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After Meal Spikes

This is one of those areas of my diabetes management where I am almost at the point of just throwing up my hands and saying, “I give up”.  I know that we all have those moments where we feel like giving up on something, diabetes related or not, but I know that I can’t.  It is just becoming frustrating beyond belief as to why I can’t seem to figure this out.

I have taken insulin 10 minutes before meal time, 20 minutes before, even 30 minutes before meal time!  None of them seem to work.  My average spike is about 75-100 higher.  I’ll go from 125 to 200 easily after a meal and then it takes a while to come down.

I have tried different sites, even “virgin sites” as my endo referred to them.  To make sure that after 7 years on a pump that it’s not the site areas that are giving me the problems.  That is another topic for another day.

I am using Apidra with a pump.

Anybody have any advice?

9 thoughts on “After Meal Spikes

  1. What about an increased basal, starting the 15 to 30 min prior, and ending a few hours after? Have you tried a short walk, or bike, after? Obviously that wouldn’t be an all-encompassing solution, but might be an interesting test. Good Luck!

    1. I discussed with the doc about possibly doing an increased basal before meal times. I usually go to the gym before I eat dinner and lunch time, I don’t really have a chance to go for a walk, but I’m sure I can find the time to do it.

  2. I’d suggest trying a Super-Bolus; including your next hour’s worth of basal into your meal bolus (it’s like getting an “advance” on insulin). I do this often for breakfast.

    For instance… my morning basal rate is 0.7 u/hour. If my breakfast warrants 3.6 units, I’ll bolus 4.3 units instead (add the 0.7) and then set a temporary basal of 0% for the next hour. In the end, it’s the same thing – you end up with the same amount of insulin overall, you just get that later basal insulin sooner to help soften the spike.

    Just be aware that the 0.7 will end up in your Insulin-on-Board if you look at it later, where regular basal does not. Some people will use the Prime/Fill Cannula option to prevent this from happening.

    1. Very interesting. I may give that a shot, my only concern is that majority of my meals require a full, max bolus of 25 units, so I will need to double bolus. My average basal rate is 3.5 and my carb ratio is 4:1. I will try this.

  3. I think the super-bolus that Scott mentioned above is probably a good thing to investigate. John Walsh talked about it on his website (http://www.diabetesnet.com/diabetes-technology/blue-skying/super-bolus).

    Another cool thing I’ve heard is take your before meal BG and use the first numbers to determine how far ahead to bolus. 120 = 12 minutes, 240 = 24 minutes, 70 = EAT NOW, etc.

    But I have to be honest – pre bolusing terrifies me. I’m always worried that my insulin will get ahead of my food and I’ll be in real trouble.

    Maybe you can also play with the composition of your meals and the GI index? Another thing to experiment with is the order in which you eat stuff – I’ve heard rumors that eating protein first will slow things down more than if you ate it last, etc.

    It might also be worth investigating some of the other non-insulin injectables. Symlin is freaking miraculous at slowing the food digestion, but I had some scary lows because I didn’t manage my bolus right. Byetta, Bydureon, or Victoza are some other options to talk about with your doc. They are currently labelled for type 2 folks, but there are many T1’s that take them.

  4. I was talking to some (extended) family members about food choices a few days ago. We were talking about eating carbohydrates and the differences in how people with diabetes on insulin and not on insulin handle them. I explained that I personally don’t really eat low carb. However, the larger the amount of carbs the larger the amount of potential error in insulin.

    I hate, hate, hate that I am even suggesting this advice, but does it happen with low carb meals the same as higher carb? Fake insulin is FAKE, and there is just no way it can keep up the way those normal peoples’ pancreases do!

  5. Sara opened the door, so I’ll step on in.

    IMO most people with Type 1 can improve their numbers and quality of life by reducing carbs. A great post about this idea was written by Katie at Diabetic Advocate: http://www.diabeticadvocate.com/2013/08/km60.html. Another great post is by Katy at Bigfoot Child have Diabetes: http://bigfootchildhavediabetes.com/2013/09/07/maybe-way-off-base-and-this-is-just-another-dumb-passing-phase/

    If you haven’t already deleted my comment, I wrote a blogpost on my decision to try to eat low carb: http://testguessandgo.com/2013/09/12/food/

    I work hard to not be preachy about diet with my T1 friends. My diet is always a work in progress and I am miles away from eating the diet I believe in. But do some reading and be open to the idea that maybe there is no perfect regimen with our currently available insulins:-)

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