How long on average do spikes last?

[rebrascora]

Hi
I am struggling to balance carbs with insulin as I posted in a previous thread. If I use a little too much Novo Rapid (ie 1 unit too much) I get a huge drop in BG. Too little and I get a large spike. I don't mind so much getting a large spike of short duration as I do with sugars from fruit but the starchy food spikes last 6-8 hrs so that if I have consecutive meals with carbs one spike stacks onto the next even with what seems to be the correct amount of NR... if I give one more unit of NR it drops rapidly and I get a hypo or false hypo depending upon my starting point. I have tried pre bolussing which does help a bit but sometimes I forget because I am busy prepping and cooking food and end up injecting just before I eat.

For instance last night my pre evening meal reading was 8.2. I took 4 units of NR and had 2 (80% meat) sausages with a tiny few parsnip chips and a large portion of cauliflower with a small amount of cheese sauce. Followed by a hot chocolate drink. My reading an hour later was 9.5 and I took my Levemir (8units). I woke up at 3.40am feeling unwell (turned out just to be a menopausal hot flush) and I was 11.7 and it was still 10.1 at 7.15am. I didn't feel well and went back to bed. I got up at 9.30am and checked again and it was 7.5 so it appears those carbs last night raised by BG by 2+ whole digits despite the NR and kept it there for 8 hrs through the night. This also happens through the day but because I am eating more than one meal through the day it is not so easy to see the spike from just one meal.

So my question is, is it normal (whatever normal is??) for spikes from complex carbs like wholemeal bread, pasta, potatoes (or parsnips and the small amount of white flour that was in the cheese sauce last night) to last 8hrs, despite taking NR?

 

[Drummer]

When investigating what I could and could not tolerate, as a diet controlled type two, those would have been short spikes for those foods, so the insulin is pushing the glucose out of your bloodstream faster than would have been normal for me.
I must ask why add flour to cheese?
My cheese sauce is cream cheese, Red Leicester grated on the top, and then a sprinkle of herbs or spices - and maybe more cheese.

 

[rebrascora]

I must ask why add flour to cheese?

I make a cheese sauce with butter, flour, milk and cheese. I didn't know any better...... but I do now 😉
Many thanks for your response.

 

[Kaylz]

Hi 🙂 I obviously don't know your circumstances (I used to be a regular here but took myself away for a while as I was focusing too much on diabetes)

I don't experience large prolonged spikes from the likes of wholemeal bread, potatoes or even jumbo oats

pre bolusing really is a good way of stopping larger spikes and yes it will take time and effort to find that 'sweet' spot for you as everyone is different but I do strongly think its a habit you should get into, even if that means setting an alarm to remind yourself to pre bolus 🙂 xx

 

[TheClockworkDodo]

Do you have a half unit pen, @rebrascora ? - that might help if you find that one unit too much means you're dropping too low, and one unit too little means you're spiking. If you don't have one, ask your diabetes team if you can get one. I use Novorapid cartridges in an Echopen - I couldn't manage without half units.

 

[Kaylz]

good point @TheClockworkDodo is spot on with that one, just a month after diagnosis my dsn's had to prescribe me a half unit pen and cartridges as I was suffering terribly with hypos on full units so that's definitely worth seeing about my lovely xx

 

[rebrascora]

Do you have a half unit pen, @rebrascora ? - that might help if you find that one unit too much means you're dropping too low, and one unit too little means you're spiking.

I did wonder about that as the dietician mentioned that you can get half unit dispensers but when I asked my diabetes nurse at my GP practice yesterday she said it would be best to wait until after I have seen the consultant.
I did pre- bolus last night by 20mins and that was definitely better and I went down after the meal instead of up but I also realised afterwards that I had not had as much carbohydrate in the meal as I had had the previous night (I was eating leftovers) but taken the same 4 units of NovoRapid, so I ended up having a tiny biscuit (such a treat!) which thankfully levelled things up before I went to bed and I started the day today on a normal reading of 6.3.... WOO HOO!! The first normal fasting reading I have had in a couple of weeks. Unfortunately I was up to 10.2 2hrs after my mushroom and onion omelette this morning which I am thinking may suggests I am also responsive to protein or perhaps just the small amount of carbs in the milk in my coffee and omelette and the onion perhaps. It seems to me like 4 whole digits is a lot to spike from such a low carb meal and it is still higher now at 10.5 without having eaten or drank anything else, which is a bit disappointing, but still better than the 15-20 BG readings I was getting when I was eating carbs with each meal.

