Post breakfast blood sugars! Best Postprandial?

[klpants]

Does anyone else have trouble achieveing thier target post breakfast blood sugars? For me the post breakfast is the worst meal to achieve stable blood sugars after. I try and cover all factors:
1. carb to insulin (even tried having very little complex carbs for breakfast!)
2. exercise (both the night before and on the morning)
3. what I had to eat the night before,
4. blood sugar at time of eating:
But always very unpredictable. One morning I'll have ok BS after breakfast then the next day awful and the next day, with no explanation?

Anyone else have the same problems, have you discovered the reason why? Is it do do with the liver's function and glucogon? How can we limit the effect?

Which is the most unstable postprandial BS for everyone on the forum?

[pizzaman3]

good morning klplants----its a fine morning in pizzaland usa----------breakfast can be tricky on certain days for me allso but generaly i seem to get my bs under controll ----what i do is i eat the same food for breakfast untill i get it right ----and then i eat the same food untill i make sure it stayes right and then no mater what i do i have to increase insulin or take less------i dont wory about it i ckeck bs 15 minuts after i eat 30 minuts after and 1hour after and 1hour and 130 minuts after and 2 hours after and if any of those times my bs goes over 100 i take more humilog i dont care when i took my last shot of insulin i have been treating myself with no doc for many years ----i dont know how to spell to good so that is all i can say about it ----i like to eat the same food day after day it is easer for me to controll that way i shoot for fastings of 40 to 60 ----and post meal of under 100 allways -----and never allowing bs to go over 100 it is possible----i check 16 to 20 times a day------all a1cs non diabetec last 30 years 2007 a1c 5.1----pizzaman current bs 58---------do you eat big breakfasts they can be hard to controll ----i eat very small meals more often than big meals---even when i eat pizza most of the time ----type 1 38 years

[klpants]

Thansk for your reply, pizzaman. I eat the same breakfast everyday, 6 egg whites, 1/4 cups oats, 1 tbs peanuts and 1 tbs flaxseed, not exactly high in any of the forms of carb.
I did used to have a banana but have cut that out to try and get better am bs, still not making a lot of difference.

I'm the same, test oftten to see the patterns. But, I'm startign to think my post breakfast bs is not so much to do with what I eat and something else? Omitting the banana should have made more of a difference?

[Gary_W]

Hi Klplants,

Breakfast seems to be a tricky meal for lots of us. From what I've read here, many people tend to be insulin resistant to some extent in the morning due to certain hormones that your body deems fit to release. On top of that, the liver can do a nice slug of glucose to help kickstart your day when you don't actually need it! Also, excercise the day before can fiddle with morning numbers (not that I'd currently know :) )

A few thoughts spring to mind in your case here:

1. Have you done a fasting test to see what happens to your BG in the absence of either food or rapid insulin? If your basal is off, nothing else seems predictable (been there, bought that t-shirt).

2. What do you think your insulin ratio is in the AM compared to other times of day?

3. Protein. My body is fairly unpredictable with protein and how it affects BG. My local clinc recon that protein does not raise blood glucose at all. A big fat steak for me will still need bolus insulin, though it will not be needed until a couple of hours after the rest of the meal. I've done the maths on your breakfast. Assuming that the egg whites weigh 45g each (large ones) and assuming that your 1/4 cup and tablespoon are the same as mine then you are eating only 17g of carbs and knocking back 36g of protein. There's a bit of fat in there but not a lot. You MAY need a bit of insulin to cover that protein, you may not.

In me, I would go higher than expected later on if I just bolused for the carbs, especially as the only real source of carbs you're having (the oats) are real slow burners too. Maybe that could be your problem? Personally, I need around 1 unit per 25-30g of protein, but I find it very tricky to habitually get right. I know that Cyborg on here says he has to whack in 1 unit per 15-20g of protein (if memory serves). If you are similar and are ignoring it in your calcs then it may do the equivalent damage to your BG of 20g of carbs but over a much longer period. In me, that would turn a BG of 5 into a BG of 9, which is all it takes to foul up your morning.


As an experiment, why not try having a fairly standard breakfast (e.g. a measured bowl of bran flakes with semi skimmed), bolus for it according to your ratios and see what happens? Not suggesting you change your eating habits overnight, but eliminating the high protein percentage as an experiment will at least let you know if that is causing you problems.

4. Insulin profile. Long shot, but maybe a different insulin would suit your morning bell curve better? For me, I eat lots of carbs and consequently Apidra is a thing of wonder in the morning. Novorapid couldn't quite keep up and while my waking BG and lunchtime BG would be great I'd have a huge spike in the middle. Apidra helps with that a great deal. I would suggest if you stick to your high protein low carb breakfast that Apridra would do you in completely as it's that quick it just isn't funny ;)

Personally, I always have a grapefruit for breakfast plus EITHER cereal or wholemeal toast. Until I bought the nutritional scales, I thought I was having 60 g of carbs which I always needed 9-10 units of insulin for. This was because the carb counting book I used had the wrong figures for grapefruit. When you weigh it, it turns out that I'm typically having 85g+ of carbs each morning so my ratio is not much worse than the 1:10 that I am later on in the day.

