Snacks ...numbers

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Charl

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Relationship to Diabetes
Type 1
Screenshot_20230803_095944.jpgHad a snack ,3 x crispbread at 7.2 hoping to stop the drop, failed, 30 mins later dropped to 4.7 where I've taken 2 x dextro to see if I can get through till lunch, any suggestions as to what to eat to stop it without spiking, bearing in mind I'm at work.Once again Thanks.
 
Hi, I would suggest a mix of carbs, such as a couple of digestive biscuits. maybe even chocolate ones (or a penguin/Kitkat). My reasoning is that the chocolate will pick up the drop and the wheat biscuit will digest slower to tide you over till lunch... ..
 
My guess is that you probably stopped it with the crispbreads before you hit the red but Libre is just slow to show that, but something with a little more sugar would work a bit quicker to stop the drop. A handful of sultanas or raisins, or a couple of dates if you like them, or a biscuit.... or even a jelly baby or 2. My guess is that you may now go high as the crispbreads continue to release on top of your Dextrose.
Do you know why you dropped like that? Have you been particularly active after breakfast?
 
Piglet said:
Hi, I would suggest a mix of carbs, such as a couple of digestive biscuits. maybe even chocolate ones (or a penguin/Kitkat). My reasoning is that the chocolate will pick up the drop and the wheat biscuit will digest slower to tide you over till lunch... ..
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Actually the fat content of the chocolate can slow down absorption. Plain digestives are better, or as @rebrascora suggests, dried fruit etc
 
rebrascora said:
My guess is that you probably stopped it with the crispbreads before you hit the red but Libre is just slow to show that, but something with a little more sugar would work a bit quicker to stop the drop. A handful of sultanas or raisins, or a couple of dates if you like them, or a biscuit.... or even a jelly baby or 2. My guess is that you may now go high as the crispbreads continue to release on top of your Dextrose.
Do you know why you dropped like that? Have you been particularly active after breakfast?
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Have been a bit more active at work, maybe that's the reason, just wish I could get steady readings throughout the day, at the moment I get spikes then it slowly comes down then all of a sudden it drops like a stone...ho hum
 
My experience has been that hypo type responses such as Dextrose or JBs work well but need a lower GI snack to consolidate the recovery. It isn't completely intuitive: why, if the JBs have worked is anything else needed? But for me it always is needed; I wait to see the turn round then find a modest extra snack such as a plain biscuit or even one finger of kitkat. How big (modest) the snack is influenced by what else I'm doing; if very sedentary then loads of self control and 1 simple biscuit, but if a full on day I'm often snacking through until the next proper meal. In effect I'm chasing the insulin, but I'm very comfortable with that principle because my CGM allows me to monitor what is going on.
 
Chasing the insulin, I know what you mean, find myself snacking most of the time till my next meal so I'm not taking my insulin when my readings are low.
 
Charl said:
Have been a bit more active at work, maybe that's the reason, just wish I could get steady readings throughout the day, at the moment I get spikes then it slowly comes down then all of a sudden it drops like a stone...ho hum
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Do you have any thoughts as to why you're getting the spikes? Are they post-meal or rebound spikes because you've overtreated a previous drop (been there done those, especially the latter when sitting around waiting for blood sugar to recover isn't very useful.)

If you're needing to snack between meals you might want to reduce your basal dose or check whether you're giving too much bolus for your meals. Both of which will cause problems if you're very active during the day.

I get the comes-down-slowly-then-drops-like-a-stone at the weekend if I'm not doing anything and then suddenly do go and do something (even just a quick walk around the block)

P.S. I'm also with the chocolate biscuits/KitKat/etc., I don't find chocolate all that slow to be absorbed and it does taste nice, one must seize these opportunities. Whether it significantly slows the absorption of the slower carbs in the biscuit substrate I don't know, but as long as the chocolate does its thing in good time I'm happy. I would opt for something like skittles or jelly babies if I'm dropping very quickly or already low though.
 
