Managing Diabetes

[Razorb64]

I’ve just had a meeting with my diabetic consultant and to say I was shocked is an understatement.
I started insulin therapy both Humulin I and Novorapid in September and was kind of struggling with it to be honest, I wasn’t sure that it was working as it should. Ratios were upped by the diabetic nurse and the consultant has now said my latest blood test has shown a drop in Hb1ac from 78 to 51…..
im shocked by this as I am still looking at some pretty big spikes after meals even with insulin And carb counting. My spikes can sometimes hit 13 or 14.
I seem to be doing ok going by the latest Hb result, but how do I control the spikes. Total carbs in a day rarely above 150.

 

[Tdm]

Well done on the a1c reduction! As for spikes -theres lots of ways to chop down those spikes...i find excercise, eg a nice walk after eating, does wonders- 20min is what i normally need but i don't get started until cgm shows that upturn of blood sugars as if you get started too early you may go a bit low. Also if you eat really low gi and high fibre you may not spike...i sometimes find this with chilli, but sometines i do. go figure!
Have you read the 'stopping post prandial spikes' thread pinned at the top of the food board? That has a lot of great ideas, or if you'd prefer a book, i'd recommend 'think like a pancreas'
Do you prebolus (inject some time before eating) cos that can help a lot...i find 15 min works for me, more at breakfast

 

[rebrascora]

Congrats on your excellent HbA1c reduction. Well done!

Exercising after a meal is good if you are able, but the key thing to prevent post prandial spikes is the timing of your insulin. You need the insulin to be hitting your blood stream at more or less the same time as the glucose is released from the food. I found NovoRapid very sluggish in this department and I needed a whopping 75 mins prebolus time before breakfast to prevent a spike and 30 mins at other times. That is extreme and I would often get distracted during that time and then forget that I hadn't had breakfast and end up hypo. I now have Fiasp which is faster but I still need up to 45 mins before breakfast with Fiasp depending on my waking reading, less if I am in the 4s or 5s but might need an hour if I am 9 or above when I wake up. The key thing for me is injecting that insulin as soon as I wake up and before I get out of bed, because my liver starts to pump out glucose as soon as my feet touch the floor and that breakfast insulin has to tackle that liver dump before it can deal with breakfast, so I need to get it in there ASAP. Obviously, don't do that if you walk your dog before breakfast or you might hypo.

As I said, this timing for me is extreme and you need to find what works for you, so start with the length of time you currently prebolus and increase it a few mins each day until your spike comes down to an acceptable level. Breakfast almost always needs longer than other meals and it can be quite significantly more so don't assume that your breakfast timing will transfer to other meals. Breakfast is usually the easiest meal to work on first and as most of us have the same thing for breakfast most morning which helps because different foods will release their glucose at different rates. Also, breakfast usually produces the biggest spike so it is probably the most rewarding one to sort out.

Good luck with it. If you don't understand anything just ask and let us know how you get on.

 

[Proud to be erratic]

Hello@Razorb64,
Your updated HbA1c to 51 is terrific and well done. Do take the positive side of this and give yourself a pat on the back.

I deduce that you are still using Libre (or another CGM) from your observation about spikes. I find Abbot's decision to present our graphs in portrait form rather than landscape is in itself simply unhelpful. That viewpoint alone just accentuates a gloomy snapshot by compressing 24 hrs activity into a narrow screen.

That said, (it is what it is), I think many of us have similar spiky graphs and I certainly am still exploring different ways to reduce the apparent turbulence on my graphs. [I'm on a Dexcom sensor and Dexcom prohibit taking screenshots, so I can't share my graphs to let you see you are not alone!] As others are saying exercise (or simple activity) and timings are big influencers, but there are many other factors in the mix. Also D is fickle and by no means always behaves in a predictable or repeatable fashion. So don't let this get to you, rather accept the irregularity and just keep chasing your next reduced HbA1c.

 

[Tdm]

On a side note...i can take screenshots from dexcom g6...
I attach screenshots, one from before i started prebolus and walking, etc and one from after (today- though i did skip breakfast this morning and its been quite a good day) so you can see the difference you can make..the old ones from libre and now on dexcom but you can get the gist...the geay bit is 4 to 11mmols on todays chart