Are spikes inevitable?

[Jean]

Reading through the postings on the board, I find references to aiming for 'not too large a spike'. Does this mesn that a spike cannot be avoided?

Whilst I'm on, there's something (only one?!) that bugs me. If a spike is induced by my own carelessness or yielding to temptation, that's one thing. I can live with that - I only have myself to blame.

But what really depresses me is when I try so hard to get things right - reduced carbs in a meal, exercise - and then after an hour for no logical reason that I can fathom, the BG shoots up. It all seems so unfair!

Do you agree that it is the latter circumstance - conscientious effort being rewarded with a kick in the teeth, rather than moral weakness - that reduces us to despair? And if so, what do you say to yourself to pick yourself up?

Or perhaps you have this diet business down to such a fine art that the only spikes you get are the ones that occur from a pre-planned binge?

 

[bev]

Hi Jean - you have stolen my question!🙂

I was thinking just this today - Alex doesnt seem to be able to eat a huge variety of foods - simply because if he does - we pay for it later! Its not his ratios that are out - because if i alter them he goes hypo after an hour! It does seem to be all fatty food, white bread, white pasta, pizza, and anything with a fatty or cheesy sauce on. Its the fat that delays absorption and then causes a spike later on.
I must admit, its getting harder to think of foods that are high in carbs and therefore filling, to feed him, so i have started to do lower carb foods every few days. Although as he is growing - he does need carbs!🙂Bev

 

[Steff]

Hi Jean a very good thread topic i think:

One thing i find is like you say if i have gone ahead and eaten something i knew i was going to have a spike then fair enough i look at no one else to blame but myself, on the otherhand this is personal to me but i am not the type of person that sets my self high goals with my diabetes because you just never know with this blasted diabetes what is going to happen , I am yet to get to a position where a spike gets to me I just think to myself i have been diabetic 5 month now and so far so good i have been able to handle most of what it has thrown at me , yet we all sit here thinking so hard about what the hell we can do to stop it or prevent it when at the end of the day our body does not listen to us it will go ahead and do what it wants regarding spikes , the really difficult thing is not to give yourself a hard time we where not all given a handbook " the perfect diabetic" , the only thing is if you look after yourself well and go down the right road the odd hiccup is allowed .

 

[insulinaddict09]

Hi Jean a very good thread topic i think:

One thing i find is like you say if i have gone ahead and eaten something i knew i was going to have a spike then fair enough i look at no one else to blame but myself, on the otherhand this is personal to me but i am not the type of person that sets my self high goals with my diabetes because you just never know with this blasted diabetes what is going to happen , I am yet to get to a position where a spike gets to me I just think to myself i have been diabetic 5 mnth now and so far so good i have been able to handle most of what it has thrown at me , yet we all sit here thiking so hard about what the hell we can do to stop it or prevent it when at the end of the day our body does not listen to us it will go ahead and do what it wants regarding spikes , the really difficult thing is not to give yourself a hard time we where not all given a handbook " the perfect diabetic" , the only thing e is if you look after yourself well and go down the right road the odd hiccup is allowed .

Well said , 🙂

 

[katie]

I must admit, its getting harder to think of foods that are high in carbs and therefore filling, to feed him, so i have started to do lower carb foods every few days. Although as he is growing - he does need carbs!

Carbs are only really filling short-term - obviously the higher the GI the better.

Ive always been told to look at the readings I get before the next meal and not to worry too much about 2 hours afterwards (or whatever). If your levels are good before each meal you are doing well and are probably within range the majority of the time. No one wants too many spikes but the odd high after a carby meal can't be that bad.

 

[Adrienne]

Carbs are only really filling short-term - obviously the higher the GI the better.

Ive always been told to look at the readings I get before the next meal and not to worry too much about 2 hours afterwards (or whatever). If your levels are good before each meal you are doing well and are probably within range the majority of the time. No one wants too many spikes but the odd high after a carby meal can't be that bad.

Ooo sorry Katie can't agree with what you have been told in any way, shape or form. Sorry.