That looks in need of a Kit Kat @Charl Although chocolate is low GI, in some confectionery it’s not that low GI at all due to added sugar to the chocolate and accompanying biscuit. Possibly I’d have had a Dextro tablet first if I felt it was dropping first, but then a Kit Kat or similar or a flapjack bar would be my next thing. You might need to adjust the amount eg 1 and a bit flapjack bars, etc, but I find that kind of thing works well. It must have a good mixture of sugar and fat.
 
For me, I do not have enough information in the numbers above to advise.
For example
- what does the graph look like when your levels are at 4.7? Was it flattening off or was teh trend significantly downhill? I know the numbers have arrows but I find these of little use as they don't take into consideration enough "history". This is illustrated with the down arrow in the 10.0 when the next number is higher.
- when did you last eat? If you had eaten within the last hour (and the graph had not peaked), iti s possible you had enough carbs on board so didn't need a snack.
- when did you last inject and how much? I would treat a 4.7 with 2 units of insulin on board (still active bolus) than a 4.7 with no insulin on board (not injected in the last 4 hours).
- what activities do you have planned? Again, I would treat a 4.7 to be followed by exercise (lifting boxes, doing the housework, etc.) differently to 4.7 followed by my favourite TV show.

I think we are looking for a rule that satisfies every "under 5.0" reading. But we need to think beyond the single reading.

And all of this would determine whether I would "nudge up" the 4.7 with a single dextrose or whether I would have a finger of kitkat too or do nothing.
As for the fat in chocolate slowing down the carb absorption, bear in mind plain (chocolateless) digestives have a high fat content - I wouldn't expect the chocolate on one to make much difference.
 
SimonP said:
Do you have any thoughts as to why you're getting the spikes? Are they post-meal or rebound spikes because you've overtreated a previous drop (been there done those, especially the latter when sitting around waiting for blood sugar to recover isn't very useful.)

If you're needing to snack between meals you might want to reduce your basal dose or check whether you're giving too much bolus for your meals. Both of which will cause problems if you're very active during the day.
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@Charl,
Notwithstanding the advice from @SimonP be very wary of altering your basal.

As I've mentioned a couple of times now: with Tresiba you are trying to achieve steady BG during the nights and accepting that you must adjust your bolus (or use exercise) to regulate your BG during daytimes. Changes to Tresiba take up to 3 days to have an effect whereas changes from bolus give a result over the 4-5 hr profile of that bolus. Tresiba needs a different mindset than that used by others on shorter profile basal insulins. That can sometimes not be understood by people relating their experiences on other insulins and thus potentially giving misleading advice.

Your Tresiba doses are not fixed forever. There sometimes is a need to tweak your Tresiba doses and that is fine. But my experience is that such changes are few and far between - for me at most 3 or 4 times in a year - once you've found that optimum Tresiba dose for steady nights. I haven't had to change my Tresiba for at least 9 months.
 
Sorry, I wasn't aware of which basal insulin we were talking about!

For abasaglar (lantus) if I knew I had a particularly energetic day coming up I would reduce morning basal for that day, but I split dose and have been doing this for a while. Assuming you're using Tresiba then this won't work for you so please heed @Proud to be erratic 's advice.
 
SimonP said:
Sorry, I wasn't aware of which basal insulin we were talking about!

For abasaglar (lantus) if I knew I had a particularly energetic day coming up I would reduce morning basal for that day, but I split dose and have been doing this for a while. Assuming you're using Tresiba then this won't work for you so please heed @Proud to be erratic 's advice.
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It is interesting how we are all different as for me on split dose Levemir I need to reduce the evening dose after exercise otherwise I will hypo during the night, rather than the daytime dose. If I exercise 3 days in a row, I need to reduce my evening dose down to 0 (usually it's about 3-4 units) and sometimes I will still hypo unless I push my BG up to 10 before bed, even though 20units in the morning holds me steady during the day. It is one of the reasons why I believe Tresiba would not suit my body, because on those days I would likely be hypoing through the night on any dose of Tresiba but need masses of quick acting insulin during the day to prop it up. I absolutely love Levemir for enabling me to adjust it and important to recognize that not all basal insulins suit everyone and whilst it is important to understand how they work from their profile, it is also important to understand how your individual body works and figure out from the two, which insulin will be likely to suit you as an individual and how best to adjust that insulin so that it works optimally for you within that profile of action.

