More insulin taken 2 hrs. after meal?

[nissen99]

Many of you say you test 2 hours after you eat, as well as before meals and at bedtime. My son (17 yrs. old) currently does not test 2 hrs. after as a rule but has in the past when his insulin dosages are being adjusted. It seems when he does the two hour after tests, his blood sugar will be high but at the next meal, it will be much lower and in the normal range (hopefully anyway.) I read on another thread that some of you test at 2 hours after a meal and if the reading is high, you take more insulin. Now, if my son were to give himself insulin at that two hour point, I feel that he would have a hypo before his next meal, which I assumed to be because the short-acting insulin is still working. But do some of you really take more insulin at the two hour point?

[shabbie6247]

hi nissen99,

i dont generally test 2 hours after meals now unless i feel like something is wrong.

but when i do test im looking for a reading thats 6.5 - 8.0/117-144. if its lower i keep a check on it or eat 10 grams carbs, or if its higher i will take a correction dose with a target BG of 7.0/126, (ie BG = 12.2, i would take insulin to reduce my Bg's to 7.0)
this way i know i will be back in range for my next meal. this works for me as i know how long the insulin takes to work its magic and wear off (for me)

hope that helps ;)

[Scratch]

If I'm higher than expected, yes, I'll take a correction bolus.

I highly recommend the book Think Like a Pancreas by Gary Scheiner -- it does an excellent job of explaining the principles of basal and bolus insulins, along with how to go about testing and developing a workable method to know how to do it for each individual.

It'll be really important for your son to learn about this and develop the skill and knowledge to handle this.

[miss_ok_ish]

It seems when he does the two hour after tests, his blood sugar will be high but at the next meal, it will be much lower and in the normal range

I have also wondered this to as a fellow newbie.

I think certain foods spike or peak in the middle of a 2 - 4 hours period after eating before numbers resume to normal, some foods this will happen with and some not, i suppose depending on its GI. Also i have read a thread on here that when you become diabetic you stop producing something called Amylin Amylin - Wikipedia, the free encyclopedia (http://en.wikipedia.org/wiki/Amylin) , which basically stops that spike, and if a diabetic wants to they can inject a seperate injection of something called Symlin to replace Amylin. http://www.symlin.com/

So i am quite interested on how people over come this, or do i just have to put up with the spiking, because at the end of the day my numbers always come back to a normal range 2 - 4hours after but with the spike in the middle does that mean i don't have good control?! :o

[nissen99]

Ms. Ok'ish, that's what I wondered. My son's numbers go back to normal (usually unless he miscalculates his carb intake and doesn't take enough insulin to cover his meal) but will being high in between meals cause his A1C to be elevated even though his meal numbers look good?

[BlueSky]

I am usually high two hours after eating. Because of the action profile of injected bolus insulin, it takes much longer to get back into the target range (3-4 hours). I think the 2 hour guideline is more applicable to T2s. Two hours after eating, blood glucose should have returned to where it was before the meal. Reducing carbs in the meal and injecting 15-30 minutes before eating helps. But I am normally higher than I would like to be to be 2 hours after eating.

[Erin]

The ideal is not to have too high spikes at any time... how high are we talking here?

I will take more insulin if my bg is high at the 2 hour point. Sometimes (especially if i worry I bolused wrong) I'll even check 1 hour after a meal. If I'm really high after 1 hour I feel like there's no need to wait the full two before taking more insulin. After 2 or 3 hours, for me, there is no risk of going low if I bolus to correct.

I wonder if your son is relying on basal insulin to bring his numbers down by the next meal. While insulins all function differently in different people, it shouldn't take more than 2-4 hours for the fast acting insulins to bring you down. If he does have a little more basal than he needs taking more short acting would definitely send him low by the next meal... just a thought. I might check to see if his fasting numbers drop over time. If that is the case i would check with his doctor about decreasing the basal and increasing the bolus ratio...

just my $.02

[shiftzor]

Hey, i have started to do injections after meals if i have miss calculated. I test 2 hours after my meal or correction. I read somewhere that 3mmol/L difference from your premeal sugar level is acceptable? Im not sure how accurate that is and i tend to play it safe.

[Alice]

I aim for a "low to moderate" spike...even if I have to correct with a few glucose tabs later. Having said that, I also have to correct "weird" meals...especially restaurant meals where I don't have specific info on hidden ingredients. (Not talking about a grilled chicken salad here...)

For instance, I had a chicken and dumpling dish last night. I haven't ever eaten chicken & dumplings, but figured the dumplings were similar to pasta. In my case, they were a super pasta...I hit a rare 315 after dinner...so I corrected with 4 units of Humalog. Still had to correct again after midnight...I just wasn't dropping. Who knew with dumplings?

There could have been added flour & such. I don't even remember eating the entire serving. But, that's a good instance of a "weird" meal where I have to test and correct.

[REDLAN]

I carb count. The actual point to testing at the 2 hour point is to check that my insulin:carb ratio is correct.

By the 2 hour mark, peak action for my insulin has passed, and I usually experience little additional BG lowering. Ideal postprandial for me is 6.0 to 8.0 mmmol (108 to 144). If I'm above 10 mmol (180) then I will correct at the 2 hour mark.

If my 2 hour postprandials are consistently off (low or high), then I shift my insulin:carb ratio up or down as required.

[modbom]

I test after meals too.
If it's very high. I'll take some more insulin. If it's just a bit high I'll leave it alone. Using a pump programmed to keep track of how much insulin is still working in you helps this out a lot. I also recommend that book: Think Like a Pancreas

[Cyborg]

You can accurately test the I:C ratio. If the bg is too high at the 2 hour mark, then either the carb counting was incorrect, too many carbs were consumed or too many high glycemic index carbs were consumed.

