high morning levels (Confused)

Dawn Phenomenon and Liver Dumps.

A link from Bristol Diabetes.
http://www.brist.plus.com/what-dawn-phenomenon.htm They are both very similar, just have different names because they are usually at different times. The same biological process.

Another link from the Mayo Clinic about the subject......many more available which explain the process:
http://www.mayoclinic.com/health/dawn-effect/AN01213

Nocturnal hypoglycemia (low blood sugars), followed by morning hyperglycemia (high blood sugars) for several nights is an indication of the Somogyi effect. It may be necessary to get help from a doctor to resolve it, because most cases are the result of medications that are mismatched to the patient's needs.

THE SOMOGYI EFFECT
Also known as “rebound hyperglycemia” and named after the physician who first described it, the Somogyi effect is a pattern of undetected hypoglycemia followed by hyperglycemia. Typically, this happens in the middle of the night, but can also occur when too much insulin is circulating in the system. The cause of the Somogyi effect is said to be “man-made”—that is, a result of insulin or diabetes pills working too strongly at the wrong time.

During periods of hypoglycemia, the body releases hormones which cause a chain reaction to release stored glucose. The end result is that the glucose level can swing too high in the other direction, causing hyperglycemia.

How can you test for the Somogyi effect?
This is the fun part. Set your alarm and wake up between 2 and 3 a.m. and test your blood glucose. Low blood glucose levels could signify the Somogyi effect is in action.

Oh yes, I too have experienced Dawn Phenomenon and Liver dumps, many times over the years. They can happen to anybody, diabetic or not... :wink:

I can have anything from no novorapid if don't fancy eating (it sometimes happens), to maybe 12 units of novorapid per day - because I only have half a unit per 10g of carbs. So a normal, healthy diet with the odd treat here and there can be easily covered by relatively small amounts for some people, definitely. Since diagnosis 2yrs ago my HbA1cs have hovered between 7.0% and 7.4% with one irritating spike up to 8.0%. The first year I honeymooned so I suppose it doesn't count but I've seen no real difference since it ended.

The GI of your meal is taken together - so the other food will have the effect of lowering the GI of the OJ. Plus, if you have butter/marg on your toast, the fat in that will further slow down the absorption of the glucose you're eating. OJ is also a natural sugar so it acts slower than eg lucozade or coke. So your brekkie sounds fine from that standpoint. I once had OJ for a hypo in the low 2s and thought it was rubbish, it worked so slowly that I eventually panicked and ended up eating loads more than I should have, so I'll only use that as a last resort in future.

A type 1 diabetic, can, and should, have the tools, knowledge and freedom to eat whatever they want and that is where DAFNE comes in. The only thing I would class as to be only used for hypo treatments, rather than as a foodstuff also, is Glucogel. Everything else is edible, and type 1s can eat it as and when they wish as long as they think about it properly and, ultimately, work out the correct insulin dose. A meal of pure sugar, eg a bag of jelly babies and some coca cola, might cause a problem as it will be quick in, quick out, but your insulin will last longer. I would never risk doing something like that close to bedtime, for example, when I wouldn't be awake to spot any potential hypo afterwards. Sensibleness is the order of the day, along with knowledge of the GI value of your complete meal (where possible) and your insulin profile (novorapid is quoted at 2-5hrs however my team assure me it can last up to 6hrs as per the evidence they see in front of them, from real people). So it's not exactly as simple as counting some units for a can of coke, but it can certainly be done and you can have whatever you like, with a little thought. I wouldn't suggest a bad diet for anyone, diabetic or not, so I only have treats in moderation, but if I want something I just have it. I'd like to see someone try to take my Pret carrot cake off me once I've decided to have it!!!! :lol:

On the original point of this thread, the same thing happens to me - and only on work days. It's the very act of going to work that makes my levels rise by the time I get there. I just correct for the rise when I eat on arrival, which means I've only had the spike for a short while (30mins maybe). It happens even if I inject before leaving, so I don't bother any more. It simply doesn't happen at weekends, whatever I do. It's got nothing at all to do with my insulin, it's just work itself, and the stress of London Transport I presume....

LWA

You have had the answer several times in this thread but it just doesn't seem to have sunk in.
It's simple really, EAT BEFORE YOU LEAVE FOR WORK ! This way you will not liver dump. :roll: :roll:

Hi Silverfox,

I see what you're saying but the thing is, it doesn't happen when I do stuff at weekends without eating first. My liver can't magically know the difference between eg going to the shops or going round the park, and going to work? I often don't eat before going out at weekends, I don't like eating for the first few hrs I'm up, and always have lucozade and a cereal bar with me plus more when I go out, just in case of a hypo. But I don't go high or low - I just stay stable at weekends, it's quite comforting, I can bumble about and do whatever I want without fear or food if I don't feel like it. I often don't eat until 9 or 10pm on a saturday.

I know that I find my job stressful, and I know that when I arrive it's going to be crazy busy and I do dread it. When I had an extremely bad situation at work before xmas, for the first two days I shot up while I was sitting on the tube, from about 6 to about 15. I know it was stress because of what was about to happen, and I proceeded to have a panic attack over the situation about an hour after I got there on the first of those days. So I put these regular spikes down to it just being a stressful job that I don't like, that's too tiring for me (I have CFS/PVFS), plus as I say, negotiating the perils of the journey. Rather than worry about it I just now add that correction in when I start eating. It doesn't happen every day, but the majority of them.

