Blood sugar levels - way out of control for 2 years !!

[James472]

Hi Folks, am new here, and looking for some help on some weird blood sugar levels.

I'm a very experienced Type 1 Diabetic - been dealing with it for long time, and I can usually look at Carbs and know exactly how much insulin to inject. I'm not saying I always ran things perfectly - I didn't, but I always checked my blood sugar once or twice every day, and if I was off target, I'd head back towards the standard 4-7 blood sugar level.

Except that ....... for the last 2 years (since about March or April 2016), my bloods have just done their own thing. Almost like when I got flu (and I'd need to inject 2 or 3 times the usual amounts), my bloods have gone sky high, even if I don't eat much.

I've tested so many things - areas of injection, different insulin, different types of food etc. to try and work out a common denominator. Had various blood tests looking for a problem, but so far nothing.

I'm actually glad to be an experienced Type 1, because it's meant I could judge how much insulin to give, to bring levels back down. But I'm stabbing fingers constantly, and injecting way too much insulin, just to keep things under some kind of control, and of course when I turn up at Diabetic Clinic, they look and think my HbA1c levels look not too bad !

I've gone to sleep with an acceptable reading (eg. 6), woken up with a similar reading (between 5 and 7, which tells me my BASAL insulin is set OK), and then eaten no breakfast (cup of tea with no milk), and 3 hours later, the blood reading can be 19 !

I'm hoping someone on the forums may have seen this before ?

I have seen some internet postings talk about things like Liver Cancer, but no other significant signs are showing up, and so far no blood tests identifying anything.

Does this sound familiar to anyone ?

Thanks folks if you're able to help.

 

[EllieM]

I've gone to sleep with an acceptable reading (eg. 6), woken up with a similar reading (between 5 and 7, which tells me my BASAL insulin is set OK), and then eaten no breakfast (cup of tea with no milk), and 3 hours later, the blood reading can be 19 !

I assume it's too extreme to be dawn phenomena?
Could you be insulin resistant?

 

[Celsus]

I assume it's too extreme to be dawn phenomena?
Could you be insulin resistant?

Definitely possible due to dawn phenomena. My own liver dump can bring such results on days where I am waking up, measure my bg to be around e.g. 7, instantly super stressed because of some work schedule a head of me, rushing to the airport which is 45mins drive away, hustling through security check, running through the corridors, boarding plane. When sitting down in my seat my bg can be at 15-20. I took only my basal at wakeup. No breakfast at all. Nothing till then. And still BAM. Reason why I like my Libre, which enables me to take some counter-shots along the way and not flaring all the way up to 15-20 before getting correction done.

Also reason why we can all shake our heads in disbelief on how we as diabetics Type1 were 'mal-treated' by the hospitals in the past. As we were told in very strict terms that when we came in for control checks (which also were a frequent hassle) then we should take NO INSULIN that morning. And we should be FASTING!
So standing up at 6am, showering, dressing up, packing the bag for the day, going to take the bus to the hospital, etc, sitting in queue at the hospital sometimes for more than 1h before it was your turn, then getting the blood taken and first then you could take your insulin and you got your hospital-style breakfast served. No wonder the bg results you got there were like high in the sky!

Adjusting your insulin dose/regime based on such control check result?
MADNESS!

 

[James472]

I wasn't aware of this 'dawn phenomenon' ! And here's me calling myself 'experienced' !!!

But I never got levels as crazy as this before. Maybe I also got the dawn phenomenon over the years, but just wasn't aware of it being a thing.

But this is extreme - e.g. 2 weeks ago, I was way up at 22.1 just after midnight (and no take away involved !), and that was after I'd injected way more than I should have needed for dinner time. I always have to add more, and even then, when I test, the results are unpredictable. And of course, the problem with being up at 22 at midnight, is you want to be able to trust the amount of insulin needed to get you safely though till morning

And yet, weirdly ....... there are times when it's as if I'm not a Diabetic at all. The results can stay in the ideal ranges for several hours, and even if I eat, the BG doesn't rise. But I know it's not for long, then it's back out of control again.

Hey, maybe my Pancreas is trying to waken up again, and spring back to life !!! I'll maybe have to go 'Atkins / protein' a bit more, and try coax it back.

I just can't (so far) identify any solid pattern to it.

