# Avoiding post prandial spikes (type 1)



## Redkite

I've copied this over from a reply buried in another thread in case it's helpful to anyone 

The following tips are what I gleaned from a presentation by Gary Scheiner (Certified Diabetes Educator, author of Think Like A Pancreas, and type 1 himself) - this was his "Strike the Spike" presentation.

1. One of the most important considerations is the relatively slow action of our so-called rapid-acting insulins. If you have a working pancreas, insulin reaches the bloodstream in seconds and is finished and gone in minutes. Whereas insulin infused or injected into subcutaneous fat can take up to an hour to circulate to where it's needed (and can still be active 3-4 hours after injection), meaning that glucose from digested food gets a head start on the insulin. *Advice is to pre-bolus 20-30 minutes before meals*.

2. Type of food eaten also has an impact. I know some people on here eat low carb or no carb meals, but assuming somebody wants to eat a reasonable portion of carbs, *opting for lower GI foods* makes sense, e.g. for breakfast replace cereals with yoghurt and berries, which will take a bit longer to digest and perhaps match insulin action a bit better.

3.* Eat veg before carbs.* Can't remember the reason for this one, but I wrote it down!

4. *Make lunch the highest carb meal *(lower carbs at breakfast and dinner). The idea being that most people are more insulin sensitive during the day when they are active. As always with type 1, this won't work for all!

5. *Increasing the acidity *(e.g. by including a glass of tomato juice or sprinkling vinegar on a salad or chips) of a meal helps delay digestion, so the rise in blood glucose isn't too steep.

6.* If pre-meal levels are high, injecting insulin into a muscle* will get the insulin working twice as fast as if it's injected/infused into subcutaneous fat. The recommendation was to use longer needles than you usually use, and inject into forearm muscle or triceps. It stings a bit apparently! Don't think my son would want to try it...

7. *Some people have benefitted from also injecting the hormone amylin,* which is absent in people with type 1. This is an appetite suppressant, delays the emptying of the stomach, and while it is active, suppresses the liver from releasing glucose. Very helpful for eliminating a post prandial spike, but risks hypos if you're not very careful indeed, and nausea is a side effect (so it's a no thanks from us!). I think "Victoza" is amylin, though I may be wrong.

That's all I can remember atm!


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## HOBIE

For the last 30 yrs I have bloused 20/30 mins before meals . It makes me feel better to.  With the pump its great, I can put what % & what time delay.  If I get halfway through a meal & not keen on it.  Stop the pump. All my life I have never been able to do that  Thanks Redkite


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## Annette

For the last n years (many) I have done as instructed and bolused 30 mins before meals. And for the last n years I have struggled with hypos that happened half way through a meal. Not until I got my pump, and the ability to bolus over a longer period of time (square wave) at a point to suit me (I now bolus immediately before eating -once my food is in front of me - over 30 minutes) that I realised that I had inherited my mothers slow digestion and what effect it had on my post prandials. Just shows, not all advice is good for all people!


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## TheClockworkDodo

I don't think anything works for all people, but it's interesting to hear some actual suggestions from someone rather than the usual "you shouldn't be having hypos/spikes" or whatever, with no helpful advice about how to stop them.

Annette, I also hypo half way through a meal if I bolus more than a few minutes before I eat.


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## Redkite

Annette Anderson said:


> For the last n years (many) I have done as instructed and bolused 30 mins before meals. And for the last n years I have struggled with hypos that happened half way through a meal. Not until I got my pump, and the ability to bolus over a longer period of time (square wave) at a point to suit me (I now bolus immediately before eating -once my food is in front of me - over 30 minutes) that I realised that I had inherited my mothers slow digestion and what effect it had on my post prandials. Just shows, not all advice is good for all people!



Interesting!  When I first heard this advice about pre bolusing, my son was 9 years old.  We tried it (already had the pump so basals were tailored to him) - insulin given 20 minutes before breakfast resulted in a hypo in the 2's halfway through eating, and the poor boy face down on the carpet feeling awful.  Took a while for hypo treatment to bring him up, and then later he was massively high.  We didn't pre bolus again for a long time!  I think in his case it was because he was small and skinny, and insulin absorbed really quickly.  Now he's 14, still skinny but much taller and with adolescent hormones circulating, we're cautiously trying pre bolusing again and it's working really well.  I think testosterone causes a degree of insulin resistance.  If he wakes with a BG in the 4's or 5's I don't want him bolusing until he's about to eat.  If he's in the 6's to 8's he can do it 15 minutes early, and if higher he should prebolus by at least half an hour.  It's a case of each individual PWD experimenting.


