Help evening bg going up after 4hour

[Littleburger]

Hello, I have been Type 1 LADA for a year now. I'm on 1levemir, and 2nova rapid in the morning, 3nova rapid, at lunch time,5nova rapid at teatime and 3levemir at 8pm. My bg is on target during the day but after my evening meal it goes down as expected then starts to rise again by 10pm. Out of range. Tonight :

5.15pm. Bg 7.9. (5 units novarapid)
2 thai fishcakes with noodles
and sweet chili sauce. Xmas
Pud and rum sauce.
(2hours after)
7.20 pm bg 8.1 feeling hot and anxious
8.15pm bg 7.9
9.53 pm bg10.3
Please can anyone shed light on why my bg had gone up nearly 6 hours after eating. I was thinking about having supper but it's going up. WHY? Thank you in anticipation

 

[Robin]

Several reasons, in combination, probably.
1. Five units of insulin probably isn’t enough for a meal containing something heavy like Xmas pud and rum sauce, after a carby main course
2. Xmas pud is usually quite fatty, so this can slow digestion down, and it takes more than 4 hours to digest. By the time the tail end of the meal is digesting, your Novorapid is done and gone.
3. Levemir doesn’t tend to last very long in small doses, and the smaller the dose, the quicker it tails off. like you, many people (me included) take it twice a day, but one unit in the morning isn’t going to last very long. If you take your evening Levemir at 8pm, you won’t have any basal left on board by the time you eat, so the evening mealtime dose of Novorapid is trying to do two jobs.
It’s early days for you, so don’t worry, but have you been offered a course to teach you how to match your insulin to your food by counting carbs?

 

[Littleburger]

Several reasons, in combination, probably.
1. Five units of insulin probably isn’t enough for a meal containing something heavy like Xmas pud and rum sauce, after a carby main course
2. Xmas pud is usually quite fatty, so this can slow digestion down, and it takes more than 4 hours to digest. By the time the tail end of the meal is digesting, your Novorapid is done and gone.
3. Levemir doesn’t tend to last very long in small doses, and the smaller the dose, the quicker it tails off. like you, many people (me included) take it twice a day, but one unit in the morning isn’t going to last very long. If you take your evening Levemir at 8pm, you won’t have any basal left on board by the time you eat, so the evening mealtime dose of Novorapid is trying to do two jobs.
It’s early days for you, so don’t worry, but have you been offered a course to teach you how to match your insulin to your food by counting carbs?

Thank you so much. This is really helpful. No I've not been offered any courses. Infact my diabetic team have told me to eat what I want and stop restricting food. They say I'm treating this like type 2. So I have to check my bg before meals and adjust my insulin accordingly keeping within a range of between 6 and 10 over 3 consecutive days. I'm coming up to age 67 this month and am finding it all very confusing, especially getting a type1 diabetes at this age.
I'm so grateful that I can get information from this site. Thank you again.

 

[Leadinglights]

Thank you so much. This is really helpful. No I've not been offered any courses. Infact my diabetic team have told me to eat what I want and stop restricting food. They say I'm treating this like type 2. So I have to check my bg before meals and adjust my insulin accordingly keeping within a range of between 6 and 10 over 3 consecutive days. I'm coming up to age 67 this month and am finding it all very confusing, especially getting a type1 diabetes at this age.
I'm so grateful that I can get information from this site. Thank you again.

It can happen at any age, a friend was recently diagnosed as Type 1 in her late seventies after being treated unsuccessfully for 2 years as Type 2.
Better to get the correct diagnosis asap.
There is no need to restrict food other than to make healthy choices but you do need to be able to use the correct insulin doses for what you do eat.
You should press for referral to the DAFNE or equivalent in your area.

 

[Littleburger]

It can happen at any age, a friend was recently diagnosed as Type 1 in her late seventies after being treated unsuccessfully for 2 years as Type 2.
Better to get the correct diagnosis asap.
There is no need to restrict food other than to make healthy choices but you do need to be able to use the correct insulin doses for what you do eat.
You should press for referral to the DAFNE or equivalent in your area.

