Mid morning spike

[Jennyninja]

Hi there, I'm in week 2 of insulin therapy for T1 so still early, tweaking days. I'll also talk to my Specialist Nurse about this. Also Googled the heck out of it and can't really find anything definite. So I was wondering if anyone else has had similar. 2 hours after a low GI breakfast of about 25 - 30g carbs and taking 3 units of Novorapid I get a spike of c13mmol. This then starts to decline and by lunchtime its 5-6 mmol. Sometimes the decline is quite rapid between 10am and Midday. This happens whether I go for a short run or not. If I don't run I'm still moving, walking the dog etc. Am taking 4 units of basal at night and dawn mmol ranges from 5.5ish.to 9. I realise a conservative dose/ start is being taken to avoid hypos especially as I am quite small and active. But I just don't understand the mid morning spike. I'm taking my bolus about 15-20 mins before meals. As there is a fairly sharp decline to closer to target numbers by lunchtime suggests perhaps doses are about right? I probably wouldn't have noticed this spike if I hadn't tested pre run. Thoughts ?

 

[PattiEvans]

Are you bolussing right before eating the breakfast? If so it looks like you are digesting the breakfast carbs faster than your bolus insulin is working hence the spike. On the other hand, even T1s have some insulin resistance early in the day and I would find 25 - 30g carbs too much at breakfast. Have you tried a protein breakfast with minimal carbs instead? I can't eat more than about half a slice of toast at breakfast time without spiking.

 

[Jennyninja]

Thanks Patti, I need the carbs for my morning activities although I do take them with protein /fat. I wonder if it's the timing of my bolus?

 

[Ivostas66]

It sounds like you are doing the right things and as you suggest a chat with your DSN or a dietician will help. I tend to bolus around 25 mins to half an hour before my breakfast in the morning and this reduces the spike. Like most people on here, I have dawn phenomenon, which tends to push me upwards; for example yesterday I was around 5 throughout the night and when I woke had moved up to 7.5 by 7:30am, breakfast then pushed me up to around 10, but I was back to 6 within an hour or so and remained in range throughout the rest of the day. If I inject 10 minutes before eating then the spike would be significantly higher. I also switched from Novorapid to FIASP recently and it has improved things quite considerably, but that is after 3 years of diagnosis and using Novorapid - as you are early on in your journey, changing bolus is probably not a good idea.

 

[helli]

A healthy pancreas will release insulin to match the speed at which food is digested.
Unfortunately, injected insulin only works at one speed. Therefore, we may need to consider whether to adjust the time of our injection so that the peak of the insulin potency matches the peak of the carb digestion. With low GI food this may mean you need to adjust your injection time ... maybe a little later.

However, before making any tweaks, I assume you are seeing the peaks on Libre. If that is the case, I would double check the, with finger pricks. Libre (and other CGMs) are notorious for being less accurate over about 8 or 9 mol/l.

The other thing worth considering is Foot on The Floor. Our livers release glucose to give us energy to start the day. For some of us, this dump is before we get up and is known as Dawn Phenomenon. For others, our liver waits until it notices our bodies moving before dumping glucose and is known as Foot on The Floor.
if you are a Foot on The Floor type, the rise may be due to this rather than your food.

Finally (sorry, I am rambling a bit), if you blood sugars return pretty quickly, I would not worry about a spike above 10. The impact is likely to be negligible.

 

[Jennyninja]

Thanks. I could experiment a bit with bolusing even earlier for breakfast. And have food ready in case I've miscalculated. On day 1 I had my fork poised over my food as I injected in case I passed out before I got the carbs in . I've moved on a bit from that and my family is more relaxed around mealtimes. It's still a journey...

 

[Jennyninja]

Thanks Helli, I've never heard of Foot on the Floor. That could be it. Off to Google the heck out of that now . I'm still fineger pricking, hopefully getting a Libre soon.

 

[Jennyninja]

Also thanks for the reassurance ref spikes that don't last long

 

[Inka]

Thanks Patti, I need the carbs for my morning activities although I do take them with protein /fat. I wonder if it's the timing of my bolus?

