Blood Sugar is High, Then Drops Dramatically

[robberr 0]

For the past couple months I have been stuck with a problem that I am trying to fix. After I eat breakfast, my blood sugar every single time is high, as in 240-380. Then, a few hours later at lunch time, my number crashes and goes low. Because of this, I don't fix the highs when I check my number, because I would go low even sooner. Originally I thought that if I raised the short acting (humalog), it would fix my problem of being high after breakfast. Then I thought I would need to lower the long acting (NPH) to prevent my better numbers after breakfast from going low even worse, since I had consistently been going low as mentioned. So for a week or two I experimented with this, going down by two with NPH and up by two with Humalog, but none of this was changing anything. After this I thought it was possible that my theorem was wrong, and that maybe the Humalog was what was making me low and by raising it I had made it worse, and I had noticed worse lows since this change. So I tried going the opposite way and still nothing is working. I really do need help with this problem, as I feel horrid for my whole morning and the rest of the day I am fine. I need to know two things that I can't get a definitive answer for: what is the peak of Humalog and NPH; do they affect lunch and dinner or post-breakfast and lunch (respectively), and should I raise or lowers these insulins? Or is it in fact my night time insulin I need to change? Thanks, sorry for any confusion with the long explanation.

[Bar&In 1,065]

Couple questions

 

1. What is your fasting BG before breakfast?

 

2. What are you eating at breakfast?

[Uff Da 7,201]

More questions:

 

3. What doses do you take of the NPH? 

 

4. What time do you take each dose?

 

5. What time do you take your breakfast Humalog?

 

6. How much time do you allow between Humalog injection and first bite of breakfast?

[Uff Da 7,201]

This will give you some general information on insulin action time. 

 

http://www.diabetesnet.com/about-diabetes/insulin/insulin-action-time

[robberr 0]

1. Before breakfast BG is anywhere from 113-240, most of the time it's under 200 though.

2. For breakfast I eat cereal with milk, an apple or pear, a hard boiled egg,yogurt, etc.

3. At the moment, 28 NPH in morning, 18 at night. Morning came down from 37 to try to correct lows

4. I take morning at 6:00 and night at 6:00 (pm)

5. Breakfast humalog also at 6:00

6. I usually take the insulin and eat right away

[Bar&In 1,065]

I don't know your situation or what you and/or doctor's game plan is for you but with fasting numbers that high, your basal needs adjusted in my opinion. Personally I run low to mid 80's but again I don't know your situation, just telling you my thoughts.

 

Cereal is an absolute NO in my opinion, I've tried almost all early on with no luck so accepted that was no longer an option. Fruit as well, okay here and there, but most loaded with sugar. Also be careful with yogurt, most contain a ton of carbs and sugars but if you look hard enough you can find some with under 5g per serving. But again we are all different so you may be able to eat things I can't.

 

My thoughts are get your basal right, it's most important and your's seems to need some tweaking. When making changes always go small and work from there, especially with your night time basal.

 

You'll get it figured out, good luck.

[Bar&In 1,065]

After you get your basal locked down a few other things to consider.

 

Do you use a scale to weigh your food?

 

Are you using regular milk? May want to switch to a soy or almond because about 13x less carbs per serving.

[Bar&In 1,065]

And to answer your original question in short, you are eating too many carbs and wrong kind of carbs at breakfast. Worst part about doing this is you not only spike but you also go low at the tail end, worst of both worlds.

[Uff Da 7,201]

I agree with Bar&In. In all probability, your biggest problem is the number of carbs you are eating for breakfast. You didn't mention quantities, but let's assume you had 1.5 cups of corn flakes, half a cup of milk, one medium apple and a hard cooked egg for breakfast. That's almost 58 carbs in one meal! You are eating it at a time that you have little to none of your basal insulin active. Plus many of us find that we are more insulin resistant in the morning. For example, I have to take twice as much insulin per gram of carb for breakfast as I do for lunch or dinner.

 

If your BG is coming back down to approximately your pre-breakfast level before noon, you are taking the right amount of insulin for your carbs. So if you reduce your carbs to half the current number, you'll need to lower your Humalog for breakfast. But your peak won't be nearly as high if you eat fewer carbs for which you take an appropriate dose. If a breakfast with just half as many carbs still sends your BG too high, try cutting carbs to about one-fourth the original amount and dose insulin accordingly to return to pre-meal level by noon. 

 

You are likely able to eat about twice as many carbs at noon than you are at breakfast or dinner, due to the peaking of your NPH around noon, plus Humalog active in the next few hours after noon.

 

If your BG is high first thing in the morning, try taking your Humalog longer before you eat if your time schedule permits. I know on work days that might not be possible.