Fluctuations seemingly unrelated to food, insulin dose, exercise.

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Jennyninja

Jennyninja

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Relationship to Diabetes
Type 1
Hi, does anyone get fluctuations in BG as above in the title? I'm 7ish months into a T1 diagnosis on Novorapid and Lantus. Like most people I get good days and bad days with BG control. However I'd like to know why, say 2 or 3 hours after food/insulin my BG spikes up. Sometimes I can just be sitting calmly, feeling happy and well. What is happening ? I'm thinking for some reason my liver dumps a load of glycogen at this time. Why? I'd really like to understand and by understanding try and do something about it. At the moment if I get a high BG I go for a run or a speed walk which usually brings it down without insulin. I've recently got a Libre which is giving me information that I otherwise wouldn't have been aware of. I've also checked the Libre against finger pricks.
 
Are you getting these peaks at the same time each day. It could be due to your Lantus tailing off. So, if you take it on an evening and your levels are rising on an evening after your meal has been digested, then that could be why. Or it could be that your meal ratio is wrong and needs adjusting. Or it could be slow release glucose from your meal, particularly if the meal was high in fat, protein or fibre or protein release from a low carb meal. Protein always releases about 2 hours after a meal for me and can continue to release for another 3-4 hours after that, so I usually do a correction at the 2 hour stage when i see it starting to rise.... but then I follow a low carb way of eating so I expect this to happen.
 
I’d like to understand why too @Jennyninja :D The truth is that that’s the very nature of Type 1. The same thing will work one day, and then not work the next for no apparent reason. Yes, it’s frustrating! Numerous things affect our blood sugar, many of which we’re unaware of at the time.

In your case, no doubt the honeymoon is playing a part too. Your own insulin production will be erratic, which can impact on your sugars. Check your basal and bolus as mentioned above so that you can rule out the obvious things.

If it’s the Libre stressing you, stick to finger pricks. Even in people without diabetes, blood sugar will go up and down through the day and night.

How high are your spikes?
 
Like @rebrascora said it can be to do with the glucose in the food you eat. Such as what you eat being a fast acting carb or a slow acting carb
 
All that @Inka said plus being as you're a lady - don't under or over estimate the influence of your natural or synthetic hormones on your BG - rather obviously once a month to begin with (the week before your period is 'usual' - if you happen to be 'usual') so that's just yet another thing you'll gradually need to get to grips with sooner rather than 'some time in the future' like your mother tells you.
Lily123 said:
Like @rebrascora said it can be to do with the glucose in the food you eat. Such as what you eat being a fast acting carb or a slow acting carb
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... and the speed of your own digestive system ......
 
Hi. I have exactly the same problem and I just can't explain the variations. Sometimes my body seems to ignore any insulin injections for hours. Fatty food is sometimes the explanation for delayed food response. I also find I need to find new injection sites as the older ones don't absorb the insulin very well. Other than that I can't find any solution.
 
Thanks everyone. The spikes can happen after any meal so don't think it's the basal insulin. Yesterday it went as high as 17 for a short time then dropped. The highest ever. Bit scary. Usually a max of 14 for a short time then goes down and plateaus. If I take correction insulin I swing to a hypo so try to use exercise. I've experimented with timing of insulin, considered composition of meal macronutrients. I've thought about injection site. I usually inject into the fatty areason my hips. Maybe I'll try the front of my belly which I think is supposed to be the best area for absorption. Also monthly cycle doesn't apply for me due to total hysterectomy several years ago. A faster acting bolus insulin has been suggested too. Waiting to here more from my specialist nurse about that. In any case I'm glad I'm not on my own with this.
Ps @Inka when you mention honeymoon do you mean I have been producing some insulin and now it's reducing ? Don't you just love moving targets !
 
If your levels come back down again then longer prebolus time is usually the key or faster acting insulin, but some of us are just slow to absorb it for some reason. I changed to Fiasp from NovoRapid and I still need to give it 45 mins head start on a morning and 20-30mins at other times of day. I would definitely try your stomach as that is usually a little faster than other sites. Quite surprised you are injecting elsewhere as most nurses start you off on injecting in your stomach.
 
rebrascora said:
If your levels come back down again then longer prebolus time is usually the key or faster acting insulin, but some of us are just slow to absorb it for some reason. I changed to Fiasp from NovoRapid and I still need to give it 45 mins head start on a morning and 20-30mins at other times of day. I would definitely try your stomach as that is usually a little faster than other sites. Quite surprised you are injecting elsewhere as most nurses start you off on injecting in your stomach.
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Thanks. I've been delaying the carbs to insulin but only by 20-30 mins. So will try longer. My hips are fattier than my belly !
 
Don’t forget the Libre gets less accurate outside of target so it may be worth doing a finger prick to check if it’s 17. But also on finger pricks you wouldn’t know about that spike so as long as you come back into target after about 4 hours then your basal and meal ratios are more or less right. It’s then just playing with timing. It’s hard to be in target all the time. You’re just aiming to increase the amount of time you’re in target not to get rid of every single spike.
 
Thebearcametoo said:
Don’t forget the Libre gets less accurate outside of target so it may be worth doing a finger prick to check if it’s 17. But also on finger pricks you wouldn’t know about that spike so as long as you come back into target after about 4 hours then your basal and meal ratios are more or less right. It’s then just playing with timing. It’s hard to be in target all the time. You’re just aiming to increase the amount of time you’re in target not to get rid of every single spike.
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Thanks @Thebearcametoo . That's reassuring. Yes, the Libre is a bit of a double edged sword showing every spike. Again maybe because of the novelty I'm checking it all the time.
 