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## novorapidboi26

As with all things diabetic, trial and error..........

I think the majority of people do benefit from their insulin going in a good few minutes before....


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## pottersusan

I find it interesting how the time for the insulin to take effect varies through the day. For me (usually - if that word can be applied to diabetes) it's an hour or more at breakfast and about 20 mins in the evening. I've come to the conclusion that the diabetes goal posts are on motorised skateboards on an oily surface.


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## trophywench

LOL - that was the rule with Humulin - inject when I put the spuds on.

I VERY quickly discovered that THAT rule does not apply when I'm using Novorapid!

2 minutes before might be OK if I am sitting down to what's left of a trifle - but not for anything normal !  (NB I haven't actually had any trifle for donkey's years, as for some reason no kids or teenagers in our family will eat it - amazing - I still consider it a mega-treat!)


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## pottersusan

just to keep me on my toes only 30 minutes this morning


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## everydayupsanddowns

pottersusan said:


> I find it interesting how the time for the insulin to take effect varies through the day. For me (usually - if that word can be applied to diabetes) it's an hour or more at breakfast and about 20 mins in the evening. I've come to the conclusion that the diabetes goal posts are on motorised skateboards on an oily surface.



HA! I find exactly the same - at least 30 mins at breakfast and lunch, not much more than 5-10 mins in the evening. Even though basal tests never show any reliably different changes in direction of travel at those times. Sometimes you just have to go with what seems to work (for as long as it continues to do so) with diabetes.


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## HOBIE

novorapidboi26 said:


> As with all things diabetic, trial and error..........
> 
> I think the majority of people do benefit from their insulin going in a good few minutes before....


Agree novorapidoi. good job we are not all the same


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## pottersusan

I envy all you folk who think 10 is a spike. I have to eat carbs to get enough calories in to my system to maintain my weight. I try to bolus at least half an hour before meals, but I still have spikes of 14+. This is aggravated by the fact that I eat every two hours. Life is a roller coaster I'm still searching for the answer (and please don't tell me to eat nuts - I hate them). I have a cow plumbed in for milk, butter and cream.


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## SB2015

Thank you for bringing this up again.  The list is so useful.  When I was at my wits ends and getting no extra ideas from DSN it was this list that set me on track and helped me to improve my profiles and therefore HbA1c.


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## Radders

Since I've had my Libre, I have realised that for me, the most effective way of keeping spikes reasonable is to bolus about 50% more insulin than I need, then top up with a snack after two hours. This means I necessarily have to keep the carbs low otherwise I will soon be the size of a house! 
I know that the DAFNE approach is to eat normally but post meal spikes were glossed over when I did the course in 2008. All the focus was on levels before the next meal. I dread to think what my two hour readings used to be when I was eating high carbs, as I used not to test because I couldn't seem to avoid spikes without having later hypos.


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## everydayupsanddowns

pottersusan said:


> I envy all you folk who think 10 is a spike. I have to eat carbs to get enough calories in to my system to maintain my weight. I try to bolus at least half an hour before meals, but I still have spikes of 14+.



I try to be relaxed about 10s an hour or two after eating as I know my bolus has only just got going and has quite a lot of juice left in it. If I don't check until more like 3 hours after eating I tend to find my meal dose is slightly running out of legs.

If I check at an hour or two and find I'm more like 12s or 14s I might think about a correction that aims to get me back down to 9, since, strictly speaking, that's where I am *supposed* to have been at that point.


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## Smiric

Annette said:


> For the last n years (many) I have done as instructed and bolused 30 mins before meals. And for the last n years I have struggled with hypos that happened half way through a meal. Not until I got my pump, and the ability to bolus over a longer period of time (square wave) at a point to suit me (I now bolus immediately before eating -once my food is in front of me - over 30 minutes) that I realised that I had inherited my mothers slow digestion and what effect it had on my post prandials. Just shows, not all advice is good for all people!


Could be gastroparesis? Glad your pump has helped you with post-prandial spikes! =)


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## Sara W

I'm still struggling to understand why spikes are so bothersome: should I be worrying about them more? Most of my readings are in the 12 to 16 range, a few still 17. But how I feel seems to bear no relationship to these high readings! 

