Help massive weight gain with fiasp and tresiba doctors are saying it’s normal in three months

Clairewills123 said:

I can have have 40g of carbs for breakfast have a massive spike 1hr later at 17 1hr later at 3

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I have a T1 friend who can eat and inject for breakfasts like that. I found I'm not so lucky, any substantial carbs in the morning do exactly what you described for me.

Dropping to 3 two hours after your breakfast suggests your breakfast dose is too high.
Spiking to 17 suggests your breakfast acts quicker than your insulin.
Taking your breakfast insulin a bit earlier might reduce this spike, but be aware of hypos before eating, should you want to try!

For myself, I've simply given up on high carb breakfasts, it's just too much hassle and frustration to me. Have you considered eating less carbs for breakfast? This would reduce the amount of insulin you need for that meal, and might help with the weight gain as well.

When you first start insulin it's common to gain weight. But it's because all that food you eat is now being utilized. Before insulin you were peeing out a good amount of the calories you ate. If you are dropping later as @Antje77 has said, it's too big of a dose for what you ate, then you eat more because you have dropped too much.............another way to add to weight gain because you are eating more food.

I know I gained weight when I first started insulin too and they said don't worry about it, yea right, they don't have to be the ones to try to lose it later.

If sugars are going up too much from what you ate, for me it's a matter of the timing of my insulin. It's not a matter of increasing insulin or you end up dropping too much later. I prebolus half of what I think I will need 20-30 minutes before I eat. That way I can adjust the second dose to what I actually felt like eating. Some people only need to prebolus 10 minutes before and if it's higher fat maybe when you eat. You have to learn what works for you because we can all vary. Fiasp is quicker than what mostly I use, so you will have to learn your timing.

But the important thing to remember is you take insulin for what you eat, not end up eating for what you take. Too much food, then too much insulin and you gain weight. I also noticed you might have a thyroid issue? That just adds to the problem of easy weight gain. While one person can eat 3 full meals a day, another person blinks and gains weight. It's unfair but it is what it is.

I just want to add. I have DP (dawn phenomenon) which is an increase in BG level before you wake to get ready for the day or FOTF (foot on the floor) which is a BG increase right after you wake. And because of the hormone releases that cause it, it also makes you insulin resistant for a few hours after. I have a problem eating in the AM because of that and I overreact to food and it's way too hard to dose right for it, so I skip eating until noon.

A few things might help.

A. Adjust your breakfast timing. Say you want 40 Grams of Carbs - Eat 20 grams and then go for a walk and have the other 20 grams while you walk. Exercise makes you more insulin sensitive so you might need less and the spreading of the Carbs will probably stop the spike as the insulin and Carbs try meet each other.

B. Careful you are not eating to your Insulin dose, but rather dosing to what you eat. I am pretty Insulin sensitive and have found the NovoPen Eco helps as it does 0.5 Units.

As always when you do any exercise and that includes walking you have hypo treat with you.

It takes time to learn what works, good luck

I gained 20 kg over the first three months when I started insulin. To lose weight I had to reduce my calories and write everything into myfitnesspal.com and increase my exercise. I had always found weight loss easy before insulin. I now just have to work hard at it.
Hypos are dangerous. Injected insulin does not act like a normal person's insulin as it does not match the food you are eating. If you eat normally you will spike. On DAFNE we learn to ignore the spikes and as long as your blood sugar has returned to pre-meal levels 4 to 5 hours after injecting, your dose was correct. If you don't want to spike you have to not eat foods that are causing the spikes. (Don't take more fast-acting insulin as you will just hypo afterwards.) I just have coffee and cream for breakfast and eat low carb for my other meals.

One thing you might want to check out is what happens in the absence of food. As this will help you understand how best to approach the problem.

As described already you could be suffering from Dawn Phenomenon. I have this and after studying it for awhile it works something like this (for me). I have generally quite minimal needs for Basal insulin, however two hours before waking they increase dramatically, but the time I wake up and for about three hours they more than double.

As such a Flat Basal like Tresiba doesn’t really cope well with this. Furthermore, if I injected Fiasp in that three hour period it wouldn’t be as effective until my Basal requirements returned to a more normal level. The thing is Fiasp will last typically longer than three hours so getting a correct dose to fit the period where my Basal needs were spiking and later when they were not was challenging. But I couldn’t increase my Tresiba dose as it would be too high for the vast majority of the day.

I tried a few things

Pre-blousing for as long as I could without going low (as Bolus Insulin generally works slower when your Basal is insufficient)

Delaying eating Breakfast for as long as I could. So that way the Fiasp’s dose would active across a more stable basal profile.

Changing the time of my Tresiba injection until the evening so it would be at its strongest in the morning (even a flat basal like Tresiba has a peak).

Alternatively, eating Breakfast as quickly as possible and then introducing a snack before levels drop too low. (You really need a Libre for this one as the timing has to be quite precise).

@Clairewills123 I too am on Fiasp and Tresiba. However, I do not put weight on. I think there is more going on here. As others have mentioned your carb heavy breakfast and early morning routine with insulin. Do you have a Libre to see what is going on during the night? Like many of us it sounds like mornings come with insulin resistance. If you are eating to soak up the insulin, you need to step back to basics and take stock. Basal testing and looking at your food. Irritating but it may help.

@becca59 has a good point, if your basal is off, everything will be off.

A good link that explains how to basal test.

https://integrateddiabetes.com/basal-testing/

Clairewills123 said:

I’ve been taking fiasp now for around four months i carnt seem to get it right at all and it’s now really starting to affect me mentally I’ve gained a stone and half in three months and they keep saying this is normal which is making me worse
I can have have 40g of carbs for breakfast have a massive spike 1hr later at 17 1hr later at 3
Any advice greatly received

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I am very similar I have just start fiasp and I think it's doing the reserve it put my blood sugar higher, i think it take over 2hrs to get it down then it just keeps going down plus I have a slow acting levimir as well.