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Insulin and breakfast

Discussion in 'Type 1.5/LADA Diabetes' started by Kristin251, Dec 15, 2015.

  1. Kristin251

    Kristin251 LADA · Expert

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    Does anyone have a problem finding a BF to match BS? I cannot eat carbs or P at breakfast. If i eat C or P i go down then up etc and ride the roller coaster. I usually just have guacamole (avocado and sea salt smashed) and stay steady but at 3 hours I spike. I am VLC HF and about 40g P. I have to take insulin in the morning or I just keep going up.
    Thanks
     
  2. Shecat

    Shecat Type 1 · Well-Known Member

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    You could try eating a little less of your usual breakfast and monitor your sugars to see if it helps. You would have to wait 3 or 4 days to see any true difference
     
  3. cz_dave

    cz_dave Type 1 · Well-Known Member

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    Another small bolus to match the spike? I find that I often spike at around 11am no matter what I eat.

    Here is what usually works for me: I eat LC breakfast and bolus right after I have finished eating. Then I ride my bike to work which takes about 20 mins. By that time NovoRapid starts taking effect and peaks around 10:30 and so helps counter the morning spike.
     
  4. Kristin251

    Kristin251 LADA · Expert

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    Dave, I think you are my new BF! That is me. Stable, stable stable, 11:00 and peak! !/2 unit at least stops the rise. Can I ask how many points you spike after BF? Are you much better at L and D and don't need the extra? I was thinking about taking 1/2 2 hours after to see if I could head off the spike. Any experience?
    What do you eat for BF? I have tried EVERYTHING and like you it seems to not matter but anything with P will spike me more. I just eat guac but it doesn't matter if I eat 1/2 or whole or add some green beans. At 11 I am about 20 points higher. L and D I stay steady
     
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  5. cz_dave

    cz_dave Type 1 · Well-Known Member

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    Glad to know it's not just me. I found, just like you, the spike is not really caused by food. I usually eat a yoghurt with one or two pieces of my home-made almond cake (10g carbs total). However, I experienced these 11:00am BS rises also when I had breakfast with close to 0 carbs. So, I figured it is not related to the food.

    Now, the spikes I experience would be described as ridiculous in the context of T1. I would simply experience elevated BS until about 12:30. It is worse when I sleep longer, e.g. on weekends. I imagine it could be related to the liver dumping glucose in the morning, who knows...
     
  6. Kristin251

    Kristin251 LADA · Expert

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    I spike worse with any exercise in the morning, better for me at night but not too much. Challenging!
    How many points do you spike at BF? Do you drink coffee? I wonder about that but not sure I want to know....
    I think the lower I start the higher I spike...You??
     
  7. cz_dave

    cz_dave Type 1 · Well-Known Member

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    The same here. I have shifted any exercise to evenings. Like I wrote, my morning BS rise can hardly be described as a spike as I would go typically from 5.2 to just under 6. When I am coping well, I remain at 5.6 or I may go to 5.8. I am well aware that these numbers could be described as normal and I owe them to my honeymoon period and low-carb breakfast. When I would eat a carb-based breakfast, I would instantly hit 8-9 mmol even with increased bolus.

    So, for me, what's interesting, is the regularity of the morning BS rise and its independence of food that I eat. Also, it is not that the spike is high but rather its persistence - I can stay at 5.8 for a couple of hours without an obvious reason. Normal for me is at the lower level of 5, typically 5.2.

    I would not say that the lower I start, the higher I spike. But if I am stressed out in the morning, my BS definitely goes higher than normal.

    As for coffee, I think it should not raise your BS. However, someone noted that too much coffee in the morning could put your liver into motion and have it dump even more glucose into your bloodstream.

    I currently take 4 units of Levemir and bolus just one unit of NovoRapid immediately before I start eating. I would eat appprox. 10g carbs for breakfast, 15g for lunch and 20g for dinner.

    My current diagnosis is T1 in honeymoon.

    You?
     
