Question about 2hrs after meal test

[Monica]

This question keeps popping up in my head every now and then.

Say your reading before the meal is 14, you eat and correct by 3. At your 2hrs after test you are 16. By the next test you are ok and around what you expected to be, 5- 6ish. Is that normal or should you be lower already at the 2hrs test?

I'm just wondering this, as I've read it's ok to be about 2mmols higher than before the meal. But of course it's not ok to be 14 or 16 in the first place.

 

[novorapidboi26]

from my experience going up about 2mmol/l is normal, and I suppose if you were higher before the meal a higher post meal reading would follow...

But there was a correction there which theoretically should of brought it down...

But I also find the higher you are the more resistant you are......

Sou going by your calculation - 1unit drops 3 mmol/l, which is the norm, however If I am 14 I use the rule 1 unit drops by 2 mmol/l, and if over 15 1 unit drops 1.5 mmol/l.....

10-15mmo/l - 1 unit drops 2

15+mmol/l - 1 unit drops 1.5

Everyones different though...

You should try that out with her.....

 

[Emmal31]

Hi

I was told by my dsn that it should be below 10 after 2 hours post meal but I don't know whether that's the same if you're above normal range before the meal I would presume that it should be below 10 still but I may be wrong. So maybe someone else can clarify that? x

 

[MeanMom]

Monica you know I'm a beginner compared to you but my understanding was that if you had taken the correct dose then (on Novarapid at least) if you tested after 2 hours the BS figure should be (about)the same as before the meal. If you had made a correction then it should be the same minus the correction (if the correction was also right) We dont do a test two hours after each meal as routine but by coincidence K's bedtime test is two hours (ish) after her teatime test (actaully closer to 2 and a half) so I use this to see if we are getting our numbers correct (which we arent, as you know)
This is how we were taught to work out our own ratios on our carb counting course (not DAFNE) as they were not worked out for us ('just start with 1:10 and see how you go from there')
Someone will no doubt put me straight but I'm sure thats what we were told

 

[novorapidboi26]

getting it below 10 every time is easier said than done, if all the doses are correct, and the corrections, taking into account increased sensitivity then its very likley you can get below 10....

 

[novorapidboi26]

Monica you know I'm a beginner compared to you but my understanding was that if you had taken the correct dose then (on Novarapid at least) if you tested after 2 hours the BS figure should be (about)the same as before the meal. If you had made a correction then it should be the same minus the correction (if the correction was also right) We dont do a test two hours after each meal as routine but by coincidence K's bedtime test is two hours (ish) after her teatime test (actaully closer to 2 and a half) so I use this to see if we are getting our numbers correct (which we arent, as you know)
This is how we were taught to work out our own ratios on our carb counting course (not DAFNE) as they were not worked out for us ('just start with 1:10 and see how you go from there')
Someone will no doubt put me straight but I'm sure thats what we were told

All sound advice but testing at the 2 hour mark wont give you the same reading as your pre meal as your food is still releasing glucose and the insulin is only half way there, novorapid peaks at 1.5-2 hours I believe.....and is finished by 4-5 hours

 

[Monica]

Carol doesn't generally test 2hrs after either, but at last clinic we've been told she should to the bedtime test 2hrs after dinner!!! That's between 7 and 7.30pm. I can rarely get her to do it at that time, as she isn't in. Before we were told this, she tested at around 9 when she does her Levemir. Most of the time by then, she's lower than her dinner reading(if she was high in the first place).

At the moment, the reason for her being over 10 before dinner/tea, is that the DSN thought the ratio was too high and reduced it. I've put Carol back on the old ratio now, so we'll see tonight...

 

[MeanMom]

All sound advice but testing at the 2 hour mark wont give you the same reading as your pre meal as your food is still releasing glucose and the insulin is only half way there, novorapid peaks at 1.5-2 hours I believe.....and is finished by 4-5 hours

No wonder I got the ratios wrong then - flippin' dietitian

What is point of 2 hour test then

 

[novorapidboi26]

Carol doesn't generally test 2hrs after either, but at last clinic we've been told she should to the bedtime test 2hrs after dinner!!! That's between 7 and 7.30pm. I can rarely get her to do it at that time, as she isn't in. Before we were told this, she tested at around 9 when she does her Levemir. Most of the time by then, she's lower than her dinner reading(if she was high in the first place).

At the moment, the reason for her being over 10 before dinner/tea, is that the DSN thought the ratio was too high and reduced it. I've put Carol back on the old ratio now, so we'll see tonight...

When you say reducing it, do you mean giving her more insulin?

I done DAFNE and they only care about the pre meal tests, and most of the time these tests are fine, but when you start investigating the between meal readings you start to see spikes which vary with different foods, you then start getting into split doses......

