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DAFNE - Morning sugar level problem...

T

Treasure_Ireland

Member
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5
Hi,

Im having problems with my sugar levels in the morning. (im on nova rapid(Quick acting) and lantus (background insulin).

When i wake up in the morning before work, sugar level was 7.9, after that i left home, got on the train to london, walked to work, when i got to work my sugar level was 16.7. This is occouring on a daily basis, and i have to do a corrective dose.

I know it isnt the lantus, because once i have done my corrective dose, it stays consistent during the day, and it doesnt drop at night.

My doctor suggested a few things, but nothing has worked, im really stuck on what to do, does anyone have any ideas?

Thanks in advance.
 
Welcome to the list

You say that this happens daily... This would suggest to me that you are suffering the Dawn phenomenon, your liver increasing it's delivery of glucose into your blood, which isn't then beening covered by your lantus background insulin.I suspect at the moment that you are taking your lantus at night for a 24 period..

You could try to increase your lantus to normal DAFNE suggest 2 units at a time, then wait a couple of days to see the effect.. But I suspect that you would achieve the morning control, but if it is the DP causing the raise it is likely by the afternoon you would be swimming in bakground insulin and then start getting hypos..

The other way if you really feel that it is DP causing this morning raise is to spit your lantus into 2 injections, so that you an have a slightly larger spilt at night time that will cover the morning then have the rest to in a morning jab to cover the afteroon... Then you can adjust the evening jab as necessary to get the control in the morning, with out effecting the afternoon...

If splitting your lantus doesn't work, then perhaps try levimer as this has a slightly different profile to it action a much longer and slower tail off than lantus and quite often gives better results to splitting...

Another thing you could actually try with caution though, is even though you haven't had breakfast is to actually still have a small jab of quick acting insulin to control your levels, but with doing this and not eating I would reccomend that you start with a dose that you know should cover 10g of carbs, and test regularly on your journey to work to ensure that you'll not in danger of havaing a hypo...
 
jopar said:
Welcome to the list

You say that this happens daily... This would suggest to me that you are suffering the Dawn phenomenon, your liver increasing it's delivery of glucose into your blood, which isn't then beening covered by your lantus background insulin.I suspect at the moment that you are taking your lantus at night for a 24 period..

You could try to increase your lantus to normal DAFNE suggest 2 units at a time, then wait a couple of days to see the effect.. But I suspect that you would achieve the morning control, but if it is the DP causing the raise it is likely by the afternoon you would be swimming in bakground insulin and then start getting hypos..

The other way if you really feel that it is DP causing this morning raise is to spit your lantus into 2 injections, so that you an have a slightly larger spilt at night time that will cover the morning then have the rest to in a morning jab to cover the afteroon... Then you can adjust the evening jab as necessary to get the control in the morning, with out effecting the afternoon...

If splitting your lantus doesn't work, then perhaps try levimer as this has a slightly different profile to it action a much longer and slower tail off than lantus and quite often gives better results to splitting...

Another thing you could actually try with caution though, is even though you haven't had breakfast is to actually still have a small jab of quick acting insulin to control your levels, but with doing this and not eating I would reccomend that you start with a dose that you know should cover 10g of carbs, and test regularly on your journey to work to ensure that you'll not in danger of havaing a hypo...
Click to expand...

Hi,

Yes i take my lantus at 11pm everynight. I say this occours everyday, but i meant every working day, as it is fine at the weekend.

I did consider it being the walk from the train to work, however when i walk to the train in the evening it will always drop slightly.

Well i used to do 19 lantus, but the doctor recommended lowering the lantus to 17 and then increasing my ratios, my ratios were already 1:2, and the DAFNE rules say to never go above 1:2, so when he suggested this (hes new to dafne) i didnt feel very comfortable with it. SO i have increased it back up to 19 again, but nothing has changed so far.

Its such a frustrating thing, as at my last checkup my HBA1C was 7.5, it was just the mornings that was stopping it from being better. and i feel by lowering the lantus, iv lost that good number.

Thanks.
 
If you are Ok at weekends perhaps you have to look at what you do differently. Presumably at weekends you get up in a more leisurely manner.
My two pennoth' is perhaps its because when you get up and push your body into action , for what sounds like a hectic journey to work, it replies by supplying some(too much)glucose.Your lantus which kept your levels down overnight (though BG isn't that low first thing) isn't enough to be able to cope with this increased input.
Jopar suggests a small dose of rapid, I think that could work but I think it might be better to have a small amount to eat with that injection. If you have some glucose from food, perhaps the liver would be less likely to dump glucose.
 
I agree with jopar and pheonix. It's that very annoying dawn phenomenon in action. You need to give a correction dose of rapid insulin to counteract it whether or not you eat.

What is a reasonable thing is to give yourself eg one or two units of novo on waking and check the bs when you get to work. Have some jelly babies or similar on you so you can correct for any hypos on the way to work.

You can adjust the dose depending on results.
 
phoenix said:
If you are Ok at weekends perhaps you have to look at what you do differently. Presumably at weekends you get up in a more leisurely manner.
My two pennoth' is perhaps its because when you get up and push your body into action , for what sounds like a hectic journey to work, it replies by supplying some(too much)glucose.Your lantus which kept your levels down overnight (though BG isn't that low first thing) isn't enough to be able to cope with this increased input.
Jopar suggests a small dose of rapid, I think that could work but I think it might be better to have a small amount to eat with that injection. If you have some glucose from food, perhaps the liver would be less likely to dump glucose.
Click to expand...

Hi,

Thanks for all your help.

I will try to eat something in the morning before i travel and see what happens. I just think that if i do have to adjust every morning, this wont go down too well at my next review.

But i shall see how it goes.

Thanks ever so much for your help.
 
If you have to adjust every morning and it works, surely at your next review this will show good knowledge and understanding of your diabetes,a positive,I would have thought,not a negative.
 
Teasure_Ireland

Don't worry about your next review, if you try something and it works then it's right for you...

As my consultant told me back in september, there is no right or wrong way, the only right way is what works for you!

DAFNE is a very good foundation in becoming your own diabetic expert, it give guidlines to what happens in a high percentage of people... Most people who would need to go above the 1:2 ratio should be looking to see if there is a problem with there background insulin, interesting though as one of the lads on the DAFNE course I was on had a 1:3 ratio!

IF it is a case that you feel that you need to break the guidelines, then you should take another look to see if by chance you missed something, If you haven't then ensure that you proceed forward with caution (adjust by small amounts) check BG's regularly and have plenty of hypo kit with you to keep yourself safe...
 
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