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Avoiding post prandial spikes (type 1)

Reading this about cataracts my husband who is not D has always had poor eyesight, always without fail has an eye test every 2 yrs, (now 12 months) went for a regular eye test 3 years ago (he was only 49)and was told he had very bad cataracts in both eyes😱 was seen at the hospital within 2 weeks(May) and had 1 eye done in the June,the other Sept.
What we didnt know was when they are developing you cant see colours correctly, had we of known this was an alarm bell, as we were always arguing about colours😛 he would have gone sooner
His eyes are brilliant now only needs glasses for distance , before we were paying £150 to get the lenses thinned out :(
 
I came back to the forum after a while to search for info on post-prandial spikes and, lo and behold, this was the first thread in the list. Pretty amazing 😱

Since I started using a Freestyle, I've gotten a much better appreciation for my PP spikes. I need to collect some more data, but so far it looks like a normal meal will raise my BG by anything between 3.5 and 5.5 mmol/L; for example, a BG of 7 before a meal could easily see me peaking at 11 or 12.

I've recently stumbled on an interesting research paper which used CGM to track BG patterns in non-diabetic individuals. It's from 2007 and it didn't have many participants, so take it with a pinch of salt.
What I found interesting was that subjects had a mean interstitial glucose of 5.0 mmol/L and their mean glucose went up by about 2.2 mmol/L after a meal.
Mean time to peak glucose concentration in the study was between 46 and 50 minutes; for me, it's somewhere between 1 and 1.5 hours after I start eating.

Here's one of the charts from the paper. You can go from mg/dl to mmol/L by dividing by 18: 180 mg/dl is 10 mmol/L.

dst-01-0695-g002.jpg


Also, subjects almost never went above 7.8 mmol/L, which I found rather cute: non-diabetics sure have it easy :D

I'm interested to hear your experiences with post-prandial spikes: how big are the oscillations for you? What would you consider acceptable?
 
This is a different prospective & I'm not in anyway advocating this as I know it's not the correct thing to do but, suits me & I'm also type 2 now on insulin.

I medicate after meals. My family owned a small Chinese restaurant for 35 years. I worked there for 10+ years. When I was diagnosed 17 years ago I found it very problematic to medicate before meals. There were no set meal times: we just ate when it wasn't busy. But, quite often after taking the tablets before a meal I either didn't get to eat much of it or get to eat it at all. So, not only would I have to run around serving customers but, I'd have to keep taking sips of full sugar coke to avoid a hypo. Then, eat once it was quiet & take tablets again. I explained this to my GP practice's nurse & she agreed that although it's not correct, it's better for me to medicate after meals. It's become an ingrained habit with me to medicate immediately after eating.

My family sold the restaurant 1 year before I was switched to insulin & I stopped working there. When I was switched to insulin the nurse advised me to inject before meals. My habit of medicating after meals was so ingrained that I found it very hard to either remember to inject before a meal or, to remember if I did not to inject afterwards. Once I injected twice before & after dinner. I had a very long night when I ate everything in sight & testing to make sure I didn't hypo. The nurse once again agreed that it was better for me to continue injecting after meals to stop this from happening again. I still, to this day, inject straight after eating.

Again I don't want anybody to think this is correct when I know it's not!
 
Welcome Lanny.
As a Type 2 your body will still be producing insulin so there will be some in your blood immediately after you start eating, as the pancreas will respond automatically.
As a T1 we are responsible for getting th insulin in place for our food as the pancreas no longer releases any. By delivering the insulin before the meal it gives it a bit more time to get from the subcutaneous fat into the system. Also the insulin that we are injecting does not get giong oats quickly as that produced by the pancreas. I had spent many years injecting straight after my meal until I saw the spikes that were appearing after meals. I have managed to change these spikes to blips for breakfast and reduced them a lot at other meals, by two main things:
- prebolusing for meals (where I can be sure of knowing when the food is arriving)
- reducing the total carbs in a meal. I now aim for about 30g per meal
The combination of these two changes then helped me to reduce HbA1c as well.
 
Ah! I think I can work out what you mean.

I test before meals aiming for 5 to 7 & 2 hours after meals aiming for less than 10. My eyesight is not as sharp as it used to be & I sometimes read the wrong time on my watch, I need a bigger watch. My pre lunch sugars was 6.5. I mistakenly tested 1 hour after & was horrified by the 16.5 reading, until I looked at my watch again. Tested again at 2 hours & it was 9.4, huge relief. 4 hours after that sugars were at 6.4 before eating dinner. I never realised that sugars were that high in the 1st. hour after eating.
 
