[foxl]

I totally understand as a T1, and heck even for the "rest" of us (I am a 1.5 rilly), "endo-approved." Mine told me 40 per meal though and I am like nuh-uh, no WAY. It might be the only way she would prescribe insulin for me ... so maybe someday?

[Subby]

Originally Posted by jenb

If you started breakfast at 169, the rise to 245 is really not that unexpected.
Jen

This point got a little lost somehow but it's central. This 2 hour spike you are reporting isn't all that unusual for a high carb meal.

Yes, you may not like that spike of about 50 (I don't like to see that spike much either). But what takes your BG so high overall, is that you are jumping off from a high pre meal place already. So while you can (and I think should) look into modifying your meal and bolus somewhat, to notch that pp spike down - the biggest or most obvious problem is that you are 170 before breakfast. That needs to be addressed.

For the spike - two suggestions I have is lower carbs (and probably lower dosage - what is very hard to say - full I:C dosaging is I think mandatory if you do want to nail your BGs better), and to prebolus.

For the pre meal high - well, tackling DP can be tricky. Baring a pump, sounds like the trick of taking some rapid acting before the spike runs away, might be a tactic to try. There is a lot of discussion to be had about trying things to combat DP.

[fgummett]

Originally Posted by gary.keith

I agree, but it's endo-approved. Still, tomorrow I'll try some extra Egg Beaters and skip the carby stuff like rolled oats or waffles.

You may also need less insulin if eating fewer carbs... again check out the "small numbers" idea... you may find that smaller inputs lead to more predictable outcomes.

[Granny Shanny]

Penny made a suggestion the other day that makes sense to me . . . she keeps one clock that is never switched to/from DST, and that is "her" clock to go by for meds/injections.

And Gary's endo's approval would carry a lot more weight if he/she were diabetic him/herself! Sometimes the book learnin' doesn't help us much . . .

[jenb]

Originally Posted by gary.keith

I agree, but it's endo-approved. Still, tomorrow I'll try some extra Egg Beaters and skip the carby stuff like rolled oats or waffles.

As you gain experience with this you'll find that sometimes advice from your doctor doesn't jibe with your real world experience. The Endo is a member of your team, but you're the captain!

To lower the carb content of your breakfast try replacing the starchy carbs with a serving of something like blackberries and strawberries. You can eat a pretty generous serving of these and still come in with under 10 net carbs, and a limited BG spike.

Jen

[gary.keith]

Thanks again, everyone. The main problem, is, I think, my horrible DP spikes. I'm going to make a concerted effort to keep my BG under control the rest of the day so I have a good starting point at bedtime from which to see when the DP starts.

Unforunately I went a bit hypo (69) this afternoon after a pre-bolus and then running out of time to eat enough carbs. I had to swallow some glucose gel in the dentist's chair. Two hours later I'm stable at 91.

Anyway, point taken about either more insulin or less carbs at breakfast. I have my Using Insulin book now so I'm sure it'll be lots easier. I've been looking for strawberries and blueberries but haven't been able to find any the last few weeks.

Shanny, I'll give the dual clock thing a try, but honestly, my mind doesn't work that way. I can't easily fool myself into thinking the time is different. I guess I've spent too many years as a programmer.

[gary.keith]

After this morning's DP fiasco, and this afternoon's lunch plunge into hypo territory, I seem to have rebounded quite nicely.

I dropped to a BG of 69 after lunch. Swallowed half a tube of glucose gel and about two hours later I was back in normal range with a BG of 91. Two hours later it was 101. Before dinner I bolused 19 units of Novolog then ate a dinner with 58 grams of carbs. One hour PP BG was just 130. Two hour PP was back down to 113. Three hour PP was still 113.

So tonite I'm going to try getting up regularly so I can see when the DP spike starts and stop it in its tracks!

I'm two chapters into Using Insulin and it's great! Thanks to everyone who recommended it to me. I'll be a know it all before you know it!

[gary.keith]

I didn't manage to wake up throughut the night to check my BG. Sleeping thru the night without awakening was quite unusual for me. Perhaps it's because my BG at bedtime was in my normal range at 88 instead of being slightly high. I woke up at 6am, checked my BG and it was 101. I took a chance that this was the start of my DP spike and bolused 4 units of NovoLog. Then I fell back to sleep until 9:00am. BG at 9:00am was 96. Normally it's well into the high range by now. It's currently 9:30am so I'll check it again in half an hour.

It seems like my body woke me up at just the right time to catch the spike. I'll keep testing this over the next few nights to confirm what I suspect.

[Granny Shanny]

Great start on your day, Gary!

Dunno about you, but I love it when I waken & realize I've slept straight through! That's really sleepin'!

[Subby]

Originally Posted by gary.keith

Unforunately I went a bit hypo (69) this afternoon after a pre-bolus and then running out of time to eat enough carbs. I had to swallow some glucose gel in the dentist's chair. Two hours later I'm stable at 91.

The dentist is something special for an insulin dependent diabetic, I think. If I haven't checked my BG recently, about 20 min in, what with the strange stress and weird feelings, I invariably want to stop everything and take a BG test. Of course, that's often not so easy. I always check just as I sit down.

Anyway, the prebolus thing, you obviously have to make sure you follow it up. I would suggest never prebulosing if you are rushed or otherwise have a chance just to miss your food. This could be life and death stuff, if for example you prebolus a decent amount, forget and go driving.

I think it's one of those things that will slowly get shuffled in your head as automatically top priority. Prebolus - must eat in x minutes, like an iron clad chain, no thing in this world can interrupt that. It will come to you, but be careful.

