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That morning blood glucose spike...

Discussion in 'Type 1 Diabetes' started by kenrobrich, May 16, 2017.

  1. kenrobrich

    kenrobrich Type 1 · Newbie

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    Hi all! I've been diabetic for 16 years now, yet I've never really paid too much attention to my health until the last 2 or 3 months. Fortunately, it doesn't seem like I was doing too badly - however now I'm actually paying attention to myself I find this condition is pretty difficult to control at times.

    I take detemir (levemir) for background insulin twice a day and aspart (novorapid) after any meals or carbs. I typically inject 2 units of aspart for every 10 grams of carbohydrate, or what I call a 2:1 ratio.

    After doing a bit of research I've found that lots of Diabetics including myself seem to suffer from the "dawn phenomenon", however whereas others' blood glucose spikes between 2am-8am, mine is typically 8am-11am. The only thing that keeps me under control by lunchtime is to inject 4 units of insulin for every 10 grams of carbohydrate at breakfast, or a 4:1 ratio - which is quite a lot of insulin.

    By lunchtime, I usually have to lower my ratio to 1:1. It's almost like my body doesn't use the insulin in the morning, stores it up, then releases it all at once after lunch - sometimes causing pretty nasty hypos. Does anyone else experience something similar to this? Do you have any other tips for managing it?

    I've also noticed I have to inject a couple units (2-4, depending on time of day) for coffees - typically I have one in the morning around 10:30, and one in the afternoon around 3pm. I don't take sugar in coffee, but do take milk. Does this sound familiar?
     
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  2. GrantGam

    GrantGam Type 1 · Well-Known Member

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    Welcome to the forum @kenrobrich:)

    You're splitting your basal insulin which is a good thing; are you finding that your fasting BG remains steady and within range on your current dose of Levemir? Your higher I:C ratios may be the result of a lack of basal insulin.

    By the way, just to make things clear - it's always best to use the correct terminology regarding ratios. Your 2:1 ratio is actually 2:10, and the difference between the two is quite huge. For a white cheese sandwich, the difference in insulin dose between the two ratios is over 70 units!

    I suffer from dawn phenomenon, but also a waking rise or 'feet on the floor syndrome' which it is also known. So for me, my BG will start to rise from about 5AM (dawn phenomenon) and then it shoots up further as soon as I get out of bed. What I need to do, is correct my high BG caused by DP (applying my standard correction factor) and then bolus 2u regardless to correct the BG spike that I get every single morning just from getting out of bed.

    It's also worth mentioning that we're typically most insulin resistant in the morning, so you might find that your larger insulin doses are a result of that. There is also the possibility that the extra insulin is neccessary because of something like a waking rise as detailed above.

    Regarding your lunchtime ratio (1:10, not 1:1) - that would seem pretty normal and nothing to be concerned about. The fact that it is lower than your morning I:C ratio, further suggests morning insulin resistance. Also, bolus insulin has a DIA of 3-5 hours, so depending on what time you eat breakfast, you may still have some working in your system at lunch time. The result of this is possible 'insulin stacking' which can result in hypos and actually appear as though you need a lower I:C ratio for lunch. Insulin stacking can be avoided by ensuring that meals are spaced at least 4 hours apart.

    As for the coffee, caffeine affects us all differently. I do find that the "real coffee" you'd get in Starbucks or Costa for example is terrible for my BG. I'm alright with instant though.
     
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  3. Deleted Account

    Deleted Account · Guest

    Different insulin to carb ratios at different times of the day is not unusual. Just as it is very common to have different basal requirements at different times of the day. This is one of the major advantages of the pump over MDI.
    The best way to understand how your body works is to have a CGM or Flash monitor for a while. These can be expensive but Freestyle have been pushing the Libre (a flash monitor) so have been offering free trials. If you can get on one of these, this will give you 2 weeks of data to review. You may want to do something like monitor for 1 week, make some tweaks and then monitor for your second week.
    Regarding coffee, it is difficult to comment without knowing more. Milk contains carbs (although cream does not) so if you are having milky coffee this could explain why you need insulin. I drink herbal tea so cannot comment from experience.
     
  4. kenrobrich

    kenrobrich Type 1 · Newbie

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    Thanks so much for the reply! It's reassuring to know I'm not alone :)

    Funny story on the basal - I've been doing two injections for about 8? years now, after I accidentally injected 120units of levemir at university (instead of 60, best not to ask how) - and it made no real noticeable difference.

