FUDiabetes

Spiking After Breakfast/ Long Pre-bolus

I am wondering if anyone else has this problem. i dont have the DP; i stay in the 70s throughout the night, and wake up similarly. although my daily ICR is 1:12, my morning ICR is 1:6.5. and even with all that extra IOB, i am still having to wait about 40-45 minutes after i bolus to eat my breakfast without spiking terribly. i can go from 75 to 175 within 1/2 hour after eating. now its gotten better, where i will only shoot up from the 70s to 125- 130s. and then within another 1 hour, i will return to my target range.

  1. is this normal?
  2. if you have this problem, what do you do about it?
  3. should i bother worrying about it for instance, changing my ICR to compensate for the spike?

just one note: for the rest of the day, i only pre-bolus for 15 minutes at most (unless my BGs are high, in which case, i wait about 20/25 mintues )

what have been your experiences? please share!!!

thanks everyone, DM

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@daisymae - I have the same questions as you do.

I think it is normal and assume it is just part of the body waking up.

On mornings when I have a shower before breakfast I do not have this problem. I assume that the heat from the shower gets the circulation going and also speeds the insulin absorption (this last part at least has been proven - that heat improves the insulin absorption rate).

On Saturdays, I am usually lazy and do not get a shower before breakfast. I find that I either need to wait for a long time for the insulin to absorb to get a drop or I will get a spike.

I already have a slightly higher ICR for breakfast, but increasing it more just causes me to need some carbs at 11 am.

What I am doing now (depending on the day):

  1. Going for a walk after breakfast ( :laughing: like that happens a lot)
  2. Giving more insulin at breakfast and just having a late morning snack.
  3. Super bolus (occasionally) to get more insulin up front
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I think it’s normal—I have to bolus much more in the morning, which is why I tend to try to eat no or low carb breakfasts (or pre-bolus considerably for the rare bagel or donut or ginger scone from my local bakery, because sometimes it’s worth it). I know @daisymae that low/no carb doesn’t seem to work the same for you, but I think it’s very common to have to make extra effort to avoid spikes in the morning however it works for that individual.

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i know that with many that YDMV. i guess i was just trying to figure out the spike issue. and you’re right; i eat hardly any carbs throughout the day, even in the morning. i was just wondering what some consider a “spike” and how high BGs go 1 hour after finished eating. basically, what i was curious about is whats a “normal” range of BG elevations?

The normal range of non-diabetics might be a good place to start.

“The highest postprandial glucose concentrations were observed after breakfast: 132.3 ± 16.7 mg/dl (range 101–168 mg/dl); peak concentrations after lunch and dinner were 118.2 ± 13.4 and 123.0 ± 16.9 mg/dl, respectively. Mean time to peak glucose concentration was between 46 and 50 minutes. After ingestion of standardized meals with fast absorption characteristics, peak interstitial glucose concentrations were 133.2 ± 14.4 and 137.2 ± 21.1 mg/dl, respectively. Meals with a higher fiber, protein, and fat content induced a smaller increase and a slower decrease of postprandial glucose concentrations with peak values of 99.2 ± 10.5 and 122.1 ± 20.4 mg/dl, respectively.”

There were only 24 people in the study, but I thought it was interesting. These are probably the best ranges to aim for. I have less insulin sensitivity in the morning too, so I avoid carbs at that time of day.

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I try to keep below 140 (8.0) after eating so I consider a spike above this as undesirable.

On a Saturday morning I can get up to just below 180 (10.0) for about 30 minutes if I eat gluten free pancakes and do not adequately prebolus (usually becuase I was cooking and I forgot to bolus). I consider too high but will.

The recommendation from “them” is less 180, 2 hours after eating, so if you can do better than that you are doing really well :laughing:

Bernstein and is followers will say 83 - at all times - no change.

I like this chart from a study of healthy subjects living a normal life. It shows that healthy people have higher spikes after breakfast than during mid-day. If you have a chance to read, you will see that some subjects actually spike to about 180 after a high carb meal.

Not trying to justify anything with this data, but pointing out that healthy non-diabetic people have variability in their blood glucose. By using insulin we can actually have less BG variability than a healthy non-diabetic.