I did wonder whether it was insulin resistance, and maybe this was what they call 'double diabetes', but ...... I feel I'd see some kind of pattern with that, a more stable ratio of insulin to Carbs. Whereas this is more random. And, if it was just resistance, then waking and eating no food (hence no insulin) surely wouldn't make it climb to 16-20 ?

Crazy stuff.

I'm now thinking - I hope there aren't too many new diabetics reading this, and worried that this is normal diabetic life !
NO, it's not !

If nothing else, I'm going to try out the Freestyle LIBRE. That will give even better granularity of results, plus reduce the number of times I have to butcher these poor fingers ! They've had a bad time.

Oh ...... appreciate your replies both.

 

[Celsus]

I wasn't aware of this 'dawn phenomenon' ! And here's me calling myself 'experienced' !!!

But I never got levels as crazy as this before. Maybe I also got the dawn phenomenon over the years, but just wasn't aware of it being a thing.

But this is extreme - e.g. 2 weeks ago, I was way up at 22.1 just after midnight (and no take away involved !), and that was after I'd injected way more than I should have needed for dinner time. I always have to add more, and even then, when I test, the results are unpredictable. And of course, the problem with being up at 22 at midnight, is you want to be able to trust the amount of insulin needed to get you safely though till morning

And yet, weirdly ....... there are times when it's as if I'm not a Diabetic at all. The results can stay in the ideal ranges for several hours, and even if I eat, the BG doesn't rise. But I know it's not for long, then it's back out of control again.

Hey, maybe my Pancreas is trying to waken up again, and spring back to life !!! I'll maybe have to go 'Atkins / protein' a bit more, and try coax it back..

Hey @James472 , miracles happen man, it is after all Easter these days right?
If that guy could resurrect from the dead, then why not your pancreas?

Now I don't know about your age, activity patterns, fitness level and muscle mass etc. But they all play a major role in how hard also that dawn phenomenon can hit you.

There are plenty of good articles online about the dawn phenomenon so happy hunting/reading here through Easter

 

[Alexandra100]

I've gone to sleep with an acceptable reading (eg. 6), woken up with a similar reading (between 5 and 7, which tells me my BASAL insulin is set OK), and then eaten no breakfast (cup of tea with no milk), and 3 hours later, the blood reading can be 19 !

Might you be one of the people who doesn't cope well with fasting? You could try eating a little something last thing and having another little something ready in the bathroom to eat just after your first fasting test. I do this with a little pot of cheese strips, and I try not to go more than 4-5 hours without eating.

 

[Scott-C]

@James472 , those rises you're getting from 5 to 19 in the morning are sounding like a sub-set of dawn phenomenom imformally called 'foot on floor".

If I get up at 5, I'll easily double to 9 or 10 in the next hour just by getting up and going to work with no food involved, and it would likely continue into the teens without a correction.

Was much easier to see with libre than with strips, so I figured out pretty soon there's a high chance of this happening most days, so I ended up taking a 2, 3 or sometimes 4 u shot shortly after getting up just to pin the rise.

After using libre for a while, you sort of get a "feel" for how much of a rise it's likely to be, and use that to decide on how big a pin is needed. Although, obviously, T1 being T1, it still throws a flyer every now and then.

There's been numerous situations where I'll get up at 5, will have 2 or 3u before even waiting for it to rise, because I just kinda know it will without the pin.

If you're getting libre, the big difference it makes is being able to see things starting to develop so you can be much more proactive in anticipating things and making the odd tweak here and there to tail it off instead of dealing with it after it's happened.


Sugar Surfing by Stephen Ponder and Beyond Fingersticks by William Lee Dubois are pretty good books about getting the most out of cgm. They helped me a lot after getting libre. They're both on kindle. Very different approach to DAFNE - adjust/correct on the fly instead of saving for meals.

 

[James472]

Hey @James472 , miracles happen man, it is after all Easter these days right?
If that guy could resurrect from the dead, then why not your pancreas?

Like it I'll see what I can do by Monday !!!

Yes, fitness ain't what it was etc. But, this switch happened pretty suddenly, about 2 years ago, it wasn't really gradual. I just started to realise things were way out of control, and before that I could always keep things in check.
And, like I say, occasionally it feels like I'm not even Diabetic ! So if it was related to fitness, muscle mass, age etc. I wouldn't expect that to change so suddenly.

