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Big spikes after evening meal

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Hi all, for the past week or so my levels have been shooting way up to 15-6 after.my evening meal. I'm carb counting and pre bolusing but I still get the sharp spikes ? Any ideas. Thank you.
 
Have you changed both your insulins? Could you be ill?

My other thought is perhaps it’s a stage in your honeymoon - a step up in your insulin requirements. Are you on any other meds that might be affecting it?
 
Sorry - forgot to ask what your pre-meal blood sugar is?
 
Does it eventually come down again? If so then maybe you need to pre-bolus even earlier than you are, how much is required varies a lot. If not then maybe your carb ratio needs a tweak.
 
Have you changed both your insulins? Could you be ill?

My other thought is perhaps it’s a stage in your honeymoon - a step up in your insulin requirements. Are you on any other meds that might be affecting it?
I switched from Lantus to tresiba as was having night time lows. But still on novorapid. No not on any medication either.
 
Does it eventually come down again? If so then maybe you need to pre-bolus even earlier than you are, how much is required varies a lot. If not then maybe your carb ratio needs a tweak.
No yesterday I had to take 6 units 3 hours after.my meal to bring it down. Only come down to 9 mmol still.
 
Sorry to hear that you are struggling with your levels. That must be making you feel rough as well as frustrated.

Can you give us an idea of what you had to eat and how much NR you pre bolused?
 
I switched from Lantus to tresiba as was having night time lows. But still on novorapid. No not on any medication either.

Sorry - I wasn’t clear. I meant change each insulin to a new pen or cartridge in case it had degraded somehow and wasn’t working.
 
Sorry - forgot to ask what your pre-meal blood sugar is?
my bloods were 5.5 before dinner
Sorry to hear that you are struggling with your levels. That must be making you feel rough as well as frustrated.

Can you give us an idea of what you had to eat and how much NR you pre bolused?
I had 2 chicken breast, new potatoes, and mixed vegetables. If.i remember correctly was 64g Cho. Took 7 units novorapid 30mins prior but still had the stubborn highs
 
my bloods were 5.5 before dinner

So ok before you ate, but your NR didn’t seem to take effect. Definitely change your NR if not the Tresiba (change NR to a new pen/cartridge). It could be your ratio has changed; your NR is ‘off’; or you have something causing insulin resistance eg stress, illness or hormones.

Did you add an extra correction amount for being over 11 (ish)?
 
Sadly - and annoyingly - all you can do is try taking a little extra NR tomorrow but not too much in case whatever is causing this goes away. You don’t want a hypo. Monitor lots. It’s better to correct after a meal than whack in too much insulin before the meal, assuming you’ll be high else. If this is a sudden change, it could change back just as suddenly.

So, maybe try a 1:8g ratio? If you can, eat pretty much the same again tomorrow to remove one variable.
 
64g seems an awful lot for those veg - unless you had a plateful of them. The chicken breasts we've been buying recently have been huge and considering the protein element of a meal for an adult should be roughly the same size as a pack of playing cards, one should be more than enough for either me or my husband who is getting on for twice my size.
 
So ok before you ate, but your NR didn’t seem to take effect. Definitely change your NR if not the Tresiba (change NR to a new pen/cartridge). It could be your ratio has changed; your NR is ‘off’; or you have something causing insulin resistance eg stress, illness or hormones.

Did you add an extra correction amount for being over 11 (ish)?
Yeah I think it could be protein
64g seems an awful lot for those veg - unless you had a plateful of them. The chicken breasts we've been buying recently have been huge and considering the protein element of a meal for an adult should be roughly the same size as a pack of playing cards, one should be more than enough for either me or my husband who is getting on for twice my size.
It was 64 Cho with the potatoes aswell.(only 10 for veg). Thanks everyone. Think it may be the protein in my meal that was sending me high. Any tips on how to bolus for protein even when consuming carbohydrate ? Thank you.
 
The body can extract glucose from both protein and fat - but ONLY if it has to because it has no available easier source of glucose ie carbs - and 64g of carb is more than enough carb for most bodies unless you are the size of a house and are in the middle of running a marathon.

I think myself that you'd do better splitting your bolus for higher carb meals which is dead easy to do with a pump but not so easy with MDI - which was far too much faffing about for me.