What ratios is carol if you dont mind me asking??

 

[Monica]

no, when I say reducing I mean less insulin. Carol has 2u per 10g for brekkie, 1 1/2 for everything else. But we reduced lunch down to 1 1/4u., which wasn't enough!! And calculating is a nightmare. The specialist doc. did show us a different way of doing it too. Like 1:6 and 1:8 for a while, but that wasn't good either.

 

[novorapidboi26]

No wonder I got the ratios wrong then - flippin' dietitian

What is point of 2 hour test then

In an ideal world the food we eat would release its glucose at the same speed and the same amount, that would enable us to engineer the insulin to match this curve (imagining a graph of time and blood sugar). But it doesnt work that way.....

The only point of 2 hour blood tests, for someone on MDI is purely to see if the doses are correct, and also to see how certain food release their glucose.

I have cut out carbs (bread and pasta) in order to avoid mid teen spikes at lunch, I now have fruit instead which means my 2 hour test is seldomly over 10

 

[novorapidboi26]

no, when I say reducing I mean less insulin. Carol has 2u per 10g for brekkie, 1 1/2 for everything else. But we reduced lunch down to 1 1/4u., which wasn't enough!! And calculating is a nightmare. The specialist doc. did show us a different way of doing it too. Like 1:6 and 1:8 for a while, but that wasn't good either.

If she has higher 2 hour post meal reading then you, or I would be thinking of more insulin........unless by the next meal she is on target, then you need to split or cut out some carbs.....is she on target for the nest meal?

I do the same as you for ratios = 3u:10g am 2u:10g lunch and 1.5u:10g the rest of the day.....

I would find any other way difficult to calculate and I think is good for pumpers who need smaller more accurate doses.....

 

[Monica]

Splitting the dose😱 ??? That will never happen.

I have increased it back to 1 1/2 at lunch yesterday, but Carol is a naughty girl. She went to grandma's for dinner/tea last night and didn't do a before meal test!!! So I won't find out until tonight if she's back to normal. It does't help that today she went for school dinner, and that's usually hit and miss. All this, just because some of Carol's readings were high at dinner time and DSN thought she might have hypoed during the afternoon, hence reduction. Next time I won't listen!!!!🙄

The other way isn't that difficult. Just add all the carbs together and divide by 8 (in this instance).

 

[novorapidboi26]

Its hard and as the teenage years come rolling in it only gets worse.....

I hope you can tweak the ratios as best you can, some people are alot more sensitive to carbs and need a much more accurate dose, where as I am just a round up round down kinda guy, but it works for me.............🙂

 

[Monica]

Its hard and as the teenage years come rolling in it only gets worse.....

I hope you can tweak the ratios as best you can, some people are alot more sensitive to carbs and need a much more accurate dose, where as I am just a round up round down kinda guy, but it works for me.............🙂

Yep, teenager already here (14 in december)!!

Guess what! I'm a round up and round down kinda girl . What else can you do? Can't give half or even quarter units. But I'm always thinking, I've rounded up here, so I can round down here to make it work. I mean if you have 7.5 cps divide that in 2 = 3.5 (to me) 3.5 + 7.5 = 11 units. LOL that's for the 1 1/2 ratio.😉

And crisps e.g. are 12.2g carbs, I count that as 1 and something that has 18 ish carbs I count as 2. In that way they add together as 3 perfectly. Oh and I hate odd numbers!!

LOL, hope that makes sense. It does to me.😉

 

[novorapidboi26]

Yep, teenager already here (14 in december)!!

Guess what! I'm a round up and round down kinda girl . What else can you do? Can't give half or even quarter units. But I'm always thinking, I've rounded up here, so I can round down here to make it work. I mean if you have 7.5 cps divide that in 2 = 3.5 (to me) 3.5 + 7.5 = 11 units. LOL that's for the 1 1/2 ratio.😉

And crisps e.g. are 12.2g carbs, I count that as 1 and something that has 18 ish carbs I count as 2. In that way they add together as 3 perfectly. Oh and I hate odd numbers!!

LOL, hope that makes sense. It does to me.😉

Spot on, thats why I do, I kinda round up all the time as for me its better to be lower than higher, then the weekend comes and that ensures my hypo awareness remains LOL.........I PMd you....

 

[Monica]

Spot on, thats why I do, I kinda round up all the time as for me its better to be lower than higher, then the weekend comes and that ensures my hypo awareness remains LOL.........I PMd you....