Might you be one of the people who doesn't cope well with fasting? You could try eating a little something last thing and having another little something ready in the bathroom to eat just after your first fasting test. I do this with a little pot of cheese strips, and I try not to go more than 4-5 hours without eating.

Thing is - I don't starve myself. I've only done some occasional fasting as a way of trying to pin down what was going on. Normally, very happy with food.

You folks will be making me feel like a bad Diabetic ! I'm very unlikely to go 4-5 hours without food

Sugar Surfing by Stephen Ponder and Beyond Fingersticks by William Lee Dubois are pretty good books about getting the most out of cgm. They helped me a lot after getting libre.

Thanks for that. I obviously need to do some more reading.

Folks, I take your points about Dawn Phenomenon / Foot on Floor . But this is happening all day long, at every meal. Like I say, it's like having FLU 24/7, but without the Flu symptoms. In fact, Flu was better, coz until the Flu eased off, you had some level of stability, and could reliably judge your extra insulin. Whereas with this, every finger stab is a fresh horror with a surprise in store every time. So weird.

You seem to be a good team on here !

 

[Alexandra100]

I'm very unlikely to go 4-5 hours without food

Except presumably overnight?

 

[EllieM]

A cgm should help, as you may be able to head things off at the pass before they get too grave, but be aware that the libre can be inaccurate for some people and occasionally has bad sensors, so you'll want to check it occasionally against a conventional meter (and to be safe, wear it for 24 hours before activating and recognise that it has a 15 minute lag against blood readings.)

OK, just throwing some ideas out there...
Has your doctor suggested a pump? (Am thinking a pump with a cgm might give you more control.)
Is your weight stable? Insulin resistance could be coming in if you've put weight on due to too much insulin...
As regards possible insulin resistance, exercise helps me...
I assume you've tried different basal insulin? (Or are you on a pump already?)

 

[James472]

Except presumably overnight?

Yes, you are quite correct there ! Yes, if I manage the full 7-8 hours sleep, then I'm fasting the whole way.

But seriously though, I am guilty of being one of those that eats right up till the end of the day. I do think it would be healthier to break off from eating earlier than I do, but I've always done it that way, and never had this type of problem. And again, this isn't just at night time & breakfast, this is all day long 24/7. The amounts of insulin I'm putting in to correct this are seriously LARGE, not just a few units to correct a small spike.

Sorry folks, I'm thinking I've loaded a real tough question on your shoulders. It's just I've been trying to work this out for 2 years, and can't find a common denom.

I really think there's something 'interesting' going on inside - maybe Liver, or something else. But it's finding it ?

A cgm should help, as you may be able to head things off at the pass before they get to grave, but be aware that the libre can be inaccurate for some people and occasionally has bad sensors, so you'll want to check it occasionally against a conventional meter (and to be safe, wear it for 24 hours before activating and recognise that it has a 15 minute lag against blood readings.)

OK, Libre will all be new to me. I don't like the fact that it doesn't work with 'some' people, coz right now, I'm feeling like an outlier from the norm !! And 15mins lag ? So if I do a blood test to compare, it should match with one from Libre 15 minutes later ? OK, noted, thanks for that good info.

OK, just throwing some ideas out there...
Has your doctor suggested a pump? (Am thinking a pump with a cgm might give you more control.)
Is your weight stable? Insulin resistance could be coming in if you've put weight on due to too much insulin...
As regards possible insulin resistance, exercise helps me...
I assume you've tried different basal insulin? (Or are you on a pump already?)

I'm on Novorapid / Lantus (you guys are probably thinking, that's so yesterday !!
But I know them well, and right now, while this weird stuff is happening, I don't want to change insulins. May revise things after I can sort this all out, but right now, "better the devil you know .......". At the moment, I don't have Blood Glucose stability, so I at least want Insulin familiarity. I did try FIASP briefly, but the problem didn't change / improve.

Insulin resistance could be part of it, but I can't see a pattern. Have tried exercise after injecting, but I'm not getting any good results. In fact, one morning in Nov or December, I headed to Diabetic Clinic to consult on it (no breakfast), and then walked for several miles afterwards, with no food at all. When I got home, it was 16, as if there had been no exercise.

Maybe a pump would at least keep my sugars in better control, if the pumps are able to deliver the levels of insulin I'm using ?

To put it in perspective folks, I'm almost celebrating if I get any hypo signs !

I am appreciating all your efforts folks. Thanks.