Source:

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haha. Great minds think alike :wink:

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…and fools seldom differ :laughing:

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While true, then the question remains is the variability important for something?

i.e. In the cardiac space there is a growing body of evidence showing that pulsatile LVAD’s are better for patients than non-pulsatile pumps, when keeping everything else the same.

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I hate the breakfast spike. I love waffles and syrup (pure fast carbs and lots of of them) but I just can’t make it work for the quantity that I’d like to eat. Even with a pre-bolus and waiting until I’m in the 50s to eat I spike to 200…

I’ve pretty much just stopped eating breakfast except weekends (I allow myself one waffle spike per week). Or I do the overbolus + late morning snack for less spiky breakfasts if I bother.

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Have you tried the “eating soon” technique? It sounds like a pre-bolus but it isn’t. The idea is about an hour before eating you give an insulin correction that would take you just to your lower BG limit (like 80 or 70 mg/dL). An hour later, when you are eating, there’s this active insulin in your bloodstream that tends to sweep glucose into the liver and store it as glycogen. You also would pre-bolus for the meal, but the combination is what really tends to shave down the peaks (in the people where it works.)

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That is a great question to ponder :slight_smile:

The more we know about setting BG targets in diabetes, the more questions it raises.

:smile: So do I - every Saturday is waffles or pancakes. I used to use a mix of whole wheat flour and white flour for pancakes and waffles and I use Walden farms syrup. I could control the spikes pretty well and keep below 140 (8). Now I have switched to gluten free flour for my son, I am lost - need to figure it out.

I eat breakfast every day but usually no more than 15g of carbs that slowly absorb.

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Yeah, but presumably that’s reflecting more heart-rate variability (HRV), right? HRV in… cardio-normals? (I don’t what you’d call that) is well established as an index of parasympathetic tone, with more of it reflecting better parasympathetic responsiveness and linked better self-regulation in all sorts of ways. Physical exercise is one of the few ways to improve it. Having a non or low-variable heart rate would reflect poor autonomic regulatory responses—it can indicate vagal nerve dysfunction and can actually be a complication of diabetic neuropathy, similar to how gastroparesis is likely caused by parasympathetic/vagal nerve damage.

My guess is that there are not similar findings for blood sugar variability, given that if all systems are working well, variability should be low (not maximized), but someone could pretty easily hook up a bunch of non-diabetics to Dexcoms and collect that data and examine how it predicts various outcomes. Would be interesting if there are are any curvilinear relationships where high variability is bad (which seems like a given) but so is extremely low variability.

YDMV for sure. Even in ourselves.

For instance, last night I ate a half real bread sandwich for dinner, had a pickle spear with it. Bg started at 92 ( about where it had been all day) and I took 20u novolog for the 40g of carbs. I spiked to 128, at three hours I was back below 100.

For lunch this afternoon I ate the other half of the sandwich. I was at 109(about the same for the last eight hours)and I took the same 20u of novolog. Now, three hours later I’m at 208!

Same parameters (carbs, insulin, level Bg for several hours). But remarkably different results.

It seems that we are chasing wisps in the wind sometimes.

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tell me about it. it can be so frustrating. i want to micro-manage a disease that has so many variables i couldnt juggle them if i were a pro juggler.

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but when i wake up in the mornings my BG is already between 70s and 80s. i dont need any correction. am i missing something here?

this is very very helpful info. its nice to know that non-Ds have a rise in BGs similar to what we have.

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Ugh totally. I’m in the same boat right now. 2 days in a row, same food… yesterday I went low after and didn’t spike and today I’ve been over 200 for the past 2 hours with 6u still on board (and my corr ratio is 1:40ish so I’m hesitant to hit it harder).

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Actually, no Heart Rate Variability (HRV) is another factor entirely, and is important as you mention. HRV is the normal variation in heart rate.

What I was mentioning is that there are two kinds of Left Ventricular Assist Devices (pulsatile and non-pulsatile) and there is some research indicating that the pressure changes associated with pulsatile blood flow is important.

interesting stuff

In that case you wouldn’t be able to use the “eating soon” technique to build up some active insulin, because it would drive you low. If you were at 100 or higher then you would have room to try it.