Test Before Morning Cuppa?

[BibaBee]

My husband has extreme anxiety following his diagnosis, so for the time being I am asking questions for him. Our DN is really happy with how his levels are coming down (he is on insulin for the moment due to being treated with steroids) but we are reducing with a view to coming off them. We just can't seem to get the pre-breakfast readings down below about 8. The other readings are heading in the right direction. We usually have a brew in bed first thing, with a tiny amount of semi-skimmed milk. He then tests after this and before he eats. Is it possible that his morning cuppa make any difference? I guess we should test to find out, but interested to see what others think. Thanks.

 

[briped]

but interested to see what others think

They do say that the first morning reading (Fasting Blood Glucose) is the hardest to lower and control, and the last to come down. but I'd test before having anything at all. Part of my routine is testing right after my morning wee + hand wash. Max. 5 minutes after setting my feet on the floor. That cup of tea might influence the reading a little, but even time will do that. My FBG was 5.9 this morning, and I've had nothing but water since, and I bet that if I test now it'll have risen to somewhere well into the 6s.
So many things affect our readings apart from our food intake, and I think you'll find that many in here struggle with keeping them stable.

 

[kitedoc]

Hi @BibaBee,
I presume a cuppa is tea and the milk. The caffeine in the tea plus the milk sugar (lactose) could put the bsl up, and the steroid medication is, I believe, a cause of increased insulin resistance ( i.e. steroid combat the effect of insulin, so often bsls are higher and as you have noted he needs insulin whilst on his current steroid medication).
Also is he just taking short-acting insulin before each meal or some other regime of insulin.? It is just that if he were to be on insulin only before meals he might be a little short on effective insulin overnight which may then effect pre-breakfast blood sugar readings and possibly exaggerate his response (rise in BSL) after the morning cuppa.
If he has long-acting insulin working overnight then that may make his bsls in the morning a bit better.
Please check with his nurse about things and see what she advises.

 

[BibaBee]

Thanks. Yes, a cup of tea (but decaf) with a small splash of semi.

He is thankfully off the steroids now, his last dose was Tuesday. He is on a long acting insulin (Abasaglar) which he has first thing and short acting (Humalog) before meals. I know the nurse plans to increase his dose of Metformin (currently toomhtwice a day) as he comes off the insulin. We speak again with our DN on Monday, so will see what she says.

His mood is often worse in the morning. He is also not always sleeping great, so I imagine this may be a contributing factor to higher readings.

 

[kitedoc]

Hi again, @BibaBee,
Knowing now what his insulin regime is, if he can stand it a blood sugar test at say 2 am, or 3 am done once or twice might help ensure he is not going too low in blood sugar at night. sometimes this happens and the person's liver releases stored glucose to raise the blood sugar leading to higher than usual blood sugar levels first thing in the morning.
Poor sleep might be due to many things but I can certainly attest to night-time hypos being one of them !!

 

[Bluetit1802]

Hi @BibaBee

To be honest, it doesn't really matter when he does his first test in the morning as long as he is consistent and the timing follows the same daily pattern. ie if he normally tests after his cuppa and while still in bed, as long as he does this every day then he will still be able to see the trends. However, a true fasting reading is just that - an empty stomach after a long fast overnight, and for the best results taken immediately after visiting the bathroom and washing hands ready for the test.

As said, morning fasting levels are the last to come down due to insulin resistance playing havoc with the liver dumps. (Dawn Phenomenon) This is when our livers deposit stored glucose in the blood stream to give us enough energy for starting the day.

Now he is off his steroids, things will improve .

 

[BibaBee]

We did his BG when he woke just after he woke this morning before his brew and it was 7.4 (it was 5.2 before bed at 11pm). It was 9am before we were ready for breakfast and his BG shot up to 9.3? Any ideas how to manage this without increasing insulin, as we are trying to take him off it. We had a very low carb dinner last night of moussaka last night and he had a couple of thin oat cakes before bed, as he was on the low side.

 

[urbanracer]

Thanks. Yes, a cup of tea (but decaf) with a small splash of semi.

He is thankfully off the steroids now, his last dose was Tuesday. He is on a long acting insulin (Abasaglar) which he has first thing and short acting (Humalog) before meals. I know the nurse plans to increase his dose of Metformin (currently toomhtwice a day) as he comes off the insulin. We speak again with our DN on Monday, so will see what she says.

His mood is often worse in the morning. He is also not always sleeping great, so I imagine this may be a contributing factor to higher readings.

I use Abasaglar and found that my glucose readings were going high overnight if I injected in the mornings.

So I started injecting at 7.00pm and over a couple of weeks (the efffect can be slow) my overnight highs came down to fairly decent levels. Abasaglar does not last a full 24hrs at full power and it's profile tapers off.

Might be worth considering a change of injection times but as always I must advise you to discuss changes to an insulin regimen with your medical team if you're not confident with administeting the changes yourself.

 

[Resurgam]

If a high carb food was required to counteract too much insulin then the whole situation is not stable at the moment. Low carb meals require less insulin - either natural or injected - and having ether an overactive pancreas or a set injection amount cause distinct wobbles which need ironing out by whatever means.
It might need your husband discussing his injections with a HCP for him to sort out not going low due to not adjusting for foods.

 

[BibaBee]

Thanks. We've been advised by our DN to keep stepping down the insulin by one or two units, whilst his levels (aside from first thing) are coming down to reasonable levels. We speak with our Diabetic Nurse on Monday, so I'll see what she says.