Morning spikes - DP

[SherwoodT1]

Hi all! Figure I'd pick the brain of the hive mind a little. I'm a little confused, to say the least.

I've noticed every morning my blood glucose will rise from 3am onwards. I'm aware this is the dawn phenomenon. But it seems to really hit hard as soon as my feet touch the floor from waking.

Today I thought I would try impromptu basal testing (of sorts). The graph is from this morning, after a dash of milk in a coffee and a couple boiled eggs. No carbs other than the drop of milk. (I'd have gone the whole hog and cut out everything but I'm working, and on my feet a lot, and the coffee was instinctual). No insulin beyond my basal too.

Now, I'm a year into diagnosis. So very aware I'm still honeymooning, albeit far less so than when first diagnosed.

I'm a touch baffled at the rise I saw this morning, despite limited carbs, followed by I assume my body naturally kicking in and regulating my blood glucose on its own. It leaves me scratching my head as how to tackle this on MDI.

Do people have any tips for this? My impromptu test was born out of struggling to dose for breakfast and going high despite my best efforts. It feels very much like insulin is water. How do people dial in a correction dose to preemptively tackle rises like this?

Thanks hive mind!

 

[Fairygodmother]

What insulin(s) are you using, and how do you administer it, pump or injection?

 

[Antje77]

But it seems to really hit hard as soon as my feet touch the floor from waking.

That one is actually called Foot on the floor effect!

Mine is pretty predictabe so I inject for it before getting out of bed, just like I would if the glucose in my blood would come from food instead of my helpful liver.
Not a safe thing to do if FOTF is less predictable and only happens sometimes though.

 

[Juicyj]

Hello @SherwoodT1 My approach to managing DP is to eat upon rising and take a bolus shot at this point, to note that if you're eating eggs (protein) you will still need a bolus for this regardless as protein converts to glucose in the absence of carbs, by eating we are giving our liver a break from releasing more glucose.

Assuming you are on injections and not a pump, managing DP on a pump is much easier to do as you simply set up a basal profile for this time period.

I can't advise on what bolus corrections should be as we're unable to do so on the forum, but it is trial and error, I also get it but from time to time, no idea as there's no pattern, but as I eat a low carb breakfast every morning I haven't had it in a while.

 

[Westley]

Like Antje77, I usually inject a few units the moment I wake up, whether I plan to eat breakfast or not. It took a while to get used to the idea of bolusing a significant amount without eating, but the effect is consistent enough for me that I've become confident it's necessary.

It's certainly an area where I can see the advantage of a pump, because no matter how good we get at adjusting our MDI, we can't inject ourselves in our sleep. Still, with practise I've found what works to control it, as long as I don't sleep in late.

I've also found that the size of my dawn phenomenon is affected by the amount of carbs I ate the day before. I guess when the liver is less loaded up with glycogen from a carby dinner, it has less to dump in the morning. I still get an early morning rise, even on keto or fasting, but much less and easier to manage.

 

[SherwoodT1]

Thank you all for the help, and for putting a name to what I'm experiencing. It's comforting to hear it sounds like a common annoyance! I've tried to tackle it the way you all suggest. Fortunately, I'm also on fiasp, and abasaglar so I can get my insulin working relatively well on waking up.

I guess plenty of trial and error lies ahead of me! Obviously everyone cannot recommend doses, but can anyone provide tips as to how they systematically dial in dosing for things like this. If this falls within the forum rules?

 

[Antje77]

but can anyone provide tips as to how they systematically dial in dosing for things like this. If this falls within the forum rules?

I'd start somewhere at a gentle for you dose and log what happens in regards to dose, BG, and possibly breakfast.
Your CGM graph should inform you if the chosen dose is too low, too high or exactly right.

For me, the dose I need for FOTF varies a bit, along with my I:C ratio.
I have days where I need more or less insulin than usual for the same meals, and my needed dose for FOTF seems to follow the trends.
I also adjust my dose for FOTF depending on morning exercise.

 

[SimonP78]

I also get a touch of dawn phenomenon with a more pronounced rise from foot on the floor and caffeine. I've yet to completely untangle them as I do like coffee in the morning.

I take 3U of Novorapid to cover the foot on the floor plus a couple of white coffees, plus whatever I need for breakfast if I'm going to eat immediately (e.g. driving to work). If I'm doing the school run I just do the cover + coffee and wait till I get back to eat breakfast and take the insulin for that.

I'm not sure how much mine varies, as my days vary quite a bit and I therefore tend to "sugar surf" (I think that's the term) by stacking corrections/eat as needed, but it seems to be roughly that ballpark for me.

To work out how much you need I'd choose a morning when you have a bit of time and have food available, and take a few units, then see what happens.

With the morning you describe you could do likewise and just make sure you have a snack handy that has at least as many carbs as you've injected just in case. As mentioned above, if you do eat something, even without carbs, some of the protein/fat will be converted to glucose, so you will have to allow for this when you determine how much cover insulin you require vs how much for food.

 

[SherwoodT1]

I'd start somewhere at a gentle for you dose and log what happens in regards to dose, BG, and possibly breakfast.
Your CGM graph should inform you if the chosen dose is too low, too high or exactly right.

For me, the dose I need for FOTF varies a bit, along with my I:C ratio.
I have days where I need more or less insulin than usual for the same meals, and my needed dose for FOTF seems to follow the trends.
I also adjust my dose for FOTF depending on morning exercise.

Thank you both for the tips, I'll give them a go and see how I get on. As if T1 is mocking me, today I've had very little rise and likely have too much insulin got to love it!

 

[Deleted member 527103]

Great advice above. A couple of extra things to add...
- my fotf rise is greatly reduced by exercise. To be honest, I exercise most days so it is more a case that I see more of a fotf rise when I do none.
- basal testing is a challenge in the morning because dp/fotf is the body giving us energy to start the day ... at least it would be if our pancreas worked properly. If we do not eat, our liver continues to dump glucose. A small amount of food will stop this. It won't mean that fotf will not happen just that our liver will stop dumping once it spits the food.

 

[SherwoodT1]

Great advice above. A couple of extra things to add...
- my fotf rise is greatly reduced by exercise. To be honest, I exercise most days so it is more a case that I see more of a fotf rise when I do none.
- basal testing is a challenge in the morning because dp/fotf is the body giving us energy to start the day ... at least it would be if our pancreas worked properly. If we do not eat, our liver continues to dump glucose. A small amount of food will stop this. It won't mean that fotf will not happen just that our liver will stop dumping once it spits the food.

This is good to know, I should really start braving exercise again! It certainly feels very unreliable right now as to when it kicks in. Today? A minimal rise.

I swear my diabetes is self-aware, and knows of a pump clinic referral I should be receiving soon and hiding my DP to scupper the referral!