Breakfast choices

[spence]

Good morning guys. I have been trying different breakfasts, obviously trying to keep my levels low. I am type 1 diabetic. I have changed milk from green top to soya or almond. I have tried un sweetened muesli, toast without butter. My levels always spike after breakfast. The rest of the day seems fine. I am on 15 slow release insulin and 7 quick Release in the evenings. Any advice would be greatly appreciated. Thanks

 

[RBZ5416]

I'll leave this one to other T1s but only taking a bolus dose with your evening meal seems odd. The usual routine is to bolus before every meal unless it's very low carb. So within reason, you should be able to have whatever you want for breakfast & just bolus for the carbs in it.

 

[Robin]

If you’re usually seen at a hospital clinic, you should have access to a DSN for advice any time you need it, and if you’re dealt with by your GP, there should be a practice nurse with some extra training in Diabetes. I think you need to contact whichever, and tell them you think you now need to add in a dose of short acting insulin at breakfast, because you are getting spikes of high blood sugar. Have you been on a carb counting course yet, like DAFNE
? (Dose adjustment for normal eating).

 

[Eternal422]

Hi @spence, it would help to know what insulins you are on and when you take them? From what you say I‘m not sure whether you are on two different insulins, slow and fast, both taken in the evening? As @Robin says, your DSN should be able to help you adjust your doses to help reduce spikes And should be your first port of call for advice.

What sort of spikes are you seeing? Do they come down quickly after breakfast? At the moment I’m having porridge with a few sultanas for my breakfasts and I get an increase of at least 4 from that, but it is back down in range within 90mins to 2 hours at most, often back to the starting level. That is with a pre-bolus of at least 30 mins of Novorapid (Fast acting insulin). My DSN is happy with that spike and says it is nothing to worry about given it comes back down fast. Do you have a Libre to see the actual effect on your BG?

Here’s a typical breakfast spike that I get :

 

[Robin]

Hi @spence, it would help to know what insulins you are on and when you take them? From what you say I‘m not sure whether you are on two different insulins, slow and fast, both taken in the evening? As @Robin says, your DSN should be able to help you adjust your doses to help reduce spikes And should be your first port of call for advice.

I was going from @spence's previous thread, it’s Abasalgar basal in the morning, with a fixed dose of Fiasp before evening meal, which has gradually been titrated upwards but none at other times of day.
My gut feeling is that possibly, spence has come to the end of the Honeymoon period, and the pancreas is able to produce less and less of its own insulin.

 

[Eternal422]

I was going from @spence's previous thread, it’s Abasalgar basal in the morning, with a fixed dose of Fiasp before evening meal, which has gradually been titrated upwards but none at other times of day.
My gut feeling is that possibly, spence has come to the end of the Honeymoon period, and the pancreas is able to produce less and less of its own insulin.

Ah - didn’t see the other post. Definitely worth talking with DSN then about it. It’s been so long since my honeymoon period that I’ve forgotten how some homegrown insulin just needs a little supplement of injected insulin to start with!

 

[Inka]

Good morning guys. I have been trying different breakfasts, obviously trying to keep my levels low. I am type 1 diabetic. I have changed milk from green top to soya or almond. I have tried un sweetened muesli, toast without butter. My levels always spike after breakfast. The rest of the day seems fine. I am on 15 slow release insulin and 7 quick Release in the evenings. Any advice would be greatly appreciated. Thanks

Sounds like you might need a little bolus insulin at breakfast time @spence When I first read your post, I assumed you were already bolusing for breakfast and was just going to suggest you injected earlier, but with no bolus, you’re fighting the normal rise that happens when we start the day plus the usually increased insulin resistance at breakfast time.

My advice is to speak to your team, get a half unit bolus pen and start injecting for breakfast. You might only need a tiny amount of insulin but it can make a big difference.

 

[spence]

Sounds like you might need a little bolus insulin at breakfast time @spence When I first read your post, I assumed you were already bolusing for breakfast and was just going to suggest you injected earlier, but with no bolus, you’re fighting the normal rise that happens when we start the day plus the usually increased insulin resistance at breakfast time.

My advice is to speak to your team, get a half unit bolus pen and start injecting for breakfast. You might only need a tiny amount of insulin but it can make a big difference.

So bolus is the quick reacting insulin? I take the slow reacting in the morning at the moment and then quick reacting with evening meal? Thanks for your reply

 

[Inka]

So bolus is the quick reacting insulin? I take the slow reacting in the morning at the moment and then quick reacting with evening meal? Thanks for your reply

Yes, bolus insulin is fast/quick insulin that’s taken for meals or correction doses. Basal is the slow, longer acting background insulin.

 

[Robin]

So bolus is the quick reacting insulin? I take the slow reacting in the morning at the moment and then quick reacting with evening meal? Thanks for your reply

Just to clarify. If you started taking a small dose of your fast insulin to help with your breakfast spike, you’d take that as well as your normal morning dose of slow acting (Basal). The Basal is there to mop up the trickle of glucose that your liver puts out 24hrs a day to keep your vital organs ticking over, even if you haven’t eaten,( so you take that at the same time every day, and it lasts until the next dose the following day.)

 

[spence]

Just to clarify. If you started taking a small dose of your fast insulin to help with your breakfast spike, you’d take that as well as your normal morning dose of slow acting (Basal). The Basal is there to mop up the trickle of glucose that your liver puts out 24hrs a day to keep your vital organs ticking over, even if you haven’t eaten,( so you take that at the same time every day, and it lasts until the next dose the following day.)

When I wake up my levels are normally between 6-7, I take my slow release insulin and have a bowl of unsweetened muesli and my levels can then go to 12 and then a while later drop down again. I am due to see diabetic nurse in the next couple weeks.

 

[Bruce Stephens]

I take my slow release insulin and have a bowl of unsweetened muesli and my levels can then go to 12 and then a while later drop down again.

Going up to 12 isn't a disaster, so maybe your DSN will be OK with that. Some bolus insulin should be able to fix it, if that seems worth doing. (I think most of us have bolus insulin with all meals that contain carbs, most definitely including breakfast.)

 

[trophywench]

It isn't just sugar itself which increases our blood glucose - it is all foodstuffs containing carbohydrate so the muesli is the culprit, not the milk or sweetener you may add to it. Hence we need fast acting insulin to deal with that, as the slow-acting one just ticks away in the background dealing quietly with our body's background needs.

 

[DaveB]

Hi. Why are you having toast without butter? Butter is not a problem for diabetes but toast is as it's a carb. What is the amount of carbs from the toast and muesli that you have for breakfast? With Basal/Bolus it is normal to use the Bolus for at least 3 of the main meals, including breakfast and to use the Basal once or twice a day.

 

[spence]

Hi. Why are you having toast without butter? Butter is not a problem for diabetes but toast is as it's a carb. What is the amount of carbs from the toast and muesli that you have for breakfast? With Basal/Bolus it is normal to use the Bolus for at least 3 of the main meals, including breakfast and to use the Basal once or twice a day.

I do have it with butter sometimes. I have the healthiest bread I can find. As of yet I only have the slow release insulin in the morning and quick release with my evening meal.

 

[nonethewiser]

I do have it with butter sometimes. I have the healthiest bread I can find. As of yet I only have the slow release insulin in the morning and quick release with my evening meal.

You need quick acting insulin at breakfast, after that you can enjoy bread cereal or whatever takes your fancy.

 

[mashedupmatt]

For me, breakfast spikes are almost always higher than other meals despite having a similar amount of carbs (I'm taking low levels of NovoRapid before each meal to help)