Pasta salad spike after 2 hours

[Eternal422]

Just after a bit of advice please.

Over the past few days I have noticed that after eating a pasta salad for lunch (about 40g), bolusing just beforehand, my BG remains flat at the pre meal level and only rises after about 2 hours. By this time it peaks and remains high, presumably because the Novorapid has almost finished its peak? I’m wondering whether if I have this meal for lunch then I should consider taking the bolus after eating, maybe an hour or even an hour and a half afterwards?

Or am I barking up the wrong tree and maybe it is due to my basal running out (I take 28U Levemir once, at about 10pm which equates to 0.3U/kg, so if it’s duration is only 16 hours which I’ve read about someplace, then it would start running out at about 2pm) ?

 

[Inka]

Pasta often needs a split bolus - some insulin before, then more at 1/1.5/2 hours (depending which of those works for you).

However, if you’re only taking Levemir once a day then that could be the issue as well. Is there any reason why you don’t take it twice a day?

 

[Lucyr]

To find out which it is, skip lunch and skip lunch bolus one day and test your bg. This is known as a basal test and will tell you if your levemir is running out then or not.

 

[Eternal422]

Pasta often needs a split bolus - some insulin before, then more at 1/1.5/2 hours (depending which of those works for you).

However, if you’re only taking Levemir once a day then that could be the issue as well. Is there any reason why you don’t take it twice a day?

Thank you for this! I will definitely have to experiment, the last few days I’ve eaten the exact same meals and the pattern is the same, BG stays flat from eating lunch then starts rising fairly sharply after 2 hours, so I’ll give the split bolus a go and see if I can get a better balance.

Only just started on the Libre at the end of July, so I’m only seeing these patterns now for the first time. Finger prick tests just don’t show this level of detail.

I was originally diagnosed as T2 and put on a single dose of Levemir at night. Since being rediagnosed this year as T1 I have titrated the Levemir slightly up to its current level and now got a lovely flat BG overnight on the majority of nights. I did ask my DSN at my last consult about splitting the dose but she wanted to wait until my next call with her in November when I will have a lot more data from the Libre. Although to be honest I’m seeing such a lot now that I would have though some changes are in order now. Bit reluctant to try splitting the dose myself, but I think if I can do the basal testing and prove that it is running out then I can call my DSN to discuss splitting the dose sooner. Is it fairly common for people who are T1 to have a split dose?

 

[Eternal422]

To find out which it is, skip lunch and skip lunch bolus one day and test your bg. This is known as a basal test and will tell you if your levemir is running out then or not.

I have been reading about basal testing and was getting around to trying it to see if the basal is indeed running out. Just need to psych myself up to skipping lunch!

 

[Lucyr]

I have been reading about basal testing and was getting around to trying it to see if the basal is indeed running out. Just need to psych myself up to skipping lunch!

Could do it on a weekend, have a more filling breakfast than usual and then you’ll last through?

 

[Inka]

Is it fairly common for people who are T1 to have a split dose?

I don’t know the figures but that’s the beauty of Levemir and basal insulins like it - splitting the dose gives more flexibility as you can have less/more during the night than the day.

 

[void]

When I was on lantus, I split mine. Now on toujeo, I had been doing that but was told not to. Maybe the profiles are different.

 

[void]

By this time it peaks and remains high, presumably because the Novorapid has almost finished its peak?

The "presumably" in your question I thought needed pointing in the direction of the definitive article

2 hrs after eating a main meal is, all other things being equal, with me anyway (and you'll be different probably, depending on age and health, as with all things like this), the start of the peak of where whats eaten shows up in bg testing.

Words about the novorapid activity profile can be found on the emc [1]

NovoRapid Penfill 100 units/ml - Summary of Product Characteristics (SmPC) - (emc) | 4779

NovoRapid Penfill 100 units/ml - Summary of Product Characteristics (SmPC) by Novo Nordisk Limited

www.medicines.org.uk

in section 4.2 it says:

"When injected subcutaneously into the abdominal wall, the onset of action will occur within 10–20 minutes of injection. The maximum effect is exerted between 1 and 3 hours after the injection. The duration of action is 3 to 5 hours."

I make sure it's 5+hrs after last novo injection before sleep because of this.

[1] https://www.medicines.org.uk/emc/about-the-emc

 

[Inka]

When I was on lantus, I split mine. Now on toujeo, I had been doing that but was told not to. Maybe the profiles are different.

Yes, the profiles are different. I remember you asked a question on one of your threads about dropping low overnight. Many people find using a twice daily basal like Levemir helps reduce this because you can split the dose in a way that works for your body. When I take a pump break and go back onto injections, I use a twice daily basal. I take roughly twice as much in the morning as I do in the evening. This reduced evening dose helps me avoid overnight lows.