 

[Celsus]

1: I really think there's something 'interesting' going on inside - maybe Liver, or something else. But it's finding it ?

2: OK, Libre will all be new to me. I don't like the fact that it doesn't work with 'some' people, coz right now, I'm feeling like an outlier from the norm !! And 15mins lag ? So if I do a blood test to compare, it should match with one from Libre 15 minutes later?

3: I'm on Novorapid / Lantus (you guys are probably thinking, that's so yesterday !!
But I know them well, and right now, while this weird stuff is happening, I don't want to change insulins. May revise things after I can sort this all out, but right now, "better the devil you know .......". At the moment, I don't have Blood Glucose stability, so I at least want Insulin familiarity.

4: Insulin resistance could be part of it, but I can't see a pattern. Have tried exercise after injecting, but I'm not getting any good results. In fact, one morning in Nov or December, I headed to Diabetic Clinic to consult on it (no breakfast), and then walked for several miles afterwards, with no food at all. When I got home, it was 16, as if there had been no exercise.

5: Maybe a pump would at least keep my sugars in better control, if the pumps are able to deliver the levels of insulin I'm using ?

Hi again @James472 , a lot of good and valid points you bring forward here, so will try and give my perspective on them one by one:

1: From all the descriptions that you have shared with us, its certainly clear that the liver glucose dump to provide energy to your body (called dawn phenomenon when at morning wake up, but can also happen at other times in case of missing insulin/glucose to feed the muscles when starting exercising) is playing a role and should not be ignored.

2: Libre 15 mins lag definition certainly depends on how you look at it. Yes, 15 mins 'delay' compared to if you took a blood sample straight out of one of your arteries. But nobody does that. E.g. a finger prick can also be 15-30 to more minutes 'off' or actually completely off the torso's artery bg level, simply because you pull that blood from the end of an exposed extremity. (your finger tip) Where your circulation is severely reduced maybe because of severe cold and lack of muscle movement in surrounding tissue. In that sense the Libre is more stable compared to fingerpricks (only exception is when laying on it while sleeping)

3: Your insulin regime/therapy is still one of the golden classics and considered equal with a few others to be the 'best' still today! As you said, you know those two drugs well, so no need to change if you don't have negative side effect like allergy or pain from using them. (disclosure: I am on same insulins myself )

4: Your description here is a completely classic example of your liver dumping glucose to get your body through the day! No breakfast and then exercise makes your liver dump! Short term, your liver can and will dump much more glucose than you can burn away with your exercise. In total the liver can store approximately 100g of glucose (in the form of glycogen) whereof it can then release this when the body needs an energy boost. (same what happens when you go hypo and your body counter-reacts).

5. The pump alone will not be able to bring you good control. Its great if you otherwise e.g. forget to take your insulin or don't like shooting up in public etc. Getting your Lantus and NovoRapid regime correct should be able to mimic otherwise what you can get from a pump, as you also need to get your basal right with the pump and press the button to bolus for your meals with it. So measuring your bg and taking the optimal insulin dose to counter will still be on you.

Maybe you would care please to share with us your body weight and the total insulin doses you typically take during a day?
There are several indicators I would say puts a question mark on if your basal rate is right.

Btw, I can strongly recommend you to take your Lantus in the morning and not in the evening as I think that you probably do now? To me making that switch was a true game changer. Even though the Lantus is effective in me beyond the 24h range, it still has a small peak effect after 3-4 hours after injection. So by changing to morning injection, I have not had one single night-hypo ever since. And I am awake and active when that peak effect happens today, as its just leading up to lunch-time. And it therefore combined enabled me to put my basal rate at the ideal max without negative side effect for the days I have where its borderline too much. (where I exercise more and unplanned etc).

 

[James472]

@Celsus - thanks for that post ! Lots of information there.

I think you're right to say don't ignore the Liver Dump. I am beginning to think it's heavily involved in all this, but I'm not sure that it's that alone. Maybe it's a combination of several things - Liver Dump, Resistance, and possibly even injection sites. I need to start doing some fresh analysis. I had considered and tested for Resistance, and injection sites, but not Liver Dump.

But nobody does that. E.g. a finger prick can also be 15-30 to more minutes 'off' or actually completely off the torso's artery bg level, simply because you pull that blood from the end of an exposed extremity.

