Glucose levels rising long after meal

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andyg2023

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Hi
My young adult son was diagnosed with T1 a few weeks ago and still very much learning the ropes. A few times he has taken what he thought was the right amount of insulin for the carbs of the meal but it has resulted in levels quickly going very low and then a sharp increase from around 2 hrs after the meal & still rising over 4 hrs after the meal. This happened this evening, he went from 4 to 13 in 2 hours then it has hovered around the 11-12 mark for the next 2.5 hrs. He thinks he may possibly have taken a bit too much insulin before eating but if he hadn’t then presumably the rise would have been even higher ? Similar has happened before so would welcome any thoughts on why this might happen? Many thanks
 
Hi and welcome.

I think the crucial question may be "What was the meal?" Fatty, high carb meals like Pizza or Pasta with a creamy sauce or Fish and Chips can often cause this problem or sometimes high fibre foods like a dahl with lentils. Fat delays the release of the glucose from the meal , so the insulin starts to kick in before the carbs are released, causing levels to drop and then much later than usual, the carbs release and levels go high when the bolus insulin is almost finished it's activity. These high fat high carb meals will usually need a bit more insulin than expected but the dose needs to be split with some up front before the meal and the rest an hour or two later.

If it wasn't a fatty meal and this is happening regularly then it might be that his basal insulin is running out or doesn't meet his needs at that time of day.
 
Thanks rebrascora
rebrascora said:
Hi and welcome.

I think the crucial question may be "What was the meal?" Fatty, high carb meals like Pizza or Pasta with a creamy sauce or Fish and Chips can often cause this problem or sometimes high fibre foods like a dahl with lentils. Fat delays the release of the glucose from the meal , so the insulin starts to kick in before the carbs are released, causing levels to drop and then much later than usual, the carbs release and levels go high when the bolus insulin is almost finished it's activity. These high fat high carb meals will usually need a bit more insulin than expected but the dose needs to be split with some up front before the meal and the rest an hour or two later.

If it wasn't a fatty meal and this is happening regularly then it might be that his basal insulin is running out or doesn't meet his needs at that time of day.
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thanks rebrascora. The meal was clear chicken soup with some bread, followed bu roast chicken, roast potatoes & some veg. He ate loads of chicken. So yes there’s fat there from the roasting but wouldnt have thought this meal ranked alongside pizza/ pasta in terms of high fat or high carb- he knows about the challenges with those & to split his dose etc. he calculated around 100g carbs to took what felt like the appropriate amount of insulin.
Will see what his levels did overnight to check if basal needs adjusting.
 
I also find that meals high in protein can cause blood sugar to rise even 3-4 hours after eating. Just something to possibly bear in mind.
 
I can't directly help you understand this sort of response so can't offer your son a satisfactory solution - because I sometimes get similar responses and no matter how much detective work, I usually can't offer myself a satisfactory explanation.

I'm pretty diligent with my carb counting and recheck after such a response to occasionally find I made a mistake or misjudged the portion size. I have a NovoEcho pen which records on its endcap the bolus taken along with the approximate time, so I can verify that I did take the planned bolus. I log food and insulin onto my LibreLink app when I bolus and review if I got the prebolus timings right (by right I mean what I intended, since my intent may not have been right anyway!). And so on.

I console myself: by knowing I've tried to do the right things and by knowing that diabetes is complicated, confusing and CONTRADICTORY. There is a list, from a published bit of research, of 42 factors that can affect one's BG; 41 of those factors apply to men. Some are obvious, such as carbs eaten and insulin taken; some are straightforward, such as environment temperature (eg summer can create different metabolic responses to winter) or exercise and activity, but not the same response for everyone (!); some are just downright obscure, but still relevant.

For me, once I've done my detective work if I find an explanation - great, lesson to be learnt. If not - I move on! I refuse to allow myself to dwell on "why", that could drag me to a standstill; if there is a pattern from the same meal, on a similar sort of day, then I return to my detective work. But often there isn't. The contradictory nature of diabetes is just that and a bad day just has to be parked and left behind.

My other major consolation is that I know I'm not alone with such inexplicable responses. There is good reason why no-one is expected to attain 100% control and why the NICE defined "times in range" are set at under 4% for lows, below 4.0 mmol/mol and under 25% for highs, above 10 mmol/mol. Control is unrealistic, good management is my aspiration - with the empathise on the word good, not perfect.

Hope this can help you to support your adult son as he works out what will work for him, most of the time. There is a slight danger that if you dwell on this too much, he might feel pressured by your close involvement. I am in no doubt that you mean well and only want what is best for your son. Even if you do find an explanation, you will need to be cautious how you relay that back to him; from my experience with our then young adult son some 20 years ago he may not want much interference from his parents. Its a tricky balance trying to be supportive but not interfering (which balance also can be complicated, confusing and contradictory!). Good luck.
 
It can be about the timing of the dose as well as the amount. It sounds like doing the injection 15-20 minutes later may have worked better or a split dose. Sometimes though it’s better to take insulin at a point where it’s habit and you’ll remember than to take it at the perfect time but risk forgetting. But either way it’s not terrible. He’s higher than target but not so high that I would be concerned and if he then comes back down again I wouldn’t correct. If he stays high all night then a correction dose at bedtime will sort that. Even on a pump with intelligent algorithm that will pause basal to try to avoid lows or add insulin to try to avoid a high there can be times where sitting at 10-12 for a few hours happens.

Long term management is about being good enough and manageable not being perfect (not that you can get perfect control anyway) so there will be some times where it all goes wonky. Understanding why is good but also not sweating it helps avoid burnout.
 
Sorry to hear your son is getting weird post meal levels.

As others have said a high fat content can delay the release of the glucose from the food. I also find that if I eat a big meal I need to up my insulin dose, (and ‘big’ can be different for each person). As frustrating as it is, we each need to find what works for us.

It is good to hear that he is pre bolusing for meals. He may find that for fatty meals he needs to split the dose. Perhaps pre bolus half his dose and then give the rest after the meal.

There will always be wobbly days, as there are so many different things impact our levels so all each of us can do is a best guess at what we do. Keeping records of what he eats alongside the data (and I think you can attach this to LibreView data, can be helpful in looking at patterns. But I limited myself to doing the review only at the end of a month, as I had a tendency to try to micro manage. As @Thebearcametoo says it is the long term that we need to focus on.
 
There should be virtually no carb content in clear soup, surely? so what on earth was in it if it dad have any. Though I appreciate I personally wouldn't have had very much bread with soup nor indeed shedloads of spuds (even roasties I'd have a max of 4) and he's a strapping young bloke - where did 100g carb come from? I also hasten to add I never even have to jab that much for 'other' veg even when there's eg cauli cheese when I know very well, cos I made it myself from scratch, there's some flour and milk in the cheese sauce and also a little bit in the gravy. Novorapid still gets going after 10 minutes or less for me and the very old advice that T1's shouldn't automatically expect BG to be back to pre-meal levels before the next meal still stands really, especially for the newly diagnosed when certainly doses of basal or bolus insulin are not as absolutely 'cock on' as they could be. They're never written in stone anyway for those 40+ reasons, but that's a story for another time as life goes on .....
 
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