Thank you. PM'd you back🙂

 

[bev]

Even when Alex was on MDI he always did a 2 hour check - its the only way of knowing whether you have spiked or not - so not sure why your teams arent telling you to check? If you are always out at the 2 hour check it can be for a number of reasons - your ratio is wrong - your timing of injection is wrong - the food itself is a food that causes spikes - or your basal is wrong.

If you are only checking pre-meal you are not seeing the full picture of what is going on. At the FFL conference they explained it by saying that only checking every 4 hours is a bit like reading the first senstence at the top of every page of a book - its not actually *telling* you anything other than the first sentence - you need to read the whole page in order to *know* what is really going on - so this means 2 hour checks after eating and making sure that you bolus for every meal and snack 10 or 15 minutes before eating. It takes 40 minutes for a fast acting insulin to start working on glucose - so you need to give it a head start.

If you dont bolus on time and you dont do 2 hour checks - you are working blindly and this shows in the hba1c but also means that you could be deviating too much from high to low and high to low and this is what causes the complications.

The first hour after eating is when your levels rise - so the aim is to match this rise with insulin - if you dont then you have at least 2 hours of high levels three times a day at least and this equates to 8 or 10 (depending how many meals and snacks you eat) hours when your levels are doing damage per day.

When Alex was on MDI and wanted something that made him spike (pizza pasta etc) he always knew that there would always be a split injection - this is non-negotiable I'm afraid as it is not good practice to think that you can eat what you want without using the right method of insulin delivery availabe, and if that means 2 or even 3 injections then it has to be done. Of course, now he is on a pump things are much easier and we can accomodate these foods better - but its all about the timing. You can see that I am not a fan of letting a child decide whether they will or wont time their injection or take a split dose - it is for their own good and should be non-negotiable - and I know this seems very harsh - but this is about their future and the more you get it right now - the better the outcome in future. It is also a brilliant foundation for them in future - they may choose in teenage years not to follow rules - but once they have been through all that they will at least know the *right* way of doing things. I dont mind Alex getting angry with me on occasion because I know that he is being given the very best advice to be able to manage his own diabetes and that is the best I can do for him.

If you think about it, we are trying to copy what a normal pancreas does - which is to release insulin 200 times a day - so to think that we can do this with a mere injection is really a very crude method of delivery. The pump is better - but still not as good as the real thing - obviously.🙂Bev

 

[Monica]

Thanks Bev. We are hoping to get the pump. Carol has been put on the waiting list. I have arguments with her all the time about doing the blood test. Whatever I say, she has to oppose, never mind that I AM right. We even have arguments when I say test now, she will leave it for another 10 min. Nag, nag, nag!!!
All the things about splitting, injection 15 min before dinner, 2hr tests I've learnt from here and you specifically. But I just can't implement it.

I just hope she will toe the line, if she gets the pump, as the DSN said they'd take it off her again, if she doesn't show willing to put in the hard work. All Carol can see is "no more injections".

 

[bev]

Thanks Bev. We are hoping to get the pump. Carol has been put on the waiting list. I have arguments with her all the time about doing the blood test. Whatever I say, she has to oppose, never mind that I AM right. We even have arguments when I say test now, she will leave it for another 10 min. Nag, nag, nag!!!
All the things about splitting, injection 15 min before dinner, 2hr tests I've learnt from here and you specifically. But I just can't implement it.

I just hope she will toe the line, if she gets the pump, as the DSN said they'd take it off her again, if she doesn't show willing to put in the hard work. All Carol can see is "no more injections".

I completely understand what your saying and I hope I didnt come across as critical at all. I just feel very strongly that we wouldnt let our children choose whether or not to have a rotten tooth out or whether to let them poke their fingers in a live electric socket - so why should we allow them to *decide* whether they want to manage their diabetes in the proper way or not?

I think you would both love going to FFL - they dont take any rubbish from teenagers there and Jo Solo advised that if you have a stroppy teenager who doesnt want to *do* diabetes - then you punish them - simple. If Carol doesnt follow the rules of diabetes - then you take away her ipod or her tv or her mobile or whatever it is that makes her happy - until such time as she decides that its easier to follow the rules. But you have to keep it up and dont let her talk you into giving in! If she has an untidy bedroom and you want her to tidy it - what do you do? Diabetes is a lot more important than a tidy bedroom and she needs to know that and suffer the consequences if she doesnt tow the line. I know I sound hard - but I have read far too many stories on here of 20/30 year olds wishing they hadnt pratted around when they were younger as they now have complications and it is *the* best gift you can give to Carol - and just ignore her rantings - its good for her!🙂Bev

p.s. I should add that Alex is mostly compliant and this is probably easier for me as he is very keen himself to keep levels as within range as possible - and he loves Jo Solo - so he doesnt want to let him down and knows that I have his email and can contact him for any advice if needed!