Lowering my Post-Meal Bloodsugar

[belyro]

I have a question that I thought of putting in one of the current threads on post-meal bloodsugar, but decided it might warrant its own thread.

For those of you out there who are able to have bloodsugar levels anywhere from the 5s to the 7s (90s to 120s) two hours after a meal, do you snack in between meals or does it just stay there. How do you keep from going hypo before your next meal?

I'm looking particularly for responses from people who are on MDI like me, but would like to hear from pumpers too.


Thanks!

[NoelD]

I do not snack between meals. Only if I get hypo. I do not go hypo between meals normally, because I get an exact bolus for the exact number of carbs I am eating, or as close as possible.

[cheryl]

It is kind of hard with Humalog, I know I am there, I am still trying to work on my basal to perfect them.....also, I do drop too before my next meal, I just wait and see if I do, like for instance today for some reason my post meal was a bit high, it was 163, but then when it was lunch time it was 69, I know so confusing............Humalog has the lovely tail end to it, it kind of lasts too long in the system. I am so curious to try Apidra because it only lasts like 2 hrs so there is no worrying about 4 hrs later going low, and then if you do something is up with the basal insulin.......Are you sure your on the right amount of basal insulin? I learned this the hard way, cause if your not then you can never get it right till you are!!! I am sure you know that, but my dr has lowerd my Lantus to see if this will help since I am constantly in the 50's and some 30's or 40's.........and he also told me it takes 3 to 4 weeks on Lantus to see if the dose is correct so I have to experiment with 18 units now for about 3 to 4 weeks to see if this is the correct amount.......

Cheryl

[jen_slc]

Bethany, I struggled and struggled to get my post-meal levels below 180 (yup, I couldn't even get them that low! I didn't know how others here could do it!) and it never happened while I was on Humalog or Novolog... and if it did, it was because I had over-bolused at mealtime and ended up hypo 3-4 hours later. I eventually gave up and decided that this was the way my body was going to be. Oh well. Then my doctor suggested I try Apidra.

I've said it plenty of other places here, but I'll say it again. I absolutely love Apidra. I know others don't and I do think rapid insulins work very differently among us. It might be something to try? With Apidra, my post-meal levels at 2 hours are pretty well consistent at 115-140, sometimes a little bit higher, sometimes a little bit lower. If I was at this level on Hum or Nov, I'd be heading for a hypo. But not with Apidra. I come in at this level at the 2-hr mark, and at 4, 6, 8 hours later, I am still there. It's fantastic, and unheard of for me before on the other insulins.

Oh, and I don't snack... I don't do anything.... the levels just stay there on their own. Fabulous!

[Injecto]

I've got the same problem as you belyro...I too want to hear how some people do it.

jen_slc, what is Apidra?

[Scratch]

Here's what you need to know to figure out what you want to do.

Know your insulin units:grams of carb and insulin units:blood sugar adjustment ratios, and decide on what your diet is going to be like, and you also need to be comfortable with how your body typically handles Humalog. Probably easiest for me to explain this all is to use my own handling of things. You'll also need to know your BGL before shooting up and what your target BGL is going to be.

Once I get to lunchtime, my insulin:carb ration is 1:10. For bolus corrections, I can expect 1u of Novolog to drop me 35 mg/dl. Now let's say my BGL is 100 mg/dl testing before lunch, and I'm going to have a meal with 40g of carbs. That's 4u of Novolog to get me back to 100 mg/dl if that's my target number.

If I were to inject the 4u of Novolog, I am pretty confident that 70% of it will have been used 2 hours after the injection. 70% of 4u is 2.8, so 2 hours after the shot I would have 1.2u of Novolog remaining. Approximately. Still, if I've eaten something reasonable without too much fat along with the carbs, I can be reasonably confident that when I test at 2 hours after the shot that any insulin remaining from the bolus will be working just like a correction bolus. So 1.2 * 35 = 42 mg/dl. 2 hours after that shot and eating that meal, I would expect to be around 142 mg/dl.

