Type 2 Extremely sluggish insulin in the morning

[JayF]

Hi. I'm a type 2 diabetic and have been on insulin for more years than I can remember. During the night my readings are fine. As my HbA1c readings have been creeping up over the last couple of years, I decided to self-fund the Freestyle Libre Sensor and what an eye opener this has been. As soon as I wake (feet on the floor), my blood sugars start to rise. I am normally on an insulin:carb ratio of 1:10 g which works fine at lunch and dinner. In the morning after breakfast (60g carbs - wholemeal toast and a slice of melon), this dose does not even touch the sides. On the advice of the DSN I have doubled my Novorapid dose but am still getting post meal spikes between 13 and 15. Today I have taken 2.5 NR but a spike of 12.4 (so somewhat lower). Btw I am bolusing 15 to 60 minutes before eating at breakfast, and even waiting an hour has no effect whatsoever on my blood sugars! I will be monitoring this "new" dose for the next couple of days and possibly change to trebling my NR dose. The DSN has confirmed that with these morning spikes, it was no wonder my HbA1c were going higher and higher. I am getting so despondent with all this but trying to not let it get the better of me.

Has anyone else had this experience? Is my body ultra sensitive to insulin in the morning? Are there any tips/tricks to kick start my metabolism? Should I switch to Fiasp? Or is a question of just accepting these spikes in the morning rather than injecting huge amounts of insulin into my body which are doing nothing but going where?

Thanks everyone.

 

[xfieldok]

Have you considered lowering your carbs?

 

[JayF]

Have you considered lowering your carbs?

Might be something to consider if, at the end of my "trials", nothing else seems to work

 

[xfieldok]

Going back to the beginning, we warn newbies about the dawn phenomenon, the liver dumps to help us get going. It's the last number to come down.

The freestyle is really helpful, I kept forgetting the time lag which confused me at the beginning. You still need to fingerprick, the freestyle is notoriously inaccurate under 4.

Most of us eat lchf to control our numbers. You might want to look into it.

 

[mike@work]

As soon as I wake (feet on the floor), my blood sugars start to rise. I am normally on an insulin:carb ratio of 1:10 g which works fine at lunch and dinner. In the morning after breakfast (60g carbs - wholemeal toast and a slice of melon), this dose does not even touch the sides. On the advice of the DSN I have doubled my Novorapid dose but am still getting post meal spikes between 13 and 15. Today I have taken 2.5 NR but a spike of 12.4 (so somewhat lower). Btw I am bolusing 15 to 60 minutes before eating at breakfast, and even waiting an hour has no effect whatsoever on my blood sugars! I will be monitoring this "new" dose for the next couple of days and possibly change to trebling my NR dose. The DSN has confirmed that with these morning spikes, it was no wonder my HbA1c were going higher and higher. I am getting so despondent with all this but trying to not let it get the better of me.

Has anyone else had this experience? Is my body ultra sensitive to insulin in the morning? Are there any tips/tricks to kick start my metabolism? Should I switch to Fiasp? Or is a question of just accepting these spikes in the morning rather than injecting huge amounts of insulin into my body which are doing nothing but going where?

Thanks everyone.

I would also spike horribly, if I ate bread in the morning - agree with @xfieldok here above. Try to get your amount of carbs down, but be careful, that the amount of Insulin you use, also follows..

 

[Resurgam]

Are you not producing insulin and being given advice as for a type one?
A typical breakfast for me - an ordinary type two on no medication is a tomato and stick of celery along with the meat or fish of the day. Even if making a 'high carb' choice it would be no more than 10gm of carbs.
Starting the day on what would be, for me almost two whole days worth of carbs seems wrong, really. Perhaps your nurse has got no idea of how type twos beat diabetes.

 

[JayF]

I was first diagnosed in June 1994. I suspect that my pancreas now produces little or no insulin at all . So I'm on 3 x NR at mealtimes and Lantus at bedtime. I bolus 15 to 30 minutes before eating which works for lunch and dinner. I even bolused 1 hr before breakfast a few days ago as an experiment but nothing changed. I even tried reducing carbs, again with no movement.

I will keep experimenting with my breakfast insulin dose (double, 2.5, treble etc) and see where that takes me. Otherwise I may ask to try Fiasp to see whether that makes a difference.

