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High morning readings

urbanracer said:
Yesterday evening we did have some pasta about 8pm so it will have contributed to the rise and I'm aware of that
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Pasta is very slow digesting in my experience and will spike me 6-8 hours later. You can't just bolus with it using rapid-acting insulin, the digestion will continue after your bolus has been used up. For a meal like that I would use regular (actrapid) insulin in combination with rapid-acting, which lasts 6+ hours and better matches the profile of food like that.
 
scotteric said:
Pasta is very slow digesting in my experience and will spike me 6-8 hours later. You can't just bolus with it using rapid-acting insulin, the digestion will continue after your bolus has been used up. For a meal like that I would use regular (actrapid) insulin in combination with rapid-acting, which lasts 6+ hours and better matches the profile of food like that.
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I think in the U.K. they only tend to prescribe one type of bolus. Not even sure many people are on Actrapid any more... They’ve recently told us that Novorapid isn’t as rapid as they’d been saying for years, and a lot of folk are having to preinject by 45 minutes - I was always told to inject it while eating, but it takes almost an hour to kick in for me. I’d love a super quick acting insulin just for corrections, mind you.
 
Mel dCP said:
No good mate, you’ll just have to stop eating ;) In all seriousness though, the protein in the low carb meal could be raising it almost as much as the carbs in the pasta. Have you tried fasting for that meal to see if your liver dumps anyway at that time?
Do you think a pump might help, or is it too unpredictable to set up a regime on one?
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Interesting, I might try fasting, thanks.

I know next to nothing about pumps, guess I should read up. I'm coming up to my 4th D anniversary, and most of that time on mixed insulin. This overnight rise only started after about a month into MDI.

I uploaded Libre data to Diasend for the hospital bods - so let's see what happens.
 
urbanracer said:
Interesting, I might try fasting, thanks.

I know next to nothing about pumps, guess I should read up. I'm coming up to my 4th D anniversary, and most of that time on mixed insulin. This overnight rise only started after about a month into MDI.

I uploaded Libre data to Diasend for the hospital bods - so let's see what happens.
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Might be worth a go to get a baseline. If you get hungry you could eat some fat (butter is always good!), as it won’t affect your blood sugars.
 
Mel dCP said:
I think in the U.K. they only tend to prescribe one type of bolus. Not even sure many people are on Actrapid any more... They’ve recently told us that Novorapid isn’t as rapid as they’d been saying for years, and a lot of folk are having to preinject by 45 minutes - I was always told to inject it while eating, but it takes almost an hour to kick in for me. I’d love a super quick acting insulin just for corrections, mind you.
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Have you tried Fiasp? I don't know why the standard MDI regime is just a rapid-acting insulin and basal. I come from a pumping mindset, where I was taught to use extended boluses for protein and slow-digesting foods, which includes a lot more than just pizza and pasta. The extended bolus simulates the profile of actrapid, so it makes perfect sense to use both a rapid-acting insulin and a slower-acting regular insulin on MDI. When I first tried going off the pump I couldn't stand it because if I ate anything high in protein I'd spike a few hours later or wake up high. You can't just take another bolus of rapid to solve this if you eat a few hours before going to sleep, and I don't think that's as good of a solution since blood sugar is already rising when you take another bolus. MDI seems incomplete without using a rapid-acting insulin, regular/actrapid and a basal insulin.
 
scotteric said:
Have you tried Fiasp? I don't know why the standard MDI regime is just a rapid-acting insulin and basal. I come from a pumping mindset, where I was taught to use extended boluses for protein and slow-digesting foods, which includes a lot more than just pizza and pasta. The extended bolus simulates the profile of actrapid, so it makes perfect sense to use both a rapid-acting insulin and a slower-acting regular insulin on MDI. When I first tried going off the pump I couldn't stand it because if I ate anything high in protein I'd spike a few hours later or wake up high. You can't just take another bolus of rapid to solve this if you eat a few hours before going to sleep, and I don't think that's as good of a solution since blood sugar is already rising when you take another bolus. MDI seems incomplete without using a rapid-acting insulin, regular/actrapid and a basal insulin.
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I’m hoping to get Fiasp at my next appointment, but according to my pharmacist, they’re having serious supply problems with it at the moment. Hopefully showing them my Libre traces and how I’m having to use NovoSluggish to deal with my issues will persuade them to let me have both.
 
