Morning Blood Sugars

[90danc]

I am currently at my wits end with my morning blood sugars.

I seem to have a wave of good blood sugars, then its starts going high again. My diabetic nurse keeps telling me to adjust my background insulin (Lantus). When I first changed to a basal/bolus regime I was doing 24u of Lantus and this seemed fine for a while, then I started getting morning highs, so my DN suggested I drop it down by one unit and see how it goes, as she though I could have been having rebound hypos. I eventually ended up on 21u but was still getting highs. So then she suggested I start increasing it by one unit, and this worked, however after a few days I would start getting highs in the morning again and have to increase it by another unit, and the same would happen over until I ended up on 30 units for around a month and everything was pretty perfect. Then I started getting highs again, so I am currently on 32u. Which seems like a large increase and yet I am still getting morning highs.

Checking my blood sugars through the night show that they are mostly stable, just of a morning I get a spike. Obviously this is making me feel like absolute rubbish for a few hours at the start of the day which is getting me down.

Any advice would be welcome. Thanks.

 

[Juicyj]

Hey @90danc - can you run us through your morning routine so what time do you get up, what do you have for breakfast and how much quick acting insulin taken - also what time are you going high ? And finally are you splitting your Lantus dose ?

 

[GrantGam]

@Juicyj has asked some very good questions, I'm sure the forum members can offer excellent advice once you provide the requested information

In the meantime, I'll outline a few reasons why high morning BG's can occur:

-Nocturnal hypoglycemia. It's very difficult to spot light hypos during the night. A hypo as minimal as 3.5mmol/l in my experience is enough to cause a fairly hefty rebound in the morning. I was taking far too much basal insulin in the early days, and small hypos overnight were causing my BG's to skyrocket in the mornings. I never noticed when doing overnight basal testing, and only pinpointed it when I started using the Libre system.

-Feet on the floor syndrome. This often comes under the same umbrella as Dawn phenomenon, but in my eyes it deserves its own title. Scenario, morning BG is perfectly in range and then as little as half an hour later can be 12mmol/l+. I have this issue and subsequently require a 2u bolus in the morning even though I'm not eating. Some diabetics require even more insulin than this (due to our bodies typically being most insulin resistant early on in the day). The bolus doesn't work quick enough to stop the spike, but it certainly minimises it and allows me to be back in range a few hours later.

-Basal injection timings. If you take your 'once daily' basal dose in the morning, you may well find that it's not lasting the claimed 24 hours and causing you high morning BG's. A lot of us split our 'once daily' basal dose into two separate injections to address the shorter than claimed action of the basal insulin. With a split dose, you can also take more/less insulin during the day and/or more/less at night, to tailor the dose to your individual needs.

I'm sure you'll get the answer you need very soon @90danc

One last thing, I'd get a copy of the following book (if you haven't already), it's very good and will almost definitely help with your BG management:

https://www.amazon.co.uk/gp/aw/d/B06XCDTPP1/ref=tmm_kin_title_0?ie=UTF8&qid=&sr=

 

[dazwalshe]

I suffered this same scenario.. the first step I did was to split my basal.. half and half 12 hours apart.. 8am and 8pm for me... best thing I ever did.. maybe a silly question... the mornings where it doesn't rise as much .. have you had any alcohol the night before? Massive impact for me on stopping liver dump am.. waking rise... just a thought.. I've now started injecting a unit or 2 on waking depending on levels...

 

[ljmercer]

There have been some incredibly useful comments on here so far!

May I ask how old you are? I know that during my teenage years my scenario was exactly the same as yours.

I was experiencing dawn phenomena, where my sugars rose drastically but were okay for the rest of the day. It got to the point where I was on 58 units of Lantus a day to try and combat it. The nurses managed to bring it down to around 30 units. I was still experiencing dawn phenomena, with no decrease in my HbA1c so I was getting a little frustrated. I asked about a pump to try and stop this from happening.