 

[xfieldok]

What are you eating in a typical day, yesterday for example?

I looked up a very old post of yours and your diet would have been horrendous for me.

Could you have something like bacon and eggs for breakfast, next to zero carbs.

 

[Resurgam]

But has your insulin production ever been checked?
Type twos are notoriously insulin resistant, which makes eating low carb the sensible thing for many. As you are increasing insulin injections to deal with a high intake of carbs, and it seems ineffectual insulin resistance seems possible - even likely.

 

[JayF]

B'fast: 2 slices wholemeal toast - one with Serrano ham, one with Leerdammer cheese slice. Portion of Galia melon. About 50-60 g carbs
Lunch: Wholemeal pitta, cucumber, ham, tomatoes. Fresh apple or stewed (with sweetener). About 50 g carbs
Dinner: Meat, fish or poultry, veggies or salad, small portion of potatoes, pasta or rice. Yoghurt with fruit (sometimes ice cream!). About 60 - 80 g carbs.
I drink water, tea (milk no sugar) or herbal teas. No coffee.

My old post was interesting, even for me to read now!! I guess our bodies change over time and bits stop working etc. Since then I have been on insulin and Byetta (exanatide) which gave good results initially but after 3-4 years started giving me horrendous unexplained and explosive diarrhoea so that got stopped. Perhaps something to do with the slow release of food through the gastric system?

Am now on Lantus, NR, metformin and empagliflozin.

If all else fails, will need to review my breakfast which, for me, is my favourite meal of the day but even reducing carbs and, consequently, the insulin, has had no effect on my blood sugars.

 

[JayF]

But has your insulin production ever been checked?
Type twos are notoriously insulin resistant, which makes eating low carb the sensible thing for many. As you are increasing insulin injections to deal with a high intake of carbs, and it seems ineffectual insulin resistance seems possible - even likely.

Not recently. About 20 years ago my body was diagnosed as being insulin resistant. I lost a lot of weight with Reductil (now withdrawn from the market) and since then I have managed to keep the weight off. As mentioned in my previous post, over the years I''ve been on various forms of drugs, insulin etc. and my beta cells produce very little or nothing at all. As the consultant said it's like trying to flog a dead horse!

 

[xfieldok]

For me, your diet is dire.

Your breakfast carbs would be my allowance for several days.

I would go back to fingerprick testing before you eat and 2 hours after the first bite. If the rise is more than 2 then you had too many carbs.

 

[lucylocket61]

B'fast: 2 slices wholemeal toast - one with Serrano ham, one with Leerdammer cheese slice. Portion of Galia melon. About 50-60 g carbs
Lunch: Wholemeal pitta, cucumber, ham, tomatoes. Fresh apple or stewed (with sweetener). About 50 g carbs
Dinner: Meat, fish or poultry, veggies or salad, small portion of potatoes, pasta or rice. Yoghurt with fruit (sometimes ice cream!). About 60 - 80 g carbs.
I drink water, tea (milk no sugar) or herbal teas. No coffee.

My old post was interesting, even for me to read now!! I guess our bodies change over time and bits stop working etc. Since then I have been on insulin and Byetta (exanatide) which gave good results initially but after 3-4 years started giving me horrendous unexplained and explosive diarrhoea so that got stopped. Perhaps something to do with the slow release of food through the gastric system?

Am now on Lantus, NR, metformin and empagliflozin.

If all else fails, will need to review my breakfast which, for me, is my favourite meal of the day but even reducing carbs and, consequently, the insulin, has had no effect on my blood sugars.

Why are you eating so many carbs? I also think you are not counting all the carbs in the fruit correctly.

 

[xfieldok]

@lucylocket61 the OP was diagnosed in 1994 and was probably given rubbish dietary advice.

 

[JayF]

Why are you eating so many carbs? I also think you are not counting all the carbs in the fruit correctly.

Obviously eating some carbs is a choice I make . I have been counting these for many years now and it has always worked, up until now where my body seems to be more insulin resistant in the morning. Just to confirm my insulin ratio 1:10 g carbs at lunch and dinner (about 5-8 units NR for each) is spot on.

 

[KK123]

I was first diagnosed in June 1994. I suspect that my pancreas now produces little or no insulin at all . So I'm on 3 x NR at mealtimes and Lantus at bedtime. I bolus 15 to 30 minutes before eating which works for lunch and dinner. I even bolused 1 hr before breakfast a few days ago as an experiment but nothing changed. I even tried reducing carbs, again with no movement.

I will keep experimenting with my breakfast insulin dose (double, 2.5, treble etc) and see where that takes me. Otherwise I may ask to try Fiasp to see whether that makes a difference.

Hi Jay, it's hard isn't it when you are trying to balance insulin with carbs! I note many are saying 'why are you eating so many carbs' as if somehow you are at fault. I get that they are trying to help and are looking at you as a type 2 and may also be thinking 'Why are you on insulin' etc, but you have been on insulin for nearly 30 years. Back then a person was classified as being collectively diabetic, 'on insulin or not'. My Mum came into the 'diabetic on insulin' group and to this day her records never mentioned either type 1 or 2 (I suspect type 1). Had someone now (30 years later) given her typical advice for 'type 2' she would likely have been very ill within a week.

I think you should be very careful about how people were diagnosed 30 years ago and trying to apply today's rules, I suspect you were already an adult 30 years ago at a time when they thought only children could be classed as type 1, now we know different and hopefully the tests you have had do show you are not producing enough (if any) insulin. You're labelled as type 2 on insulin (thanks to old & ignorant diagnosing) but you may have been type 1/lada etc).

Having said all of that, you seem to be on around 150 -180 carbs (a low carb diet is around 130 carbs or less).I find that if I stick to a lower carb diet it is easier to manage my insulin so maybe you could start off with even lower carb meals and work your way up to see what you can tolerate in conjunction with your insulin, (don't forget to test, test, test though especially if you are eating fewer carbs.

Once you sort of start from scratch you might be able to get to a point where the balance is easier to maintain. x

 

[KK123]

@lucylocket61 the OP was diagnosed in 1994 and was probably given rubbish dietary advice.

or she was actually type 1/lada in the first place but due to how people were diagnosed back then, it's likely they thought ONLY children could be type 1 so everyone else must be 'type 2 on insulin'.

 

[JayF]

Hi Jay, it's hard isn't it when you are trying to balance insulin with carbs! I note many are saying 'why are you eating so many carbs' as if somehow you are at fault. I get that they are trying to help and are looking at you as a type 2 and may also be thinking 'Why are you on insulin' etc, but you have been on insulin for nearly 30 years. Back then a person was classified as being collectively diabetic, 'on insulin or not'. My Mum came into the 'diabetic on insulin' group and to this day her records never mentioned either type 1 or 2 (I suspect type 1). Had someone now (30 years later) given her typical advice for 'type 2' she would likely have been very ill within a week.

I think you should be very careful about how people were diagnosed 30 years ago and trying to apply today's rules, I suspect you were already an adult 30 years ago at a time when they thought only children could be classed as type 1, now we know different and hopefully the tests you have had do show you are not producing enough (if any) insulin. You're labelled as type 2 on insulin (thanks to old & ignorant diagnosing) but you may have been type 1/lada etc).

Having said all of that, you seem to be on around 150 -180 carbs (a low carb diet is around 130 carbs or less).I find that if I stick to a lower carb diet it is easier to manage my insulin so maybe you could start off with even lower carb meals and work your way up to see what you can tolerate in conjunction with your insulin, (don't forget to test, test, test though especially if you are eating fewer carbs.

Once you sort of start from scratch you might be able to get to a point where the balance is easier to maintain. x

Thank you

 

[Flora123]

I would also spike horribly, if I ate bread in the morning - agree with @xfieldok here above. Try to get your amount of carbs down, but be careful, that the amount of Insulin you use, also follows..

I’m the same. I just can’t eat carbs in the morning. It’s a disaster for my BG.

 

[lucylocket61]

I note many are saying 'why are you eating so many carbs' as if somehow you are at fault

Thats was me. I am not being harsh. My tone has been misread. I am asking a question. Some people, myself included, have to eat more carbs than others due to other medical conditions. If this is the case with the OP, then its important to know that.