Postprandials

[Lisa65]

I have a question about post prandial readings, last night I had dinner around 6.30, hunters chicken with most of the bbq sauce scraped off, sprouts and broccoli and my levels were 5.4 before eating.
They reached a high of 8.8 just after 9pm after a gradual climb. They didn't get properly back down until about 1am just before I woke up for the loo.
So in itself a 3mmol rise isn't bad and I can mark that meal as OK to have again, but eight hours to return to baseline seems like a lot. I had taken 15 units of abasaglar around 4.30pm.
I seem to have absolutely no first phase insulin and not much second by the looks of it .

Is this more grounds for asking for some rapid acting to be prescribed so I can hopefully stop these rises from dragging on so long? I want to be informed and armed with info before I have my appointment with the DSN next month.

 

[mashedupmatt]

The fact that your BG Level had not come down some time after eating a relatively low carb meal from what you have said would be a cause for concern, but was this an isolated incident? If it happens every time you eat and fails to come down 4hrs later then this could indicate that some quick acting Bolus insulin may be of benefit - my suggestion would be to keep a detailed log of what you are eating (and try to count the carbs too), with BG Readings before, 2hrs after, then 4hrs after - you can give this data to your DSN next month and it will help them make an informed decision

 

[Lisa65]

Yes, it always takes ages to come down. Good idea about making a detailed log, I'll start that today 🙂

 

[rebrascora]

In the absence of enough carbs (usually about 30g carbs) the body will break down protein to release glucose but this is a much slower process starting about 2 hours after eating and continuing for several hours after that. If you were Type 2 then your second phase insulin should be able to deal with that meal pretty easily. It seems to me that you have very minimal endogenous insulin if your levels rose after a meal like that and took so long to come back down and I suspect the Abasaglar may have been responsible for bringing it down in the end. I definitely think it would be reasonable to ask for a bolus insulin if you are eating so low carb and still seeing rises, but I think you should ask for a C-peptide test to establish just how much insulin your body is able to produce, if you haven't had one recently.

 

[Lisa65]

I've never had one, I guess because I was quite overweight at diagnosis they automatically assumed type 2?

 

[rebrascora]

Unfortunately, being overweight or being a mature adult or both makes a Type 2 diagnosis so simple for medical professionals to assume and of course a slow onset Type 1 can appear to respond like Type 2 in the early years of diagnosis potentially reinforcing that Type 2 diagnosis, which then makes it quite difficult to overturn later because few doctors want to suggest someone got it wrong x years ago. I definitely think you should ask for a bolus insulin but a C-peptide test too would be really helpful to clarify your situation.

 

[everydayupsanddowns]

I also find it interesting that there was a gap of 2hrs between your dose, and starting the meal @Lisa65 - your Absalgar would have been operating at ‘full strength’ when you ate (its onset is around 1 hour I think?), and it did work eventually - so the dose seems appropriate, assuming you aren’t dodging hypos left and right.

Hopefully you can have a constructive conversation about a meal insulin, and decide whether it might be right for you 🙂

 

[Lisa65]

I haven't had any hypos yet Mike, the lowest I've seen so far is 4.8. I didn't have work today so I've had quite a chilled day, sitting between 5 and 7 mostly after no breakfast and a low carb lunch (6g). So I guess the basal is about right, maybe i could add another unit or two but not much.

 

[Lisa65]

After home made chicken stir fry (around 40g cho) last night I went from 4.9 up to 9.3 after three hours. There it stayed until about 1am and finally decided to go down to 6.4 when I woke up. Then it's been between 7 and 10 all day, I ate exactly the same lunch as yesterday, the only difference was that I had a tub of cottage cheese 9g cho for breakfast. Even the dog walk was approximately the same length and time as yesterday. It's very puzzling.

I've given myself an extra unit of abasaglar this evening, in the hope it knocks the post meal high down a bit. I'm working the next two days, and on work days I always have a big rise in the morning followed by a fairly steep drop in the afternoon.

I'm keeping a log of before and after dinner numbers and carb counts to show the nurse next month.