I've eaten before work a few times, but, as I haven't been about to eat again on arrival I haven't tested, plus I'd naturally go higher for a bit after food too, so I don't know if a test on arrival on those days would say anything useful? Someone somewhere here mentioned what she called 'the almond trick', she said you can try eating a few almonds before leaving the house and it can keep a liver dump at bay. I tried it but it didn't work for me maybe LWA you could give it a go and see? If it is stress-related, I think that could explain the extra trouble bringing the numbers down, because of the action of the stress hormones, if memory serves. Could you try having a unit or two before leaving the house (with hypo treatment on you just in case)?

It's up to you to eat or not - if you can't stomach it, then you're right to try to find a solution if possible. Both me and my manager are type 1s and he's had it over 30yrs, he's exactly the same, can't eat in the morning. He doesn't test regularly though, so I can't say if he spikes or not!

y

y

Hi there,

I think that's a little bit unfair CarbsRok, because the way I've read it, you've suggested DAFNE and queried LWA's carb counting/insulin adjustments and all he/she has done is answer your questions and agree a DAFNE course would be a good idea. I don't sense any idea here of LWA not listening or not taking kindly to your advice, in fact I feel it has given LWA food for thought indeed. As you and I know, a DAFNE course would enable LWA to understand (and undergo, during the course) basal testing. It's all fine, and just remember, LWA is not the only one reading your posts - any information you give could be just the thing that an anonymous forum-user needs to hear. I think it's fair to say I have heard elsewhere that not eating + moving about can cause its own little liver dump, unrelated to a hypo, which is where I heard about the almonds thing from, so I take your point but that doesn't lead me to think LWA isn't listening or is ungrateful.

I do know that when I wake up with readings about 5 or below (ie, below DAFNE targets, irritatingly), I do not get the spike on the way to work, I just get the result of the coffee + honey that I treat myself with before leaving. Interesting! Now that makes me think - many diabetics need double the amount of QA in the mornings compared to evenings. Maybe, just maybe, this has happened to you LWA and you might be having a cup of tea/coffee or two before leaving, and maybe the milk is having more of an effect than you realise? Maybe at weekends you don't feel the need to do have tea/coffee because you don't have to be alert for work? Just a thought/idea.

I did discuss this several times on my DAFNE course and the nurses weren't too bothered, because of the short amount of time it lasts for, and my HbA1cs are good, and as I said we ruled out a million causes for it. However, as LWA knows, it makes you feel a bit rubbish while the spike is sorting itself out, so finding the way forward is the key. I agree CarbsRok that a little novorapid is one potential solution, although it didn't work for me we're all individual and it might well work for LWA. I am grateful for your knowledge on the 80%/2hr mark - I didn't know that figure and that's extremely useful information.

LWA I hope you find an answer - and to see if stress is the cause, can you try listening to calming music on the way to work, have a bit of quick-acting before leaving and see what happens over, say, two weeks? It's understandable that you don't want to change your BI because if the readings are inconsistent, a rise in BI or a split dose with a resultant peak in the morning could cause problems on those days when it doesn't happen (although, maybe, you could dose adjust for the weekends?). The idea of DAFNE is to let you eat whenever and whatever you like, so you shouldn't have to eat before leaving if you don't want to. But, yes, sometimes the result for some people is that you simply have to do different things on work days compared to weekends, and that's the only answer. One size doesn't fit all with us, because we all have different (and changing) bodies, minds and lives. And after 23 years of this, I'm thrilled for you that this is what seems to be the only trouble you're having and I sincerely hope I can equal you at the 23yr mark

Hi LWA,

Glad to be of some help! You're right about striving for perfection - that can only suit a certain proportion of the diabetic population unfortunately. It's simply not possible for most people, and my team at King's don't judge me or make me feel bad if I get it so-called 'wrong'. Sometimes, other things are at play of which we are unaware, eg unacknowledged stress, or monthly cycles (for women only of course!!).

Moonstone

Dawn Phenomenon and Liver Dumps ARE very similar processes, just at different times.........they are both automatic processes of the body which will cause Bg levels to rise, especially in the circumstances you posted about. They have been explained fully in previous posts.

LWA said:

I normally wake with perfect levels (between 4-6) and start work at 8am 'prior' to having insulin/breakfast at 9.30am. My problem is that 'before' i do my pre breakfast injection my blood will already have risen from anywhere between 8-10. As a result my mid morning levels remain high (Sometimes peaking at 16) prior to dropping to normal around mid-day. i use Novorapid and inject 20/30 mins before eating!

My observations/Theories are as follows but ANY HELP WOULD BE MOST USEFUL?:-
1) i've heard of liver dumps but can't accept this happens the same 'most' days?
2) Could 'stress' in first 1.5 hours at work be the cause.....if so i think i will quit work!!??
3) I use currently use 33units Levimir at night.....does anyone believe changing to lantus may help?
4) Could eating nearer to injection time possibly help?
5) Does insulin 'generally' absorb slower in the body at mornings rather than other periods of the day
For information i inject 10 units of Novorapid and only comsume 1no toast, poached egg and very small glass of natural orange juise so i cannot really accopt that i need to increase morning insulin?

Click to expand...

well im a type1 on lantus 16 units once a day at 5pm. in the mornings before b/fast novorapid 10 units my readings are between 5.9 to 6.7 10 minutes before b/fast c/o 2 x toast and 1 cup of tea no sugar and powdered milk. then a lunch 12.00 pm 1 x novorapid 10units and 1x novorapid 10 units at 5pm also i dont eat eggs at all now or natural orange juice..