But hopefully to help you understand what's going on, imagine if I'd selected 65 mg/dl to be my target after that premeal test of 100 mg/dl. So instead of 4u, I would have shot up with 5u to get the 35 mg/dl of correction from 1u additional. If I had done that, at the 2 hour mark after the lunch bolus, I would expect my blood sugar to be around 117 mg/dl, since 70% of 5u is 3.5u which means 1.5u remaining. 1.5 * 35 = 52.5 mg/dl of action left to go, and adding that to my target of 65 mg/dl gives me the 117 mg/dl.

I hope that helps some. I don't know if I really explained it well, it's something I don't have to think about too much now that I've become accustomed to it.

But if you look at that, you might see that the way to potentially get the numbers lower 2 hours after a meal is to bolus some extra insulin, do your test 2 hours after and then from there work out how much of a snack you may need to keep from dropping low. But you should only go mucking around with overbolusing if you are confident that you'll be in a good position to take care of yourself in case of hypoing and only if you are confident with your numbers, ratios, and typical insulin uptake profile.

I'll often do overbolusing when I'm at work and know I can safely have snacks during the afternoon.

[Gangrel]

Scratch, that's all well and good, and I think belyro has her carb ratios and fix ratios down. What we are just wondering is how you can eat, bolus, and have a 2hr reading of 5-7, and not go low in the next two hours, with no snacking?

If i eat 40gs of carbs, I take 4u. I will shoot up to 10, then back down to 4-6 on a good day. IF I take MORE Hlog, i'll be lower at the 2 hr mark, probably 6-8. but then 2 hours after that, due to the extra Hlog, I'd be 2 or 3......

We're wondering if it's possible to have such tight control on Humalog MDI, or if we're stuck shooting for 10.0......

[Scratch]

Scratch, that's all well and good, and I think belyro has her carb ratios and fix ratios down. What we are just wondering is how you can eat, bolus, and have a 2hr reading of 5-7, and not go low in the next two hours, with no snacking?

If i eat 40gs of carbs, I take 4u. I will shoot up to 10, then back down to 4-6 on a good day. IF I take MORE Hlog, i'll be lower at the 2 hr mark, probably 6-8. but then 2 hours after that, due to the extra Hlog, I'd be 2 or 3......

We're wondering if it's possible to have such tight control on Humalog MDI, or if we're stuck shooting for 10.0......
Well the point is this: if you eat more carbs, you're going to have more insulin that needs to be taken. More insulin taken equals more insulin remaining equals more that that blood sugar will still come down after the 2 hour mark.

If I take 4u, there'll be 1.2 units or still 42 mg/dl of drop left. 5u = 1.5u remaining or 52.5 mg/dl drop remaining. See what's happening? Which gives you two principles to consider if you want your postmeal numbers to be closer to normal --

1. eat fewer grams of carbs
2. take more insulin but be prepared to have a snack to cover the remaining insulin.

Those aren't mutually exclusive options, both can be used to the degree that one finds comfortable. But you need to observe enough data to establish what your bolus insulin profile is like and have your numbers. You then need to figure out what you want to target for, and once you know that, what you'll have to do to get the numbers in that target. Some may choose to reduce their carb intake. I aim for that by trying not to go hogwild and eat meals with a huge load of carbs that'll take larger shots of insulin to cover. But I also sometimes aim for some extra insulin when I want to indulge a bit more.

It's a pain in the arse. It's just what I've been able to develop for myself as I collect the data. And I expect my next A1c to be around 6 or better.

[cheryl]

Hey, I noticed if for instance breakfast I eat my oatmeal apple with peanut butter what not I can be 120 2 hrs later and then about in the 80's like by lunch.......I think it is the balance of your protein with the meals sometimes. Like pizza I know for me this is not all, I have to have to drink a soda with pizza wonder why cause pizza is so slow to absorb that the soda, fights the hypo, and all and then by the two hr mark I am a little lower than when started and then by four hr's I might be a little higher but not that bad.......food and balance has a lot to do with it also, it is trying to find what works is the key easier said then done cause it always doesn't work out for me either, but a lot better sometimes.........