I've never had a blackout, or felt I might - I never get sweaty though I occasionally feel 'wobbly' (which I've always put down to having ME, but now realise might be caused by the diabetes - they are going to test my blood for ME next week to be certain). 

I did come a cropper down the escalator at Tottenham Court Rd three weeks ago, which was how I got diagnosed in the hospital after mentioning my severe weight loss - but that was due to drinking too much wine on an empty stomach, after a long period of barely drinking at all in recent years... It was a one-off event, if indeed it was caused by a super-spike and not just losing my balance due to drink taken...


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## everydayupsanddowns

Sara W said:


> I'm still struggling to understand why spikes are so bothersome: should I be worrying about them more? Most of my readings are in the 12 to 16 range, a few still 17. But how I feel seems to bear no relationship to these high readings!



In diabetes terms, regularly spiking up well into the teens after meals puts quite a lot of strain on the micro-vascular system over time, and increases the proportion of the day when you have higher than ideal BGs, which again can cause damage to blood vessels and nerves and, in the long term, increase your chances of developing long term diabetes complications. It's a sobering thought that only 20% of the costs of treating diabetes are spent on the regular check-ups and all the medications that we need. The other 80% is spent on the extra resources needed when people start to develop those nasties (eye problems, nerve problems, kidney problems etc etc). Of course it's not just money, there is also a huge personal cost involved.

Generally you can look at your HbA1c to keep a longer-term view of whether you are on track to avoid complications, but increasingly it is recognised that an HbA1c of the same value is very different when it is due to someone wildly spiking after meals and crashing down into multiple hypos, versus someone who is able to have a much lower glucose variability and potter along more gently.


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## Amigo

everydayupsanddowns said:


> In diabetes terms, regularly spiking up well into the teens after meals puts quite a lot of strain on the micro-vascular system over time, and increases the proportion of the day when you have higher than ideal BGs, which again can cause damage to blood vessels and nerves and, in the long term, increase your chances of developing long term diabetes complications. It's a sobering thought that only 20% of the costs of treating diabetes are spent on the regular check-ups and all the medications that we need. The other 80% is spent on the extra resources needed when people start to develop those nasties (eye problems, nerve problems, kidney problems etc etc). Of course it's not just money, there is also a huge personal cost involved.
> 
> Generally you can look at your HbA1c to keep a longer-term view of whether you are on track to avoid complications, but increasingly it is recognised that an HbA1c of the same value is very different when it is due to someone wildly spiking after meals and crashing down into multiple hypos, versus someone who is able to have a much lower glucose variability and potter along more gently.



I appreciate I'm a type 2 and my situation is therefore different but this is a valuable discussion for me as I've been thinking about my control recently and probably taking stock now I'm 2 years in.
Being diet control only, I can't rely on anything but myself (and I'm not always as reliable as I'd like ). I also sometimes feel guilty when others report much lower daily levels than mine, particularly waking. I'd say my average waking level is about 6.7 but I really have to work at it on a meal by meal basis.
I'm reassured therefore to hear everydays that it's better to potter along more gently with less extreme variations. I probably rarely register outside of a 6.3 - 8.5 level but occasionally hit a 9.8 with a big meal which I know isn't ideal. My GP seems to think anything under 10 is 'acceptable' but I'm unconvinced. I'm still of the belief that some complications have crept in and wonder if the development of the cataract I now have is more likely with diabetics? 

These are useful reminders @Redkite so thanks


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## trophywench

Well even somewhat brilliant control can still cause cataracts to develop quicker were the person not diabetic - it's kind of like us being more susceptible to anything that's auto-immune.  You have to be prone to getting cataracts in the first place though, so I understand, to get them at all.

So in my case when my optician told me I had one starting on one eye, I wasn't all that bothered - as I don't consider it to be a complication of D, nor caused by it, nor affected by my control.  It's a certain fact that since the thing 'budded', I've had far better control than ever in my diabetic life before - and it still needed sorting within approx. 2 years instead of 'might not ever need it' as in the case of some non-Ds.  Ironic really.

It's like the frozen shoulder thing, is all.  Normals have a journey of 6 months from start to finish - we travel for 18 months to 2 years instead.

When they get round to doing it, you're only in theatre for approx. 20 minutes - and you can't either feel or see, a thing!

I don't count it like I do any of the '~opathies' at all.


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## Bill Stewart

amigo I wish I was as well controlled as you, I would trust the Doc.