Mel dCP said:
I’m hoping to get Fiasp at my next appointment, but according to my pharmacist, they’re having serious supply problems with it at the moment. Hopefully showing them my Libre traces and how I’m having to use NovoSluggish to deal with my issues will persuade them to let me have both.
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I always have to order it, and it still surprises me how many pharmacists have never heard of it (or Tresiba for that matter - I don't think new drugs are pushed/marketed as hard in Canada as in other places) but can get it in a day. It's much faster, if I have an up arrow on my CGM it will stabilize by the next reading minutes after injecting! It peaks earlier though meaning that it is even less effective than NovoRapid at dealing with high protein/fat meals, making using it in combination with Actrapid the perfect combo in my experience!
 
Mel dCP said:
Do you have a source for this new advice?
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I was invited to follow up the reference my dn gave me to the Accord study. I did so and it was clear that the low hba1c targets might not be worth aiming for if more and harsher drugs were needed to achieve them. The work of Dr Jason Fung also shows that the benefits of lowering hba1c levels below 10 are minute - the actual % reduction in risks not being shown along with the level of original risk. Statistics are poorly understood by so many people...they see a 20% reduction in risk as huge - but if the original risk is, say 2%, the 20% reduction is going to lower that to 1.6% and may not be worth the risk involved in taking the extra drugs.
 
Cocobolo said:
I was invited to follow up the reference my dn gave me to the Accord study. I did so and it was clear that the low hba1c targets might not be worth aiming for if more and harsher drugs were needed to achieve them. The work of Dr Jason Fung also shows that the benefits of lowering hba1c levels below 10 are minute - the actual % reduction in risks not being shown along with the level of original risk. Statistics are poorly understood by so many people...they see a 20% reduction in risk as huge - but if the original risk is, say 2%, the 20% reduction is going to lower that to 1.6% and may not be worth the risk involved in taking the extra drugs.
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But do you have a reference to the original source for this, please? I have a strong background in statistics, biochemistry and science in general, so I’d like to read the actual research that shows this. What with hoping to hang on to my feet and eyesight and all that.
 
Cocobolo said:
I was invited to follow up the reference my dn gave me to the Accord study. I did so and it was clear that the low hba1c targets might not be worth aiming for if more and harsher drugs were needed to achieve them. The work of Dr Jason Fung also shows that the benefits of lowering hba1c levels below 10 are minute - the actual % reduction in risks not being shown along with the level of original risk. Statistics are poorly understood by so many people...they see a 20% reduction in risk as huge - but if the original risk is, say 2%, the 20% reduction is going to lower that to 1.6% and may not be worth the risk involved in taking the extra drugs.
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The ACCORD trial is about people with type 2 diabetes.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2258341/

I would imagine that wouldn't apply to Type 1 diabetes, however, having said that, I have, personally concluded, that if it's a choice between getting a decent night's sleep, and low blood sugar overnight, I'll take the sleep.
 
Mel dCP said:
But do you have a reference to the original source for this, please? I have a strong background in statistics, biochemistry and science in general, so I’d like to read the actual research that shows this. What with hoping to hang on to my feet and eyesight and all that.
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As I say in my comment the idea that one's own body may have a (poorly understood) reason for boosting glucose levels is simply my own surmise. The study that shows medication may be more harmful than a higher hba1c (up to around 10) is the Accord study
https://www.nejm.org/doi/full/10.1056/NEJMoa0802743 and the recent work of Dr Jason Fung also shows thia
 
urbanracer said:
At the moment I seem to get a flat line overnight about once a fortnight and cannot identify a pattern.
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Some people have commented on flatline be result of sleeping on the arm with the libre and compressing out the interstitial fluid from around the sensor.
 
Hi there.
I used to have hi readings in the morning.
Ive sorted this by eating low carb meal evening with lots of protein. Pre bed do you eat anything ?
 
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