I have had a pump now since March 2013 and because it's a much tailored basal, giving more in the morning and less throughout the day, it works. I'm on 32 units now but it works and there's less highs on a morning.

Maybe ask about a pump? Hope this is useful @90danc

 

[ljmercer]

Also, how long have you been diabetic for @90danc? Insulin resistance can also creep up the longer you've had diabetes potentially.

 

[Kristin251]

Alcohol most definatley effects my fasting as well as my evening meal. Too much protein OR saturated fat will give me a higher fasting.
Even my pre meal little cheese plate before dinner will give me a higher fasting

 

[90danc]

Hi all, sorry for the slow reply, had a busy week.

To answer a few of the questions:-
I am 27 and have been diabetic for nearly 14 years. I have been on basal/bolus for nearly 2 years, previously I was on novomix 30. I do one does of Lantus at 6pm.

The highs are as soon as I wake up, or I will test in the night if I wake up and usually any time after 5am it can be high. I tend to wake up if I am having a hypo. However, I do wake up in a sweat often, but upon checking my blood sugar it is normally fine.

I do find if I have alcohol that my morning blood sugars and sugars the following day are pretty spot on. However, I don't drink that often so I do have some none alcohol related perfect morning blood sugars .

I am seeing my DN on Friday and I will be asking about the splitting dosage, insulin pump etc and I am considering investing in a CGM. It's just frustrating that I have been asking my DN about this issue for over a year and not really got any answers or insight until I came on this forum.

 

[donnellysdogs]

See if you can get a Libre off your DSN to try free for a couple weeks. This wil show what happens during the night. Dont belueve the first 24 hour readings or change anything based on the first 24hrs ysing a Libre.

From my libre days it was possible to see that my bloods rise from 4am. I now have to wake each day and give an injection. I can stay good then till waking. I test as soon as I wake... still in bed. Then I have another two injections as well. I then wait 30mins before my feet hit the floor...

Now, I'm not saying that you will have this extreme but some people have to wake to give themselves injections before getting up to stop rises.

Before you have to do this though your background insulins could be split to two a day to see if you can stop rises that way.

Currently I am on two different basals and still having to do correction bolys before putting feet to floor and every morning I have to wake at 4am for a jab.

My consuktants and educators say otgers have to do the same, that I'm not the only one. I've never met anybody that has to do my **** regime though. Hopefully splitting your doses will help.

See if your nurse can give you a libre for a couple weeks to save waking and ttesting. If not you need to check nights on a 3,5 and 7am blood test and the next nught on a 4,6 and 8am test. Do this for a few nughts and try to establush exactly what is happening and what time levels rise.

Do they carry on risng after you get up??

 

[donnellysdogs]

Is your nurse at a hospital or gp?

 

[TheBigNewt]

You didn't say when you take the Lantus, I assume in the morning. It's quite possible that it's run out of gas by morning, so splitting it and taking a portion at bedtime may work. 32U isn't a great amount either. I take 25 for years and that works in the AM for me.

 

[90danc]

I went to my clinic today and actually saw a different Diabetic Nurse who was much more concerned about getting it sorted, she spoke of Dawn Phenomenon and is going to sort a 2 week trial of a libre for me.

 

[DaftThoughts]

If you continue to have issues, it might be worth considering switching from Lantus to either Tresiba or Toujeo. A lot of people find they are more stable with less issues overall on either of these, and I personally manage to curb DP in the mornings quite well with Toujeo.

For example, on most days I wake up anywhere between 5.5-6.5, and if I put off eating I may go up to 7.5 after one or two hours, but that's really the extent of it. If I bike within a few hours after waking I may climb up to 8-9 but never into double digits. With Toujeo my DP goes pretty slow and I feel like I get a head start on the **** thing so it doesn't go out of control.

 

[fletchweb]

I am currently at my wits end with my morning blood sugars.