Thank you. Yes I was treated for type 2 for 3 months and lost 2stones . I'll ask my diabetic nurse about DAFNE tomorrow. Thanks again

 

[trophywench]

So - do what they've told you to do - with Type 1 diabetes our goal is to manage our blood glucose (cos attempting to actually completely control it, since there are over 40 variables that can easily affect exactly what it reads on a blood glucose monitor machine (AKA a glucometer) by finger pricking and applying the blood drop to a test strip, isn't 100% possible 100% of the time - so much more sensible to aim to achieve as good management of blood glucose for as long of every day as we can manage)

Calculate the carbohydrate content of the meal you are about to eat and adjust the amount of insulin you inject for it, until you get a decentish match.

 

[Inka]

Thank you so much. This is really helpful. No I've not been offered any courses. Infact my diabetic team have told me to eat what I want and stop restricting food. They say I'm treating this like type 2. So I have to check my bg before meals and adjust my insulin accordingly keeping within a range of between 6 and 10 over 3 consecutive days. I'm coming up to age 67 this month and am finding it all very confusing, especially getting a type1 diabetes at this age.
I'm so grateful that I can get information from this site. Thank you again.

You don’t necessarily need a course. You can teach yourself. Xmas pud is very high carb, so a small serving will have far more carbs than you’d imagine. It sounds like you’re not carb counting and are on fixed dose of Novorapid. That’s never going to work.

I’d begin by adding up the carbs in your meal (choose one meal at a time to do, eg breakfast) and then you’ll get an idea of what your insulin to carb ratio is for that meal.

 

[Littleburger]

You don’t necessarily need a course. You can teach yourself. Xmas pud is very high carb, so a small serving will have far more carbs than you’d imagine. It sounds like you’re not carb counting and are on fixed dose of Novorapid. That’s never going to work.

I’d begin by adding up the carbs in your meal (choose one meal at a time to do, eg breakfast) and then you’ll get an idea of what your insulin to carb ratio is for that meal.

Thank, yes, my diabetic team have given me a sheet advising I up or down insulin before a meal if bg is not in range over 3 days. I see my team once a month and can phone them or email them any time. I had been keeping a food diary and was told before Christmas that they never want to see another food diary. I need to eat what I want and stop treating it like type 2. I'm starting to put weight on now. Was 8st 8 now 8st 11 and I'm 5ft7inches. All this info helps thanks

 

[Robin]

I had been keeping a food diary and was told before Christmas that they never want to see another food diary. I need to eat what I want and stop treating it like type 2.

I kept a food diary when I was first diagnosed. Like you I was assumed to be Type 2 to start with, even though the general pattern of sudden rapid weight loss and sky high BGs suggested otherwise, it was only when I got referred to the hospital and had GAD antibody tests that they realised I was Type 1. But I went on keeping a diary (though nobody at the hospital ever wants to see it) just so I could work out patterns, and how I reacted to different meals etc, and it was really useful. 15 years on, I don’t write everything down, because it’s all in my head!
I did the BERTIE online carb counting course, once I’d worked most of it out for myself, and it did help with refinements and things I hadn’t thought of. I also found the book Think Like a Pancreas by Gary Schneider, very useful.

 

[helli]

It is not unusual to start on fixed doses on insulin. However, from reading the forums over the years, being on fixed doses of basal/bolus regime after a year is unusual.
Comments from your DSN about never wanting to see another food diary seems odd and makes me wonder if your DSN is a general nurse at your GP surgery who knows a bit more about diabetes than other nurses or whether they are a dedicated diabetes nurse at a dedicated diabetes clinic usually at your local hospital. Someone with Type 1 diabetes (and LADA is a version of Type 1) needs support from a dedicated diabetes team including DSN, endocrinologist and some times a dietician. The dietician tends to turn up to me annual reviews and provides support for carb counting so would definitely be interested in my food diary.
This is a long winded way of suggesting you definitely need a dedicated diabetes team not someone at your GP surgery who knows a bit about diabetes but mostly about type 2. If you do not have access to a dedicated diabetes team, you need to request/demand it. If you do have a dedicated diabetes team, you need support on carb counting and adjusting your insulin dose accordingly which is what the DAFNE course is. DAFNE (not Daphne) stands for Dose Adjustment For Normal Eating and you are not adjusting your dose because you have not been taught to do so.
You mentioned your age - 67 is not too old to learn.

 

[rebrascora]

Just seconding that the rise will almost certainly be down to the Xmas pud and rum sauce. I had some New year's Eve at about 8.30pm after a very leisurely evening meal which was a roast dinner. I injected plenty of insulin to cover it all and when I went to bed at 12.30am my levels were actually a bit low in the low 4s, but then the Xmas pudding kicked in through the night and I woke on a whopping 15.9!

 

[Inka]

Thank, yes, my diabetic team have given me a sheet advising I up or down insulin before a meal if bg is not in range over 3 days. I see my team once a month and can phone them or email them any time. I had been keeping a food diary and was told before Christmas that they never want to see another food diary. I need to eat what I want and stop treating it like type 2. I'm starting to put weight on now. Was 8st 8 now 8st 11 and I'm 5ft7inches. All this info helps thanks

It’s good that you’re eating more and putting weight on 🙂 The recommended diet for Type 1s is the same healthy diet recommended for people without diabetes.

You should be getting (or finding yourself) support to adjust your bolus/mealtime insulin before you eat, by counting the carbs in your meal and applying your ratio. The calculation you should be doing isn’t really concerned with your previous days’ blood sugars. It’s what your blood sugar is at that moment (ie is it in range) and how many carbs you’re about to eat. This is referred to as “carb counting”. It doesn’t mean limiting your carbs, it simply means totting up the carbs in your meal, applying your ratio, and injecting the correct dose of bolus/meal insulin.

The reason I said to add up your carbs was so you could get an idea of what your ratio is for each meal. Ratios can be things like 1:10g, which means 1 unit of insulin for every 10g of carbs. So, if you were about to eat 40g carbs, you’d inject 4 unit. If your ratio was 1:8g and you ate the same 40g carb meal, you’d need 5 units of insulin (40 divided by 8); if your ratio was 1:20g and you ate the same 40g carb meal, you’d inject 2 units.

Here’s some basic information:

The nuts and bolts of carb counting

When you live with type 1 diabetes, carb counting is a great way of managing your blood sugar or glucose levels. It can give you more freedom and flexibility in what you eat when you're preparing meals at home, grabbing food on the go or eating out. Carb counting does take some time and effort...

www.diabetes.org.uk

And here’s BERTIE:

Bertie Diabetes

​

 

[Littleburger]

I kept a food diary when I was first diagnosed. Like you I was assumed to be Type 2 to start with, even though the general pattern of sudden rapid weight loss and sky high BGs suggested otherwise, it was only when I got referred to the hospital and had GAD antibody tests that they realised I was Type 1. But I went on keeping a diary (though nobody at the hospital ever wants to see it) just so I could work out patterns, and how I reacted to different meals etc, and it was really useful. 15 years on, I don’t write everything down, because it’s all in my head!
I did the BERTIE online carb counting course, once I’d worked most of it out for myself, and it did help with refinements and things I hadn’t thought of. I also found the book Think Like a Pancreas by Gary Schneider, very useful.

I've just bought the book "Think like a Pancreas" and I'm half way through it. It's really helpful. I'll try BERTIE on line too.

 

[Littleburger]

It’s good that you’re eating more and putting weight on 🙂 The recommended diet for Type 1s is the same healthy diet recommended for people without diabetes.

You should be getting (or finding yourself) support to adjust your bolus/mealtime insulin before you eat, by counting the carbs in your meal and applying your ratio. The calculation you should be doing isn’t really concerned with your previous days’ blood sugars. It’s what your blood sugar is at that moment (ie is it in range) and how many carbs you’re about to eat. This is referred to as “carb counting”. It doesn’t mean limiting your carbs, it simply means totting up the carbs in your meal, applying your ratio, and injecting the correct dose of bolus/meal insulin.

The reason I said to add up your carbs was so you could get an idea of what your ratio is for each meal. Ratios can be things like 1:10g, which means 1 unit of insulin for every 10g of carbs. So, if you were about to eat 40g carbs, you’d inject 4 unit. If your ratio was 1:8g and you ate the same 40g carb meal, you’d need 5 units of insulin (40 divided by 8); if your ratio was 1:20g and you ate the same 40g carb meal, you’d inject 2 units.

