Just some thoughts on insulin sensitivity (it's so weird!)

[Hannah Robyn]

just going to ramble about my experience with heavy insulin resistance in the morning despite my otherwise very insulin sensitive day!

i'm a type 1 on 5 units of Tresiba basal, it works well. In the afternoon or evening, I rend to only need about 1 unit of rapid insulin for 30-40g of carbs!!! There's been times when i've been fine on 2 units for 100g of carbs in the evening.

However, in the morning, i need about 1:10 or 1:8 insulin:carbs and unless i do a hefty pre-bolus, i'll be spiking up to 12 or 13 easily. It's got to the point that I'm not able to have carbs in the morning at all, anymore, without spiking really high, so now I'm doing a 16:8 intermittent fasting window. I snack at 11am, when finally i am able to tolerate carbs again- usually it's an apple or blueberries and it doesn't spike me high. Then i have to be careful the rest of the day to eat enough carbs frequently enough, even without any rapid insulin, otherwise i'm chasing hypos all day. My rapid insulin seems to be water in the morning, and super intense the rest of the day.

Porridge is one of my favourite things and i had to give it up for breakfast because i was shooting so sky high, up to 15 or 18, even with pre bolusing. I thought porridge was something i wouldn't be able to have anymore. However, i tried eating it for dinner, and the exact same porridge that would easily require 5 units in the morning and still spike me, now doesn't even spike me over 10 and i take 2 units for it (it' rye porridge though, not Scottish oats, so is absorbed slower anyway). I loaded it up with berries the other night and only went up to 9.8, then fell nicely back down to 5 a few hours later. Wow! I was so happy thinking about eating porridge regularly for the rest of my life

So weird that the insulin resistance effect in the morning can be so strong even in someone like me who is usually incredibly insulin sensitive!!

 

[Juicyj]

Heya @Hannah Robyn

I have never been more aware of this than when I started using a pump as you can change your basal ratios during the course of the day and I have about 6 different ratios set up, but mornings are a nightmare for me unless I am out running and then I can eat toast/cereal fine and just run it off, otherwise I would be in double digits till 1-2pm.

Some people add cream to their porridge to delay the spike, but exercise would be my way forward if I wanted to have some.

 

[In Response]

Hi @Hannah Robyn we are all different but due to Dawn Phenomenon/Foot on the Flor it is not uncommon to be insulin resistant in the mornings.
Some people find a small amount of food when they get up can convince their livers that it doesn't need to flood any more glucose and help reduce the morning blood sugar rise.

If this is causing your problems, I would advise talking to your diabetes team. With such differing insulin sensitivies, you may be a good candidate for an insulin pump which allows you to adjust your basal at different times of the day.

 

[Hannah Robyn]

Heya @Hannah Robyn

I have never been more aware of this than when I started using a pump as you can change your basal ratios during the course of the day and I have about 6 different ratios set up, but mornings are a nightmare for me unless I am out running and then I can eat toast/cereal fine and just run it off, otherwise I would be in double digits till 1-2pm.

Some people add cream to their porridge to delay the spike, but exercise would be my way forward if I wanted to have some.

Honestly, it was such a daily battle that I decided to just start skipping it and start with the intermittent fasting. The rye porridge was better, (because of the added fibre that delays the spike), as was adding peanut butter (delays the spike similar to your suggestion about cream) but it just wasn't worth the worry. I don't mind eating my porridge for dinner instead every so often.

Low carb breakfasts worked too, I still spiked a bit from the dawn phenomenon effect but it was much more manageable without eating carbs. But all the recipes were savoury and i have to admit i'm not a fan of savoury breakfasts!

You're right, though- exercise does massively help. It is the best way to combat the dawn effect that i've personally found.

 

[Hannah Robyn]

Hi @Hannah Robyn we are all different but due to Dawn Phenomenon/Foot on the Flor it is not uncommon to be insulin resistant in the mornings.
Some people find a small amount of food when they get up can convince their livers that it doesn't need to flood any more glucose and help reduce the morning blood sugar rise.

If this is causing your problems, I would advise talking to your diabetes team. With such differing insulin sensitivies, you may be a good candidate for an insulin pump which allows you to adjust your basal at different times of the day.

It's not really causing problems now i've started the intermittent fasting. I'm in range almost all day, now. My team already knew about it but honestly they didn't seem to care i was spiking so high because for the rest of my day my control was fantastic and my a1c was already low (they are worried it's too low). Their philosophy seems to be that one spike a day will not do long term damage, which I disagree with. So i doubt a pump is on the horizon for me unless I self fund it.