Morning high, after breakfast

[Rach85]

Hi all,

Just wondering if anyone is able to advise on what to do with my daughter's morning highs after breakfast or even just after a few mouthfuls.

She has a perfect night remaining around a 5.0 - 6.0mmol/l and wakes up anytime between 6.30 - 9am on the same perfect reading and it doesn't matter whether 6.30am or 9am, her bloods start to rise the minute her feet hit the floor. They then spike to 18 after breakfast she hypos an hour later on her current ratio(1:10). Prior to this she was on 1:12 and was taking until 12.15 lunch time (after breakfast at ten to 8) to come back down. The rest of the day she is fine. She's on mdi, and 4 units of levimir before bed. Any more levimir makes her hypo in the evening/early hours.

I have tried reading about the liver dump on waking (different to dawn phenomenon I believe?) but I am unable to find anything that really informs me how to stop it. The only other thing I can even consider is a carb free breafast.

From how fast she has dropped I know her morning ratio is not right, but otherwise she's just staying high. My daughter is 8 and has been diagnosed for nearly 2 years. Thanks in advance!

 

[Antje77]

I can only speak for myself, my bg rises from the moment my feet hit the floor, so I inject for that before getting out of bed. After that, I just inject as usual for food, which may be anywhere between half an hour and 4 hours after getting up.
I don't know what your daughter has for breakfast, but many instant cereals are very high in very fast carbs (and sugar) and are notoriously difficult to dose for, as they hit faster than the insulin.
Good luck!

 

[Rach85]

Many thanks for your quick response and advice. Can I please check: would I inject her an odd unit when I wake and then for her breakfast when she's up?

If she has cereals (mainly school days due to breakfast club etc) it is mainly bran flakes or all bran...thought these were a little lower and the fibre doesn't affect bloods, starting to question if I understood that right though!

I have all things ready for bacon, sausage and eggs for breafast tomorrow for her, I'm thinking it would be best to still give her a little insulin.

Thanks a lot

 

[donnellysdogs]

I also have a bolus for putting my feet to the floor. I used to do it an hour before getting up but the FIASP bolus insulin now and I do it about 5 mins before getting out of bed.

 

[kitedoc]

Hi @Rach85, From my experience as a T1D, not as professional advice or opinion:
At your daughter's age it would be best to speak with her doctor about what to do.
That is assuming said doctor is aware of these early morning and feet-hit-the floor type phenomena.
Three other thoughts:
It is tricky balancing the effects of an early injection of insulin given some time before breakfast between solving the after breakfast result and not inviting a hypo.
Could your daughter be having a small growth spurt, in which the hormones triggering growth are causing her to be more resistant to insulin?
On an insulin pump the solution could be easier to achieve as changes to say, her basal level, could be programmed in to anticipate the problem.
Best Wishes and let your daughter know she is a champion !!

 

[Rach85]

I also have a bolus for putting my feet to the floor. I used to do it an hour before getting up but the FIASP bolus insulin now and I do it about 5 mins before getting out of bed.

Thank you for your advice and it does seem like a good idea, that could work. May give it ago if I'm brave enough!

 

[Rach85]

Hi @Rach85, From my experience as a T1D, not as professional advice or opinion:
At your daughter's age it would be best to speak with her doctor about what to do.
That is assuming said doctor is aware of these early morning and feet-hit-the floor type phenomena.
Three other thoughts:
It is tricky balancing the effects of an early injection of insulin given some time before breakfast between solving the after breakfast result and not inviting a hypo.
Could your daughter be having a small growth spurt, in which the hormones triggering growth are causing her to be more resistant to insulin?
On an insulin pump the solution could be easier to achieve as changes to say, her basal level, could be programmed in to anticipate the problem.
Best Wishes and let your daughter know she is a champion !!

Hi, thanks for your reply. And I have passed on your kind words. She does do amazingly well.
I have spoken to her dsn about it who has said she will have a look at her reads and come back to me. But I think they are just going to say increase her levimir which will then lead to a hypo before 12 midnight.

It could be down to a growth spurt, she has grown a little, but she has always spiked after breakfast more so than the rest of the day. It's almost like she is 2 different bodies, one morning the other in the afternoon.

People do say and I have read that a pump would be able to be set to adjust her basal for different types of the day, but it is something that has neither been offered or explored mainly due to my fear of technology failing. Having said that we are using a libre, miaomiao and xdrip and I have come to realise the value of technology it has been since then I have realised how bad her spikes get.

We did carb free ish breakfast, have realised there were 5 carbs in the sausages she had, she still raised but not as bad and not the sudden drop. She had a curve over the period of 3.5 hours and hit only 13 as opposed to 22. I know this is still not ridiculously high, but still higher or time spent in higher than I would like. Will try again tomorrow minus the sausage.

Failing that, as suggested I will speak to her dsn, we have an appointment on 13th Feb, so not too long a wait.

Thanks all for your advice

 

[kitedoc]

Hi @Rach85, It is important that you and your daughter know you are doing the best you can and have already made a difference with your daughter's BSLs after breakfast.
One way to ease the tension perhaps is a game with your daughter:" now - are we going to use insulin or food change today" ?
And have bets on what the after breakfast BSL will be.
The loser does some task e.g. washing up, getting the ingredients out for a suitable cake recipe (the loser does not necessarily have to 'lose out', it could be a different type of 'win').
Make it into a challenge and let your daughter show her DSN what the mother-daughter team has achieved.
And your efforts not only make your own day but encourage the DSN to join in.
Best Wishes.