Does anyone test post-meal to see how high their glucose is going? From what I'm reading, it's really important not to let glucose numbers get too high, and it seems to be they would be most likely to spike after eating, even with pre-meal insulin. And, there's a column on our doc's report sheet to include numbers 2 hours after some meals, but he doesn't ask us to do that.
Maybe I'm worried too much about the long-term effects of spikes?
Mo
Alright, I'm not sure if this will be any help but I'm going to share what I've seen for the heck of it :) (and because no one's posted on here yet... come on, people!)
I don't recall if my doctors specifically instructed me to test after meals, however I sometimes do. Not like every time a certain number of hours/minutes after eating like I typically do before I eat, but I like to see how the food is working out.
One thing that concerns me always is how high I (used to anyway... I haven't noticed it much lately... there's a reason to smile today!) get after eating. Any thoughts on this? I always thought 'I'll know I have good control when I'm under 150 after eating...' Is that a pipe dream? LOL
I imagine it is important to watch, though. I think this wasn't very much help :)
The solution to keeping your blood sugars relatively normal (90-120) after meals is simple: It's called a very low carbohydrate diet. Presently my diet includes approximately 6 grams of carbs for breakfast and 12 grams of carbs each for lunch and dinner. Furthermore, the carbohydrates I eat are the slow-acting ones like vegatables and the carbs in cheese. I have completely eliminated fruit, bread, pasta, cereals and all packaged prepared food from my diet.
What can you eat on this diet? You can eat meat, poultry, fish, eggs, vegatables, butter and oils. I used to take between 8 and 16 units of insulin before a meal.
Now I take between 1 and 3 units. I've cut my daily insulin intake from around 60 units to less than 40. Higher doses of insulin and high blood sugar spikes contribute heavily to insulin resistance.
Some "diabetes specialists" and "endocrinologists" subscribe to and promote the misconception that "as a person with Type 1 you can eat anything you want as long as you cover it with enough insulin." It's only true if you think having an A1c of 9+ is ok for your long-term health. The blood sugar roller coaster is a prescription for a diabetes train wreck. I wish someone had the knowledge or decency to tell me this thirty years ago.
You should definitely check your blood sugar after meals (i.e. postprandial).. The question is how long after meals, and this is going to depend on your particular rate of digestion and metabolism. It is particularly complicated for people who have had Type 1 for a long time and may have some degree of gastroparesis. I generally test between 2 and 3 hours postprandial and will cover anything more than 20 mg/dl above my target at that time. Humalog actually takes as much as five hours to completely leave the system but I haven't found that it affects my blood sugars much after 2-3 hours, but everyone is different.
Going on a very low carbohydrate diet is a major commitment and many people find it very difficult to stick with. But, it is the key to excellent blood sugars... even right after meals.
Thanks for your input, Paul. Wasn't it you who recommended "Dr. Bernstein's Diabetes Solution"? I've been reading it over the past couple of days, and it's brought up a lot of questions.
I'm all for the low-carb diet, and am working on reducing the carbs in our family's meals as much as possible. Unfortunately it's our 8-year old who has T1, and he's a carb fiend; has been his entire life. I've been getting a little frustrated with Bernstein's recommendations, because they are clearly directed toward adults with diabetes, with just short notes here and there regarding children. While the diet he suggests may be something I would tackle for myself, it's just not realistic to expect a child to comply. And, he endorses artificial sweeteners, which I'm just not a fan of, especially with kids.
One thing I have noticed, however, is that since William's diagnosis last month, and since we've gotten his numbers mostly in his current target range (80-150), he's been satisfied eating fewer carbs with meals than he used to. And, he's not craving milk like he always had (I swear that boy drank 1/2 gallon a day by himself). It makes me wonder how long he'd been "pre-diabetic" before his diagnosis. But, I've been slowing cutting back carb portions for everyone, serving out carbs at each meal rather than just sticking the pot in the middle of the table, and everyone seems to be fine with it. But, getting William to eat veggies...well, that's just not gonna happen. Believe me, I've been trying for 8.5 years, doggedly plopping veggies on his plate at every major meal. Thank goodness he likes meat and dairy.
Right now we're testing before breakfast, lunch, dinner, and bedtime snack, and giving Humalog before each of those meals. If we add testing before his afternoon snack, we'll basically be testing every two hours while he's awake. I may be able to sneak in that extra test without too much squabbling, so I can get a sense of what his BS is doing after lunch. Today it dropped to 60 before it was time for his snack :(
Anyway, thanks for chiming in. I've spent most of today digging into the diet issue, and have come up with more questions than answers. I'm scheduled to attend my care-taker's class on Wednesday, and am sure I'll have more questions then. If it were me, I'd be far more willing to "experiment". But, with a child, gosh, you feel like every tiny decision will have a life-long impact.
Mo
Hi Monique,
If you've gotten William's blood sugars even pretty much into a 80-150 target range, I think you're doing exceptionally. And of course you're right, Dr. Bernstein's diet is difficult for most adults, so for a child I can't even imagine. I'd be curious to see how he manages children in his practice. I know he says that one of his first steps is to "negotiate" the diet with the patient. I wonder if he "negotiates" it with the child or the parents.
I think the most important thing in the case of a child is that the parents acquire and foster the nutritional facts. It's fantastic that you are demonstrating what's right by having the whole family partake in a lower carbohydrate diet. It makes so much more sense to the child with Type 1 if he sees it as the entire family eating a more healthy diet. Of course, what you're up against is the barrage of advertising for high carb and high sugar foods, as well as the "peer pressure" from other kids in school.
