Time or Dosage

[Charl]

Insulin taken on a reading of 7.7, breakfast on 8.3 which was granola , milk and a few blueberries, 2 hours later its still sitting high, any help as to what is the cause as it usually takes around 3 hours before its back dowh, any advice appreciated.

 

[Inka]

What’s your fingerprick reading @Charl ? The Libre isn’t so accurate at the higher end of the range.

 

[rebrascora]

There is nothing wrong with that at 2 hours. You can see insulin is starting to turn things around and bring them back down and it has another 2-3 hours of activity so may well have you back down to 7 by lunchtime.
Is there a reason why you are testing at 2 hours? I think it is easy to have the mindset that Type 2 guidance applies to those of us on injected insulin, but it doesn't. As long as your levels are back down into range by the next meal, you got your insulin right. If you want to fine tune the timing to prevent it going quite that high, then you need to give it a bit longer to work before you eat your breakfast, but going up from 8 to 14 isn't bad provided it comes down again promptly, which it looks like it is doing.

 

[helli]

The first thing to consider is your nasal. Does it keep your BG stable through the night?
If this is not correct, your bolus is taken on "unstable foundations".
If your basal is ok, you need to consider whether your BG returns to normal levels when it "runs out". You mention it takes 3 hours to come back down which suggests the dose is ok. If you took more insulin, after 3 or 4 hours, your BG would be too low.
Therefore, my, non medical, thoughts are that it is a timing issue.
If you are happy to adjust it, I would do so gradually and try to keep as much as possible the same - so eat the same breakfast and move the previous time by 5 minutes at a time.

 

[Lucyr]

View attachment 29467
Insulin taken on a reading of 7.7, breakfast on 8.3 which was granola , milk and a few blueberries, 2 hours later its still sitting high, any help as to what is the cause as it usually takes around 3 hours before its back dowh, any advice appreciated.

Insulin works for 4hrs so if it’s coming down by the time the dose wears off that’s correct. You might need to change the timing eg bolus earlier if you want a lower spike

 

[Charl]

Cheers, always thought the 2hr mark applied to type 1, back to normal now..

 

[JJay]

It can be confusing, though. NICE guidance still states

1.6.23 ​

Advise adults with type 1 diabetes who choose to measure after meals to aim for a plasma glucose level of 5 to 9 mmol/litre at least 90 minutes after eating. (This timing may be different in pregnancy – for guidance on plasma glucose targets in pregnancy, see NICE's guideline on diabetes in pregnancy.) [2015]

I used to get quite stressed by this until I learned differently from this forum!

 

[rebrascora]

Cheers, always thought the 2hr mark applied to type 1, back to normal now..

Before CGM Type 1s were generally only advised to test (finger prick) before the next meal and as long as we were back into range then, we were doing great and generally to keep meals at least 4 hours apart, because insulin lasts that long. Whatever reading you see at 2 hours is likely only the half way point of the insulin's activity whereas the carbs will have mostly released by then, so the remaining insulin will continue to work to brink that level back down.
I think there is a saying about injected insulin being the wrong insulin, in the wrong amount, injected in the wrong place at the wrong time..... or something like that. So endogenous insulin produced in the pancreas is released after food hits the stomach in small amounts that goes straight into the blood stream and works really fast to balance BG levels. We have to inject our insulin in advance because we inject into the subcutaneous fat and I believe our injected insulin is significantly slower than natural insulin, even taking absorption issues into consideration, and we have to inject it all at once or mostly all at once. This is why we will never get it as good as our pancreas used to do. Sounds like you had a success though since your levels came back down into range by lunchtime. Injecting just a bit more in advance ie giving the insulin a little bit more of a head start on breakfast will likely reduce the spike a bit more but that isn't always convenient, particularly waiting long periods at breakfast time, but 5 extra mins could mean you only spike up to 10 or 11 instead of 14.

 

[trophywench]

Yes indeed - and exactly why @everydayupsanddowns tagline refers to him impersonating a pancreas - and that thing is precisely what all of us with insulin dependent diabetes, have to do.