FUDiabetes

Postprandial spikes in late honeymoon: where do I start?


#1

I can’t figure out how to ask this without it sounding ridiculous, but I’m just going to go for it…

My post meal BG has been all over the place for a couple weeks. It’s spiking much higher and much faster than I’m accustomed to. I’m beyond frustrated. I feel like I’m throwing the kitchen sink at it - tinkering with I:c ratios, temp basal, exercise, etc. and nothing’s changing.

I think I’m still “honeymooning”, so maybe this is my pancreas giving up… or maybe a change in weather, stress, less exercise, more lenient eating habits - but whatever it is, I have to figure out how to deal with it.

When nothing seems like its working, where do you start? I need to simplify and be logical but am at a loss.


Exogenous basal in honeymoon: a hypothesis
#2

I’m sure this is all wrong, but can you start with something you know WILL work? Just tell yourself it’s a temporary solution until you get through this?? Maybe you could scale it all back and trim the carbs for a couple of days and see what happens when you do that. If you get through your meal without a ridiculous post-meal spike, you try adding 5g— or 7 or 8. Maybe you could think of it as the science experiment it is. :smiley:

I’m sure you already know, but diabetes can be like this sometimes. At least for me it is. I would spend as much energy as you can without draining yourself on pinpointing the problem, but I’d also keep your sights on just getting through it. Maybe it’s your pancreas, or maybe there’s something else that you’re not thinking about, and maybe it’ll never happen again (for these reasons). I think I’d try pouring myself into getting through it— because you’ll use that skill down the road.

Too preachy? :smiley: Oh! Maybe you could try moving your dinner time, too??? Or just try to get your numbers pushing downward as you head in???

I should’ve stopped after “I’m sure this is all wrong.” :smiley:

Keep your head up, @kpanda01. You’ll get it to settle down.


#3

I tend to have 2 perspectives on diabetes management. One involves “in the background” pattern checking. The other involves “in the moment” problem solving.

For my own personal sanity, it’s really important that I try to avoid frustration with any “in the moment” problems. Those are temporary, and I can only do so much for those. Feeling guilty or frustrated about those doesn’t end up helping me.

Frustration in background patterns can more easily be channeled into finding more long term solutions. Since finding solutions makes me feel like I have some control, this perspective can be empowering.

So I would start by identifying if something is a background pattern (consistent post meal spikes are too high) or a temporary issue.

This one sounds like a background problem, and my gut reaction would be that you need more basal because your honeymoon phase is ending. I don’t have the whole story though!!! So there’s plenty of potential for me to be wrong, and the real problem is that you need to prebokus earlier and increase your insulin to carb ratio. Or something else altogether.

There are lots of strategies to try, but I’d opt for the most simple solution first. Try that solution while simplifying your eating habits to what has worked in the past. Once you find a solution that works, you can edge back into the lenient eating habits again. :grin:

I hope that helps! Do you have any specific examples?


#4

Once I get to this point (which is about every three weeks…having a helluva time transitioning from sedentary work week to super active Still Unpacking and Momming day as far as basal and boluses are concerned…and hormones freakin’ blow)…I go back to Big Picture and Basics. I’ll abandon fancier techniques and go by the book on spacing meals, prebolusing, and testing before meals and 1.5 hours after to try to get a handle on it.

Limiting variables is the name of the game for me in this scenario.

Good luck!!!


#5

You’re probably right about the carbs. I don’t like it, but you’re probably right :slight_smile:

Not at all! I’m glad you didn’t stop - i appreciate your insight. And thanks for the encouragement. I’m already working on the trimming carbs… i skipped the little pumpkin cookies i brought to go with lunch :blush:


#6

I’m wondering if this is the case also. It’s been hard to pay attention to whether my daytime basal is ok because even when i do make it several hours between meals, there’s usually a correction in there somewhere (due to the aggravating post meal numbers) so it’s rarely been on a straight and narrow for long. I do know overnight I’m good. I bumped it up just one notch this week, but i’m getting mostly straight-ish dexcom lines overnight. However, all the increased temp basals in the world haven’t been doing much good during the day, so i don’t know.

