Type 1 Morning insulin/breakfast

[Rich1889]

Hi all,

Have been using the Libre now for a few months and getting on with it really well. It has shown lots of useful data that has allowed me to get my hba1c down to 45 (!) which I found out on Monday!

One thing I just can't get right is my morning meal. I seem to be very insulin resistant but food goes straight in!! The other day as an example, I had my insulin 30 mins before my food (usually wait 10-15 for other meals) and left it as long as I dare before heading towards hypo but then as soon as I ate (shredded wheat 6cp's) up it shoots. See photo

Any thoughts on how I can control as need to stop going so high. Shredded wheat is low gi and can't each much less in the morning or will be ravenous by about 10am!

Thanks

 

[slip]

Rich, What time exactly did you inject and eat? What is your I:C ratio for breakfast, you may have different ratios for different meal times.......

Do you have sugar on your Shredded Wheat? & milk? In the graph picture it's not easy to see actual times, did you do any corrections (although it looks like you log meal and insulin) just wondered if you missed a correction - what did you do at lunch time and when?

any activity involved?

I know answering a question with a question! (or 2...or 3....!)

 

[Rich1889]

Hi,

Inject at 8.15 and then eat about 8.45/8.50.

Ratio is 1unit per 1.5 CPs and it's correct as that graph indicates with no corrections and sat at a desk. Comes back to the right level as shown eventually but just takes a long time and after a significant high.

No sugar and 150ml milk so allow for that also, have also tried with soya.

Lunch about 1pm so 4 hrs passed.

Thanks

 

[Mickyduff]

The way cereals effect me is pretty similar to you.
Looking at your Libre results, I would say your ratios are fine, as you return back to your previous result afterwards. I had the same problem so reduced my carbs at breakfast. I now have 1 slice of toast and 1 poached egg (around 23g of carbs). I did try duel bolusing on my pump but that didn't have much impact, though I do duel bolus if I'm having a bacon sandwich .

 

[slip]

So at 1pm (~4hrs after breakfast) you're back to your pre breakfast levels, so I guess your I:C ratio is right, I'd give the injection 45mins before breakfast then to see if that would dull the peak so to speak, at least you can scan as often as you like inbetween injection and eating if you're afraid of dipping too low - looking at the graph you could wait until you hit the very low 4s before eating as it does shoot up quickly.

Which brings me to the Libres accuracy, have you done a blood test to confirm the peak is what the libre says it is - it's re-noun for over estimating the highs (and the lows!), how sure are you that the libre is reporting pretty accurate levels?

 

[GrantGam]

I agree that your I:C ratio seems fine also, given that you're returning to within range with no corrections.

Are you injecting your bolus into your abdomen?

Even though 30 minutes is a fairly lengthy time to advance bolus for, you could always try a little longer - but I'd do that in small increments. Given your large spike, it would seem like you'd be unlikely to hypo if you try an extra 5 minutes each time.

I wouldn't attribute the spike to a waking rise, as it would be normal to require extra insulin to bring you back to your target range. Which you don't seem to need.

You could try (if you aren't/haven't already) full fat milk with your cereal as fat can help to dampen BG spikes from carbs.

I agree with @slip, the Libre overestimated my highs as well. Anything above 10mmol/l was often wildly inaccurate.

Do you split dose your basal? I've sometimes seen a small gap in time where there appears to be no overlap. This might be an issue with you?

Apart from the wee spike, nice control by the way

 

[noblehead]

Ratio is 1unit per 1.5 CPs and it's correct as that graph indicates with no corrections and sat at a desk. Comes back to the right level as shown eventually but just takes a long time and after a significant high.

As a suggestion, if you don't want to deviate away from your usual breakfast you can try adding some fat to the meal in the way of some Natural Greek Yogurt, fat is well known to dampen down spikes but whether it will make a difference in your case is debatable.

Personally I tend to stick with traditional porridge (oats, milk, yogurt, seeds & blueberries) over other cereals as the spikes can be controlled, but the suggestion earlier about poached eggs on 1 slice of toast is worth trying, maybe try the eggs scrambled and add some cheese to the eggs as they cook and this will help dampen down the spike.

 

[fletchweb]

Hi all,

H

Any thoughts on how I can control as need to stop going so high. Shredded wheat is low gi and can't each much less in the morning or will be ravenous by about 10am!

Thanks

My own findings in regard to BG levels and mornings - for me it's less to do with food and more to do with the stress of getting up. I can wake up at a BG level of 5.6, not eat anything and within an hour, with no food, my BGs are up around 11. I'm convinced it's the stress of waking and getting up. As a result I don't eat breakfast and have to give myself 5 units of humulog to keep it within a normal range for the first part of teh morning. By the time mid morning comes around I'm fine.
Mornings are very stressful for most people - one of the reasons why Heart Attacks are so common during that time.

 

[Kristin251]

I agree with @fletchweb and the morning rise. If I don't eat I have to bolus all morning. I eat half and avocado 15 min after I get up and bolus. Then an hour later I need another small bolus to stop the rise. I tend to continue to rise until after noon. So at noon I take another small dose and smal snack. Then I eat lunch around 3 with a regular bolus.

 

[slip]

@fletchweb other wise known as Dawn Phenomenon? (DP for short!) Lots of people do find if they don't have breakfast their liver starts dishing out glucose to prepare your body to get going (and go out and catch something to eat!) @Rich1889's issue certainly isn't DP.

I agree that adding fat might help.

 

[Kristin251]

@fletchweb other wise known as Dawn Phenomenon? (DP for short!) Lots of people do find if they don't have breakfast their liver starts dishing out glucose to prepare your body to get going (and go out and catch something to eat!) @Rich1889's issue certainly isn't DP.

I agree that adding fat might help.

It could be the combination of carbs and the morning natural rise. Of course I would try a much lower carb bf first and see what happens.

 

[Rich1889]

Thanks for the responses, increased fat sounds like the first step combined with even earlier bolusing. Have green top milk so fat content would be better with full fat. Will give it a try!

Weekend breakfasts are fine as I do have eggs and toast but not practical mid week.

Basal wise I am on split and try and keep these 12hrs apart which works well.

Libre is great but mine actual reads a little low. Finger prick tonight showed 7.6 before driving home and Libre was at 6.9. Like most, good to see trends and generally keep tabs on it throughout the day

 

[GrantGam]

One other thing worth noting is that the glycemic index is only an advisory system and isn't tailored to everyone's individual response.

As @noblehead has already suggested, maybe a change of breakfast (even if that is just the type of cereal) may help a long way in reducing your morning spike.