Avoiding post prandial spikes (type 1)

[Annemarie]

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.

@trophywench I was getting hospital phone physio of very little help, we’d never met and each Physio wanted background details taking up much of the time. Coincidentally the department manager left to work in a private clinic near our home. I see her once a month for an hour, she’s brilliant worth every penny although she doesn’t take prisoners so it’s hard work with sheets of activities to do at home. My calf muscle had almost disappeared, both legs had hardly been used for several weeks but they are now.
My recent Hba1c was 66, 64 last year so it does seem high and yet my time in target isn’t bad (or so I thought) it seems my Libre A1c wasn’t a good indicator. We have never been cake, biscuit or pudding eaters so I didn’t need to cut them down. After reading the menus from other members I was quite shocked as I wouldn’t ever have eaten most of those foods but it’s given me some ideas for a bit more variety in future.

 

[trophywench]

Good! made me laugh being told I was working, amongst other things my quads. Good job the chap told me they were my thigh muscles cos I didn't actually know where your quads were! One of those many things I'd never bothered finding out about cos formerly on a 'need to know' basis, I never had !

 

[everydayupsanddowns]

and yet my time in target isn’t bad (or so I thought) it seems my Libre A1c wasn’t a good indicator.

I’ve always found Libre’s A1c estimates rather optimistically low. I am expecting the same with Dexcom, but haven’t had an A1c since switching.

I think it depends on what sort of a ‘glycator’ your body is (how much glycated haemoglobin you make at what BG levels). And also I suppose... which of the vague and imperfect conversion formulae they have chosen?

 

[Paulbreen]

I’m must be in the hyper-sensitive crowd, with novarapid anything earlier than 10mins before eating I would hypo, recently started fsiap and it works really well, I bolus as I start to eat and unless there is something naughty in the meal there is barely a bump in my BG trace.
I really like I can decide as I’m about to eat what I’m gonna have rather than planning ahead, makes me feel almost normal lol

 

[Annemarie]

I’ve been working on breakfast; I tried everything possible but even fresh air was sending me into double figures. With very careful frequent monitoring I not only seem to have more control I have gone back to eating my favourite and very filling choice, home made muesli. With a half increase of Novarapid (5) and a much longer gap, c75 minutes, I stay in my green zone, not every day but most days.

 

[rebrascora]

With a half increase of Novarapid (5) and a much longer gap, c75 minutes, I stay in my green zone,

That is pretty much my timescale on a morning with NR. I'm down to about 45 with Fiasp but I had a few hypos in the readjustment period after changing over. Just about got it cracked a month down the line.... I'm a slow learner 🙄 !

 

[nonethewiser]

I’m must be in the hyper-sensitive crowd, with novarapid anything earlier than 10mins before eating I would hypo, recently started fsiap and it works really well, I bolus as I start to eat and unless there is something naughty in the meal there is barely a bump in my BG trace.
I really like I can decide as I’m about to eat what I’m gonna have rather than planning ahead, makes me feel almost normal lol

Interesting mate, about to start on fiasp once prescription comes thru. Needed something more fast acting so don't have to wait 20-30 minutes before eating, often bolusing this far ahead isn't practical, so giving fiasp trial.

 

[Paulbreen]

From what I heard from my DN in my clinic she said it’s hit and miss, she thinks it’s 50/50 with her patients, so far after 5 weeks using it it’s working great for me, I’m doing a bit of tweaking with my basal pattern for my pump and I think once that’s done I’ll be 90-95% in target range

 

[nonethewiser]

From what I heard from my DN in my clinic she said it’s hit and miss, she thinks it’s 50/50 with her patients, so far after 5 weeks using it it’s working great for me, I’m doing a bit of tweaking with my basal pattern for my pump and I think once that’s done I’ll be 90-95% in target range

So no issues with infusion sites using fiasp, heard this can be issue in some.