I admire how well you're doing. And, as you implied, in order not to damage William emotionally sometimes the diet has to be compromised. It's certainly not going to help by making yourself "the enemy." You're fantastic? Keep it up!
Paul
BTW: Has William had a recent A1c?
I don't eat low carb, but *usually* manage to keep my sugars 120 - 180 after meals (around 2 hours post). For me, that means slightly higher doses of the short acting insulin, so I sometimes drop low around 4 hours post meal. I just keep some fruit around for between meal snacks to avoid this. Everyone is different, but my philosophy is that my life is crazy enough w/ D, so I want to be able to eat as normally as possible (i.e. out at restaurants w/ friends!!).
But, to more specifically answer your question Mo, I definitely test after each meal, meaning I test at least 6x/day, usually more. It's worth it and my A1c's are usually in the non-diabetic range.
im supposed to, but know i have stopped. when im bored and notice that its about 2 hours after a meal, i usualy test. most of the time im too busy. its important to on a pump because it could not be workin properly or something and after a meal would tell you that easily. im not saying that everytime it goes high after a meal your pump isnt working because my pump works fine but my blood sugar went 19mmol after a meal.
That reminds me - I still have the 2 hour post-bolus alarm set on Rex (my pump :)).... I bet I can take that off now haha since I don't really test any more when it goes off
I was told to test 2 hours after a meal. Now that I have a CGMS I will often wait longer than 2 hours to test unless the number is out of range. The CGMS has definitely cut down on my between meal tests.
[quote user="Paul Glantzman"]What can you eat on this diet? You can eat meat, poultry, fish, eggs, vegatables, butter and oils. I used to take between 8 and 16 units of insulin before a meal.
Now I take between 1 and 3 units. I've cut my daily insulin intake from around 60 units to less than 40. Higher doses of insulin and high blood sugar spikes contribute heavily to insulin resistance.[/quote]
I tried the low carb thing after reading Bernstein's book some years ago. It did not work. I could manage okay during the day but overnight my BG would skyrocket. I'm talking about waking up with BGs in the 400-500+ range. I also don't like eating meat all the time. I'm not a vegetarian but I don't eat meat every day and don't have red meat often. I love cheese but if I have more than 2 oz. for a snack, my BG shoots up in a couple of hours.
I currently take 2-4 units before meals (usually in the 2.5 - 3.5 range) eating a fair amount of carbs (~250/day). I am pretty sensitive to insulin. I use 25-30 units a day (all Humalog, with a pump). My last A1c was 5.4. My triglycerides are nonexistent.
I do really like the idea of eating less carbs to reduce blood sugars. I do have some concerns about eating extremely low carb though. Now don't quote me on this, but from what I know, eating a high protein diet, as well as not eating enough carbs is hard on the kidneys (ketones). As well, eating a lot of animal products is detrimental to the environment and of course hard on all the factory farmed animals. (Sorry that last part I had to throw in there because I'm a vegetarian :)). I think that it's good to reduce the fast carbs (aka anything white: white bread, white flour, white rice, etc) and eat low GI foods. I like beans, whole grain breads, quinoa, etc. Like I said though, these are just my thoughts, I'm no dietician for sure. I like to check my blood sugar about 2 hours after I eat at least sometimes because then I can often predict if I will be low or high later depending on how much insulin I still have working.
I hadn't thought a whole lot about your post because my doctor talks about night time and morning numbers being the most important but I have noticed some big spikes in my BS after meals. Just yesterday I noticed about 1.5 to 2 hrs after a meal that my BS was 286 at around 7:00PM. I go to the gym, come back and check it before I went to sleep at 9:38PM and it's 146 which is about what my doctor wants before I go to sleep. Wake up and check it at 9:00 AM and it's 111 which again is about right on point for me. So I wonder what exactly are the effects of high spikes. I think it's harder for me to control because I don't bolus. I just basal with Lantus. But it's hard to spread meals out instead of just eating 3 meals.
I try to test 1.5 to two hours after a big meal just to make sure I took the correct amount of insulin. As I've gotten older I've started to care, and feel, more of my high blood sugars and thus try and stay away from them as much as I can. I woulnd't say you have to after every meal, but any meal where you might not be so sure of things it can't hurt!
I do occasionaly. Very occasionaly!
Hey, Paul,
Thanks so much for your continued support and input. We're very lucky to be homeschooling the kids, so they're not surrounded by kids bringing ding dongs for lunch every day :) The families we spend most of our time with are very health conscious, and a few kids have other dieteary considerations, so everyone is used to asking about foods first, and being sensitive to those how are on a more restricted diet. One of many blessings for our family.
William has not had an A1c yet, because he was only diagnosed last month. Dr. A usually waits about 3 months for the first test, so we can see how we're managing, rather than see how horrifically high he went prior to diagnosis. Ugh, I'm not sure I'd want to know that. I know he spiked to 500+ before the IV insulin kicked in and started bringing him down. Right now I'm really watching him for drops; I think he was used to be high for long enough, he sometimes starts feeling hypoglycemic around 85, but he's getting more comfortable being down in the lower normal range. He had another drop before lunch today, but we caught it and he was fine within about ten minutes.
Okay, rambling now. Thanks for listening, and for recommending Dr. B's book. I'm going to continue reading it, if anything just for the perspective and information.
Mo
BIG thanks to everyone who responded! What I'm really noticing is there seems to be a wide range of testing and dosing regimens out there. It's kind of bewildering, actually. But, it's also giving me a sense that as William grows, and especially after his honeymoon has ended, things are going to be changed and adjusted. I shouldn't get too "comfortable" with our current program, because it might need to be changed.
Mo