Newbie question re post prandial readings

[Andywidd]

Hi, I’m about 5 weeks in having had an out of the blue type 1 diagnosis following rapid onset of symptoms. I’m fortunate to have had a Libre 2 sensor for last 9 days. Currently I’m on 5 units slow at bedtime and no unit before a low carb breakfast (staying between 4.2 and 6.1) then 1unit lunch and again at tea time. Lunch today I had 45 g of slow release carb (German rye bread) with soup, cheese and a salad. Took 1 unit novorapid 15 mins before eating. I have just sat after eating all afternoon. 2 hours after insulin my BG is 7.8. Is this okay? It peaked at 8.7 briefly. I’m unsure if I need to keep the spike to below a certain number in which case should I take another unit of insulin or are these numbers good/bad/ expected? During the time I’ve typed this I’m down to 7.2 with an arrow straight across. Thank you for any guidance.
It was similar yesterday (reached 9.8 with a straight up arrow) so I did a 1mile walk and BG dropped to 4.2! Started to rise though once I sat down over half an hour to low 7,s then started reducing.

 

[Inka]

Those numbers are absolutely fine @Andywidd In people without diabetes, blood sugar can sometimes go up into the 10s after a big meal and frequently goes up to 8ish.

 

[Inka]

Just an additional note to say that Type 1 is a very different condition to Type 2. Please don’t be misled by comments from Type 2s who are diet-only. Their condition, their diet and their targets are not to be compared to Type 1s.

 

[Inka]

These are the target levels for Type 1 from Diabetes U.K @Andywidd You’ll notice that the target is to be back in range by the next meal:

If you’re an adult with Type 1 diabetes​

• when you wake up and before meals: 5 to 7mmol/l
• before meals at other times of the day: 4 to 7mmol/l

 

[Andywidd]

These are the target levels for Type 1 from Diabetes U.K @Andywidd You’ll notice that the target is to be back in range by the next meal:

If you’re an adult with Type 1 diabetes​

• when you wake up and before meals: 5 to 7mmol/l
• before meals at other times of the day: 4 to 7mmol/l

Hi Inka, thanks for that. I’ve no idea what is reasonable for post prandial type 1. So as long as I’m not harming myself on current guidelines that is reassuring to know.

 

[Inka]

Hi Inka, thanks for that. I’ve no idea what is reasonable for post prandial type 1. So as long as I’m not harming myself on current guidelines that is reassuring to know.

There’s no official guideline basically @Andywidd because it’s accepted that Type 1s will never be able to be a perfect pancreas. Injected insulin works more slowly than our own, and if someone were to obsessively try to stop any post-prandial spikes whatsoever, they’d put themselves at risk of hypos and cause a rollercoaster of highs and lows.

Type 2s have a post-prandial target - Type 1s don’t.

Remember too that if you’re recently diagnosed, you’ll still be making some of your own insulin. That tends to kick in late after eating, so if you corrected you could then plunge right down when your own insulin kicked in.

If you were above 12 at two hours after a meal, you could possibly consider a tiny correction but in the early days personally I wouldn’t. I can’t stress enough how nasty some early hypos can be soon after diagnosis. So, I’d leave correcting until your next meal if you correct at all, and only do so very cautiously and if you’re confident to do so.

 

[Andywidd]

There’s no official guideline basically @Andywidd because it’s accepted that Type 1s will never be able to be a perfect pancreas. Injected insulin works more slowly than our own, and if someone were to obsessively try to stop any post-prandial spikes whatsoever, they’d put themselves at risk of hypos and cause a rollercoaster of highs and lows.

Type 2s have a post-prandial target - Type 1s don’t.

Remember too that if you’re recently diagnosed, you’ll still be making some of your own insulin. That tends to kick in late after eating, so if you corrected you could then plunge right down when your own insulin kicked in.

If you were above 12 at two hours after a meal, you could possibly consider a tiny correction but in the early days personally I wouldn’t. I can’t stress enough how nasty some early hypos can be soon after diagnosis. So, I’d leave correcting until your next meal if you correct at all, and only do so very cautiously and if you’re confident to do so.

Thanks Inka.I’ve one more question (for the moment anyway!):- When the honeymoon ends does it tend to be gradual or sudden? I guess I’m asking if I’ll notice that I’ll gradually have to increase insulin or will it be that one day my BG suddenly go high and I’ll have to increase my units quite a lot?
Thanks again for your advice and your time in replying.

 

[helli]

Thanks Inka.I’ve one more question (for the moment anyway!):- When the honeymoon ends does it tend to be gradual or sudden? I guess I’m asking if I’ll notice that I’ll gradually have to increase insulin or will it be that one day by BG suddenly go high and I’ll have to increase my units quite a lot?
Thanks again for your advice and your time in replying.

We are all different.
For some people, the honeymoon period means our body sometimes decides to produce insulin and sometimes it doesn’t.
For others, the honeymoon period means the body slowly produces less and less insulin and we need to inject more.
For some people, the honeymoon period lasts months. For others, it lasts years.
For some, the honeymoon finishes suddenly. For some, it appears to finish and then, suddenl, the body decides to have a last insulin production bout.

For me, my injected insulin needs gradually rose until they reached their current levels .. about 8 years after diagnosis.

I think, the best you can do is roll with it and learn as you go along.

 

[Andywidd]

We are all different.
For some people, the honeymoon period means our body sometimes decides to produce insulin and sometimes it doesn’t.
For others, the honeymoon period means the body slowly produces less and less insulin and we need to inject more.
For some people, the honeymoon period lasts months. For others, it lasts years.
For some, the honeymoon finishes suddenly. For some, it appears to finish and then, suddenl, the body decides to have a last insulin production bout.

