Bloods Spiking

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Beckybrown22

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Hi everyone,
Looking for some advice/help if possible please. My partner has type 1 diabetes and has been diagnosed for nearly 2 years now. For some reason his bloods keep spiking after breakfast and we are just looking for some advice if this happens to other people or if there is any help you would be able to give us as it is getting him down at the moment because he injects his correct insulin weighs everything out.
Thank you!
 
First thing in the morning, it is very common for our livers to "help us out" by dumping glucose to give us energy to start the day. This happens whether you have diabetes or not. Those with a healthy pancreas will release insulin and we won't notice. On the other hand, those with a less than perfect pancreas will notice we become more insulin resistant and our levels rise. As a result, many of us with Type 1 find we need to pre-bolus earlier for breakfast and we may need a different insulin to carb ratio.

If you search for Dawn Phenomenon and Foot on the Floor you will find more about this subject.
 
Welcome @Beckybrown22 How high does he spike? And how far in advance of his breakfast does he inject his insulin? It’s normal to spike after meals. Even in people without diabetes, their blood sugar rises. If his spike is moderate that’s ok. However if it’s high he could try injecting earlier as this can often reduce the spike.
 
Inka said:
Welcome @Beckybrown22 How high does he spike? And how far in advance of his breakfast does he inject his insulin? It’s normal to spike after meals. Even in people without diabetes, their blood sugar rises. If his spike is moderate that’s ok. However if it’s high he could try injecting earlier as this can often reduce the spike.
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Hello, the highest has been around 13, today he tried injecting 15 minutes earlier but it still spiked, I think he feels he is doing something wrong but I didn’t think he would be, should he inject earlier and maybe change his ratio for breakfast? Thank you.
 
helli said:
First thing in the morning, it is very common for our livers to "help us out" by dumping glucose to give us energy to start the day. This happens whether you have diabetes or not. Those with a healthy pancreas will release insulin and we won't notice. On the other hand, those with a less than perfect pancreas will notice we become more insulin resistant and our levels rise. As a result, many of us with Type 1 find we need to pre-bolus earlier for breakfast and we may need a different insulin to carb ratio.

If you search for Dawn Phenomenon and Foot on the Floor you will find more about this subject.
Click to expand...
Thank you very much, really appreciate your help.
 
Do his levels return (more or less) back to their starting point by lunch time with no extra insulin?

‘Rapid’ Insulin acts over something like 4-5 hours, so the spike may be occuring when there’s still quite a bit of the dose still chugging away.

If his levels are returning back to where they started after 4-5 hours it suggests the carb counting, ratio and insulin dose are working, but the spike can be an indication that the timing of the insulin action is off, and the insulin is a bit late getting going.

I managed to drop my post-breakfast peaks from 12s and 14s down to 9s and 10s just by leaving a bit of a gap between dosing the insulin and eating the food. The gap that works for me has changed over time but generally ranges from 20minutes up to nearly an hour 😱 (not recommended without careful experimentation!)
 
Beckybrown22 said:
Hello, the highest has been around 13, today he tried injecting 15 minutes earlier but it still spiked, I think he feels he is doing something wrong but I didn’t think he would be, should he inject earlier and maybe change his ratio for breakfast? Thank you.
Click to expand...
What was his blood sugar before breakfast? If he is getting more than a 4 point rise then perhaps change the carb ratio.
 
Beckybrown22 said:
Hello, the highest has been around 13, today he tried injecting 15 minutes earlier but it still spiked, I think he feels he is doing something wrong but I didn’t think he would be, should he inject earlier and maybe change his ratio for breakfast? Thank you.
Click to expand...

13 isn’t too bad. He might be able to improve that by injecting a little more in advance. As an example, I have to inject 30 mins in advance of breakfast (because I’m most insulin resistant in the morning and due to the factors @helli mentioned).

He could try 20 mins. He should always be careful and always watch out that he doesn’t drop too low before he eats. I moved my injection time in stages 5 minutes earlier time until I found the right time. If that doesn’t work, then perhaps his ratio needs a small change.
 
Hang on - what's his BG as soon as he wakes up? or doesn't he test it till he's ready for brekkie?
(I'm wondering if his basal is OK)
 
everydayupsanddowns said:
Do his levels return (more or less) back to their starting point by lunch time with no extra insulin?

‘Rapid’ Insulin acts over something like 4-5 hours, so the spike may be occuring when there’s still quite a bit of the dose still chugging away.

If his levels are returning back to where they started after 4-5 hours it suggests the carb counting, ratio and insulin dose are working, but the spike can be an indication that the timing of the insulin action is off, and the insulin is a bit late getting going.

