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Controlling high peaks

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P

pav

Well-Known Member
Relationship to Diabetes
Type 2
My morning BS are excellent starting at 4.4 just as getting out of bed to 6.5 to 7.5 2 hours after breakfast. and in the 4's to 5 before lunch.

After this it goes to pot, before tea it can be approaching 10, then 2 hours after tea it can be around 12 or 13. Its not all predictable as I can eat the same thing one day and be ok the the next.

If high before tea, I tried having no carbs (or very low carbs) this does have an effect that brings the BS down but it then goes to low at bed time to around 4.0 especially if I have tea a bit to early.

I am currently on 2000 mg of metformin split into 1000 mg in the morning and 1000 mg at tea time. I also take 160 mg of gliclazide in the morning.

I tend to eat around 100 g to 150 g of carbs a day (not worked out to a great detail the carbs I do eat). I don't have a diabetic team to refer back to and though do have a diabetic screening nurse who I don't think is allowed to discuss meds in detail, and docs don't want to do anything at the moment.

If I had docs authority to take more gliclazide at night, I think I would be in trouble at bedtime as could well end up going hypo and don't want that.

Without the aid of a diabetic team support, I am wondering if an injectable BS reducer would be of benefit in treating these spikes, though after hearing things about these other meds is it a good idea or bad. Then it would obviously need to get a docs ok on this.
 
Maybe the help of a longer acting insulin to help stabilize your BG when not eating would give good results.....

Definitely worth discussion....😉
 
It sounds like either your meds don't give sufficient coverage for the middle of the day, or it's your lunch that's causing the issue. Have you tried having a low carb lunch to try and prevent your BG rising, as opposed to a low carb tea when the BG is already elevated? Another strategy you could try if it fits in with your day, is to go for a brisk 15-20 min walk immediately after eating lunch. This could help the insulin you produce work harder at that time of day.
 
Lunch is usually the lowest carb meal of the day at 2 slices of wholemeal bread and a filling usually no or low carbs sliced ham, eggs, bacon on occasions.

Normally go for a walk before lunch as thats when circumstances permit, I have to watch the walking as I have arthritis in the knee and its out of alignment, docs says live with it and can't refer me to have it fixed. :(
 
Try something really simple for lowering the lunchtime carbs... switch to small loaves of bread, still have two slices and add a bit more protein filling.
 
Lunch is the problem, not your tea. If your tea reading starts at 10 and goes to 13 as a 2-hour postprandial, then your tea isn't really affecting your blood sugar, particularly when you consider meter margins of error. I also wouldn't consider a reading of 4.0 to be 'low'. 4.0 is completely and utterly normal and in an ideal world would be your BG reading 90% of the time.

It's definitely lunch that's the problem but rather than simply chuck more medication (and thus, more variables) at the problem, I'd be inclined to alter what I was eating and build exercise into my afternoon if possible.

If you're not eating that many carbs at lunch then I'd say you're going to have to look at cutting them right down. But wholemeal bread isn't low-carb at all. A wholemeal sandwich will still clock in at something like 40g of carbs. I'd start by having your carb intake - go for an open-faced sandwich with more topping to make up the calorie imbalance, eat nuts at lunch. See if that helps. It's better to start low and then 'add in' carbs as you go so you get a better idea of your carb limit for lunch time.

Lunch is a tricky one as we're culturally attuned to having carbs as the basis. But it's also the meal that gives you the most flexibility. If salads don't float your boat, other options are reheating any protein and fat based leftovers from your tea the day before - personally I love chili in a bowl, or the remains of my phad kra pao the next day. It's very easy to make a filling lunch with fewer carbs in it provided you put the groundwork in the night before. You can also find various 'cheats' - some places do wraps made of soy flour that have about 5g of carbs per wrap which have completely transformed my approach to both lunch and cooking enchiladas!

The other obvious option is to look at a bolus insulin for covering your lunch. However, if your issue is insulin resistance, all you're doing is trying to put out a fire with petrol. So my preference would always be lifestyle and diet changes, rather than medicine.
 
I used to run around the bloke when i was young & bg came down. How about going for a walk after your meal. Nice weather & makes you feel better 🙂
 
Due to circumstances beyond my control its not easy to get out. :(

Today's readings have been good.

