Hilary,
I had the same problem, for years, with those post-meal spikes being really high. What solved it for me was taking my boluses (I'm on a pump, using Humalog) 10 -15 minutes before I begin eating. It's a pain, and I can't always guess accurately, but if I'm doing things right, I don't see anything over about 180 in the two hours after my meal. How long are you waiting between insulin and food?
This may be part of my problem. I'm not bolusing until 15-20 minutes after I eat...I'm hoping that guesstimating how many carbs I will consume in the meal will help to bring these numbers down. I've found them particularly frustrating lately and like I'm on a yoyo.
Ooooh, yeah... I would bet that's your culprit. Your food is peaking before your insulin is. Even if you have to take a couple units after eating for what you didn't estimate earlier, it makes a huge difference when you bolus about 10 minutes out from eating.
My guideline is - If I test and am high, so I'm doing a correction on top of my food bolus - wait 15 minutes.
If I test and I'm within range, I wait 10 minutes.
If I test and I'm low, I bolus after I take my first bite. :)
This really worked well today for me! I bolused before meals and estimated my carb intake and ate plenty of protein throughout the day...fewer lows.
Thanks for the feedback. This place is great!
[quote user="Hilary"]
This really worked well today for me! I bolused before meals and estimated my carb intake and ate plenty of protein throughout the day...fewer lows.
Thanks for the feedback. This place is great!
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*throws hands up in the air*
Hooray!
I'm new to posting on here and much of what I'm saying has been said earlier but here is my experience...
Several years ago I read about research that a "mini bolus" taken in advance of breakfast could really help cut the highs off - I work hard to be tightly controlled (5.7 - 5.9 A1C) so I decided to start experimenting on myself.
First I read some more and came to understand "first phase insulin response" - in the morning we are all more insulin resistant...all part of waking up (I'm not a morning person)...but one of the big things going on in our bodies is that we don't have any automatic system around to respond to glucose the liver releases (both in the overnight and as part of the wake up cycle) - most of us know this as the "dawn phenomenon" where our BGs go up starting about 4 in the morning. Those of us with pumps can adjust our basal rate to compensate and I thought that is what I'd been doing. I'd wake up most mornings and be in a pretty good place. Then I started wearing CGM and discovered that almost every morning I was going way too high (low 200s) after a simple oatmeal breakfast.
So I began my experimenting - wearing a CGM really made this possible - I began by giving myself a full unit of insulin pretty much as I woke up and then waited to see how long till it hit my system (I use humalog) - I was amazed to discover it pretty much didn't!!!! An hour later my BGs would be pretty much where I'd started...maybe 10 points lower. It seems that this first unit of insulin was going up against what my liver was releasing. I took things up in half unit increments (and I always checked with real blood as well as the CGM). What I learned was that it wasn't until I got to the 2 - 3 unit mini-bolus that my BGs really reacted much and even then it took a solid 45 minutes (unless I'd had a good cardio workout the evening before - then it could hit as fast as 30 minutes). So what I started doing is giving myself a 2 unit mini bolus pretty much as I get up, then shave, shower, get breakfast ready and as I eat breakfast give myself the rest of my bolus. The result is that I rarely go above 180 at breakfast and often manage to keep it below 160 (this is with an oatmeal breakfast).
After talking with my endo and participating the artificial pancreas trial I decided to adjust my basal rate up much more aggressively starting about 4:30 a.m. - I tend to run that basal program when I'm home and know I'll be having a "normal" schedule. When I'm running this basal the mini bolus starts working very rapidly (under 30 minutes).
I realize I'm a nut and that most folks don't have the time to experiment on themselves but I really did learn a lot from this exercise...when folks ask me how I manage to have such low A1Cs I always say a big part of it was learning how to really handle breakfast!!!
Tom
PS - I should also say that at lunch and dinner I don't need to bolus way in advance - typically just 5 - 10 minutes before.
Good info Tom.
I'm going to be giving this experiment a try. I ate oatmeal for breakfast this morning and I'm waiting to see what my BG reaction looks like.
I bike to and from work everyday and this affects matters as well.
Morning is such a beast.
Hilary
Tom,
Also you mentioned that you are participating in the artificial pancreas project. Very cool! What has been your experience with it so far?
Also, what time are you getting up in the morning when you start running a higher basal rate at 4:30am?
Thanks,
Hilary
Hilary -
The easy one first...my alarm goes off just after 7 a.m. and I'm generally out of the bed by 7:15 (OK - 7:20 a.m.)...remember basals are administered over the course of an hour so even with the ramp up it will take over an hour before they start to hit the system at full - my basal goes from .2u/hr to a full 1u/hr at 4:30 a.m.
The artificial pancreas experiences have been awesome - totally wild. Imagine not having to think about diabetes...not worrying about your BGs or taking insulin or even sweating how much you're eating...after years of never stopping, never getting to walk away from managing my type 1 I got to do just that (for the most part) while doing the artificial pancreas trials. The first trial was eating and living on the artificial pancreas. The second trial was eating, living, and exercising on the artificial pancreas - both times the control system did way better than I did and I'm tightly controlled. The first time I went low six times in 20 hours and it went low only once - second time I went low eight times (the trial protocol was designed to make a person go low...it worked!) and the system went low only three times. Big thing to emphasize is that these are Phase I safety trials and so you're in the hospital being constantly (and I mean constantly) monitored - the trials are designed to push the limits of the patient (when I'm in control) and of the artificial pancreas when its in control. You can read some of my blogs at www.artificialpancreasproject.com - or maybe I should cross post them.
