Morning highs in the 30’s

[bellabella]

Morning all
So I’ve always struggled with morning highs to a certain extent ( BSLs in the teens) which I’ve always put down to dawn phenomenon
I’ve tried increasing my lantus dose but past a certain level I wake up with hypos at night
The last few mornings I’ve woken up feeling very unwell with BSL of 30. I haven’t changed anything in my routine or insulin dose to explain this
I also had ketones of 6.4 which thankfully cleared after lots of hydration and novorapid.
I’m planning to get the freestlye libre to try and see what the hell is happening at night time.
Plan for tonight is
1) use a new lantus pwn( although my current one is in date but you never know)
2) increase dose by 3 units
3) wake at 3 am to check sugars

Anyone have anymore wisdom? I go on holidays for three weeks next week so really don’t want this happening every day as it really ruins the morning
I’ve lost some weight (4kg) and started working out a lot more recently but I would have thought that would reduce my insulin requirement if anything
Don’t do low carb or Keto so have no other reason to have serum ketones

 

[EllieM]

1) use a new lantus pwn( although my current one is in date but you never know)
2) increase dose by 3 units
3) wake at 3 am to check sugars

What's your insulin resistance like? How much insulin do you need for 10g of carbs? ie you could be going low at night, your liver pumps out sugar to compensate, and then you're high in the morning. I'd be tempted to miss out number 2 for the first night and just do number 3.

Also, have you reviewed your injection sites? If you inject lantus into a bad site it can act fast instead of slow....

 

[EllieM]

On second thoughts, a reading of 30 plus ketones suggests a severe shortage of insulin... Changing the lantus might just fix it. Otherwise, I'd get checked out at the GP - if you're coming down with something (eg a urinary tract infection might not have obvious symptoms) you could need more insulin. I'll assume you've ruled out pregnancy if that's a possibility.

 

[bellabella]

Thanks for the detailed reply.
I wondered about a possible low as well but the ketones is what threw me off. I’m not sure if this could happen with Dawn , although my dawn has never been high enough for me to be worried enough to check ketones before.
I’m pretty resistant to insulin from morning to noon- 1:7/1:8 compared to 1:10 at lunch and dinner. Usually I need one unit of Novorapid to bring me
Down by 3mmol but this doubles in the morning, so 1 unit for a 1.5 drop roughly.
Have ruled out pregnancy. UTI is a possibility although my daytime readings are fine.
Got a CGM recently although it didn’t sense data for all of the days except one which was annoying. So I might just self fund the Libre and get more info from there.
Sorry for the rant- I just got quite a shock by two readings of 30 in a row as well as the ketones, so wanted to put feelers out there to see if anyone else has had this before.
Thanks for the tips

 

[kitedoc]

If you look up: diabettech.com Lantus: Lethal or Saviour , that might suggest to you the use of a different long acting insulin.
Ketones of 6.4 plus high sugars is listed on my sick day plan as very danderous to be actioned by heading to hospital as DKA is a possibility.
Changing the ampoule of Lantus makes sense, provided the batch of Lantus in your fridge has not been frozen and thus inactivated. Or if somehow the Lantus the ampoule or batch of Lantus has been exposed to > 30 degrees C. That will also inactivate it.
I assume you are use pens to administer your insulins. So is the plunger mechanism working properly? And ? no crack in the glass ampoule? And as @EllieM queried, i too find a spot on my sbdomen where no needles have ever ventured before in order to rule out risk of porr absorption as a cause.
And i am assuming that yiur Lantus injection is in the morning? Could the Lantus dose be wearing out before 24 hours in that case.
Of course all of the above needs to be checked with DSN. Or doctor. Best Wishes -

 

[bellabella]

@kitedoc
I use lantus in the evening time always. And my BSLs have now normalised completely with no ketones. Which makes me think that it’s either severe Dawn phenomenon or hypo
With reactive hyperglycaemia.
I will try a new site tonight though and a new pen to see if that makes a difference.
When my ketones were 6.4 I did consider going to the hospital. But then I was resssured when they started to come down quite quickly after hydration and Novo.... I’ll see what happens tomorrow morning I guess

 

[EllieM]

I use lantus in the evening time always. And my BSLs have now normalised completely with no ketones.

Just a thought, but can you tell whether your basal is working properly later in the day? I'm guessing you can't because by the time you've got your blood sugars back under control it's too late to fit in a few hours with no bolus on board.

Honestly, my money (and hope) is on a problem with the lantus..... How's your fridge temperature? Any chance the lantus could have been frozen?

 

[bellabella]

I’ve just eaten right there so it’s hard to tell. But it might well be the lantus. I did have a few semi used pens in my insulin pack that I’ve been rotating between that are still in date but probably not working as well maybe. So I’ve ditched them all and will use a new pen this evening

 

[becca59]

Seems that you are planning to change pen and site, and check at 3am I would hold off increasing by 3 units tonight. It is a large increase and may not be the issue.