I seem to have a wave of good blood sugars, then its starts going high again. My diabetic nurse keeps telling me to adjust my background insulin (Lantus). When I first changed to a basal/bolus regime I was doing 24u of Lantus and this seemed fine for a while, then I started getting morning highs, so my DN suggested I drop it down by one unit and see how it goes, as she though I could have been having rebound hypos. I eventually ended up on 21u but was still getting highs. So then she suggested I start increasing it by one unit, and this worked, however after a few days I would start getting highs in the morning again and have to increase it by another unit, and the same would happen over until I ended up on 30 units for around a month and everything was pretty perfect. Then I started getting highs again, so I am currently on 32u. Which seems like a large increase and yet I am still getting morning highs.

Checking my blood sugars through the night show that they are mostly stable, just of a morning I get a spike. Obviously this is making me feel like absolute rubbish for a few hours at the start of the day which is getting me down.

Any advice would be welcome. Thanks.

I deal with the same issue and have done so for years. There's two things I focus on - one is the amount of Lantus I take (1 nightly shot before going to bed) and just as important - the time I have my last meal. I used to consistently wake up with morning highs running between 13-18. Like you I would increase my Lantus it would be good for a while and then morning highs again.

I basically took the approach of - let's not try to make my morning BGs perfect - let's just try to get it down. So I tried that and stumbled on the correlation that when I ate earlier in the day my morning BGs were better. Finally after years of this I have got to the point where my morning highs are now 10 and usually are between 4-7. A 10 I can live with and takes next to no effort getting it down.

Right now I'm on 24 Units of Lantus and my last meal has to be before 7 pm otherwise my BGs will be high in the morning. Try that - the time you have your last meal - if you eat late try eating earlier - that might be a factor.

Good luck!

 

[donnellysdogs]

I went to my clinic today and actually saw a different Diabetic Nurse who was much more concerned about getting it sorted, she spoke of Dawn Phenomenon and is going to sort a 2 week trial of a libre for me.

Brilliant, thats good news...

 

[donnellysdogs]

If you continue to have issues, it might be worth considering switching from Lantus to either Tresiba or Toujeo. A lot of people find they are more stable with less issues overall on either of these, and I personally manage to curb DP in the mornings quite well with Toujeo.

For example, on most days I wake up anywhere between 5.5-6.5, and if I put off eating I may go up to 7.5 after one or two hours, but that's really the extent of it. If I bike within a few hours after waking I may climb up to 8-9 but never into double digits. With Toujeo my DP goes pretty slow and I feel like I get a head start on the **** thing so it doesn't go out of control.

It needs staff to change insulins. They try thngs in accoordance to NICE guidelines .

If DP is a problem then tresiba is unlikely too work withoout an additional dose of bolus.

For me DP makes me have tresiba5.30pm, 1st shot of insulatrd at 4amm, another at 8am with a ppre correcting bolus of novo rapid too!!

 

[DaftThoughts]

It needs staff to change insulins. They try thngs in accoordance to NICE guidelines .

If DP is a problem then tresiba is unlikely too work withoout an additional dose of bolus.

For me DP makes me have tresiba5.30pm, 1st shot of insulatrd at 4amm, another at 8am with a ppre correcting bolus of novo rapid too!!

I think you misunderstood me. Tresiba/Toujeo won't prevent DP from happening, but they seem to stabilize levels long enough to give you a head start in the morning. I've seen Lantus giving people issues with DP but things get better when switching to one of the other two.

Rather than waking up in the double digits, you could wake up in middle single digits and get ahead of the rise by bolusing for the rise (+breakfast if you have it). That's what I typically do, Toujeo doesn't prevent my DP, but I wake up consistently around 6 and get a chance to bolus for my expected rise before it becomes an issue. Tresiba and Toujeo are also known to cause less lows during the night, which can prevent morning highs as well. There are tons of benefits to explore if Lantus doesn't work out for someone.

I don't know if that's going to help 90danc or not, but it's worth considering, and GPs/DSNs can switch it over fairly painlessly.