Odd blood sugar behaviour

[Mamado]

Hello!
First thing's first, I'm not diabetic, only the boyfriend of a lovely young woman whose got diabetes. I've been trying to help her as much as I can with her management (counting carbs, keeping an eye on her blood sugars, and even starting to read think like a pancreas, which I highly recommend).

I've noticed an odd trend in her blood sugars that happens almost daily and I was wondering if anyone here could shed some light on it and perhaps offer a solution, even partial.

What happens most days, is that we'll have dinner, usually between 50 and 100 grams of carbs, we'll count all the carbs and bolus the right amount - 1 unit per 10 grams. Her bloods then rise a bit, up to 10, 12, maybe even 15 if it's a big meal, but from what I've gathered that's perfectly normal, as long as they're back in range after 2-3 hours. And most of the time when we check her bloods at that time it's starting to go down. But, suddenly, about 4 hours after she's eaten anything they'll start shooting up to 15/17! This doesn't make any sense to us. I've read that fatty meals can make a bloods ride slower but this happens even when we eat relatively healthy stuff like curry and brown rice.
It's very annoying because at that time we're starting to go to bed and seeing the bloods go high means she has to inject more insulin, which means she needs to either stay awake longer, or set alarms every few hours in bed to make sure her bloods don't drop too low.
This also doesn't seem to happen at lunchtime, even if she eats the same amount of carbs! The bloods will just rise and drop back into range after 2/3 hours.

Does anyone experience anything similar and happen to know a way to prevent this? Does she just have an abnormally slow digestion cycle or something? Meaning that she's still digesting the carbs after the mealtime insulin has stopped working? This is pure speculation and I've honestly got no real idea of what it could be...

Anyways, thanks for reading, this forum is a great place for support and I hope you can help

 

[Lucyr]

What time does she take the basal (long acting) insulin? Could it be that it’s starting to run out? A basal test would be the way to find out, which is seeing what happens to blood sugar at that time without any carbs/rapid insulin.

 

[Inka]

I agree with @Lucyr It sounds like it could be a basal issue. Has this always happened or is it a recent thing? I ask because I’ve had to change my evening basal rate to stop a similar rise (I’m on a pump). I don’t know why but I suspect the time of year (lots of peoples basal needs vary somewhat according to the season/length of day/temperature).

 

[trophywench]

YES!! Ambient temperature has always affected how much insulin my body needs so plodding along the frozen pavements outside in winter here, to get back and forth to work needed more than walking from our holiday accommodation to the beach and back we liked in Southern Crete in high summer.

I highly recommend Basal testing though same as @Inka - see
Basal insulins « Diabetes Support Information Exchange (diabetes-support.org.uk)
for a full explanation.

Those of us who've been at it a long time agree it's a waste of time and effort fiddling with Bolus ratios unless you've already got your Basal sorted out as much as possible first.

The carbs in brown rice digests a bit slower than white: but anyway over the (many) years I've found that I have to limit a rice meal to 60g carb if i don't want that spike after I'm in bed. This means less rice and more curry or chili ! Suits me!

 

[Bloden]

Hi there @Mamado. The same rise happens to me every now and then, usually 3 or 4 days in a row. It’s so annoying, like you said, cos it’s usually at bedtime. I don’t keep detailed records or anything like that, but it seems to coincide with me having lowered my basal dose a few days earlier. Once I’ve raised my basal dose again, it disappears. Good luck! (I love Think Like A Pancreas too, it’s very straightforward).

 

[Amity Island]

Hello!
First thing's first, I'm not diabetic, only the boyfriend of a lovely young woman whose got diabetes. I've been trying to help her as much as I can with her management (counting carbs, keeping an eye on her blood sugars, and even starting to read think like a pancreas, which I highly recommend).

I've noticed an odd trend in her blood sugars that happens almost daily and I was wondering if anyone here could shed some light on it and perhaps offer a solution, even partial.

