Good/steady control on carbs?

[rak1978]

I have been trying for quite some time now to gain good control/steady numbers while still eating carbs. It seems unlikely that I'm going to nail down a good I/C ratio despite my best efforts. If I take enough insulin so that I don't spike at the 1 & 2 hour marks, then I'm too low by the 3rd hour. If I lower the dose, so that I don't plummet, then I'm high up in the sky the first couple of hours. Plus, because I'm a mother of three young children, I really can't have a consistent activity level every day. I'm consistently inconsistent!
My doc seems to think that I am VERY unusual in that I can't seem to get my numbers steady even with careful attention and constant modification of pump settings (especially in the morning).
I know that there has been MUCH debate and heated discussions on the forums regarding carbs, and I don't intend to initiate one. I would like to keep an open mind to both sides since everyone's body responds differently. I know people are gladly posting their excellent numbers while low carbing, but I don't see a lot of numbers from people who are not.
I sincerely want to know if any of you are able to achieve good control while still eating carbs? I have been beating my head against a wall trying to make this work.

Thanks for reading.
Rachel

[fgummett]

Probably not what you are asking, but have you read up on Dr Bernstein's Law of Small Numbers? It makes a good deal of sense to me that smaller inputs lead to more predictable outcomes.

[rak1978]

Probably not what you are asking, but have you read up on Dr Bernstein's Law of Small Numbers? It makes a good deal of sense to me that smaller inputs lead to more predictable outcomes.

Yes, it makes really good sense to me also. I was completely on that track until I started coming here and realized that people (type 1's at least) were able to eat moderate, even high amounts of carbs as long as their bolus ratio's and basal settings were correct. Since then, I've been trying to do the same and it's simply not working.
Now I'm just confused and quite honestly despressed!

[fgummett]

I can't provide a link (against policy) but do a search on "Dr Bernstein's Law of Small Numbers" and I was able to read on-line chapter 7 of Bernstein's book. Even if your ultimate aim is to eat higher amounts of carbohydrates, it might make sense to start off by cutting right back... regain good predictable numbers as a baseline and then gradually re-introduce your chosen foods one by one with plenty of testing.

[sarahspins]

I have 3 kids (2, 4, & 8).. I manage to eat carbs without huge spikes "most" of the time... below is a CGM image from last week, where I had a huge breakfast including 2 cups of coffee and then later for lunch I had pop tarts (2 of them!) of all things, and I was rock solid steady... and it wasn't because the CGM wasn't working. (and this may look peaky, but anyone who has work a CGM for any lenght of time can appreciate how over 12 hours, it's really not).

http://farm3.static.flickr.com/2712/4032201495_d293e4504d.jpg

I am active, and our schedule is VERY unpredictable. No two days are the same. The key for me is pre-bolusing (usually 30 minutes unless I am low-ish), dead-on accurate carb counts, and making the BEST use of combo boluses. If I bolus and immediately eat, I'll go high no matter what the food is... without a combo bolus for most things, I'll be fine for the first hour or so, but usually end up on the higher side by 2 or 3 hours. I am rarely low because of meal boluses.. if I go low it's usually because I fail to set a temp basal for increased activity - usually it's when I get caught up in something like housework, and just don't think about it. Thanks to the CGM though, I am catching those faster, rather than not having a clue and testing with say, a 43.

I try to keep my basal profiles dialed in so that I'm taking the LEAST amount of insulin possible.. I don't rely on my basal to cover any snacks or the effects of eating lots of protein. I bolus for just about everything that I eat.

That said, I'm not suggesting this works for EVERYONE. I know it doesn't, and there are days the Dex screen doesn't look so wonderful (such as today, but I seem to be having accuracy issues, not bad #'s exactly.. dex keeps drifting up while my BG is not.). However I personally find it more difficult to manage my D with a low-carb type diet... my #'s become much more erratic and I end up with stubborn persistent highs.