You really don't need to find a "fatty" bit of body, unless you are rather emaciated. If you can pinch half an inch, it's adequate. It may even be part of the problem that you are injecting into your fattiest area. I always feel that the front of my thighs are mostly muscle, but that is a recognised site and I often use them for basal insulin but keep my stomach for bolus as it is slightly faster..... but still snails pace for me, even with a supposedly fast acting insulin.
The other thing to bear in mind is that bolus insulin can be less effective if your levels are higher and takes longer to be effective. If I am above 8 I inject and then watch for my BG levels to come down into the low 6s or high 5s before eating. If I start to eat when my levels are 7 or above I will always spike, no matter how long I waited. At a push if time is an issue I will eat when my levels are above 7 but not if they are above 8 as it takes ages to get them down into range again afterwards. That said, I live on my own and am retired and can please myself when and if I eat, so if my levels are too high I can either delay or skip that meal and just do a small correction to bring it down into range and then eat later.
 
Jennyninja said:
Thanks everyone. The spikes can happen after any meal so don't think it's the basal insulin. Yesterday it went as high as 17 for a short time then dropped. The highest ever. Bit scary. Usually a max of 14 for a short time then goes down and plateaus. If I take correction insulin I swing to a hypo so try to use exercise. I've experimented with timing of insulin, considered composition of meal macronutrients. I've thought about injection site. I usually inject into the fatty areason my hips. Maybe I'll try the front of my belly which I think is supposed to be the best area for absorption. Also monthly cycle doesn't apply for me due to total hysterectomy several years ago. A faster acting bolus insulin has been suggested too. Waiting to here more from my specialist nurse about that. In any case I'm glad I'm not on my own with this.
Ps @Inka when you mention honeymoon do you mean I have been producing some insulin and now it's reducing ? Don't you just love moving targets !
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First try a different injection site eg tummy or thigh. If that doesn’t work, move your bolus forward a little more, cautiously and gradually. I’d also add that perhaps you’re simply not having enough bolus insulin. You’re spiking slightly too high. Too little bolus seems a likely factor too if pre-bolusing well in advance doesn’t sort it.

In the honeymoon period what often happens is that you still have a few working islets but they’re damaged. You eat, you spike - and your own islets respond, but they respond too late (ie you hypo some hours after eating because they responded too slowly to your spike) and sometimes too much (again, adding to the hypo). This is simple to deal with - bolus enough in advance and take enough bolus to limit the spike to below 13ish, then if your blood sugar drops some hours later, which it probably will do, all you need to do is have a snack of between 10-20g carbs (or however many carbs you need). Do NOT bolus for the snack obviously.
 
Morning all. I've been thinking about this further and also had the benefit of 3 meals since my 1st post. To refine the issue further - what happens is shortly after the food and insulin my BG is either great at 5 or 6 or goes down, threatening a hypo. It's later - about 2 hours after that it swings up. Let's assume I don't have a hypo and have not taken any fast acting glucose. I think from your earlier replies this is down to protein, fat and fibre slowing down the absorption. Also those pesky faulty islets enjoying their honeymoon. With taking my insulin earlier I'm preventing a higher swing upwards sooner after the meal but the increase still happens later. I think split bolusing could help with taking the 1st lot with an interval - maybe up to 45 mins before the meal then the 2nd half about 30-45 mins after. BG has tended to swing up if I leave the 2nd dose any later. Oh and injecting into my belly. Apologies if I've missed any advice already given. Any other thoughts?
 
Jennyninja said:
Morning all. I've been thinking about this further and also had the benefit of 3 meals since my 1st post. To refine the issue further - what happens is shortly after the food and insulin my BG is either great at 5 or 6 or goes down, threatening a hypo. It's later - about 2 hours after that it swings up. Let's assume I don't have a hypo and have not taken any fast acting glucose. I think from your earlier replies this is down to protein, fat and fibre slowing down the absorption. Also those pesky faulty islets enjoying their honeymoon. With taking my insulin earlier I'm preventing a higher swing upwards sooner after the meal but the increase still happens later. I think split bolusing could help with taking the 1st lot with an interval - maybe up to 45 mins before the meal then the 2nd half about 30-45 mins after. BG has tended to swing up if I leave the 2nd dose any later. Oh and injecting into my belly. Apologies if I've missed any advice already given. Any other thoughts?
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Split dose was going to be my next suggestion as I was reading through your post so definitely worth experimenting with. Would be rather surprising if you needed to split your dose for every meal though. I eat pretty low carb all the time which means I have to account for the protein, but my up front 30-45min prebolus insulin deals with the inital carb spike and then a couple of units later deals with the protein as it is releasing 2 hours later. The protein release is slow so the insulin injected as I see my Libre levels start to rise works fine for dealing with that. It is only the carbs which hit my blood stream very quickly where I need to give the insulin a good head start.
That said, we are all different and you have to find what works for you. If you are still honeymooning, the problem may go away or change and you will need a new strategy to cope with the new scenario. As you are becoming aware, those goal posts are highly mobile and you need to be on your toes to stay in the game.
 
Thanks for this. I do eat a fairly high protein diet because of my running. Back to the experiments !
 
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