2 hours after eating question

[astbury1]

Started my MDI and seems to be going ok. Am happy to have ranges of 7-8 before food and DSN is happy about this at the moment. Howver how do I stop the highs after 2 hours of eating? The first night started carb count I tested every hour to see what was happening and was impressed that it went something like 7.9 6.4 7 8.2 however the following few days have more been like
5.9 then 2 hours after 15 and then eventually back down into a normal range again within 4 hours? I also can be quie high at bedtime and although I know there maybe some insulin novorapid in my system I will be in the 7's again in the morning from somewhere like 14 at bedtime? Anyone ? Is it a question of injecting before eat rather than straight after? Dont like the extreme highs but also dont want to fall low by giving more novorapid given that I come into a normal/acceptable range 4 hours after eating?

 

[Caroline]

I don't inject so don't know how it works properly. Some people split their doses and test, but I am not sure how. I'm sure someone will be along soon with a better answer.

 

[everydayupsanddowns]

Started my MDI and seems to be going ok. Am happy to have ranges of 7-8 before food and DSN is happy about this at the moment. Howver how do I stop the highs after 2 hours of eating? The first night started carb count I tested every hour to see what was happening and was impressed that it went something like 7.9 6.4 7 8.2 however the following few days have more been like
5.9 then 2 hours after 15 and then eventually back down into a normal range again within 4 hours? I also can be quie high at bedtime and although I know there maybe some insulin novorapid in my system I will be in the 7's again in the morning from somewhere like 14 at bedtime? Anyone ? Is it a question of injecting before eat rather than straight after? Dont like the extreme highs but also dont want to fall low by giving more novorapid given that I come into a normal/acceptable range 4 hours after eating?

Yes.

But only sometimes 🙄

Your rapid acting insulin will have an 'onset' period after it has been injected before it starts acting on glucose in your blood. Your digestion will have a delay between eating food and that food beginning to have an impact on your BG levels. The tricky thing is that these delays (especially with food, but to some extent with the injection too) will not always be the same.

Your return to 'in range' after 4 hours (the likely duration of the insulin dose) suggests the doses are right, but the 'spike' in BGs after eating suggest that the food is hitting fast and your insulin is coming along later to mop things up.

Many people inject after eating because it is safer, and/or because they may not always be sure that they will finish their food. But, but doing so they end up giving the food a major headstart, and in many cases food is much faster than insulin anyway so they see significant rises after eating before the insulin 'gets going'.

Injecting immediately before can help, injecting 15-30 minutes (or more) before sitting down to eat can help further, but obviously carries risk of the activity of insulin peaking before food.

At the end of the day you'll have to work out a few basic rules of thumb that work for you - then discover which foods are particularly fast (or slow) acting for you and work out how you deal with those - or choose not to bother with them 🙂

 

[Copepod]

It's not just about food / carbohydrate, though - if you've been very active, your insulin sensitivity may reduce, so you'll need lower short acting doses for next meal or two, and perhaps lower long acting next dose; if stressed, you insulin sensitivity may rise, so you'll need higher doses.

Regarding injecting well before eating - so much depends on your local situation. When camping, eating in student hostel etc, I never inject until I have the food on my plate or my spoon in cooking pot when camping, as there's too much scope for delays, such as stove gas running out, fire alarms etc.

 

[trophywench]

The old advice used to be have your jab just after you put the spuds on to boil, so you know you'll definitely be eating in 20 mins! LOL

If you aren't sure how much you'll eat of it - then have half your insulin before and the rest immediately after based on just what you did consume.

At least there will be some insulin there to cope with the early arrival of carbs - which is always better than none.

If you go to bed on 7 and wake up at 15 then there's something not right with your basal dose which is sposed to keep you stable all day and night in the background.

There's a way to test, but it means delaying or completely missing meals. And you can only do it one time block at a time, not all in one day! It takes time, but it's worth it.

You may feel it's a bit early to start doing this, but here it is anyway.

http://www.diabetes-support.org.uk/info/?page_id=120

Once you're in the swing of MDI, or pumping! - it's something we ALL have to do what - every few months? or more frequently if you hit a problem patch.

 

[astbury1]

Thanks for the advice all. Would it help maybe if I had less carbs at dinner and more protein?

 

[everydayupsanddowns]

You shouldn't need to unless you want to - though I find very high carb loads tend to absorb more slowly. I think the basic rule of thumb seems to be half your weight in lbs as grams of carb. So if you were 140-150lbs, then meals up to 70-75g CHO should behave OK, but higher than that might need more careful handling.

There are others who find that low-moderate carbs do give them better results, but I don't think it's essential.

 

[astbury1]

I dont seem to be eating a ridiculous amount of carb however am slightly concerned that the DSN is considering changing the ratios of novorapid at night meal. This is making me think that likely to go low in night as again this morning I was 7.4 which was the aim. (tend to aim for 8 at the moment)

The only other thing I can think of is I take my basal at 6. Now am wondering if it hasnt had time to kick in. Wondering whether worth trying it earlier. I take 12 units levemir at 6 and that lasts all day although maybe it has tailed off before 6 and then taking a while to get back into system in the eve before bed? But then again am most likely to go higher at lunch then. ooooo who knew it would be so complicated!🙄

 

[everydayupsanddowns]

If a dose change is being suggested (most likely because of something you have mentioned and/or something the DSN has spotted in your results) make sure you get an explanation of what issue the change is intended to tackle and how it is supposed to do that.

I have had many condersations with HCPs over the years where some change or other is suggested to fix a perceived 'problem' where as soon as I understand what they are trying to do I can feed in more information, "... ah well I think the week of results you are looking at isn't actually very typical and I'm concerned about [whatever might happen if the change is tried]..."

It must be very hard for consultants and DSNs to make recommendations based on a 5 minute chat, and talking around any proposed tweaks can help them understand your situation better.

DUK's 'Meds and Kit' supplement lists Levemir's onset as between 30 mins and an hour, so it should be up and runnign by bedtime I'd expect. Have you been running high through the evening? Have you tested at 2am/4am or 3am to get a feel for what happens overnight?

 

[astbury1]

Hiya I havent tested in the night but I clearly come down into normal range usually after 4 hours. Am wondering if maybe I should cut back on the carbs a bit and try and see what happens. Maybe try more protein within my sandwichs and see if it helps give a slower release. I wondering if I have been loading on more carbs as I have been used to insultard. IE have to eat lots of carbs of drop through the floor like lead🙂