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High morning readings

Discussion in 'Insulin' started by jimmyf, Apr 7, 2018.

  1. jimmyf

    jimmyf Type 1 · Newbie

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    I have always struggled with high blood sugar readings in the morning, to try and tackle this my consultant has moved me from taking lantus before bed and when i wake up to toujeo just at bedtime but unfortunately my blood readings are now high teens early twenties, has anyone had a similar experience, is there anything i should be doing other than increasing the dose a couple of units each night until it corrects itself, any advice would be much appreciated.
     
  2. urbanracer

    urbanracer Type 1 · Moderator
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    Do you know when it starts to rise? Do you have a glucose monitoring device or have you done any finger pricks at night time.

    Asking this question because my Libre is showing that my BG starts to rise around 2am whilst I am asleep.
     
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  3. cool_blonde212003

    cool_blonde212003 Type 1 · Active Member

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    I agree a CGM or libre, even for a few weeks, would help identify what’s happening. I go into hypo during sleep sometimes but can wake up high - I would have never known this was happening if I hadn’t used a libre
     
  4. Cocobolo

    Cocobolo · Member

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    So many people do seem to have this high BG first thing. It is attributed to the liver providing a glucose boost during the night (unless midnight feasting!) and as such I see it as a natural way that the body protects itself. Known as dawn phenomenon, it is not well understood, like so many 'anomalies' diabetics are subject to. Readings in teens are not too alarming, as new advice does say that Hba1c of 10 is now acceptable, though not ideal, and is preferable to the drugs and doses needed to bring it down. The drugs companies may have influenced research to get these targets lower and lower on the grounds that it will lower risk of complications but this should always be balanced with the risks of harm from the drugs themselves, and sometimes, (eg Vioxx ) these are not always immediately known and there is some risk in that very aspect - I mean with ongoing new formulae that keep appearing on the market. Realistically, a truly valid trial should last 50 years or so and that would be impractical.
     
  5. LooperCat

    LooperCat Type 1 · Expert

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    Not just me, then? I wake around then, scan and see it’s beginning to rise so have to whack in a couple of units to keep it in range until the proper liver dump wakes me at around five...
     
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  6. TonyH1108

    TonyH1108 Type 1 · Newbie

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    I have the same problem. Only found out what it was when I went on the DAFNE course and borrowed a Libre meter and bought a sensor (expensive, but good). My morning reading ranges fro 12.0 to 19.0 and nothing I do changes that. I've been referred to Addenbrooks hospital in Cambridge for an insulin pump as I was told that unless I set my alarm for 3am every day and pop in a few units of Novorapid, I'll always wake with him readings. I'm not sure about a pump, but I do need to get some help as my Hba1c is never great!
    It would be worth asking if your GP will provide a CGM for a month to confirm it's the dawn phenomenon....
    Good luck
     
  7. urbanracer

    urbanracer Type 1 · Moderator
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    Are waking naturally or setting an alarm for the middle of the night?

    At the moment I seem to get a flat line overnight about once a fortnight and cannot identify a pattern. I tried upping my basal, not only did it not work but I was fighting off hypo's during the following day. The Libre shows that some nights I am peaking higher than 15mmol at around 2am, before a steady decline to a more respectable figure around 6am.

    @therower suggested to me to eat something before bed and bolus for it, which I've tried. It doesn't really seem to do anything for me.
     
  8. donnellysdogs

    donnellysdogs Type 1 · Master

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    Addenbrookes is good. Good luck.
     
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  9. LooperCat

    LooperCat Type 1 · Expert

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    D810124B-7F9D-417F-940B-03B43BFF6C58.jpeg
    I just wake up, with a bit of a jolt. I can see on the scanner that it’s just tipping upwards, and I’ve worked out how much Novorapid to take depending on what the BG is. The arrow in the pic shows where I woke up and injected. Think it was around 6.5mmol that morning. So when I wake up, I scan, and refer to a ready reckoned I worked out with a bit of trial & error (and dextrose!), and take a small shot of Novorapid. I took 1.5u that morning as it was between 6-7mmol. It works about 90% of the time.
     
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    #9 LooperCat, May 8, 2018 at 8:56 AM
    Last edited: May 8, 2018
  10. urbanracer

    urbanracer Type 1 · Moderator
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    Well if we're sharing,,,,

    upload_2018-5-8_9-27-33.png

    Actual readings show I was at:-
    7.5mmol at 23:50,
    10mmol at 1:45,
    12mmol by 04:40 - where I took a single unit, but didn't record it.

    Some nights I'm over 15mmol by 03:00.
     
  11. LooperCat

    LooperCat Type 1 · Expert

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    What basal are you on?
     
  12. scotteric

    scotteric Type 1 · Well-Known Member

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    Try Levemir, it has a slight peak and if you split it into 2 doses you can time your night dose for the peak to hit when you need it most. Also what do you eat for dinner? Some meals can hit you up to 6-8 hours later.
     
  13. scotteric

    scotteric Type 1 · Well-Known Member

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    This is nonsense, I've never heard of any organization saying an a1c of 10 is acceptable. Usually it is under 7 or 6.5, and even these targets are above normal. The poster is a type 1 and thus treats with insulin. There is no way running blood sugars in the teens is preferable to using more insulin.
     
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  14. urbanracer

    urbanracer Type 1 · Moderator
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    Abasaglar (Lantus biosimilar).
     
  15. urbanracer

    urbanracer Type 1 · Moderator
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    Thanks for the reply.

    Yesterday evening we did have some pasta about 8pm so it will have contributed to the rise and I'm aware of that. My problem is that there's no strong correlation because I see similar effects if I go virtually carb free with fish and side salad or an omelette.

    Then out of the blue my line will be flat at say 7 - 8mmol the whole night. Next day, back to normal.

    I think my basal is about right as my line will stay flat below 6mmol during the day if I don't eat, but as soon I eat/bolus everything goes squiffy.
     
  16. LooperCat

    LooperCat Type 1 · Expert

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    No good mate, you’ll just have to stop eating ;) In all seriousness though, the protein in the low carb meal could be raising it almost as much as the carbs in the pasta. Have you tried fasting for that meal to see if your liver dumps anyway at that time?
    Do you think a pump might help, or is it too unpredictable to set up a regime on one?
    Ten is an horrendous HbA1c target - that’s an average on-the-meter of over 13mmol! Was that sponsored by the foot amputation people, or the guide dog people? Levels like that pretty much guaranteee horrific complications...
     
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  17. LooperCat

    LooperCat Type 1 · Expert

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    Do you have a source for this new advice?
     
  18. donnellysdogs

    donnellysdogs Type 1 · Master

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    I believe that NICE actually state that it should NOT be accepted for people to be told to accept high waking levels....

    I will try to find link..
     
  19. donnellysdogs

    donnellysdogs Type 1 · Master

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    1.6.13 Advise adults with type 1 diabetes to aim for:
    a fasting plasma glucose level of 5–7 mmol/litre on waking and

    a plasma glucose level of 4–7 mmol/litre before meals at other times of the day. [new 2015]

    From NICE guidelines... dont know where 10 being acceptable is mentioned anywhere..
     
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  20. scotteric

    scotteric Type 1 · Well-Known Member

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    It's good for us to shout out dangerous nonsense like that. Not everything is a drug company conspiracy!
     
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