LCHF - Basal - Dawn Phenomenon - Fixed??? :)

[Applenerd81]

If you are seeing lows after waking up my guess is that your 200% DP basal was wrong and was being used to cover a carby breakfast that is now missing because you are low carbing. In other words I think that your morning basal was too high and instead you should have used a higher IC ratio at breakfast. And my further guess is that if you change to those settings now, your problem will go away, and stay away even if you stop low carbing.

For protein by the way when low carbing I dose 1/3 of normal IC for the same amount of carbs. So I dose for 60g of protein like it was 20g of carbs. If I dose 50% I consistently go hypo. I use a 2 hr delayed bolus, ie delivery spread over 2 hours rather than immediate.

Thanks Spiker; Breakfast and mornings used to need a fair bit of insulin (basal and higher IC in my case). With LCHF I have dropped from 22iu to 14.5 with no peak. So far so good but I'm only in Day 4.

I'm guessing (in my case at least) the basal requirements & profile change as the body uses up its glucose stores...? Am keeping an eagle eye on BGs.

 

[Spiker]

Day 4 you are probably still keto adapting so all bets are off really until you get keto adapted.

 

[Applenerd81]

So I'm around 15 days in, ketones have ranged between 0.2-1.7, had one bad day (90g carbs) but other than that pretty good (30g per day avg).

The tricky things I'm finding are:

1) The protein affect - creeping BGs hours after eating (currently bolusing for 1/3 of protein, prob need extended bolus for 50% although carbs messes up this guesstimate). Need a better formula for bolusing for protein, especially if carbs are included.

2) Still getting DP, BGs ok till 4am then creep up 3-4mmol by 9am. What causes this? Is it muscle breakdown? Should DP disappear when in optimal ketosis? Planning to experiment with more fat at bed time...

 

[robert72]

So I'm around 15 days in, ketones have ranged between 0.2-1.7, had one bad day (90g carbs) but other than that pretty good (30g per day avg).

The tricky things I'm finding are:

1) The protein affect - creeping BGs hours after eating (currently bolusing for 1/3 of protein, prob need extended bolus for 50% although carbs messes up this guesstimate). Need a better formula for bolusing for protein, especially if carbs are included.

2) Still getting DP, BGs ok till 4am then creep up 3-4mmol by 9am. What causes this? Is it muscle breakdown? Should DP disappear when in optimal ketosis? Planning to experiment with more fat at bed time...

I found it easiest to eat similar meals at similar times - i.e.: keep the carb/protein/fat ratios for breakfast lunch and dinner until I had worked out patterns. Your body will make as much glucose as it needs from protein apparently, but you also need enough protein to repair muscle etc so you might need more protein if you exercise or work out. I have my protein goal at around 1g per kilo bodyweight but I only do light exercise.

DP is caused by your liver dumping glycogen to give you energy when you wake up (it doesn't know your pancreas is broken ) If it's a repeatable pattern then you will be able to programme your pump to cover this. I'm not a pumper so can't help with that.

 

[Applenerd81]

I found it easiest to eat similar meals at similar times - i.e.: keep the carb/protein/fat ratios for breakfast lunch and dinner until I had worked out patterns. Your body will make as much glucose as it needs from protein apparently, but you also need enough protein to repair muscle etc so you might need more protein if you exercise or work out. I have my protein goal at around 1g per kilo bodyweight but I only do light exercise.

DP is caused by your liver dumping glycogen to give you energy when you wake up (it doesn't know your pancreas is broken ) If it's a repeatable pattern then you will be able to programme your pump to cover this. I'm not a pumper so can't help with that.

Thanks, similarly I am having a minimum 1g per kg body weight.

With regards to DP, I understand what causes it, but was assuming on LCHF the liver's stores are meant to be depleted so DP should stop should it not??

 

[robert72]

Thanks, similarly I am having a minimum 1g per kg body weight.

With regards to DP, I understand what causes it, but was assuming on LCHF the liver's stores are meant to be depleted so DP should stop should it not??

