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Lunchtime High BG readings! What should I do?

Kevlar87

Well-Known Member
Messages
68
Location
London
Type of diabetes
Type 1
Treatment type
Insulin
Dislikes
Tomatoes
Hi guys,
I haven't posted regularly on here for a while but I went to a DAFNE course about 6 weeks back and it has really changed my attitude and made me more proactive in controlling my diabetes!

I am on Novorapid and Levemir. My novorapid ratios are pretty steady for when I eat lunch and dinner. Lunchtime ratio 2.5:1. Dinner ratio 2.5:1. I never eat breakfast.

My Levemir : I take two doses per day each 17 units. 1 dose at 8.30am and 1 dose between 10-11pm.

Here is my question - I inject my Levemir right before I go to bed so the latest time it gets is 11.30 pm. I will wake up with a great BG reading usually between 4 - 5.5 mmol/l. However, no matter what happens - my BG will drift higher and higher until lunchtime (around 12.30-1pm) and my BG will usually be around 12/13 mmol/l.
I never have breakfast and so this is a carb-free morning until lunch (I will only have a carb-free protein drink or a carb-free energy drink). I have tried increasing my bedtime levemir however if I increase it too much, I will wake up with a hypo, but then once I treat for my hypo, my BG will still continue to drift high towards midday.
It has got to the point now where I need to inject novorapid to keep my BG from rising too much, even though I do not eat anything. My morning novorapid ratio is 3 units/10 g carbs. However on occasions even when injecting so much as 8 units of insulin, on an empty stomach, my BG will still be around the 11/12 mark at lunchtime.

What would be the reason for this drift? I am really quite stuck as to what do?

Would it be the timing/overlap of my levemir doses? Would it be some continuous effect of the dawn phenomenon?

I am really stuck! Any help or advice would be so much appreciated!

Thanks guys
 
Many of us have the same thing. It's your hormones ( cortisol and adrenaline) waking up.
Lots of us have to eat something tonstop the rise. It doesn't have to be big but no or low carb. Some do well with just coffee and double cream, a hard boiled egg, a small chunk of cheese, a couple low carb nuts.
 
I discovered something similar with me a few years back and like you I did not eat breakfast - morning BGs were within range but just the stress of waking up, having a shower, driving to work in traffic would drive up my BGs - I've been told that statistically, most people have heart attacks in the morning because getting up in the morning and starting your day carries a level of stress to the body for most people. I've verified this with a BP kit - as my blood pressure will go up too from 100/60 to 130/70 - interesting thing though - it doesn't if I sleep in.
I've dealt with this in one of two ways - 1. I will take a second morning shot of fast acting insulin mid morning to keep it within normal limits or 2. I do a semi fast for the entire morning and don't eat anything until lunch time - noon. I actually prefer to do a semi fast although there are times where I'm just hungry so I'll have a mid morning snack but compensate with a shot. I'm not over weight.
That works for me - can't say if it would work for others. I'd be interested in reading other suggestions @Kevlar87 - so I hope other people respond.
 
I experience the same if I have no breakfast.
As @Kristin251 mentioned, having small breakfast seems to knock the BG rise on the head.
Another approach I have found works is a corrective dose of bolus insulin (NovoRapid) mid morning.

However, this may not be the reason for your rise. You wrote that you may have carb-free protein and energy drinks. Another phenomenon is a rise in BG when eating protein only meals. I find I need a small insulin dose (just 1 unit) when I have a (carb-free) cheese omelette. So, it *may* be your carb-free drinks pushing your BG up.
 
Ah wow thanks for all the responses guys - I appreciate it!

@fletchweb Yh I definitely agree with the sleeping-in thing - when I sleep in on the weekend my BG remains nice and steady! it's a shame I don't get to work from home more often haha I'm not sure what you mean by the semi-fast!?

@helensaramay I've tried to do the mid-morning shots of novorapid but I still get a huge increase even with quite a large dose of fast-acting - I've done 6 units at around 10am and my BGs still rise until 12.30-1pm! I have also thought it might be the protein/energy shakes so it could be that

I think I will start off by having small, low carb breakfasts and see if this helps in addressing this issue!

Thanks guys!
 
Twice I have just taken insulin and not eaten ( for lab work) and it acts like water and I still get that rise, even worse actually. I need food. Mostly fat. As @helensaramay said protein is very insulinogenic and I require insulin for half my protein like it were a carb. I need to keep protein low at bf and ramp up through the day as I become more sensative. So I eat a small fatty bf, ( lettuce wrap with a thin slice of turkey, mustard and mayo) and then about and hour and a half later I need another small bolus to stop the rise. This keeps me quite steady.
 
Hi @Kevlar87 . Great advice from everyone.
One day a week , Saturday, I don't have breakfast on rising. I eat out ( full English breakfast) about 2 hrs after rising. If I was to do nothing between rising and eating my BS would rise in those 2 hrs. I usually have a small shot of novo to compensate for the rise until I eat ( have to remember i.o.b at breakfast time ).
As for protein. For a lot of people a high protein intake will cause a significant rise in BS ( gluconeogenesis ). Our bodies use protein to build and repair muscles and unless you are using the protein for that purpose it is excess to requirements. Your body uses this excess as a source of energy and ultimately this causes a rise in BS. A few carbs alongside your protein drink , 10 g maybe a biscuit, would probably stop the gluconeogenesis affect occurring ( it does for a lot I know ).
In the past I've heard people refer to BS rising as soon as they get out of bed as " feet on the floor ".
Hope you find a solution. Trial and error does no harm. Good luck.
 
Kevlar87 said:
I've tried to do the mid-morning shots of novorapid but I still get a huge increase
Click to expand...

It definitely sounds like "foot on floor" which other posters have mentioned. Only suggestion I make is about your timing of the novo. You say mid-morning. If you do it then, the rise has already started so it'll already be fighting to bring it back down

I get the same thing - I'm a "non-breakfaster" and can wake to a 4 or 5 or 6, will easily ramp up to 8 or 9 or 10 within an hour just by getting up.

So, I usually have a few units to pin it pretty much as soon as I get up to get ahead of the game, rather than a few hours later in mid-morning after it's already started.
 
I sympathise, high BS in the morning is driving me nuts as well. Type 2 and not on insulin yet, but BS is anything from 8 to 11 on getting up, and if it is at the lower end it will continue to rise, although it may not rise so much if high to begin with. Went up from 8 to 11 the other day two hours after a boiled egg and a half a small slice of toast. May be I should up the toast! I've tried doubling the gliclazide but that made no difference. Seems what we need is drugs that block cortisol? Frustrating because I can keep things under control from lunchtime onwards.
 
It sounds like foot on the floor syndrome to me, a correction dose of novorapid when you wake up, rather than when the rise has already started, might be wise.

Or eating something and bolusing for it. You mention a low carb breakfast, just be wary of having a breakfast that is too low carb high protein because if you aren't eating carbs your body will work to turn the protein into glucose causing a delayed blood sugar rise anyway. This is gluconogenesis, and not covered on DAFNE, but that's why often no carb meals will require a bolus to deal with the protein.

Hopefully some combination of food and bolus will tackle your foot to the floor syndrome. Have you done any morning basal tests to check you are on the right morning levemir dose? You mentioned trying to increase your pm levemir dose, but if the morning rise is happening right through to lunchtime it could be your am levemir that needs adjusting

The alternative would be to consider a pump, because then you could have your basal rate set to ramp up as you get up heading off the rise, with not extra basal hanging around when you don't need it, so it sees off the rise with out hypo risk.
 
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