[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]

Originally Posted by 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......

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]

Originally Posted by 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!

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]

Originally Posted by Scratch

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]

Originally Posted by Gary_W

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.