[rak1978]

I have 3 kids.. I manage to eat carbs without huge spikes "most" of the time... below is a CGM image from last week, where I had a huge breakfast including 2 cups of coffee and then later for lunch I had pop tarts (2 of them!) of all things, and I was rock solid steady... and it wasn't because the CGM wasn't working. (and this may look peaky, but anyone who has work a CGM for any lenght of time can appreciate how over 12 hours, it's really not).

http://farm3.static.flickr.com/2712/4032201495_d293e4504d.jpg

The key for me is pre-bolusing (usually 30 minutes unless I am low-ish), dead-on accurate carb counts, and making the BEST use of combo boluses. If I bolus and immediately eat, I'll go high no matter what the food is... without a combo bolus for most things, I'll be fine for the first hour or so, but usually end up on the higher side by 2 or 3 hours. I am rarely low because of meal boluses.. if I go low it's usually because I fail to set a temp basal for increased activity - usually it's when I get caught up in something like housework, and just don't think about it. Thanks to the CGM though, I am catching those faster, rather than not having a clue and testing with say, a 43.

I try to keep my basal profiles dialed in so that I'm taking the LEAST amount of insulin possible.. I don't rely on my basal to cover any snacks or the effects of eating lots of protein. I bolus for just about everything that I eat.

That said, I'm not suggesting this works for EVERYONE. I know it doesn't, and there are days the Dex screen doesn't look so wonderful (such as today, but I seem to be having accuracy issues, not bad #'s exactly.. dex keeps drifting up while my BG is not.). However I personally find it more difficult to manage my D with a low-carb type diet... my #'s become much more erratic and I end up with stubborn persistent highs.

Interesting! Thanks for sharing. It helps a lot to hear other people's experiences....especially when they're in a similar situation. I don't usually pre-bolus. I tend to bolus while I am eating. I will try this. Thanks.
It's not that I'm trying to get away with eating junk, I just would like to eat moderate/reasonable amounts of healthy carbs and not be on a roller coaster. I am not good with moderation in anything. It's all or nothing for me.
That's interesting that you find it hard to control on a low carb diet. Everybody is so different and obviously, what works for one, may not work for another.

[Gordonm]

I don't low carb by any means. I average about 180 or so most days with some days in the 220 range. I am also on the CGMS and have had days look like the above figures. My activity level can be from driving all day to riding my bike for hours. It is challenging and some days the IC ratio seems out of whack. I just look at the averages and do the best I can from day to day. I do try to limit most meals to 50 carbs or under but on occasion do go over and still get pretty good results. I am on the theory of eating more small meals than 2 or 3 bigger meals.

[sarahspins]

It's not that I'm trying to get away with eating junk, I just would like to eat moderate/reasonable amounts of healthy carbs and not be on a roller coaster.

No worries, I completely understand.. I don't usually eat a ton of junk or processed foods either.. and 72g of carbs for lunch (and all at once!) is definitely pushing it even on a good day, but it was a craving I just *had* to satisfy (you know, chocolate, crunchy, salty.. can you tell I was PMSing? Hence the Chocolate Chip Pop Tarts!) :) I usually cook from scratch and most meals are heavy on fresh produce.

That's interesting that you find it hard to control on a low carb diet. Everybody is so different and obviously, what works for one, may not work for another.

I don't find it that weird.. the liver can process 60% of the protein you consume in to glucose... whether you low carb or not, this is a process that still goes on. My experience is that the effect is often somewhat unpredictable.. it could be a steady rise, or the liver can suddenly kick out a bunch at once. I don't like the unpredictability - especially since I am one of the few who can match insulin to carbs fairly well. It's easier for *me* to just eat carbs - that isn't the case for everyone. We are all unique. I don't even pretend to think that "my way" can be universally applied to everyone.

Anyways, I like to place myself solidly in the "moderate carb" diet category... I generally do best with about 40-60g carbs for a regular meal.. 10-20g for a most snacks... it's really right in line with the ADA diet as far as carb content, except that I don't intentionally follow the ADA diet at all. I usually average about 160-180g a day, which by many standards here is "high carb" however when I compare what I eat with what my husband and kids eat, it's definitely not :) Also, when you consider what the boluses are for those, I am not usually taking large amounts of insulin all at once either... and I think that helps in terms of ups and down. Combo bolusing also make a difference... because any lows that are the result of a miscalculation generally happen in sort of slow motion.. I usually have more time to react/treat before it becomes serious (I don't feel lows at all).

Definitely try pre-bolusing earlier... since you wear a CGM I'm sure you have some idea of how long it takes insulin to really "kick in" - don't be afraid of it. Even if you just start with 15 minutes, that will likely help with your post-meal spikes. As you get more comfortable with it, and can reassure yourself that you won't forget to eat, you can add more time. My general routine for breakfast and lunch is that I bolus, prepare food for the kids, get them all set up and assist them if needed, then sit down to eat as they're finishing... the timing usually works really well. For dinner, unless it's something that will take a while to cook (like anything that has to be baked), I usually bolus when I start cooking.

