Liver Dump ? 10am

[Spirit of Eden]

The one constant in my numbers has always a huge spike at about 10 am and to a lesser extent 2pm. Over the past 2 weeks i've monitored at 10:00 - 11:00 every day. The average is about 15mmol.

My numbers since going over to insulin have generally been excellent including pre breakfast/lunch, but that mid morning spike is the same as it ever was. It seems to be resistant to the ever increasing amounts of Basal I take in the morning at about 7:30

I assume this is a liver dump

Does anybody have the same problem. How do you deal with it ?

Thanks in advance
Paul

 

[angieG]

If the basal is causing a liver dump, have you tried decreasing the amount?
HTH
Angie

 

[smidge]

Hey Paul!

I doubt the 10am spike is a liver dump, although you don't give enough details to be sure of that. Your profile states you are Type 1.5 on basal insulin. I am assuming you take no bolus? The problem with LADA (which I Assume you have) is that the spikes are generally very much post prandial as you will be producing some basal of your own and you are now supplementing that with injected basal. However, injected basal can only do a limited amount to help with post prandial spikes. What time do you have your breakfast and what do you eat? The 10am spike could well be connected with that and you might need to change what you eat or take a rapid acting basal like Apidra with your breakfast. Increasing the basal to try to cover food spikes won't work. Sometimes they give LADAs intermediate acting insulin like Insuman. These do have a peak at about 6 hours, so if you coincide that peak with the spike of a meal, it can cover that meal, but if you are taking your basal at 7.30, it wouldn't have peaked enough by 10 to cover that spike.

Would it be possible for you test every hour from 7.30 onwards til midday to get a complete profile of your morning? That will show you what your BG is doing in relation to breakfast and the insulin you have injected. You will probably be able to spot something from that. Post your results along with the detail of what you ate and I'll try to help.

Smidge

 

[Spirit of Eden]

Thanks for the replies

On 1 October i recorded

07:30 BG 4.3
07:40 16u of Humulin I with 2x Weetabix with full fat / Coffee
10:00 BG 15.6 / Coffee
11:40 BG 8.1
12:30 BG 4.2
12:40 Baguette (brown)with Cheese + Tomato
14:30 BG 10.3
18:30 BG 5.0
18:40 Dinner .....

Smidge - not hourly, but it does give a good idea. You can see why i'm really pleased with pre-meal reading. I didn't get close to this on oral meds. If I ate 2x weetabix for my evening meal i'm sure i wouldn't get this kind of spike, hence the thought that its a dump.

I used to get same spike when on oral meds

Any further thoughts ?

 

[smidge]

Hey Paul!

Humulin I has about a 22 hour action, but is mainly spent by 16 to 18 hours. However, it has a vey pronounced peak at 4 to 8 hours. So, you take yours at 7.30am and eat breakfast at the same time. Your previous dose will no longer be active and the dose you've taken won't yet be strong enough to cover the rise you get from a very carby breakfast like weetabix and milk (maybe 35g carb) - hence the spike. By 12.30 your Humulin is at its peak so your BG has come right down. However, you have another very carby meal (maybe 35 - 40g carb depending on size of baguette) and the Humulin manages to hold that at 10m/mol spiking by 5 m/mol - without the insulin at its peak I think you'd be in the 20s there! By tea time, the Humulin has got you back to good figures but the peak of its action has passed and it is tailing off now.

As a rule of thumb, each 10g carb will raise your BG by 3m/mol. At its peak, the Humulin is controlling this to some extent, but I personally think you need some rapid acting if you are going to eat those kinds of food. As a Type 1.5, you will be producing some of your own insulin, but it seems like you don't produce enough first phase insulin to stop those post food spikes, so you're spiking up but the combination of your own insulin and the Humulin is bringing your BG back down over a 4 or 5 hour period.

I'm not a doctor, but if I were you I'd be discussing your insulin regime with your diabetes team in light of those figures. You probably need to reduce the Humulin and add a rapid acting at meal times. I would also look to cut the carbs significantly from your meals -but you'll need to do that carefully, as the Humulin will cause you to hypo.

For info, I'm also LADA and was started on a similar insulin to you. I had the same issue and had to go onto rapid acting within a few months. I also low-carb to try to keep my BG steady. I know that's probably not what you want to hear, but LADA is notoriously spikey and difficult to control.

Let us know how you get on

Smidge

I should also have said, your body might well be better at dealing with carb later in the day - your own insulin might be stronger at that time. It's difficult to know, but several members do report a better tolerance to carbs in the afternoon/evenings.

Smidge

 

[Spirit of Eden]

Smidge - this is very very helpful thank you

I think I have made a mistake in that I had only been testing pre meals since moving on to Insulin. Fast acting with meals had been suggested but discounted as my pre-meal figures were really good. I only started testing post mealtimes as a curiosity and was shocked !

Your analysis makes an awful lot of sense. I've got a HBAC1 test and a review later this month so i'm going to experiment especially on the dietary front to try and work out what's happening. The first and most obvious test would be to fast in the morning and see if the spike is still there.

I do have fast acting Humalog for "special occasions". If I go out for a meal at night and have a few glasses of wine i'm almost guaranteed a nightime hypo. I skip the basal and just take the bolus. I will speak to the doc though before I make any significant adjustments on a day to day basis. As you have spotted, I need to be a lot more aware of the carb situation.

Will let you know

Thanks again
Paul

 

[Spirit of Eden]

Quick update and Thanks to Smidge :clap: :crazy: :thumbup:

Have now gone on to fact acting mealtime insulin, Humalog and switched to taking night time "Humulin I" before bed

The Humulin I is most active when I eat breakfast 6-8 hrs so I only need a small top up (3u) of Humalog to cover 2x weetabix or similar. Both start to tail off just before lunch.

Liver dump or not, my morning numbers are now superb !

Next challenge - Cut out the baguettes for lunch :eh: