Treat High Post Meal Glucose with Insulin?
| Author: Judy Kohn, RN, BSN, CDE |
| Last Updated: Monday, February 13, 2006 |
Q: "When I have a high post meal glucose, should I take more insulin to bring it down? I have been taking insulin for 2 ½ months, having been diagnosed a year ago, and I am having trouble keeping my blood sugars down."
A: First of all, because you are so new to all of this, I want to assure you that even though it may seem overwhelming, it will get easier over time and you should eventually be able to get your diabetes in better control.
To answer your question in a general way
Usually no, a person would not take extra insulin to bring down a temporary post-meal elevated glucose.
Talk to your healthcare team:
Without knowing your insulin types, dosages, regimen, etc., I cannot fully answer this question nor would it be appropriate. This type of medical advice must be provided by your healthcare team. For brevity, I'll refer to your healthcare team as HCP (healthcare professionals). Let me explain some of the things to consider:
-
Keep a record and look for patterns: Ideally, it would be
better to carefully record both your pre-meal and post-meal glucose levels,
along with appropriate notes explaining when you overate, exercised, had
stress, or other intervening factors, so that you and your HCP can analyze the
data and most importantly look for patterns.
- For example: If you were frequently too high 2-hours after breakfast, then your HCP would either recommend that you decrease your breakfast carbohydrate, or increase your morning dose of rapid-acting insulin, to prevent the post meal glucose from being too high. Or perhaps you reduced your activity level, and that is the cause of the temporary high glucose.
- Risk of hypoglycemia: There is a risk in over-correcting a high glucose, if you are trying to correct a post meal glucose elevation right at that time--this is because your previous insulin dose may not have fully peaked yet, so if you then took additional rapid-acting insulin to try to fix this temporary elevation, you could have two doses overlapping which could result in a low blood glucose before the next meal.
- Food effects vary: Some foods can cause a rapid rise in your blood glucose (such as a "smoothie" which is often very high in carbohydrate but very low in fat) followed by a rapid drop in blood glucose, soon after the meal. If you tried to correct the post-meal glucose with extra insulin, you might end up with hypoglycemia soon afterward.
-
Exceptions: There are some occasions where certain people
will be advised to take extra insulin to correct a very high glucose right
after a meal. Such instances might include:
- Overeating: If you knew you overate excessive carbohydrate and forgot to take adequate insulin to handle it--then in this case, your HCP might advise you to take extra insulin to cover that carbohydrate, but it would not be based on the post-meal glucose level since that level is only temporarily elevated and could be misleading.
- Insulin pump problem: If you were using an insulin pump and discovered a high glucose; following the specific pump rules provided by your HCP, you checked the pump connection, and retested hourly, but the glucose had not come down, and in fact it went even higher. This scenario is something very specific to insulin pumpers who might suspect that their tubing is clogged or that the insulin is not infusing correctly--so in this case, the HCP may have given the pump user a specific protocol to take extra insulin. Needless to say, these are specific examples and would not apply to you unless your HCP advised you accordingly.
- Illness/stress: There are certain times when your glucose may be temporarily elevated due to illness or stress. In this situation, your HCPs might advise you to take extra insulin, but this would be related to persistent elevated glucose levels, not just one elevation after a meal.
- Pregnancy: During pregnancy, blood glucose levels are very tightly controlled, and pregnant women with diabetes or gestational diabetes are given tighter goals and specific advice for correcting high glucose levels.
Again, be sure to review all of this with your healthcare team.
Related Questions
Unused Insulin Rule
Q:
"I was reading one of your articles on diabetes and noticed you referred to
the unused insulin rule. I could not find any discussion on the site clarifying
this rule. Could you elaborate?"
Related Links
Joslin Diabetes Center
http://www.joslin.org
Important Notice: The responses provided by the team of Diabetes Educators are based on their personal experiences and expertise as practicing diabetes healthcare professionals, and are not to be considered diabetes management advice from Abbott Laboratories. Remember that information provided by the team of Diabetes Educators is for general background purposes and is not intended as a substitute for medical diagnosis or treatment by a trained professional. You should always consult your physician about any healthcare questions you may have, especially before trying a new medication, diet, fitness program, or approach to healthcare issues.
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