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    High Blood Glucose from 5pm to 8pm
    JesusA posted:
    I have type 1 diabetes. I have it since I was 13, 10 years ago, I am now 23. I go to the gym in the morning and practice box or run in the evening.
    I take insulin shots with every meal containing carbs and 1 shot (lantus) at night.

    Since this past friday I am having trouble controlling my blood glucose after 5pm until 8 pm, for some reason it is going up.
    I eat lunch at 2:30pm check my BG at 4:30 and it is fine, at about 150 or lower. But then I start feeling high blood glucose, I check and I am high, at about 250!
    I inyect 3 units of fast acting insulin (humalog) and check again at 6, it is still high at 250, I inyect another 3 units and check again at 7 only to find out I am at about 200.

    This is afecting my blood sugar and my evening excercise, since i like to box or run at 8pm.

    What could be causing this? What can I do?

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    nutrijoy responded:
    It's not possible to provide you with a diagnosis in a public forum of this nature. Your best bet is to check with your own doctor/healthcare provider(s). However, you can do some preliminary detective work by analyzing the contents of your lunches, your stress levels, other medications you may be taking that could affect/raise blood glucose levels, presence of inflammation or infection (a subtle dental infection or gum inflammation is a common culprit), remote possibility of complications (such as gastroparesis), and don't forget the obvious: your bottle of insulin could have suffered physical changes such as polymerization and might be compromised — try a fresh vial to see if it alters the outcome.
    Anon_74671 responded:
    lots of things here.
    first of all, fast acting insulin stays in your system for 3-4 hours. its not a good idea to inject again 1 hour after your first shot, this is called insulin stacking and can cause a serious low blood sugar, especially at this time of the evening.

    That said, you may need to see your doctor or CDE and talk about adjusting your lantus dose if you are going high at the same time every day, or adjusting your carb ratio for lunch.

    your workout can also make your blood sugar higher, depending on what kinds of exercise you do.

    you might even consider an insulin pump, it helps to counter these variances in parts of the day when you might need more basal insulin
    auriga1 responded:
    Good idea to call your doctor. Since these changes started just last Friday, maybe something else is going on.

    Keep a journal of what your are eating and how many carbs are in those foods. I have no idea what your insulin to carb ratio might be if your doctor gave you one (for the Humalog.)

    Has the intensity of your workouts changed? I never go high during workouts or physical activity. As a matter of fact, it's the opposite. Always going low. Insulin inhibits the production of glucose from the liver.

    Check with your doctor regarding your basal insulin dosage if these keeps happening.

    Also, make sure that both your insulins are still within the "safe" range of expiration dates. I, too, use both the Lantus and Humalog. I injected Lantus one day past expiration and my BS shot up into the stratoshphere. Two hours after having a meal that consisted of 19 carbs, my BS was 435.

    We can only tell you what works for us. We're speaking from an "experience" point of view. Your doctor would know best regarding what is going on in your body.

    Good luck and let us know how you are doing.
    JesusA replied to auriga1's response:
    Thank You

    I am going to start the detective work and keeping a journal to remember what I eat, injected, and excercise.

    I was thinking maybe I can Inject 2 or 3 units of humalog at 5, just before I start going high. What do you think?
    auriga1 replied to JesusA's response:
    Good idea on keeping the journal. It helped me. I am extremely intolerant of carbs. My doctor also thinks my pancreas "pooped" out, that it doesn't make any insulin. I was diagnosed as a Type 2 because of my age bracket. Excess weight was never in the picture. Most of the time, too lean. Always ate right and exercised. I don't fit neatly into any box.

    If your doctor advocated or gave you the go ahead to inject insulin because of high blood sugar readings, please do. The Humalog peaks at 2 hours and stays in one's system 4-6 hours, depending on the patient. It also starts to work immediately, within 10 minutes.

    There is a wonderful article on the dLife website, , titled "Adjusting Your Insulin Dose." Check up on the "1800 Rule" which lets you set up a personal sliding scale to correct your high glucose values.

    As I stated above, your doctor should have given you the go-ahead regarding adjusting your insulin dosages. Mine did by 2-4 units at a time.
    fdanko replied to auriga1's response:
    I am going to assume that being type 1 you check your glucose in the morning and also before lunch and the numbers are good. Since you have been using the lantus and humalog for a while and this change is recent and has lasted a few days I would look for something other than the insulin or the exercise. What you do need to consider is that the Humalog has different peak time and duration time in different people.
    What I would consider is your lunch time meal. If your meal is high in protein or you are taking a protein drink you need to consider that even protein breaks down into blood glucose (less so that a carb but still produces considerable blood glucose) Protein also converts to glucose more slowly than carbs. The glucose from the protein may not be peaking for 2 to 4 hours after your meal. If your Humalog peaks in 1 hour and has a duration of 2 hours, the glucose from the protein is peaking at the end of your insulin effectiveness.
    Now for why additional insulin isn't helping. If your are consuming large amounts of calories (protein, carbs or fats) at lunch the insulin at lunch will cause your body cells will be overloaded with energy producing chemicals. The body reacts to stop that situation by creating additional insulin resistance at the receptor sites. That means that adding more insulin may only increase the insulin resistance to block the excess energy (glucose) from entering the cells.
    Try cutting down on the number of calories, especially proteins, at lunch.
    RATHAN responded:
    Dear friend
    I too got this deadly disease, 6yrs back and recently doctor advised me to take up insulin shots, since my FBS was 250 AND PPBS was 370. I started taking metformin tablets 500 mg morning and night every day instead of insulin shots. for nearly 1 month i was feeling very tired and slowly i subsided. after strictly restricting the diet and exrecises within 3 months, i have lost a weight of 5 kgs, and my blood sugar has reduced to FBS: 109 and PPBS: 169.