Cheryl

[belyro]

Bethany, I struggled and struggled to get my post-meal levels below 180 (yup, I couldn't even get them that low! I didn't know how others here could do it!) and it never happened while I was on Humalog or Novolog... and if it did, it was because I had over-bolused at mealtime and ended up hypo 3-4 hours later. I eventually gave up and decided that this was the way my body was going to be. Oh well. Then my doctor suggested I try Apidra.

I've said it plenty of other places here, but I'll say it again. I absolutely love Apidra. I know others don't and I do think rapid insulins work very differently among us. It might be something to try? With Apidra, my post-meal levels at 2 hours are pretty well consistent at 115-140, sometimes a little bit higher, sometimes a little bit lower. If I was at this level on Hum or Nov, I'd be heading for a hypo. But not with Apidra. I come in at this level at the 2-hr mark, and at 4, 6, 8 hours later, I am still there. It's fantastic, and unheard of for me before on the other insulins.

Oh, and I don't snack... I don't do anything.... the levels just stay there on their own. Fabulous!

Actually I've been hearing more and more about Apidra and am potentially interested in trying it. I don't think it's available in Canada though. :( Hopefully soon.

[belyro]

1. eat fewer grams of carbs
2. take more insulin but be prepared to have a snack to cover the remaining insulin.



I've been experimenting with #1, and so far it's not working well. It seems that my insulin needs do not decrease at the same rate as I decrease my carbs for some reason. It's becoming frustrating.

I don't really like to have to eat a snack because sometimes I don't feel like it or it's not convenient, etc.

I might just have to fiddle around with my ratios on lower-carb and see if I can make it work.

Thanks for the input!

[Gary_W]

Very interesting stuff.

Scratch - thanks for the maths breakdown; helps to clarify things for me on this subject.

Personally, I'm on novorapid which is supposed to be a bit quicker than humalog. I find with most meals that it is all used up by about 2.5 to 3 hours. Certainly once I get to hour 3, my BG does not seem to go any further south.

If I'm low at hour 2, I sometimes go hypo, sometimes not. I am guessing it is to do with the GI of the meal you have eaten, though I'm willing to listen to other theories ;)

Which brings me to Apridra. I'm really interested in this and would like to find out more. I like the idea of something that works like crazy for 2 hours and then leaves you alone. I would imagine the only problems come if you have eaten a nice, healthy, low GI meal (or something awkward like pizza etc). Would apridra make you immediately hypo and then leave you high as a kite two hours later?

Belyro - do you try and eat low GI? If your carbs for a meal come from the slow stuff like beans, is your 2 hour BG better than if your carbs came from pasta?

Gary

[belyro]

Very interesting stuff.

Belyro - do you try and eat low GI? If your carbs for a meal come from the slow stuff like beans, is your 2 hour BG better than if your carbs came from pasta?



I haven't tried to eat low-GI yet, Gary, but I'm going to see a dietician tonight and want to bring that up with her.

Thanks!

[Gary_W]

Hope it helps you :)

There's lots of websites that can give you a good start. I got some little pocket books over here in the UK that were about £4 each and give basic details of GI as well as carb content.

From what I understand, including some of the slow release stuff in there with each meal can help to spread out the food absorbtion rather than having it peak badly. I guess if it peaks whilst your insulin is still only 1/2 way through working then it explains the 2 hour high, 3 hour low. Or it does to me. Not that I know much these days! Anyway, I try to throw chick peas or beans of some kind into pretty much everything I cook these days.

Don't seem to have many friends left for some reason....

Gary

[johgn]

Diet makes a HUGE difference for this, I know I struggle with it.
If I have soup & salad for lunch (about 5 days a week), my BS spikes
up pretty quick (mainly from the soup) but steadily drops after about 1 hour.
If I have a sandwich it stays a little more steady. I hardly ever eat anything like pasta though.

[cheryl]

Diet makes a HUGE difference for this, I know I struggle with it.
If I have soup & salad for lunch (about 5 days a week), my BS spikes
up pretty quick (mainly from the soup) but steadily drops after about 1 hour.
If I have a sandwich it stays a little more steady. I hardly ever eat anything like pasta though.

