New T1D - unexplained rise after dinner

Newly Diagnosed
1

New here and new to type 1. Was diagnosed a month ago. Im 37 and only had a cousin who had T1D. This is all so bizarre and so much to learn. But i’m starting to get things managed overall. However, i’m having a weird issue if anyone has any info on what could be cause or advice.

My insulin:carb ratio is about 1:12. I’ve been able to accurately carb count and get my sugars down below 150 two hours after meals without going below 90 rapidly. On good days, i cruise at about 95-120. But i’m struggling with dinner.

I’ll add up my carbs and dose, wait, eat, then watch my CGM show my rise in sugar where I’ll peak at 180-200, then plateau. After about 30-45 mins, i’m my sugars slowly rise about 200 and sometimes hit 240. I cant figure out why. I tried a super lean meal with low glycemic veggies and still didn’t work. I even have tried lowering to a 1:11 ratio and have done a correction dose two hours later and it didnt do anything.

My sugars take all night as I sleep to come down to 150-120. Then i start the day over and repeat the night issue over again.

I dont get it. Im hydrated and take a walk after dinner. Only way i get it down otherwise is to do a 30 min power walk just before bed. Anyone else have this problem? Or heard of it? Thanks in advance!

2

You might want to check your evening basal rate. From time to time our needs to change, and if you’re not getting enough basal insulin it can be hard to get the response you want from your meal bolus.

3

Hello @JakeVA welcome to Type One Nation. You don’t say shots or pump, so I’ll just add to @wadawabbit comment about basal rate to include talking to your doctor about the type and frequency of your long acting shot of background insulin. If you are on Lantus for example, many people split their shot into 2 shots at 12 hours apart.

Given that you were diagnosed a month ago, you may still be making a little insulin. It’s common for newly diagnosed people. As your body stops all insulin production, you may see more erratic blood sugar as well as need more insulin.

Cheers and good luck :four_leaf_clover:

4

One other thing I can think of is protein/fat combo at dinner. Carbs are going to spike you quickly depending on the carb, but around 2.5-3 hours out for me (other people vary) if I have something that’s heavier in fat or protein I’ll begin to see that spike around then. There are ways to help with this, you’ll just have to have some trial and error first. I would recommend making sure your basal insulin is correct though first because if it’s not, this will just be another thing to try and nail down and a good basal dose is really the foundation of all diabetes things. High fat/high protein is tricky because on days where I work out hard the protein helps keep me up overnight, but that’s also something I’d look into. The highs I get from delayed carb absorption due to heavier fat or protein tend to keep me up longer too then a carbier dinner with lower fat/protein. So let’s say I’m 160 before bed 3 hours after dinner, I tend to still be around 160 even with a correction three hours later if the fat/protein are the issue and then I correct again. Both come with their own set of challenges but just a thought!

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@JakeVA Hi Jake, and welcome to the JDRF TypeOneNation Forum! Members here, most of whom are not “medical professionals”, do not offer advice, but rather share with others thoughts and techniques that have, or have not, helped them manage their diabetes successfully.

As less than 10% of people diagnosed with T1D have a first degree with TypeOne, you are not unusual in this respect. And yes, as most of long-termers will share here there is much to learn and learning new things about your individual case will last a lifetime

“Cruising at 95 - 120” is really good for most people - keep in mind that an HbA1c of 6.0% means that your daily glucose average for about 90 days has been 120 mg/dl. There are many reasons that your BGL may be rising like it does after dinner, and the “rise” could very well be different for you even on two days when you eat exactly the same thing and take the same insulin dose - just one of the “built in things” that is there to baffle us. I have days like that, but if my BGL is below 150 two hours after eating. Do you really have the same I:C ratio all day long, most of us with T1DM have ratios, and insulin sensitivity factors [ISF] - also called correction rates, that vary throughout the day - mine vary fron 1:10 to 1:19.

One thing of which you can be certain is that insulin ratios, amounts of insulin you need will change over time, be observant of your own body and learn the trade called “Doctor Me”. Learn about yourself.

