Spike in sugar levels

[Ep040249]

I can have 1 slice of toast in the morning and levels can rise between 6 and 10 units from whatever level I’m on but then after an hour or 2 may shoot down very quickly - a huge spike but comes back down before next meal - any ideas?

 

[Kaylz]

Your profile states you are Type 1, are you pre bolusing before your toast or injecting right before you eat? Also which type of bread are you using?
xx

 

[Sally71]

That's what carbs do unfortunately, spike you very high very quickly, and then you drop down again when your insulin kicks in. You could try doing your insulin earlier before you eat, to give it time to get working before the toast reaches your stomach and then the spike might not be so high.

 

[Ep040249]

Thanks I sometimes take insulin earlier if my sugar levels are higher when I get up before eating which helps, or take more to minimise the spike then eat something else when I see the sugars dropping... I am finding there is no pattern however and difficult to control the spikes. For eg this morning I was 3.9 when I got up and didn’t want to inject first. This is the first time I’ve joined a forum so good to share experiences thanks for your comments x

 

[Kaylz]

I find if below a certain level then a reduction in insulin like half a unit and the same pre bolus still applies, I would've personally treated the 3.9 with a glucose chew and waited until I was above 4 to inject at a reduced dose xx

 

[Ep040249]

What level do your sugar levels go up to after eating? Do you try to minimise it or do you focus on achieving the right levels before the next meal?

 

[Kaylz]

Personally I try to minimise spikes by pre bolusing and usually I'll be in range by my next meal too, I rarely go above 9mmol these days and that's on a diet of porridge for breakfast, a sandwich and chocolate biscuit (kit kat or the likes) for dinner and potatoes with tea xx

 

[Ep040249]

I never eat that amount of carbs not sure if I’m not eating enough carbs and need more insulin or mine is just super sensitive to carbs? Sometimes I take more insulin and sugars shoot down sometimes 1 point every 5 mins that scares me I’m on humalog (approx 4 or 5 units per meal) and Lantus 16 units once a day - ?

 

[Kaylz]

So you say 4-5 units per meal, are you carb counting and adjusting? Like do you have an insulin to carb ratio? How long have you been diagnosed?
xx

 

[Ep040249]

I have had it for 10 years and doc always said my average was excellent however I mainly eat the same things to try and regulate it. However I sometimes know that I need less or more for eg toast in the morning sometimes I take 3 units other days 4 it is also hugely effected how ‘routine’ my day is the ratio usually is 1 unit to 5 grams of carbs

 

[Ep040249]

It’s the spikes that worry me and how quickly sometimes they come down

 

[Kaylz]

Have you considered asking to try a different rapid acting insulin? Do you have the Libre? xx

 

[Ep040249]

No - haven’t been to hospital for 2 years they keep cancelling my appointments I will ask thanks
I have the libre and use it all the time but when I see my sugars dropping quickly I panic then eat then it stays higher than normal I think you are right about injecting earlier maybe I should take less insulin min spike and they may not drop as quick - thanks for your help

 

[Kaylz]

Are you comparing the Libre to finger pricks?
xx

 

[Ep040249]

No really focusing primarily on quickness of increases decreases rather than levels

 

[Kaylz]

I highly suggest you start comparing as the Libre isn't 100% accurate and doesn't work for everyone so you could in fact be treating things that aren't needing treated etc, always safer to check and Abbott themselves recommend this xx

 

[rebrascora]

It sounds like you may be reacting a bit too hastily to the Libre arrows. Are you aware that there is a time lag of 10-15 mins between what the Libre shows and what your BG is doing?
As regards the spikes after food and then rapid drops, pre bolussing really is key. Find time, on a weekend perhaps, when there are less work pressures, to experiment with injecting that breakfast insulin earlier.
To put it into context, I need to inject my NovoRapid as much as an hour before eating on a morning to prevent a huge spike but I only need 20 mins at lunchtime or in the evening. Also, even if I am not having any carbs (ie an omelette), I still need to inject 1.5-2 units of bolus insulin to cover Dawn Phenomenon. There are other members here who find the same but probably many people who would hypo waiting so long before eating. That is why experimenting by increasing the time between injecting and eating by 5 mins each day will help you find the "sweet spot" for you where the insulin starts working as the carbs hit your system. Having the LIbre is a huge benefit with this testing. I usually wait until my Libre shows a downward arrow in the 5s before I start eating. It will continue to drop after eating and level out in the low 4s or high 3s and then start to rise but I usually find the Libre reading is a bit lower than my finger prick BG particularly at the lower end of the scale so I don't worry if I drop into the high 3s as I rapidly come back up with the food that is starting to digest in my system and DAFNE guidance actually considers a hypo as 3.5 or below rather than the standard 4.

Timing of that injection does also vary a bit if you are starting the day low or high as you have realised, so if you are high it will often take longer for the insulin to have an impact whereas if you are low it will usually take less time and as @Kaylz says, dialling it back by half a unit is usually a good idea (if you have a half unit pen and if not, ask for one) Having that extra flexibility to fine tune the dose by half a unit is a great option.
I also agree that asking for a more modern bolus insulin might be helpful. It definitely sounds like you need a diabetes clinic appointment to upgrade your management and ideally something like a DAFNE (Dose Adjustment For Normal Eating) Course or whatever your local equivalent it. It is an intensive course but hugely beneficial. Unfortunately, with Covid, things are all on hold at the moment both with outpatient appointments and courses but I believe they are setting up virtual courses.

 

[SB2015]

No really focusing primarily on quickness of increases decreases rather than levels

Sadly our levels don’t come down as quickly as they go up. With the insulin taking some time to get going it takes a good hour to see any difference. The pre-bolusing really helps the insulin to meet the absorption of glucose head on.

I find that I need to inject about 20 minutes before breakfast, which works out as test - inject - shower - make a cuppa - eat breakfast. I adjust this if I wake with low reading and shift breakfast to the front, or if hypo just go for the jelly babies and wait then start the process. If I am high I correct and prebolus and watch that I am below 8 before eating. For evening meals it is about 30 min. BUT we are all different and I worked these times out by trial and improvement. For lunch I am rarely organised enough to get a Bolus in before eating, but I reckon two out of three meals is a good balance, and my lunch is always a lot lower on the carbs so the spikes are smaller anyway.

 

[silentsquirrel]

Sadly our levels don’t come down as quickly as they go up. With the insulin taking some time to get going it takes a good hour to see any difference. The pre-bolusing really helps the insulin to meet the absorption of glucose head on.

I find that I need to inject about 20 minutes before breakfast, which works out as test - inject - shower - make a cuppa - eat breakfast. I adjust this if I wake with low reading and shift breakfast to the front, or if hypo just go for the jelly babies and wait then start the process. If I am high I correct and prebolus and watch that I am below 8 before eating. For evening meals it is about 30 min. BUT we are all different and I worked these times out by trial and improvement. For lunch I am rarely organised enough to get a Bolus in before eating, but I reckon two out of three meals is a good balance, and my lunch is always a lot lower on the carbs so the spikes are smaller anyway.

Amused to see the other ex Maths teacher still using 'trial and improvement' rather than 'trial and error' !!

 

[trophywench]

Ah well, see Madam, the Type 2 advice to 'Test, Review & Adjust' which my old mate Alan Shanley has been advising for at least 20 years - applies equally to Type1s as it does to 2s!

Yours an ex pupil of a senior school where all female teachers were addressed as 'Madam' rather than 'Miss'.