Hi, what does pasta do to you, I know type 2's have this issue, but I see your type 1, I can eat it and I do ok with it......aslong it is just 1 cup of it that is, Just wondering why it affects type 1's,

cheryl

[belyro]

I hardly ever eat anything like pasta though.

But I LOOOOOOVE pasta.... :(

[johgn]

Hi, what does pasta do to you, I know type 2's have this issue, but I see your type 1, I can eat it and I do ok with it......aslong it is just 1 cup of it that is, Just wondering why it affects type 1's,

cheryl


It just goes to my blood sugar too quickly and I'm not comfortable taking a huge injection of humalog. Although I do usually have an apple or a banana for dessert.

[soso]

Bethany
I do 2 units of Novorapid to 16-20 g carb per meal...I am great at 2 hrs, but start to drop into the low 4s and even 3's sometimes in the 3rd hr pp.
What I do is either have 2 slices of apple(about an ounce) @ about 3 hrs or if I am walking or working or otherwise busy i eat 2-4 smarties (candy coated chocolate buttons) both things seem to work.. If I don't do that, I eventually recover when my liver cranks up enough, but I feel terrible, tired and have a cracking headache that persists even when my bg is normal again...I try to head it off while I am in the high 4's and then all is golden...
Just got my latest A1c 4.9 (first one since using insulin)
ss

[jen_slc]

That's too bad that Apidra is not yet available there... maybe soon? How about Novolog? That, at least, was an improvement from Humalog for me. But still, on Novolog, I had to just put up with higher 2-hr postmeal readings because I would rather be on the higher end for 2-3 hours and return to normal at 4 hours than deal with hypos after every meal (I hate snacking when I don't want to... and I never want to when I have to, if you know what I mean). We shouldn't have to feed the insulin.

[BlueSky]

..... If I were to inject the 4u of Novolog, I am pretty confident that 70% of it will have been used 2 hours after the injection. 70% of 4u is 2.8, so 2 hours after the shot I would have 1.2u of Novolog remaining. Approximately. Still, if I've eaten something reasonable without too much fat along with the carbs, I can be reasonably confident that when I test at 2 hours after the shot that any insulin remaining from the bolus will be working just like a correction bolus. So 1.2 * 35 = 42 mg/dl. 2 hours after that shot and eating that meal, I would expect to be around 142 mg/dl. .......
It would be so cool if it actually worked like that! But the harsh reality is that, for many of us, it simply doesn't. Much of the discussion above highlights the fact that balancing the action of short acting insulin against a glycemic load is is very difficult. Absorption rates are inconsistant and easily altered. And this makes results unpredictable.

With Regular, we were restricted to eating low glycemic high fat/protein food, which is essentially well suited to the dysfunctional diabetic metabolism. The effects oin blood glucose are minimal. Quicker acting insulin has added some flexibility to food choices. But, unless we want to do numerous 2+ hour corrections, we are obliged to eat carb heavy, fat deficient meals. Which is really a counter-productive way for diabetics to be eating, because of the BG spiking it causes.

The short acting insulins are great for using with a pump. But, IMHO, using them with MDI is more trouble than it is worth. I have reverted to using Regular for pre-meal bolusing. And I am using Novolog for corrections. It works much better.

Bethany, reducing your carbs to minimise post-prandial spikes is a good idea. But you should be replacing the calories with fat and protein. This will change the glyceamic action profile of the meal. And you may find that you need to cover these meals with a longer acting insulin. :wink:

[tanyatype1]

Hi Belyro! Do you ever get a tinch low but just leave it be to see what happens? Or do you always treat it immediately? Sometimes, like tonight with my buttery popcorn, I was 4.1 at the two hour mark and did feel a little funny. I didn't treat the low though and a half an hour later, I was up again to 5 something. I just tested again and I'm 7.1.

