The post meal spike

[bennyg70]

Im sure this is something thats been discussed numerous times, but as a new member, I thought Id be lazy and start a new topic on it.

Theres so much conflicting information to the type 1 diabetic, about where your sugars should be after a meal.

Should it be after 1 or 2 hours, should it be below, 10, 9, or 7.6785736.

I find it all very confusing. So I wondered where people felt happiest with their own post meal spikes? What do you consider safe?

Im happiest if say my bloods are between 5 - 7 and I have a post spike between 7 - 8 after 2 hours. Because usually if it were lower Id end up hypo at 3 or 4 hrs. (Ive still got a lot to learn, and advice is welcomed).

And where do you feel is OK to be at the 1 hour mark too? I dont know whether I should be higher at 1 hour than 2, or the other way round!

Would love all your inputs and again thanks for all your wark welcomes on my previous post

Benny M

 

[Northerner]

I'd be happy with those numbers too Ben. I think that the point of doing the one hour test as well as the two hour is to find how quickly the particular meal is spiking and whether you need to adjust the timing of your insulin, or perhaps start omitting likely culprits from your diet. I think current thinking is (in an ideal world!) to try and avoid any spikes above 2-3 mmol/l over your pre-meal level, as it is thought it is the large variation in ievels is perhaps more harmful than a steadier and less-pronounced rise, even if at a higher level. So, peaking from 5 to 10 after an hour, but dropping back to 5 at two hours is not as good as peaking from 6 to 8 and never exceeding 8 (if you see what I mean!).

 

[everydayupsanddowns]

Hi Benny

Haven't welcomed you to the forum yet so, er... welcome!

For me, like so many things with diabetes, I guess "it depends". For all the things you mention.

If it's pizza or a massive fat-laden carb blowout from the chippy then my reading at 1 hour is only to check that I've not dipped too low. For me the food absorption of fatty meals with a high carb load is quite extended so I need to spread the bolus out over many hours to prevent being 3.x an hour after eating, then 6.x at 4 hours after eating, but 11.x after 5-6 hours.

I tend to check around 1.5 to 2 hours after eating if I am unsure how things are going, or have concerns over my carb-counting/portion accuracy. Breakfast and lunch are very similar day to day, so it's evening meals that tend to need more attention for me (though I do have issues after breakfast with my liver playing silly beggars off and on so a mid-morning test is often wise - an identical breakfast can return wildly different results on different weeks).

In simplistic terms I am relatively happy if I stay in single figures between meals (which was the advice I was given way back when I was diagnosed, though targets have tightened since). My absolute ideal is to time boluses and meal absorption with such flukey accuracy that BG remains +/- 2-3 mmol all day. Those days/weeks are incredibly rare, but put a big grin on my face.

I am less happy is a meal pushes my BG up much more than 3-4mmol/L, certainly if it does that in the first hour or two. So if I start at 4.2 and reach 9.9 at 1.5 hours I consider that a bit of a fail, even though I (just!) stayed in single figures.

As with everything, I think it's important to recognise that there is no 'one size fits all' and that it is vitally important that we 'own' our targets rather than feel they have been imposed on us from people who have no idea how hard this is to manage day to day. It's also important to give ourselves a bit of slack when other factors royally mess things up, but overall to work with what we can achieve now and try gradually to tighten things up/improve things a little at a time.

Some research suggests that reducing the variation in BG swings can be as effective at preventing complications in the long term as achieving a low average with wide variation.

EDIT: writing while Northie posted his shorter (and much more eloquent!) reply

 

[Pumper_Sue]

I try to be no more than 5.5 before a meal and no more than 8.5 two hours after.
Anything less than the 8.5 tends to make me a bit hypo towards the four and five hour mark after eating. ( I use animal insulin in my pump)

 

[bennyg70]

Great replys guys,

Everydayupsanddowns... (Is there a short version you go by!)

My situation mirrors yours, Especially the fatty food carb loaded meals..

Ive discorvered and tried dealing with this only recently, when I found Id always wake up high after going to bed with good bgs. and I related it back to the fatty meals, hence internet research and voi - la (However you spell that!).

I actually had success the other night doing it too, split my dose over a few hours and a small shot before bed and woke up in the right region, i was very very happy!