There’s nothing wrong with carbs. I eat around 45g carbs for breakfast. It’s probably the timing of your bolus, as you say. I find I have to bolus almost twice as far in advance for breakfast as for other meals.

You could try cautiously moving your bolus earlier in 5 minute increments. I’d try that first. You might even find that if you have your bolus earlier, you can reduce it a little too.

 

[Jennyninja]

There’s nothing wrong with carbs. I eat around 45g carbs for breakfast. It’s probably the timing of your bolus, as you say. I find I have to bolus almost twice as far in advance for breakfast as for other meals.

You could try cautiously moving your bolus earlier in 5 minute increments. I’d try that first. You might even find that if you have your bolus earlier, you can reduce it a little too.

Thanks Inka. There's so much to learn!

 

[Jennyninja]

Thanks Inka. There's so much to learn!

 

[Inka]

Thanks Inka. There's so much to learn!

There is but you’ll pick things up gradually as you go along 🙂

 

[Deleted member 25429]

Have you tried injecting for your food and then checking every 10 mins to see when it starts becoming effective? Count to 10 when you inject, and where are you injecting... for example the lower down my leg I go the longer it takes to kick in .. ( I can’t inject in my stomach as I have scaring )

 

[Jennyninja]

Thanks Freddie. I hope when I get my libre I can monitor this more closely

 

[Deleted member 25429]

Thanks Freddie. I hope when I get my libre I can monitor this more closely

I don’t have a libre I just tested before each meal as my timings are different at different meal times . When I was diagnosed I read everything I could so did my husband and asked questions on here . One thing I have learnt is every day is a school day with diabetes...the weather today being sunny means things have changed. Good luck x

 

[Jennyninja]

I don’t have a libre I just tested before each meal as my timings are different at different meal times . When I was diagnosed I read everything I could so did my husband and asked questions on here . One thing I have learnt is every day is a school day with diabetes...the weather today being sunny means things have changed. Good luck x

Thanks

 

[pm133]

Hi @Jennyninja

If you are getting a spike after 2 hours, it is most likely to be your food I would think.
Your bolus will have kicked in by then I would have thought.
I'm not convinced it would be Foot on the Floor either because it seems to be specific to your breakfast.
I get a spike to about 11 or 12 from my morning cereal but it lasts only about an hour. Nothing else causes that sort of spike for me except for things like chocolate.

You could experiment by trying a different kind of breakfast tomorrow - maybe something low carb. If the spike goes away, that'll explain the source as being your current breakfast. Then you could play around with portion sizes, switch to something lower carb permanently or accept a short term spike as part of the price to pay for a nice breakfast cereal.

 

[pm133]

@Jennyninja
To answer your other points, if your levels are back normal before the next meal, you've got your bolus pretty much spot on so that's great news.
My spike comes from 50g of Bran Flakes with 50g of grapes on top and 100ml of fresh fruit juice so I'm fairly piling in the carbs in that one meal but I don't care. I have decided to spit in the eye of Diabetes and take the delicious hit.

It also sounds like your basal is working too if you are waking up to readings of 5.5 to 9.
You should feel hugely encouraged by all of this. It sounds like you are making brilliant progress.

 

[Jennyninja]

Thanks pm133. It's usually weetabix with some seeds which I thought was pretty healthy, low sugar and high fibre. However I was surprised to see it is higher carb than some other cereals. In fact shredded wheat which I thought was really blameless is even higher carb. I had scrambled eggs on 1 small slice of Vogel linseed bread yesterday but still had a spike. I'm worried if I don't have the right amount of carbs to insulin I'll hypo especially with being a runner. I've read that different carb foods have different effects on different people. I'll continue to experiment !

 

[Inka]

I disagree @pm133 The spike is more likely to be incorrect timing of insulin. As I said above, I eat 45g carbs breakfast (cereal) and have for years. If I bolus 10-15 mins before, I’ll spike up to 11 or more. However, if I eat the same cereal and bolus 30 mins in advance I don’t spike and my 2hr result is in the 6s.

Food is rarely to blame with Type 1 @Jennyninja It’s almost always the insulin - the amount or the timing.