 

[void]

This reduced evening dose helps me avoid overnight lows.

I take my basal shortly after I wake up. What I mean is that I have no evening dose to reduce.

 

[Inka]

I take my basal shortly after I wake up. What I mean is that I have no evening dose to reduce.

I know 🙂 It was me who asked you when you took the Toujeo on another thread. The point I was making was that a twice-daily insulin like Levemir allows more flexibility as you have two doses/time-slots to adjust, so if you’re still going low at night, then you could consider a change to a twice-daily basal. I realise you split your Lantus but the profiles of action of Lantus and Levemir are different.

If you think about it, the beauty of a pump is that you can have lots and lots of micro-doses of basal to keep your blood sugar on track by trying to more closely match your body’s needs. Some people find that even the difference between a once daily and a twice daily basal can be helpful as rather than having, say 30 units of basal upfront that will disperse itself over 24hrs whatever your needs, having the flexibility to have say 20 units in the morning and 10 at night better matches your body’s needs, which can differ significantly from daytime to nighttime.

 

[Eternal422]

Thwarted by a 4.5 at lunchtime from doing a basal test, so I ended up having lunch, but avoiding the pasta salad this time. Had the rise to peak at 8 three hours after eating it then dropped back quite slowly throughout the afternoon to 6 after four hours. Dinner has given a peak of 8.3 and now it looks like it is dropping back. So hopefully that means the basal isn’t too far off and still working although obviously a basal test would be the best course of action to confirm.

The more I read what people say about a split dose the better it sounds, the extra flexibility may be what I need. Of course a pump gives the ultimate control but I don’t think I would qualify for one given that my control isn’t too bad (and hopefully improving now that I have the Libre).

 

[Eternal422]

@void - thanks for the links, great to see something definitive!

 

[Eternal422]

I think I’ve solved my pasta spike (well, at least today, of course despite doing the exact same thing tomorrow I wouldn’t expect it to work again - lol!). I took all of the bolus insulin 30 minutes after eating the pasta salad at lunchtime and lo and behold - no spike, BG stayed around 6 with absolutely no spike at all! Really pleased!

 

[void]

@Eternal422 thats interesting. If I bolused like that, all it would do is make the spike bigger.

I have to take mine usually less than 5mins before anything. If what I'm going to eat is something sweet and carby like cake then I'll need to gauge it even earlier because the carb is always faster than the insulin (with me anyway). Not much earlier but, depending on where my levels are at, maybe 10min before.

Pasta is a complex thing with a lot of people because it's wheat, and wheat is problematic for a significant part of the population. I'm not talking about coeliacs. Things like cereal spike me higher and for longer than plain glucose, plus if I have more than say a bacon sandwich I'll have (mild but uncomfortable) digestive problems.

But pasta isn't a problem for me. The way I have it is home-made (I mean dried pasta like pasta shells that you cook at home) but it's always served with a little pesto swirled, and always al dente. i think the oil might 'slow' the carb a bit. But it responds normally to a bolus, with me anyway.

 

[void]

Just after a bit of advice please.

one thing you might consider is the velocity of your digestion. Is it quick/normal/sluggish/erratic? I'd ask yr diabetic doc because they'll probably be able to give you a handle on it. because it can influence if some foods are slower or more rapid to spike

 

[Barbie1]

I second that about considering the speed of your digestion. Over the years I have found that my personal digestion is slow, very slow at times.
I always now split my bolus so that I take at least 25% of it sometimes only 45 minutes later but often up to 2 hours. For a pasta dish in sauce I would delay by the full 2 hours. And as for pizza……..well, I have to spread it over 4 hours to stay anywhere near level!
As an aside, that also means I struggle dealing with hypos anything like “quickly” with my blood sugar sometimes taking up to an hour to return to normal, no matter what I try to dose it with!

 

[Eternal422]

Very interesting! This is a cold pasta salad (a Morrisons Chicken & Bacon pasta salad) and I don’t see a rise in BG until about an hour after eating it. Hence why I decided to try delaying the bolus. Trying the same again today to see if I really do take time to digest this type of meal and therefore need to delay my bolus to more closely match the BG spike.

 

[nonethewiser]

I think I’ve solved my pasta spike (well, at least today, of course despite doing the exact same thing tomorrow I wouldn’t expect it to work again - lol!). I took all of the bolus insulin 30 minutes after eating the pasta salad at lunchtime and lo and behold - no spike, BG stayed around 6 with absolutely no spike at all! Really pleased!

That's a win in anyone's book.