If I go with the toast, I'll usually be around 9.0 at 1 hour and 7.2 at 2 hours. By 2.5 hours I'll be down to respectable levels. If I go with cornflakes (evil things for GI) I'll be 10-11 after an hour but down to 5.5 at 2 hours! You could argue which is worse. Personally, I'm not too bothered as I like 'em both, I feel well and my A1c is currently very good indeed.

Good luck with breakfast; hopefully you'll find a way of skinning the cat AND eating what you like!

Gary

[ngueld]

I have the same problem, Breakfast is usually the meal of the day I need to keep most stable. If i can continuously eat the same thing at the same time every morning my sugars will gradually get back to normal, however Monday's are my biggest problem day since I usually go off my normal breakfast for the weekend.

I find if I do cardio the night before, my morning sugars are a lot more on target as well.

I eat a slice of cheese and instant oatmeal everyday but the amount of novorapid i take definetly changes!

[xMenace]

I cut back on the carbs and pre-bolus. I also super-bolus but that's a pump thing. It means borrowing later basal and adding it to my bolus.

Together these have worked for me.

[rzrbks]

Yep,

Breakfast is the only meal I have to bolus at 1:7 and often still have to do 2 hr. correction. The rest of the time I cover at 1:15.

Have the same thing every morning: PB & J sandwich with coffee.

Interestingly enough, PB & J sandwich is 1:15 any other time.

[Alice]

In my case, taking Lantus in the morning, means I must wait four hours for the Lantus to be at 100%. So, sometimes I must bolus an extra unit or two during the Lantus "launch".

I just recently started doing morning fasts (still taking Lantus) to see how the basal rate was going. My first test showed I needed more basal units. Today I was even at 105...116...125...then back to 90 for about two hours before lunch. I also take a small split dose of Lantus at night that is factored into that morning fast.

I had just increased my a.m. Lantus by 3 units per endo's suggestion, (well she suggested more, but I do increases gradually to avoid the ER!) I may try a bit more in a few days and see if I'm still running good basals, or not...don't want to be too low.

But, if taking Lantus in mornings, many people forget about the 4-hour warm-up. See the package graph for a clear example, if needed.

[Cyborg]

Find out how the protein is affecting your bg. You may need to take insulin for it. Also, try bolusing 1/2 hour before you eat to give the insulin a head start...

[TenderVittleS]

Breakfast is the hardest for me too! :confused:

[klpants]

Quoting Gary

1. Have you done a fasting test to see what happens to your BG in the absence of either food or rapid insulin? If your basal is off, nothing else seems predictable (been there, bought that t-shirt).
My basal is the best I can get at the moment, as I exercise a lot, tweaking my basal just one until sends me into hypos all the time. I will try your suggestion though.
2. What do you think your insulin ratio is in the AM compared to other times of day? It's about 1.5 -2 units to 10 grams carbs, compared to 1 unit per 10 grams carbs after AM.

3. Protein. My body is fairly unpredictable with protein and how it affects BG. My local clinc recon that protein does not raise blood glucose at all. A big fat steak for me will still need bolus insulin, though it will not be needed until a couple of hours after the rest of the meal. I've done the maths on your breakfast. Assuming that the egg whites weigh 45g each (large ones) and assuming that your 1/4 cup and tablespoon are the same as mine then you are eating only 17g of carbs and knocking back 36g of protein. There's a bit of fat in there but not a lot. You MAY need a bit of insulin to cover that protein, you may not.
I agree, most people don't seem to inject for protein, but for me protein does affec the BS, not instant, probrbaly 2-3 hours after. I know it makes a big difference if the proten is lean protein or fatty, maybe that's what's going on with your steak!??

Thansk for your helpful reposnse a Gary. My moring BS has been a bit better since I ommitted the banana. If I have the banana later in the day, not much of an effect on my BS compared to AM.
I also think the female hormone cycle has a lot to do with my unpredictable BSs (and many other women's BS). I've tried to set up a diary of when this woudl happen, but unfortuanly each month is never the same! :eek:

[orsaugen]

I had the same trouble with post-breakfast BG until I started taking my breakfast Humalog bolus 30 minutes before the meal. At 15 minutes before the meal, the glucose would shoot sky high. Now it stays perfectly flat and I am a heppy ket.
-Olaf

[Gary_W]

Quoting Gary

1. Have you done a fasting test to see what happens to your BG in the absence of either food or rapid insulin? If your basal is off, nothing else seems predictable (been there, bought that t-shirt).
My basal is the best I can get at the moment, as I exercise a lot, tweaking my basal just one until sends me into hypos all the time. I will try your suggestion though.
2. What do you think your insulin ratio is in the AM compared to other times of day? It's about 1.5 -2 units to 10 grams carbs, compared to 1 unit per 10 grams carbs after AM.