You definitely have to think about the readings after meals. If you don't then you don't know whether you have the insulin right. For example if you have white bread then it will shoot you up pretty immediately and you will possibly be back down by the next meal. If you have granary or other seeded bread then you should (in theory) not spike so much but you should be ok by the next meal as well. If you don't test and therefore you don't know then you will be having lots of highs without actually knowing because what you've been told is that if your level is ok before a meal then you are probably within range the majority of the time. I think this is dangerous and bad advice that you have been given.

Don't get me wrong I'm not saying that you eat white bread all the time, I used it as an example.

Carbs can be the one food that can keep you stable ie keep you full up for longer, not shorter. The lower the GI the longer the acting. For example normal cereals ie cornflakes, rice krispies, coco pops (eek) are high GI and you will no doubt spike and come back down. Porridge on the other hand (real porridge oats and not ready brek I hasten to add although its not actually too bad) is lower GI and levels stay more stable eating that rather than spiking.

Sorry I hate disagreeing with friends but I think you've had duff advice here. I'm sure others will have their own thoughts on this.

 

[katie]

Sorry I hate disagreeing with friends but I think you've had duff advice here. I'm sure others will have their own thoughts on this.

Hehe no worries. Are you saying you disagree with what I said about carbs making you feel full in the short-term though? Because what I meant was that if you eat a large bowl of white pasta with tomato sauce (for example) you will probably feel hungry again after 2 hours (for example lol), but if you had a smaller bowl of wholemeal pasta with some chicken then because of the low GI pasta and the protien you will probably feel fuller for longer.

I know that white bread will probably make you have a spike after eating, but what I meant was there is nothing wrong with having a spike now and again (yes, I usually have wholemeal and only have white bread when it's the supermarket baker's stuff, usually at the weekend...). I don't have white pasta more than once a week normally. Basically I really don't care if I get a spike, sorry

 

[aymes]

Carbs are only really filling short-term - obviously the higher the GI the better.

Ive always been told to look at the readings I get before the next meal and not to worry too much about 2 hours afterwards (or whatever). If your levels are good before each meal you are doing well and are probably within range the majority of the time. No one wants too many spikes but the odd high after a carby meal can't be that bad.

I can see where you're coming from on this. In terms of making sure you've got your ratios etc I think the 4hr post meal/before next meal reading is the important one as you can assess exactly what that insulin has done in relation to the food you've eaten. I think the 2 hour (or so) reading then becomes important in terms of timing of the insulin (eg split doses) adjusting your diet (looking at GI for example and so on). I think it's quite difficult to compare the two readings as, for me at least, they are telling me very different things.

Interesting though that dafne doesn't necessarily suggest you spending much time looking at the 2 hour reading, and I can see why as it is focussing on getting your carb counting/ratios spot on. For me looking at the spike is something that came later once everything else was sorted, fine tuning if you like!

 

[Adrienne]

Hehe no worries. Are you saying you disagree with what I said about carbs making you fill full in the short-term though? Because what I meant was that if you eat a large bowl of white pasta with tomato sauce (for example) you will probably feel hungry again after 2 hours (for example lol), but if you had a smaller bowl of wholemeal pasta with some chicken then because of the high GI pasta and the protien you will probably feel fuller for longer.

I know that white bread will probably make you have a spike after eating, but what I meant was there is nothing wrong with having a spike now and again (yes, I usually have wholemeal and only have white bread when it's the supermarket baker's stuff, usually at the weekend...). I don't have white pasta more than once a week normally. Basically I really don't care if I get a spike, sorry

You have me really confused now with the GI and I thought I was ok. I am thinking you have it the wrong way around. White bread is the highest GI, all GI is measured against white bread which is 100. White pasta is higher GI than wholemeal. It is the lower GI you need to eat to make you feel full for longer and which keep your levels more stable for longer. It is the higher GI which will give you a spike which you should try to avoid. So you are right in that with white pasta you would be hungry again and with wholemeal you shouldn't be hungry so quickly.

Of course everyone has spikes every so often, the breakfast spike is a nightmare to get right of. On injections it is damn hard to get right of spikes but if you inject in different places for different foods and inject at different times according to what a particular food does to you then you can combat them easier.