 

[Deleted Account]

Some good suggestions from @EllieM
The only thing I can think of adding is to ask what you ate for your evening meal and when.
For me, a high carby and fatty meal such as pasta with a cheesy sauce or curry has a habit of delayed carb absorption so I go to bed fine but my bg continues to rise overnight. I overcome this with a split bolus dose. This is a tad scary because I go to bed with a good bg and insulin on board. But it works.
Because I become insulin resistant above about 15mmol/l, and I find once my bg reaches that level it will continue to rise as it needs more basal to maintain levels.

Regarding the Lantus issue @kitedoc referenced, I can only refer to my experience : I took it for 12 years and had no problems.

Good luck with your detective work.

 

[bellabella]

New pen. New site. Same dose. I’ll keep you all posted on the ‘3am result’
Fingers crossed for a BGL less than 30

 

[bellabella]

Hi @helensaramay. Good point. I’ve has similar issues with pizza before and needing to split dose- it’s so stressful! On Friday I had a late meal of raw oats, banana and soya milk. I took 10 units for this (1:10). I had an active evening of cycling done prior to this meal so sensitivity probably high . I did wonder if the 10 was a bit much causing a hypo—-> high later on in the night.
Last night I had red beef curry and a small amount of rice with 2 glasses
Of red wine at bout 7.30pm. Went to bed normoglycaemic. Usually the wine causes
Me to be a bit low the next day so I tend not to be aggressive pre bedtime. Theoretically, it absolutely could have been a delayed hyperglycaemia from these foods. It does seem a little suss that it happened two nights in a row though, as it hadn’t done that before with similar pre bedtime meals.
I totally appreciate all the great suggestions here- it’s really nice bouncing ideas off other type 1’s during confusing times like this.

 

[Scott-C]

Hi, @bellabella , I've read Stephen Ponder's book, Sugar Surfing, a couple of times since getting libre.

He says that in its journey round the body before it gets to work, as much as an astonishingly high 80% of insulin can be destroyed. There seems to be a range of "insulin antagonists" involved which counteract insulin, glucagon being the main one, there are lots of others, the articles I've read are way too "sciencey" for me to understand, but what Ponder is saying is that on some days, random biology just gives injected insulin worse odds than on other days.

I've no reason to doubt Ponder - he's not only T1 himself, he's also an endo. This idea of insulin antagonists goes a long way to explaining the randomness of T1, why the same meal, same units, gives radically different results two days in a row.

If it's just been a couple of occasions, I'd be inclined to just write it off to randomness.

I had a similar experience a few days ago. I ate a meal I'd had on hundreds of occasions, some spring veg soup, blt sandwich, some brambles, maybe about 80g. Normally don't go above 7 or 8 with a 20 min prebolus for that, but on this occasion, it skyrocketed to 15, despite another bolus when it got to 9. 15! ***! I was getting really narked off with it, but took a few deep breathes, and thought, ok, this is T1, sometimes this happens, it doesn't mean much in the long run.

If you're getting libre, I'd highly recommend Ponder's book, couple of quid on kindle, lots of advanced stuff on how to use cgm.

Many of us are blinging libre by putting a MiaoMiao transmitter on top which reads it every 5 mins and pings it to an android app xDrip+, so we get full on cgm, with alerts and calibration.

I've not had much trouble with dawn phenomenon, but I do get "foot on floor" big style, so having the alerts takes care of the occasional dp by waking me for a few units before it gets near 8 or 9, and 2u or so getting up to pin the fof.

 

[bellabella]

So update this morning
Went to bed at 6.6, with 0.3 ketones. At 2.30 I was 8.6. At 4.30 10.7
My only query was that my ketones are 1.9 at 4.30. Not huge but still a bit of a rise

Morning all
So I’ve always struggled with morning highs to a certain extent ( BSLs in the teens) which I’ve always put down to dawn phenomenon
I’ve tried increasing my lantus dose but past a certain level I wake up with hypos at night
The last few mornings I’ve woken up feeling very unwell with BSL of 30. I haven’t changed anything in my routine or insulin dose to explain this
I also had ketones of 6.4 which thankfully cleared after lots of hydration and novorapid.
I’m planning to get the freestlye libre to try and see what the hell is happening at night time.
Plan for tonight is
1) use a new lantus pwn( although my current one is in date but you never know)
2) increase dose by 3 units
3) wake at 3 am to check sugars

Anyone have anymore wisdom? I go on holidays for three weeks next week so really don’t want this happening every day as it really ruins the morning
I’ve lost some weight (4kg) and started working out a lot more recently but I would have thought that would reduce my insulin requirement if anything
Don’t do low carb or Keto so have no other reason to have serum ketones

 

[jillsymes66]

Since going in the Libre sensor I have noticed my bsl begin to rise from about 3am with a sharp rise on waking. I have upped my night time Lantus but it's still early days. I do eat a very low carb diet and take only small amounts of bolus insulin. I am waiting to see my DN for some help and guidance with this. Good luck getting yourself sorted.

 

[Deleted Account]

@jillsymes66 I hope you hear from your DN soon.
In the meantime, you may find something useful if you search the forum for "Dawn Phenomenon".