Pesky postprandial spikes (and some other bits

StephanieMLW

StephanieMLW

Well-Known Member
Relationship to Diabetes
Type 1
Hello, I am having a bit of a challenge with my postprandial spikes at the moment. I've been diagnosed for two years now, and this is something that has become more challenging over the past six months (maybe those final beta cells are now lost forever..!)

I tried to go ultra low carb for a few months earlier this year, but it didn't really work out for me as my starvation ketones would accummulate quite quickly and this didn't feel ok to me. It's also worth noting that I have struggled with my behaviour with food since being diagnosed (something I can now recognise and have spoken to my medical team about), and went through a bit of an episode where I wasn't eating because I felt like witholding food was easier than dealing with spikes. Sounds crazy, I know, but this disease does crazy things to you sometimes!

At the moment, I'm having seeds, a few fresh raspberries/blueberries and low sugar plant milk for breakfast, and then will try and have around 20-30g of carbs at lunch time to avoid the starvation ketone situation. Today my starting BG at lunch time was 6.2, and I injected 4 units of novorapid for two small pieces of wholemeal toast with avocado and tea with low sugar plant milk (on paper that's 28g of carbs, I'm on a 1:10 ratio but know that bread causes me to spike so I threw in an extra unit). Two hours later, by BG is now 12, which I know isn't awful, but I am unsure whether I should correction dose at this stage to help my time in range.

I'm generally resistant to increasing my insulin dose and try and focus on increasing my sensitivity, but I'm concerned about the spikes as my husband and I are hoping to try and conceive, and I feel like these kinds of spikes are just not acceptable when conceiving/expecting.

Appreciate there's a lot covered in this post, but if anyone has advice on any of the above topics I would greatly appreciate it!

At the moment, I am thinking of doing a bit of reset on my doses and doing some basal testing and a glucose/after meal BG diary, just to try and optimise my doses instead of stressing out over the spikes.
 
Hi @StephanieMLW I am sorry you feel as if you are struggling but glad you are trying to build a better relationship with food. Diabetes is a pest because it makes us focus on food and numbers so much of the time.

Like you, I found very low carb as difficult. It was not the ketones for me but the way that our body breaks down protein into carbs if we don't eat enough carbs. Bolusing for carbs is more complex because it needs to be done later and at a different ratio.

When considering correction doses you need to remember that your fast acting insulin will remain active for up to 4 hours. So, although your BG was 12 after 2 hours, you still had about 2 units of insulin in your body to bring that down.
OK, so that is an over simplification because the insulin's activities is "front-loaded" so you will use up more in the first 2 hours than the second 2 hours. But it is, usually, a good enough approximation when considering a correction.

Therefore, you need to look at your BG 4 hours after bolusing. If this was back to your target, your insulin dose was correct and does not need to be corrected.

If you think about the activity profile of your insulin, as I mentioned, it is front-loaded. In fact, there is a peak of activity when you look at the graphs. I am not sure what fast acting insulin you use but assuming you use NovoRapid, you can Google "NovoRapid profile" and you will see the graphs which may make my explanation easier to explain.
When we eat carbs (or our body breaks down protein into carbs), there will be similar graph of "carb digestion". Ideally, we want to align the insulin peak with the carb digestion peak.

Sorry, this feels like a long way to explain my point ...

If your BG is spiking after, say, 2 hours, but returning to your target after 4 hours, your have not aligned the peaks and need to pre-bolus earlier.

Try to do this slowly by moving your pre-bolus time by 5 minutes earlier (in relation to the time you eat) each day until the spikes are lower. There will still be spikes - that is perfectly normal.

Unfortunately, as with everything diabetes, this may not be consistent
- often we are more insulin resistance in the morning so we may need to pre-bolus earlier for breakfast
- some food is digested faster than other food. The obvious extremes are hypo treatment (very fast) and pizza (slow)
- the speed of some fast acting insulins is dependent upon your BG. I find Fiasp works immediately if my BG is s5.5 or lower and can take an hour if my BG is higher that 10.

Lastly, back to that checking after 4 hours - if your BG is too high after 4 hours with no correctio, you need to increase your insulin dose. There is nothing wrong with increasing your insulin dose if you need it. As is often written, the right amount of insulin the amount your body needs.
 
The only thing I would add to @helli's excellent explanation above is that first and foremost you need to know that your basal insulin is holding you reasonably steady.