That's a very good point - I hadn't even considered that. So I guess any delay is only an issue if I'm trying to double check the Libre's accuracy, and match it against blood measurement. Otherwise, as long as blood and Libre interstitial fluid 'roughly' match each other as the hours flow, the 15min lag isn't a big deal. OK.

(disclosure: I am on same insulins myself )

Thanks for that @Celsus - it's reassuring to hear. It's so true that one little phrase like that can sometimes be reassuring !

No breakfast and then exercise makes your liver dump!

I did not know that. And that does make sense based on my no breakfast and long walk. Although ........ this is still new, I've never seen this in my years of being Type 1, the extreme levels I'm seeing. And in fact, although I usually eat something for breakfast (but not loads), I can remember for many years, I ate nothing for breakfast, but I never ever had BG issues like I'm getting now.

I would even say, maybe it's just part of getting a bit older, but I can actually pin down the period it started happening (March or April 2016 - 2 years ago).

same what happens when you go hypo and your body counter-reacts

I was always aware of that, but just assumed that was the body grabbing fat, and converting to energy + ketones. But wasn't expert on the actual mechanism involved. Is that also the Liver at work ?

The pump alone will not be able to bring you good control

So the pump is just applying insulin as directed by you - it's not doing CGM as well ? I'm not that worried about getting a pump, I'd rather focus on identifying the root cause of the problem here. Whereas Libre sounds like it might help me record the unseen levels, as well as giving my fingers a well-earned rest.

Maybe you would care please to share with us your body weight and the total insulin doses you typically take during a day?

I'm heavier than I should be, but not over-the-top. Just logged into my account, hoping it would have been recorded there, but it isn't. Can give you BP, Kidney filtration, Cholesterols etc. etc. but it didn't have weight. Last time I remember them weighing me, it was around 14stone. I reckon I am 1 - 1.5 stone overweight.

Insulin levels are:
Lantus - 16
Novorapid:
Breakfast - should only be 1 or 2, is actually 6 or 7
Lunch - should only be 4 or 5, is actually 12-14.
Correction top-up 2 hours later (most days) 6-8.
Sometimes another correction is needed 6-8.
Dinner - should be 6-10, is actually 16-20.
Supper - should be 3 or 4, is actually 12-14 (partly correcting).
If BG's are then heading in wrong direction, probably another 6-8, just from experience, knowing what will happen overnight.

The reason I'm generally happy with the Basal Lantus, is when I've had any illness, I cut foods out (particularly Carbs), just minimum foods that I can get away with, and have ridden through with beautifully stable readings just on 16 Lantus. And of course, these weird BGs weren't always here - I previously had good control, and with Lantus of 16.

If I've ever suffered any night hypos (HYPOS ? These days, if only !!! ), it's been with incorrectly judging Novorapid, rather than my Basal.

But well spotted that I do take Lantus in the evening. For several years, I judged that the most stable time for me would be between 9 and 12 midnight, so I aimed it there. I could try experimenting with that, although the night hypos isn't an issue I need to solve.

Folks - thanks for all your efforts here.

Oh by the way (not sure I can post links yet, but here goes):

Greg1986's thread in the Type 1 Forum rings bells with me, and looks like there are a few others posting who recognise the signs he's getting:
"For example today I had my lunch, looked up the carbohydrates in that bread roll on the Sainsbury’s website, injected accordingly and three hours later it was 23! I did 9 units of insulin, just in case I’d somehow messed up, but 90mins later it had gone up to 24. It’s very frustrating!"

https://www.diabetes.co.uk/forum/threads/unexplained-blood-glucose-rises-throughout-the-day.140315/

 

[Celsus]

Its a religious time of year, so please let me confess...

We were up quite late last night with friends and family. And when going to bed we all agreed to sleep a little longer this morning and then all meet to have a big brunch from around 11am. So I thought that was a perfect occasion to check out my own dawn effect, as haven't actually done as such to 'let it run wild' for a long while!

I only need 4-5 hours sleep and then I wake up and cant get back to sleep. So I woke up at 7am and measured my bg to be at 4.0.
During the night I can see on my cgm tracker that it went from 5.6 around 2am when I went to bed and then a little dip down to 4.3 within the following 2 hours. And then more or less flat-lining at 4.0 till I woke up at 7am.

