Type 1 Suddenly gone high in the mornings after breakfast?

[conniecar]

Hi all. Been type 1 for 43 years on Novarapid and Glargine and been ok until recently. My tests are fine when I wake up but rocket, no matter what I’ve had for breakfast ( no carb or low ) and stay like that until I have my tea? My consultant suggested Levimir ( can’t remember why ) but it’s not made any difference. My carb ratios are generally around 1:3 -1.5 but now my morning one is 2:10? Still not much change. Feel rubbish on tests above 12. I’m 49 nearly. Any help appreciated as I miss my morning porridge, as even that’s spiking me, as well as scrambled egg?

 

[leahkian]

It is just a thought with the weather turning cold insulin tends to work a bit slower and when it is really hot it works faster. Have you checked that your blood machine is working ok. Have you just started levimir as this may be just starting to work, or you could try contacting your DNS and ask her if increasing your noverapid on a morning as you say they rocket during the day. Has something changed like you may be less active with the cold dark nights and mornings

 

[conniecar]

Thanks for the reply! I’ve been put on Levimir because of the blood sugars in the morning problem, but it doesn’t seem any different to Glargine. I’ve had my meter about 10 years actually......and haven’t got any test solution so may check that out. There again it tends to reflect how I’m feeling. My morning ratio is now 2:3 which I’ve never had before! Can’t seem to eat anything any more! I’m off to see the dietician and hopefully the nurse soon to try and unravel it all. Can’t think of any other disease where you have to have a degree in maths to work out your own day thanks again for your suggestions! X

 

[catapillar]

. My carb ratios are generally around 1:3 -1.5 but now my morning one is 2:10? Still not much change.

My morning ratio is now 2:3

I'm confused by your ratios:
Units of insulin : grams of carbs
1u : 3g so if you were having a 30g carb breakfast you would have 10units
1u: 1.5g so if you were having a 30g carb breakfast you would have 20units
2u: 10g which is the same as 1u: 5g so if you were having a 30g carb breakfast you would have 6units
2u:3g which is the same as 1u: 1.5g above, so if you were having a 30g carb breakfast you would have 20units

So, obviously, if you are usually on 1:3 then moving to 2:10 is going to mean taking less insulin and clearly won't help with post breakfast spikes

You say you've never had a 2:3 ratio before, but you also say your ratios are generally around 1:3-1.5. A 2:3 ratio is exactly the same as a 1:1.5 ratio.

If you are having no carb breakfasts, are you bolusing for protein? Usually if you are eating a reasonable carb meal the carbs will be enough for your body. But if you have no or very low carbs then your body wants to get glucose from somewhere, so it turns protein into glucose in a process called gluconogenesis. That means if you aren't eating carbs, you need to consider bolusing for protein. The gluconogenesis blood sugar rise is a bit hit and miss, so generally the advice is to bolus for 50% of the grams of protein on the same as your I:c ratio, and if you are pumping extend the bolus, or delay it if on mdi.

 

[paulus1]

that sounds very complex. could you translate it for the thinkos ie me.

 

[conniecar]

I’m on an accutest expert which I was told to program as follows..... 1 unit of insulin to 10g of carbohydrate initially. The nurse adjusted it as time went on. It says units of insulin on the left, and grammes of carbohydrates on the right? Maths is my weak point so I’m totally confused now

 

[slip]

Conniecar what did you have for breakfast today, and what amount of carbs do you think was in it, what ratio did you use and so what insulin did you take - if it was low carb what amount was protein? Also give blood tests results before (and after if you have them).

May be we can then see (as a one off) whats going on and to sanity check your maths with out confusing anyone.

 

[conniecar]

Conniecar what did you have for breakfast today, and what amount of carbs do you think was in it, what ratio did you use and so what insulin did you take - if it was low carb what amount was protein? Also give blood tests results before (and after if you have them).

May be we can then see (as a one off) whats going on and to sanity check your maths with out confusing anyone.