You mention a quite meagre breakfast of a few berries and seeds with plant milk. Are you happy with that breakfast or would you prefer something more filling but have chosen that to try to manage your diabetes better. If the latter, choose something you actually want to eat and practice dosing for it until you get it right.
Or perhaps you may be one of those people who doesn't want breakfast, in which case there is no need to eat anything. If however your levels rise significantly if you don't eat something (Dawn Phenomenon/Foot of the Floor Syndrome) then you can just do a correction with your fast acting insulin to cover that but obviously not bolus for food, because you are not having any.
So if I am going to skip breakfast, I still need to inject 1.5-2u (depending upon my waking reading) of Fiasp to deal with that morning liver dump. Perhaps you don't get a surge of glucose from your liver on a morning or your basal insulin manages to cover it, so you don't need to employ this tactic, but it is an option if you do get a big rise just after you get up and you aren't a breakfast person.
The trick with Type 1 is in learning to use your insulin to balance what you want to eat, not restricting your food to try to inhibit glucose spikes. You have to practice to get good at it and be prepared to experiment to find how to make it work. Far better to do that experimenting now before you get pregnant because you need plenty of good nutrition when you are feeding 2 of you, so you really need to start pushing your boundaries a bit now and learning how to manage carbs rather than being scared of them. See it as a challenge or a game if you like, rather than something scary. That certainly works for me. I used to spike up to 15 nearly every morning after breakfast and then come crashing back down later until I found the optimum timing for my breakfast bolus. The more you practice the better you will get, but yes there will be times when you get it wrong, we all do. Learn from the mistakes or things that don't work and keep trying to find the best ratios and timing for you and that food and you will start getting better results and less occasions when you spike so high.

The other thing to remember is that CGM and particularly Libre over exaggerate the peaks, so you may not actually be going as high as 12, but even if you are, 12 is not bad unless you are stuck in double figures for hours on end. Out of curiosity, what is your TIR? I am guessing you are maybe trying too hard to achieve 100% when you only need 70% to be successful.
 
Diabetes is awful for affecting your relationship with food @StephanieMLW Don’t let it mess with your head! You should be aiming for a normal healthy diet - especially if you’re trying to conceive. Your breakfast sounds very meagre. That could be contributing to some of your lunch spike problems. I find if I don’t eat a proper breakfast, my blood sugar will run higher and be a pain.

So, my advice is to a) eat more carbs at breakfast; b) aim to increase your food overall, thinking of your plans to conceive whenever the deceitful diabetes whispers rubbish about food in your ear; c) eat the exact same lunch for a week and perfect your ratio and also the optimum time to bolus in advance. Don’t get too hung up on a 12 if it comes down.

But basically, I suspect the lack of carbs is sabotaging your control.
 
Starvation ketones?
Do you mean diabetic keto acidosis - or does low carb put you into ketosis - where you are burning fat safely at low glucose levels, as the latter is normal for low carb.
When starting Atkins and on fairly low levels of carbs - in order to start ketosis, neither fruit nor bread is on the list of things to eat.
Perhaps a reassessment of what is a 'healthy' diet might help. I'm a bit concerned about wanting to conceive on what you are eating now. Babies are made more from proteins than carbs and their brains require lipids from animal sources in some quantity, I went through my first pregnancy low carbing to some extent - loads of veges, salad and some fruit, but meat, fish, eggs, cheese - I did end up with a baby over 9lb who grew like a weed and is a foot taller than me, now with 6 children, so be warned, good nutrition has consequences.
My regime to control diabetes is totally different from a type 1, but I do wish that I'd eaten the same way in subsequent pregnancies as for the first one.
 
As you say, Drummer, Type 1 is totally different to Type 2. Moreover, nowadays a baby of that weight would flag possible blood sugar problems - perhaps a forerunner of your Type 2?

The recommended diet for Type 1s is very different to yours. I saw a dietician for two of my three pregnancies and it was made very clear that carbs were important, both for pregnancy and breastfeeding. I don’t remember exactly what she wrote out, but it was similar to what I was already eating plus some extra calories and calcium.
 
Inka said:
I missed that! Was that in response to the OP’s mention of plant milk, Drummer?? Vegetarians and vegans can and do have perfectly healthy babies. As an aside, breast milk - the ideal food for babies - is more carbohydrate than protein.
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Yes! it's really terribly misinformed. I don't blame them, as this kind of messaging is rife in nutrition spaces. The level of misinformation in the high-carb, low-fay and vegan spaces is bad enough, but certain gurus and doctors within the low-carb movement have taken the problem to extraordinary new heights.

I wish peope would do some measure of due diligence before posting things like this. It's not just the active member here to consider. All the guests and offline readers will see this, tell a couple of friends, family members etc., who will in turn do the same, and suddenly millions of people believe something that is demonstrably false.