[HelenM]

I use lantus and Novo rapide and have a Ac1 of 5.
I don't snack between meals unless I'm low from exercising. I take controlled amounts of dextrose whilst I'm exercising. I do try to keep my BS very low and don't always correct but as Tanya says leave it and see what will happen.
I'm sure that part of my relative ease of control is that lantus works very well for me. I take it at about 6pm and it lasts for about 22 hours so I sometimes see a rise in BS late afternoon onwards but otherwise my BS is fairly steady after the mealtime fast acting has stopped working. Last night, I was reluctant to eat a snack and I went to bed with a BS or 79 without too much fear (my doc says that I should eat if lower than 90 at night) and woke up at 71
My lantus dose was worked out after a stay in hospital , where everything was monitored and I've only had to alter it a bit when I've upped my activity levels. I'm sure the right dosage is crucial.
Like Garry, I do try to eat low GI. although I don't add chick peas etc (yuk!). I have also found it impossible to eat pasta or noodles without going too high after a meal (and without taking more insulin than the carbs would suggest) so I avoid them. I do sometimes find that my 2 hour BS level in the evening is lower than my 3 hour BS level so I don't correct unless its very low. (thats maybe the wine I drink with dinner).

If you're interested in the gi index their website has a useful database The Glycemic Index (http://www.glycemicindex.com/)

[johgn]

I would also say if you're eating pasta and you're controlling your BS OK, then who cares.

[belyro]

That's too bad that Apidra is not yet available there... maybe soon? How about Novolog? That, at least, was an improvement from Humalog for me. But still, on Novolog, I had to just put up with higher 2-hr postmeal readings because I would rather be on the higher end for 2-3 hours and return to normal at 4 hours than deal with hypos after every meal (I hate snacking when I don't want to... and I never want to when I have to, if you know what I mean). We shouldn't have to feed the insulin.

Jen...I might still be able to get it because my endo is licensed to write U.S. prescriptions, and it's only a 3-hour drive to a good U.S. pharmacy for me (along with some U.S. shopping!!), so I might still look into this. Thanks!

[belyro]

Hi Belyro! Do you ever get a tinch low but just leave it be to see what happens? Or do you always treat it immediately? Sometimes, like tonight with my buttery popcorn, I was 4.1 at the two hour mark and did feel a little funny. I didn't treat the low though and a half an hour later, I was up again to 5 something. I just tested again and I'm 7.1.

Tanya, sometimes I have been leaving it....and it really depends on the time of day and what activity I'm having. If my humalog is still acting, it definitely does keep coming down. If it's not, and I'm just sitting on my butt, it *may* stay, but not always.

[belyro]

So I met with a dietician last night, and she suggested going "lower" carb (as opposed to "low" carb). She recommended 130-150g per day which is very do-able for me. She also highly recommended low GI. So I'm going to give both of those a try and see what happens.

I also may eventually look into giving the Apidra a try, but we'll see.

Thanks for all your suggestions!

[Scratch]

It would be so cool if it actually worked like that! But the harsh reality is that, for many of us, it simply doesn't. Much of the discussion above highlights the fact that balancing the action of short acting insulin against a glycemic load is is very difficult. Absorption rates are inconsistant and easily altered. And this makes results unpredictable.

With Regular, we were restricted to eating low glycemic high fat/protein food, which is essentially well suited to the dysfunctional diabetic metabolism. The effects oin blood glucose are minimal. Quicker acting insulin has added some flexibility to food choices. But, unless we want to do numerous 2+ hour corrections, we are obliged to eat carb heavy, fat deficient meals. Which is really a counter-productive way for diabetics to be eating, because of the BG spiking it causes.

The short acting insulins are great for using with a pump. But, IMHO, using them with MDI is more trouble than it is worth. I have reverted to using Regular for pre-meal bolusing. And I am using Novolog for corrections. It works much better.

Bethany, reducing your carbs to minimise post-prandial spikes is a good idea. But you should be replacing the calories with fat and protein. This will change the glyceamic action profile of the meal. And you may find that you need to cover these meals with a longer acting insulin. :wink:
Yes, there is variability in the metabolic systems for diabetics, which is why I strongly recommend for people to collect the data. What is working for me may not be appropriate for others. The only time I have trouble with delayed digestion from a meal is if I eat one with high fat content -- if I keep fats to a minimum I can get very good results using Novolog for my meal bolus insulin, and personally I prefer that greatly over the variability and long profile of R insulin. I very much prefer having a bolus insulin that's gone in 4 hours, and if that one viaject(?) comes to market and works in 2 hours like it's supposed to, I'm going to be knocking down my doctor's door for an RX.