    From there, the doctors screamed at me to reduce my doses, so I ended up splitting it 30u - 30u. The past 6 months I've thought about lowering it and seeing what happens. To my surprise, nothing really happens. I've got it down to about 12 units each now, and noticed that my levels are generally still stable throughout the day other than the morning (I've eaten a couple 0 carb meals a few days to confirm this).

    My recent blood tests show (slightly - not concerning) high levels of serum albumin, something I've done a little research into and found that can relate to high levels of insulin resistance - which in turn can be caused by dosing a lot of insulin. Does this sound familiar? Admittedly, I haven't had a chat with a diabetes specialist for a while, so maybe this is worth bringing up.
     
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  5. GrantGam

    GrantGam Type 1 · Well-Known Member

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    I've not heard of high doses of exogenous insulin making T1's insulin resistant, but just because I haven't heard it doesn't mean much.

    I do find it bizarre that you've gone from 60u basal down to 24u without noticing any significant change in your BG.

    Although the theory suggests that a zero carb meal means no need for bolus insulin and no BG rise, you might find that that's not actually the case. In the absence of carbs, the body can convert protein into glucose - so it's possible to still see a BG rise.

    You'd almost definitely benefit from a chat with your diabetic specialist doctor:)
     
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  6. ickihun

    ickihun Type 2 · Master

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    @kenrobrich I think the serum in insulin injections can increase insulin resistance. I've just been moved to toujeo300, I think for that reason. Huge water retention too. I've been complaining of chest pains and breathlessness which have been investigated and my heart is fine.
    I'll be able to back your findings soon, I hope.
    The liver, other orgzns and muscles store from carbs and protein. Be careful your protein isn't refuelling your body so it can dump to keep you going.
    A basal check will put you back in sync and should reduce your dawn or waking up dumping.
    The clue is how much dumping occurs. I get on average 3mmol/l extra dump pre-toujeo300 thou.
    Yes basal can mop up the dumping but you can also do liver blocks before sleep.
     
  7. EllsKBells

    EllsKBells Type 1 · Well-Known Member

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    Hi @kenrobrich and welcome to the forum! I don't get DP, but my feet to the floor rise is extremely aggressive, although not so bad since moving onto Tresiba, which has helped slightly with my extremely variable requirements throughout the day. Could also be a good move if you are concerned about the size of your dose - I've gone from 30 units of levemir to 21 of tresiba.

    I don't drink coffee anymore - it doesn't mix well with my heart medications - but even drinking it black used to give me a spike, possibly because of the caffeine. Might be worth doing an experiment - have the same lunch 3 days running, 1st day have your normal coffee, 2nd day have it black, 3rd day have decaf + milk?

    What times are you having your basal? When I was on split levemir, I wasn't splitting it evenly - it was 18 and 12, although don't ask me which way round it was now. Levemir doesn't have the most stable action in the first place, and your body at night when asleep is a very different place to your body moving around in the day. Your requirements might be differing.

    All in all, I think the best thing to do is to make a note of all your concerns and have a good long chat with your specialist.
     
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  8. Kristin251

    Kristin251 LADA · Expert

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    It took me awhile to figure this out as I rise from the time I get up until about 1

    Correction boluses or not eating only make things worse for me. I rise even higher and insulin acts like water.

    What I do now is take my bf bolus and eat my avocado and celery. Then an hour later I take a small bolus. Then 2 hours after that another small bolus. This system keeps me very steady and heads off the rises. If I take it all at once I hypo then hyper so splitting my morning into 3 injections has worked great. Of course nobody wants extra injection snut it feels better than the rollercoaster. It took months of testing to find wham my rise begins and it's literally one exact hour after my first bolus and then 2 after that bolus. I take 1/2 unit for the extra ones.
    I did an experiment a few months ago to see when insulin kicked in and then I would eat. It NEVER kicked in for over 3 hours and by then I had taken a whole days worth of my insulin. So for me not eating is worse. I also cannot eat carbs for bf. Just fat so avocado works best though I still get a slow rise.

    Hope this helps. It works for me but may not work for you. Test test test. The smaller doses spread out are much less stressful on my body than larger doses all at once. We are all different though.
     
