Carbohydrates for breakfast... yet another fail!

[rebrascora]

Hi all

As many of you will probably know I am a big advocate of omelettes for breakfast but occasionally it would be nice to have something quicker and lighter. I have tried no added sugar museli bars and Nature Valley Protein Bars and this morning I tried Bran Flakes with a few strawberries and a mixture of a little almond milk and cream. I weighed the Bran Flakes very accurately and calculated that there were 25g carbs in the portion and 3 med/large strawberries makes up the other 5g carbs.... negligible carbs in the amount of milk and cream I had with them, so a total of about 30g carbs.
My fasting reading was 5.8. I took a 3 unit N/R bolus at 9.30am. I tested again at 10.29am (an hour later) to see if the insulin was kicking in but my reading had gone up to 6.4, I'm assuming due to DP. I waited another 10mins before starting my bran flakes, so that is 1hr 10mins after injecting the bolus.
20 mins after starting to eat it was up to 8.8 and an hour and 10 mins later it was 9.8. It eventually came down to 4.7 at 2pm and has stabilised there, so I would guess that my bolus was correct at 3 units but why does it take so long to kick in and if I don't pre bolus by a significant time margin I run the risk of going hypo in the afternoon, which has happened a few times.
Are other people as resistant to insulin in the morning as this? Should I worry about it? I don't like getting caught out by a hypo in the afternoon but how much longer dare I pre bolus the N/R before I eat. I had a bit of a panic this morning because I took my glass of fibre supplement in water whilst I was waiting and then had the thought that the layer of gel it forms might prevent the carbs in the breakfast cereal from being absorbed so quickly (or hypo treatment if I needed it), so I ate then rather than waiting any longer for my BG to show signs of dropping, as I had intended. I'm really just trying to roughly match the profile of the insulin with the surge in BG from the breakfast carbs.
This scenario happens every time I have carbs for breakfast. If I don't give it at least an hour pre-bolus, my BG rockets and stays there until the afternoon and then plummets, if I give it longer than an hour it still goes higher than I would like for longer than I would like plus I feel I need to monitor it to make sure I don't put myself at risk of a hypo during that period between bolus and food.
If I wasn't out of yoghurt, I would just have had that with the strawberries or antipasti worked well last week as a breakfast. I guess a trip to Lidl to stock up on both is needed!

 

[nonethewiser]

In all seriousness, you would be picking me up off the floor if I injected so far ahead as you did.

No don't have issues with insulin resistance in a morning, 5 units covers 50g of carbs which is what I consume, bolus 25 minutes before eating. Stick with the low carb brekkie, easier for you by the look of things.

 

[rebrascora]

Thanks for your response. I am reasonably sensitive to insulin at other times, but in the morning it just seems to get stuck for a few hours and then in the afternoon when I think I am in the clear (without using any more insulin or eating any lunch) I get a sudden drop. If I use more insulin and eat something at lunchtime, things become even more unpredictable, so I try to stick to 2 meals a day with low carb snacks like cheese or nuts at lunchtime. So far I haven't had a problem in the evening at all, which is when I have my main carb portion and I usually pre bolus by 10-15mins then. Will stock up on low carb breakfast options again when I hit the shops. Interestingly I still need 2 units of N/R with my morning omelette and salad even though there are negligible carbs and those 2 units never cause me a problem later in the day and my BG is lovely and stable until my evening meal.

 

[Drummer]

I hope 'you type ones' don't resent my reading these posts - there is a certain wry amusement - my breakfast 'allowance' is no more than 10 grams of carb from foods which contain 10 percent carbs or less - and my maximum fro the day is usuallly 35 gm - again from low carb foods. My resistance to my own insulin was always rather higher in the mornings than the evenings - I don't eat in between.
My first meal in hot weather usually has salad involved, and I add a little psyllium husk flour to the coleslaw - it stops me breathing it in accidentally and it seems to ensure it gets eaten. I found that adding the whole husk to a glass of water usually resulted in it sticking to the glass and it was really diffiucult to get it off the glass - and of course that meant I was not getting the benefit, if benefits there are...