Hi thanks

25 g of carbs ( oat bran low sugar cereal 30gm weight 19g Of carbs with splash of milk ).7 of novo rapid and 15 levimir. It was raised at 9.1 when I ate at 7. It’s now 16 and I feel rubbish! Wish I got maths! X

 

[slip]

so a ratio of ~2u:7g used this morning? Now I'm confused as earlier you said you were on 2:3

Also if it was at 9.1, depending on your correction factor maybe an extra 1 or 2u on top would have helped.

 

[dancer]

Were you 9.1 when you got out of bed, or had you been up for a while before having breakfast?

If you are consistently high when you waken, either you need to increase your basal or you could be going hypo during the night, followed by a liver dump. A basal test would be useful.

Do you take 2 Levemir injections, as one doesn't last 24 hours?

If you were within target when you woke but increased before breakfast, and this happens consistently, you could try taking some Novorapid as soon as you get out of bed.

Basal testing would tell you which insulin needs to be increased. It could be both.

 

[catapillar]

I’m on an accutest expert which I was told to program as follows..... 1 unit of insulin to 10g of carbohydrate initially. The nurse adjusted it as time went on. It says units of insulin on the left, and grammes of carbohydrates on the right? Maths is my weak point so I’m totally confused now

It does seem like maybe you and /or your DSN don't understand the ratios. So, to keep them as simple as possible, try and keep the ratios as 1 unit covers X grams of carbs. That way, to work out how many units you need to cover a meal you just divide the total grams of carbs by X.

So if your ratio is 1:10 and you're eating 30g of carbs you divide 30 by 10 to get 3 units you will need to take to cover 30g.

If you're on a 2:X ratio that just adds another step to the maths and over complicates things as to work out how much insulin you'd have to dived the total carbs by X then times by 2.

So, if you keep the ratio at 1:X hopefully that keeps it simpler and it makes it easier to compare what the ratios actually mean. The important thing for you to bear in mind would be that as the X value gets lower the insulin you take increases.

So, with a 30g carb meal and various ratios lets see how the insulin dose varies:
1:10 3u
1:3 10u
1:1 30u.

So, the lower X is (i.e. the number on the right hand side, which represents the number of grams of carbs 1 unit covers in a 1:X ratio) the more insulin you take.

And, you can work it backwards to figure out what ratio you used for breakfast this morning when you had 7 units to cover 25g of carbs by dividing 25 by 7 = 3.5. So this morning you used a 1:3.5 ratio.

It does seem like a 1:3.5 ratio doesn't work very well for you. But that would be expected as you have previously said your ratios are "generally around 1:3-1.5" and 3-1.5 are lower numbers than 3.5, meaning you would apparently usually take more insulin to cover this meal. Remember, lower number for X means more insulin is needed.

If you had been using a 1:1.5 ratio, which previously you had indicated you were supposed to be using, you would have had 16units (25/1.5 =16.666).

 

[conniecar]

It does seem like maybe you and /or your DSN don't understand the ratios. So, to keep them as simple as possible, try and keep the ratios as 1 unit covers X grams of carbs. That way, to work out how many units you need to cover a meal you just divide the total grams of carbs by X.

So if your ratio is 1:10 and you're eating 30g of carbs you divide 30 by 10 to get 3 units you will need to take to cover 30g.

If you're on a 2:X ratio that just adds another step to the maths and over complicates things as to work out how much insulin you'd have to dived the total carbs by X then times by 2.

So, if you keep the ratio at 1:X hopefully that keeps it simpler and it makes it easier to compare what the ratios actually mean. The important thing for you to bear in mind would be that as the X value gets lower the insulin you take increases.

So, with a 30g carb meal and various ratios lets see how the insulin dose varies:
1:10 3u
1:3 10u
1:1 30u.

So, the lower X is (i.e. the number on the right hand side, which represents the number of grams of carbs 1 unit covers in a 1:X ratio) the more insulin you take.

And, you can work it backwards to figure out what ratio you used for breakfast this morning when you had 7 units to cover 25g of carbs by dividing 25 by 7 = 3.5. So this morning you used a 1:3.5 ratio.

