Avoiding post prandial spikes (type 1)

I echo the exercise thing. When my kid has a big post-meal spike, we find that 10-15 mins of moderate exercise (e.g. star jumps, dancing) gets back down to range. The issue is the resistance to it - which I understand as it's no fun jumping around after a meal. On the other hand, with the right music on, we've been known to cause a hypo with post-meal exercise, when there is so much fun she does not want to stop!
 
I am only 3 months into taking Insulin. I was told to take my Novorapid 10 minutes before eating but I am having high glucose spikes after a meal and wondering if I should take it earlier before a meal. I also suspect I may not be taking enough Insulin. I was told 1 unit for 20g of carbs but I dont know how this was calculated and it means I am taking tiny amounts. I don’t really know how to get help with this. I have a couple of appointments coming up one with ‘Diatetics Diabetes’ team and o e with ‘Diabetes Service’ team. Can anyone explain what these teams do?
Thanks
 
Try taking the NR 15 minutes before eating @CathyFP As you’re recently diagnosed, your own insulin will probably kick in late so you can’t have too much injected insulin else you might have a hypo (if/when your own insulin kicks in).

Where are your appointments? One sounds like a dietician appointment which is probably about counting carbs, etc, and the other looks like a general diabetes appointment.
 
CathyFP said:
I am only 3 months into taking Insulin. I was told to take my Novorapid 10 minutes before eating but I am having high glucose spikes after a meal and wondering if I should take it earlier before a meal. I also suspect I may not be taking enough Insulin. I was told 1 unit for 20g of carbs but I dont know how this was calculated and it means I am taking tiny amounts. I don’t really know how to get help with this. I have a couple of appointments coming up one with ‘Diatetics Diabetes’ team and o e with ‘Diabetes Service’ team. Can anyone explain what these teams do?
Thanks
Click to expand...
The thing about managing diabetes with insulin is that we are given guidance when we start to keep us safe whilst we are learning how to do the basics. Once you have got the hang of the everyday stuff and start to get into a routine of injecting and counting carbs etc, then you can start to fine tune things to your body.
It is unlikely that anyone would end up hypo from injecting Novo Rapid 10 mins before they eat, so that is a safe starting point, but many people need longer than that. Once you feel ready to start experimenting, choose one meal, perhaps breakfast on a weekend when you are under less pressure of getting to work etc and try increasing it by 5 mins if you always spike high after breakfast and see how you get on with that. If you continue to spike high, try 20 mins and see how that works out. Gradually you will find a timing which works for you. To give you an idea of just how different we all are, 10 mins does work for some people but I ended up needing 75 mins prebolus time with NovoRapid at breakfast most mornings, which was just silly so I changed to a quicker insulin called Fiasp. I still often need 45 mins between injecting and eating breakfast but other times of day I usually just need 10-20mins. We are all different and also the time of day makes a difference and sometimes the type of meal we are about to eat. I don't want to confuse you too much at this stage, but start to do some careful experimenting to see if you can reduce the spike a bit by increasing it a few mins every few days until you find what works for you.

As regards your meal ratio of 1:20 again, that is probably the nurses erring on the side of caution. I was started on 1:10, but perhaps you are very slim and petite whereas I am quite muscular and stocky, so that can make a difference to how much you need. Are you back down to your premeal reading by the next meal or are your levels progressively increasing through the day, so that your pre lunch reading is higher than your pre breakfast reading and your pre tea reading is higher than before lunch? That would indicate that either your ratio is wrong or your basal insulin isn't enough to hold you steady through the day.

Are you doing correction doses with insulin to bring your levels back down if your pre lunch meal for example is above target? Have you been given a correction factor, for instance that 1 unit of insulin will drop you 4 mmols for example...... so that if you are on say 10 before lunch, a single correction unit should bring you down to a BG of 6mmol and you would add that to your calculated mealtime bolus, so if you were having 40g carbs with a ratio of 1:20, you would have 2 units for lunch plus the correction unit so that hopefully you end up around about 6mmols before tea, assuming your ratio is correct. Does that make sense? If not please ask me to explain again.

