blood sugars

[VBH]

The peak BG from a meal is usually around 60-75 mins depending on content and combination. The pizza effect is a well known exception and pasta can be equally unpredictable. Peak BG from pizza hitting at 4 hours post-meal is not that unusual.

The profile of an insulin also reaches a peak and for maximum efficiency you want your bolus at its peak by the time the meal reaches its peak. This is hard to arrange if you are injecting after a meal, particularly if its a long meal.

There is a growing body of opinion that spikes are what cause damage and may not even show up in the A1c. So even if the 2 hour reading were something like 8 mmol/l, if the 1 hour BG was 20, that would still be alarming. I think what your doc was getting at is that by injecting after rather than before a meal you are more likely to get a high BG spike before the bolus kicks in.

Apart from the prospect of damage being caused of course there's also the effects of having rollercoaster BGs where its up and down fast - which generally makes people feel quite grotty. Although a lot of people don't notice how bad this is until they tighten their control and feel the difference.

 

[Northerner]

Hi 🙂 It was a shop brought one, as I'm so poor right now I can't afford a takeaway.

And you know what, I have no idea why he shouted at me...but it was pretty intense. He turned round and said injecting after meals wouldn't counter the spike...or something i dunno, but he ruined the nice little setup I'd had going for years *grumble*

I think that, as I've discovered many times whilst reading this site, he didn't know enough about the subject and was spouting only what he'd been told or read somewhere. I always get them to explain their reasons for such assertions - if he knew a little more about diabetes, he'd know that personal experience is what counts as everyone is different in either small or large ways - there is no 'one way' of doing things.

 

[SilentAssassin1642]

I think that, as I've discovered many times whilst reading this site, he didn't know enough about the subject and was spouting only what he'd been told or read somewhere. I always get them to explain their reasons for such assertions - if he knew a little more about diabetes, he'd know that personal experience is what counts as everyone is different in either small or large ways - there is no 'one way' of doing things.

Yep, which is exactly what I said! Although ive only ever had a bad experience with the specialists here in winch, never anywhere else. I actually think they get everything from books and really don't care about how personal experiences affect peoples diabetes differently...

 

[runner]

Hope things continue to go OK today Salmonpuff - thanks for the info about Pizza and levels, didn't know that.

My DSN said you can inject before meals but he would recommend straight after with the Lantus in case for some reason your meal gets delayed or you eat less/more. I sometimes inject when I sit down to eat with a specific meal and sometimes after, particularly if eating out/elsewhere. 🙂

 

[Northerner]

Hope things continue to go OK today Salmonpuff - thanks for the info about Pizza and levels, didn't know that.

My DSN said you can inject before meals but he would recommend straight after with the Lantus in case for some reason your meal gets delayed or you eat less/more. I sometimes inject when I sit down to eat with a specific meal and sometimes after, particularly if eating out/elsewhere. 🙂

I don't think you meant Lantus there, did you?

 

[runner]

I don't think you meant Lantus there, did you?

Ah that's where I'm going wrong - only joking! No silly me, I meant Humalog. 😱

 

[insulinaddict09]

I don't think you meant Lantus there, did you?

He he he if you did at least i'm not the only one doing it wrong 😉

 

[VBH]

Just in relation to what I mentioned earlier about getting the peaks to coincide...

The peak BG from a meal is usually around 60-75 mins from the start of the meal. The most common insulin profiles can be seen here:
http://www.diabetes-support.org.uk/joomla/insulin/iprof

Now then, if a meal were to last 30 mins and you then injected, the BG peak would hit about 30 minutes later. Taking novorapid as an example, the max effect of novo is from 1 hour after injection onwards. So the peak efficiency of the insulin starts 30 mins after the peak release of glucose from the meal and 90 mins after the start of the meal.

Now depending on when you do your post-meal testing, you may well miss the BG peak because of these timings. So it might be 8mmol/l for example at 2 hours after the meal - when the novo has been working at max efficiency for 90 mins. But what was it like 60 mins from the start of the meal? It may have been a very high peak, but you never see it. You could have been up to 20 and never know it. But by shooting before the meal it may never have risen above 10.

The problem is that its now increasingly thought that the peak BG that causes the damage. So although the BG at 2 hours may be ok, you've missed the bit that did the damage.

So I suspect what the doc was thinking in relation to the timing of the shot is to get the max efficiency of bolus insulin timed to be in line with the max glucose release of a meal so that the peak is minimised and so the damage is minimised.

 

[insulinaddict09]

Hi Thank you for this post !! it is brilliant , you have told me more in that one post than I have found out in over 17 months of being on Insulin 🙂🙂

 

[runner]

thanks for that too VBH. Not sure when Humalog peaks, but I might try testing an hour after the odd meal.

 

[Northerner]

It's something that has worried me in the past, as it does seem likely to be a problem - after all, a non-diabetic will never peak at 15-20 or above. But how do you know where the BG level peaked? I did quite a few random tests from between 1 hour and 4 hours and all seemed OK i.e. BG less than 10 mmol/l. But, unless you have a CGM then it's going to be very difficult to be sure.

 

[runner]

Yes, and another thing is, I need my BS to be 10 or more to allow for the drop during excercise, - or maybe I should eat the 'emergency banana' just before

That's something you'll need to adjust and work out AM when you start eating regular meals and injecting to enable your body to use the excercise efficiently and to maximum benenfit too - phew doesn't it all make your head hurt at times!!