 

[rebrascora]

Hi Drummer
Very happy for you to chip in with your two penneth.
Normally I have less than 10g carbs for breakfast but occasionally I would like to be able to have a bowl of cereal or porridge. The situation is complicated by the fact that I live between two houses, my own and my partners, so sometimes I don't have an appropriate breakfast option at the house that I wake up in.... especially if he has been eating my supplies (usually the eggs) and doesn't mention it until I open the fridge door to make my morning omelette) 🙄
As regards the fibre in a glass of water, doing it that way ensures that I drink the requisite water and I would be less inclined to do so if I had it in my food.. It is taken in a glass of fluid and then the glass refilled and drank straight after, so most of what has stuck to the sides goes down with the refill waterm especially if you give it a stir. I have just recently started using chia seeds as well and leaving them to swell and then adding the psyllium and mixing and that seems to stop a lot of the adherence to the glass for some reason.

I do wonder why more type 1s don't eat very low carb.... I guess it is because they don't have to, but coming to this from an initial Type 2 diagnosis and going very low carb to try to control it by that means first, I do feel that low carb is beneficial, especially when hypos are so scary and risky. It makes sense to me to use the minimum bolus insulin required to reduce that risk, but I have only been at this for a few months and I am sure being several years or decades down the line with it might put a whole new angle on it. And of course the original insulins were much less flexible, so a set amount of carbs per meal was standard I believe. I would guess it is also tied in with the dated government guidelines on healthy eating. ie low fat, higher carb.

 

[rebrascora]

Thanks @Benny G
I too eat a lot of omelettes (I keep chickens, so plenty of eggs most of the year) but was just looking for an occasional alternative. I can assure you I will be back to my omelette and salad tomorrow. Out of curiosity, do you need bolus insulin with your breakfast omelette?
Good luck with hitting your target HbA1c. I will be happy if I can get mine below 60 in October.

 

[rebrascora]

I am pretty sure if I had an omelette at lunchtime or in the evening, I would not need a bolus.... haven't tried it yet but I seem to need two in the morning with it. We initially thought it was the mocha I had with it (made with just one spoonful of Options drinking chocolate, so less than 5g carbs) but just have coffee now and still need 2 units or I go up into double figures.

 

[rebrascora]

Thanks for the info and link. I will take a look tomorrow when I am more alert.

 

[Edgar]

If you like them,tinned sardines are a nice alternative for breakfast.

 

[Robin]

A good lowcarb meal, like an omelette, usually requires no bolus. A meal that is low carb, or to cover exercise, or fix a hypo, is basically 'free'
I try to eat only 'free' meals.

Don’t you find the protein requires some insulin? Or do you cover this with higher basal? I find if I have eggs for any meal, I get a rise 5-6 hours later, when I assume my body is converting some of the protein to glucose.

 

[Matt Cycle]

I'm not insulin resistant and I'm now in my 34th year of T1.

My fasting reading was 5.8. I took a 3 unit N/R bolus at 9.30am. I tested again at 10.29am (an hour later) to see if the insulin was kicking in but my reading had gone up to 6.4, I'm assuming due to DP. I waited another 10mins before starting my bran flakes, so that is 1hr 10mins after injecting the bolus.

There is no difference between 5.8 and 6.4 on meters. I think if you're waiting for your levels to drop before eating then you're likely to have timing problems because the bran flakes will take time to hit your blood glucose.

This scenario happens every time I have carbs for breakfast. If I don't give it at least an hour pre-bolus, my BG rockets and stays there until the afternoon and then plummets, if I give it longer than an hour it still goes higher than I would like for longer than I would like plus I feel I need to monitor it to make sure I don't put myself at risk of a hypo during that period between bolus and food.

This doesn't sound right. Are you sure your basal is correct? Do you only take one daily dose of Levemir? Most are on 2 doses as it only lasts around 18-20 hours. If you do basal testing and get that right then it will make what's going on with the NR a bit clearer.

 

[rebrascora]

Yes I am just on a single dose of Levemir ....normally anyway.... I was a total numb skull last night though and accidentally gave myself two full basal doses a couple of hours apart.... I deviated from my normal routine and somehow got in a muddle..... first time I have made a mistake like that and did not sleep well for worrying and checking through the night. My consultant is not keen for me to split the Levemir dose just yet..... I don't really understand why.
Bran flakes hit my system pretty quickly.... within 10-15mins after eating them my BG was rising even though I had prebolussed the insulin and hour and 20 mins before that..... I am pretty good at breaking foods down rather rapidly and efficiently. I might try a few days of skipping breakfast and having an early lunch instead and see how I go with that.

I'm reasonably confident my basal is about right at 8 units. I started on 6 and we upped it to 8 and my fasting readings for the past month are anywhere from 3.8-9.2 (I often eat very late at night and struggle to maintain a routine of eating or sleeping due to years of rotating shift work) so there will be a lot of variability due to that but mostly they have been in the 6s.