I totally agree with @Proud to be erratic that Tresiba needs to be adjusted to suit night time needs, but if you are like me and your night time needs are very low and sometimes zero because your muscles are sucking glucose out of your blood whilst you sleep, then it isn't a good choice for everyone, just like Levemir or Lantus or Toujeo may not be a good choice for everyone. We are so lucky here in the UK that we usually have the opportunity to try different basal insulins if our first prescribed insulin doesn't work well for us. I think understanding the different basal insulins and finding what works for your body and lifestyle is key to good management.
 
By reducing the morning dose I end with a less active insulin for that ~24h period, so during that day and overnight, at least that's my working hypothesis, it may be wrong! 🙂

When I used to do a single dose before bed I would need to reduce that to avoid going hypo the night after exercise (and I would taper it back over a few nights if not doing much exercise). If I'd not reduced it the night before the exercise I would end up needing to eat constantly while riding.
 
SimonP said:
By reducing the morning dose I end with a less active insulin for that ~24h period, so during that day and overnight, at least that's my working hypothesis, it may be wrong! 🙂
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It depends on your basal insulin, how big the dose is and when you take it. Levemir is short of the 24 hours by quite a bit (depending upon the dose) smaller doses last a shorter time than larger doses. There is a really interesting 3 dimensional graph somewhere which explains it based on insulin to bodyweight ratio and when the peak of activity is likely to hit.
I don't know enough about Lantus to know how different it is to Levemir but I believe it is slightly different in it action/profile..... but of course our bodies are all different too in how they respond. I just know what works for me and reducing the evening dose seems to be the important adjustment for me. Also I can never be sure that I will fit exercise into the day. I tend to be more spur of the moment as planning is not my strong suit, so at 7am when I inject my Levemir, I have no idea what I am going to get up to that day, whereas at 10pm, I know what I have done!
 
Absolutely it does depend, I was just commenting on why I do what I do, but as you say we're all different. fwiw I take a total of 18 units a day (I weigh 82kg). I take the morning dose sometime between 6am and 9am (depending on when I get up, which is changeable depending on school run, work/WFH days, holiday) and the evening dose between 10pm and midnight (depending on when I remember to look at my phone and see the reminder/when I get home if out - rarely these days)

If you can find that 3D graph I'd be really interested to see it (perhaps I can then find something similar for what I'm using), I'm basing my changes on an assumed and simplified activity curve that I pulled out of XDrip+ (though I'm pretty sure I also found a similar shaped thing in the medical notes for the insulin, just the XDrip+ curve was simpler to plot, I'll have to have a look)

I usually know if it's going to be a long day on the bike as I need to leave shortly after doing my morning dose and eating breakfast, certainly more so than when I previously had to decide the night before, risk running high over night and then if I didn't feel like it the next day would have to take some extra insulin to make up the shortfall - hence the decision to move to split doses seemed like a sensible thing to do (and I'd already been practising.)

P.S. I'm surprised there's no tools available to help people make these decisions, you'd have thought that for the standard long acting insulins it would be fairly straight forward for the NHS to prepare some curves and then it's a question of combining those with some actual or assumed insulin sensitivities throughout the day. Not super easy, but would be quite useful as guidance as otherwise changing dosages at one end of the day sometimes has unexpected consequences when the peak/plateau occurs significantly later and the overall duration is also very long, plus stacking from multiple days.
 
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Thanks @Inka. I don't think anything similar is available for other basal insulins though is it?
 
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