[SueM]

I have been trying for quite some time now to gain good control/steady numbers while still eating carbs. It seems unlikely that I'm going to nail down a good I/C ratio despite my best efforts. If I take enough insulin so that I don't spike at the 1 & 2 hour marks, then I'm too low by the 3rd hour. If I lower the dose, so that I don't plummet, then I'm high up in the sky the first couple of hours. Plus, because I'm a mother of three young children, I really can't have a consistent activity level every day. I'm consistently inconsistent!
My doc seems to think that I am VERY unusual in that I can't seem to get my numbers steady even with careful attention and constant modification of pump settings (especially in the morning).
I know that there has been MUCH debate and heated discussions on the forums regarding carbs, and I don't intend to initiate one. I would like to keep an open mind to both sides since everyone's body responds differently. I know people are gladly posting their excellent numbers while low carbing, but I don't see a lot of numbers from people who are not.
I sincerely want to know if any of you are able to achieve good control while still eating carbs? I have been beating my head against a wall trying to make this work.

Thanks for reading.
Rachel

Hi Rachel,
It may sound daft but go back to basics.
IE have a set amount of carbs per meal each day. This way you can work out your upper limit of what works for you.
I find that as long as I do not go over 70 carbs/meal I am fine.
So no matter what is on offer that's my top wack. I normally average about 50 carbs/meal now and find I have very good control from this.
Also have a good look at the type of carbs you are eating.
Glycemic index is a very good starting point.
Are you using your pump to it's full advantage? IE using the different types of bolus's depending on what is being eaten.

Best wishes
Sue

[Subby]

Rachel, I think what we need to do is appreciate that there is a wide range of how T1s manage their condition, in terms of ease of bolusing and what carbs or types of carbs they can get away with.

Read some of the answers to this current thread. http://www.diabetesforums.com/forum/type-1-diabetes/45114-type-1s-how-much.html

My mouth hangs open at the idea of getting A1cs in the low 5s with just getting rid of the most obvious offenders - but there you go, it appears to be the experience for some people. I suspect it's a lot of T1s who find that.

Then, there are people like you and me. I just don't know if it's classic insulin resistance, or any of a number of things that effectively make insulin slow and unweildy and carbs work fast, but for me that is certainly the case and I have to modify diet heavily and walk on a knife edge to get mid 6s A1cs, and still some pretty regular spiking. For me a lot of it is also basal related, in that whatever I eat I will often fly off at certain times of the day. THankfully metformin is helping somewhat with that.

I think it's a case we need to recognise these differences between people. It is not that the T1s who can bolus and cover carbs quite easily and well are "wrong", it is not that people who find carbs problematic have "got it wrong". We've just got different physical outcomes to food and insulin therapy.

I find much more than 150g of carefully selected carbs and I am fighting highs a lot of the day (the option being to take so much to cover problem carbs it WILL catch up with me in a few hours, as you find. No reasonable middle ground). So all I can suggest is we who do have difficulty (and know it's from limitations of insulin/carb speed, not just from inexperience etc) need to accept it, and employ more the T2 mantra and modify diet according to meter (bearing in mind we can also modify dose too if we think it's worthwhile).

I'd suggest metformin - it's helped me, but I know you are on it, and we both know it just tends to "cap" highs (a great service, though). I think until there are very different ways of administering insulin, you and I just need to be very careful with carbs, and just avoid ones that are spiking problems, and shrug wryly at those who can seem to get away with eating a lot more. The prebolusing mentioned above - it could be a huge benefit for making progress here. I usually aim for 20 min. Without that my spikes would be easily 2x as bad across the board.

[rak1978]

Thanks everyone for the advice. I was talking with my husband about this last night, how I feel like I'm beating my head against a wall over and over. He said respectfully that was the definition of insanity...doing the same thing over and over and expecting a different result.
I have said before that I really struggle with consistency and moderation. It's not in my blood. I am an all or nothing in short spurts kind of person. So, obviously, this makes good control very challenging for me.
Subby, I do see that there is a wide range of how type 1's manage their condition. I am still trying to see where I fit in on the spectrum of carb intake. It's really intriguing to me to see the wide range. I guess I don't want to accept that I would have to eat close to zero carbs even with an insulin pump when others have no problem. So, I keep trying....over and over to eat carbs, and am constantly changing pump settings to try to accommodate, and I am never steady. And, yes, I am going insane.
Hopefully I will get a handle on this soon and figure out what works for my body and STICK WITH IT.
I'm so glad to hear that the metformin is working well for you. That's great news.
It helps me a lot too. My doctor recently prescribed symlin to try in the morning to see if I can get some better results, but I'm having trouble getting it due to insurance.

