb free tea or take sufficient insulin, novorapid, to cover low Gi meal, bloods return to normal, 5 to 7, 2 hours after eating, then slowly creep up to 11+ by 10pm.

I’m desperate to stop these rises as trying to avoid further deterioration to autonomic dysfunction. Any ideas? I have greatly reduced carbs eaten through the day, could it be that my liver is releasing glycogen, or whatever the correct term is to compensate for my reduced intake. Reduced from 150g to 100g? Any ideas greatly appreciated.

 

[Inka]

I’d guess it’s either a delayed rise from your meal or a basal issue. If you’re not eating many carbs sometimes you have to consider protein as that can cause a late rise.

 

[rebrascora]

For me on a low carb diet, protein kicks in about 2 hours after I have eaten and will slowly release glucose for 2-6 hours after that, so that may be your problem or as @Inka says, it may be a basal issue.
I inject for the protein about 2 hours after eating when I start to see my levels rising on my Libre. I sometimes need 2 or even 3 small, often "stacked" corrections on an evening to deal with it which is by no means ideal as I often go to bed with active insulin in my system but I have it down to a fine art now. Some of those corrections go in when my BG is only at 8 but I can see that it is rising.
I am not recommending you do any of that, but just saying it can be managed but you need to keep a close eye on Libre and be prepared to use your NovoRapid cautiously and preemptively to deal with the rise.

If you are eating low GI stuff like lentils and beans etc I find those release far more glucose than they are supposed to for me. I don't know if it is because I follow a low carb way of eating that my body does it's best to wring every last carb out of anything I eat, but I rarely have legumes now (other than peanuts) as I find them difficult to manage. (Peanuts are worth the effort but need a lot more insulin than they should)
To be honest, my body doesn't seem to understand the principle of low GI in general. Jumbo oats made into porridge start hitting my blood stream 20 mins after eating them which is not much slower than hypo treatment (JBs or dextrose), so don't assume that low GI will solve any problems. Test and see how your body responds.

 

[AJLang]

You mention autonomic dysfunction. Do you mean autonomic neuropathy. If yes that can include gastroparesis (delayed stomach emptying) which can impact on your blood sugars in a way that you suggest. I have gastroparesis and have problems with blood sugars going up over after meals even though I tend to have around 100 g carbs a day - I don't purposely low carb but that's all I can manage to eat on an average day. Ironically on days when I eat more carbs (max 130g) I can have better BG levels - but there is no pattern to that. I'm not saying this is what you've got but it might be worth looking at. Also, are you on an insulin pump because that can help if your blood sugars start going over later than you expect after eating. PS don't let the gastroparesis literature scare you - I've now had it for 12 years (the original tests showed that it was severe gastroparesis) but still enjoy nice food through a combination of using my pump to optimise my blood sugars, accurate carb counting, two small snack type meals during the day and an evening meal - but in the early days all I read was doom and gloom about it.

 

[Kearnspaula]

You mention autonomic dysfunction. Do you mean autonomic neuropathy. If yes that can include gastroparesis (delayed stomach emptying) which can impact on your blood sugars in a way that you suggest. I have gastroparesis and have problems with blood sugars going up over after meals even though I tend to have around 100 g carbs a day - I don't purposely low carb but that's all I can manage to eat on an average day. Ironically on days when I eat more carbs (max 130g) I can have better BG levels - but there is no pattern to that. I'm not saying this is what you've got but it might be worth looking at. Also, are you on an insulin pump because that can help if your blood sugars start going over later than you expect after eating. PS don't let the gastroparesis literature scare you - I've now had it for 12 years (the original tests showed that it was severe gastroparesis) but still enjoy nice food through a combination of using my pump to optimise my blood sugars, accurate carb counting, two small snack type meals during the day and an evening meal - but in the early days all I read was doom and gloom about it.