I took my basal insulin right away as usual. Stayed in bed to read a bit. Bg stayed around 4.1.
Then I stood up. Walked the dog, got some great bread at the bakery to bring back. Back home, time now 8:30, Bg at 6.3.
Now sitting down reading online news and pages on this very forum. My bg continued the steady rise. Looking at the cgm graph, it was a stable rise from the moment I stood up.

Within 1 hour my bg went from 4.1 to 14.1 mmol/L.
Sorry, I interrupted this study when my bg went above 14 and took some fast acting.
I am certain it would have continued quite some higher, by judging the rapid ramp-up that bg curve had this morning.
But it just shows how crazy our bg can go up, despite taking our basal as usual and despite not eating anything.
Pure Dawn Effect. People without diabetes also gets this, as the liver dumps glucose to support the body, but their pancreas releases insulin to support it also to maintain ideal bg levels. We diabetics needs to do this manually, as we no longer have a working pancreas running on auto-pilot.

Oh, and just to throw in some extra spice into life.
As it is with all human nature, its all a gamble. Not all diabetics that experience this dawn phenomenon. Its actually only around 40-60% according to some studies. And its not all days you will have them, despite you have had them previously.
So as they said in the tv police serie: "Good luck and be careful out there!"

Happy Easter everybody !

 

[Celsus]

...
Last time I remember them weighing me, it was around 14stone. I reckon I am 1 - 1.5 stone overweight.

Insulin levels are:
Lantus - 16
Novorapid:
Breakfast - should only be 1 or 2, is actually 6 or 7
Lunch - should only be 4 or 5, is actually 12-14.
Correction top-up 2 hours later (most days) 6-8.
Sometimes another correction is needed 6-8.
Dinner - should be 6-10, is actually 16-20.
Supper - should be 3 or 4, is actually 12-14 (partly correcting).
If BG's are then heading in wrong direction, probably another 6-8, just from experience, knowing what will happen overnight.

The reason I'm generally happy with the Basal Lantus, is when I've had any illness, I cut foods out (particularly Carbs), just minimum foods that I can get away with, and have ridden through with beautifully stable readings just on 16 Lantus. And of course, these weird BGs weren't always here - I previously had good control, and with Lantus of 16.

If I've ever suffered any night hypos (HYPOS ? These days, if only !!! ), it's been with incorrectly judging Novorapid, rather than my Basal
...

Wow @James472 , that is quite an amount of fast acting bolus you are on there!
I understand from your 'should be' goals that the insulin therapy 'should have been' along these lines:
Lantus 16 units and NovoRapid 17 units / day.
Which all sounds correct based on the rule of thumb that your fast acting total units should be approx. equal to your total basal number of units over a 24h period.

But in reality you are now more at:
Lantus 16 units and NovoRapid 42 units (even using the most modest of your quoted 'real-life' numbers)
And honestly, that looks quite wrong in most aspects.

Regarding the total unit dose per day, then the medical guidelines for treating Type1 diabetes are that most people in this patient segment need a total of 0.5 - 0.8 units of insulin per kilogram of body weight each day. So considering your body weight is around 89 kilos, that gives an estimated daily dose of 45- 71 units per day. So except if you are in the high insulin sensitive segment, with a high muscle mass and high level of physical activity, then your initial ("Lantus 16 and NovoRapid 17 units") 'norm' appear to be in the very low end in any case, as that is just 33 units in total / day.

Your 'reality now' with Lantus 16 and NovoRapid 42 = 58 units per day is more expected to be within reason. (all are individually different though, so there is no right or wrong here). But your split of such a low proportion being basal slow acting versus more than the double volume in bolus does not appear correct.

From all the symptoms that you have described so far, it definitely still matches with the basal being too low in general throughout your day and the dawn effect and no breakfast playing its role in your specific morning peaks.
I think first priority should be to check and potentially recalibrate your basal rate.
Think there are some good guides on this forum on 'best practices' if you want some inputs.

 

[LooperCat]

Its a religious time of year, so please let me confess...

We were up quite late last night with friends and family. And when going to bed we all agreed to sleep a little longer this morning and then all meet to have a big brunch from around 11am. So I thought that was a perfect occasion to check out my own dawn effect, as haven't actually done as such to 'let it run wild' for a long while!

I only need 4-5 hours sleep and then I wake up and cant get back to sleep. So I woke up at 7am and measured my bg to be at 4.0.
During the night I can see on my cgm tracker that it went from 5.6 around 2am when I went to bed and then a little dip down to 4.3 within the following 2 hours. And then more or less flat-lining at 4.0 till I woke up at 7am.