@Kaylz and @TheClockwork .....Thank you both for your input.

 

[Kaylz]

@rebrascora do you have an appointment date for your consultant? as it definitely seems like the best option for you, it could just be feet on the floor syndrome or maybe you dropped overnight and are having a rebound?

I have carbs at every meal so I cant offer a solution if you think it is the protein/milk etc

I do suggest you experiment with the timing of pre bolusing as well as for me at least it can depend on time of day

I find for my myself breakfast - 15 minutes is good, dinner - 10 minutes is good and tea - 5 minutes or I'll be hypoing before I know it! lol, also not just the timing has to be factored, injection sites plays a big part as the absorption times are different too 🙂 xx

 

[rebrascora]

Yes my appointment date is 30th April and can't come a moment too soon!

I always use my stomach for insulin injections as that was what I was advised although they did mention thighs as an alternative and I always alternate the site around my navel. Some definitely go in easier than others. I don't know if that makes a difference

I just cannot manage to balance carbs if I have them more than once a day, so I am getting best results just using insulin on an evening and that 20mins pre-bolus last night seemed to work well..... but then things are less good today..... I feel like I take 2 steps forward and then 1.5 back..... still heading mostly in the right direction but not making much progress and trying to see patterns from the limited testing offered by finger prick BG is difficult. I know I need to test more often but I do feel guilty having to ask for more strips when I am not written up for a repeat prescription for several more weeks and I have bought extra strips myself to enable more testing..... the medical professionals do not encourage you to test nearly as much as you need to.

 

[Kaylz]

glad to hear you haven't long to wait on your appointment, I've got my annual consultant appointment next month, 4 months late but hey ho

I inject in my thighs for breakfast and dinner, left for breakfast right for dinner then my stomach for tea, would you not feel comfortable using your thighs?

are you only on insulin for meals?

I guess I'm lucky where I am as my team have always encouraged me to test whenever I felt the need/want to xx

 

[Drummer]

You seem to be as sensitive to carbs as I am - I have really cut out anything sugary - such as milk, reduced the amount of onion (I usually used it finely chopped and raw to get the maximum effect) and I eat two two meals a day far apart with my main portion of carbs in the evening as my meter showed that was best - presumably I am more insulin resistant in the mornings.
Keep on trying out different ways to do this and keep notes for your consultant/nurse - so you can back up what you decide is the best way for you.

 

[rebrascora]

glad to hear you haven't long to wait on your appointment, I've got my annual consultant appointment next month, 4 months late but hey ho

I inject in my thighs for breakfast and dinner, left for breakfast right for dinner then my stomach for tea, would you not feel comfortable using your thighs?

are you only on insulin for meals?

I guess I'm lucky where I am as my team have always encouraged me to test whenever I felt the need/want to xx

Got no problem with injecting into my thighs but was told to use stomach, so I have. Is there a benefit in using thighs instead? I have a thinner layer of fat on my thighs so I assumed my stomach was better, since it needs to go into fat.

I have basal Levemir that I take on an evening and then NovoRapid when I have a meal containing carbs. I do wonder if splitting the Levemir dose might also be beneficial but again the nurse doesn't want to change anything until I see the consultant so I am just trying to tick along and learn a bit as I go.

 

[rebrascora]

You seem to be as sensitive to carbs as I am - I have really cut out anything sugary - such as milk, reduced the amount of onion (I usually used it finely chopped and raw to get the maximum effect) and I eat two two meals a day far apart with my main portion of carbs in the evening as my meter showed that was best - presumably I am more insulin resistant in the mornings.
Keep on trying out different ways to do this and keep notes for your consultant/nurse - so you can back up what you decide is the best way for you.

