Hello! I have a question that’s probably the most basic, beginner insulin-use question you’ve seen in a while, so I hope you’ll humor me I’m new-ish at this and working hard at it but still learning the ropes.
If my BG goes higher than expected after a meal, but does eventually come back down, what is that telling me in terms of what I did “wrong”? For example, I treated myself to a delicious panera egg/cheese/pastry souffle for breakfast (NOT typical for me, more of a splurge). Within an hour and 15 minutes my blood sugar had spiked up something like 80 points from where it started and is way higher than i’m comfortable with. It’s leveled out a little and looks from my dexcom graph like its about to start wandering back down, about an hour and a half after eating,
I actually took a little more insulin than my typical ratio, about 15-20 minutes before I ate. Does a spike like that suggest not enough insulin? Not taken long enough before I ate? Or is it just telling me I shouldn’t have eaten the darn souffle? I’d like to believe I can splurge every now and again without this happening, but I’m at a loss.
That’s a difficult meal to eat, an 80-point spike doesn’t sound that bad for eating that honestly. All you can do is experiment, there is no right answer and it will probably be different every time. Remember breakfast is the hardest meal to bolus for since you are countering insulin resistance and dawn phenomenon (which can last for hours as your liver dumps its glycogen stores). I would expect a meal like that would require a lot of insulin up front, a long pre-bolus and then more insulin later on due to protein and fat. If it’s a once in a while thing it’s probably not worth your time thinking about it or trying to get it right. There are too many variables!
I think that’s just a matter of not bolusing early enough.
Dana Lewis developed a plan for that. Bolus a couple hours before you eat to get down to 80. Then bolus for the meal when you eat it as normal. Seems to work like a charm.
If it comes back down within a few hours that means the carb ratio is correct but you may need to give yourself the insulin a little bit before you eat. Insulin takes 15 minutes to even start working in your bloodstream, so next time try maybe taking the insulin then waiting 5 minutes, then 10 minutes – whatever amount keeps you below 140 mg/DL. Of course, the day-to-day variability can also be high, so you’ll need to do this experiment quite a few times.
Another option is to superbolus: give yourself more insulin upfront and then set a 0 temp basal on your pump (if you have a pump).
Warning Not a beginner approach, but since you are using a Dexcom, [please note, this isn’t the smartest thing to do if you don’t have access to a CGM]
Use 1.5 - 2x the insulin you should, pay attention about an hour later, and eat your way into a flatline using whatever carb increment works for you. For my very carb sensitive son, 4g at a time works. He might need to administer this 1 - 3 times to get the flatline he is looking for. Then you can splurge and not have as high a rise. Also, if you are above 100 then pre-bolus this by 30-60 minutes.
Did you bolus only for carbs? Some people find that higher protein/fat meals require insulin for that. It is referred to as TAG, for total available glucose.
But if your BG eventually returned, then only the timing needs to be adjusted. Pre-bolusing works well for me in most cases.
To some extent this is just a fact of life an 80 point rise shortly after eating something exciting is relatively acceptable in my mind. Pre-blousing earlier would likely help, but this becomes infinitely complex with different meal compositions and other factors, and if you’re newly diagnosed it’s further confused because quite likely you’re still producing a fair bit (likely unpredictably and erratically) of home-grown insulin…
Sounds like you’re on the right track though, overall. I’d consider an 80 pt rise then going right back to normal a pretty good success.
Personally, I’d be happy with an 80 point spike for that souffle. If I’m looking at the correct one online, it’s 38 grams of carbs. When I sometimes splurge and get Panera breakfast, I get the breakfast sandwich on an asiago cheese bagel and it’s amazing. Also 50+ carbs for it. And I get moving after I eat it to give my insulin a boost.
On shots, I figured I could control dose size and timing. The more lead-in time I gave the shot, the less insulin I needed. If the blood sugar goes up, levels, and comes back down…you’re doing perfect and can tweak timing for less spike. If the blood sugar goes up, levels, and stays level…you probably need more insulin either because of a miscount, or because of a higher fat or protein content that burns longer and slower than the carbs.
For eating out and enjoying a breakfast, I myself try to balance the blood sugar side and the safety side. Eating out always adds a couple of variable for me…like timing and how long I sit and chat afterward (if eating in with friends) vs being active immediately afterward.
I’ve read that anytime you are 160 and under, you’re not incurring damage to your body. Not sure if people on here disagree with that statement. So depending on your starting point, 80 point rise for certain foods may be no problem. Just IMHO.
Thanks guys! By about 3-3.5 hours it did end up back where it started, so I suppose the insulin amount was probably about right. I did try to pre-bolus, but probably should have waited longer, so next time I make a wacky breakfast decision, I’ll try to wait it out a bit longer and we’ll see what happens. I started out higher this morning than i usually wake up to, so the 80 point rise took me higher than it normally would.
This is exactly what I’ve been wondering… Why does nobody tell you this stuff when you are diagnosed? lol. It sounds so simple now that i’ve asked the question! You guys are so helpful, thank you!
the other thing you can do is bolus some small amount – for us this is about 0.2 units but for an adult would be more – well in advance, say an hour early. Then just bolus for the remainder when you actually sit down to eat.