And yes, you're correct: There are currently thriving long-term vegans, also thriving long-term 'from birth' (even from conception i.e mama was already vegan) vegans, and this number is increasing all the time.

For whatever reason, there are many who believe an all-meat diet is nutritionally complete (It isn't), but the very same people are spreading this mis-info about vegans.

The heath and nutrition movement, as a whole, needs to do much better.
 
Hi @StephanieMLW - I'm just over two years in, and have had to increase my insulin dosage quite significantly over the past 6 months to stop the massive spikes (Honeymoon period over!) - small adjustments are sometimes necessary, as mentioned earlier, and definitely at different times of the day - do you have a 1/2 unit pen (Novopen Echo)? If not, I would definitely ask about one - this makes small adjustments easier and less scary of over-doing it and going hypo - a reading of 12 two hours after food would not be a big cause for concern though, I wouldn't worry about that - as long as it comes down before your next meal you shouldn't need to correct - and I wouldn't advise correcting within 4 hours as you will still have some insulin on board, meaning you could hypo - also as mentioned above, consider when you are dosing before a meal - I was on Novorapid for 18 months, which wass actually not so rapid for me (and others too) so you may need to inject earlier to give it a chance to work (now on Fiasp which works a bit faster, and doesn't last as long (For me!)) - wishing you all the very best with it - We all know its not easy!!
 
Hi @StephanieMLW
Like you I found I was getting big post meal spikes when I first started using sensors.
This is a list I developed for me from Gary Sheiner’s book Think Like a Pancreas.
Strike The Spike
  • Do something for 15 minutes after a meal -don’t sit down, walk, do the ironing, clear up, …
  • Pre-bolus for meals - I find the timing of this changes for me through the day
  • Use sensor to identify the impact of certain foods - change portions/do swaps
  • Find the amount of carbs that suit you -I aim for 30g per meal but it is just a target
  • On a pump use different ways of delivering insulin to suit foods -split doses (for pizza for me)
 
Inka said:
As you say, Drummer, Type 1 is totally different to Type 2. Moreover, nowadays a baby of that weight would flag possible blood sugar problems - perhaps a forerunner of your Type 2?

The recommended diet for Type 1s is very different to yours. I saw a dietician for two of my three pregnancies and it was made very clear that carbs were important, both for pregnancy and breastfeeding. I don’t remember exactly what she wrote out, but it was similar to what I was already eating plus some extra calories and calcium.
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I was always having to deal with the consequences of the diet others thought I should be following - right from my early 20s.
I don't need carbs, it is as simple as that.
The consequences of eating a diet too high in carbs still upset me deeply.
 
Drummer said:
I was always having to deal with the consequences of the diet others thought I should be following - right from my early 20s.
I don't need carbs, it is as simple as that.
The consequences of eating a diet too high in carbs still upset me deeply.
Click to expand...

But you’re not the OP; you’re not Type 1; and you’re not planning to try to conceive. You’ve also posted misinformation about dietary needs during pregnancy, and, implicitly, implied that a vegan diet is inadequate. Nothing about your fear of carbs justifies those things.
 
Hello everyone,

It was so nice to log on today to read all of these helpful and supportive replies. Honestly it has made my evening! So thank you for taking the time.

There has been some really great advice in here. @helli I have actually been tracking my 4-hour post meal levels today, and things look a better from that angle! I really like your perspective also that the right amount of insulin is the amount your body needs. I’ll remember that one.

@rebrascora i would absolutely love to have a big breakfast, it’s my favourite meal of the day! But I’ve gone onto the seeds and berries (I sound like some sort of woodland creature haha) because I’m trying not to start my day with high sugars. I also get dawn phenomenon too, so as soon as I wake I roll over and take 1.5 units, and any carbs I eat sends my BG skyrocketing using my usual ratios. What I would actually like to eat is peanut butter on toast!! But I feel like I’m too sensitive to carbs in the morning to have something like this. My time in range is generally good and around the 80% mark. Perhaps like you say I need to be a bit more forgiving with breakfast and try and figure out the dose for what I actually want to eat.

@mashedupmatt sounds like we’ve had similar experiences! I have the half unit pen and agree it’s super helpful. I did try Levemir but it didn’t get on with me unfortunately.

@Inka thank you for your thoughtful and helpful posts as per usual. I’ve gotten much better at not letting the diabetes voice dictate whether I eat, but like you say it can mess with your head! I’m going to finish my basal testing and take up your suggestion of eating the same breakfast and lunch for a week and seeing what tweaks might need to be made.