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## goosey

Reading this about cataracts my husband who is not D has always had poor eyesight, always without fail has an eye test every 2 yrs, (now 12 months) went for a regular eye test 3 years ago (he was only 49)and was told he had very bad cataracts in both eyes was seen at the hospital within 2 weeks(May) and had 1 eye done in the June,the other Sept.
What we didnt know was when they are developing you cant see colours correctly, had we of known this was an alarm bell, as we were always arguing about colours he would have gone sooner
His eyes are brilliant now only needs glasses for distance , before we were paying £150 to get the lenses thinned out


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## Simbul

I came back to the forum after a while to search for info on post-prandial spikes and, lo and behold, this was the first thread in the list. Pretty amazing 

Since I started using a Freestyle, I've gotten a much better appreciation for my PP spikes. I need to collect some more data, but so far it looks like a normal meal will raise my BG by anything between 3.5 and 5.5 mmol/L; for example, a BG of 7 before a meal could easily see me peaking at 11 or 12.

I've recently stumbled on an interesting research paper which used CGM to track BG patterns in non-diabetic individuals. It's from 2007 and it didn't have many participants, so take it with a pinch of salt.
What I found interesting was that subjects had a mean interstitial glucose of 5.0 mmol/L and their mean glucose went up by about 2.2 mmol/L after a meal.
Mean time to peak glucose concentration in the study was between 46 and 50 minutes; for me, it's somewhere between 1 and 1.5 hours after I start eating.

Here's one of the charts from the paper. You can go from mg/dl to mmol/L by dividing by 18: 180 mg/dl is 10 mmol/L.







Also, subjects almost never went above 7.8 mmol/L, which I found rather cute: non-diabetics sure have it easy 

I'm interested to hear your experiences with post-prandial spikes: how big are the oscillations for you? What would you consider acceptable?


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## Lanny

This is a different prospective & I'm not in anyway advocating this as I know it's not the correct thing to do but, suits me & I'm also type 2 now on insulin.

I medicate after meals. My family owned a small Chinese restaurant for 35 years. I worked there for 10+ years. When I was diagnosed 17 years ago I found it very problematic to medicate before meals. There were no set meal times: we just ate when it wasn't busy. But, quite often after taking the tablets before a meal I either didn't get to eat much of it or get to eat it at all. So, not only would I have to run around serving customers but, I'd have to keep taking sips of full sugar coke to avoid a hypo. Then, eat once it was quiet & take tablets again. I explained this to my GP practice's nurse & she agreed that although it's not correct, it's better for me to medicate after meals. It's become an ingrained habit with me to medicate immediately after eating.

My family sold the restaurant 1 year before I was switched to insulin & I stopped working there. When I was switched to insulin the nurse advised me to inject before meals. My habit of medicating after meals was so ingrained that I found it very hard to either remember to inject before a meal or, to remember if I did not to inject afterwards. Once I injected twice before & after dinner. I had a very long night when I ate everything in sight & testing to make sure I didn't hypo. The nurse once again agreed that it was better for me to continue injecting after meals to stop this from happening again. I still, to this day, inject straight after eating.

Again I don't want anybody to think this is correct when I know it's not!


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## SB2015

Welcome Lanny.
As a Type 2 your body will still be producing insulin so there will be some in your blood immediately after you start eating, as the pancreas will respond automatically.  
As a T1 we are responsible for getting th insulin in place for our food as the pancreas no longer releases any.  By delivering the insulin before the meal it gives it a bit more time to get from the subcutaneous fat into the system.  Also the insulin that we are injecting does not get giong oats quickly as that produced by the pancreas.  I had spent many years injecting straight after my meal until I saw the spikes that were appearing after meals.  I have managed to change these spikes to blips for breakfast and reduced them a lot at other meals, by two main things:
- prebolusing for meals (where I can be sure of knowing when the food is arriving)
- reducing the total carbs in a meal.  I now aim for about 30g per meal
The combination of these two changes then helped me to reduce HbA1c as well.


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## Lanny

Ah! I think I can work out what you mean.

I test before meals aiming for 5 to 7 & 2 hours after meals aiming for less than 10. My eyesight is not as sharp as it used to be & I sometimes read the wrong time on my watch, I need a bigger watch. My pre lunch sugars was 6.5. I mistakenly tested 1 hour after & was horrified by the 16.5 reading, until I looked at my watch again. Tested again at 2 hours & it was 9.4, huge relief. 4 hours after that sugars were at 6.4 before eating dinner. I never realised that sugars were that high in the 1st. hour after eating.


