High in Morning/Breakfast

[clarentina]

I'm 20yo female, been type 1 diabetic for 9 yrs, have been a forum lurker but this is my first post.

At the mo I am splitting Levemir 12u in the morning and before bed.
Having 12ish units of Humalog before meals, I'm not low carbing or anything but trying to be a bit healthy.
Doing DAFNE/carb counting in 1 weeks' time...can't wait!
...ANYWAY my question was I go so high after breakfast, most mornings are a total write off.
Cause it's been so high I've upped my morning dose to 14u. I only eat 2 slices of wholemeal toast with vegemite and spread. It's doing my nut in!
My specialist said that for that kind of meal I should be having 8 units maximum!
Totally confused.
If anyone experiences this too/has any advice for me, it would be much appreciated

Clare

 

[hanadr]

Is your specialist a diabetic? They talk authoritatively, with NO personal experience.
2 slices of toast would send my BG through the roof. I have scrambled eggs. 2 eggs beaten with a tablespoon of cream and a little butter. in a small glass basin. 90 seconds on full power, remove from microwave and whisk until fully cooked with residual heat. Delicious, and carb free. and even quicker than toast. 8)
A further question. what is your fasting Bg. Are you starting from a point that's higher than ideal?

 

[LittleSue]

12 Humalog with 2x wholemeal toast does sound a lot. Its common to need more insulin at breakfast than later in the day though. On the other hand are you sure you're not having a hypo/liver dump when the Humalog kicks in?

If your DAFNE course is an intensive week, next week, I'd avoid making big changes before then. Once you start DAFNE it should become clear what needs to change and whether your insulin:carb ratio changes during the day, or whether your 2 doses of Levemir need to be different. You could try different things for breakfast in case wheat (bread) gives you bigger spikes than other foods, but you need to carb count, otherwise you're not comparing like with like.

 

[clarentina]

Hanadr, I don't think I'd get on with a carb-free diet (yet). I think I am eventually going to try and reduce it but at the moment I don't think I'd have the energy on a couple of eggs(!). Will talk to the diabetes crew And yeah, I'm starting in the morning from levels I'm not proud of, I really hope to have this sorted and will be able to report back positive things.

LittleSue, thanks for the info, I thought it was loads of insulin!! What's a liver dump? Sounds scary. My dietician did suggest that I might be going low then high but I tested and it didn't seem to be the case. Can that even happen? I have tried doing my insulin 30mins before the meal and stuff like that but I am not getting anywhere with it
It's a conundrum!
Clare

 

[kegstore]

Hi Clare, carb counting really is the key as a T1, a lot of diabetics can get good blood numbers just by doing this and getting the insulin balance right. Hopefully you'll learn about your insulin/carb and correction ratios - which are so important - on the DAFNE course. I never cease to be amazed how T1 diabetics cope without this info. You'll be able to tailor your dose according to what you eat, which is kind of what your pancreas used to do!

You'd know about a liver dump if it happened to you - basically if you have a really bad hypo then your blood sugar goes so low that the liver dumps glycogen into the bloodstream as a last-ditch attempt to get your blood sugar up. I've had truly horrible hypos at night and woken to a bg level in the 30s, which is a bit scary, and felt pretty rough for the rest of the day. Best avoided!

Good luck on the course.

 

[LittleSue]

And yeah, I'm starting in the morning from levels I'm not proud of.....

LittleSue, thanks for the info, I thought it was loads of insulin!! What's a liver dump? Sounds scary. My dietician did suggest that I might be going low then high but I tested and it didn't seem to be the case. Can that even happen?
Clare

Yes liver dumps happen. As kegstore described, they are a rescue mechanism but tend to leave you feeling hungover.
Early morning liver dumps, or going high, due to wrong Levemir dose overnight, may explain your difficulties in the morning. You should find that once you get your Levemir dose right, post-breakfast control will improve. You may need an uneven Levemir split or maybe adjust the timings. DAFNE will help you with this, its the basis of DAFNE. (In order to enable safe mucking about with meal amounts/timings, you need your basal to keep you as level as possible, not letting bs drift up or driving you hypo.) Most clinics tend not to adjust basal doses accuratley enough because its time consuming. As long as you're not spiking up or crashing hypo too often, they tend to leave it at that. But getting it just right (with a half-unit pen if necessary) tends to make things more stable and predictable all round.