What happens most days, is that we'll have dinner, usually between 50 and 100 grams of carbs, we'll count all the carbs and bolus the right amount - 1 unit per 10 grams. Her bloods then rise a bit, up to 10, 12, maybe even 15 if it's a big meal, but from what I've gathered that's perfectly normal, as long as they're back in range after 2-3 hours. And most of the time when we check her bloods at that time it's starting to go down. But, suddenly, about 4 hours after she's eaten anything they'll start shooting up to 15/17! This doesn't make any sense to us. I've read that fatty meals can make a bloods ride slower but this happens even when we eat relatively healthy stuff like curry and brown rice.
It's very annoying because at that time we're starting to go to bed and seeing the bloods go high means she has to inject more insulin, which means she needs to either stay awake longer, or set alarms every few hours in bed to make sure her bloods don't drop too low.
This also doesn't seem to happen at lunchtime, even if she eats the same amount of carbs! The bloods will just rise and drop back into range after 2/3 hours.

Does anyone experience anything similar and happen to know a way to prevent this? Does she just have an abnormally slow digestion cycle or something? Meaning that she's still digesting the carbs after the mealtime insulin has stopped working? This is pure speculation and I've honestly got no real idea of what it could be...

Anyways, thanks for reading, this forum is a great place for support and I hope you can help

Hi,
As Lucyr mentioned, has your girlfriend tried missing dinner one night to see what happens to her blood sugar? If her blood sugar remains flat/level throughout during a missed meal, then that would indicate that the meal/ bolus insulin are causing this rise. If the blood sugars rise without the evening meal then this would point to the basal insulin. It could even be a combination of both basal and bolus shortages?
If mealtime insulin is taken at the right time (enough minutes ahead of eating, n.b can be as much as 30mins for me depening on the g.i of the meal) there shouldn't be a rise into the 15+ like you mentioned. Perhaps also, the amount of bolus for the meal is insufficient? Are the carb amounts measured correct, are the evening insulin to carb ratios correct at 1:10g of carb?

 

[Mamado]

What time does she take the basal (long acting) insulin? Could it be that it’s starting to run out? A basal test would be the way to find out, which is seeing what happens to blood sugar at that time without any carbs/rapid insulin.

She takes her basal around dinner time, but she's been slowly getting it done earlier and earlier in the day. Is there an ideal time for basal injection? She's on tresiba btw.
We might try the basal test one night, but we're not sure if she needs more of it since her blood sugars sit around 4/5 at night with her current dose, and she's got a lot of hypo anxiety, so she doesn't want to risk night time hypos

Thanks for your reply!

 

[Mamado]

I agree with @Lucyr It sounds like it could be a basal issue. Has this always happened or is it a recent thing? I ask because I’ve had to change my evening basal rate to stop a similar rise (I’m on a pump). I don’t know why but I suspect the time of year (lots of peoples basal needs vary somewhat according to the season/length of day/temperature).

I've been living with her since lockdown and it's been regularly happening since then (maybe not every day but pretty often), I'm unsure about before then as I was less involved...
She uses tresiba for basal, which is a single shot a day so I don't think she can adjust it just for nighttime. Her bloods are pretty stable at night after they go down from the spike (between 4 and 6), would increasing the basal affect this and lead to nighttime hypos?

Thanks for your reply!

 

[Inka]

I’ve never used Tresiba so I don’t know, but when I take a ‘pump break’ (go back to injections for a while) I choose a twice a day basal insulin specifically so I can adjust one half of the day and not the other. It might be worth speaking to her team for advice. You’re right that her blood sugar shouldn’t be lower than that during the night.

 

[Mamado]

YES!! Ambient temperature has always affected how much insulin my body needs so plodding along the frozen pavements outside in winter here, to get back and forth to work needed more than walking from our holiday accommodation to the beach and back we liked in Southern Crete in high summer.

I highly recommend Basal testing though same as @Inka - see
Basal insulins « Diabetes Support Information Exchange (diabetes-support.org.uk)
for a full explanation.

Those of us who've been at it a long time agree it's a waste of time and effort fiddling with Bolus ratios unless you've already got your Basal sorted out as much as possible first.

The carbs in brown rice digests a bit slower than white: but anyway over the (many) years I've found that I have to limit a rice meal to 60g carb if i don't want that spike after I'm in bed. This means less rice and more curry or chili ! Suits me!