I took my basal insulin right away as usual. Stayed in bed to read a bit. Bg stayed around 4.1.
Then I stood up. Walked the dog, got some great bread at the bakery to bring back. Back home, time now 8:30, Bg at 6.3.
Now sitting down reading online news and pages on this very forum. My bg continued the steady rise. Looking at the cgm graph, it was a stable rise from the moment I stood up.

Within 1 hour my bg went from 4.1 to 14.1 mmol/L.
Sorry, I interrupted this study when my bg went above 14 and took some fast acting.
I am certain it would have continued quite some higher, by judging the rapid ramp-up that bg curve had this morning.
But it just shows how crazy our bg can go up, despite taking our basal as usual and despite not eating anything.
Pure Dawn Effect. People without diabetes also gets this, as the liver dumps glucose to support the body, but their pancreas releases insulin to support it also to maintain ideal bg levels. We diabetics needs to do this manually, as we no longer have a working pancreas running on auto-pilot.

Oh, and just to throw in some extra spice into life.
As it is with all human nature, its all a gamble. Not all diabetics that experience this dawn phenomenon. Its actually only around 40-60% according to some studies. And its not all days you will have them, despite you have had them previously.
So as they said in the tv police serie: "Good luck and be careful out there!"

Happy Easter everybody !

I can provide a similar example from this morning. I woke at 6 with a dump of cortisol like every morning (time varies from 5-7, but it happens every day - can’t set an alarm for it because the time is so variable). I scanned my Libre, and it gave me an 8.6, just starting to rise from a steady night in the 5s. I took 2 units Novorapid, rolled over, farted and tried to go back to sleep, like usual. Bladder was having none of it, so after 10 minutes reluctantly I crawled out of my pit, went downstairs to the bathroom and got back into bed. Scanned again to see a 10.1 - pure liver dump. Managed to get back to sleep until 7, where I was at 7.7 - unlike me, my liver seems to be a morning person!

 

[James472]

Your 'reality now' with Lantus 16 and NovoRapid 42 = 58 units per day is more expected to be within reason. (all are individually different though, so there is no right or wrong here). But your split of such a low proportion being basal slow acting versus more than the double volume in bolus does not appear correct.

I do take that point @Celsus - but I know it shouldn't be as high as that. I think my official doses (last time there was any real stability !) were something like 16 / 22. I've dealt with this condition for a long while, and never had this - you just have to trust me there. This only happened two years ago, and although I've sunk some extra pounds on, my weight has always varied over the years, and again, I never had such a weird situation as this if I lost or gained weight.

Like we've already discussed, maybe it's a combination of various things - resistance, injection sites, dawn phenomenon, extra weight, age, stress, fitness levels etc. but ........ why so sudden (Mar / Apr 2016, and why SOOOO utterly radical, and why does it occasionally feel like I'm not even Diabetic - for several hours, BG just stays stable even if I eat extra things (you would agree it's not as if my Lantus is so high, that I can fit extra Carbs in !)

My HbA1c scores have always been in the acceptable ranges - not perfect (and looking at some of your scores here, I'm definitely thinking - roll on LIBRE), but they were always acceptable, and without Libre.
And particularly while 'this' has been going on for 2 years, they've still been acceptable at Clinic.
So that proves to me that I know how to control my Diabetes.

So if I think something is wrong here (and different to the norm), I have to go with my own instincts.

So, if this morning wasn't typical for you @Celsus , what would your normal routine be ? You don't sound as if this rise to 14 happens every day, so what is a typical balance of Insulin / Food / Exercise for you that would normally avoid this Dawn rise, and keep your CGM stable ?

Because right now, it doesn't seem to matter whether I eat, or don't eat, exercise or don't exercise, my BGs will do what they will. And when I try to counter them, they'll just as often keep headed upwards. To me that's ALL-DAY Phenomenon 'Extreme'.

Sorry folks ...... I'm really not wanting to be that guy that just won't listen to everybody's advice ! And if I'm wrong, and it turns out I've missed something very significant, I'll happily take that on the chin. Is their an Emoji for that ?