Here’s some basic information:

The nuts and bolts of carb counting

When you live with type 1 diabetes, carb counting is a great way of managing your blood sugar or glucose levels. It can give you more freedom and flexibility in what you eat when you're preparing meals at home, grabbing food on the go or eating out. Carb counting does take some time and effort...

www.diabetes.org.uk

And here’s BERTIE:

Bertie Diabetes

​

That's great. I'll try that. It's like going back to school

 

[Inka]

You can work out your own ratios by working backwards. If you count your meal carbs, note how many units of insulin you injected, then look at how your blood sugar behaved afterwards, you can judge what ratio should work for you. Eg if you have 80g carbs in your evening meal and had injected 5 units of insulin and your blood sugar was all good afterwards, then you’d divide your 80g carbs by 5, which is 16. You’d then know that each unit of insulin covered around 16g carbs for that meal. So, your ratio would be 1:16g.

If you then ate a meal the next day that only had 48g carbs, you’d apply your ratio (divide by 16) and take 3 units of insulin.

Often, people need different ratios for one or more meals, eg 1:10g for breakfast, 1:15g for lunch and 1:25g for evening meal (those are just example figures - your ratios will vary).

 

[Littleburger]

It’s good that you’re eating more and putting weight on 🙂 The recommended diet for Type 1s is the same healthy diet recommended for people without diabetes.

You should be getting (or finding yourself) support to adjust your bolus/mealtime insulin before you eat, by counting the carbs in your meal and applying your ratio. The calculation you should be doing isn’t really concerned with your previous days’ blood sugars. It’s what your blood sugar is at that moment (ie is it in range) and how many carbs you’re about to eat. This is referred to as “carb counting”. It doesn’t mean limiting your carbs, it simply means totting up the carbs in your meal, applying your ratio, and injecting the correct dose of bolus/meal insulin.

The reason I said to add up your carbs was so you could get an idea of what your ratio is for each meal. Ratios can be things like 1:10g, which means 1 unit of insulin for every 10g of carbs. So, if you were about to eat 40g carbs, you’d inject 4 unit. If your ratio was 1:8g and you ate the same 40g carb meal, you’d need 5 units of insulin (40 divided by 8); if your ratio was 1:20g and you ate the same 40g carb meal, you’d inject 2 units.

Here’s some basic information:

The nuts and bolts of carb counting

When you live with type 1 diabetes, carb counting is a great way of managing your blood sugar or glucose levels. It can give you more freedom and flexibility in what you eat when you're preparing meals at home, grabbing food on the go or eating out. Carb counting does take some time and effort...

www.diabetes.org.uk

And here’s BERTIE:

Bertie Diabetes

​

That's great just downloaded BERTIE

 

[Littleburger]

It is not unusual to start on fixed doses on insulin. However, from reading the forums over the years, being on fixed doses of basal/bolus regime after a year is unusual.
Comments from your DSN about never wanting to see another food diary seems odd and makes me wonder if your DSN is a general nurse at your GP surgery who knows a bit more about diabetes than other nurses or whether they are a dedicated diabetes nurse at a dedicated diabetes clinic usually at your local hospital. Someone with Type 1 diabetes (and LADA is a version of Type 1) needs support from a dedicated diabetes team including DSN, endocrinologist and some times a dietician. The dietician tends to turn up to me annual reviews and provides support for carb counting so would definitely be interested in my food diary.
This is a long winded way of suggesting you definitely need a dedicated diabetes team not someone at your GP surgery who knows a bit about diabetes but mostly about type 2. If you do not have access to a dedicated diabetes team, you need to request/demand it. If you do have a dedicated diabetes team, you need support on carb counting and adjusting your insulin dose accordingly which is what the DAFNE course is. DAFNE (not Daphne) stands for Dose Adjustment For Normal Eating and you are not adjusting your dose because you have not been taught to do so.
You mentioned your age - 67 is not too old to learn.

My diabetic team is made up of 2 DSNs and a dietitian. They sit there discussing what should be done. Last time I took my husband along hoping he might pick more out of the meeting. He certainly wasn't made welcome. No seat for him and the DSN actually said "It's Rather crowded in here". After I was told to get rid of my food diary, I came out feeling close to tears. This is the info they give me. I still had to email them to explain the 10%adjustment which cannot be done on a 1 -5 unit shot. It actually meant put it up or down 1 unit.