Sarah, no judgement here on the pop tarts! They sound yummy. You have to satisfy both body and soul! :)

Frank & Sue,
Thanks for the advice! I do need to go back to basics. Start from scratch! Looks like I have some work to do.


I'm going to try the pre-bolusing today as well as sticking to lower glycemic carbs, a little at a time.
Thanks everyone for putting up with this dramatic post once again! I know that I just need to execute on what I know to do and stay focused. I get real distracted with what works for other people and try to make it work for myself.

Rachel

[dbaratta]

I know that there has been MUCH debate and heated discussions on the forums regarding carbs, and I don't intend to initiate one. I would like to keep an open mind to both sides since everyone's body responds differently. I know people are gladly posting their excellent numbers while low carbing, but I don't see a lot of numbers from people who are not.


Thanks for reading.
Rachel


Key Differences Between Paleolithic and Modern Diets - What Cavemen Ate (http://lowcarbdiets.about.com/od/paleodietcavemandiet/a/paleodietmodern.htm)

[rak1978]

I should've just said this instead of all of the lengthy monologues...

I'm trying to figure out if I just have yet to figure out the correct I:C ratio, or if I truly just can't have carbs and need to call it quits.

[sarahspins]

I'm trying to figure out if I just have yet to figure out the correct I:C ratio, or if I truly just can't have carbs and need to call it quits.

What are your #'s like at 2 hours or 3 hours after eating? That really seems to spell it out the "correct" more than your max spike does.. managing the spikes becomes more about managing the timing.

[lark 27]

Great thread to read and see the divergent experiences many are having. I'm still wrestling myself with balancing what my goals are for carbs, nutritional intake overall, and acceptable BG control. I've definitely found that I had much more difficulty maintaining euglycemic levels in the morning if I have much carbs--quick spikes and hard to bring down. So for breakfast I either go with eggs or more occassionally (somewhat of a treat) plain yogurt with frozen blueberries (yummy and a serving size for me comes in at 15-20 carbs).

thankfully I have better success with having carbs (trying to stick with good GI carbs and still not too many) for lunch and supper. Normally 30-50 per meal seems to work. Once I start going above 50, I'm more prone to having some spikes and then overreacting from the spikes leading to a hypo later.

i'd suspect I could do better still with less carbs for lunch and dinner, but mentally, I'm fine with going low carb in the morning, but I haven't come to that point for all meals. And from experimenting I don't see a significant improvement.

One thing that I'm going to add to my goals for better D management is to try to stick with low carb lunch and dinner if I know I"m going to be active at all following the meal because if I have a bigger bolus on board and then go for a walk with the family or to the pool or something, I am just set up for hypos. Sunday was my wife's birthday so I made her a brunch and had swedish pancakes for a total of 75 carbs. We then went for a walk following and although I'd tried to reduce my bolus somewhat, I still ended up consuming an additional 90 carbs to correct lows/borderline readings over the next 2 hours! That was simply unacceptable.

I guess for me, the law of small numbers makes a lot of sense, but what is sustainable and acceptable for me currently is the law of small numbers for breakfast and the law of medium numbers for the rest of the day and watching for other key times where I need to revert back to law of small numbers.

[fgummett]

Maybe already mentioned but in getting back to basics are you confident in your basal rates? Also it seems common that I:C ratios can be different at different times of the day... I read here quite often that breakfast carbs need more insulin than later in the day, for example.

[rak1978]

Here's my story yesterday....

fasting: 140, bolus 1.2, 0 carbs: eggs

2 hrs after breakfast: 61, took 2 glucose tabs

20 min later: 105, bolus 3, 46 carbs: z bar & something else?

before lunch: 77, bolus 2, 50 carbs: chicken curry & naan, only took bolus for half of carbs because of the low (whoops)

1 hr after lunch: 224, bolus 1.1 correction

2 hrs after lunch; 205, bolus .8 correction

before dinner: 158, bolus 2.4, 45 carbs: turkey & soup

1 hr after dinner: 156

2 hrs after dinner: 117, bolus 1.3, carbs 16: greek yogurt w/ berries & almond butter

2 hrs after snack: 78, took 1 glucose tab

This was a fairly good day for me because I was trying to be really mindful of things. On a more typical/bad day, I'll have extremes of 35-400. Never steady.

