Need advice when to correct for highs after meals

Hi Everyone, been feeling super frustrated dealing with high BG 2-3 hours after a meal. I count my carbs, bolus, eat a meal after about 15-20 minutes, but lately notice my BG stays high 2-3 hours post meals. I try to take a correction dose after the 2 hour mark, but sometimes I notice it still stays high, not as high, but in the 190-210 range. I’m not sure I’m correcting highs right and when to add more insulin? Still learning after originally being diagnosed as a T2 4 years ago but diagnosed as LADA, T1 about 1.5 years ago. My head is spinning with managing T1.

My doctor told me not to give an additional bolus until x hours after my first (unless of course I mis-counted my carbs or ate something more). I’m not saying what “my x” is as we may use different insulins that have different time frames). Check with your doctor on that number as adding insulin too soon may result in a serious drop later. Meals high in fat can cause a delayed rise so it might be helpful to use an extended bolus of you’re on a pump. Which begs the question - do you use a pump, or are you on injections; and which type/s of insulin do you use? That might help us puzzle things out.

hi @DFBB I can give you a general rule of thumb, but you should ask your doctor.

fast and rapid insulin (regular - not mixed R, Humalog, Novolog, Apidra) .last for ABOUT 4 hours. Meaning that if you inject fast or rapid, it will have a tendency to lower your blood sugar for 4 hours… then it stops.

so the rule of thumb is this: if you start a meal by testing your blood sugar lets say with normal blood sugar (100mg/dl) and eat about 30-50 grams of “not mixed” carbohydrates (a separate discussion for now lets say wheat bread with low fat something like turkey) you bolus, wait 0-15 minutes and eat. Then at 2 hours later, you should be about 150 mg/dl. (50 points higher then your pre meal test) this gives you 2 hours to return to 100. if that is your blood sugar trajectory, and your sugar comes down to 100mg/dl 4 HOURS LATER then when you started eating, then your meal insulin is perfect

so many things can affect this: metabolism, if your long acting insulin or basal rate is too much, too little, any activity, illness, stress, mixed carbs or too much fat, super fast carbs like cereal, etc. etc. that this rule of thumb is rarely the actual case.

please buy the book “Think Like a Pancreas” it is worth it’s weight in gold.

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Thank you for your reply. Right now I do injections, but my endo is advising a pump, the Tandem T slim to pair with my Dexcom 6 CGM. For basal insulin I was just switched to Toujeo, and Humalog for bolus injections. My doctor gave me the insulin:carb ratios that I use to calculate mealtime injections as well as a correction scale when sugars are higher than expected 2 hours after meals or at bedtime. I always wondered if math was in my future. :slight_smile:

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Thank you, I’m ordering the book right now. I feel I have so much to learn, never knew about mixed carbs.

oooooh, math is definitely in your present and future! The Tslim does a lot of math for you but it is good to know how to do it manually.

As you probably know, from time to time it’s necessary to adjust carb ratios, basal dose, etc. Hang in there and work with your doctor until you get comfortable doing it on your own.
Exciting news about going on a pump. I’ve been on a pump for 30-some years, and T-Slim for around 10 of those. I got my first CGM (am older model Tandem) a few years after that. I’m a huge fan of pumps but here’s an article you should read that may help you composer questions for your doctor.
BIQ is a relatively new addition and I used my pump manually die many years before it went on the market. I would suggest you use your pump manually for a while - you can still use Dexcom for your readings but you would make your own corrections for highs and decrease or stop insulin add needed for lows - before relying on CIQ. It’s good to know how to “go old school” just in case. Know that CIQ relies on getting good background settings in place - some of which you are familiar with from injections, but there are more that you’ll learn about when the time comes. Expect some tweaking and try not to get frustrated as you get set up - it’s part of the process.

Hi Diane,
I am also newly diagnosed as a T1D - June 2021 at the age of 56! First of all, Think Like a Pancreas is a must read for all newly diagnosed. Gary Scheiner really lays out the math aspect well - how to determine what your carb:insulin ratio, how to ensure your basil insulin is correct, etc. My endo suggested a 12:1 cart to insulin ratio when I first met with her and I determined within a month my real ratio was more like 6:1 - a big difference.

Are you looking at the glycemic index of your food? This was a big thing for me because I was treating all of my carbs the same and that is really not the case. Based on what you are eating, you may find that shifting when you take your bolus is necessary.

Lastly, and I know this is really hard, try not to stress too much. I was obsessing about my numbers at the 2 hour mark when I really should have been looking at my trend line and my numbers at the 4 hour mark when most of my bolus should be gone. Getting a CGM was a life changer for me! Being able to see when my BG is and where it is heading (the arrows) gives me a much better picture on how to treat my BG as well as WHEN to treat it.

Good luck and please let us know how things work out.

MF

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Thank you so much for your replies. I truly appreciate the knowledge and support of this forum. There’s so much to learn and deal with T1 that it can feel overwhelming. I feel more encouraged reading your replies and advice.

Diane F. Bejcek

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Hi Diane and sorry for being late to the party and hopefully you see this as I missed the initial message. One thing also to remember that all carbs are NOT the same. For carbs you need to consider the Carb Index and Carb Load as different carbs are digested differently. Some, like chocolates etc. will be very fast acting as they have a high sugar index, while potatoes and rice, have a high sugar load - so they are digested and releasing cabs over a longer period of time. I have the very same situation so you just need to know what you are eating, how it affects your BG and then manage it. One thing of course to avoid is high carb loads before bedtime, unless you have a CGM activated pump/pod or can get up regularly during the night to manage. Definitely also good to do continued reading to learn more and to continue to “think like a pancreas” and also act like a pancreas.

If it stays high, than try moving around. Even just going on a walk can help.