3. Protein. My body is fairly unpredictable with protein and how it affects BG. My local clinc recon that protein does not raise blood glucose at all. A big fat steak for me will still need bolus insulin, though it will not be needed until a couple of hours after the rest of the meal. I've done the maths on your breakfast. Assuming that the egg whites weigh 45g each (large ones) and assuming that your 1/4 cup and tablespoon are the same as mine then you are eating only 17g of carbs and knocking back 36g of protein. There's a bit of fat in there but not a lot. You MAY need a bit of insulin to cover that protein, you may not.
I agree, most people don't seem to inject for protein, but for me protein does affec the BS, not instant, probrbaly 2-3 hours after. I know it makes a big difference if the proten is lean protein or fatty, maybe that's what's going on with your steak!??

Thansk for your helpful reposnse a Gary. My moring BS has been a bit better since I ommitted the banana. If I have the banana later in the day, not much of an effect on my BS compared to AM.
I also think the female hormone cycle has a lot to do with my unpredictable BSs (and many other women's BS). I've tried to set up a diary of when this woudl happen, but unfortuanly each month is never the same! :eek:

Hi Klpants,

Sounds like you really are walking a bit of a tightrope there. As far as the excercise goes, I can't really comment these days as (apart from taking the kids to the park) I don't get a great deal. I need to work on that.

Thanks for the thoughts on lean vs fatty protein. I hadn't considered that. I must admit that egg white omelettes are not something I go for (first time I heard of them was on at a conference in the US a couple of years back when an American colleague ordered one for breakfast. I asked if I could have an omelette + the yolks from his :D ).

Also, as far as female hormones go I can't help; just as well as I can be irrational and moody with no chemical help whatsoever ;)

It's so hard spotting patterns when things go to pot. I know that my numbers have gone off a bit over the last couple of weeks, but there has been a fair bit of stress and a couple of nice bugs doing the rounds here so it's not surprising.

Good luck with spotting the pattern here and hope it improves for you soon.

Gary

[hstavisky]

Have you heard of the Dawn Phenomenon? It causes a lot of problems for me. As soon as I wake up, even fasting, my blood sugar starts at 137 then goes to 150 an hour later, and then 179. Finally, about 11:00 am, it starts to go back down, and because the dose of Lantus I took the night before starts to work again, apparently, my blood could go really low in the afternoon. I do not know of a solution to this, because the more I increase the basal insulin, the worse and hungrier I get in the afternoon. I don't even try messing with carbs in the morning, or it's game over for me. I can only eat them in the afternoon. Try that.

[Richard157]

Hello kplants, I looked at your profile. We both test 12 times per day. We obviously want to get good control and frequent testing helps.

I do not know your age but I am 67 and as I have grown older my Humalog takes longer to do its thing. Not that many months ago I would wake up with a good level (80-110) and eat about 40 carbs at breakfast. Two hrs. later I was 160+ and sometimes 200+. I found that if I did not take any additional Humalog at that time I would drop to the low 100's by 11pm. Now I take my pre-breakfast Humalog an hour ahead of time. Two hours later I am in the low 100's because my insulin has been working 3 hours. That has solved my problem with post breakfast highs. If the insulin takes even longer to be absorbed in the future I may have to take Humalog 90 mins. or even 2 hours before breakfast.

If any of you have trouble with the Dawn Phenomenon then you might want to look at the following site:

Dawn Phenomenon (http://www.diabetic-talk.org/dp.htm)

Good luck to you!

Richard

[kidvid]

[QUOTE=klpants;256331]Does anyone else have trouble achieveing thier target post breakfast blood sugars? How can we limit the effect?

QUOTE]

I don't know how hard it is to get in the UK, but Symlin helps me by about 50 points. I've used it for over a year now. I'm a firm believer.

Joe

[dinosaur]

Morning Sugar levels.

Hey Klpants.

I think the key to be aware of is that your not alone in this struggle. The Dawn Phenomenon is something that needs quantification in each person. The advent of pumps I think has brought attention to something most of us have struggled with for years. For me it's like a slide rule effect. For every m/m above say 5, the harder it is to stay on track at lunch time. What I'm surprised about is how few people on this site have walked the path of animal insulin. (it demonstrates the control big companies have with their marketing policies). Animal insulins have longer acting periods, lower bell curves (gives you softer entry and exits from hypos), hypo awareness is heightened because of the presence of glucagon molecules in them. There's been some excellent links posted here by SueM to the IDDT site with background on how erratic some peoples' results can be on the genetically engineered insulin
Welcome to Insulin Dependent Diabetes Trust (http://www.iddtinternational.org/gmvsanimalinsulin/index.htm).
To me GM (genetically modified )insulin gives a lack of life style due to continuous blood testing, instead of recognizing your own mood swings due to BS (blood sugar) levels and hypo awareness. And in case you didn't know, human insulin is the first genetically modified drug in the world to be tried out on humans (us guinea pigs).