I managed to drop my post-breakfast peaks from 12s and 14s down to 9s and 10s just by leaving a bit of a gap between dosing the insulin and eating the food. The gap that works for me has changed over time but generally ranges from 20minutes up to nearly an hour 😱 (not recommended without careful experimentation!)
Click to expand...
Yes they do return to the starting point by lunch time. Perfect, thank you I will get him to try an extra 5 minutes tomorrow morning so move it up to 20 minutes to see if that helps.

Thank you for your advice and help.
 
Pumper_Sue said:
What was his blood sugar before breakfast? If he is getting more than a 4 point rise then perhaps change the carb ratio.
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Well before breakfast they were around 8 this morning and then spiked up to 13 and then now they are back down to 4.7.
 
Inka said:
13 isn’t too bad. He might be able to improve that by injecting a little more in advance. As an example, I have to inject 30 mins in advance of breakfast (because I’m most insulin resistant in the morning and due to the factors @helli mentioned).

He could try 20 mins. He should always be careful and always watch out that he doesn’t drop too low before he eats. I moved my injection time in stages 5 minutes earlier time until I found the right time. If that doesn’t work, then perhaps his ratio needs a small change.
Click to expand...
Yes, I have suggested now tomorrow morning adding an extra 5 minutes and see how that helps. Honestly all of this information is so helpful, so I really appreciate everyone's help and suggestions!
 
Beckybrown22 said:
Well before breakfast they were around 8 this morning and then spiked up to 13 and then now they are back down to 4.7.
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Def, sounds like a timing problem 🙂
 
If it helps any, I consistently need 45mins between injecting and eating breakfast. I inject before I get out of bed to allow the insulin to get going before my levels rise too high. Then I potter about getting washed and dressed and making my breakfast and getting a cup of coffee and drinking it and then I eat my breakfast. Not sugesting your partner leaves it 45mins but just to let you know that needing longer at breakfast time is common and it can need quite a bit longer than is recommended by nurses and consultants. ie the usual 15-20mins they suggest. If he had a Libre then he can keep scanning every few minutes to keep an eye on his levels and he should see when the insulin starts to kick in.
 
Your chap has exactly what Mike (@everydayupsanddowns ) and I (plus hundreds of other Type 1s) get every morning, which we decided to call the 'Foot on the Floor' phenomenon - it's now so common we abbreviate it to FOTF. Basically BG stays exactly where it is until we actually get out of bed - then starts to increase practically on the way to the bathroom before we sit down again there or do, well, anything at all. However, much like the 'Dawn Phenomenon' which is associated more with Type 2 diabetes - it is remedied by breaking our fast - although with Type 1, of course we need to inject before eating, BUT really should only jab the amount needed for the food and not add anything for a correction, since otherwise we will hypo. If he already knows what he's gonna have for his brekkie, no reason why he can't do that sooner than just before brekkie.

Does he now have a Libre? Very useful thing - can see if his BG is going up without doing a fingerprick so if his BG isn't shooting up he wouldn't jab well before eating. All part of the personal medical trial we have to do!
 
I have had a few bad days where time in range was 0% and average >17 mmol/L. Also developed an UTI. Contacted GP and am told that both the issues are feeding on each other. High BG levels - UTI - higher readings. Taking antibiotics now.

I ve never got my readings under control since diagnosis 4+ moths ago. This episode has really made it worse.

I feel low seeing waking up numbers above 20 or near about. I carb count and take insulin as advised. I put a lot of effort in regards to my meals. Unfortunately nothing seems to be working for me just yet. My patience has worn thin, low morale and losing hope to the point that at times I want to forget about DM, gorge on sugary treats and crawl back under covers for once and all.
 
@Purls of Wisdom You are clearly not using enough insulin if your levels are that high and you are being careful with your diet. You need to get back in touch with the DSN about increasing your doses. I believe you were given the go ahead to use correction doses of quick acting (bolus) insulin.... Have you been using those to bring your levels down? If so and they are still remaining high then it is likely that your basal insulin doses are not enough and need increasing.
please push for more help from a DSN not a GP.

PS. Sending (((HUGS))) because you clearly need them.
 
Purls of Wisdom said:
I have had a few bad days where time in range was 0% and average >17 mmol/L. Also developed an UTI. Contacted GP and am told that both the issues are feeding on each other. High BG levels - UTI - higher readings. Taking antibiotics now.

I ve never got my readings under control since diagnosis 4+ moths ago. This episode has really made it worse.

I feel low seeing waking up numbers above 20 or near about. I carb count and take insulin as advised. I put a lot of effort in regards to my meals. Unfortunately nothing seems to be working for me just yet. My patience has worn thin, low morale and losing hope to the point that at times I want to forget about DM, gorge on sugary treats and crawl back under covers for once and all.
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Sorry you are having such a tough time @Purls of Wisdom

Have your doses / ratios / correction factors been adjusted since they were first suggested? Often the initial suggestions are just that - suggestions based on educated guesswork or basic rules of thumb… but these almost always need to be adjusted and amended to suit the individual.
 
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