I think the basals are pretty good, but may need some adjusting in the afternoon. I do have many different basal/bolus settings depending on the time of day. Basals range from .20-1.05. Boluses range from 1:7-1:18.

[Grunch]

The biggest thing is pre-bolusing if you're going high early and low after that.

The key things are: counting carbs precisely, figuring your exact I:C and ideal timing for bolusing. If you can control these 3 things then there's a very high chance you can eat high carb meals without problems.

It's easy to over/underestimate the amount of carbs in some foods. Like the soup you had, depending on what kind of soup it can be pretty hard to know how many carbs you are actually eating and that can make it seem like your D is out of control when in reality you're just miscalculating. I avoid some foods just because I have no idea how much to bolus for them.

[xMenace]

as long as their bolus ratio's and basal settings were correct.

So do you know if your basal settings are correct? Have you basal tested? Basals should keep you flat-lined without food. You really need to invest time in basals before you can hope to figure out I:C's.

So assuming your basals are correct, can you please tell me your I:C ratios? I have made similar observations as you between breakfast and lunch. I would be fine pp but constantly hypo before lunch. My basals are pdg.

My theory here is that because my breakfast I:C is higher than my lunchtime I:C, 2.5:10 vs 1:10, my tailing morning bolus was too high for my need. A bolus lasts about 6.5 hours. Ignore your pump setting, because that is different. The final couple of hours tend to be small and insignificant, hence shorter times for pump OB calcs. However in the case where your I:C drops from one meal to the next, this tailing bolus can be significant. In my case my 10:30am to 1:30pm OB insulin is 2.5 times my need!

I fixed my problem by dropping my breakfast pp basals between 10am and noon. Works great!

This may confuse someone, but effectively I now treat my morning bolus like a superbolus.

superbolus - Google Search (http://www.google.com/search?q=superbolus&rls=com.microsoft:en-us&ie=UTF-8&oe=UTF-8&startIndex=&startPage=1&rlz=)

[rak1978]

It's easy to over/underestimate the amount of carbs in some foods. Like the soup you had, depending on what kind of soup it can be pretty hard to know how many carbs you are actually eating and that can make it seem like your D is out of control when in reality you're just miscalculating. I avoid some foods just because I have no idea how much to bolus for them.

The soup was homemade and I was too lazy to figure out how many carbs were in it...so I guessed.
It was made from all the sugary/starchy vegetables (carrots, parsnips, onions, sweet potatoes, butternut squash) roasted and then pureed w/ chicken stock. It was very good, but I'm sure it was loaded with carbs. This is the kind of thing I would like to be able to eat though without a problem. I don't want to have to say no to produce.
I do have a major problem with miscalculating/guessing. Most of the stuff i make is from scratch, and has a lot of ingredients, so it takes a long time to figure out carb content.
From now on though, I this is precisely what I need to do. I've counted very accurately today as well as pre-bolused and have been in the low 100's all day. Go figure. :)

[rak1978]

So do you know if your basal settings are correct? Have you basal tested? Basals should keep you flat-lined without food. You really need to invest time in basals before you can hope to figure out I:C's.

So assuming your basals are correct, can you please tell me your I:C ratios? I have made similar observations as you between breakfast and lunch. I would be fine pp but constantly hypo before lunch. My basals are pdg.

My theory here is that because my breakfast I:C is higher than my lunchtime I:C, 2.5:10 vs 1:10, my tailing morning bolus was too high for my need. A bolus lasts about 6.5 hours. Ignore your pump setting, because that is different. The final couple of hours tend to be small and insignificant, hence shorter times for pump OB calcs. However in the case where your I:C drops from one meal to the next, this tailing bolus can be significant. In my case my 10:30am to 1:30pm OB insulin is 2.5 times my need!

I fixed my problem by dropping my breakfast pp basals between 10am and noon. Works great!

This may confuse someone, but effectively I now treat my morning bolus like a superbolus.

superbolus - Google Search (http://www.google.com/search?q=superbolus&rls=com.microsoft:en-us&ie=UTF-8&oe=UTF-8&startIndex=&startPage=1&rlz=)

I have not done basal testing. I initially just went with the settings that my dr gave me and we've modified from there. Not very smart, huh? I have the book "Pumping Insulin", but haven't read it yet. Is the technique for basal testing in there?