Still, when you get down to it, none of this is really what is needed: an actual cure that restores a reactive system. The tools we are using to simulate the body's system are crude, clumsy and subject to too much user error.

[Lilly164]

Possibilities?
Before you eat, how soon are you taking short-acting Insulin?
What about your Levimir dose? How much is on board during a low? Have you tested to see if your BG remains level during a 5-6 hour fast?


Lilly

[belyro]

Possibilities?
Before you eat, how soon are you taking short-acting Insulin?
What about your Levimir dose? How much is on board during a low? Have you tested to see if your BG remains level during a 5-6 hour fast?


Lilly


I take my short-acting insulin while I eat. I can't take it sooner because I never know how much I'm actually going to feel like eating, and the *worst* is forcing myself to eat when I'm not hungry.

My levemir is great. I've done a few basal tests and all show me that my amount is perfect.

[DanG]

... and if that one viaject(?) comes to market and works in 2 hours like it's supposed to, I'm going to be knocking down my doctor's door for an RX.

I would really like that 2 hour stuff also.
In reading this thread, I am thinking about the "tail" on humalog.
My routine is 5 units breakfast/supper and 12 at lunch. Why?
Why does it take 12 at lunch when I am not eating any more than my breakfast or supper?

I read one thread here recently that spoke of the "tail" on humalog. I think that "tail" is a pain to deal with. I am thinking that the 12 from lunch has a tail that probably lasts a good 8 hours and becomes problematic as it is acting during/after supper. Then 5 at supper keeps going on into my sleep hours and I am waking at 100 lower than when I went to bed - not so much due to lantus, but the "tail" from humalog.

If my understanding of "tail" is correct, I am thinking that "tail" is different in each individual. For instance: I can take my lunch 12 units 45 minutes prior to lunch and no reaction is evident. The peak seems to be sooo slow, I never see it for lunch, but I am wondering if the "tail" carries on into supper and beyond, and then supper humalog goes into my sleep hours.

Bottom line: I want an effective short acting mealtime insulin. I have read hear about apidra, which is same manufacturer as lantus, I think (aventis). I believe the apidra users are saying apidra peaks and then leaves you alone - no tail. I want that, if that is a correct characterization.

[BlueSky]

If you get rid of the tail in Humalog/Novolog, you will start having problems with protein/fat in a meal pushing up you BG 3+ hours after eating. If you aren't using a pump, you will have to inject a second time for meals containg low GI carbs and significant amounts of protein/fat. Which is also very limiting ....

[belyro]

If you get rid of the tail in Humalog/Novolog, you will start having problems with protein/fat in a meal pushing up you BG 3+ hours after eating. If you aren't using a pump, you will have to inject a second time for meals containg low GI carbs and significant amounts of protein/fat. Which is also very limiting ....

Does this happen with Apidra?

[grace girl]

Very interesting thread! I find that I'm generally around 175-180 two hours after most meals, and if I'm even as low as 140 I will go low before the next meal.
The thing is, there are so MANY factors involved: what I ate, how active I was before the meal, how active I am after the meal, what time of the month it is (oh goodie!)....and sometimes I think the cycle of the moon must have something to do with it, too! It's such a balancing act sometimes!
I hate eating when I don't want to, and there are times that I want to eat, don't want to bolus, and know I really, really shouldn't!
If you get it figured out, please let me know!

[jen_slc]

Does this happen with Apidra?Yes, I have noticed this problem on the rare occasion that I do eat a high(er) protein or extremely high fat meal. Being the semi-vegetarian I am, my meals are primarily carbs and I don't have a problem with this, even with the lower GI foods. The protein I do eat isn't enough to have this effect most of the time, and I try to avoid those high fat meals. Maybe for some people it takes only just a little bit of protein or a little bit of fat to raise bg levels later on, but it takes quite a bit for me, I've noticed. With those rare super high protein or super high fat meals, I usually just leave it alone and correct myself later, it's not like I've gone super high... or if I'm feeling proactive, I will shoot up another unit a little time after my meal, but I'm wary of doing that.