 

[howie]

hey clarentina,

i've been having the same trouble with my breakfast too, for the last few weeks. i thought it was cos i added a (very) small glass of orange juice to my usual 'porridge & peanut butter' but i left out the o-juice last few days and it made no difference.

i have one daily dose of levimer (14 units) before bed. ive only been diabetic for a few months but i can't remember waking up with a level that wasn't between 5 and 5.3 and i check every day, so that's sorted, but after breakfast i'm hitting 9's! so been thinking bout low carb breakfast too.

interesting to hear that it's common for people to need more insulin with breakfast cos i've not heard that but i have been wondering if that was the case.

do you wait for a while before eating after waking clarentina or do you eat straight away? cos i've been leaving it for a few hours recently which i guess could be a factor. i know my BG raises to 6 when i leave it a few hours pre brek. i think your liver gets going releasing more glucose when it anticipates waking and i'm guessing this carries on a bit throughout the morning (hence maybe peoples need for more insulin in mornings)

all best,
howie

 

[bmtest]

After breakfast to me is the critical period to watch especially if you like 2 shredded wheat and plenty of milk.

What I do and find is a safeguard is check you blood 1hr after breakfast in my case it is a 1hr commute to work so when I arrive I test and if needed inject fast acting Novorapid. For me no other problem periods arise if I do this, it is a practise I have done for years back in the days with my rocket metal and glass syringe.

Its simple stats and to start off with just key your readings into excel and do some analysis look at your activiy dose what you have eaten and eventually you can gauge what is the correct amount to give yourself without the risk. I must point out this method is not for everyone but I have found it gives results

Using the blood test actuals you punched Excel you will find you will be able to find your average reading for the month and should tie in with the clinics figure, I do not bother with this now but you may find it interesting it good for showing where control is needed.

 

[Kirsty-Marisa]

Hi Clarentina,
morning blood sugar levels are a direct resut of the previous evening's injections.
If you are finding your morning levels are high, it is the previous evening's long-acting insulin you need to increase.
DAFNE will be great for you, it gives you so much more freedom over what you eat!
I eat whatever I want, and just tailor my insulin to how much I consume. That way there are literally no restrictions to having Type 1 Diabetes, woo!
Take care,
Kirsty-Marisa

 

[howie]

personally my long-acting is sorted, added 1 unit to by brek this morning, still went high so did 1 unit correction dose and just went down to 2.7. but i walked to the chemist in between so that probs made the difference, probs would have been ok if i sat on my a*se.

think i'm just gonna go low carb breakfast now, just can't be bothered with preping anything in the mornings. but if it sorts my BG level then safe it'll be worth it.

howie

 

[Iambackwards]

Do you exercise much? I used to have problems with eating small amounts of carbs and was at a point where 12ui of novarapid wouldn't enough for 2 slices of toast, which made no sense to me at first.

Because we have to inject insulin into fat tissue, it takes longer than a non diabetic to get into our systems and start moving glucose out of the bloodstream. Because of this we need to stay as insulin sensitive as possible and 12ui of humalog for 2 slices of toast is a sign that you may be a bit resistant to insulin.

I know a lot of type 1 diabetics say that they aren't insulin resistant, because that is a symptom of type 2, but large doses of insulin will cause your cells to become more resistant. Being type 1 means we generally have more insulin in our bodies than a non diabetic, because the pancreas creates a perfect amount of insulin which gets to work as soon as glucose enters the blood stream, whereas type 1 diabetics are more likely to be feeding the insulin to avoid lows.

Luckily, you can change this by exercising and eating lower GI food for a while to improve how sensitive your body is and you could defiantly get to a point where 2ui or even less humalog is needed for the same breakfast. Insulin will also act faster the more sensitive you are, so 30 minutes to an hour after a meal you don't need to have spikes of 10mmol+, your sugar levels will always be in a healthy range.