On a pump getting rid of spikes is a piece of cake - gosh I would really love to say that and mean it 🙂 It is however much easier. You either make sure the ratios are right or you add or take away basals and increase or decrease.

We have pretty much got rid of Jessica's spikes now. The post breakfast one has been the hardest but we now manage it with a basal rate set at 5 am to combat a 10 am spike, ridiculous and something you can't do on injections.

 

[katie]

I can see where you're coming from on this. In terms of making sure you've got your ratios etc I think the 4hr post meal/before next meal reading is the important one as you can assess exactly what that insulin has done in relation to the food you've eaten. I think the 2 hour (or so) reading then becomes important in terms of timing of the insulin (eg split doses) adjusting your diet (looking at GI for example and so on). I think it's quite difficult to compare the two readings as, for me at least, they are telling me very different things.

Interesting though that dafne doesn't necessarily suggest you spending much time looking at the 2 hour reading, and I can see why as it is focussing on getting your carb counting/ratios spot on. For me looking at the spike is something that came later once everything else was sorted, fine tuning if you like!

What I meant was that I don't think people should obsessively check 2 hours after meals everyday. Maybe if you are eating something different and don't know how it affects your levels, then test 2 hours after. I also meant that if you only eat something that causes a spike occasionally, then it wont hurt. I think some people stress themselves out too much, thinking that they are failing because they had a spike or that they are going to come to harm because of the odd high BG. Like you said, the 2 hour reading is good for fine tuning, but I dont think people should get depressed if it's high once in a while.

 

[katie]

You have me really confused now with the GI and I thought I was ok. I am thinking you have it the wrong way around. White bread is the highest GI, all GI is measured against white bread which is 100. White pasta is higher GI than wholemeal. It is the lower GI you need to eat to make you feel full for longer and which keep your levels more stable for longer. It is the higher GI which will give you a spike which you should try to avoid. So you are right in that with white pasta you would be hungry again and with wholemeal you shouldn't be hungry so quickly.

Eeek it was me who was confused lol, I was saying High GI when I mean low and vice versa 😉

I have a problem with the breakfast spike grr, that is the only spike that bothers me because I can't even change what I eat to avoid it, I always go high.

 

[bev]

The problem i have , is that if A spikes after the 2 hour mark, which he invariably does, if i give him a correction, however small, he always goes hypo. So then he ends up having a cereal bar - so i dont know which is worse - the extra cereal bar or the spike?Bev

 

[katie]

The problem i have , is that if A spikes after the 2 hour mark, which he invariably does, if i give him a correction, however small, he always goes hypo. So then he ends up having a cereal bar - so i dont know which is worse - the extra cereal bar or the spike?Bev

thats the thing bev... so does Alex have a good level by the next meal without a correction? because that means it's the right amount of insulin, it's just that the insulin and BG level peaks at different times. Is the spike very high? because the only way to help that is split doses etc or not eating things that make you spike ooorrr by ocassionally putting up with a spike.

 

[bev]

Mostly he is on target before the next meal, so i know his ratios must be right. When he spikes he can be as much as 18!!!!!😱

But if i give him a correction he always hypo's.Some foods dont do this to him, but the others do - so i must admit i have restricted some foods because it worries me when he spikes!😱 This is why i am looking forward to the pump because it may help with the spikes etc..🙂Bev

 

[Adrienne]

thats the thing bev... so does Alex have a good level by the next meal without a correction? because that means it's the right amount of insulin, it's just that the insulin and BG level peaks at different times. Is the spike very high? because the only way to help that is split doses etc or not eating things that make you spike ooorrr by ocassionally putting up with a spike.

See this is not what we have been told and our team are one of the top in England. Bear in mind it is a paediatric team though but shouldn't be that much difference.

In theory you should be able to tell two hours after eating if the insulin ratio is ok, if you eat a basic meal (forgetting pasta and rice here). The only way to test an insulin ratio is by testing two hours after eating. All the good teams amongst our group of 200 odd all say the same. You can only really test this if your level is ok and within range pre meal. If your level two hours after eating is within 2 mmol either way the ratio is right.