Can you post a typical photo of a day's Libre graph showing the peaks you are concerned about. I used to spike up to 15 more or less every morning after breakfast and then crash back down to about 5 about 2-3 hours later until I started adjusting(extending) my prebolus timing and now I mostly don't spike above 8..... but it does take time and practice to find what works for you as an individual. Eventually, with careful experimentation, you will become the expert in your own diabetes and yopu will be able to tell the nurses how much prebolus time you actually need rather than them giving you advice. My consultant was horrified when I told him I still need 45 mins with Fiasp at breakfast, but he can't argue with my graphs.... or that I do actually need that long although just recently it has been reducing..... which is another thing to be aware of. Diabetes doesn't stay the same for long... and it is a case of getting ratios and timings just right and having some great results for a few months or maybe even years and then it all goes to pot and you have to overhaul your management and find new ratios/strategies/timings or basal doses.... which is why we need to become the experts because the nurses can't be there to constantly tell us where things need tweaking. Once you have had your DAFNE course or whatever your local equivalent is, you will have more confidence to do this.... or at least I did.
 
rebrascora said:
The thing about managing diabetes with insulin is that we are given guidance when we start to keep us safe whilst we are learning how to do the basics. Once you have got the hang of the everyday stuff and start to get into a routine of injecting and counting carbs etc, then you can start to fine tune things to your body.
It is unlikely that anyone would end up hypo from injecting Novo Rapid 10 mins before they eat, so that is a safe starting point, but many people need longer than that. Once you feel ready to start experimenting, choose one meal, perhaps breakfast on a weekend when you are under less pressure of getting to work etc and try increasing it by 5 mins if you always spike high after breakfast and see how you get on with that. If you continue to spike high, try 20 mins and see how that works out. Gradually you will find a timing which works for you. To give you an idea of just how different we all are, 10 mins does work for some people but I ended up needing 75 mins prebolus time with NovoRapid at breakfast most mornings, which was just silly so I changed to a quicker insulin called Fiasp. I still often need 45 mins between injecting and eating breakfast but other times of day I usually just need 10-20mins. We are all different and also the time of day makes a difference and sometimes the type of meal we are about to eat. I don't want to confuse you too much at this stage, but start to do some careful experimenting to see if you can reduce the spike a bit by increasing it a few mins every few days until you find what works for you.

As regards your meal ratio of 1:20 again, that is probably the nurses erring on the side of caution. I was started on 1:10, but perhaps you are very slim and petite whereas I am quite muscular and stocky, so that can make a difference to how much you need. Are you back down to your premeal reading by the next meal or are your levels progressively increasing through the day, so that your pre lunch reading is higher than your pre breakfast reading and your pre tea reading is higher than before lunch? That would indicate that either your ratio is wrong or your basal insulin isn't enough to hold you steady through the day.

Are you doing correction doses with insulin to bring your levels back down if your pre lunch meal for example is above target? Have you been given a correction factor, for instance that 1 unit of insulin will drop you 4 mmols for example...... so that if you are on say 10 before lunch, a single correction unit should bring you down to a BG of 6mmol and you would add that to your calculated mealtime bolus, so if you were having 40g carbs with a ratio of 1:20, you would have 2 units for lunch plus the correction unit so that hopefully you end up around about 6mmols before tea, assuming your ratio is correct. Does that make sense? If not please ask me to explain again.