Bottom line for me - using off the shelf technology that wasn't designed to work together controlled by first generation computer software the artificial pancreas did substantially better than I did...imagine what it will be like as an integrated suite of technology that uses a even more robust control program?!?!? Personally I can't wait!!!
Tom
Very cool. I'm actually going to interview Aaron Kolwaski about the Artificial Pancreas Project for NPR outlet that I work for.
www.earthsky.org
I'm really interested in what the technology is doing for people beyond trials.
I will let you know when the piece is released.
H
Excellent! Aaron is the best - he's really led this whole effort - I'm glad he's where he is...and I should mention...I work with him at JDRF!
PS - Earthsky.org is a top favorite of mine - glad you're there!
When are you calibrating the sensor? If you don't get the timing right, you'll see a difference between the readings. I think timing has more to do with it than location of the sensor.
I have tried two CGMs as a trial before, and I find that my meter is about 30+ points different from my CGM. My doctor couldn't really explain why except that the fluid it was reading from could be behind.
I have been wearing the MiniMed glucosensor for about a year with mixed results. My understanding is that you will see the largest difference between a meter reading your glucose sensor reading at a time when you blood sugar is rising or dropping (i.e. you aren't in a steady state). At that point, your sensor reading will be about 20 minutes behind because it is reading from your interstitial fluid rather than your actual blood glucose. This is why calibration while you are in a steady state is so important.
i know you can't mix lantus with other insulins or they won't work right. as far as taking to seperate injections, though, i guess it's feasable...check with your md first, though
I would definitely talk to your endo about all this. As far as being high after breakfast maybe your insulin to carb ratio isn't low enough and you might just need to take a little more humalog in the Am. Are you waiting more than 2 hours after you eat to test? If you are testing less than 2 hours after breakfast you may be reading a false high, as all of the insulin hasnt finished working yet. Are you going high after every meal? Because then you may need to adjust your ratio all day. For the night time highs I would say you may need to adjust your lantus doses and/or the times you are taking it. When I was on humalog and lantus I only took it at night so I am not sure how exactly you would change it with the 2 doses. I hope this is helpful, but I would definitely call or email your doctor and tell them what ur numbers are looking like and when/how much insulin you are taking so they can help you. Good Luck!
[quote user="sarabago"]
I was hoping someone might have some input for me. I take lantus in the morning and at night and I take humalog for food or as needed. I first take my blood sugar in the morning when I get to work and it is usually around 150 to 250 (Yeah a little high). I then take my lantus and my humalog right before I have breakfast at the same time. Most mornings my breakfast is oatmeal with dried cranberries and oatmeal. My bloodsugar is always jumping after this. I will take my bloosugar around 9.30 and it can be up in the three hundreds. If I take more insulin at this point I generally have a pretty bad low. Any ideas on what I am doing wrong? Any suggestions?
One other thing is that if I wake up in the middle of the night and have a 250 I can take one unit of humalog to bring it back down which will generally cause a low blood sugar.
I am really concerned to have my sugars going this high between meals!
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I was having high post numbers. I started to inject for food about 45 before I eat and it is helping. Trying to time insulin coming on and food in. My post numbers have been good.
I'm on a split dose of lantus (i.e. 2x/day) and humalog too. What you're describing sounds very typical for me. I tend to run low in the early morning but high after breakfast. Check w/ your endo, but I would: 1) make sure you have enough Lantus overnight so you don't have to correct if possible (obviously, there are always "bad" nights, but in general!), 2) like Keith mentioned, I inject 20-30 min before eating breakfast to make sure the humalog is into my system, but don't have to do this at other meals, 3) use a lower insulin to carb ratio at breakfast (I use 1:5 instead of 1:8 later in the day), and 4) I try to keep my breakfasts as low carb as possible and add in protein to slow the absorption of the carbs. Good luck!
Your endo will be the best person to consult but it sounds llike your lantus rate needs to be raised as well as the humalog to carb ratio in your diet. Also the peak time for humalog is usally between 30 mins to 45 minutes depending on your bodies metabolic rate so take your sugars/ insulin between twenty to thirty minutes before meals as well as check the sugar between two to three hours after the meal and record them so your endo can make the nesscary adjustments. Lantus is does not have a peak time and stays active throughout the entire day. Humalog peak in about thirty minutes and stays active up to two hours in your system before it wears off. Also dicuss your diet with your endo and dietian as their are various rates at which food type like carbs, proteins and sweet foods are broken done into glucose and begin to run their course through your bloodstream and body. Foods like candy, orange and really sweet food item are broken down into glucose within 15 mintues and will spike your sugars for the next thirty minutes to an hour. Straches and carbs take 30 to 45 minutes to be processed and will keep you elevated for around two hours. Proteins can be the trickest as they take three hours to be processed and will stay active in your system for up to six hours. That is why nearly every type one has had terrible bloodsugar after eating foods like pizza. It is a nasty combination of heavy protein and straches. Oatmeal is a heavy starch and carband the cranberries are consider a sweet food. You will more then likely notice this pattern. You take your sugar and insulin and then eat and within 30 minutes your bloodsugar is quite elevate where you then try to treat it with additional insulin only to find yourself with a low blood sugar within an hour to hour and 45 minutes. The roller coaster of your digestion being out of sync with your insulin's timing of response to the glucose in your system. You take it it too late prior to eating and you get the high blood sugars, then if you take it to late or more in response to the high you find yourself facing a low as a result of the glucose not being there when the insulin reaches its peak effectiviness.