On waking 4.6
2 hours after breakfast 6.5
Before lunch 6.9 a touch higher than normal though lunch was a bit earlier than usual.
2 1/4 hours after lunch 8.0
Before tea 6.8

Good figures all round would be happy if they were all like this.

Yesterday Sunday

On waking 4.4
2 1/2 hours after breakfast 7.5
Before Lunch (had some fruit pastilles as doing main shop & driving) 7.1
After lunch 8.9
Before tea 9.5
2 hours after tea 9.4
Bed time 6.9

Saturday

On getting up 4.7
After breakfast 6.8
Before lunch 4.4
After lunch 8.0
About 3 hours after tea 11.5
Before bed 11:30 PM 4.7

Friday

00:30 3.8 treat time 2 sweats
Getting up 4.4
After Breakfast 6.9
Before dentist 6.9 (12:30) 1 hour later, after leaving dentist 3.4 (now know a dentist visit crashes BS)
Before tea 10.9
After tea 6.8, this should normally be high as this was having chippy chips and fish cake for tea.

On the Tuesday after tea was 12.1 and before tea 5.9.

Taking some getting used to as variations are random, when expecting a high they are normal and when should be normal they are high.
 
I cant see the problem after so many sweets & chippy. ??? I WOULD love to have your problem 🙂🙂
 
Wow - they look pretty good results to me! I would be so pleased if my son's levels were like yours every day 🙂. OK, so you have brief excursions out of your target range, but it doesn't look like they are out of range for long. I'd say you're doing a pretty good job!

Re your knee, could you get a second opinion on that? If the joint is out of alignment you must be in quite a bit of pain, and perhaps a candidate for a knee replacement op? Even if not, there are surely other treatment options which could be offered rather than telling you to just put up with it - my Dad had something injected into his knee joint recently (he described it as like lubricating the joint with WD40), and it's made a huge difference for him, though it needs repeating 6-monthly I think.
 
I missed the bit about your knee. I have osteoarthritis, worst is my big toe but my knees were causing a few problems when I was big - thankfully gone now that I'm merely overweight rather than morbidly obese. Walking was a bit painful, but cycling was fine. If the saddle is high enough to let you fully extend your leg, it puts little pressure on the joints and all the work is done by the leg muscles. Swimming is also good, but not really practical for a lunchtime.

Re: the injection, it's a corticosteroid. Effective for a few months, but can cause BG to rise until it's out of the system (see other posts about steroids).
 
Compared to some reading being shown on here, my numbers are good, though since my BS hit the 20's earlier in the year. I find that as my BS goes up I can feel the toes tingling and keeping the numbers within a good range has now got to be a major benefit.

Its taken a lot of hard work getting the BS as they are, and feel its a shame that I can't get them more right. Checked my BS after tea tonight 5.9 and they were lower than before tea which was 6.8 :confused: Tea was 2 slices of wholemeal bread with a chunks of turkey in between and 2 rich tea biscuits with a cuppa tea.

Its so random, when looking on the graphs the peaks around 12.0 to 13.0are to many. The strange thing is even though gliclazide is meant to encourage weight gain In have had to put extra holes in my belt as though my weight is going down 🙂 Still have the spare tyre around the middle 😱 a bit more work needed.

I would love to find a different doctor, talking to others they are all about the same in my area, not found one that's been given a good word about the ones taking on patients.

The knee problem has been seen by numerous doctors over several years and all did naff all until it was to late. I was put on some tablets to ease the problems but reacted very badly after taking just one tablet, now just take codeine to ease the pain when required. Tried to see the xray of my knee which did not go down well with the doc I asked, think the expression about mushrooms comes to mind.

I did buy a bike when, DVLA stuck and revoked my driving licence, which took well over a year to get back, might need to get it out of the garage and dust it off to see what its like.
 
Pretty good set o results there Pav, but great that you want them to be even tighter!

D is a fickle ole beast, and it can be quite annoying when we don't get the results we expect. Hope some T2s can come along with their own experience, but I wonder if it might help you to note down a rough guestimate of the amount of carbs at each meal as well as your BG. I know that helps me a lot. The only thing I know about Glic is that it stimulates the pancreas to release insulin - which could explain lower readings after meals? (carb load of the meal gets the pancreas going and the glic - combined with heat of the day/exercise/other factors causes a brief overshoot???) From a T1 perspective I have to play with dose timings continually to get the food and insulin to play nicely together so I guess it might be the same for you, albeit that your insulin is 'home grown' :confused:
 
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