  8. Kristin251

    Kristin251 LADA · Expert

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    Thanks Dave for your thorough explanation.
    as for me, I take one unit of Novolog per meal and 2 Lantus if below 94 and 3 if above, I am usually around 90-99 before bed. 2 keeps me very even and 3 can drop up to 20 so I need to contemplate any late protein etc that may or may not be there.
    I think if I drink coffee 1st thing I will spike because of cortisol/adrenaline and I have read coffee competes with insulin just like vitamin C. I know C spikes me as well. I seem to do better with coffee at least an hour after insulin and better after 2 hours still.
    I wasn't sure what you meant by ridiculous but I guess I am there too. I rarely see BS over 120 but after BF I can get into the teens. Fastings are usually in the 80's. So like you numbers are all great but it is that persistent morning spike that drives me crazy. I usually go into lunch around 92-100 and dinner as well. So I don't have many spikes during the day unless I over eat. The morning spike rarely comes down after 3 hours unless I take extra insulin. I think since DX I have no 'honeymoon' phase. I am too consistent everywhere but BF and too predictable. I can fast from BF to dinner (skipping lunch) with maybe a few nuts in between and I stay steady but BF drives me nuts! I feel the increase and I also feel the extra bolus and it feels like I am crawling out of my skin when BS moves and it makes me hungry. Interesting about stress in the morning vs other times of day. Animal protein makes me feel wonky at BF too. I will go down and then up so I don't eat it then, just lunch and dinner and keep it to small portions so I don't need to bolus again.
    For me the bike ride to work would spike me in the morning. Do you notice a difference on your days off with no bike ride?
    Can I ask how much animal protein you eat and what meals? BF for me is guac and celery, lunch is 2 oz P usually poultry, tuna or egg) and a handful of veg mixed with mustard/mayo dressing . Dinner is same with 3 oz P (mostly fish but occasionally lamb or beef) and a few more veg/small salad. snacks are a few macadamias, 2 or 3 olive or the little 1-1.5 oz guac I have left from BF. I KNOW P spikes me as much as carbs.
    Have you ever split basal? I have considered it but fear I will go low the rest of the day. Novolog is much more predictable.
     
  9. cz_dave

    cz_dave Type 1 · Well-Known Member

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    Hi Kristin,

    I think the predictability we enjoy is based on the fact that we still have quite a lot of our own insulin. Low-carbing helps too for sure. Based on what you are writing, I think I have a very similar diet like you. By the way, I have not noticed any major BG spikes caused by proteins but may be I just was not attentive enough. I eat all types of protein, including animal. I just try to limit saturated fats, as I also have issues with high LDL cholesterol. I try to eat a lot of fish, poultry and enjoy red meat, cream and cheese only occassionally.

    I am 41 and have just recently "celebrated" my first year with diabetes. Whenever I see my doctor, he keeps reminding me that the current predictability of my BG will unfortunately not last forever. In fact he has never mentioned LADA, he classifies me as Type 1 in the honeymoon period. You?
     
  10. Kristin251

    Kristin251 LADA · Expert

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    Hi Dave,
    I have no official diagnosis but feel I don't produce any insulin as I never come back down after 3 hours when supposedly insulin runs out. I also see more than just trends but specifics. If I eat the same type (macros) meal everyday I see the same results. I think if I was still producing my own insulin I would randomly see different results. So I consider myself a T1. I am 51 and celebrated my one year anniversary with a pair of strappy sandals 6 months ago. On that beautiful day I didn't know if I should laugh or cry so I shopped, haha. At DX my BG was 550 and GAD was over 250 so that also says I produce no inulin. Just an FYI, my endo told me he wanted to take me off insulin and get a c peptide test because my BG was so good and I barely take any insulin but his nurse reminded him of my GAD so he said never mind and told me I was one of his best controlled diabetic and my BG was better than his. What ever that means. I think our roads do run parallel as I too have higher LDL but also high HDL. Limiting red meats and dairy in exchange for fish and poultry helped but LDL is not low. I don't worry too much about CHO because my ratios are all ideal and my Dad always had low CHO as well as lots of heart disease and my Moms has always been high and no heart issues. They are 85.

    My main goal is to keep insulin levels low so that is why I eat the way I do. I think you eat a few more carbs than me but I also think given you are not a woman and most likely have more muscle than me you can eat it without issue. It would be interesting to see if you are effected by protein. Do you eat large quantities? I keep my daily total to around 4-5 ounces a day split between L and D. I can eat extra occasionally but it does seem as I then 'store' it and BG will go higher until I deplete some glycogen.

    How much insulin do you take at meals and the extra bolus at around 11?
    I also find a small glass of scotch or a glass of red wine with dinner helps.
    Funny thing is a you mentioned waking up later and being higher happened to me today. I woke up an hour later and fasting was 20 pts higher. I ate the same guac BF and came down then up again 3 hours later. I could not eat yogurt for BF because dairy makes me insulin resistant. I wish I could.
     