 

[insulinaddict09]

Yes, and another thing is, I need my BS to be 10 or more to allow for the drop during excercise, - or maybe I should eat the 'emergency banana' just before

That's something you'll need to adjust and work out AM when you start eating regular meals and injecting to enable your body to use the excercise efficiently and to maximum benenfit too - phew doesn't it all make your head hurt at times!!

Argghh I know !! I really wish a non diabetic would swap lives with one of us for even just a day and see its not about just not eating that cake or chocolate , its much more complex .the annoying thing is , you think you have it cracked and then all the rules change , thats when you realise their are no rules with Diabetes .😡

 

[VBH]

Northerner - Ask a T2 who's done a lot of intensive testing in the early days 😉

Alternatively do tests every 15 mins starting 30 mins after a meal until it tails off. Gets a bit expensive on strips but its useful to know since it varies depending on the individual and their eating habits.

The action of injected insulin is a bit of a complication when it comes to finding the peak, but as far as things go with a T2, I find that most "normal" meals will peak at 60-75 mins. So the release of glucose from a meal will be around there. There are exceptions of course and no matter how much butter you put onto a jacket potato, or how slowly you eat that cereal bar, you're still going to get a nasty peak at about 45 mins.*

A lower carb and/or lower GI meal will have a lower peak but not necessarily a slower one. For example, weetabix hits me at about 60 mins and adds 5-6 mmol/l to my BG at breakfast, dropping by about 3 points at 2 hours. A 2-egg omelette with cheese, onion, peppers, bacon will raise my BG to a peak again at 60 mins by about 1mmol/l and stay nailed there for 4 hours before tailing off.

Fat will slow the peak and reduce its height of course, but may not be enough to make a particular meal acceptable from a BG point of view.

Hope thats useful.

*Jacket potatoes have a particularly high GI and this was probably the cooking method which was used when someone clocked a potato with a GI of 158. Cereal bars on the other hand are usually held together with glucose.

 

[runner]

Yep trial and error to adapt everything to you as an individual, but I guess that's where the health care professionals come in to assist you in this. I do feel I'm getting there and my control is better, but as you say, you still learn new things and have to think again sometimes! I'm sure with everyone's help and after seeing a specialist, you will get there/feel more in conrol too! 🙂

 

[Northerner]

Thanks VBH. Does the HbA1c actually help in this respect? For example, if all your meter readings look OK and your HbA1c is good, wouldn't that mean that you're not getting prolonged peaks? Or do you know if it is any peak - even sharp ones that subside quickly - that are thought to be harmful? I'm no scientist, but assuming that a short peak doesn't affect as much haemoglobin?

 

[VBH]

Northerner,
I'll have to rummage around and find some research links and summaries, but peaks are not necessarily reflected in the A1c as I understand it. I would expect this to be because ACE's (Advanced Glycation Endproducts) are more readily produced than the rate at which actual red blood cells are glycated.

Or to put it another way, the blood vessel walls in the eyes, kidneys and extremeties can be damaged during a BG spike which does not last long enough to glycate the red blood cells and raise the A1c.

Overall the A1c over a period of years does correlate with compliactions rates though. The one I quote most often is that someone with an A1c of 7% has 8 times more chance of third-stage retinopathy over 15 years than someone with an A1c of 6%. (source: Gretchen Becker/Ron Sebol). If the A1c is higher than 7%, the chances increase exponentially.

So although the spikes may be causing the damage, the reason it correlates to the A1c is probably that those with a higher A1c are likely to have higher and more frequent spikes.

I also tend to believe that thinking of the A1c as being an "average" is potentially dangerous, although its a useful concept under some circumstances. It can lead some people to misguidedly think that as long as they have a lot of lows to offset their highs, they will be ok.

I'll have a rummage around tonight and see if I can dig up some stuff thats interesting and not too techinical/dull 😉

 

[runner]

Thanks VBH. Does the HbA1c actually help in this respect? For example, if all your meter readings look OK and your HbA1c is good, wouldn't that mean that you're not getting prolonged peaks? Or do you know if it is any peak - even sharp ones that subside quickly - that are thought to be harmful? I'm no scientist, but assuming that a short peak doesn't affect as much haemoglobin?

Yeah, ditto !

 

[runner]

Northerner,
Overall the A1c over a period of years does correlate with compliactions rates though. The one I quote most often is that someone with an A1c of 7% has 8 times more chance of third-stage retinopathy over 15 years than someone with an A1c of 6%. (source: Gretchen Becker/Ron Sebol). If the A1c is higher than 7%, the chances increase exponentially.

Aarghh, my A1c target is 7.5 or below as prescribed by my DSN, I think because I am sensitive to insulin, so to avoid too many hypos

 

[SilentAssassin1642]

just back from town - checked again due to epic thirst again - 11.2 tried phoning the dsn but well...that didn't go well. And GAH, irritating arm pain again which according to the GP has nothing to do with the diabetes WHATSOEVER!. This is irritating me now. It's only up at 11 because I went low earlier...

well, appointment on friday morning to sort out various things again. Am going to ask the doc AGAIN about this arm pain and the sugars and whatnot, and I might even try the dsn again later or tomorrow. But dyu know what, I'm slightly fed up with the sub par diabetes care in winchester