Hiya, I did wonder if stomach could be affected, at the moment it’s mainly affecting blood pressure, neurologist named it dysfunction! Im waiting for follow up with hospital diabetes team, which I was discharged from years ago. I will mention gastro ? Then. So many thanks for your reply.

 

[Kearnspaula]

For me on a low carb diet, protein kicks in about 2 hours after I have eaten and will slowly release glucose for 2-6 hours after that, so that may be your problem or as @Inka says, it may be a basal issue.
I inject for the protein about 2 hours after eating when I start to see my levels rising on my Libre. I sometimes need 2 or even 3 small, often "stacked" corrections on an evening to deal with it which is by no means ideal as I often go to bed with active insulin in my system but I have it down to a fine art now. Some of those corrections go in when my BG is only at 8 but I can see that it is rising.
I am not recommending you do any of that, but just saying it can be managed but you need to keep a close eye on Libre and be prepared to use your NovoRapid cautiously and preemptively to deal with the rise.

If you are eating low GI stuff like lentils and beans etc I find those release far more glucose than they are supposed to for me. I don't know if it is because I follow a low carb way of eating that my body does it's best to wring every last carb out of anything I eat, but I rarely have legumes now (other than peanuts) as I find them difficult to manage. (Peanuts are worth the effort but need a lot more insulin than they should)
To be honest, my body doesn't seem to understand the principle of low GI in general. Jumbo oats made into porridge start hitting my blood stream 20 mins after eating them which is not much slower than hypo treatment (JBs or dextrose), so don't assume that low GI will solve any problems. Test and see how your body responds.

Hiya and thank you, could well be protein, which I don’t understand at all?! I’m saying may well be as you say because porridge kicks in for me about 20 mins, but does then last nicely. And I am finding low Gi does raise bloods higher than all info says. Typical my Mum was never normal! Thank you I really was thinking I’d lost the plot!

 

[Kearnspaula]

I’d guess it’s either a delayed rise from your meal or a basal issue. If you’re not eating many carbs sometimes you have to consider protein as that can cause a late rise.

Hi, yes I have raised basal, in an attempt to do the basal test, not managed yet due to rise at 10pm, only raised by one unit, I’ve done the same today, I guess that’s easy to check, I will reduce by one tomorrow. And protein sounds a likely suspect to. Blimey ignorance was bliss, but not good for me! Thank you.

 

[Kearnspaula]

You mention autonomic dysfunction. Do you mean autonomic neuropathy. If yes that can include gastroparesis (delayed stomach emptying) which can impact on your blood sugars in a way that you suggest. I have gastroparesis and have problems with blood sugars going up over after meals even though I tend to have around 100 g carbs a day - I don't purposely low carb but that's all I can manage to eat on an average day. Ironically on days when I eat more carbs (max 130g) I can have better BG levels - but there is no pattern to that. I'm not saying this is what you've got but it might be worth looking at. Also, are you on an insulin pump because that can help if your blood sugars start going over later than you expect after eating. PS don't let the gastroparesis literature scare you - I've now had it for 12 years (the original tests showed that it was severe gastroparesis) but still enjoy nice food through a combination of using my pump to optimise my blood sugars, accurate carb counting, two small snack type meals during the day and an evening meal - but in the early days all I read was doom and gloom about it.

 

[Kearnspaula]

Sorry forgot to say, I’m not on pump currently, always been put off as I swim and worried I would need to many needles and cost to nhs and where I live are v reluctant to issue such devices, and Gp advises they have been told not to issue, so I self fund Dexcom 6.