Thank you! I appreciate the encouragement. It’s all very crazy and frustrating at times, but I suppose we just do the best we can, right? Perhaps Panera for breakfast is not “the best” I can do, but the occasional treat is important too
Oh I love those asiago bagel bacon egg and cheeses!! Generally I spike quite a bit, its been a while since I’ve had one but for me its about 8u then I have to snack a little bit to prevent a low later.
And the occasional spiky smoothie… but that often means a 200 so I do that rarely.
Another related question… someone mentioned that being a pretty difficult meal to bolus for. I assume this is because of the combo of the fast carbs and the fat?
I often eat a slice of whole grain toast with an egg for breakfast… fewer carbs total and at least they are whole grain, but that probably doesn’t make a ton of difference. But anyway, that breakfast doesn’t give me near the trouble that the souffle did. Is the toast and an egg a meal most other people would struggle with? What makes a meal “easy” (aside from being completely without carbs!)
I don’t eat meat, and try to stick to whole grains like brown rice and quinoa, beans, veggies, whole wheat bread for my carbs. I have tried to reduce carbs and make smart choices for what carbs i do eat, but without actually going low carb. I try to keep meals balanced and combine protein, fat, and carbs so the carbs are slowed down a little and not so spiky, but by that logic the souffle would have a good mix, and it still gave me trouble.
I believe so. That souffle is listed as 38g carb, 28g fat, 15g protein. Due to the cheese and maybe the quantity of egg, the high fat content probably adds a layer of difficulty to the insulin execution.
By comparison, a piece of whole grain toast and one egg looks to be 12g carb, 6g fat, 10g protein.
I have not mastered eating high amounts of protein or fat, especially if they are without accompanying carbs. I find my blood sugar is less predictable eating protein/fat-heavy without many carbs vs when eating a fair combination of carbs/fats/protein in moderation together. If I go heavy on protein or fat instead of carbs, it seems I may have overall less of a spike, but it can be stubborn for a long time and I’m never quite sure how much insulin I’ll need (or when) due to the different processing effects of protein/fat. I believe that once you eat more than 20g of protein, you bolus for 60% of the protein above 20g (i.e. If you eat 30g of protein, count 6g of it as carbs to bolus for at the end of the meal…which is a pain with shots). Fat is another animal, but similar to protein in my observations in my body, but I’d have to check my notes at home for how to count it specifically. I eat so many repetitive meals that I just try to take what has worked in the past.
I eat two pieces of whole grain toast with peanut butter in the morning…but my pre-bolus time can vary from 20 minutes to an hour. And that doesn’t always give me what I’m looking for depending on my hormones and insulin pump site integrity. But I do my best.
I also defer to the very smart people of FUD for their knowledge. I’m still pretty new here.
I’m betting my one slice of toast is more similar to your two slices… mine’s a good-sized slice of pretty hearty bakery bread with about 24g carbs. With the toast and an egg, I can usually keep the post meal spike reasonable. I should try peanut butter on it again and see how that works… I love peanut butter toast but haven’t experimented with it yet.
I guess all the extra fat from that flaky pastry dough is what messed me up today Darn.
Most fast food and almost anything from a restaurant is difficult. It doesn’t seem to matter what it is, they find ways to pack 3x the amount of fat and carbs vs if you made the same meal at home!
I am assuming from your conversation that you are pretty new to the game. Once you get time, you might want to consider a couple of weeks where you try to figure out how many carbs is “easy” for you, and at what point it gets difficult.
For instance, my son can easily eat and control 30-40 carbs in a meal, but when we go over about 120 carbs in a day, his control gets really unpredictable. Because of this, he eats 100 carbs most days.
Of course, there are days when pizza and a milkshake are called for, but we do these when he doesn’t need to be tightly controlled for the next day or so and wonky control is ok.
Just fyi - that souffle looks like it had enough fat to slow digestion and might be better controlled by adding a second dose of insulin 30 minutes after eating.
This is exactly me (and I am probably 25 years older than @Chris 's son). The only way I can go over about 120 carbs in a day is to exercise more.
Some people on this forum (like eric) have no problems eating tons of carbs, but he is fairly athletic which I think sets him up better for eating carbs.
When I am active, I can just pack-away carbs.
Dr. Bernstien, who is often spoken about on diabetes forums, advocates for a low carb eating, but if you read between the lines he recommends fast acting carbs for exercise - so if one follows Bernstien and exercise a lot you could be eating a lot of carbs in a day. …just sayin’
Yep, very new at this still. On MDI maybe 6 weeks or so. I was pretty strict with myself with my eating habits in the very beginning, and have managed pretty well, but as I add more opportunities to “treat” or try different things, I’m encountering new challenges for sure! It does seem like once things get wacky, the rest of the day continues to be hard to control. I’m going to have to continue to experiment to see if I can find that sweet spot!
I can tell from my reading on this forum that you guys are an incredibly knowledgeable bunch, so I appreciate you all taking the time to answer some questions from a newbie!
I’m new-ish at this and working hard at it but still learning the ropes.