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## SB2015

The spike after a meal will depend on the type of carbs you are eating, and the amount of carbs.  If you wanted to lower the spikes, you could lower the carbs you eat and/or aim for lower GI foods so that the glucose is released more slowly.


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## Radders

The spike will also be larger if the insulin is given after eating.


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## Lanny

Thanks guys.

I've been thinking & want to try medicating before meals again. I've been reading a lot of posts across the forums & can't remember where I read this. Someone mentioned a timed cap for those did I or didn't I moments?


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## Robin

Lanny said:


> Thanks guys.
> 
> I've been thinking & want to try medicating before meals again. I've been reading a lot of posts across the forums & can't remember where I read this. Someone mentioned a timed cap for those did I or didn't I moments?


If you use Novorapid, you can get a Novopen Echo, which tells you (roughly) how many hours since you did your last injection, and how many units you injected. I've got one, it's saved me a lot of those did I didn't I moments!


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## Lanny

I use Levemir & Novorapid 300 units flexpens Does that make a difference. My mum, in Hong Kong, used a slightly fatter pen that 100 units cartridges were slotted into.


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## Kaylz

You could ask your diabetes to be swapped to cartridges rather than the pre-filled pens x


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## Lanny

Thanks guys.

Just googled it. I'll ask for if I can have one when I see my GP practice nurse on 21/03/18. I've just ordered on Saturday a box of Levemir, as I a took out the last one from the fridge. So, when I pick that up at the chemist tomorrow, that'll last me another month or so. But, that's only injected once a day & I can remember that!

Several articles came up about a recall last July 2017 about cracking cartridges. I assume that's been sorted out & there's no problems?


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## Robin

Lanny said:


> Several articles came up about a recall last July 2017 about cracking cartridges. I assume that's been sorted out & there's no problems


There was a problem with some batch numbers. Mine weren't affected, and I haven't had a problem with them, I would hope and expect that any old stock has been withdrawn by now.


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## Lanny

Thanks Robin.

Was looking at the diabetes uk shop for the carbs & cals book & saw Timesulin: a cap that you put on the flexpen instead & has a timer on it.

But, as I understand it, when carb counting sometimes half units are required. So, I think I'd prefer to get Novopen Echo, if I can get one.


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## Lanny

I was hoping for the best this morning when I woke, around 4am, with a reading of 11.3.

I have a borderline slightly under active thyroid that I have blood tests regularly, every 6 weeks, to keep an eye on it but, as yet, no medication for. It can make me really tired after eating. Last night's pre dinner reading was 5.3 & I fell asleep before taking the before bed reading.

Here's a confession for you, I fell asleep with the iPad, surfing these forums, on top of my stomach. I woke with a reading of 11.3 & felt half of last night's dinner still in my stomach. The last thing I wanted then was breakfast.

By the time I could face breakfast, 08:30, my sugars were 12.6. So, I injected & waited half an hour to eat.

My 2 hour after breakfast reading was 11.2. I'm quite happy with that. I was expecting horrors of over 15.

Thanks guys for explaining things to me.


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## mikeyB

Since I developed Parkinson’s, which slows everything down, particularly in the evening, I’ve developed delayed gastric emptying, especially for the evening meal. The spike from eating can happen anything between one and three hours. That’s most disconcerting with a pre meal bolus, because I use Humalog, which takes an hour to reach a peak. So sometimes I catch it right, and sometimes go hypo after eating. It’s a sod because of that variation.


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## Annemarie

Wow what a lot of very interesting issues most of them relevant to me. I can spike after a low carb meal as high as 17 Increasing the insulin may help one day then it may not. The higher it goes the faster it drops to 4 or below. @trophywench I share your love of trifle! Hadn’t had it for over 6 years but made it for my 70th this year then finished it for breakfast the next day. That was a poke in the eye to my diabetes, it felt naughty but very nice


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## Annemarie

Hba1c is often mentioned, is there a recommended level? My local nurse recently said mine has gone up again and needs attention. She asked what my target score is - I’ve no idea, it’s never been discussed. My Libre records 60% to 70%in target.
Does anyone have an ‘acceptable’ score and if so may I ask what it is?