For me, my injected insulin needs gradually rose until they reached their current levels .. about 8 years after diagnosis.

I think, the best you can do is roll with it and learn as you go along.

Thanks Helli,
Finding my feet and getting great help on this forum.

 

[Inka]

Thanks Inka.I’ve one more question (for the moment anyway!):- When the honeymoon ends does it tend to be gradual or sudden? I guess I’m asking if I’ll notice that I’ll gradually have to increase insulin or will it be that one day by BG suddenly go high and I’ll have to increase my units quite a lot?
Thanks again for your advice and your time in replying.

It was gradual for me @Andywidd 🙂

 

[rebrascora]

There were noticeable steps up in basal insulin needs for me as my honey moon period came to an end. First one was about 6 months in and then I think about 14 months. I had the third step just after my first Covid vaccination earlier this year and my Levemir dose nearly doubled, but it wasn't overnight, it took 2-3 months and involved a couple of units every few days/week and in between I might be firefighting with corrections of quick acting insulin to keep levels in range until I gave in and increased my basal again. It is a bit disconcerting as you start to wonder where it is all going to end or if you are suddenly going to have a massive hypo at some point in the future and I did have a day in May when I had 7 hypos in one day. I dialed it back a couple of units as a result of that and it has been reasonably stable since then give or take a couple of units tweaking in either direction occasionally which is pretty normal for me.

 

[Andywidd]

Cheats Barbara. Thanks for for sharing that. A very useful insight. Sorry to hear about the hypos but sounds like you have a great knowledge of what to do. Interesting re: your dose increase needed after covid vaccine as my diagnosis started after my second dose along with other unrelated diabetes symptoms….

 

[rebrascora]

Hypos are a part of diabetes and I would much rather have multiple small ones, as I did that day, than a really severe one which was what I was concerned might happen.

There is a close link between Covid and diabetes which will no doubt take many years to unravel. We are definitely seeing quite a few new members join who have developed or discovered they are diabetic as a result of Covid infection and quite a large proportion of people here on the forum who were already diagnosed, experienced BG upheaval following their vaccination. My (lay persons) thought on the vaccination is that it triggers the immune system (which of course is the whole purpose) and perhaps that causes it to target more of the pancreas' insulin producing beta cells whilst it is in that heightened activity mode. So it may be that you were already developing diabetes and the vaccine accelerated the onset. We will probably never know.

 

[Andywidd]

Thanks Barbara. Also first reply is supposed to say ‘cheers’ not cheat!

 

[Mumpie_olgran]

Hi all - I'm still relatively new to this Type 1 game (diagnosed mid Jan '23). No particular question here but just wanted to mention that I've been browsing this forum a lot and a couple of things resonated:

1. I'm struggling a bit with post-prandial spikes, although only at breakfast funnily enough. I'm going to gently tinker with injecting my Novorapid a bit earlier before breakfast than I have been. I also got a Libre 2 recently and suspect I'm only now noticing those spikes as I tend to drop down again before I'd test my normal pre-lunch finger prick. Oh and I'm interested in the theme of a walk or mild exercise after breakfast to try and keep the BS in check too. I can do that at the moment, but will be harder when I get back to work...

2. I just want to call out @rebrascora @Inka in particular for your overall contributions. Actually there are tons of other people that I've been really comforted, educated and supported by. so if you're ever having a "down" moment, please take heart from the fact that you've truly lifted me at times and doubtless hundreds of others!

 

[Spathiphyllum]

Thanks Inka.I’ve one more question (for the moment anyway!):- When the honeymoon ends does it tend to be gradual or sudden? I guess I’m asking if I’ll notice that I’ll gradually have to increase insulin or will it be that one day my BG suddenly go high and I’ll have to increase my units quite a lot?
Thanks again for your advice and your time in replying.

Dear Andy-- it is *not* the case that everyone with T1D has a 'honeymoon period' after diagnosis.

As you probably know, T1D is caused by your immune system attacking and killing off the insulin-producing cells (called 'beta cells') in your pancreas. Your immune system may do this swiftly or slowly, and completely or incompletely.

Some people are diagnosed at a point at which their immune systems are only a little way into their murderous campaign! So, at the time of diagnosis, their bodies are still producing significant amounts of insulin-- less than normal, but still quite a bit. For them, the period between diagnosis and when their immune systems have finished the job is the 'honeymoon period'.

For other people, though-- by the time they're diagnosed, their immune systems are well into or have nearly completed the massacre! So these people will not have a 'honeymoon period'.

The way to tell the difference is by having a C-peptide test. This reveals how much insulin your own body is producing.

This table, from the University of Exeter, is useful: https://www.exeterlaboratory.com/test/c-peptide-plasma/

At diagnosis, my C-peptide result was already in the very low range: "Expected in longstanding type 1 diabetes" 3 to 5 years post-diagnosis. No honeymoon period for me, alas!

Have you had the C-peptide test? That will show whether or not you're going to have a 'honeymoon'. If you are-- I'm not sure there is any way of predicting its course. *Except*-- there is research suggesting that, the better your glycaemic control, the more likely you are to preserve the beta cells you have left-- for a long time, or even permanently.

Oh, and PS: Very low insulin requirements do not necessarily mean you're in the honeymoon period. It could mean that-- or it could mean you are very insulin-sensitive, which my situation. What you say about the effect on your BG of even a shortish walk is interesting: a large component of insulin sensitivity is how good your muscles are, while exercising, at sucking up BG with little or no insulin. Anyway, all the best!