  11. cz_dave

    cz_dave Type 1 · Well-Known Member

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    You are right, there seem to be a lot of similarities between us. By the way, I had the c-peptide test taken and it revealed I still have quite a bit of my own insulin. It is already below what's normal but not that much. Someone pointed out that us, LADAs, have a significantly impaired bolus ability but the ability to keep our BG levels steady outside of mealtimes is quite good. This is very true for me. I would think you are in the same boat.

    As for protein, I never ate a lot of protein and in fact I tried to increase a little bit on it after going low-carb. Still, I think my protein input is not above 100g/day. Eating these moderate quantities does not seem to have any noticeable effect on my BG.

    And yes, when I drink alcohol in the evening, I also tend to haves slightly lower readings the next morning. In fact I like to have a wine every other evening.

    Now, the extra bolus to counter the 11am BG increase was just an idea. I have only done it once - recently - when I had a flu and my BG was running higher than usual and it worked very well on that occassion. Normally, the increase is not as high to justify an extra bolus. Also, recently these morning spikes were not as profound as they used to be - perhaps due to the evening glass(es) of wine? :)
     
  12. Kristin251

    Kristin251 LADA · Expert

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    Seems there is one big difference between us and that is that my GAD test was over 250 meaning I make none of my own insulin. So at about the 3 hour point after injection I will not come back down without an additional bolus. I do tend to need 1/2 unit around 11 am if I eat around 8. Exercise will raise me and I will not come back down without additional insulin either. I can keep my BS great within meals is it outside of meals that becomes random. I still struggle with the right BF but as you mentioned it is not always food in the mornings.
    As far as protein with you it could help eating it because it does cause a rise in insulin (which I don't have) . When I was a T2 and had a little high reading or after exercise I would eat a few nuts (about 3) and it would be enough to elicit an insulin reaction and bring me back down because it also was not enough to raise BG. I have a friend who plays tennis and always pops up and started eating 3 macadamias and she always comes back down now. Funny trick.
    Yes, wine is my friend. I do have a glass every night. I like to keep every thing consistent haha
    One thing I am not sure of is it is said that is more important to keep insulin low than BS but I am not sure how to keep BS low without insulin. I understand I take extremely low doses (1 unit at meals and 2-3 basal) but I still don't know how to fix higher BG without insulin if I pop up. Maybe this applies to people who are IR and not so much me?? Thoughts?
     
  13. tim2000s

    tim2000s Type 1 · Expert
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    Hi @Kristin251, a high GAD result doesn't mean you don't produce any insulin, just that you show a lot of the antibodies. Have you had a c-peptide test done? You may be surprised at the outcome!
     
  14. Kristin251

    Kristin251 LADA · Expert

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    Interesting Tim. I will ask for one in Jan but he seemed to think with a GAD that high I didn't need one but now you have peaked my curiosity!
     
  15. cz_dave

    cz_dave Type 1 · Well-Known Member

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    Just to let you know, it has been a week that I started splitting my basal. I went from 4 units Levemir total to 4 evening + 3 morning. So, I have in fact increased it. I have also slightly increased my carb intake without increasing my bolus. It seems I get more stable BS like this.
     
  16. Kristin251

    Kristin251 LADA · Expert

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    Good to know! I have been experimenting with timing my insulin and it seems to be helping however I also started yoga again and ditched the nuts so who knows what is working, haha. I am taking my insulin 6-10 min prior to eating BF and then doing yoga an hour later and not eating nuts between BF and lunch. I also take my lunch bolus before I start making it and am down before dinner. Who knows what is working....
    Could it be body temp in 1 degree weather??? YUK
     
  17. tim2000s

    tim2000s Type 1 · Expert
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    Unfortunately, the only way to really identify what works is to change one thing at a time and observe. FWIW, I've never found that Yoga, Bikram or otherwise, has lowered my BG levels.
     
  18. Kristin251

    Kristin251 LADA · Expert

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    I agree about yoga. One of the most frustrating things for me is the inability to do any form of exercise and not see an increase. And when I do see an increase it is always at random times. For now I am keeping it to 15 min of stretching 1 hour after BF so I have some food and some insulin still, and nothing intense so I am not seeing an increase and at least I am doing something. Even a brisk walk raises me.
    It does seem taking insulin earlier is helping and perhaps the fat in the nuts not keeping me higher longer or creating any IR.
    Thanks for your help Tim. You are a man of reason!
     
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