It is not unusual to start on fixed doses on insulin. However, from reading the forums over the years, being on fixed doses of basal/bolus regime after a year is unusual.
Comments from your DSN about never wanting to see another food diary seems odd and makes me wonder if your DSN is a general nurse at your GP surgery who knows a bit more about diabetes than other nurses or whether they are a dedicated diabetes nurse at a dedicated diabetes clinic usually at your local hospital. Someone with Type 1 diabetes (and LADA is a version of Type 1) needs support from a dedicated diabetes team including DSN, endocrinologist and some times a dietician. The dietician tends to turn up to me annual reviews and provides support for carb counting so would definitely be interested in my food diary.
This is a long winded way of suggesting you definitely need a dedicated diabetes team not someone at your GP surgery who knows a bit about diabetes but mostly about type 2. If you do not have access to a dedicated diabetes team, you need to request/demand it. If you do have a dedicated diabetes team, you need support on carb counting and adjusting your insulin dose accordingly which is what the DAFNE course is. DAFNE (not Daphne) stands for Dose Adjustment For Normal Eating and you are not adjusting your dose because you have not been taught to do so.
You mentioned your age - 67 is not too old to learn.

It is not unusual to start on fixed doses on insulin. However, from reading the forums over the years, being on fixed doses of basal/bolus regime after a year is unusual.
Comments from your DSN about never wanting to see another food diary seems odd and makes me wonder if your DSN is a general nurse at your GP surgery who knows a bit more about diabetes than other nurses or whether they are a dedicated diabetes nurse at a dedicated diabetes clinic usually at your local hospital. Someone with Type 1 diabetes (and LADA is a version of Type 1) needs support from a dedicated diabetes team including DSN, endocrinologist and some times a dietician. The dietician tends to turn up to me annual reviews and provides support for carb counting so would definitely be interested in my food diary.
This is a long winded way of suggesting you definitely need a dedicated diabetes team not someone at your GP surgery who knows a bit about diabetes but mostly about type 2. If you do not have access to a dedicated diabetes team, you need to request/demand it. If you do have a dedicated diabetes team, you need support on carb counting and adjusting your insulin dose accordingly which is what the DAFNE course is. DAFNE (not Daphne) stands for Dose Adjustment For Normal Eating and you are not adjusting your dose because you have not been taught to do so.
You mentioned your age - 67 is not too old to learn.

 

[Littleburger]

Just seconding that the rise will almost certainly be down to the Xmas pud and rum sauce. I had some New year's Eve at about 8.30pm after a very leisurely evening meal which was a roast dinner. I injected plenty of insulin to cover it all and when I went to bed at 12.30am my levels were actually a bit low in the low 4s, but then the Xmas pudding kicked in through the night and I woke on a whopping 15.9!

That's me down to a T. My bg is good at 10pm then I fancy supper and know it will go high for the morning.

 

[Littleburger]

My diabetic team is made up of 2 DSNs and a dietitian. They sit there discussing what should be done. Last time I took my husband along hoping he might pick more out of the meeting. He certainly wasn't made welcome. No seat for him and the DSN actually said "It's Rather crowded in here". After I was told to get rid of my food diary, I came out feeling close to tears. This is the info they give me. I still had to email them to explain the 10%adjustment which cannot be done on a 1 -5 unit shot. It actually meant put it up or down 1 unit.

 

[rebrascora]

That's me down to a T. My bg is good at 10pm then I fancy supper and know it will go high for the morning.

If you are using the correct amount of insulin for your supper then mostly it shouldn't happen but some foods are tricky. Xmas pud is just usually once a year so it's OK to accept that it happens with that and not worry too much about it, but things like pizza or pasta with a creamy sauce are notorious for delayed digestion and causing a much later spike and a split dose of insulin is the general tactic to deal with it.... so injecting some before the meal and then the rest 1-2 hours later.
In an ideal world it is best to eat 4 hours before you intend to go to bed so that the insulin you inject for your meal is near enough spent before you go to sleep, so having a low carb supper is a safer option that having something that needs insulin near bedtime because that active meal time insulin increases the risk of a nocturnal hypo, if we miscalculate or we had a particularly active day and our body becomes more sensitive to that insulin.... or we engage in activity after we get into bed. There are lots of things to think about with insulin use. The important thing is to err on the side of caution and accept that sometimes we just don't get it right despite our best efforts.