I’m struggling with specific examples that don’t take a book of explaining. Given that I’m complaining about this, it’s going to sound lazy when i say i haven’t been logging much of anything, but I haven’t. So while in my head i know things aren’t going normally, i am having a hard time laying down any hard evidence, haha. Maybe this is a lesson to me in taking notes to work this stuff out :slight_smile:


#7

This has been my problem. I currently don’t have the energy and time to track everything, so it was hard to make my case on needing help.

Have you tried a basal test (and I ask that as someone who can’t fast, so I get it if the answer’s no)? It feels like that would be the quickest way for you to determine if it’s a daytime basal issue or not.

Unfortunately, in my experience in the honeymoon phase (2.5 years so far), things can vary so much, it’s sometimes incredibly frustrating to try to pin down the problem.


#8

I need to try this, it’s just been challenging to find a long stretch with no bolus insulin. I took my lunch bolus at noon, so I’m going to see how the rest of the afternoon goes from here. Not eating isn’t my favorite, but I’ll try it for the sake of science i guess :slight_smile:


#9

BASAL is where to start. You need a good foundation for your bolus.

If you play with ICF’s or ICRs before basal you are setting yourself up for a roller coaster.

Now how can we will with basal?


#10

@kpanda01, I am sorry this is being such a difficult period :frowning:

We encounter such periods every few months, when suddenly everything seems broken :slight_smile: But then we figure it out and everything goes back to normal!

First, some questions

  • are your schedules suddenly different?

  • did you have radical changes to your daily habits or to what you do every day? For instance, for us, going back to school is a major change that takes several weeks to deal with.

  • did you change your diet?

  • are you starting a new medication?

  • are you stressed, or getting less sleep than you should?

  • is your exercise regimen/ activity level changing often?

Any of these factors can cause, for us, increased basal, or changes in dosing ratios of all kinds.

Second, a note on honeymooning

The end of honeymooning, for us and for many people, was a difficult time, because your beta cells start going on and off: they work for three days, then shut off for a week etc. Every time, all your ratios and basals radically change. But it is only a stage!

Some ideas

A. Basal
As @Eric often says, your basal is the rock on top of which you build. If you are able to figure out a good basal, everything goes easier. For us, the easiest time to figure out basal is late night. We always try to have early dinners (we don’t always succeed) so as to be left with no IOB as early as possible. Our insulin remains active for 5.5 hours (that’s pretty common), so, from the time you inject, you need to count more or less that time (or your version of it) until you are IOB free.

This is where it really helps to have a partner. My son does not wake up at night, like many teenagers. So I am typically on duty at night. If we eat at 6:00pm, he will inject at 5:15pm, which means that around 11:00pm he is IOB free. By that time, he is in bed, which is perfect because it takes out much trouble: no weird BG behavior outside of basal (unless he had a hard exercise period during the day and did not refuel properly). I will carefully tune his basal until it is steady, using his PDM (and milk/sugar if needed). Many times, it is the same basal as the day before, but it may not be if his sports regimen changed, for instance. If, say, it takes me 3 hours to tune his basal (a fairly common case), it means that, by 2:00am your basal is nice and steady. My advice is to let your partner deal with it over a couple of consecutive nights, so as to establish a clean basal.

As a note, we now all know that there seem to be 2 weeks per month where it is harder to deal with basal for a woman. Maybe @T1Allison has some advice on experimenting with basal during one of those weeks.

B. Ratios (Insulin to Carbs, Correction Factor)

They vary heavily with your basal: if your basal is good, they will be much better behaved. If your basal is too low, they will be very high and give you trouble anyway. So they are difficult to resolve without having a good basal established. For us, they can double if your basal is too low, which causes constant highs after meals and does not allow you to correct highs well: a bad situation, but one which may be what you see?

