Morning correction/basal dosing

[sjm1308]

Hi everyone hope you are all having fab weekends

Have to say I've been doing really well lately and have managed to get my A1c down. Now I have one issue that I still need to resolve and that is my mornings.

When I seen my consultant on Tues I was telling him that my bg remains stable overnight but from 6am each morning it starts to rise. I go to bed say 6 or 7 then when I check at 6am it will still be 6 or 7 but by 9am it's risen to 10 or 11. This is every morning even when I'm not getting up and am just taking it easy. What I've been doing is taking 2u correction but he has told me to stop doing this as it's dangerous. Now I see his point and I know DAFNE doesn't recommend insulin without food but.. It's really been working well for me.

He suggested increasing my morning basal from 12u to 14u but I take it around 8am so the rise has already kicked in by then. The only thing I can think of is to eat but I'm not a big breakfast eater.

Has anyone experienced this and how do you handle it?

Im on mdi of Novorapid and Levimer. I split my Levimer 16u at 10pm(ish) and now 14u at 8am(ish).

 

[malek.elgazzar]

I believe this the dawn phenomenon..
I suffered from it a lot and was doing exactly what u r doing and my consultant was telling me just as ur consultant telling u .. they always afraid from corrections doses.

Anyways, I did few things and got this controlled 100%

1. I switched to Tresiba as a long acting.
2. I minmized my carb intake during the whole day and especially in the dinner.

I would suggest to start with the 2nd point for few days and check accordingly if u would switch to Tresiba.

Let me know if u need further assist. Good luck

 

[becca59]

Hi everyone hope you are all having fab weekends

Have to say I've been doing really well lately and have managed to get my A1c down. Now I have one issue that I still need to resolve and that is my mornings.

When I seen my consultant on Tues I was telling him that my bg remains stable overnight but from 6am each morning it starts to rise. I go to bed say 6 or 7 then when I check at 6am it will still be 6 or 7 but by 9am it's risen to 10 or 11. This is every morning even when I'm not getting up and am just taking it easy. What I've been doing is taking 2u correction but he has told me to stop doing this as it's dangerous. Now I see his point and I know DAFNE doesn't recommend insulin without food but.. It's really been working well for me.

He suggested increasing my morning basal from 12u to 14u but I take it around 8am so the rise has already kicked in by then. The only thing I can think of is to eat but I'm not a big breakfast eater.

Has anyone experienced this and how do you handle it?

Im on mdi of Novorapid and Levimer. I split my Levimer 16u at 10pm(ish) and now 14u at 8am(ish).

I've tried splitting basal, taking at different times, different doses at different times. None of these things has made an iota of difference. The morning rise just has a jolly good laugh. There has been an improvement with the darker mornings, but, on a regular basis the Libre shows a flat line all night and a steep rise beginning 4am. Am always awake early (5:45am) on swim mornings and it is usually high. This morning at 6:30 it was 10.4. I took 2 units of Humalogue, had another hour in bed and it was still 9.6. If I'd taken that dose in the day my levels would have dropped dramatically. What would they have been had I slept in. The dawn phenomenon has a mind of its own!

 

[donnellysdogs]

I have a split morning dose of insulatard now. 4 units at 4am that kick in at 8am fully. Then another 5 units at 8am plus a correction of bolus as well. I dont eat breakfast and rarely lunch.
I also have a 2.5 unit insulatard at 6pm.

Tesiba was awful for me. DP and waking phenomen was ridiculous and having to also have insulatard and a pre getting up correction.

After following hospitals wants of insulin/pumps for 12 months as I have a funded cgm, I am now back doing regime that I am happier with. It was awful having 3 different injections on bedside table (two of which have the same coloyred outer colour to pen)..

I refuse to lower my standards and accept levels too high with DP and waking P.

Many people have corrections pre getting up or earlier.

I never go back to sleep if I have had my getting up doses at 8am as I will go hypo. My rises start around 3-4am.

 

[Celsus]

Hi @sjm1308, what you experience is totally normal!