The reason your specialist is saying you only need 8 units max for this type of meal is because they're used to people being more sensitive to insulin and might not even understand that everyone has a different level of insulin resistance/sensitivity.

I read a lot on these forums and other forums about how people are taking huge amounts of insulin to keep their sugar levels under control, but then there are other people who take tiny amounts of insulin and have similar diets. What's the difference? The first group are fairly resistant to insulin and the second are very sensitive to insulin. In my opinion insulin resistance is what makes type 1 diabetes so difficult to control which leads to most of the complications.

 

[Soundgen]

hi there not sure if this would help , but see the Benfotaimine thread http://www.diabetes.co.uk/diabetes-forum/viewtopic.php?f=1&t=9454 , one Insulin user said he hypod when taking Benfotiamine so gave up Ithink . instead of taking it and adjusting his Insulin level , this version of vitamin B1 cuts blood sugar !! , diabetics who get this high from Carbs may be lacking B1 , whereas ones who don't have such highs may have it available , it's worth a try

 

[howie]

i don't really agree that it's insulin resistance that makes diabetes hard to control, but it's defo true that exercise improves efficiency etc. and do you mean that bad control due to insulin resistance is the reason for complications or just the bad control you say comes with it? i'm sure if we surveyed some long-term type 1's their insulin requirements would not have changed significantly over the years. not enough to imply resistance anyway. providing your dosage is accurate you won't have much more insulin going round than a non-diabetic, just cos you have to maybe top-up with a glass of juice that we probably leave out at another time of the day. i would say it’s only when exercising when we're using too much insulin cos you can't just stop it going round as soon as you get going so you have to top up extra, but then most of my (non-diabetic) mates drink lucozade anyway with sport so naturally their bodies will produce that extra insulin needed when they down a bottle.

unless your overweight or got a particular pre-disposition or eating bare cakes with loadsa insulin i doubt it's insulin resistance. more likely thiamine deficiency like soundgen suggested, lack of efficiency or just different metabolic rate to others. then again it is possible so i'm not totally discrediting what iambackwards said cos their might be something to it, i just sounds like all T1's are doomed to T2 from what you're is saying.

basically i agree that it's sensitivity but not resistance that makes that difference, or possibly the lack of B1.

soundgen still bigging up the benfotiamine lol, i'm all for it for sure! getting myself some asap.


all best
howie

 

[kegstore]

Some have theorised that a feature of dawn phenomenon is insulin resistance, but I'm not so sure. I don't see why insulin resistance would be that transitory. There are plenty of hormonal changes taking place at night that offer a much clearer explanation. And just because you're on insulin doesn't mean you're doomed to dose more and more over the years. My daily insulin requirement has reduced slightly in the last 10 years, but that may have something to do with much tighter control. My complications are down to a quite appalling "management" (if you can call it that) of the condition during the early years...

VERY interested to read about Benfotiamine, lots more reading to do!

 

[Iambackwards]

The reason I say insulin resistance leads to bad control is because if I eat tons of carbs for a week and don't exercise, my insulin requirements go up. I need more basal and more bolus, because as I'm putting more insulin into my body my cells become more resistant. If after that week I switch my diet to a totally healthy diet, where all my foods have low GI, my insulin requirements are still high. I am more resistant to insulin now, than I was before I ate tons of carbs for a week.

In the second week, even though I'm eating healthy and avoiding high GI food, I'm still having to take large amounts of insulin to deal with small amounts of low GI foods. Now if on that first week I had eaten healthy, avoided high GI foods and exercised 5 times for an hour, I am much more sensitive to insulin when the second week starts. My insulin requirements have lowered and insulin reacts much faster in my body. This means after meals I don't spike at all and I'm constantly below 8mmol/l, whereas when I am insulin resistant even healthy meals make me spike to 12mmol/l+. This means my average sugar level is much, much better, along with all the health benefits of having less insulin in my system.