 

[Inka]

I just disconnect my pump for swimming @Kearnspaula It takes two or three seconds. The actual cannula stays in. Then when I’ve finished swimming I put my pump back on. So it doesn’t use any more needles 🙂

 

[rebrascora]

Supposedly about 40% of protein breaks down into glucose in the absence of enough carbs and about 10% of fat. I find protein release is pretty slow and forgiving and as I said, starts about 2 hours post meal. I don't calculate bolus insulin for it per se (ie work out how much weight of protein and calculate 40%) but just correct with 1-2 unit corrections when I see my levels rising. If they continue to rise I stick another couple of units in an hour or so later..... Naughty I know stacking corrections 😱 but once you do it regularly and can see what is happening on Libre or Dexcom and keep a close eye on it, you soon learn how it works and how much you need. I probably end up using the same amount of insulin for protein as I would for carbs if I ate normally, but it is much slower release and now I understand how to deal with it and don't worry about breaking the rules on stacking, I find it reasonably easy to keep levels in range most of the time and there is much less variation than there would be with carbs. Ie no sharp peaks and troughs, more just gentle rolling hills on my Libre graph. It just takes time and practice to learn how best to deal with it for you as an individual with the insulin you have. Sometimes on an evening, if I ate late, I will increase my Levemir dose at bedtime instead of (or as well as) using my quick acting insulin to deal with the protein release during the night.
Anyway, that is just my experience. I used to find it frustrating but Libre has really helped me to get my head around it.
As far as I am aware GPs have no say over pump funding or allocation. If you feel you would benefit from one or want to try to get Libre on prescription then you usually need "the nod" from a consultant. Perhaps pushing your GP for a referral to a hospital diabetes clinic might be easier than trying to get support and resources from your GP directly. You might also benefit from a swap to Levemir as your basal insulin as you can split the dose and tailor it more to your body's needs. I love my Levemir for it's flexibility and I don't think I could get much better control with a pump, even though I get the impression my consultant would find funding for me for a pump if I wanted one, but I hate the thought of the amount of consumables necessary and I am very happy with my MDI management now that I have Libre to help me.

 

[Bloden]

Hi there @Kearnspaula.

Does the high glucose continue through the night, as if there wasn’t any basal insulin working at all? I only ask because after I had been using Lantus for about 6-7 years I realised it was only lasting for approx 16 hours. I was taking it at 10pm and at exactly 4pm every day my glucose would shoot up to 16 (and just stay there if I didn’t give myself a correction dose).

So, eventually I had to switch to a different basal (Tresiba) which solved the problem.

I hope you get to the bottom of the problem asap.

 

[Drummer]

I did a few checks on GI an GL foods - the difference was so low it was not really significant.
I also found that legumes seemed far higher in carbs than listed.
As I am type 2 and not on medication for me it was just a matter of eliminating the foods which caused the problem. If you are relying on information about the food, rather than your own reaction to them, that could be the cause of the rises - if low GI meals cause spikes I'd suspect the information is wrong for you (and possibly wishful thinking for many) rather than repeating the same actions and expecting a different result.
I had a scientific education and it has proven very useful over the decades.

 

[Kearnspaula]

I just disconnect my pump for swimming @Kearnspaula It takes two or three seconds. The actual cannula stays in. Then when I’ve finished swimming I put my pump back on. So it doesn’t use any more needles 🙂

Oh wow, that makes sense, I just presumed, thank you, hopefully I will be allowed one then, thanks for the info.

 

[Kearnspaula]

I did a few checks on GI an GL foods - the difference was so low it was not really significant.
I also found that legumes seemed far higher in carbs than listed.
As I am type 2 and not on medication for me it was just a matter of eliminating the foods which caused the problem. If you are relying on information about the food, rather than your own reaction to them, that could be the cause of the rises - if low GI meals cause spikes I'd suspect the information is wrong for you (and possibly wishful thinking for many) rather than repeating the same actions and expecting a different result.
I had a scientific education and it has proven very useful over the decades.

That sounds about right, I have a close friend, type one also, we do have very different reaction to same foods, I’ve always thought it was me doing something wrong, which of course it still could be. Very many thanks for the info.

 

[Kearnspaula]

Hi there @Kearnspaula.