I do feel like ive had to start all over again with this now they have put me on apidra. Would be interesting to hear from others who have made the swap from Nova, too apidra.

So you know, even though ive been diabetic for 20 years its only recently ive tried to get a hold on all this, 1 hour and 2 hour post meal test are a bit of a new thing to me! I used to never test, now i get a little obsessive! But at the same time, see it as a challenge!

 

[Northerner]

Why did you change from novorapid to apidra?

 

[bennyg70]

Ive just been refered to a new DSN.

She had recomended it (Sales pitch) on my first meet with her, when i was struggling along. Within a couple of months between the next visit, Id really started to get a handle on things mainly by slashing my lantus. Plus I was learning a lot about how the nova worked when my basel was holding me a lot steadier than previous. When I went back she still wanted me to change so I thought Id give it a go for a month and see how I got on. My initial thoughts are its possibly not for me. I dont think its going to be as useful as nova for the higher fat meals etc. But I'm certainly not writing it off yet. Ive been on it a week, and can also see a couple of the beneifts. Ie, correction doses work a lot quicker which is relieving, and its definatly out of my system quicker.

benny

 

[Pumper_Sue]

Hi Ben,
some people who low carb/high fat find the best way to control their diabetes is to use the older insulin's ie, not analogs. This is due to their longer duration.
People that use pumps can extend their boluses to counter act the effect of the late onset of spike or just general rise in blood sugars. Some on MDI find the simplist option is to increase basal. So lots of options to think about.

 

[everydayupsanddowns]

Great replys guys,

Everydayupsanddowns... (Is there a short version you go by!)

I've seen EDUAD, but many people just say 'Mike' 😉

My situation mirrors yours, Especially the fatty food carb loaded meals..

Ive discorvered and tried dealing with this only recently, when I found Id always wake up high after going to bed with good bgs. and I related it back to the fatty meals, hence internet research and voi - la (However you spell that!).

I actually had success the other night doing it too, split my dose over a few hours and a small shot before bed and woke up in the right region, i was very very happy!

Another thing which might affect you with bigger meals is that your insulin:carb ratio may fail above a certain carb load - plus tha fact that higher carb meals tend to have a bigger margin for error. Someone here suggested a rule of thumb that they used which I have adopted and works pretty well, though you need to use it with caution, which is to 'add a third' to what you *think* you are eating when you calculate the bolus. I wrote about it here if you are interested: http://www.everydayupsanddowns.co.uk/2011/06/new-big-meal-strategy-thirds.html

I do feel like ive had to start all over again with this now they have put me on apidra. Would be interesting to hear from others who have made the swap from Nova, too apidra.

So you know, even though ive been diabetic for 20 years its only recently ive tried to get a hold on all this, 1 hour and 2 hour post meal test are a bit of a new thing to me! I used to never test, now i get a little obsessive! But at the same time, see it as a challenge!

The people I know who have moved to Apidra have done so to gain the advantage of its faster action and shorter profile. Generally it seems to be 'faster in'-'faster out' so might be expected to have more effect in the first hour, and be out of your system by perhaps 3.5 hours (though your own individual timings will vary of course). This will need to be factored in when splitting doses for longer-acting meals.

 

[bennyg70]

Brilliant blog, Ive read a couple of the articles, and some very familiar stuff!

Anything on how you approach split doses for fish and chips and the like? SOmething ive played aorund with recently, and I love fish and chips, especially been scared of cheese, so i call it the fish and chip effect rather than the pizza effect!

 

[everydayupsanddowns]

Brilliant blog, Ive read a couple of the articles, and some very familiar stuff!

Anything on how you approach split doses for fish and chips and the like? SOmething ive played aorund with recently, and I love fish and chips, especially been scared of cheese, so i call it the fish and chip effect rather than the pizza effect!

On MDI my approach was basically a 60:40 split. Calculate the bolus for the whole meal, including any 'extra' that might be needed for 'larger than usual' situation, then inject roughly 60% immediately before eating (or a little while before eating if a touch high to start with). The final 40% of the meal dose would be taken approx 2 hours after the meal (test before the second dose to see how things were going). Can't say it would work for anyone else, but it wasn't bad for me on several occasions.