But nothing I really understood the full details about until I got onto the Libre CGM meter type. So today 40+ years later, I can only laugh about the days back in the 1970ties when as a young boy had to travel to the hospital every 3 months for my important diabetes checkin. So dictated to not eat any breakfast, fasting from the evening before. As you were to have your bloodsamples drawn to measure your bg. As it took me 2-3 hours at best from leaving home, due to travel time and waiting times etc for endo and lab nurses. Now I know how hilarious and none-telling those bg tests really were. As typically when you wake up and for some even just a short time before, you have the dawn phenome, where your liver releases glucose to support your body for a new day to start (given you the much needed glucose burst for you to leave your cave to go hunting for your breakfast mammoth! ;o) In some periods I have really not much appetite early in the morning and will at times skip it all together. With my bg meter I track if it then goes too high, as I do indeed then take 1-2 units of fast acting to counter regulate. There is absolutely nothing dangerous or wrong about that. To the contrary actually I think. But it takes that you know how to regulate your bg very well. E.g. 1 unit fast acting for me drops my bg with around 3mmol/L. So if it goes up to 9-10 mmol/L then I definitely take 1 unit of fast acting to counter. It is even natural I would say, as this is also why the caveman in the example above had the glucose liver dump. And he also had a fully functioning pancreas which then also released some insulin when the bg went up, as we all need that for the glucose to get into the muscle cells to provide some energy to them. I can say with certainty that that consultant is full of bull...... E.g. if I were to increase my basal Lantus for my dawn glucose dump, then it would result in going way too low for the rest of the entire day! You don't adjust your basal rate for that. Certainly not if its a basal insulin with long steady efficiency curve over 6+ hours. (advanced pumpers may of course have a different way of looking at it, but I am on manual injections and suppose you are the same as this was not posted in the pumpers forum)
Happy hunting!

 

[donnellysdogs]

Insulatard has a peak acting time of 4-8 hours for me and is more stable at night and firs in to my body needing a little higher basal between 8-12pm and then less. So I have my evening jab between 4-6pm depending what I am doing.
I need more at 8-12am so giving a shot at 4am uts working its peak when I need it. and then drops off in afternoon when I'm busy and the 8am one is working nicely then for me.

However to get up I still need an extra bolus on top of the Insulatard and I also do my jab in bed and wait 30 mins before getting up.
Got agorgeoys husband that brings me a cuppa so I am lucky.

You have to fibd a way with or without consultants advice (thats all it is) for what works for you.

Years ago we were told not to bolus without food but this advice for up to date consultants has changed.

You need to monitor, and check what happens consistently. Dont go in with a heavy dose to start off with. It maybe that you jyst need a 1/2 unit in mornings of bolus..

Have a look at acting times of insulins and see how they fit in with your activitys and your lifestyle.

 

[Scott-C]

With cgm becoming more common, there seems to be a sea-change going on with doctors.

In the pdf at link below, they actively encourage micro-bolusing to tweak sugar between meals and recommend the book Sugar Surfing for further reading, the author recommends micro-bolusing between meals - see page 7.

http://www.edinburghdiabetes.com/s/CGM-guide.pdf

http://www.edinburghdiabetes.com/cgms/

I get foot on floor too, can rise from 5 to 9 just by getting up, so it just seems to make sense to pin it with 1 or 2u so I'm going into the next meal in range instead of out. I don't see the point of saving the correction dose till the meal, might as well have it before hand to save me going out of range in the first place.

 

[Kristin251]

I have to eat something or my rise is even worse. So I eat a pice of deli turkey on a lettuce wrap with mustard and mayo or an avocado wedge. I bolus ahead 20 min, make it and eat. An hour later I need another bolus and an hour and half again to stay steady. I continue to rise until after noon and I'm still slightly resistant then.
I can't take extra basal or I'll hypo so I jus take counter that with correction bolus in the morning. One unit will drop me about 30 without food and a half until about 20. But in the morning that's a different story. 1/2 unit every hour and a half keeps me steady but i did LOADS of testing to find the times I start to rise. I eat the same bf so I have as good of an idea as I can as to what's going to happen.

My doc didn't like the idea either but it works wonders for me. And guess what? He doesn't have diabetes. Wonder what he'd do !!!

The two times I didn't eat,( fasting blood work) but still bolused I got a much higher rise.