I’m pleased. What I suggest is that you stay

6

Thanks all who replied.

So I’m not on a pump. My doc had me start out with taking 13 units of my basal dose, and a 1:15 ratio. I’m finding i need lower or higher ratios at different times of day yes. My correction dose is just 1 for every 50mg/dl over 150. No idea what my sensitivity is.

Ive been reading the book “Think like a Pancreas,” and its been very informative. I think i need to nail down my basal dose as someone suggested.

What I’d be curious to know is how basal works in regards to keeping your BG level. Does basal just keep you level at whatever your blood sugar is at 3-4 hours post meal and bolus? Or does it bring you down to a point and then level out?

For example, lets assume my basal happens to be spot on. If I had a premeal BG of 100 and theb bolused and ate but ended up with 200 BG 2-3 hours post meal, would a perfect basal slowly bring me down to 100ish BG, or would it keep me around 200 until I corrected (for this example assume no physical activity or snacking etc)?

Hope that makes sense. What I’m trying to determine is if i go to bed at 150 BG, is it normal for my BG to slowly drop to 80 and then level out around 4am.

I also understand none of what i read online is medical advice. And that everyone is different.Thanks!!

7

Jake - our livers break down protein in particular and this part of the carb algorithm isn’t accounted for - it’s ignored. I had a long conversation with my endo about this and he agreed that after the protein breaks down and the liver processes this, the release will cause a rise several hours later. Gauge your typical consumption and adjust but know you might need to further adjust based on protein quantity. It can be all as salmon does that to me so not protein type dependent. Might also play with Oz and find your “trigger OZ amount”. Mine seems to be 8oz. Anything more, it spikes.

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Thanks for reply. For dinner last night I had 15 gr from bread, 15 gr from cooked veggies, and had 3 oz of Baked pork loin. My sugars rose above 200 and stayed there late into night. I gave myself two units to correct 2 hours after and nothing happenend.

Its just so weird to me. I eat 15-30 gr of protein at each meal and never have issues with insulin absorbtion its just at dinner and night…

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I have exact same issue. Only at night. About 4-5 hours after. The liver aspect is ignored as almost impossible to measure the carb break down there. Nutritional science is ancient and honestly hadn’t been updated as far as this aspect.

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Jake @Sqduarte , I’ll add a couple of observations for some of the questions you have attempted. Just remember that T1DM is a condition that attacks the host body, and it will continue attacking - this will prevent you from continuously having “perfect” BGL readings all the time. Also, what Susie @Sqduarte wrote is very true and is one of the reasons I wrote that you must observe how your body behaves - after a trip to a steakhouse where I might enjoy a tasty porterhouse, my correction dose 3-4 hours after eating is close to the amount of insulin I needed earlier for an for an 7 oz. baked potato with all the fixins. Additionally, all “cooked vegetables” are not created equally; carb content differs.

“Does basal just keep you level at whatever your blood sugar is at 3-4 hours post meal and bolus?”
There are many factors that come into play here: What insulin formulation being used for basal. IN THEORY what you wrote is close to what should be happening - a correct dose of basal should keep your body glucose to level [ +/- 20 ? ] on a day of normal activity when no food is eaten; basal is not intended to offset BG changes attributed to food. Meal time bolus insulin should be adjusted for all eating. As for basal insulin formulation, depending on your body a single dose may stay effective doing the intended job anywhere from 18 to 42 [yes, 42] hours. That is, when using a true “Background Insulin” formulation; many people are prescribed “Long-Acting” formulations for basal.

" My correction dose is just 1 for every 50mg/dl over 150": This tells me that you are assuming 150 mg/dl to be your target glucose. That is fine, and in my opinion a safe strategy while you are learning and getting used to living with diabetes; I agree with your doctor for this decision. And seeing that this strategy keeps you at 80 or higher it appears to be “perfect” for you. I use different targets during the day; 140 when exercising, 110 when sleeping, 120 for most of the day.

