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Blood glucose going high, then crashing after meal

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Gorman2001

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Type 1
Hello all - long time lurker but first time poster! I'm after some advice from other diabetics about what I should do here...

I've been diabetic, and fairly well controlled, for about 15 years. I take 3 times/day injections of Novorapid with meals, and nightly Livermir. Recently, I've started to noticed that within 1-2 hours of a meal, by glucose levels shoot very high - from pre-meal of about 4-6 to 16 in some cases, from eating meals I've eaten for years. For example, I've just eaten 2 Shredded Wheat with skimmed milk (no sugar), to find that within an hour I'm getting an 11...

... then within 2 hours, I'm getting 2.9!!! This cycle has started to repeat after most meals (save for evening meal, which seems to involve me shooting to 12-13 and then sitting there until 2-3 am, then plummeting to 2-3 by 6 am).

Anyone have any ideas on the reasons for this? I've not lost or gained significant weight, and nothing else about my lifestyle has changed. I had a recent diabetes check up and we discussed monitoring the situation, and possibly moving to twice daily injections of Livermir. I'd be fine with that, if it would help regulate these annoying peaks and troughs, but the constant cycle of highs and lows is really getting to me.

Thanks in advance for any help!
 
Hi Gorman2001, glad to see you delurk! 🙂 Sorry to hear you are having problems though :( It sounds to me like your food is peaking before the insulin - have you tried injecting earlier before eating? What do you currently do, inject just before, or 15 mins before? Strange that this should have only recently become an issue though, and with familiar meals :confused: What about your injection sites, do you 'rotate' regularly? There's a possibility that after 15 years you may have developed some subcutaneous scar tissue that might be changing the speed of absorption. Does it happen at every meal?

Sorry for all the questions! 🙂
 
I should add that I have to inject about an hour before breakfast, about 30-40mins before lunch, and just before evening meal so that my insulin starts to peak as the food digestion peaks - so at different times through the day.
 
Welcome!
There is a condition called gastroparesis that affects the digestion!
 
Thanks for the replies!

@Northerner - my diabetes nurse actually thought might be insulin absorption, so we're trying out more rotation of sites. I do rotate, but every site seems to have developed the typical bumpiness so I'm looking further afield ;-( I tend to inject then eat more or less right away - I've always done that really! I think that I've probably become more aware of these peaks from starting the Freestyle Libre - I have have noticed that the readings aren't as accurate (probably due to interstitial blood sampling) as my USB Contour, but both systems are reporting those annoying peaks shortly after meals...

@ Grovesy - wasn't actually aware of that condition! Will look into it...
 
Gorman2001 said:
Thanks for the replies!

@Northerner - my diabetes nurse actually thought might be insulin absorption, so we're trying out more rotation of sites. I do rotate, but every site seems to have developed the typical bumpiness so I'm looking further afield ;-( I tend to inject then eat more or less right away - I've always done that really! I think that I've probably become more aware of these peaks from starting the Freestyle Libre - I have have noticed that the readings aren't as accurate (probably due to interstitial blood sampling) as my USB Contour, but both systems are reporting those annoying peaks shortly after meals...

@ Grovesy - wasn't actually aware of that condition! Will look into it...
Click to expand...
I would recommend trying injecting earlier before food and seeing what difference it makes - once you have it figured out (if this proves to be the problem!) for the meals you eat most often, it's not too troublesome 🙂 I used to think I was fine injecting just before until I started regularly testing an hour or two after eating - I was always fine by the time of the next meal, but could get quite big spikes in the first hour or two before dropping back. Changing timings of insulin has smoothed out those spikes 🙂 The Libre will certainly reveal things we are unaware of, if only they were available on the NHS! 🙂
 
Hi Gorman - as another corrugated T1, that's one of the (many) things that made me want a pump.

Levemir was originally intended to be injected twice a day, not once anyway. Have a look at the profile and you can see from that how long yours is actually likely to be actually doing anything useful for you, I always find increasing the screen resolution helps enormously to follow the lines! First calculate your daily dose per kilo.

http://www.diabetes-support.org.uk/info/?page_id=428
 
That's really helpful stuff, I will definitely try that out. The morning peak tends to be the worst, and I definitely have time in the morning to inject earlier so I will try that.

@trophywench - I'd actually never realised that Livermir could be taken twice a day! I'd been using it once a day for years, but looking into it I'm going to discuss with my diabetes nurse whether I might try twice a day. That might help smooth things out a little! I feel like I never really have a "resting" glucose level - if that makes sense - because I'm always going up, then coming down, then correcting, then going up again from the next meal, etc.
 
I'm sorry to hear about your problems. I have Gastroparesis and your symptoms sound like the opposite. With gastroparesis the food takes much longer to Be digested so the risk is a major hypo soon after the meal with BG levels going up later. So, for example, with my evening meal I cannot bolus upfront but have an extended bolus of six hours to vaguely match the length of time that it takes my food to digest - sometimes it can take 12 hours to digest.
 
@AJLang on looking into Gastroparesis, you're right - I don;t have any of the symptoms either. Sorry to hear about your suffering that condition too - that can't make diabetes any easier... I'm trying out the earlier injecting and I'll see how that goes...
 
The two does of Lev might not finish up 12 hours apart and might not be each of 50% - but that's what you start with. And then test test test until you get the right amounts and the right times - it takes a while but hey! - this is a marathon not a sprint LOL - so you just have to be patient.

I started off on 18u nightly and landed up on 14u first thing in a morning (I was at work then so around 7.00 to 7.30) and another 4u at around 9.30 at night. In the winter I'd probably need 5u at night. However - your needs will be different cos you aren't me or anyone else!
 
Hi Gorman2001 and welcome 🙂

I have been having exactly the same problem lately, also after having reasonable control up until now - at least I've always had too many hypos, but not highs readings followed by plummets like this. Mine are nearly all in the morning, and I have improved the situation by raising my morning bolus and dropping my basal (hypos for me are nearly always related to my basal), but it's still not ideal - I'm now going up to 8 or 10 mid-morning rather than to 16 or 17 and I'm still hypo-ing, though not quite as frequently. I'm about to switch to a different basal, so will see whether that makes any difference before I try anything else.

I also have a peculiar digestive system, though not quite the same as Amanda's - my muscles don't work properly so my digestion speed is a bit random!

Hope you manage to find out what's causing the problem for you and get it sorted - it is a bit of a shock when you suddenly get a 16 followed 2 hours later by a 2, isn't it? 😱
 
TheClockworkDodo said:
I'm now going up to 8 or 10 mid-morning rather than to 16 or 17 and I'm still hypo-ing, though not quite as frequently.
Click to expand...

Bother, spoke too soon - I was 14.8 two hours after my initial 4.7 this morning, so something is not working once again.

Please let me know if you manage to work out what's causing it for you, @Gorman2001 and I'll let you know if I work out what's causing it for me!
 
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