Can you post a typical photo of a day's Libre graph showing the peaks you are concerned about. I used to spike up to 15 more or less every morning after breakfast and then crash back down to about 5 about 2-3 hours later until I started adjusting(extending) my prebolus timing and now I mostly don't spike above 8..... but it does take time and practice to find what works for you as an individual. Eventually, with careful experimentation, you will become the expert in your own diabetes and yopu will be able to tell the nurses how much prebolus time you actually need rather than them giving you advice. My consultant was horrified when I told him I still need 45 mins with Fiasp at breakfast, but he can't argue with my graphs.... or that I do actually need that long although just recently it has been reducing..... which is another thing to be aware of. Diabetes doesn't stay the same for long... and it is a case of getting ratios and timings just right and having some great results for a few months or maybe even years and then it all goes to pot and you have to overhaul your management and find new ratios/strategies/timings or basal doses.... which is why we need to become the experts because the nurses can't be there to constantly tell us where things need tweaking. Once you have had your DAFNE course or whatever your local equivalent is, you will have more confidence to do this.... or at least I did.
Click to expand...
Thanks for the very detailed reply. It sounds complicated but I am starting to experiment a bit
 
Example graph
1716974895197.png
 
Wow! That is a bit of a whopper!! o_O
It has nicely come back down into range though and then remained there, so that is excellent! Did you do a correction with insulin at lunchtime to get it back down or did it come back down on it's own?
If this is a typical breakfast spike then adjusting your insulin timing by cautiously extending the prebolus timing should help.
 
I agree with @rebrascora I find that I need longest in advance for breakfast boluses. Carefully and gradually increase the time between your breakfast bolus and your breakfast @CathyFP What time did you eat your breakfast?
 
My prebolus time for breakfast varies enormously depending where I start from. A waking reading in the 5s means a prebolus time of no more than 5-10 minutes, 6-7s - 15-20 mins, but anything over 8 needs at least 30-40 minutes
 
rebrascora said:
Wow! That is a bit of a whopper!! o_O
It has nicely come back down into range though and then remained there, so that is excellent! Did you do a correction with insulin at lunchtime to get it back down or did it come back down on it's own?
If this is a typical breakfast spike then adjusting your insulin timing by cautiously extending the prebolus timing should help.
Click to expand...
Hi
It came back down on its own. I haven’t really tried doing corrections yet. I don’t know why I had such a huge spike it was a pretty standard breakfast. I’m thinking of going back to low carb breakfasts. Just had yogurt today and all was fine. I’m also extending pre blouse time. Thanks for all the tips
 
Inka said:
I agree with @rebrascora I find that I need longest in advance for breakfast boluses. Carefully and gradually increase the time between your breakfast bolus and your breakfast @CathyFP What time did you eat your breakfast?
Click to expand...
I ate breakfast at 9.30. I had exactly the same breakfast the day before but only spiked to 13 but I exercised after breakfast that day which presumably got it down.
 
helli said:
Did you check that spike with a finger prick?
I find Libre has a strong tendency to exaggerate highs. Your BG probably went into double figures but may not have reached such heights.
Click to expand...
I didn’t check with finger prick but will next time. Thanks
 
Inka said:
Try taking the NR 15 minutes before eating @CathyFP As you’re recently diagnosed, your own insulin will probably kick in late so you can’t have too much injected insulin else you might have a hypo (if/when your own insulin kicks in).

Where are your appointments? One sounds like a dietician appointment which is probably about counting carbs, etc, and the other looks like a general diabetes appointment.
Click to expand...
Thanks Inka. Taking my Novorapid 15 mins before dinner tonight almost worked. I went down to 3.8 on Libre just after eating but then came up quickly to 6 without any hypo treatment. I guess I fine tune it by taking a bit less insulin ? Lots still to learn.
 
CathyFP said:
Thanks Inka. Taking my Novorapid 15 mins before dinner tonight almost worked. I went down to 3.8 on Libre just after eating but then came up quickly to 6 without any hypo treatment. I guess I fine tune it by taking a bit less insulin ? Lots still to learn.
Click to expand...

Type 1 is a pretty constant learning experience @CathyFP Even after having it for years, there are still things that we need to tweak or experiment with. Yes, you might find that if you inject further in advance of eating, you can reduce your bolus insulin amount. I found that when I ‘perfected’ my breakfast. I found that injecting 30 mins in advance helped the spike and I also found I could reduce the bolus by around 20%. (Note - I put ‘perfect’ in inverted commas there because you can never perfect Type 1 - it’s impossible. Things change, things change again, they change back. All we can do is our best).
 
trophywench said:
LOL - that was the rule with Humulin - inject when I put the spuds on.