I do very little basal between 9 and noon also! As far as my settings go, here they are....

basals:
12am-3am: .95
3am-7am: 1.05
7am-9am: .80
9am-12pm:.20
12pm-3pm: .75
3pm-12am: .80

bolus:
12am-11am: 1:15
11am-2pm: 1:12
2pm-5pm: 1:7
5pm-8pm: 1:18
8pm-12am: 1:12

sensitivity: 35
I take glucophage at breakfast and dinner

That's my life story. :) Gotta love the pump. It was a nightmare trying to manage this on injections.

[Subby]

I think it is smart to modify basal based on observation. Basal testing is just a way to ensure you're acting on the right feedback, and once it is established that someone may have a dynamic basal, and are willing and engaged, I think it's criminal that endos and DEs don't get them basal testing ASAP. Rachel, as you suspect Pumping Insulin has a section on basal testing. Basically, I couldn't get joy on the pump at all, until I basal tested. I think that's a place for you to start. Looking at your settings, I've got a feeling it's gotten too complex without a solid grounding, and at that point it's all somewhat out the window. I really admire how much you've obviously been involved and experimenting.

[justongarl]

Having headaches the same time every night a symptom of high sugar level? Also, I am extremely tired, more tired than ever before at night, too early for bed, fall asleep in my chair etc.. do you think this is when my sugar levels are too high?

[rak1978]

Okay, quick question....
I'm going to do the basal testing this morning until mid-afternoon. I take glucophage in the am w/ breakfast usually, do I still take that today? In "Pumping Insulin", it says to eat small amounts of protein throughout the day as desired, so I ate a couple of bites of eggs. Should I take the meds w/ the eggs while basal testing?

Thanks!

[foxl]

Okay, quick question....
I'm going to do the basal testing this morning until mid-afternoon. I take glucophage in the am w/ breakfast usually, do I still take that today? In "Pumping Insulin", it says to eat small amounts of protein throughout the day as desired, so I ate a couple of bites of eggs. Should I take the meds w/ the eggs while basal testing?

Thanks!

I would, I think ... though I am not an insulin user, don't you want to know your basal needs under "typical" conditions?

[Subby]

No eating of anything for 4 hours previous or during basal testing.

As for the glucophage, interesting question. I don't know of a definitive answer, and I haven't basal tested since going on met, so haven't thought about it. I would say, if you can take the glucophage without food with no adverse effect (feeling sick etc), do that.

Here's a great cheat sheet by John Walsh for basal testing, all the little rules involved:

Integrated Diabetes Services - Diabetes Management (http://www.integrateddiabetes.com/pump_bt.shtml)

[rak1978]

Thanks for the link, Subby.
In "Pumping Insulin" it says, "You may snack on small amounts of protein foods, such as nuts or cheese, during the test."
Hmmm...not sure which way to go. I am not very educated on this yet...just looked at the book at midnight last night.
I think you're right, Linda, about "typical" circumstances. I'm going to take it. Hopefully I'll get an accurate test. :)

Thanks for the quick help!

[Subby]

I hadn't noticed that in the book before Rachel, thanks for pointing it out. Well I guess it's up to you... I find some proteins can have an effect on my BG, albeit much slower and not as much as carbs. So I wouldn't personally snack except perhaps the very smallest amounts. Do you have a feel for if some do affect your BG? If not, I think you're best going without, or just really tiny snacks.

In the book I note that he "simplifies" basal testing by suggesting 6 or 8 hour stretches. Just a note that I find at times, I prefer to do it for shorter that that, and I can't see anything wrong with that. Once you are beyond the set up 4 hours, it's useful data...

[foxl]

No Changes in the Body's Normal Glucose Output

* No hypoglycemic episodes for at least 6 hours preceding the basal test.
* No illnesses during the testing (fever, infection, virus)
* No steroid medications being used
* Avoid testing during major stages of menstrual cycle if blood glucose changes are usually noted

Not taking your normal glucophage might fall under the category of a "Change in Body's Normal Glucose Output!" since it regulates gluconeogenesis ...

[Subby]

I definitely agree with that, provided if taken without food it doesn't backfire on you. Both not feeling sick, and for myself, I see metformin usually working only WITH food (still working out the best time to take it, but without much food it barely seems to work) to "do it's thing" in regulating my dynamic liver releases through the day. Rachel, if you share that suspicion at all for yourself, then I guess it is just going to be potentially a bit of a wildcard influence.