I did wonder if the onion was to blame today but I had the same amount yesterday and the same amount of milk and only got a spike of 2 digits yesterday but I started out 4 units higher with my fasting reading..... don't know if that has a bearing on it. It does sound like our situation is similar with regard to how little carbohydrate affects us and even with insulin I can only manage this with 2 meals a day plus snacks and my main carbs in the evening.
I am not ready to give up the small amount of milk that I have in my morning coffee but I suppose I don't need to add it to my omelette.

Yes, I have a "Sugar Diary" app on my phone which my sister downloaded for me, so food, medication and BG are all documented there. It does all sorts of clever stuff like plotting a chart of your readings and working out daily/weekly/monthly averages etc and it must be simple to use because I am managing to do it and easier than writing in the little booklet the nurse gave me which has tiny boxes to put numbers in that I can barely see with my deteriorated near sight, let alone fit digits into.
There are just so many variables, it is difficult to keep everything the same and just change one thing at a time to see what difference it makes and I am an horrendously disorganised person, which I know doesn't help. Evening meal can be anywhere from 8pm to midnight and breakfast 6.30am to 10.30am. Years of working shifts means my body has no affinity to a normal sleep pattern. I can manage for a few days to a week and then something crops up that knocks me off the rails again.

 

[Drummer]

I use cream in my coffee - on berries and for anything else.
Once in a while I make Yorkshire puddings and use cream and water for that - after decades of making them with milk I am now told that they are better than ever.
I only eat if I am hungry - several times recently I have had coffee and then not eaten in a morning. I never used to eat breakfast, and I seem to be turning the clock back.

 

[Kaylz]

Got no problem with injecting into my thighs but was told to use stomach, so I have. Is there a benefit in using thighs instead? I have a thinner layer of fat on my thighs so I assumed my stomach was better, since it needs to go into fat.

I have basal Levemir that I take on an evening and then NovoRapid when I have a meal containing carbs. I do wonder if splitting the Levemir dose might also be beneficial but again the nurse doesn't want to change anything until I see the consultant so I am just trying to tick along and learn a bit as I go.

i alternate with thighs and stomach to try and eliminate the chances of absorption problems arising from only using 1 area, as you can see by my signature when I was diagnosed I was under 7 stone so I really was just skin and bone all over at 5ft 5" and I found injecting my thighs fine, thankfully I am putting weight on 🙂

I'd say you might/should have a word with your team, how many strips are you getting per month? as you are on basal/bolus they shouldn't really be restricting you especially if you drive, I get 200 per month but can order more if needed xx

 

[SB2015]

I did wonder about that as the dietician mentioned that you can get half unit dispensers but when I asked my diabetes nurse at my GP practice yesterday she said it would be best to wait until after I have seen the consultant.
I did pre- bolus last night by 20mins and that was definitely better and I went down after the meal instead of up but I also realised afterwards that I had not had as much carbohydrate in the meal as I had had the previous night (I was eating leftovers) but taken the same 4 units of NovoRapid, so I ended up having a tiny biscuit (such a treat!) which thankfully levelled things up before I went to bed and I started the day today on a normal reading of 6.3.... WOO HOO!! The first normal fasting reading I have had in a couple of weeks. Unfortunately I was up to 10.2 2hrs after my mushroom and onion omelette this morning which I am thinking may suggests I am also responsive to protein or perhaps just the small amount of carbs in the milk in my coffee and omelette and the onion perhaps. It seems to me like 4 whole digits is a lot to spike from such a low carb meal and it is still higher now at 10.5 without having eaten or drank anything else, which is a bit disappointing, but still better than the 15-20 BG readings I was getting when I was eating carbs with each meal.

@Kaylz and @TheClockwork .....Thank you both for your input.

Well done on your first ‘normal’ morning reading. That must feel so good.

I was surprised when My BG rose after a very low carb meal, as I had smugly thought at least this one won’t spike!! On here I found the explanation that If I don’t have carbs, my body will then use the protein insteadand convert that to glucose. Too much for me to start to learn all about amount of protein in meals as well as the carbs, so I took my carbs back up and now stick to 30 g carbs per meal, and with that I don’t need to concern myself with protein. As with so many things to do with D it is trial and improvement.

It sounds as if you are still on fixed doses of insulin at meals. When is your next Specialist appointment? If it is a long way off I wou9d still ask for a half unit pen. At the start we are often on quite small doses of insuiln so the half unit pen makes life a lot easier when trying to make adjustments.