I VERY quickly discovered that THAT rule does not apply when I'm using Novorapid!

2 minutes before might be OK if I am sitting down to what's left of a trifle - but not for anything normal ! (NB I haven't actually had any trifle for donkey's years, as for some reason no kids or teenagers in our family will eat it - amazing - I still consider it a mega-treat!)
Click to expand...
@trophywench I am using Novorapid. Could you explain to a relative new T1 what this means. Are you saying that with Novorapid you inject just before eating - which is what I mean as told to do?
 
I found if I didn't start eating pdq after jabbing I'd be feeling - and definitely going! - hypo within 10 minutes - hence I never needed to jab until my meal was in front of me and I could start eating it immediately.

I always had a desk job nominally BUT though I worked on the first floor of the 6 storey building our firm occupied I'd most likely need to visit every single floor several times a day (Ladies loos were on 3rd and 5th for starters) plus eg Accounts or Typing etc and usually much quicker up and down the stairs than stand waiting round for the lift - and being as we were in Birmingham City centre, I usually ran round the shops for something or another most lunchtimes. Plus of course the half hour-ish walk from/to station/office station/home twice a day. Aerobics once a week, a weeks shopping, a weeks washing/ironing and clean the house every weekend.
 
I think that many of us find the experiences described by @JJay, at post #70 on May 29, are our experiences, when taking NovoRapid. Our natural insulin resistance is generally higher (=stronger) at the start of a day; so a longer pre-bolus time is needed. Likewise the influence of the BG level when taking that bolus.

@trophywench neatly illustrates how regular and fairly constant exercise / activity can so easily need a dose size to be reduced as well as that exercise / activity affecting pre-bolus timing. @TW were you in those working days benefitting from any form of CGM? If not, with only fp and meter strips, in conjunction with your own awareness of hypo warning signs, were you more normally often close to your hypo threshold anyway? If so, then would your normal lowish BG explain why you didn't need much or any pre-bolus lead time?

@CathyFP, I do still find judging the pre-bolus timings tricky. My Consultant who sees me twice a year thinks I should move to Fiasp from NovoRapid and she is probably right. But for the last 12 months we've been house sharing with our daughter and her family and that family lifestyle does mean meal timings are varied and frequently not when expected. The delay with NovoRapid helps mitigate the meal timing issue as well as the portion sizes changing the carb count. I delibrately under assess the carbs when I prebolus and am happy to take some extra bolus later (ie make it a split bolus) if I'm confident that my initial carb count was actually low.

My breakfasts are my only meals when I can be sure of timings and carb content and they always need a generous pre-bolus. Often, thanks to my CGM, I can see that FotF is doing it's worst [something I was fairly oblivious to before I had CGM]; so I might wake at 5.5, take my basal and my pre-bolus but by the time I start eating my BG can climb to >8 - but NOT always! So I dare not factor that into my pre-bolus. If I'm in the mid 4s I often eat a small (6gm) biscuit to nudge my BG up because at 4 something I need minimal prebolus and can't get my breakfast onto a plate quickly enough!! But that can also be explained by my brittle D, 'cos I have no panc'y.
 
Hi @CathyFP , one strategy that works well for me on post prandial spikes is to not sit down for 15 minutes after a meal. We sometimes go for a walk, and if we do this I sometimes need to make adjustments to my bolus and reduce it a bit, other times I will just make sure that I do something:clearing up, ironing, some weaving, … anything just to get some of the glucose used up.

As you are in the early stages your own beta cells will make sure that they confuse the issue at times, so it is difficult to get things to follow patterns. We just need to do the best that we can.

Before we had any sensors we simply did not know of the massive spikes as we were just testing before the next meal with a finger prick. The extra information that we now have helps us fine tune things, but Diabetes definietely likes to keep us on our toes all the time. You are doing so well within such a short amount of time.
 
You must log in or register to reply here.
Back
Top