Changing post meal levels

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Hi

I've posted for help for dealing with levels after meals before, mainly for trying to keep peaks reasonable and prevent Hypos occuring before my next meal. Felt I was getting somewhere with smaller peaks and less hypos but think it's the result of something else that started to happen. I'm peaking much later after a meal than before and staying at that level until my next meal.takes about 3 hours after eating until I peak. I initially get a small peak and fall the first hour and half but not too low. Anyone experienced this before ? Been going on for a week now. Looking for suggestions.

Thanks
 
If your levels are peaking after an hour and then starting to come back down and then slowly creeping up towards your next meal then it may be that your basal insulin Levemir is not holding you steady and may need increasing. The way to test if it is your basal insulin is to skip a meal where this is happening and see what happens in the absence of food and bolus insulin. If your levels still rise then it suggests that your basal insulin is not enough. That may be because it is running out, since it looks like you are just taking Levemir once a day or it may be that the dose is not enough.
When do you take your Levemir and are there particular times of day/meals when this happens or after every meal?
Diabetes is all about looking for patterns. It might not be totally consistent but if something is happening 3 or 4 days out of 5 then it suggests there may be a specific problem that needs looking at.
 
Breakfast has been okay except on the weekend because I have it at a later time. Seems to be 10 am onwards. I have the levermir around 11pm everynight as that's when I go to bed during weekdays. I actually did a few basal tests the weeks leading up to this starting. There was nothing wrong with the basal levels for morning afternoon and overnight . I never got to test my evening levels though.

This has happened all of sudden. Haven't made any changes to the foods I eat. I imagine if it was the bolus then I'd see much higher levels ? I was concerned my digestion has slowed down but if that was the case I'd probably hypo right after eating with the insulin taken. Soo much to think about
 
Ah diabetes! The game of continually chasing after the moving goalposts, making progress, and fixing issues, only for your carefully constructed strategies and approaches to need overhauling all over again!

As @rebrascora suggests, check of basal is often a good place to start, as your basal needs can ebb and flow through the year and give the impression that meal doses are wrong.

It might also be connected to food type and absorption rate. sometimes if a food absorbs slowly you can need to split the meal dose, taking a proportion up front, and then the remainder an hour or more later, to stretch the activity of the insulin over a longer period.

Certain foods have a bit of a reputation for needing this - pizza and pasta are often mentioned - but my experience is that diabetes is quite happy to behave in a maddeningly illogical way at times (mine decided to absorb a particular shape of pasta in super-slow-motion a few years back, but not other shapes, and has since forgotten all about that!). I also tend to find that bigger meals absorb more slowly, especially when doses rise above a certain number of units.

Hope you find a strategy for evening this out again.
 
@everydayupsanddowns the pasta shape,that is a weird one

Have you ever had long periods of time were your diabetes seemed steady or is it really just a day to day challenge? Maybe I'm just not there yet mentally .

Regarding food, I've been eating the same meals , I generally split a dose for anything over 30g of fat which usually does the trick. Its been suggested many times by members on here to split my basal dose. I'm a little weary about trying that seeing as the consultant keeps telling me not to. But if it's the basal and it's running out , if I increase the single dose I'll just create more problems the first so many hours it's active. I assume increasing a dose doesn't extend its duration ? But just makes the concentration higher for the duration. Hope that makes sense
 
jazzchicken said:
@everydayupsanddowns the pasta shape,that is a weird one

Have you ever had long periods of time were your diabetes seemed steady or is it really just a day to day challenge? Maybe I'm just not there yet mentally .

Regarding food, I've been eating the same meals , I generally split a dose for anything over 30g of fat which usually does the trick. Its been suggested many times by members on here to split my basal dose. I'm a little weary about trying that seeing as the consultant keeps telling me not to. But if it's the basal and it's running out , if I increase the single dose I'll just create more problems the first so many hours it's active. I assume increasing a dose doesn't extend its duration ? But just makes the concentration higher for the duration. Hope that makes sense
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I think increasing a basal dose can to some extent extend the duration as well as the concentration.
 
jazzchicken said:
@everydayupsanddowns the pasta shape,that is a weird one

Have you ever had long periods of time were your diabetes seemed steady or is it really just a day to day challenge? Maybe I'm just not there yet mentally .