However if you are talking breakfast spike you have the resistance in there as well from overnight. This is why people have the breakfast spike and on injections its damn hard to get rid of. Most people I have come across who have a breakfast spike do it the same way I had to, purely to try and avoid the spikes. Bev - if it were me and this is what I did I used the ratio that stopped the spike but then had to give 15 g of free carbs mid morning to stop the hypo at lunch time. Loads of people do this, there is sometimes no way around it. I personally believe it is better to give 15 carbs free than have a high teen number every morning but that is my view and others may well differ.

Spikes once in a while, as Katie says, can't be helped, we've had loads today and just loaded on insulin to bring her down but if you can use the insulin and food to stop a spike it has got to be better.

 

[Adrienne]

Mostly he is on target before the next meal, so i know his ratios must be right. When he spikes he can be as much as 18!!!!!😱

But if i give him a correction he always hypo's.Some foods dont do this to him, but the others do - so i must admit i have restricted some foods because it worries me when he spikes!😱 This is why i am looking forward to the pump because it may help with the spikes etc..🙂Bev

Absolutely bring on the pump - any news yet on when?

 

[Becca]

This is why i find it invaluable to know what adults say because as a parent of a child with type 1 swinging BMs and spikes are somewhat normal

When you guys get spikes what would you register it as? On MDI for R her's would be in the 20s but on the pump it's virtually not there now. I would love to know if this is something that gets better as the person stops growing etc... although i know other issues/factors will come into it then.

I guess if you are noticing a lot of spikes at different times etc. or with certain foods then using CGMS might be a good idea to see what and when things actually happen.

 

[rossi_mac]

Evening, thought I'd pop in with my pennies worth.

I agree with the statement that if the reading for the next pre meal is within range then ratios are correct. The following 1 or 2 or 3/4 hour reading is useful, depending on how you are looking into your control, some of us are a lot harder on ourselves than others, with varying results. We all spike when eating carbs, it's what carbs do, however different foods spike at different times, and by different amounts, so timing injecting may help so the spike of the carbs lines up with the peak of the insulin effectiveness. Trial and error is the school I'm attending! It's a game and we've all read the rules slightly differently, I hope some of us are wining!

Finally all of the above is Rossi's thoughts and could be completely wrong!!!

 

[Adrienne]

This is so true Becca. Jessica started the day at 19.1, where did that come from and I immediately thought oh no swine flu. But we bolused, went out for breakfast - treat, we discussed the carbs and she then forgot to bolus and she had (wait for it horror of horrors) sausage, chips and peas (very horrible greasy chips as well) and so an hour or so later we had a 28.8 what fun. We realised this just as she was going to take said pump off and play in the sea. So quick huge bolus and unplugged. We finally came down to 12.2 at about 6 pm and had fish and chips unplanned with friends on the beach - this has been an horrendous day for food !!!! I overbolused for everything and now have fingers crossed we don't hypo later, so its going to be a long night.

I find listening to the adults with diabetes very interesting as well. Jessica's spikes when they appear are high teens with the very odd 20.0. She used to only have in the 20's for spikes mid morning and mid afternoon and no amound of insulin would bring her down and I couldn't correct at the time as she would always hypo hours later. Nightmare.

 

[Adrienne]

Evening, thought I'd pop in with my pennies worth.

I agree with the statement that if the reading for the next pre meal is within range then ratios are correct. The following 1 or 2 or 3/4 hour reading is useful, depending on how you are looking into your control, some of us are a lot harder on ourselves than others, with varying results. We all spike when eating carbs, it's what carbs do, however different foods spike at different times, and by different amounts, so timing injecting may help so the spike of the carbs lines up with the peak of the insulin effectiveness. Trial and error is the school I'm attending! It's a game and we've all read the rules slightly differently, I hope some of us are wining!

Finally all of the above is Rossi's thoughts and could be completely wrong!!!

Absolutely, I agree, it is a game of trial and error and we all do it slightly differently. Its good to hear other peoples way of doing things though as we may pick up bits and pieces along the way.