Post meal spikes

[jetsmom]

Does anyone know how much affect post meal bg spikes have on A1C?

[kel4han]

I would also like to know. A mom in our support group started to prebolus by 15min (even just a few carbs) and her 5yr olds A1c went from 8.9% to 7.8% or something crazy like that.

[twodoor2]

I believe they have a huge effect, and are often the cause for those "mysterious" A1C's that are too high. This is because many people only test before meals, and they should probably test 2 hours postprandial.

[jilmarie]

I can't point you to any studies, but I started pre-bolusing meals earlier this year and was able to drop my A1C to below 6%. When you have fairly tight control, I think pre-bolusing (especially at breakfast) can make a big difference in A1C.

[jetsmom]

Thank-you JilMarie. I have heard that from our endo (ie. the pre-bolus idea). He sleeps late during the summer (what teen doesn't) and during school it's a miracle that he even has enough time to eat a decent bfast, but we're going next week for his check-up and we'll see how he's done this past 3 months. For the most part I think we're ok (last aic was 7.3) but I think we can do better.

[Tau1061]

So you'd expect an active/athletic d to have a great A1c... mine has been between 6.0 and 6.3 for the last 5 years... others I know avg 5.8-6.6. We're all shooting for 5.8 to 6.0... so we often feel like we have room for improvement too!:D

But the question came up with a lot of us as well b/c we're all trying to get things dialed in all the time just like you do with your kids... no, you're not alone in those kinds of efforts!:D The "management crew" some of us talk to all the time agreed that it would have an effect, so we all started looking and experimenting a few years ago...

-Even as "fast" as today's insulins are, taking them 10-20 mins prior has a big effect on postprandials
-Postprandials have a HUGE effect on A1c's outside of avg bg

At FfL in Orlando, John Walsh's seminar on pumping is AWESOME! Walsh agrees and reiterated this in his discussions. If I remember correctly, he DOES have data to show this.

Post-p's are one of the reasons why Amylin worked on developing Symlin (to slow gastric emptying thereby slowing bg impact), and why so many diabetic athletes have also now switched to Apidra for short-acting insulin (the action curve is faster than Huma & Novolog).

The hard part with a child is going to be determining how much they're going to eat in order to bolus or inject 15min prior to a meal... :confused: I know that's almost impossible for young kids, but a possible point to address with those of you with teens.:cwds:

I don't use Symlin. I have been using Humalog in my pump for 3yrs, but after playing with Apidra for the last month I'm switching in the next 2 weeks when I see my endo again. I try as often as I can to bolus 10-20min prior, but it isn't always possible. The Apidra and timing are keeping my post-p's much lower on avg. The Apidra is forcing me to adjust my usual combo bolus for higher fat meals like pizza!

Hope this helps. Take care --J

[Jacob'sDad]

My son Jacob has breakfast spikes sometimes even with Apidra. Prebolusing works the best to curb those spikes but isn't always possible or convenient. Overbolusing breakfast and then adding an uncovered snack about 2.5 hours later also helps, but it's hit or miss.
Setting the basal too high is another way to allow for an uncovered snack later but is risky because if he doesn't eat breakfast on time he will go low.

I've tried temp basal increases too and also extended boluses, but always with mixed results.

I've also tried superbolusing which is when you lower the basal rate way down (with a temp basal) and then add all the missing basal to the breakfast bolus in the hopes that the big blast of insulin will break through the insulin resistance. It didn't work for Jacob. His spike might have been slightly lower but it wasn't much of a difference.

Because of all this I am strongly considering Symlin for Jacob, however I have become convinced, due to the advice I have received on this board, that it would be best to wait until Jacob has a CGMS to start Symlin. There is too much risk that he could go low and not respond well to treatment for the low due to the delayed stomach emptying that Symlin can cause. With CGMS we could head off a low before it got TOO low. We could also "Map out" the exact effect that the Symlin is having.
Hopefully Jacob will have a CGMS real soon and then we can seriously look at the possibility of starting him on Symlin.

Oh and I didn't even mention the option of changing what he eats for breakfast. Certainly there are food choices and combinations that can drastically reduce or eliminate spiking, but I don't want Jacob to spike NO MATTER WHAT he eats for breakfast (regular breakfast food of course, not candy :p)

[Tau1061]

Jacob isn't alone. I, even at 32, have trouble in the morning. They say kids are the only ones that really have a dawn phenom effect... that's not true. I am royally sensitive in the morning... sometimes things work great, sometimes they drop, and sometimes they run high. My ICR has always been different in the morning than later in the day.

Since starting the Apidra, I definitely bolus 15-20min before breakfast. Better trend than without and when using Humalog, but still have spikes some days. Can't account for all the variables, just keep our heads up and go!

Definitely agree with JDad's approach for Sym. It's hard enough for an adult initially. CGM will definitely make it a feasible option.

Take care --J :)