Regarding food, I've been eating the same meals , I generally split a dose for anything over 30g of fat which usually does the trick. Its been suggested many times by members on here to split my basal dose. I'm a little weary about trying that seeing as the consultant keeps telling me not to. But if it's the basal and it's running out , if I increase the single dose I'll just create more problems the first so many hours it's active. I assume increasing a dose doesn't extend its duration ? But just makes the concentration higher for the duration. Hope that makes sense
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As @Lucyr says, with Levemir particularly, increasing the dose can extend the activity period. The other option you have, if you have been expressly told not to split it, is to change when you take it. You might find first thing in the morning as soon as you wake up will give you more activity through the day but tail off during the night when many of us need less. I currently take 24 units in the morning at 6.30am which keeps me nice and steady during the day and just 4.5 units in the evening. I find that the evening dose is the one that seems to vary the most, so if I have had an active day, I need to reduce the evening dose by a couple of units. If I do a lot of exercise 2 or 3 days in a row, I sometimes have to reduce the evening dose down to zero and then start reducing the morning dose. It is a case of constantly reassessing and tweaking my basal insulin, but yes, I do go through spells of weeks or months when I don't need any adjustment and it can be really settled and consistent and then I have weeks where I need to tweak it every few days. As Mike says, the goal posts keep moving and you have to watch and adjust to match them.
 
@jazzchicken I’ve had Type 1 almost 30 years - and the bl***y thing still gets one over on me! This week for no reason whatsoever it’s decided to put my blood sugar up around bedtime. This could caused by anything - the movement of celestial bodies, a solar flare, a mole digging under my lawn, a rogue GPS satellite, an unwashed teaspoon in the sink…

Seriously though, this is the very frustrating nature of Type 1. It’s always changing. You don’t sort it and forget about it. It’s tediously needy. Adjusting, changing, tweaking, changing back - it happens a lot over the year.

In your situation, if the peak wasn’t too high, I’d put up with it because it will probably disappear as randomly as it came, or, if it persisted, I’d do another basal test.
 
@Inka is absolutely spot on. I don't think DSNs or consultants really forewarn or prepare you for how much tweaking is necessary, particularly with basal insulin needs. I think many people just assume that once your basal dose is set, that is pretty much it and there may be some people who can get away with that, but I think most people's basal needs change for a variety of reasons and some of them can be pretty spurious.
Interestingly @Inka I too have been having problems with my levels rising on an evening for a couple of weeks off and on but not totally consistent. The last few nights I have either been in double figures or hypo through the night on the same basal dose. Absolutely no idea why and difficult to fix until the trend settles. Very frustrating!
 
Inka said:
It’s tediously needy.
Click to expand...

Spot. On! That is such a good description 😎

jazzchicken said:
the pasta shape,that is a weird one
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Yes, it was spaghetti. Spent about a year behaving completely differently to regular pasta (which has always been pretty meek and well behaved for me). Had me chasing post-meal hypos and later rises for a while until I’d worked it out - which took a while because it makes absolutely NO SENSE!

These days it’s pretty much back to behaving normally. 🙄

If your consultant isn’t keen on splitting Levemir (which is a little bit surprising as Lev was initially suggested as a 2x basal I think), maybe it would be helpful/informative to basal test the late afternoon / evening time slot, just to see what’s going on in the background, and how the single dose is holding up without food/bolus muddying the waters?
 
@rebrascora I don't think I've quite got my head round the basal tweaking. I don't even change it after exercise, I just snack extra or adjust my bolus in the evening. I hope I can get to a stage were I'm confident with tweaking. I'm generally more active in the evening when I get home , walking the dog and any exercise. During the day I sit in an office. So would make sense to have more basal during the day than the evening. I've actually considered going back to working in retail just to be on my feet again but sure that would mean more adjusting.

