Hello Angela
@GracefulAng,
The last time Paul and I spoke he had been turned down with his request for a rapid (=bolus =mealtime) insulin. I assume that still applies.
When you say his BG is now spiking, what sort of readings is he typically getting? Ideally he should be testing immediately before the1st mouthful and expecting that to be well below 7; but some people are more susceptible to either of the 2 Phenomena known as the Dawn Phenomenon (DP) or Foot on the Floor (FOTF) syndrome - both of which can cause their BG to rise significantly, even before eating.
Whatever his initial (before first mouthful) BG is, he should be eating a breakfast which will cause a rise, but that rise should be below 8-8.5, two hrs after that first mouthful. With that sort of response Paul will know that his metabolism is managing that meal successfully. If once in a while those typical numbers aren't achieved, then that is not a disaster; but if those nos are regularly not achieved that type of meal needs attention: either a different and lower carb choice of meal or smaller portions.
All Bran is one of the lower carb cereals, with only 18g carbs per serving.
@GracefulAng does Paul weigh or measure his portion of All Bran? It's one if those cereals that can be moreish, if you enjoy All Bran (I know, I used to indulge!). I know Paul was resisting getting into carb counting and I understand that background circumstance.
Has cereal and milk been his regular breakfast for a long time or is this a fairly recent change? One of the (many) unhelpful things about Diabetes is that "things change". It is possible that even if Paul was previously enjoying milk and All Bran with manageable BGs something has triggered a change! I've no idea what, without a lot of further quizzing!
In the final analysis:
How big are these spikes?
Do they coincide with non-working days? Because garden centre workload can be seasonal, have these spikes started recently, coincidentally with "slow start" days at work after the Xmas / NY busy times? Before Xmas he would be very busy from the moment he arrived; are his days temporarily, noticeably, less busy before the probable Easter rush? It's quite possible this is about a change in work routine and activity levels. As I write this the more I think that seasonal activity levels could be less for Paul and that reduction of activity is the cause of "change".
Gentle, steady exercise or activity shortly after eating can often help fend off spikes. I know Paul is both lean and fit for his age; the activity or exercise is a way of improving (reducing) his natural insulin resistance allowing his basal to do more as well as his own "home grown" insulin.
I agree that milk is not likely to be the cause of spikes, but cereal can be. There are plenty of filling lower carb alternatives for breakfasts and other meals.
If Paul has reduced his carb counting awareness, please encourage him to get on top of this!
If this is not the case, ASSUMING the explanation is not because of reduced work activity level, then he has potential strong evidence to ask his Diabetes Nurse to review/reverse the decision to not provide that bolus insulin. BUT bolus insulin does mean Paul will need to get on top of real carb counting before each meal and take the right amount of insulin for each meal. Is he truly ready to do this?
I hope some of this helps. Roland