[gary.keith]

Originally Posted by Granny Shanny

Great start on your day, Gary!

Dunno about you, but I love it when I waken & realize I've slept straight through! That's really sleepin'!

Same here, Shanny. I feel lots more rested than usual.

Now for the bad news... It seems I didn't catch the DP spike after all! I took a shower, just checked my BG again, and it's up to 136! I haven't eaten anything, haven't even swallowed all my morning meds. I dunno, maybe I need an early and later bolus to cover DP.

Now I don't know if I should wait until the pre-breakfast bolus or try something now. I think I'll just wait because I've done enough experimenting for one morning.

Originally Posted by Subby

The dentist is something special for an insulin dependent diabetic, I think. If I haven't checked my BG recently, about 20 min in, what with the strange stress and weird feelings, I invariably want to stop everything and take a BG test. Of course, that's often not so easy. I always check just as I sit down.

Anyway, the prebolus thing, you obviously have to make sure you follow it up. I would suggest never prebulosing if you are rushed or otherwise have a chance just to miss your food. This could be life and death stuff, if for example you prebolus a decent amount, forget and go driving.

I think it's one of those things that will slowly get shuffled in your head as automatically top priority. Prebolus - must eat in x minutes, like an iron clad chain, no thing in this world can interrupt that. It will come to you, but be careful.

Thanks, Subby. I'm also sure it'll all get sorted out in my mind given some more time. I sometimes forget I'm a bit more than a month into this adventure and barely three weeks out of hospital.

You raise an interesting point about the dentist. Every time I've been there since being diagnosed, that's three times so far, I've gone hypo within 20-40 minutes. I have no fear of the dentist and all his whirring, hissing gadgets. So I doubt stress is the reason. Still, it is an interesting coincidence.

[Subby]

Gary, it's interesting to consider that for some people, some stress appears to lower their BG, contrary to the usual scenario of stress releasing hormones, glucagon and shutting down insulin receptors in the cells (thus causing IR and highs).

I do hear you that you don't feel stressed at the dentist (and am jealous). I guess whatever is going on, you are getting a profile to act on next time at the dentist. It may be co-incidence, but you can always experiement if you wish. You could try a small medium term carb snack vefore the dentist, without bolus (something that should have some effect, but won't shoot you up dangerously) and see if that gets you through the visit intact BG wise.

[fgummett]

I've experienced similar where a stressful situation has lowered my BG... I figured it has something to do with extra brain cycles using up BG (it can be a real energy hog) together with tension in muscles. Perhaps similar to moderate activity/exercise?

[gary.keith]

Originally Posted by Subby

Gary, it's interesting to consider that for some people, some stress appears to lower their BG, contrary to the usual scenario of stress releasing hormones, glucagon and shutting down insulin receptors in the cells (thus causing IR and highs).

I do hear you that you don't feel stressed at the dentist (and am jealous). I guess whatever is going on, you are getting a profile to act on next time at the dentist. It may be co-incidence, but you can always experiement if you wish. You could try a small medium term carb snack vefore the dentist, without bolus (something that should have some effect, but won't shoot you up dangerously) and see if that gets you through the visit intact BG wise.

Next time you go to dentist bring your mp3 player along and crank up the volume. Music is my pacifier. Always has been. I can block out anything external when I've got music blasting in my ears! I've worked out some hand signals my dentist can use to let me know what he wants me to do. Tap on the right shoulder and I turn my head right. Opposite with the left shoulder. He runs his finger down my chest to open my mouth. Up it to close my mouth. When I bite his finger it means I want him to stop!

What would you consider a medium term carb snack?

Originally Posted by fgummett

I've experienced similar where a stressful situation has lowered my BG... I figured it has something to do with extra brain cycles using up BG (it can be a real energy hog) together with tension in muscles. Perhaps similar to moderate activity/exercise?

Good point on both your parts about stress sometimes causing BG to go down. I doubt that was the case at the dentist, but it could easily explain it in other scenarios.

[Subby]

Originally Posted by gary.keith

Next time you go to dentist bring your mp3 player along and crank up the volume. Music is my pacifier. Always has been. I can block out anything external when I've got music blasting in my ears! I've worked out some hand signals my dentist can use to let me know what he wants me to do. Tap on the right shoulder and I turn my head right. Opposite with the left shoulder. He runs his finger down my chest to open my mouth. Up it to close my mouth. When I bite his finger it means I want him to stop!

What would you consider a medium term carb snack?

Well done on getting yourself a trained dentist there Luckily, the dentist doesn't actually stress me that much or ruin my BG, it's just a not so common mix of loss bodily of freedom, with certain physical stresses and sensations I often associate with going low, that precipitates me wanting to check my BG "just in case".

I recently did need to keep going back, and it was starting to get on my nerves. I will keep the mp3 player idea in mind if I am blessed with too many dentist visits...

A medium term moderate carb snack... hard to say specifics as we are all different. I guess in this scenario of wanting some upward action over the next 30 min - 1 hour, half a piece of moderate spiking fruit might be suitable, or a relatively low GI couple of biscuits. If you find out what raises you say 30 or 40 mg/dl over the course of an hour, without continuing into trouble land, that would seem to be a good basis to try. I'd suspect about 20g carbs, but we are again all different. Such snacks may also be helpful in the case of certain exercises, when the presence of insulin that normally keeps you even (your basal and remaining boluses), is in some circumstances going to cause persistant lows as you exercise... and the way to deal with that may be to snack the right amount of mid-range carbs to keep your BG up over a period of time.