If you know the I:C ratio is correct, then try pre-bolusing. Even 15-20 minutes helps...

[Gary_W]

I can't find the references, but there are studies claiming that large variations in BG (ie spikes and troughs) are more harmful than having a consistant but slightly high HBA1c. I know that I feel better when I don't spike and trough too badly, so the improvement in the here and now is welcome no matter whether the research is correct. For reasons of feeling good now, I often test at hour two and correct if needed.

It's really about matching the reaction profile of the insulin to the reaction profile of the food as closely as you can. In your son's case, you know that the amount injected is correct for the carbs eaten as he is back to normal at hour 4. The problem you are getting (if indeed it is a problem at all) is that the food he is eating is getting into his system a lot quicker than the insulin is. If the spike is not too huge, he feels well and his HBA1c is good then I personally wouldn't worry about it too much. In me, the constant morning high used to make me feel pretty grim hence I was motivated to do something about it. I must say changing to a different insulin did help that.

As far as correcting at 2 hours goes, I find it far from an exact science. I know with Apidra in my body, around 80% of the payload gets used up by hour 2. The last 20% trickles in over the next 2 hours. This part seems reasonably consistant. What fouls up the calculations is the variability of the meal that you had plus your body's capacity for change. So I do sometimes inject or eat at the 2 hour point and often get it right, but sometimes get it very wrong. Such is the joy of diabetes. I now feel I have a very good understanding of the management of it, but there is still an element of guesswork and gut feeling involved no matter what you do. If you understand GI and your insulin profile, you are purely enabling yourself to make an educated guess as opposed to winging it completely. In my opinon of course :D

A practical example. I eat a meal with 100g of carbs for which I inject 10u of Insulin (If you wondered what the crashing noise was, that was BlueSky fainting as I ate 3 days carbs in one meal ;) ). If I test at hour 2 and my BG is down at a 4.5 and I know that all the carbs I ate were pretty fast acting (white rice, white bread etc), I'll have an apple just to cater for the fact that I have 2u of insulin on board but no food. If some of the meal I ate was fatty / protein full / had slow acting carbs, I'll leave well alone and test a little while later. Quite often, that last 2u will match the slow absorbing food and I'll be good. This last example is where it works best for me, as I'm at a perfect level at hour 2 and stay there more or less. If only that could happen all the time...

If I'm 10+ at the 2 hour point, I'll know I stuffed up the carb counting and can correct. If I'm about a 7 or 8 I will consider injecting more depending what I ate.

Gary

[RobiJo]

If you know the I:C ratio is correct, then try pre-bolusing. Even 15-20 minutes helps...

Cyborg's right, taking it early can make a huge difference.
When is he taking his meal bolus? Before, during, or after eating? This can play a huge role in how fast/high bg spikes and when it comes down. If you son is fine at the next meal, he could just need to bolus before the meal rather than after. (A lot of kids/teens wait till they're done, because they don't know how much they will eat). For most meals, I bolus for 30-45g of carb before the meal. If I eat more than that I'll do another bolus. This has really helped my meal spikes.

[cheryl]

Easy way to fix that, I was always like that back in the days...I'd be normal by the next meal...the key is to wait about 15 to 30 minutes after injection to eat.....depending on the meal....if it is a high fat meal, you can get away with doing it right away...it if will hit your blood sugar faster, then I wait, depends....or if I am already heading on the low side, I eat as soon as I bolus but the easiest way to fix a high spike postmeal is to wait after a bolus...

Cheryl

[cheryl]

Also I don't correct if postmeal is a bit high unless I just know I should...like if I am over 180 yea I will but very little bit like .5 or .6 units.....or if I overdid my meal yup I know i need more insulin it just depends on the high....but for me If I am over 180 there is no way I am going to return to normal range within 2 hrs without a tiny bit extra

Cheryl

[Alice]

I try to bolus as close to beginning of meal or immediately after, depending on whether I'm at home or at a restaurant. I've had some bad lows 30 minutes after eating due to pre-boluses, so I'm more careful and have fewer problems. It depends on the type of food.

I count carbs too...but I do find 15 carbs of one food can be very different to digest than 15 carbs of another...so, I take that into account also.

I wish it was as easy as just using the ratio, but for me, it's not.

[miss_ok_ish]

also do some insulins work faster then others?

I am on novorapid and heard it works in 10mins... maybe that should be taken into account to....??

[Alaska]

also do some insulins work faster then others?

I am on novorapid and heard it works in 10mins... maybe that should be taken into account to....??

Always, different insulins and meds work, act and are timed differently. Then you also have to take into account how your body reacts to it. If you and I took the same insulin it doesn't mean we will both react to it the same way and at the same time :)

[Cyborg]

Also, find out if and how protein affects your bg. If it does have an affect, you should consider bolusing for it...

[JJM335]

also do some insulins work faster then others?

I am on novorapid and heard it works in 10mins... maybe that should be taken into account to....??

I suspect that we all absorb carbs at different rates and react differently to insulins. You just need to work out how YOU react. Personally, I never found Novorapid having any effect at 10 mins, and it hung around for geological time (I suspect that diabetic dinosaurs are still feeling the tail end of that last Novorapid bolus, the one they took just before the asteroid hit the Earth!). I've recently switched to Apidra, which gets in a bit quicker than Novorapid, but seems to be pretty much done by 3.5 h.

Personally, carbs go through my digestive system like a rat down a drainpipe and always seem to beat even the fastest analog insulin. I try to pre-bolus by as much as 30 mins (a bit scary with Apidra given typical pre-meal BG's of 5 or less). Even then moderate quantities (50g) of high GI carbs will spike me to >8 at 2h.