[rak1978]

Honestly, I'm not sure if protein alone raises my blood sugar.
The only meal that I occasionally go without any carbs at all would be breakfast and then I have the dawn phenomenon going on, so my blood sugar keeps rising on it's own, even without carbs.
I think you're right, Subby, that the best way to test would be to avoid any snacking at all. I just had the couple of bites of eggs so that I could take the met.
I do have a head cold right now as well, so this may be all for not, but we shall see.
So far, other than the immediate 30 pt rise upon waking, I've been dead even. My major morning problems usually start coming on about now, so we'll see.

Thanks for all the help. I am quickly finding out how little I know. It's not surprising that I have been in a loosing battle. Education is a good thing. And you can't get this kind of education from the endo. I haven't been around for a few weeks and it's nice to be back. :)

[Subby]

Hey that's great to have a flat BG period at the start of your testing, inspires confidence and you have somewhere to come from if things start drifting. Have fun! :)

[JJM335]

Rachel:

A couple more points to add what others have posted.

If the problem is spikes at 2 h after eating and lows after 4, you need to try to get the insulin working as quickly as possible. You might do better with Apidra than with Humalog. Based on the figures put out by the manufacturers, Novolog and Humalog have a duration of action of 5 - 6 hours, whereas Apidra is less than 4 hours. Although Apidra won't start working much more quickly than Humalog, at 2 hours after taking your bolus, about 65% of the Apidra will have been active, compared to around 50% for Humalog.

More insulin active earlier means less of a spike. If you can combine than with a pre-bolus, that will also give you a bit of a push. A second plus point is that with Apidra you will have used up all your bolus after 4 h, whereas with Humalog, there will still be a fair amount of active insulin left to give you a late hypo.

A lot of people love Apidra, others don't find it helpful, but it might be worth talking to your endo about giving it a try.

Joel

[rak1978]

Rachel:

A couple more points to add what others have posted.

If the problem is spikes at 2 h after eating and lows after 4, you need to try to get the insulin working as quickly as possible. You might do better with Apidra than with Humalog. Based on the figures put out by the manufacturers, Novolog and Humalog have a duration of action of 5 - 6 hours, whereas Apidra is less than 4 hours. Although Apidra won't start working much more quickly than Humalog, at 2 hours after taking your bolus, about 65% of the Apidra will have been active, compared to around 50% for Humalog.

More insulin active earlier means less of a spike. If you can combine than with a pre-bolus, that will also give you a bit of a push. A second plus point is that with Apidra you will have used up all your bolus after 4 h, whereas with Humalog, there will still be a fair amount of active insulin left to give you a late hypo.

A lot of people love Apidra, others don't find it helpful, but it might be worth talking to your endo about giving it a try.

Joel

Thanks, Joel! I hadn't considered this. I will talk with my dr about it. Also, I just checked my pump and I had 4 hours plugged in as the active insulin time. I just changed it to 6. That may help in regards to stacking and corrections.

[CarrieJett]

This thread has taken a new turn, but after reading the carbs debate, I have started really paying attention to my protein, especially for dinner. I was curious about Sarahspins experience with protein, and I actually am starting to think I have a similar constitution!
While eating a lot more high-protein, low carb, I used to wake up a few times with my BG at 200+, no explanation. Very frustrating. My endo couldn't figure it out, especially because I am very athletic andburn food like crazy.
I have tried over the last week or so to eat less protien at dinner. I used to eat like chicken and greens, now I have been eating veggies, rice, and beans.
What do you know, every morning I have been waking up with a lovely 90 on my meter, and no lows in the night! I used to be pretty convinced about lo carb, but I can't debate my numbers!
I've also been taking the pre-bolusing advice, and no more sleepy post-meals. Wow! Thanks everyone, I can't wait to see my labs in a few months...:o

[genie86333]

I have tried over the last week or so to eat less protien at dinner. I used to eat like chicken and greens, now I have been eating veggies, rice, and beans.
What do you know, every morning I have been waking up with a lovely 90 on my meter, and no lows in the night! I used to be pretty convinced about lo carb, but I can't debate my numbers!


Hi, CarrieJett.