I think you're absolutely right that Dawn Phenomenon is in the mix. I wasn't even aware of it before I posted here, and now thinking back over years ago (when you didn't have BG kits with you at work), I can remember feeling high bloods during the mornings before lunch. But even then, the corrections after work (5-7pm) weren't horrendous, and the HbA1c's were generally OK.

So I'm with you that it's in the mix, and once I get LIBRE'd, my HbA1c's will be even better.

But this is way more than DAWN. There's something else.

(if you want, from now on you can call Dawn Phenomenon @James472 LITE !!!

I honestly do appreciate the time and effort you're all putting into this, and @Celsus - roll on dude, am impressed that you let it run wild this morning. RESPECT

 

[Celsus]

I ... X! Y! and Z!, like usual.

Thank you for sharing your vivid description of your bodily functions!

 

[Celsus]

...
Like we've already discussed, maybe it's a combination of various things - resistance, injection sites, dawn phenomenon, extra weight, age, stress, fitness levels etc. but ........ why so sudden (Mar / Apr 2016, and why SOOOO utterly radical, and why does it occasionally feel like I'm not even Diabetic - for several hours, BG just stays stable even if I eat extra things (you would agree it's not as if my Lantus is so high, that I can fit extra Carbs in !)

My HbA1c scores have always been in the acceptable ranges - not perfect (and looking at some of your scores here, I'm definitely thinking - roll on LIBRE), but they were always acceptable, and without Libre.
And particularly while 'this' has been going on for 2 years, they've still been acceptable at Clinic.
...
So, if this morning wasn't typical for you @Celsus , what would your normal routine be ? You don't sound as if this rise to 14 happens every day, so what is a typical balance of Insulin / Food / Exercise for you that would normally avoid this Dawn rise, and keep your CGM stable ?
...
But this is way more than DAWN. There's something else.

Its usually always more than just 'one thing'. Its a combination of a lot of things. And you mention most of them already in your intro to your last post here.

And lets please focus on one area at the time in this discussion, as each need their own understanding and care plan, so to speak.
E.g. you mention you occasionally feel that you are not even any longer diabetic. Yes, most experienced Type1s experience some euphoric days like this from time to time. Its like we keep going down and down in bg no matter how much and how bad carbs we eat. High insulin sensitivity, the metabolism in overdrive, some reviewed or newborn beta cells? Who knows? But as always, these days are coming to an end sooner than they started and you are back at your usual carb counting insulin shooting match game...

As you share that your situation with consistent high bg levels has gone on now for more than two years, then its no longer just a short term fluke of some kind. If your bg measurements are indeed consistently up above the 12-15 mmol/l range, well then your HbA1c must also be suffering in terms of being higher than it could/should ideally be. You say that it is 'acceptable at Clinic'. So what does that really mean? What is it? Its also not like the doctor and nurses at the clinic will spank you like a little schoolboy for bad behavior if your HbA1c level is highish. You are an adult. You have had this disease for years. As you say yourself, you know what to do to manage it. And yes indeed, its for you to control it best possible you can. The medical staff cant really do that for you and they know well that arguing with any patient doesn't help either.
(and I am not contemplating that it is 'a manageable disease' either...)

With the total quantity of insulin units you take every day, it definitely points towards that your basal is way too low. The consequences of that also match almost all the symptoms that you have described above. So your situation right now is that you basal is too low and then you try and compensate with fast acting bolus to punch it down every time it peaks up, again and again. And due to too low basal this will happen both around meal times but also in between no matter if you eat or not. But your bolus is a short acting insulin, which at best results in your bg taking the typical ongoing rollercoaster rides up down up down up down...

Its mission impossible!

Getting basal in check should be your priority number 1.

The dawn effect is secondary to getting your basal in check. But yes, your descriptions so far indicate you suffer from this, especially as you don't take any breakfast while still engaging in physical activity before lunch. Personally I always try my best to head straight to breakfast when I wake up. My liver dump appear less or none if I can get carbs digested within first hour after wakening up. And on the days where I don't or skip entirely my breakfast, then I do exactly the same as described above by @Mel dCP. I take some fast acting bolus when I observe the bg starts peaking upwards. (1, 2 or 3 units, depending where I am on the bg scale and how rapid it peaks up). So yeah, it may sound counter-intuitive to take fast acting insulin on a morning where you didn't have breakfast. But it is often required to keep your bg below 10 on days where you skip it. Likewise I often need to take 1-2 units extra of fast acting if starting my breakfast meal late in the morning.​