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## trophywench

I can't help cos I don't have one either !  Mine's usually in the low 50s, 53 ish, though sometimes goes up a bit.  I happened to have an A1c a few weeks after I did my knee which was by no means ideal as the last 4 weeks prior to visiting the vampire, has the most effect on the total result - and not at all surprisingly it had shot up to 64.  Came back down again to 57 and then back to 53 by 6 and 12 months after.

If you are still suffering pain and discomfort from your breakages and hence lack of exercise generally this could affect your A1c too.  Are you getting any physio for the leg or not?

Just wondering if the ones they had me doing - lying sat up on the bed! - would do you any good, because they work all your leg muscles above and below the knees and therefore also help more than a bit with circulation of oxygenated blood so excellent for healing and assisting prevention of arteries getting any harder if they are.


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## Annemarie

trophywench said:


> I can't help cos I don't have one either !  Mine's usually in the low 50s, 53 ish, though sometimes goes up a bit.  I happened to have an A1c a few weeks after I did my knee which was by no means ideal as the last 4 weeks prior to visiting the vampire, has the most effect on the total result - and not at all surprisingly it had shot up to 64.  Came back down again to 57 and then back to 53 by 6 and 12 months after.
> 
> If you are still suffering pain and discomfort from your breakages and hence lack of exercise generally this could affect your A1c too.  Are you getting any physio for the leg or not?
> 
> Just wondering if the ones they had me doing - lying sat up on the bed! - would do you any good, because they work all your leg muscles above and below the knees and therefore also help more than a bit with circulation of oxygenated blood so excellent for healing and assisting prevention of arteries getting any harder if they are.


@trophywench I was getting hospital phone physio of very little help, we’d never met and each Physio wanted background details taking up much of the time. Coincidentally the department manager left to work in a private clinic near our home. I see her once a month for an hour, she’s brilliant worth every penny although she doesn’t take prisoners so it’s hard work with sheets of activities to do at home. My calf muscle had almost disappeared, both legs had hardly been used for several weeks but they are now.
My recent Hba1c was 66, 64 last year so it does seem high and yet my time in target isn’t bad (or so I thought) it seems my Libre A1c wasn’t a good indicator. We have never been cake, biscuit or pudding eaters so I didn’t need to cut them down. After reading the menus from other members I was quite shocked as I wouldn’t ever have eaten most of those foods but it’s given me some ideas for a bit more variety in future.


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## trophywench

Good!  made me laugh being told I was working, amongst other things my quads.  Good job the chap told me they were my thigh muscles cos I didn't actually know where your quads were!    One of those many things I'd never bothered finding out about cos formerly on a 'need to know' basis, I never had !


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## everydayupsanddowns

Annemarie said:


> and yet my time in target isn’t bad (or so I thought) it seems my Libre A1c wasn’t a good indicator.



I’ve always found Libre’s A1c estimates rather optimistically low. I am expecting the same with Dexcom, but haven’t had an A1c since switching.

I think it depends on what sort of a ‘glycator’ your body is (how much glycated haemoglobin you make at what BG levels). And also I suppose... which of the vague and imperfect conversion formulae they have chosen?


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## Paulbreen

I’m must be in the hyper-sensitive crowd, with novarapid anything earlier than 10mins before eating I would hypo, recently started fsiap and it works really well, I bolus as I start to eat and unless there is something naughty in the meal there is barely a bump in my BG trace. 
I really like I can decide as I’m about to eat what I’m gonna have rather than planning ahead, makes me feel almost normal lol


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## Annemarie

I’ve been working on breakfast; I tried everything possible but even fresh air was sending me into double figures. With very careful frequent monitoring I not only seem to have more control I have gone back to eating my favourite and very filling choice, home made muesli. With a half increase of Novarapid (5) and a much longer gap, c75 minutes, I stay in my green zone, not every day but most days.


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## rebrascora

Annemarie said:


> With a half increase of Novarapid (5) and a much longer gap, c75 minutes, I stay in my green zone,


That is pretty much my timescale on a morning with NR. I'm down to about 45 with Fiasp but I had a few hypos in the readjustment period after changing over. Just about got it cracked a month down the line.... I'm a slow learner  !


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## nonethewiser

Paulbreen said:


> I’m must be in the hyper-sensitive crowd, with novarapid anything earlier than 10mins before eating I would hypo, recently started fsiap and it works really well, I bolus as I start to eat and unless there is something naughty in the meal there is barely a bump in my BG trace.
> I really like I can decide as I’m about to eat what I’m gonna have rather than planning ahead, makes me feel almost normal lol



Interesting mate, about to start on fiasp once prescription comes thru. Needed something more fast acting so don't have to wait 20-30 minutes before eating, often bolusing this far ahead isn't practical, so giving fiasp trial.