Have you tried testing (both ways) during the night? It's possible that with the chicken & greens you were going too low at night & rebounding up to the higher level. Maybe a snack before bed would help. What are your post-dinner readings with the veggies, rice & beans? If they're ok, then no reason to change it if you like that diet, but if they're high, you might want to see what the chicken/greens dinner plus a bedtime snack do

[rak1978]

CarrieJett, that's really interesting. It is apparent that we are all extremely different, and there isn't one diet that works for all. I find that when I eat extremely low carb I am steady, but high all day. It seems that I would have to increase my basals substantially without bolusing for meals...either that or figure out how to bolus for proteins/fats.

Subby, Protein DOES raise my blood sugar. I did basal testing two days in a row for the early morning until mid-afternoon.
The first day I had small portions of protein/fat and they definitely raised my blood sugar both times (by about 40-50 mm/dl). This was for a couple of bites of eggs and a slice of cheese. I wasn't sure that this was due to the snack until today, I thought it was possible that it was due to my basal being decreased at those times. So, today I did a second basal test to confirm without the bites. No spikes. It was dead even all morning.

Thanks to everyone for all of your suggestions. They were super helpful. I have been pre-bolusing and the numbers have been improved significantly. No major spikes, no major hypos. It's amazing to me that my dr never has suggested this to me (or the basal testing, for that matter!). He is very attentive and likes to be involved, but I'm surprised that he didn't think of these things.

Thanks again to everyone for your help!

[CarrieJett]

Hi, CarrieJett.

Have you tried testing (both ways) during the night? It's possible that with the chicken & greens you were going too low at night & rebounding up to the higher level. Maybe a snack before bed would help. What are your post-dinner readings with the veggies, rice & beans? If they're ok, then no reason to change it if you like that diet, but if they're high, you might want to see what the chicken/greens dinner plus a bedtime snack do

I may have to do some more testing to be sure, but I am basing a lot of it on a week of CGM that I did recently. I assumed that I would be going low during the night, and that's what my endo thought but in fact I wasn't. I was steady all night rigt around 100, then at 6am I would climb up to 200 in a half hour. Dawn phenom, yes. If I up my lantus it's too much and I get a lot of lows.

I wonder if the protein gives my liver a big boost for my DP? This is a new experiment, so I will keep track of my dinners and maybe torture myself with nighttime readings and post my findings. Wish I had that sensor all the time! It bring out the geek in me.

In experimental mode, I also did some pre-bolus testing, nd found that it takes an entire half hour for my humaog to kick in in the morning!:eek:

[It Ain't Over]

With the low carb diet I think it is important to find what the rate of the rise in Bg's with the various foods, and the rate a bolus lowers your bg.
If those two were to match up perfectly your bg's would remain the same after a meal.
The hard part is to sort them all out and at the same time find a bolus that is correct for that meal.
With the low carb diet this does become apparent but it requires a lot of work to find the patterns.
After 9 months on the diet I am beginning to understand some, but not all of this. I have found that everything put into my mouth will raise blood sugar eventually.
I try to eat the same basic food every meal. Easier to work out the details. It is not absolutely necesary to do it this way. We all know that.
Have found green vegtables raise bg the least. Cheeses raise it for the longest time, and meats raise bg's the most and fastest. Any food requires a bolus. But if I eat a breakfast of sausage and a 2 oz serving of cheese, which I do most days, I can bolus 1.6 and the bg's will remain flat until lunch. With lunch I eat about the same and add in some green vegatables. Bolus goes to 1.9. Dinner is about same as lunch, but I am a little more insulin sensitive at that time, so bolus is 1.6.
Doesn't seem like that much difference, but it makes for a steady bg with me. The point is to take the time to find out. Eliminate as many variables as possible and test-test- test until you know. Then you can add in the variables and make the adjustments.

[Lilly164]

This is a very interesting thread. Rak1978, your BG numbers look just like mine!
Delaying eating breakfast for 30 minutes or more has really helped morning numbers. That said, I want to qualify by adding, NOT, for a morning low, An AM reading of 140, take insulin, wait 30-60 minutes to eat.
I always eat carbs with breakfast. Oatmeal and milk, usually. Another change that seems to have helped is reducing the oatmeal to 32 grams, (it was 1/2 cup) add 1 cup milk and 1/4 cup cottage cheese for some more protein.

Delaying food in the morning to allow time for insulin to reach the cells and reducing the carbs a bit seem to have helped, not solved the DP.
The suggestion to allow more time between insulin and food all day looks good. I plan to give it a try.

Thanks all.
Lilly