Increase in blood sugars in the late morning for no apparent reason

[phdiabetic]

Hey everyone, I have had type 1 diabetes for 1 year and am currently on 4 units of Lantus at night and Novorapid at mealtimes. Recently, I started getting pre-lunch numbers were too high (above 10) and my blood sugars started to increase about 3 hours after my breakfast. A couple of mornings have been really bad, with mid morning results (about 9 or 10 am) of 14.3 and 17.9. I have been managing this by taking extra correction doses of Novorapid, generally between 2 and 4 units throughout the morning, which seems to give good results.

Does anyone know why I might get a sudden increase in blood sugars in the late morning? I also noticed a similar but less pronounced increase in the 1-2 hours preceding dinner, although the pre-dinner numbers (6's-8's) were not as high as the pre-lunch ones.

A couple of things to note:

• My Lantus dose is correct as I usually get good pre-breakfast numbers (in the 5's) and a couple of times I have gone slightly low in the night, so I am reluctant to increase the Lantus
  
• I eat the same breakfast every day but this problem only started 2 weeks ago, so I don't think my food is an issue
  
• I don't think this is dawn phenomenon since my fasting numbers are good and it only happens after I've been awake a few hours
• I have not eaten anything between breakfast and lunch to cause the spike
• My cortisol is slightly high but my doctor is not concerned

 

[noblehead]

I would skip breakfast (and bolus dose) and test your bg up to lunch to see if it's a basal issue, if it isn't then it could be your I:C ratio needs adjusting.

 

[phdiabetic]

I would skip breakfast (and bolus dose) and test your bg up to lunch to see if it's a basal issue, if it isn't then it could be your I:C ratio needs adjusting.

Thanks, I actually suggested skipping breakfast to my doctor but she advises against it. My numbers are fine after breakfast, usually in the 7's, so I think my bolus is ok. If it is a basal issue, how could I fix it? I'm on MDI.

 

[noblehead]

Thanks, I actually suggested skipping breakfast to my doctor but she advises against it. My numbers are fine after breakfast, usually in the 7's, so I think my bolus is ok. If it is a basal issue, how could I fix it? I'm on MDI.

Basal testing is the foundation to good bg control, have a read of the following which explains how to do a basal test in different time frames:

http://www.salforddiabetescare.co.uk/index2.php?nav_id=1007

If it is a basal issue then discuss things with your DSN, but some people on MDI find that splitting their basal dose into 2 injections gives them a better & flatter 24 hour coverage.

 

[Kristin251]

I have the same issue. I eat and am steady for an hour or two but at 3 hours I peak. Not that high though. Ive tracked it to activity and coffee. However I cannot eat carbs and only very little protein if any. Generally I have half an avocado with celery and this helps emensly. I tolerate no carbs at all until lunch. Coffee too close to breakfast is an issue. I need to wait until late morning. I cannot do anything strenuous until late morning either.

 

[Phil-86]

Morning

I had the same issue. My nurse said it may be down to the 'honeymoon' period where you become a little resistant to it due to your pancreas waking. She also mentioned it could have been the final get hours of lantus effect writing off.

I've since moved my lantus to an AM shot and it has worked wonders. I'm on 24 Lantus in an AM and was on 10 novorapid pre meals until I moved my lantus shot to the morning. For some reason since then, I've not needed novorapid as bloods are stabilising (down to honeymoon the nurse thinks).

I've been t1d since November and had the same issues. All question and guess work and obviously support on places like this that helps.

Hope you find the solution.

Phil

 

[Helen_S-C]

Hi, I have been type 1 since January this year and I have this problem of spiking mid-morning. I take 12 lantus at night and then novorapid for meal times based on carb counting using the carbs and cals app - this isn't always accurate but I'm trying to be as organised as possible! In the recent weather my numbers have been high but recent weeks numbers have generally been sporadic - another issue of the honeymoon period I think!
My doc suggested splitting my lantus dose or taking it in the morning so you could try that. I find that something may work one day but not the next - nature of the beast???

 

[Diamattic]

It really depends on what you are eating, and how long after eating is it peaking.

Its easy to say that you haven't changed the meal so it must be something else but our bodies change and it might still be the meal. If you peaking within 4 hours of eating any food - its usually the food.

Overeating can lead to slower digestion which would shift your peak to longer after the meal, as can constipation, higher fat or protein content.

I would agree with Noblehead and skip breakfast for one day and see if it still increases at the same time. If it doesn't then you know its the meal, and maybe your morning carb ratio has changed.