The spike after a meal will depend on the type of carbs you are eating, and the amount of carbs. If you wanted to lower the spikes, you could lower the carbs you eat and/or aim for lower GI foods so that the glucose is released more slowly.
 
The spike will also be larger if the insulin is given after eating.
 
Thanks guys.

I've been thinking & want to try medicating before meals again. I've been reading a lot of posts across the forums & can't remember where I read this. Someone mentioned a timed cap for those did I or didn't I moments?
 
Lanny said:
Thanks guys.

I've been thinking & want to try medicating before meals again. I've been reading a lot of posts across the forums & can't remember where I read this. Someone mentioned a timed cap for those did I or didn't I moments?
Click to expand...
If you use Novorapid, you can get a Novopen Echo, which tells you (roughly) how many hours since you did your last injection, and how many units you injected. I've got one, it's saved me a lot of those did I didn't I moments!
 
I use Levemir & Novorapid 300 units flexpens Does that make a difference. My mum, in Hong Kong, used a slightly fatter pen that 100 units cartridges were slotted into.
 
You could ask your diabetes to be swapped to cartridges rather than the pre-filled pens x
 
Thanks guys.

Just googled it. I'll ask for if I can have one when I see my GP practice nurse on 21/03/18. I've just ordered on Saturday a box of Levemir, as I a took out the last one from the fridge. So, when I pick that up at the chemist tomorrow, that'll last me another month or so. But, that's only injected once a day & I can remember that!

Several articles came up about a recall last July 2017 about cracking cartridges. I assume that's been sorted out & there's no problems?
 
Lanny said:
Several articles came up about a recall last July 2017 about cracking cartridges. I assume that's been sorted out & there's no problems
Click to expand...
There was a problem with some batch numbers. Mine weren't affected, and I haven't had a problem with them, I would hope and expect that any old stock has been withdrawn by now.
 
Thanks Robin.

Was looking at the diabetes uk shop for the carbs & cals book & saw Timesulin: a cap that you put on the flexpen instead & has a timer on it.

But, as I understand it, when carb counting sometimes half units are required. So, I think I'd prefer to get Novopen Echo, if I can get one.
 
I was hoping for the best this morning when I woke, around 4am, with a reading of 11.3.

I have a borderline slightly under active thyroid that I have blood tests regularly, every 6 weeks, to keep an eye on it but, as yet, no medication for. It can make me really tired after eating. Last night's pre dinner reading was 5.3 & I fell asleep before taking the before bed reading.

Here's a confession for you, I fell asleep with the iPad, surfing these forums, on top of my stomach. I woke with a reading of 11.3 & felt half of last night's dinner still in my stomach. The last thing I wanted then was breakfast.

By the time I could face breakfast, 08:30, my sugars were 12.6. So, I injected & waited half an hour to eat.

My 2 hour after breakfast reading was 11.2. I'm quite happy with that. I was expecting horrors of over 15.

Thanks guys for explaining things to me.
 
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Since I developed Parkinson’s, which slows everything down, particularly in the evening, I’ve developed delayed gastric emptying, especially for the evening meal. The spike from eating can happen anything between one and three hours. That’s most disconcerting with a pre meal bolus, because I use Humalog, which takes an hour to reach a peak. So sometimes I catch it right, and sometimes go hypo after eating. It’s a sod because of that variation.
 
Wow what a lot of very interesting issues most of them relevant to me. I can spike after a low carb meal as high as 17 Increasing the insulin may help one day then it may not. The higher it goes the faster it drops to 4 or below. @trophywench I share your love of trifle! Hadn’t had it for over 6 years but made it for my 70th this year then finished it for breakfast the next day. That was a poke in the eye to my diabetes, it felt naughty but very nice
 
Hba1c is often mentioned, is there a recommended level? My local nurse recently said mine has gone up again and needs attention. She asked what my target score is - I’ve no idea, it’s never been discussed. My Libre records 60% to 70%in target.
Does anyone have an ‘acceptable’ score and if so may I ask what it is?
 
I can't help cos I don't have one either ! Mine's usually in the low 50s, 53 ish, though sometimes goes up a bit. I happened to have an A1c a few weeks after I did my knee which was by no means ideal as the last 4 weeks prior to visiting the vampire, has the most effect on the total result - and not at all surprisingly it had shot up to 64. Came back down again to 57 and then back to 53 by 6 and 12 months after.

If you are still suffering pain and discomfort from your breakages and hence lack of exercise generally this could affect your A1c too. Are you getting any physio for the leg or not?

Just wondering if the ones they had me doing - lying sat up on the bed! - would do you any good, because they work all your leg muscles above and below the knees and therefore also help more than a bit with circulation of oxygenated blood so excellent for healing and assisting prevention of arteries getting any harder if they are.
 
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