I have noticed that my bg for a low carb / zero protein meal reaches its peak two hours or more after a meal and whether anyone else sees this
As the norm is always 2 post prandial to be down it seems odd that it takes that long to peak ? When I eat protein it takes 5 hrs but I can see this effect and it’s consistent with everyone else but this morning for example I had 8g of carbohydrate at 8 15 and it was 10 15 before it peaked - it seems to be consistent irregardless what I eat (avocado, skyr)
It’s becoming annoying as I try and tighten my control as I don’t want to get stuck at 110 which happens a lot - as by that time the hunalog has worn off and if I take another one it goes too low and also takes too long - if I do more before it goes low too quickly as the total amount of hunalog is too much ?
Fats and protein do take longer to digest than carbs. We try to eat lean cuts of meat but when we splurge on a strip steak or ribeye, I will see a delayed and/or prolonged rise. I am learning to add a little more to my bolus dose and extend it over a couple of hours to help cover it.
@Robellengold, are you saying you see the highest rise from a meal 5 hours after eating? Wow! I eat heavy on the protein/fat, but with Novolog on board, I usually peak around 1.5-2 hrs (I think this is one of those situations where YDMV, of course). To your Afrezza question, it is GREAT for quickly bringing BG down from a delayed spike (or spike in general, really). @Sam has more experience on using it in that situation. It rarely ever causes any lows, either.
I typically stick 1 unit in about an hour before I eat for carbohydrate - I watch the dexcom for it to start dropping a few points before eating but it’s normally an hour - and then I wait 45mins after eating before taking the protein injection of 2 and any adjustment to carbohydrate if it’s required
The rise them normally starts About the same time after eating but as you can see goes on for a good 2hrs after by which time both the protein and the carb injection are running out - I’m wondering whether I need a 3rd unit 2hr after instead
@Robellengold, your peak is later than many (most) PWDs, but I believe it is because you eat LCHP. My son eats medium carbs, and his peak is about 1 hour after eating. But your peak is primarily driven by proteins, not carbs, so it is quite a bit slower to come up (since they process slower).
For instance, when my son has a meal with very high protein and fat (on top of carb), he gets a second, later peak. That’s what happened last winter when we went to Louisana, and every dish had a stick of butter and a pound of andouille sausage
If you had a pump, you would probably do an extended bolus. But, on MDI, what we have done in the past is a second insulin shot 2 or 3 hours after the first one. That worked when we got the timing right, but sometimes we didn’t If, on the other hand, it is a regular, repeatable phenomenon for you, I would totally do it.
Mmmmmm, and this is why I have those delayed spikes. I may be in TX now, but I learned how to cook in LA.
When I was doing just injections (no Afrezza), I handled the delayed spikes the same way - an injection timed (hopefully) to head off the spike. As I said, I have a delayed spike at 1.5-2 hours, so at 1 hour, I would dose to time the insulin action with the spike (for me, rapid-acting insulin starts working between 30-45 mins). The formula I used was recommended to me on the FB group I was a part of - 60% of carbs up front; 40% dosed at 1 hr. Since then, of course, I’ve learned there’s also additional dosing considerations for the fat and protein, so I would do it a little differently now to have a flatter line.
Several hours for a LCHF meal to peak seems normal to me—I always take small doses of insulin for protein/fat mostly meals (like a veggie, cheese, and meat containing omelet, say) after eating (instead of pre-bolusing, which I only do for carbier meals), which seems to work well for me.
Thanks guys - all advice appears to be working fantastically on delaying the bolus depending on the protein eaten
Ive actually found now after being more disciplined for the last 2.5 wks with the low carbs so I always keep under 40g a day (before I was in an around that number as I only had the odd treat or piece of bread really) and also restricting the high absorb carbs - has removed all the erratic behavior from my results - where what type of protein/ amount of fat etc etc all effected things. Now its become very predictable - 23g of protein irregardless of what it is or what I eat it with needs 1 /2 or 3 unit of humalog 45mins after I eat is exactly what i need to keep me completely flat as long as i keep below the 40g. Once I go over that, it all gets erratic again.
I finally read the bernstein book the other day (a long read someone should simplify and get out a 20 page version). I decided to try and get a consultation with him and called his offices - and he actually answered so I got to chat with him for a bit - but I decided I couldn’t be that disciplined but this appears to work for me where I am - its just removes the complication of trying to predict the unpredictable as I’m heading for a 4.9 A1C this quarter per my sugar mate app which I reset from the day I started the LCHP diet. Its a lot of effort to get to 4.5 which he advocates.
(3 days with Bernstein is 11k USD by the way and not covered by insurance !!!)
Thanks -yes I certainly will - I’ve been out of work for the last 3months which has allowed me to reset myself and do this big change in my life - the big test will be going back to work again and how I cope
I keep meaning to try something like this. But I’m wondering: a second bolus a couple of hours later would have a different effect than an extended bolus, but does it counter that later peak any better? As far as I’m aware, I can’t program a later bolus with the Omnipod,so extended is my only option (short of remembering to set a timer).