You know @Type1Pat - the 'old' advice was to not worry about post meal rises as long as by next mealtime (so 4 or 5+ hours later) the BG had come back down to something more reasonable. As I didn't have any other means of testing than firstly boiling my urine up again (so couldn't reasonably done except in the privacy of my own bathroom) then later using a glucometer and was trying to hold a normal life working, commuting into the city and whatever, I didn't worry about it between meals - and good grief - I'm still here, and still have no 'diabetic complications'.

There is little point in having things like Flash GM/CGM if they cause folk to become obsessive about minor hiccups like BG increasing for a bit after eating. Non diabetics have increases in BG after eating - just they haven't the slightest idea they do since they don't test their BG. It is therefore the natural reaction of the body - so to stop it you'd have to first die.
 
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The body can extract glucose from both protein and fat - but ONLY if it has to because it has no available easier source of glucose ie carbs - and 64g of carb is more than enough carb for most bodies unless you are the size of a house and are in the middle of running a marathon.

I think myself that you'd do better splitting your bolus for higher carb meals which is dead easy to do with a pump but not so easy with MDI - which was far too much faffing about for me.

You know @Type1Pat - the 'old' advice was to not worry about post meal rises as long as by next mealtime (so 4 or 5+ hours later) the BG had come back down to something more reasonable. As I didn't have any other means of testing than firstly boiling my urine up again (so couldn't reasonably done except in the privacy of my own bathroom) then later using a glucometer and was trying to hold a normal life working, commuting into the city and whatever, I didn't worry about it between meals - and good grief - I'm still here, and still have no 'diabetic complications'.

There is little point in having things like FGM/CGM if they cause folk to become obsessive about minor hiccups like BG increasing for a bit after eating. Non diabetics have increases in BG after eating - just they haven't the slightest idea they do since they don't test their BG. It is therefore the natural reaction of the body - so to stop it you'd have to first die.
Yeah I understand what you are saying, but my levels are not coming back down after these meals. So although I'm eating carbohydrate with every meal I need to understand how to cover large protein amounts with insulin. For example my dinner tonight is a steak and jacket potatoe with veg. 55g carbohydrate. But there is 100g protein in the steak.
 
It is more likely that you need to adjust your carb ratio than bolus for protein if you are eating that many carbs, but in general for protein, you calculate how much protein and bolus for 40% of it but you would need to bolus for it after the meal, usually 1-2 hours after, otherwise that insulin will take your BG levels too low before the protein has started to break down, so it would involve injecting for the carbs in advance of the meal and the protein afterwards which is what I often end up doing.
So to calculate your bolus for the steak, if you say your steak is 30% protein and it weighs 200g (8ish oz) then that is 60g protein and you would bolus for 40% of that 60g which would be 24g, so if you are on a 1:10 ratio then near enough 2.5 units if you have a half unit pen otherwise I would round it up if it was me as I usually need more rather than less.
I find it far easier to just watch my Libre after a meal and stick in a conservative 2 units when I see the protein starting to release and then another 1 or 2 an hour or so later if it continues to rise, rather than try to calculate the bolus required which will probably be quite individual anyway. The 40% is very much a rough ball park figure. I am not recommending you do this as stacking corrections is dangerous and very much frowned upon, but I use my Libre to keep a very close eye on things and that helps me to know what I can safely get away with as regards stacking, particularly the more experienced I get at it. You soon learn how many units particular lumps of protein will need. So a 2 egg cheese omelette with a big side salad will require 2 units for me injected afterwards.
 
Well IF the body gets around to turning the protein into glucose then it can only obtain 40% of what it can make from carb. So treat the 100g protein as if it were 40g of carb to calculate the extra bolus for it.

Frankly - I have never found that my body DOES convert protein to carb and my hypothesis has always been that the body only bothers to do it, when folk otherwise go very low carb - so well under 130g carb a day.

Try not eating the jacket spud - and just have and jab for the steak, just to see what happens, cos you can.
 
Yeah I understand what you are saying, but my levels are not coming back down after these meals. So although I'm eating carbohydrate with every meal I need to understand how to cover large protein amounts with insulin. For example my dinner tonight is a steak and jacket potatoe with veg. 55g carbohydrate. But there is 100g protein in the steak.

You’re on a 1:10g ratio? I’d change that to 1:8 as I suggested. If that still doesn’t work or if it seems to work but then you go up high a few hours later, then you could suspect the protein, and rethink.

If I’m eating a lot of protein, I rarely bother to calculate the amount exactly if I’m having carbs with it. I just add on a little insulin and then test regularly to see how it worked.
 
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