As for the plant based angle, I appreciate everyone pointing this out as misinformation for others who find this post too. For the record, my healthcare team are fully aware of my diet and have no concerns about my overall health or ability to grow a baby 🙂
 
If you want peanut butter on toast then have it. You might get a few spikes early on but I don't think it would be too difficult to deal with. The fat in the peanut butter should slow the carbs down. It will just be a question of injecting the right amount of time before eating it and that will take a bit of trial and improvement. You may also find like @mashedupmatt and myself that Fiasp enables you to manage the timing better. I used to have to wait over an hour with Novo(not so)Rapid on a morning between injecting and eating, but Fiasp is definitely better. It might be that you inject your bolus for the peanut butter and toast before you get out of bed and then keep an eye on how your levels respond whilst you are getting washed and dressed and then if they are dropping too quickly have a jelly baby before you eat your toast just to slow things down a bit and then the toast. That is what I do if I mistime it slightly and it is surprising how 1 jelly baby can buy you 10 mins to get your breakfast into you if you have left it a bit too long. Having your alarm set at least mid 4s or perhaps 5 to warn you it you are dropping too low helps.
I would love to hear that you have spent a week working on getting a good insulin regime with peanut butter on toast for breakfast, so that you are at least having a filling breakfast that you enjoy. Take it as a challenge or homework. 😉 If you get stuck, we are here to help you. Maybe start on a non work day when you have more time to think and see how it goes and don't end up unable to drive to work due to a hypo because you mistimed it etc.
 
StephanieMLW said:
i would absolutely love to have a big breakfast, it’s my favourite meal of the day! But I’ve gone onto the seeds and berries (I sound like some sort of woodland creature haha) because I’m trying not to start my day with high sugars. I also get dawn phenomenon too, so as soon as I wake I roll over and take 1.5 units, and any carbs I eat sends my BG skyrocketing using my usual ratios.
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A couple of thoughts come to mind regarding this
- I find my BG continues to rise in the morning until I eat "enough" carbs. It's as if my liver thinks I am starving myself and dumps glucose until it spots what I have eaten. Then it will stop the dump. So, I find it easier to manage by DP by eating something carby.
- it is very common to have different ratios at different times of the day. Usually, breakfast needs a higher ratio than other meals - we are often more insulin resistant until our bodies have fully woken (which needs some food)
- I find exercise the previous day significantly reduces my DP. It's as if the exercise uses up some of my liver stores so there is little left to dump the next morning.

Ooops - that was more than "a couple". The Spanish Inquisition comes to mind.
 
I’m exactly the same as you @helli I’m most resistant to insulin in the mornings so I thought I’d try a very low carb breakfast I happened to come across online - only 2 or 3G carbs per serving, plus a bit of coconut milk so no more than 5g carbs in total. However, my blood sugar rose more than it should have done, then stubbornly stayed higher through the morning. Of course, that then had a knock on effect on lunch, even with a correction.

@StephanieMLW Contrary to instinct, it’s often easier to eat a normal carby breakfast than eat very few carbs. Get the carbs in, get the insulin in, and you might well find it’s easier to manage than very few carbs. That goes for the whole day too, but the breakfast effect really surprised me.
 
For what it's worth, my experience is well below her knowledge, I agree with @Inka. Also the author of Think Like a Pancreas, Gary Scheiner, early on in his book recommends any single main meal should exceed 30gms of carbs. If it doesn't Scheiner tells us that our brain feels there aren't enough carbs to meet the brain's tequirement and gets our bodies to convert fats and proteins into carbs.

There is nothing wrong with that, in principle. But those conversions take different amounts of time and with irregular conversion rates. Those things, of course, can also broadly be calculated. But this process is just not as clean and simple as it is for our carb counting. For a non-D individual the process is invisible. For us it's extra faff and stress.

I'm also noticeably more insulin resistant in the mornings and if I wake up highish I need extra bolus for my correction, as well as extra time for that correction to join my inner party.
 
Inka said:
But you’re not the OP; you’re not Type 1; and you’re not planning to try to conceive. You’ve also posted misinformation about dietary needs during pregnancy, and, implicitly, implied that a vegan diet is inadequate. Nothing about your fear of carbs justifies those things.
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But I don't fear carbs - and you have no idea what I went through when trying to carry a child to term on a 'healthy' high carb diet. Nor will I elaborate on that subject.
 
helli said:
A couple of thoughts come to mind regarding this
- I find my BG continues to rise in the morning until I eat "enough" carbs. It's as if my liver thinks I am starving myself and dumps glucose until it spots what I have eaten. Then it will stop the dump. So, I find it easier to manage by DP by eating something carby.
Click to expand...

So I'm not the only one, your experience mirrors my own @helli
 
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