Fasting BG spiking -advice

[Raghu_Nandan]

Need advice/help ,so off late i am observing my fasting BG's are regularly in 6 to 6.8 range ( for example last evening post dinner/before bed it was 4.1 and today morning it was 6.6 , day before before bed/post meal it was 5.2 and in morning it was 6.2) , earlier they used to be in low 5 and mid 5 ranges , i am little concerned as i haven't changed anything same exercise level and medicines and following low carbs .

Is it dawn phenomemon or my med's are no more effective or my d2 is progressing ...

any suggestions ,advice ,experinence -welcome

T2 dignosed 8 months back taking Novomix-30/70 (3 units morning , 2 units before dinner) and .5mg Amryl .
TIA

 

[Chook]

It sounds like dawn phenomenon. You might need to experiment to be certain. I get it too and I've found that if I eat anything after dinner my FBG will be higher the next morning.

I've also found that mine carries on rising until mid morning before taking a downward turn but I can stop it from carrying on rising by eating - my go-to breakfast at the moment is two boiled eggs and buttered Lidl protein roll soldiers and, if eaten very soon after getting out of bed, it stops it rising any further.

 

[Bluetit1802]

Are you very low carb?

What are your levels before lunch and before evening meal? Have they also risen? If so it could be PIR.

There is something called physiological insulin resistance. (PIR) This is quite different from the diabetes related insulin resistance. If you are very low carb this can kick in. It seems mainly to affect base line levels rather than post meal ones. It happened to me during early 2016 and I have a feeling it is starting to happen again. Time will tell. Have a read of this:
http://ketopia.com/physiological-insulin-resistance/

I should add that it is temporary and can be stopped by 2 or 3 days of increased carbs (around 150g.)

 

[Raghu_Nandan]

Are you very low carb?

What are your levels before lunch and before evening meal? Have they also risen? If so it could be PIR.

There is something called physiological insulin resistance. (PIR) This is quite different from the diabetes related insulin resistance. If you are very low carb this can kick in. It seems mainly to affect base line levels rather than post meal ones. It happened to me during early 2016 and I have a feeling it is starting to happen again. Time will tell. Have a read of this:
http://ketopia.com/physiological-insulin-resistance/

I should add that it is temporary and can be stopped by 2 or 3 days of increased carbs (around 150g.)

Thanks for your reply .... yeah following low carbs try to remain under <30 , post lunch after 2 hrs they are in 5-6.
One thing i have observed is if i take even very small amounts of grains now a days i spike in range of 8 ...like yesterday in lunch i tried bowl of mixed lentils and took half n hr stroll post lunch and after 2 hrs my BG was at 8.4 but by the evening it was back in 5-6 ...after dinner 4.1 and today morning again 6.6 so not sure what is reason ...

 

[Bluetit1802]

If you have ruled out PIR then maybe your insulin dose needs adjusting. I can't comment on this as I know very little about it.
I will tag a couple of Type 1s to see if they can offer some advice.

@azure @Jaylee

A more simple explanation may just be the Dawn Phenomenon as @Chook explained.

 

[Raghu_Nandan]

If you have ruled out PIR then maybe your insulin dose needs adjusting. I can't comment on this as I know very little about it.
I will tag a couple of Type 1s to see if they can offer some advice.

@azure @Jaylee

A more simple explanation may just be the Dawn Phenomenon as @Chook explained.

Thanks

 

[Jaylee]

Hi @Raghu_Nandan ,

I'm not sure if during your morning routine the blood test is upon waking, or a little later before breakfast after the "preparation for the day thing."? (During the hustle & bustle..)

If the latter? I'd be tempted to test immediately on waking.? Though I'm on a different insulin regime to yourself & don't do breakfast. I can get a guaranteed jump of about 1.2mmol from the first test (a respectable 4.8/5.2er.) on waking to two hours later, just before I set off to work..
Which I blame on Dawn phenominom.
(Lol, I've "prepped up" & walked a dog too!)

Another question comes to mind.. (This is thinking outside the box.)
Bare with me...
How do you store your opened/currently using insulin? 5units of insulin a day can go a long way.
It can last for around 28 days? (Life wise whilst in use.) You mentioned you have observed this "of late"?
If you can, try a new vial/cartridge...?
I may well be barking up the wrong tree on the insulin..

 

[Raghu_Nandan]

Hi @Raghu_Nandan ,

I'm not sure if during your morning routine the blood test is upon waking, or a little later before breakfast after the "preparation for the day thing."? (During the hustle & bustle..)

If the latter? I'd be tempted to test immediately on waking.? Though I'm on a different insulin regime to yourself & don't do breakfast. I can get a guaranteed jump of about 1.2mmol from the first test (a respectable 4.8/5.2er.) on waking to two hours later, just before I set off to work..
Which I blame on Dawn phenominom.
(Lol, I've "prepped up" & walked a dog too!)

Another question comes to mind.. (This is thinking outside the box.)
Bare with me...
How do you store your opened/currently using insulin? 5units of insulin a day can go a long way.
It can last for around 28 days? (Life wise whilst in use.) You mentioned you have observed this "of late"?
If you can, try a new vial/cartridge...?
I may well be barking up the wrong tree on the insulin..

Thank you Jaylee for your reply ,
exactly i tried this multiple times in morning on waking (immediately after brushing my teeth) and couple of times after an hr from waking , i observed same that BG raise by 1 odd mmol .. (i think blame on human evolution ) ...
regarding insulin yeah i am using insulin pen and keeps them in fridge and took them out for 20-30 mins at room temperature before injecting ... since its NPH i ensure it is rolled multiple time before injecting....
but as suggested let me try with a new pen ... efficacy of insulin could have been comprised due to long exposure ...
or is it i am because now days i am injecting only on my stomach ..that could be another reason??

 

[Jaylee]

Thank you Jaylee for your reply ,
exactly i tried this multiple times in morning on waking (immediately after brushing my teeth) and couple of times after an hr from waking , i observed same that BG raise by 1 odd mmol .. (i think blame on human evolution ) ...
regarding insulin yeah i am using insulin pen and keeps them in fridge and took them out for 20-30 mins at room temperature before injecting ... since its NPH i ensure it is rolled multiple time before injecting....
but as suggested let me try with a new pen ... efficacy of insulin could have been comprised due to long exposure ...
or is it i am because now days i am injecting only on my stomach ..that could be another reason??

Lol, indeed "evolution" wake up & hit the ground running...
Of course! I remember the old NPH with the little glass ball.? "Stirred, not shaken." (James Bond reference, sorry!)

Sounds like your doing all the right things with the insulin storage & mixing.

Sometimes the stomach sites (though the most convenient.) can occasionally be a little "temperamental".
That is the problem. There are soooooo many "variables."

To be totally fair to you.. Regarding the "stray" BS readings? You're not blown wildly "off course" yet!
But always worth keeping an eye on.
I'm a firm believer in "brainstorming".. It may just throw up a "eureka" moment! "Wood for the trees" in this game...