The bottom line, do what you need to do to keep your diabetes at a level where you can lead an active, productive, and fulfilling life. You will get to the point where well-managed diabetes will stay in the background and not be the dominant ruller.

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100% agree. Plus recognize many endo aren’t also researchers who dig in &/or treat more T2D and thyroid than T1D. I work in clinical research and had a hard time finding one not afraid of trial & error or from straying from guidelines despite studies proving efficacy. You will learn your body but even then - other aspects (stress, exhaustion, etc) can add in a curve ball. Reach out. Vent. Most importantly - don’t aim for perfection.

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Thank you Susie and Dennis for following this thread and the inputs you’ve shared.

Some background on me if it helps understand where I’m at in this journey:
I’m six weeks into my diagnosis. I’m 37 and, although I have a desk job, I’m moderate to very active most of the time. However, since being diagnosed, I’ve tried not to be as active so that I can 1) gain some weight back, and 2) learn how I’m responding to insulin and carbs before adding strenuous activity into the mix. This was the advice of my doctor; I’m mostly walking and doing some light strengthening exercises now.

I’m taking 12 units Basaglar 1x/daily in the morning. I was on 13, but 12 seems to keep my BG more level throughout the night, where as 13 dropped it <40-50. My doctor started me on 1:15 bolus ratio (I use NovoLOG flexpens), but she understood I’m very proactive and data-oriented (she gave me a G6 right away), so I’ve been able to try some modifications to my ratios (just ever so slightly).

My goals right now are as follows in order of priority:

  1. Stay below 200 post-meal: I’m currently learning about post-meal spikes.
  2. Less than 2-3 hypo events (<70) a week.
  3. Spend 50% in target range 80-150 (while I’m learning; will increase the goal to 70% eventually).
  4. Fine-tune my carb ratio (breakfast, lunch, dinner).
  5. Learn how to correct my lows and sudden drops without overcorrecting.

#1 & 2 are what my doctor prescribed. She also gave me the 150 target, but I set my goal to 50% in range and I try to aim for 110 when dosing and correcting.

I have less than 2 or 3 hypo or <70 events a week right now, especially after getting my basal dose to 12. My biggest challenge has been timing the post-meal spike. But, I’m learning what foods do what and have been able to predict how some meals will play out. Except for dinner (which is what brought me to this forum).

For dinner, my doctor said my long highs were either an “inappropriate glucagon response,” too high fat/protein meal, or not enough insulin. Your responses around the fat/protein influences are helpful and have helped give me some guidance on data to pay attention to. However, I haven’t been eating porterhouse steaks by any means. I’ve been under 30grs of protein most of the time. I did notice I eat a lower % of carbs at dinner compared to breakfast and lunch. Perhap[s that is the outlier…

Again, appreciate your support and responses. I’m not aiming for perfection, but I am trying to build my understanding quickly. I have twice been able to do a correction dose 4 hours after a meal and fast and find it brings me down by 100 mg/dl over 3 hours. So I tend to only correct when above 200 accordingly. But it didn’t work at dinner the other night. The joys of T1D it sounds like :p.

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13

Alright, I found a trend and adjusted for it tonight with results.

Couple things happening. 1) I had not been eating as much carbs compared to breakfast and lunch. Ie, I was getting less calories at dinner and found myself snacking within two hours after. My go to snack has been almonds…

Almonds have 15gr of fat in one serving. Add that to my meals that have up to 15 gr of fat and now I’ve had 30+grs of fat. I’m guessing this is causing the delay.

I had chicken and broccoli for dinner tonight that came out to 40gr of protein, and <15gr of fat. I didn’t dose until after I ate it, then took my bolus and waited 15 mins before eating my pasta to get ~40 carbs. I had a little dark chocolate after for a total of 45 carbs.

My BG didn’t spike and I had to do a minor snack an hour later as I was dropping below 80. So I think I figured out that problem. However, I realize T1D has many variables so what worked for me today could not be tomorrow. But it’s a start!