Does the high glucose continue through the night, as if there wasn’t any basal insulin working at all? I only ask because after I had been using Lantus for about 6-7 years I realised it was only lasting for approx 16 hours. I was taking it at 10pm and at exactly 4pm every day my glucose would shoot up to 16 (and just stay there if I didn’t give myself a correction dose).

So, eventually I had to switch to a different basal (Tresiba) which solved the problem.

I hope you get to the bottom of the problem asap.

Strange but I also did wonder if that could be the case, yes it does stay on the high side and rise does kick in around the same time. Knowing me it’ll be a combination of everything! Many thanks, something else to discuss when I speak with diabetic team!

 

[Kearnspaula]

Supposedly about 40% of protein breaks down into glucose in the absence of enough carbs and about 10% of fat. I find protein release is pretty slow and forgiving and as I said, starts about 2 hours post meal. I don't calculate bolus insulin for it per se (ie work out how much weight of protein and calculate 40%) but just correct with 1-2 unit corrections when I see my levels rising. If they continue to rise I stick another couple of units in an hour or so later..... Naughty I know stacking corrections 😱 but once you do it regularly and can see what is happening on Libre or Dexcom and keep a close eye on it, you soon learn how it works and how much you need. I probably end up using the same amount of insulin for protein as I would for carbs if I ate normally, but it is much slower release and now I understand how to deal with it and don't worry about breaking the rules on stacking, I find it reasonably easy to keep levels in range most of the time and there is much less variation than there would be with carbs. Ie no sharp peaks and troughs, more just gentle rolling hills on my Libre graph. It just takes time and practice to learn how best to deal with it for you as an individual with the insulin you have. Sometimes on an evening, if I ate late, I will increase my Levemir dose at bedtime instead of (or as well as) using my quick acting insulin to deal with the protein release during the night.
Anyway, that is just my experience. I used to find it frustrating but Libre has really helped me to get my head around it.
As far as I am aware GPs have no say over pump funding or allocation. If you feel you would benefit from one or want to try to get Libre on prescription then you usually need "the nod" from a consultant. Perhaps pushing your GP for a referral to a hospital diabetes clinic might be easier than trying to get support and resources from your GP directly. You might also benefit from a swap to Levemir as your basal insulin as you can split the dose and tailor it more to your body's needs. I love my Levemir for it's flexibility and I don't think I could get much better control with a pump, even though I get the impression my consultant would find funding for me for a pump if I wanted one, but I hate the thought of the amount of consumables necessary and I am very happy with my MDI management now that I have Libre to help me.

Thank you, you have very supportive and clear way of explaining things, I too tend to have a number of 1to 2 ml jabs if the Dexcom graph doesn’t start dropping after 15 mins. I should have an appointment with the hospital beg of October so I will mention a pump to them rather than pursue Gp. I had no idea about protein and that could link as it mainly happens after I’ve had a carb free or very low carb meal, no more than 10g, I did the same tonight as a test, now I have so much for useful information i am more confident I can sort this out. Huge hugs P.

 

[rebrascora]

So pleased my experience was able to be of help to you. Life with diabetes is so much easier when things make sense or even just when you realise you are not the only one to come across a particular problem.
Good luck at the clinic enquiring about a pump. Most people get rejected first time around, so don't let that put you off. Go with a list of reasons why you think it would help you and how you think you fit the criteria so that they can see you have done your homework. If they refuse, ask them to email you the reasons for their decision and then you can work out how to counteract their decision when you go next time.

 

[nonethewiser]

Experience same as rebrassco on low carb diet, each meal would require 3 injections to keep levels steady.

 

[helli]

As well as needing extra injections, I find low carb needs a lot of experimenting to work out the correct insulin to protein ratio for each food type. For me, there were different ratios for prawns, salmon, eggs, nuts, ... I gave up with the experimenting at this point and returned to a normal level of carbs and simplicity.
Is there a reason why you are following a low carb approach @Kearnspaula ?
It works great for some people like @rebrascora but others find it too complex.