We've been mostly staying in the flat this year because of lockdown so I don't think changes in temperature are what's affecting it in this case but it's good to know that it can!
We'll try a basal test, but as I've said in my other replies her bloods are stable at night so we don't want to lower them any more. We'll look into that before changing her boluses though.
It's a good idea lowering the amount of rice though, especially if we have dessert, so we'll start doing that. And I think she'll like the idea of more curry/chilli

Thanks for your reply!

 

[Pumper_Sue]

ide slower but this happens even when we eat relatively healthy stuff like curry and brown rice.

Rice is a major issue re late rise in blood sugars.
Easy option is to split the insulin dosage for the meal.

 

[Mamado]

Hi there @Mamado. The same rise happens to me every now and then, usually 3 or 4 days in a row. It’s so annoying, like you said, cos it’s usually at bedtime. I don’t keep detailed records or anything like that, but it seems to coincide with me having lowered my basal dose a few days earlier. Once I’ve raised my basal dose again, it disappears. Good luck! (I love Think Like A Pancreas too, it’s very straightforward).

We'll definitely have a look into basal testing as most of the responses are suggesting this.
Think like a pancreas is great, lots of helpful stuff in it!

Thanks for replying!

 

[Mamado]

I’ve never used Tresiba so I don’t know, but when I take a ‘pump break’ (go back to injections for a while) I choose a twice a day basal insulin specifically so I can adjust one half of the day and not the other. It might be worth speaking to her team for advice. You’re right that her blood sugar shouldn’t be lower than that during the night.

That's interesting, we'll mention it to her team. I'm not sure if having more basal at night is the right idea though, if we don't want lower BG at night.

Thanks for your help!

 

[Inka]

That's interesting, we'll mention it to her team. I'm not sure if having more basal at night is the right idea though, if we don't want lower BG at night.

Thanks for your help!

No, I don’t think she should have more at night either! I was saying that a twice a day basal insulin gives more flexibility eg on my pump break, I split my basal insulin and have almost twice as much in the morning than at night. Tresiba is a once a day basal.

She could experiment with changing the time she has the Tresiba maybe.

 

[Bloden]

Rice is a major issue re late rise in blood sugars.
Easy option is to split the insulin dosage for the meal.

That’s interesting @Pumper_Sue. I never have a problem with rice. We’re all different!

 

[trophywench]

Dry Basmati from Tesco, not 'easy cook' rice.

The 1 - 2 -1 method always works fine. I cup or mug, however much dry rice you need for the 2 of you, 2 cups of cold tap water, 1 teaspoon of salt. Lid on, bring to boil, turn gas down to it's smallest setting immediately, cook until no water left when you tip the pan sideways. Turn gas off - no more heat. Leave it completely alone for approx 10 mins. Serve. Perfick.

6 tablespoons is my serving.

 

[everydayupsanddowns]

I’ve split the ‘rice’ thread over here, because I think it might interest a few more people

T1s - how do you get on with rice

Mod note: Split from this thread https://forum.diabetes.org.uk/boards/threads/odd-blood-sugar-behaviour.90790/#post-1031756 The carbs in brown rice digests a bit slower than white: but anyway over the (many) years I've found that I have to limit a rice meal to 60g carb if i don't want that...

forum.diabetes.org.uk

 

[everydayupsanddowns]

Welcome to the forum @Mamado

I find it interesting that your carb load for the evening meal is quite wide. Do you find the same late rise happens at the lower end of the scale too (say 50-60g CHO)?

For me it feels more meal-based and probably likely to be insulin-dose-running-out rather than basal.

If it’s not impolite, I wonder how heavy your girlfriend is? A rule of thumb (possibly one of John ‘pumping insulin’ Walsh’s) was that there was a tipping point in carb load approx your weight in kilos as grams of carb.

So if you were approx 8-9 stone (50-60 kilos-ish) then much above 60g in carbs and you would need more insulin - a different ratio or adding a proportion to the whole dose. Maybe as much as a third extra(!)

And that since larger meals digest over a longer period (there is more material to work through the digestion) there may be a need to split the overal dose into two parts some time apart to extend the insulin action.

No idea of that would apply for your girlfriend, but it’s an idea I have carefully experimented with.