As for Dawn Management, for me it has always been a struggle. While I was on Lantus/Actrapid my normal ratio was 2:3, but for the morning what ever I worked out for carbs etc., it was x4 plus wait 1/2 an hour before eating add an extra 12% for leg shots or 6% for arm shots. Like Richard157 my neutral, especially leg shots, are much slower. These days when I'm up at say 4 am (for a wizz ) I test BS then give my self a Dawn Kick-Start which is BS + 2 units neutral. I can almost set my clock that by 7-8 am, I'll be bang on 5 or near to, right in the zone to start my day. The only other rule I've worked with is through my 47 year diabetic life is "Half an Hour from Hypo". Animal insulin allows me to exploit this rule. In simple terms if your half an hour late at morning tea, at lunch, at afternoon tea, at tea or at supper then you'll have early symptoms of hypo. This also acts as a check on how accurate your BS tester is. (If your tester is 30% wrong, are the manufacturers going to be responsible for 30% of loss of your leg, your sight, your heart attack or your stroke.) I've done the fasting times thing, but when it comes down to it you won't stick at it if that's not you. Try drawing your bell curves on a graph sheet with your overlaps so you understand just how much insulin is working at any one time (I've done it on my computer in a spread sheet program that draws all the graphs for me. Takes a lot of the guess work out of some of the understanding to see it visually) At 2.6 the human brain stops functioning normally. This doesn't mean you can't function, it just means you'll struggle and some of your decisions may not be sound. You need to know that your meter reflects this and not be 30% off. I'm sorry Richard157, but blood tests 12 times a day is not for me (maybe you should start your endo on 12 blood tests a day and see how he likes it BIG GRIN). Richard this is not a criticism but an observation.

Without a good start-up and control by the time the billy goes on at morning tea, then every day can be a struggle. In case your wondering I've never had a A1c below 7. I try to live my life despite having diabetes not because I have diabetes . I try to be near hypo 3-4 times a day. I currently test between 3-5 times a day, but most the time I can tell when I'm below 5. I don't have any major problems. Don't get me wrong there are times that I have a struggle just the same as you all do.

[klpants]

Hi Dinosaur

Thansk for your reply. I have in the past tried drawing out my insulin patterns on graphs and am aware of how long the insluin will be in effect for and yes, has helped.
You say at such a time of day your BS is the same and you can count on this result, well, this is one of my probelms. One day my BS at one time of the day will not be the same at the exact time of day the next day......My exercise routine has a lot to do with this, I train at high intensity (sprints, plyometrics, weight intervals) one day then lower intesnsity (longer runs, aerobic sessions) for longer periods the next...and if I have a rest day the next day is all screwed up, but I must have a rest day!! :D

Ever since I have took out the banana for breakfast my bs have come down in the am, actually I have noticed the better levels all day long, funny what one little banana can do. But then I know if my post breakfast BS is good, the rest of the BS will be better throughout the day.
I've added a tablespoon of peanut butter to my breakfast so I'm not feeling hungry by 11:00!!

As for your comments on animal insulin....I'm not prepared to use it, I've used human insulin for the past 22 years and making that change would seem like a major routine upheavel. I can't appreicate the effects of animal insulin unless I'd have used it so won't comment.....I can appreciate that animal insulin works for some but not others just like human....

Ahhhh, this disease will only make you stronger! (and slightly insane....;)

[dinosaur]

Hi back Alpants,

I think you may have just answered your own Q's. When I was in my late 30's through my early 40's I use to run 8-9 km 6 days a week. The fact that you vary your training either in intensity or duration will just make your management harder. I remember when I started intervals, and introduced 12 km every second day things finished pretty much belly-up for me back then and I realised that sometimes less is more. Good work on what your doing though, that will stick by you later in your diabetic life. We're just coming out of winter downunder so I don't have any reason not to get back on my own bike and do a few k's a day. Almost time for my wizz now

Cheers d

[Jan2306]

I had the same problem, as many of us did. Finally nipped it in the bud by changing my insulin to carb ratio from 1:12 to 1:6 and I bolus 30 mintues before I eat. I eat the same thing every morning (soy cheese, turkey bacon, and 1/2 Think bar with coffee) but with these changes, knocked my post prandial down 50 points. Actually, I also increased my basal in the early morning hours (via the pump) and that was the finishing touch.