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## Paulbreen

From what I heard from my DN in my clinic she said it’s hit and miss, she thinks it’s 50/50 with her patients, so far after 5 weeks using it it’s working great for me, I’m doing a bit of tweaking with my basal pattern for my pump and I think once that’s done I’ll be 90-95% in target range


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## nonethewiser

Paulbreen said:


> From what I heard from my DN in my clinic she said it’s hit and miss, she thinks it’s 50/50 with her patients, so far after 5 weeks using it it’s working great for me, I’m doing a bit of tweaking with my basal pattern for my pump and I think once that’s done I’ll be 90-95% in target range



So no issues with infusion sites using fiasp, heard this can be issue in some.


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## Paulbreen

Not so far, I’m using Meditronic 680G and the infusion tubes are amazing, I’m experimenting with new sites at the minute and best so far is under my arm on the side of my chest, I tried there because i was getting 600mm long tubes and it was the best place to use up excess tube length and turns out it’s a great site and great for bed too, I just dump the pump beside me and I love a good thrash around during the night and that spot allows more or less free movement


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## Eman @

Redkite said:


> Interesting!  When I first heard this advice about pre bolusing, my son was 9 years old.  We tried it (already had the pump so basals were tailored to him) - insulin given 20 minutes before breakfast resulted in a hypo in the 2's halfway through eating, and the poor boy face down on the carpet feeling awful.  Took a while for hypo treatment to bring him up, and then later he was massively high.  We didn't pre bolus again for a long time!  I think in his case it was because he was small and skinny, and insulin absorbed really quickly.  Now he's 14, still skinny but much taller and with adolescent hormones circulating, we're cautiously trying pre bolusing again and it's working really well.  I think testosterone causes a degree of insulin resistance.  If he wakes with a BG in the 4's or 5's I don't want him bolusing until he's about to eat.  If he's in the 6's to 8's he can do it 15 minutes early, and if higher he should prebolus by at least half an hour.  It's a case of each individual PWD experimenting.


My son is 9 years , thank you for that


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## Teddy*

Redkite said:


> I've copied this over from a reply buried in another thread in case it's helpful to anyone
> 
> The following tips are what I gleaned from a presentation by Gary Scheiner (Certified Diabetes Educator, author of Think Like A Pancreas, and type 1 himself) - this was his "Strike the Spike" presentation.
> 
> 1. One of the most important considerations is the relatively slow action of our so-called rapid-acting insulins. If you have a working pancreas, insulin reaches the bloodstream in seconds and is finished and gone in minutes. Whereas insulin infused or injected into subcutaneous fat can take up to an hour to circulate to where it's needed (and can still be active 3-4 hours after injection), meaning that glucose from digested food gets a head start on the insulin. *Advice is to pre-bolus 20-30 minutes before meals*.
> 
> 2. Type of food eaten also has an impact. I know some people on here eat low carb or no carb meals, but assuming somebody wants to eat a reasonable portion of carbs, *opting for lower GI foods* makes sense, e.g. for breakfast replace cereals with yoghurt and berries, which will take a bit longer to digest and perhaps match insulin action a bit better.
> 
> 3.* Eat veg before carbs.* Can't remember the reason for this one, but I wrote it down!
> 
> 4. *Make lunch the highest carb meal *(lower carbs at breakfast and dinner). The idea being that most people are more insulin sensitive during the day when they are active. As always with type 1, this won't work for all!
> 
> 5. *Increasing the acidity *(e.g. by including a glass of tomato juice or sprinkling vinegar on a salad or chips) of a meal helps delay digestion, so the rise in blood glucose isn't too steep.
> 
> 6.* If pre-meal levels are high, injecting insulin into a muscle* will get the insulin working twice as fast as if it's injected/infused into subcutaneous fat. The recommendation was to use longer needles than you usually use, and inject into forearm muscle or triceps. It stings a bit apparently! Don't think my son would want to try it...
> 
> 7. *Some people have benefitted from also injecting the hormone amylin,* which is absent in people with type 1. This is an appetite suppressant, delays the emptying of the stomach, and while it is active, suppresses the liver from releasing glucose. Very helpful for eliminating a post prandial spike, but risks hypos if you're not very careful indeed, and nausea is a side effect (so it's a no thanks from us!). I think "Victoza" is amylin, though I may be wrong.
> 
> That's all I can remember atm!