If you have a good basal, it is not too hard to figure them out through a couple of days of experiments! Be aware, however, that, for us, and also for many women across the month (from what we have read on FUD), hormone peaks and glucose peaks may not behave the same way in terms of corrections. For us, glucose peaks are fairly consistent, while hormone peaks require a different CF.

If you feel it would be easier to chat on the phone, feel free to PM me: we can exchange phone numbers and talk!


split this topic #11

5 posts were split to a new topic: Keeping track of meal and post-meal BG: pictures


#14

Trying to simplify here…

Is this your main issue? Is this the consistent problem?

If you are spiking fast and high after each meal, but you aren’t experiencing other problems (stuck high all night, spiking overnight, tanking overnight, etc)…then I’d say I’d start with increasing your prebolus timing. If that doesn’t help and nothing else significant in your routines have changed, then I’d look at either adding a unit (or half unit, or whatever, depending on how sensitive you are currently) to your meal boluses to see if that helps…and if that doesn’t help, then starting tweaking basals carefully and with enough time to see what they do.

I hope your main issue is fast, high meal spikes because there are certainly ways to help that which don’t involve a ton of voodoo (and by that, I mean strategies that may be as full of pitfalls as benefits, and are unpredictably successful).


#16

I loved your reply. This is excellent.

Also, I made it to the end of the thread and ready @Michel’s reply and it’s solid too! Yay! Good advice!!


#17

You all are so kind to leave such thoughtful and helpful responses. I’m blown away.

I’m going to take the advice of the many who have suggested getting my basal right first, along with moderating my carb intake a bit to simplify things a little. Plus a run today… I definitely could use a run.

To answer a few of the questions in previous responses… my routine is pretty much the same as always. No major stress right now, just the normal stuff. Exercise has been somewhat less than usual, but not significantly. My diet has not been the best over the past few weeks but as of yesterday I’m on it.

The trouble really is primarily after meal spikes. No prolonged highs other than if a post-meal gets high enough to get stubborn. But those are times I know it was a meal issue. I don’t tend to get the hormonal highs and fluctuations experienced by some women. I’m pretty consistent with pre-blousing, although I’ve noticed my usual half hour wait for breakfast isn’t always giving me the dip it did before! I don’t know why that would change, but it used to be trouble if I waited any more than 30 minutes, and that hasn’t always been the case lately.

Nighttime is typically pretty steady for me, with the exception of occasional nights when it seems a heavy meal waits to digest until after I fall asleep and I spike shortly after going to bed. Otherwise, nighttime is good with mostly nice straight Dexcom lines. I was noticing a slight upward trend at night and bumped my basal up a notch just a couple days ago, so I actually think at night I’m good. I’ll continue to keep a close eye on it.

I have always used one basal rate for night and day but want to experiment now with a higher one for daytime. I’d prefer to keep it simple, but for now I feel like it might be helpful. I’ll try some daytime testing this weekend. I want to do it right but am not sure how long I can make it between meals, so we’ll see what happens. :smile:


#18

I m fascinated by this because it sounds a lot like what’s going on. I’ve never seen anyone explain it this way before!


#19

Hello all! I wanted to follow back up on this and thank each and every one of you for the thoughtful advice on this topic a couple weeks back.

I upped my nighttime basal a tick and took my daytime basal up a couple notches, and things have smoothed out significantly. My daytime may be higher than it needs to be, but I’m making it work with snacks/grazing/occasional leftover Halloween candy. I’m a snacker/grazer by nature anyway, so I don’t mind this at all, particularly heading into the holidays!

Anyway, just wanted to provide an update and say a sincere “thanks” to those who helped with this particular moment of stress as well as those who have given me so much other guidance over the past few months. Wishing all of you a very happy and restful Thanksgiving! For those whose thanksgiving isn’t shaping up to be what they expected for one reason or another, and those elsewhere that aren’t celebrating a holiday this weekend, sending my warmest wishes in your direction as well. :blush: