Higher fast action dosage needed after breakfast

[JGibbons]

Hello everyone,

First time posting on here. I have often read threads from others and taken advice so I thought why not sign up and become a part of the community.

After having breakfast (varied from toast, yogurt and cereal day to day) I often find I need an out of proportion dose of Novorapid to ensure my levels don't spike. Eating no more than 14 units for a 1 in 10 carb counting plan. I find that I usually have to give more than 20 units, sometimes as high as 25 to prevent blood sugars from soaring up to 17-20. On waking up my levels are often quite controlled between 5-9.

Could this be due to dosage of my long lasting insulin? Maybe poor sleep or stress? Any advice would be great.

Thanks for reading, hope you're having a good day

 

[Rokaab]

Often people will need different ratios at differing times of the day, I know I need more in the morning than the rest of the day, you may also need to pre-bolus earlier to calm down the spike, I do (when I was still using Novorapid I needed to pre-bolus by a good 30-40 mins to have any chance of not spiking horribly - though obviously we are all different)

And welcome to the forums

 

[JGibbons]

Often people will need different ratios at differing times of the day, I know I need more in the morning than the rest of the day, you may also need to pre-bolus earlier to calm down the spike, I do (when I was still using Novorapid I needed to pre-bolus by a good 30-40 mins to have any chance of not spiking horribly - though obviously we are all different)

And welcome to the forums

I have never done a pre-bolus dose, correction doses when I get a bit snack frequent on hypos but it's something I'll explore in the coming days.

Thank you for the reply

 

[Rokaab]

I have never done a pre-bolus dose, correction doses when I get a bit snack frequent on hypos but it's something I'll explore in the coming days.

Thank you for the reply

If you're trying pre-bolus'ing for the first time I'd start on a smallish time frame and extend as necessary, you don't want it all kicking in before you eat

 

[Heathero]

I agree with comments above had same problem when using actrapid/ novopen. Much better since changing to Omnipod pump a few years ago. I always need a higher ratio of insulin after breakfast even if exercise soon after. Still occasionally need an adjustment dose if no exercise. Or BG can rise too high
.PS also changed insulin to Fiasp 7/12 ago which works immediately. So spikes reduce quicker.
Type 1 Diabetes since 1965 / age 4 years.

 

[miahara]

Hi @JGibbons and welcome, you come to a great place for support and advice and I'm sure someone will come up with a near perfect solution to your question. My less than perfect slant on your query is -
Your basal dose of insulin seems pretty good if you are waking to 5 - 9.
I too find breakfast a tad difficult to manage. My usual intake of carbs is about 35 -37 (microwave porridge) and despite taking my bolus 30 minutes before eating I seem to always get a big spike an hour later and then a pretty rapid fall. I'm slowly increasing my bolus, it was 8u and I've just increased it to 9u but it doesn't seem to have made a vast difference so far so I'll give a try at increasing it a bit more.
As mentioned in previous comments breakfast does, for many folk, seem to need a much higher I:C ratio than at later meals.

 

[EllieM]

I agree with the others, insulin ratios can vary by time of day.

Also, there is a factor called the dawn phenomena which may be coming into play. Many people's livers pump out extra glycogen when they wake so as to give the body energy for the day, and as a T1 you may need extra insulin to cope with this.

 

[MarkMunday]

... Could this be due to dosage of my long lasting insulin? ...

Yes, you could be running out of basal insulin at that time of the day. You can find out by skipping breakfast and testing every hour until lunchtime. If blood glucose rises a lot, it is because of lack of basal insulin action. What basal insulin do you use and when do you inject it?

 

[TypeZero.]

Your options:
-Muscular injection
-Prebolusing
-0 carb brekkie

 

[JGibbons]

Thank you all the responses.

It's good to know that others are having similar problems and finding solutions.

Right now I take 20u of Toujeo in the morning before breakfast. This can vary from 6.30am to as late as 10am.The suggestion of a basal or experimenting with skipping breakfast and seeing what happens to my levels is something that I am going to incorporate

 

[Dianemacfaden]

I have had type 1 for nearly 50 years so am quite experienced but still find mornings a bit hit and miss with the dawn effect but find just giving one unit as soon as I wake can minimise it. Experiment with this on days you can skip breakfast to see if it works for you. I also and find eating as low carb breakfast as I can is the easiest way to avoid spikes or lows.

 

[bmtest]

It is quite normal as the human body has its own process in starting you up for days activity.

One of these is raising your blood glucose and its a battle to bring it under control early am.

40 years ago doing heavy manual and cycling 5 mile or walking a mile to bus stop in heavy snow i could manage with no actrapid insulin just monotard.

Breakfast 1 shredded wheat a bowl of bran flakes and glass of fresh orange and cup of tea. 2 hours later egg sandwich at transport cafe. The heavy manual for 1 hour a pint of fresh milk. Hypo usually around 12pm dose already pre determined at home as b4 portable pens. 3 bottles of holsten at pub for dinner back to work at 1pm.

So more you do straight after breafast keeps your levels down in later years working in office i and with invention of pen i always corrected if needed on arrival at work.

 

[Jollymon]

We call the need for more insulin in the morning “morning phenomena”. It’s a common occurrence. There’s some science behind why. I just know that I have to address is with more insulin.