 

[Paulbreen]

Not so far, I’m using Meditronic 680G and the infusion tubes are amazing, I’m experimenting with new sites at the minute and best so far is under my arm on the side of my chest, I tried there because i was getting 600mm long tubes and it was the best place to use up excess tube length and turns out it’s a great site and great for bed too, I just dump the pump beside me and I love a good thrash around during the night and that spot allows more or less free movement

 

[Eman @]

Interesting! When I first heard this advice about pre bolusing, my son was 9 years old. We tried it (already had the pump so basals were tailored to him) - insulin given 20 minutes before breakfast resulted in a hypo in the 2's halfway through eating, and the poor boy face down on the carpet feeling awful. Took a while for hypo treatment to bring him up, and then later he was massively high. We didn't pre bolus again for a long time! I think in his case it was because he was small and skinny, and insulin absorbed really quickly. Now he's 14, still skinny but much taller and with adolescent hormones circulating, we're cautiously trying pre bolusing again and it's working really well. I think testosterone causes a degree of insulin resistance. If he wakes with a BG in the 4's or 5's I don't want him bolusing until he's about to eat. If he's in the 6's to 8's he can do it 15 minutes early, and if higher he should prebolus by at least half an hour. It's a case of each individual PWD experimenting.

My son is 9 years , thank you for that

 

[Teddy*]

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! 🙂

I’ve just changed insulin to Fiasp which is VERY quick acting - so can start eating and inject - works immediately. Previously on Novorapid which took 20 mins to kick in and thus having spikes or inject 20 mins before a meal, which was ok but a problem if meal not quite what you thought or delay etc. Would definitely recommend. But as previous replies say, perhaps doesn’t suit all! I’ve also come to the conclusion that a low carb diet is the way forward! I’ve been ‘chasing carbs’ for years- it really turns into a vicious circle of carbs=insulin=Spikes and lows. The combination of fairly low carb diet, fiasp quick acting insulin and the gentle long acting Tresiba, I manage to avoid (most of the time) the huge swings in blood sugars. I think it’s trying to find the right combination that suits you, that makes life easier.

 

[Annemarie]

I’ve just changed insulin to Fiasp which is VERY quick acting - so can start eating and inject - works immediately. Previously on Novorapid which took 20 mins to kick in and thus having spikes or inject 20 mins before a meal, which was ok but a problem if meal not quite what you thought or delay etc. Would definitely recommend. But as previous replies say, perhaps doesn’t suit all! I’ve also come to the conclusion that a low carb diet is the way forward! I’ve been ‘chasing carbs’ for years- it really turns into a vicious circle of carbs=insulin=Spikes and lows. The combination of fairly low carb diet, fiasp quick acting insulin and the gentle long acting Tresiba, I manage to avoid (most of the time) the huge swings in blood sugars. I think it’s trying to find the right combination that suits you, that makes life easier.

Thank you I found that very interesting

 

[helli]

I have been using Fiasp for a couple of years and it is certainly better for me than NovoSluggish but it is not perfect.
- It doesn't work as fast now as it did when I first started using it. It's as if my body has got used to it
- It does not last as long out of the fridge. After a couple of weeks, I may as well be injecting water.
- The speed at which it works for me depends on my starting blood sugar. It works very fast when I am under 5 so I definitely do not pre-bolus but it can appear to stall for an hour when I am in double figures
- Some people just don't get on with it.

 

[trophywench]

@Pattidevans has been using FiASP in her pump for a number of years and still gets on pretty darn well with it.

 

[PattiEvans]

No, @trophywench I use Apidra not Fiasp.

 

[helli]

No, @trophywench I use Apidra not Fiasp.

I have been using it in my pump ... possibly two different pumps if I think back to when I started Fiasping

 

[trophywench]

For some reason only known to Apidra - its name will NOT stay in my head.

 

[Tdm]

I tried the "acid' tip and found increasing the acidity of the meal made no diffrence for me. Not surprised given the low pH of the stomach, tbh.

What does work (and I got this idea from an academic paper) is excercise (brisk walking) for 20 plus min after eating. I start just when bs start to rise. Stop as soon as possible when bs start to fall. If it goes back up (which sometimes it does) repeat.
See the attached screen shot for an illustration. As it happens, I didn't take a prompt walk last night due to slippy pavements, giving a good control peak. I has a 38 carb, not especially carby tea, peaked over 12 (really unusal for me), stayed up high for ages, and only finally came down with a delayed walk and some vigourous vaccuming. With a walk i'd have expected a 7-8 peak.
Compare that with this morning. I had museli..abeit nutty museli, but still 54 carb per 100g. I find breakfast is my 'peakyest' meal. Peaked 9, and went straight back down to 6. This is peakier than normal for me.
Mind you, i do find walking has a big effect on my bs, but it may be worth seeing if this works for you.

 

[Tdm]

Please don't judge my average bs...its not been a good week on the bs front!