It does seem like a 1:3.5 ratio doesn't work very well for you. But that would be expected as you have previously said your ratios are "generally around 1:3-1.5" and 3-1.5 are lower numbers than 3.5, meaning you would apparently usually take more insulin to cover this meal. Remember, lower number for X means more insulin is needed.

If you had been using a 1:1.5 ratio, which previously you had indicated you were supposed to be using, you would have had 16units (25/1.5 =16.666).

Thanks for all of your replies. I’ve been type 1 since 1976 and obviously things have changed and I haven’t. It’s just a persistent morning problem that’s caused this, and I’m sure it’ll get sorted, but by someone who will sort my meter for me. I’m a library manager but sadly my maths is another issue which is as serious as my dead pancreas thank you though, I do appreciate it but staring at ratios and numbers is pushing my sugars up

 

[slip]

The acutest expert should calculate your dose taking in account your current BG level, current Insulin On Board, and I:C ratios, correction factor/glucose factor and target range which should all be entered into the meter. Try sitting down with your DSN and going through those settings asking as many questions as possible with them. Especially as your mind is more letter orientated and not numerically inclined!

You should learn how to adjust your ratios on the meter, for when things start to drift off. Insulin Ratios rarely are permanent

 

[conniecar]

Thank you. I sat down with the nurse when I got it, but have fiddled with it now and messed it up yes meh indeed xxx

 

[conniecar]

By Jove she’s got it! Managed to sort it all via this site. What a gem you are ️ thank you so much, trying to get through to the DSN is like trying to get through to the Kremlin. Feeling like I’ve achieved something this week, and as we all know, good blood sugars = happiness. Thanks x

 

[scotteric]

It's called "feet on the floor" phenomenon, it's part of the dawn phenomenon. For me, my blood sugar will start rising the minute I get out of bed no matter what time and how good or stable my BG was before waking. You have to counter it with taking an injection right away when you wake up. It also makes sense to take more for breakfast and sometimes a bit after too. Also, are you splitting your Levemir dose? It doesn't last as long as Lantus, so it's best to take it in the morning and at night. If you take it right away or soon after waking, you will ensure it kicks in fast enough to help with rising glucose from DP/feet on the floor.

 

[Tony337]

Hi Conniecar
Type 1 since 1974 and now 49 and on levimir and novorapid.
I don't want to add anything that confuses the issue just wanted to say I suffer from a little insulin resistance from time to time and can't identify the reason.
If theres anything I can share that might help as we have a similar regime age etc then please just ask.

Good luck
Tony

 

[conniecar]

That ‘feet on the floor’ thing sounds exactly right. I’ve started doing my jabs ( Novorapid and Levimir first dose ) when I get up, rather than half an hour later when I’m showered and eating breakfast. I’m on 16 Levimir at breakfast and 5 at night, which so far is working very well ( last two days ). Can’t believe how helpful this site is as it allows you to talk to people who know. I know my consultants are trained but living it day to day needs hands on experience I’ve found. Thanks again x

 

[conniecar]

Hi Conniecar
Type 1 since 1974 and now 49 and on levimir and novorapid.
I don't want to add anything that confuses the issue just wanted to say I suffer from a little insulin resistance from time to time and can't identify the reason.
If theres anything I can share that might help as we have a similar regime age etc then please just ask.

Good luck
Tony

You’ve not confused anything Tony 1970’s diabetes eh? Them were the days ...... can still smell boiling syringes and antiseptic wipes so nice to speak to another veteran x

 

[conniecar]

It's called "feet on the floor" phenomenon, it's part of the dawn phenomenon. For me, my blood sugar will start rising the minute I get out of bed no matter what time and how good or stable my BG was before waking. You have to counter it with taking an injection right away when you wake up. It also makes sense to take more for breakfast and sometimes a bit after too. Also, are you splitting your Levemir dose? It doesn't last as long as Lantus, so it's best to take it in the morning and at night. If you take it right away or soon after waking, you will ensure it kicks in fast enough to help with rising glucose from DP/feet on the floor.

Glad you’ve mentioned that as I was getting a bit freaked out by it, and was envisaging petrol tankers of insulin being delivered for me to get my tests down. X