Reading about your treat of a biscuit reminds me how pleasant it is when you get to eat one ‘for free’.

 

[SB2015]

I did wonder if the onion was to blame today but I had the same amount yesterday and the same amount of milk and only got a spike of 2 digits yesterday but I started out 4 units higher with my fasting reading..... don't know if that has a bearing on it. It does sound like our situation is similar with regard to how little carbohydrate affects us and even with insulin I can only manage this with 2 meals a day plus snacks and my main carbs in the evening.
I am not ready to give up the small amount of milk that I have in my morning coffee but I suppose I don't need to add it to my omelette.

Yes, I have a "Sugar Diary" app on my phone which my sister downloaded for me, so food, medication and BG are all documented there. It does all sorts of clever stuff like plotting a chart of your readings and working out daily/weekly/monthly averages etc and it must be simple to use because I am managing to do it and easier than writing in the little booklet the nurse gave me which has tiny boxes to put numbers in that I can barely see with my deteriorated near sight, let alone fit digits into.
There are just so many variables, it is difficult to keep everything the same and just change one thing at a time to see what difference it makes and I am an horrendously disorganised person, which I know doesn't help. Evening meal can be anywhere from 8pm to midnight and breakfast 6.30am to 10.30am. Years of working shifts means my body has no affinity to a normal sleep pattern. I can manage for a few days to a week and then something crops up that knocks me off the rails again.

Once you are on adjustable doses, your varied meal times should not cause any problems. It is however important to make sure that your basal insulin is given at a consistent time every day. My first DSN said to give that at ‘bedtime’. She must have assumed that 8 went to bed at the same time every night. Things were a lot better once I delivered my background at the same time each day. I only realised that I should do this, when I met another T1, who complained that he had broken his basal insulin pen when he was out and sat on it. I asked why he took it out with him, and he was the one that told me it needed to be delivered at the same time each day. As usual I learn so much from others who have D. That is why this forum is so helpful.

Keep asking

 

[rebrascora]

Just want to say many thanks to all the people who responded to my post.
I am delighted to report that my BGs have been much, much better the last 2 days. Not sure if it is taking the Levemir at the same time each night or luck or maybe I'm starting to be a bit more intuitive about when I need insulin and how much. I have done a couple of small "corrections" with a single unit of NovoRapid here and there when I felt it would be beneficial and I took 2 units this morning before my omelette instead of none to bring me down from 9.0 but then had to have a tiny biscuit to keep it just above 5, but I have managed to keep it in the normal range for 50% of my readings today which is HUGE progress and best of all I feel a lot more confident about using the NR but mostly keeping the number of units low unless I have something that really requires 4 like the roast pork sarnie today at our driving club meet. I was going to not have any, but then I decided that I needed to participate and gave myself the NR and ate the butty but didn't have any roast tatties with it and got away with it..... My average for the day is 6.9, lowest reading was 5.1 and highest was 9.0 fasting reading this morning, so I am really, really chuffed with that. Especially as I got 30% of my readings in the normal range yesterday and I had a lovely low carb Italian meal last night with family. Out for lunch again tomorrow at my sister's so fingers crossed I don't blow it and can manage 3 days of good readings in a row!
I really appreciate everyone's input in helping me work this out. Can't tell you how relieved I am to get some consistently normal readings over 2 whole days.

 

[rebrascora]

Just wanting to update this to say that my reading have really stabilised the past week or so. I am getting much more consistent readings in the 5 and 6 range and whilst I have occasional readings in the 8s and 9s and more rarely above 10 (and the odd upper 4), I usually know why (ie I have been naughty with my diet). I really feel like I am getting the hang of things now but also that my body is perhaps balancing itself a bit too.

I am sticking to having carbs just once a day in the evening and whilst I am tempted to try to reintroduce porridge on a morning occasionally, I am reluctant to upset the current status quo having taken so long to get things settled. I saw the consultant on Tuesday who seems to think that I am type 1 and I had testing for that on Friday as well as another blood sample for HbA1c so it will be interesting to see how far my reading has come down since the end of March when I started on insulin. Keeping fingers crossed it will show significant improvement.