Pre-Take Off Blood Sugar

[ScottyD]

Happy New Year everyone!

Quick question - don't really have an answer for this...

This morning I was up at 4am for work. I woke up doing my pre-work check to see if I'm good to go flying. The result was 8.5mmol. Gave myself a little correct (on pump). I got ready for work and was on my way to work. In the car, checked my Libre and my blood was 6.4mmol with a downward trend - thinking all was good!

I parked up, passed though security, was in the airport, getting all the paper work usual chatting and then walked out to the aircraft with the crew. Had a quick check of my blood on my Libre again. 11mmol. I gave myself another correction - wasn't much as I already had active insulin working away. My pre take-off check was 8 or so mmol.

On a day off, my DP is usually controlled very nicely. At 6-7am would the DP take effect? Usually I see it around 8am on days off. Or does it kick in just whenever the body is seeing my activity? Will my corrections also not be as effective due to more insulin resistance in the morning?

I know these cold temperatures may have an effect too? I haven't really catered for that if I'm honest.

I have an slight feeling that my honeymoon period may be coming to an end (6-7 months). I just see my levels ever so slightly higher that usual for foods I typically eat.

Just had my A1c check on the 22nd and knocked it from 41mmol to 40mmol but just really picky with my control!

Any thoughts on that rise would be ideal. No food was consumed that early in the morning - no appetite at that time!

 

[tim2000s]

@ScottyD There are two things that go on with early morning rises. There is DP, which usually starts at around 3am-ish and then there's waking phenomenon, which is the feet to the floor point, where as soon as you physically get up you see a rise. It's likely that both of these had some effect. What I'd suggest that you do is set a basal profile for the days you get up at different times so that you can switch between them to ensure you are getting insulin about an hour before the rise. Unfortunately, this all requires careful observation of the libre traces.

The only way you know if you have more insulin resistance in the morning is to test your ISF at that time. If you find that 1u is less effective at that time, then yes, you are more insulin resistant.

 

[ScottyD]

@ScottyD There are two things that go on with early morning rises. There is DP, which usually starts at around 3am-ish and then there's waking phenomenon, which is the feet to the floor point, where as soon as you physically get up you see a rise. It's likely that both of these had some effect. What I'd suggest that you do is set a basal profile for the days you get up at different times so that you can switch between them to ensure you are getting insulin about an hour before the rise. Unfortunately, this all requires careful observation of the libre traces.

The only way you know if you have more insulin resistance in the morning is to test your ISF at that time. If you find that 1u is less effective at that time, then yes, you are more insulin resistant.

Thanks for that @tim2000s. Really informative.

When I got my pump, the diabetes team did say you can sort out different basal profiles.

Usually, my blood never really seen a rise so I'll try again tomorrow and see if it's a reoccurring theme then I'll consider setting up and Basal profile for early starts. Would it be a case of doing my current profile but bringing the increase in insulin forward slightly to counter the DP and WP?

 

[tim2000s]

Would it be a case of doing my current profile but bringing the increase in insulin forward slightly to counter the DP and WP?

It's typically dependent on what's going on. Does your current profile include an increased raised in basal rate to countre a later dawn phenomenon? If it does then maybe you can just move that earlier. If not, then you may need to increase your basal rate 1-2 hours prior to your dp in 10% increments until you see from the Libre that it is under control.

You can see in my basal profile (the blue line below) that I have to kick off a higher rate at 3am that then needs to jump up at 6am before steadily dropping down over the morning. I get up at 5am usually.

 

[ScottyD]

It's typically dependent on what's going on. Does your current profile include an increased raised in basal rate to countre a later dawn phenomenon? If it does then maybe you can just move that earlier. If not, then you may need to increase your basal rate 1-2 hours prior to your dp in 10% increments until you see from the Libre that it is under control.

Yes, at 3am my Basal steps up to the highest amount. Maybe I'll bring that forward to around 2am - Think Like a Pancreas did mention that you'd move a basal amount around 2hrs in advance of where you want to see the changes. I'll then take it from there, seeing if I need to increase more. Thanks for the help!