    following are the routine of events i used to do for this reduction:

    1. drink atleast 0.5 ltr of water and an orange in the early morning and do exercises at the gym . the exercises would be typically brisk walking on the tread mill [burning 50 cals within 10 mins> for 20-25 mins, perform situps, pullups

    2. eat chickpea [5-10> that was dipped in water the previous night itself with two tomatoes after exercises. this provides enough proteins and tomato removes all the antioxidants that we get after doing exercises

    3. have a tablet of glycophage gp1-500 before going to bath and drink one cup of green tea. green tea removes all impurities in the blood

    4. have three rotis with some vegetables and a small serving of curd rice [boiled rice>. less sugar food and rotis will make the rice to digest at a decelerated rate

    5. after meals have 1tbsp of flax seeds and 1 spoon of apple cider vinegar in a cup of water. flax seeds has alpha amino acids which decelerates the metabolism of sugar and vinegar in water increases sensitivity of insulin to pick up sugar

    6. afternoon three rotis and a full serving of indian sambar rich in rice. we need atleast some nutrients

    7. evening walk 2kms in the evening [atleast for 30 mins> in a fresh garden so basic warm up is done

    8. come home and have half cup of coffee and one orange . Coffee is a stimulator of energy [spikes>.

    9. in the night have one ragiball, three rotis and a cup of rice for dinner. after dinner have one walk for just halk a km.

    This is what my routine is and now it has reduced completely .
    auriga1 responded:
    JesusA, I ran across a Q&A session that could be a possibility for your BS going up between these times.

    When carbohydrates are consumed, 100% of it is converted into glucose within a few minutes to hours. Most of the glycemic effect is due to carbohydrate consumption so the bolus of insulin depends on the carbs eaten.

    For some people, protein and fat do impact glucose and insulin needs depending on the quanity eaten, digestion, absorption and composition of the meal. The effects on blood glucose may occur hours after eating it. The nutritional guidelines for protein should be 10-20% of total calories and should be consistent day to day.

    Is this a new exercise regime for you? Have you upped your protein intake?

    If you stay within the 10-20% guideline of protein intake and are consistent with that, your insulin needs should be covered by the Lantus you take. A meal high in protein can raise your blood sugar levels.

    The same is true of fat. A meal high in fat content can raise the blood glucose levels hours later.

    I don't know if your diet has changed at all due to your gym workouts, etc.

    Just something to think about.
    JesusA replied to auriga1's response:

    Thank you. My diet has actually changed I am eating less carbs and more protein. So when I eat more protein I should be careful later? 2 to 4 hours after I had lunch?

    auriga1 replied to JesusA's response:
    If you are going to eat more protein and less carbs, your BS will most likely go up hours later. You may have to configure your basal insulin dosaging so you don't go up hours later after your protein intake.

    You are already covering the carb intake issue with your mealtime insulin. In order for your BS not go up on you hours later after eating more protein, you may have to adjust your Lantus injection. Ask your doctor if this is a possibility.

    I can't tell you what to do. If your doctor has given you the go ahead to adjust your insulin a unit or two at a time, by all means do so. He/she should know that you have done this on your next office visit.

    I understand how hard it can be to exercise, use insulin and eat balanced meals. I do it most days. My job responsibilities vary from day to day. Some are very busy, some slow, and then you have in between. Today was slow, but somehow I took too much Lantus for the amount of work I did. I came home to a reading of 56. I need to fix it by ingesting pure sugar. Use insulin to bring BS readings down and then it goes too low if you are too active. Some days, I just say "what a crock." LOL. I ate lunch and didn't take my Humalog to cover the carbs I ate. The activity at work burned those carbs and then some.

    I'm still working it out to keep within range. I don't go high; low too often.

    Maybe if you cut back on protein intake a little at a time and see if your numbers improve. Most nutritionists will tell their patients to moderate all types of foods and keep it consistent. No more than the daily allotment/requirement should be ingested. My dietician recommended 2 grams of protein per meal which is a pretty lean number. At diagnosis, the doctors charted me as "uncontrolled diabetic." Not a pretty moniker.

    Good luck. Let us know how you do.
    flutetooter replied to auriga1's response:
    Auriga, are your sure your dietician didn't say "2 ounces" (as a total weight) of a protein food? Regular diets with portion control suggest a piece of meat the size of a deck of cards, which would be 3 ounces of meat as a good size to eat. I usually limit my meat to a 2 ounce size.

    If a person is measure grams of protein in a food, the size of the portion is not being measured. For instance one boiled egg contains about 6 grams of protein, but weighs only about 1 ounce. A one ounce cube of cheese if about 1 inch in every direction, but it contains about 6 or 7 grams of protein. Confusing, huh?
    If at first you don't succeed, try, try again!

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