You may have less, but you will still have enough glycogen to give DP - you wouldn't want to not have any if you were to go hypo.

 

[Applenerd81]

You may have less, but you will still have enough glycogen to give DP - you wouldn't want to not have any if you were to go hypo.

This makes sense! I'll try the extra fat before bed, then work on the basal rate (again), thanks!

 

[Applenerd81]

Update, still low carbing, ketones are in the light range (0.2-1) blood sugars are starting to creep up throughout the day - basal rates appear to be returning to pre LCHF days!

 

[Spiker]

Update, still low carbing, ketones are in the light range (0.2-1) blood sugars are starting to creep up throughout the day - basal rates appear to be returning to pre LCHF days!

Possibly the creep up of BG is your body creating glucose? Up your basal slightly I suppose.

 

[Spiker]

1) The protein affect - creeping BGs hours after eating (currently bolusing for 1/3 of protein, prob need extended bolus for 50% although carbs messes up this guesstimate). Need a better formula for bolusing for protein, especially if carbs are included.

Try 50% of protein with 100% of that as Extended. What period is your Extended over? I do it over 2 hours for protein.

 

[donnellysdogs]

I do low carb
This was my profile for 24 hours. I'm
currently just playing around with fine tweaks to it but you will see that my levels double and then stay at peak for 3 hours before gradually leveling off.
I try to eat breakfast but unless hubby is around to eat with me I generally end up missing it. So I effectively end up basal testing the mornings a fair bit.
I also do one night at testing at 10,12,2,4,6 am and another night at 11,1,3,5 am etc.

My rates change as to when my hubby works AM or PM shift.

I don't think you are unusual to have basal that can double. I just thank my lucky stars that I have a pump to enable me to fine tune these rates rather than the mdi.

 

[Applenerd81]

Possibly the creep up of BG is your body creating glucose? Up your basal slightly I suppose.

My main worry insulin resistance (some days I'm down to <20g carbs), also I am finding it easy to over eat on the protein (aiming for 86g a day based on 86kg weight). I'm surprised my basal has returned to pre lchf levels and concerned I may need even more than before!

 

[Applenerd81]

Here's some data. Rows are blood glucose, basal rate, bolus, food, activity.

 

[Applenerd81]

And the same days the week before:

as you can see avg daily bg is up on avg 1mmol per day, insulin is up, carbs are similar...

 

[donnellysdogs]

My Basals have changed from 18 down to 13 and now adjusting back down (again). We don't stay at the same. It may just be exercising on specific days has an impact the following days etc. it could be just colder weather or hotter weather. That's the beauty of a pump to be able to adjust though. I don't worry if bolus' or anything needs tweaking regularly as we all have so many different individual reasons for the changes. Certainly nothing stays the same on a pump.

Eg. I changed to Insight pump. Never had increases after a set change before. The pump is set up to deliver a prime of 0.7 for the set. I need to change it to a 1 unit prime as my levels raise after a set change with these plastic sets and not using the steel ones. I could have been blaming my body for insulin resistance on every 3rd day, but when looking at things in more detail and recognising activities, set changes etc you will worry less.

To be honest, I don't worry if anything changes.

 

[Applenerd81]

Try 50% of protein with 100% of that as Extended. What period is your Extended over? I do it over 2 hours for protein.

Still experimenting, with 2hrs extended I am running at 8-9mmol at 2hrs, multi phase seems to be a little better as it appears my meals may contain some "incidental" carbs.

 

[Applenerd81]

Hi all, just an update, I've been offline for a while with whole load going on at work.
I'm still living the LCHF lifestyle and am still having fantastic results with both bodyweight and diabetes control.
In the past 2 months my body has improved even further having noticed I was getting serious hypos at waking, I have tweaked my basal rate further and low and behold my pesky DP issues are no more! My basal profile is flat as pancake (0.75iu per hour) and my BGs are more stable than ever.
I don't understand the physiology behind how this has happened but am ecstatic