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  9. slip

    slip Type 1 · Well-Known Member

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    A complete and proper basal test will help give a clearer picture, coffee/caffeine may give you a rush much like a hypo so maybe your body is doing a liverdump to help that fight or flight adrenaline rush?

    Are you sure you're not dropping low in the night/early morning and so the mid morning rise is a rebound from that?

    The Freestyle Libre would give you a complete picture and also make a basal test that much easier too.

    It's funny how we all have the same condition but we're all so different - my bolus ratio is smaller for breakfast than any other meal time!
     
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  10. GrantGam

    GrantGam Type 1 · Well-Known Member

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    Fully agree, this helped me so much. I never realised I was doing things so wrong, especially regarding my evening basal. I was experiencing rebound hyperglycemia as you've so rightly mentioned as a factor here. Without the Libre, the obvious thing is to keep dialing up the basal...
    It really is, isn't it? I'm one of those weirdos who needs more basal during the day:)... The polar opposite to the majority as far as I'm aware.

    Great advice @slip
     
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  11. ickihun

    ickihun Type 2 · Master

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    I too need more basal depending on a carb treat. I too have a protein breakfast so less novarapid needed than evening meal which contains some carb.
    I'm loving seperate insulins. Much more freedom.
     
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  12. noblehead

    noblehead Type 1 · Guru
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    A 2:1 ratio is what is used on the DAFNE programme @GrantGam , 1 CP (carbohydrate portion) is 10g of carbs.

    Admittedly mine doesn't differ much, morning dose is typically 5u of insulin for 50g of carbs.
     
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  13. Kristin251

    Kristin251 LADA · Expert

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    I was curious how it was working for you!!!

    Sounds great. So happy for you
     
  14. GrantGam

    GrantGam Type 1 · Well-Known Member

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    I stand corrected @noblehead:) Thanks for the heads up, I'll remember that for the future.

    Still haven't done the DAFNE course yet (DIANE where I am) as I'm struggling to fit it in around my work.
     
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  15. kitsunerin

    kitsunerin Type 1 · Well-Known Member

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    I didn't actually realize this was this common, but it makes me feel a bit better that I too get a morning spike haha (around 8am-1pm). I've been trying to gently bolus it down and always end up with a hypo around 2-3pm. Feels like a constant science experiment!
     
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  16. becca59

    becca59 Type 1 · Well-Known Member

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    Yep I too use that ratio following DAFNE course.
     
  17. slip

    slip Type 1 · Well-Known Member

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    As I've already mentioned that sort of behaviour could be caused by a low during sleep, then the liver dumping glucose into the blood stream (to keep you alive), problem is the liver will take back blood glucose to replenish it's store at some point - that some point is usually just after you've bolused a correction for the high! And hence the roller coaster starts all over again.

    Obviously any time you hypo it could be followed by a liver dump - question is, is that resulting high a liver dump or just too many jelly babies??!

    "to correct or not, that is the question"
     
  18. noblehead

    noblehead Type 1 · Guru
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    I don't, too old school ;)

    But yes it's DAFNE speak, I had the impression all newly diagnosed type 1's were taught to use CP's.
     
  19. hdragon

    hdragon Type 1 · Member

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  20. hdragon

    hdragon Type 1 · Member

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    Hi , this is so familiar. I have been having this strange phenomenon for at least the past 15-20 years and no-on has bothered to try and explain or change it until now . it is taking a lot of changing and fussing about from the 2:1 ratios to 1;1 in the evening now that is resulting in higher readings in the morning and yes I am also a big coffee - milky drinker so I am so on your pathway. I usually had an early morning hypo around 3am so ended up with high readings at breakfast time . I am a poor eater so rely on a milky coffee once or twice in the mornings and if I can manage it a small snack in the mid afternoon so you can imagine how difficult it can be to control insulin ratios . it seems a nurse has thought about how a body stores and moves the insulin in the body . this slow movement of either food or the insulin itself could be the problem but what to so about it we don't know . just keep trying and changing the ratios in the hope of some sort of progress.. I am slowly moving tin the right direction after so long I am forever hopeful but it doesn't seem too promising . if anyone has any other ideas of how or ta different ratio to try I will give most a go even if it's only for a few weeks to see if there is a difference. I am looking into the books by Peter D'adamo who explores eating right for your individual blood type. worth a thought. good luck.
     
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