@Inka I hope it's a phase. It doesn't help that I'm still fixated on perfect bloods and I know I shouldn't be. Trying to be realistic but it's difficult to get into that mindset. I ended up speaking to another type 1 locally who was diagnosed a few years ago and all I got from them was it's very difficult and they still haven't got their head round it.

@everydayupsanddowns yes even any info on levermir I have found it says it last no more than 16 hours. I will be seeing them again soon , I think from the last few meetings their concern was my frequent hypos. Maybe thought I'd be better running high for a while .

I will definitely be doing a test tomorrow to see what is going on.
 
I wasn't confident to change my basal doses until after I had my DAFNE course, so it is totally understandable that you are not ready to tweak things yourself yet. It will all come with time and learning and experience.

I can really relate to your impatience and frustration in wanting to get it right and have better results but you are not yet equipped with all the tools and expertise to do so. As we often say on here, Diabetes is a marathon not a sprint. Try to resign yourself to a steadier pace.
 
@jazzchicken I attach a graph showing how long Levemir lasts dependent on dose per kilo of body weight. To find where you are on the graph divide your dose by the number of kilos you weigh. e.g. a 55 kilo person taking 28u Levemir would be on the line 0.5 down the left hand side of the graph and the Levemir could be expected to last somewhere between 22 and 24 hours. If the same 55 kilo person were on 10u Levemir then the dose would be 0.18 so closer to the 0.2 line and the Levemir would likely be lasting approx 18 hours.

I would also reinforce what others have said about basal needs changing (sometimes quite abruptly) from time to time. It quite often depends on the weather - that sounds strange, but our blood tends to be thinner in hotter weather.

@everydayupsanddowns I have saved the Levemir graph from DSF onto my laptop. DSF will shortly be permanently offline, so if it's useful I can email it to you, or you could save it off this page.
levimirspeeddose.jpg
 
@rebrascora dont think I'll be on that course for a while, a couple of people I spoke to who have had diabetes a few years and go to the same clinic are still waiting.

Should be interesting to see what happens later with my levels. Looking forward to not eating again though have to say the 3 times I tested before it was great to see that nice steady line. Does anyone ever post graphs of their bloods on the forum? I'd be interested to see some.

@Pattidevans thanks this looks helpful. Though I'll be honest I wanna check I'm understanding right. So if I follow a line across as soon as it goes flat that's the levermir running out ? I'm 74kg and take 6 units , so 0.08? So say 0.1 it looks to be around 14 to 16 hours ?
 
jazzchicken said:
@Pattidevans thanks this looks helpful. Though I'll be honest I wanna check I'm understanding right. So if I follow a line across as soon as it goes flat that's the levermir running out ? I'm 74kg and take 6 units , so 0.08? So say 0.1 it looks to be around 14 to 16 hours ?
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Yes, that's right @jazzchicken. Though actually it might be more like 12 - 14.
 
Pattidevans said:
I have saved the Levemir graph from DSF onto my laptop. DSF will shortly be permanently offline, so if it's useful I can email it to you, or you could save it off this page
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Thanks Patti

Yes I’ve got a few DSF things saved that we have linked to in the past from the forum that I‘ll be adding to the Links section with an appropriate credit etc 🙂
 
So the basal test from 130pm to 730pm had me hypo at the end. I wasn't doing anything strenuous. It held between 4.5mmol and 5mmol until 630pm when it started to drop. I take the levermir at 11pm every night so surely 6 units isn't still working by then, that's over 20 hours later. Leaves me wondering what is going on with the meals still. The quest continues
 
jazzchicken said:
So the basal test from 130pm to 730pm had me hypo at the end. I wasn't doing anything strenuous. It held between 4.5mmol and 5mmol until 630pm when it started to drop. I take the levermir at 11pm every night so surely 6 units isn't still working by then, that's over 20 hours later. Leaves me wondering what is going on with the meals still. The quest continues
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@jazzchicken when did you start/finish your last meal prior to the test?
 
630am breakfast, snack at 930am as I usually go tad low mid morning.
 
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