I've copied this over from a reply buried in another thread in case it's helpful to anyone
The following tips are what I gleaned from a presentation by Gary Scheiner (Certified Diabetes Educator, author of Think Like A Pancreas, and type 1 himself) - this was his "Strike the Spike" presentation.
1. One of the most important considerations is the relatively slow action of our so-called rapid-acting insulins. If you have a working pancreas, insulin reaches the bloodstream in seconds and is finished and gone in minutes. Whereas insulin infused or injected into subcutaneous fat can take up to an hour to circulate to where it's needed (and can still be active 3-4 hours after injection), meaning that glucose from digested food gets a head start on the insulin.
Advice is to pre-bolus 20-30 minutes before meals.
2. Type of food eaten also has an impact. I know some people on here eat low carb or no carb meals, but assuming somebody wants to eat a reasonable portion of carbs,
opting for lower GI foods makes sense, e.g. for breakfast replace cereals with yoghurt and berries, which will take a bit longer to digest and perhaps match insulin action a bit better.
3.
Eat veg before carbs. Can't remember the reason for this one, but I wrote it down!
4.
Make lunch the highest carb meal (lower carbs at breakfast and dinner). The idea being that most people are more insulin sensitive during the day when they are active. As always with type 1, this won't work for all!
5.
Increasing the acidity (e.g. by including a glass of tomato juice or sprinkling vinegar on a salad or chips) of a meal helps delay digestion, so the rise in blood glucose isn't too steep.
6.
If pre-meal levels are high, injecting insulin into a muscle will get the insulin working twice as fast as if it's injected/infused into subcutaneous fat. The recommendation was to use longer needles than you usually use, and inject into forearm muscle or triceps. It stings a bit apparently! Don't think my son would want to try it...
7.
Some people have benefitted from also injecting the hormone amylin, which is absent in people with type 1. This is an appetite suppressant, delays the emptying of the stomach, and while it is active, suppresses the liver from releasing glucose. Very helpful for eliminating a post prandial spike, but risks hypos if you're not very careful indeed, and nausea is a side effect (so it's a no thanks from us!). I think "Victoza" is amylin, though I may be wrong.
That's all I can remember atm!