I’ve just changed insulin to Fiasp which is VERY quick acting - so can start eating and inject - works immediately. Previously on Novorapid which took 20 mins to kick in and thus having spikes or inject 20 mins before a meal, which was ok but a problem if meal not quite what you thought or delay etc. Would definitely recommend. But as previous replies say, perhaps doesn’t suit all! I’ve also come to the conclusion that a low carb diet is the way forward! I’ve been ‘chasing carbs’ for years- it really turns into a vicious circle of carbs=insulin=Spikes and lows. The combination of fairly low carb diet, fiasp quick acting insulin and the gentle long acting Tresiba,  I manage to avoid (most of the time) the huge swings in blood sugars. I think it’s trying to find the right combination that suits you, that makes life easier.


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## Annemarie

Teddy* said:


> I’ve just changed insulin to Fiasp which is VERY quick acting - so can start eating and inject - works immediately. Previously on Novorapid which took 20 mins to kick in and thus having spikes or inject 20 mins before a meal, which was ok but a problem if meal not quite what you thought or delay etc. Would definitely recommend. But as previous replies say, perhaps doesn’t suit all! I’ve also come to the conclusion that a low carb diet is the way forward! I’ve been ‘chasing carbs’ for years- it really turns into a vicious circle of carbs=insulin=Spikes and lows. The combination of fairly low carb diet, fiasp quick acting insulin and the gentle long acting Tresiba,  I manage to avoid (most of the time) the huge swings in blood sugars. I think it’s trying to find the right combination that suits you, that makes life easier.


Thank you I found that very interesting


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## helli

I have been using Fiasp for a couple of years and it is certainly better for me than NovoSluggish but it is not perfect.
- It doesn't work as fast now as it did when I first started using it. It's as if my body has got used to it
- It does not last as long out of the fridge. After a couple of weeks, I may as well be injecting water. 
- The speed at which it works for me depends on my starting blood sugar. It works very fast when I am under 5 so I definitely do not pre-bolus but it can appear to stall for an hour when I am in double figures
- Some people just don't get on with it.


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## trophywench

@Pattidevans has been using FiASP in her pump for a number of years and still gets on pretty darn well with it.


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## Pattidevans

No, @trophywench I use Apidra not Fiasp.


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## helli

Pattidevans said:


> No, @trophywench I use Apidra not Fiasp.


I have been using it in my pump ... possibly two different pumps if I think back to when I started Fiasping


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## trophywench

For some reason only known to Apidra - its name will NOT stay in my head.


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## Tdm

I tried the "acid' tip and found increasing the acidity of the meal made no diffrence for me. Not surprised given the low pH of the stomach, tbh.

What does work (and I got this idea from an academic paper) is excercise (brisk walking) for 20 plus min after eating. I start just when bs start to rise. Stop as soon as possible when bs start to fall. If it goes back up (which sometimes it does) repeat.
See the attached screen shot for an illustration. As it happens, I didn't take a prompt walk last night due to slippy pavements, giving a good control peak. I has a 38 carb, not especially carby tea, peaked over 12 (really unusal for me), stayed up high for ages,  and only finally came down with a delayed walk and some vigourous vaccuming. With a walk i'd have expected a 7-8 peak. 
Compare that with this morning. I had museli..abeit nutty museli, but still 54 carb per 100g. I find breakfast is my 'peakyest' meal. Peaked 9, and went straight back down to 6. This is peakier than normal for me.
Mind you, i do find walking has a big effect on my bs, but it may be worth seeing if this works for you.


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## Tdm

Please don't judge my average bs...its not been a good week on the bs front!


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## Wutanga1

I echo the exercise thing. When my kid has a big post-meal spike, we find that 10-15 mins of moderate exercise (e.g. star jumps, dancing) gets back down to range. The issue is the resistance to it - which I understand as it's no fun jumping around after a meal. On the other hand, with the right music on, we've been known to cause a hypo with post-meal exercise, when there is so much fun she does not want to stop!


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## Wutanga1

On that note, I've been using some of the info on The Glucose Never Lies (usual disclaimers) and it seems pretty handy, especially the table with the CGM status arrows, pre-meal bolusing time ranges, etc.

See: https://theglucoseneverlies.com/stop-highs-game/


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