Rising glucose level first in the morning

[AliBal]

Hi I have been having real issues with a rising glucose level up to 2 mmols from early hours and often again after immediately getting up. This morning was 4.9 at 4.30am which had been steady overnight but on waking has now already risen to 7.1 . Have been watching trends closely on my libre and this seems common most mornings which make managing time in range after breakfast a real challenge. Have heard about the dawn phenomenon but any suggestions to help management greatly appreciated . Thanks

 

[Nayshiftin]

Does it lower after you eat? I am asking as I have this also however I cannot advise on how to manage as I do not understand it myself. Hope you do not mind my question,

 

[Robin]

Hi I have been having real issues with a rising glucose level up to 2 mmols from early hours and often again after immediately getting up. This morning was 4.9 at 4.30am which had been steady overnight but on waking has now already risen to 7.1 . Have been watching trends closely on my libre and this seems common most mornings which make managing time in range after breakfast a real challenge. Have heard about the dawn phenomenon but any suggestions to help management greatly appreciated . Thanks

The same thing happens to me. If I increase my basal I just crash low in the first part of the night. My overnight Libre graph always resembles a slack washing line.
The only way round it I've found is to whack in my breakfast bolus as soon as I wake up (with an extra bit for a correction dose, basically to help the basal out for a couple of hours) and then wait til I see the graph level off or just start to fall before I eat breakfast.

 

[Robin]

Does it lower after you eat? I am asking as I have this also however I cannot advise on how to manage as I do not understand it myself. Hope you do not mind my question,

For a Type 1 on insulin, it’s never going to lower all by itself, only if we inject insulin to make it come down.

 

[Nayshiftin]

Okay so that definitely makes me type two as mine always lowers when I drink or eat . I just wondered if you had injected insulin into you then when you ate it reacted. Sorry for my ignorance

 

[Inka]

No need to apologise @Nayshiftin 🙂 You asked a question that many others might ask🙂

Only an insulin pump can really sort Dawn Phenomenon (unless you want to set an alarm to bolus at 4am or whatever). When I have a pump break and am on pens, I inject a unit of insulin as soon as I get up as that helps stop the rise. I also find not delaying breakfast helps too - ie I try to bolus and eat breakfast as early as I can in my morning routine.

 

[everydayupsanddowns]

Sorry to hear you’ve been wrestling with some DP @AliBal

Mine has sort of come and gone over the years and only kicks off when I get out of bed, so I can generally manage it with a bit of a rise in my basal pattern and a slightly generous breakfast dose.

I can get caught out if I don’t eat breakfast straight away. Or on any days when it just doesn’t happen!

 

[helli]

Okay so that definitely makes me type two as mine always lowers when I drink or eat . I just wondered if you had injected insulin into you then when you ate it reacted. Sorry for my ignorance

I guess, if you produce insulin (type 2) eating and drinking can kick your pancreas into action.
When we have to inject it (Type 1), our pancreas doesn't have that option.
However, some people with Type 1 still find that eating can stop our liver dump so stop the rise.

As for injected insulin reacting when we eat, that would be a dream. I believe there are some studies into this but, for now, injected insulin has a set profile about how long after it is injected that it starts to react and how long it reacts for. You may read about fast and slow acting insulins - these react at different speeds and last different periods.

Thank you for your interest - as many people without diabetes think that all diabetes is the same, it is important for me to know enough about other types to be able to explain.

 

[Nayshiftin]

I guess, if you produce insulin (type 2) eating and drinking can kick your pancreas into action.
When we have to inject it (Type 1), our pancreas doesn't have that option.
However, some people with Type 1 still find that eating can stop our liver dump so stop the rise.

As for injected insulin reacting when we eat, that would be a dream. I believe there are some studies into this but, for now, injected insulin has a set profile about how long after it is injected that it starts to react and how long it reacts for. You may read about fast and slow acting insulins - these react at different speeds and last different periods.

Thank you for your interest - as many people without diabetes think that all diabetes is the same, it is important for me to know enough about other types to be able to explain.

Thanks for explaining. I don't get the basal and the other doses I sort of thought one was to keep insulin in the system and the other for the deficit like a sliding scale type but I don't really understand this as you point out but yes I am interested. All my family have got elderly onset and all ended up on insulin so I have a chance of doing so myself hence the interest. I guess I come across as interfering where it does not concern me. Sorry. May I add those of my family are now deceased so I cannot ask.

 

[helli]

@Nayshiftin - there is no need to apologise.

Regarding basal, this is a slow acting background insulin.
Our bodies drip glucose from our livers 24 hours a day. The basal insulin is used to work with this glucose.
Some people with type 2 will only use this slow acting, basal insulin.

With Type 1 (and some people with type 2), we typically also use a fast acting bolus insulin which is used to work with the glucose in the food that we eat.

You may hear talk about the profile of insulin. This is the rate that the insulin starts working, when it is at a peak and how long it continues to work. A basal insulin, such as Lantus, lasts for about 24 hours and has a flat profile over that time. In contrast, a bolus insulin like NovoRapid lasts for about 4 hours and spikes after 15 minutes.

A few people will take a mixed insulin (and not basal/bolus). This lasts 12 or 24 hours with peaks around meal time. It can be restrictive as the time you need to eat is fixed as is the amount of carbs you need to eat. I believe this is more common for people with type 2 who are still producing their own insulin and use the injected mixed insulin as a "top up".

As I mentioned at the start of this comment, there is no need to apologise. You definitely do not come across as interfering. I am happy to explain if you are interested.

 

[Nayshiftin]

Thank you,

 

[rebrascora]

I discovered the same technique as @Robin I inject my bolus insulin for breakfast as soon as I wake up before I get out of bed, along with 1.5-2 extra units to cover the rise caused by Dawn Phenomenon or in my case mostly Foot on the Floor (FOTF) syndrome as my levels don't usually rise until I stand up, but then they can really rocket. I then potter on getting a coffee and shower etc but wait before I eat breakfast. Currently about 45 mins with Fiasp but it was over an hour with Novo(notso)Rapid) to allow that insulin to tackle FOTF before I eat breakfast. This stops me spiking and then plummeting later in the morning. Like Robin I keep a close eye on my Libre so that I can see when my levels are starting to drop and I can then eat my breakfast. It took a while to get the correct timing for me but now I have a routine that works really well and sometimes I don't get any rise at breakfast at all if I time it "perfectly".

Not suggesting anyone else follows these timings themselves as they may well hypo because 45 mins is excessive, but cautiously experimenting with the pre bolus timing at breakfast (by extending it by 5 mins every day until you find your sweet spot) and getting that quick acting insulin into your system as soon as you wake up, can really help to deal with this problem in my experience.

 

[AliBal]

I discovered the same technique as @Robin I inject my bolus insulin for breakfast as soon as I wake up before I get out of bed, along with 1.5-2 extra units to cover the rise caused by Dawn Phenomenon or in my case mostly Foot on the Floor (FOTF) syndrome as my levels don't usually rise until I stand up, but then they can really rocket. I then potter on getting a coffee and shower etc but wait before I eat breakfast. Currently about 45 mins with Fiasp but it was over an hour with Novo(notso)Rapid) to allow that insulin to tackle FOTF before I eat breakfast. This stops me spiking and then plummeting later in the morning. Like Robin I keep a close eye on my Libre so that I can see when my levels are starting to drop and I can then eat my breakfast. It took a while to get the correct timing for me but now I have a routine that works really well and sometimes I don't get any rise at breakfast at all if I time it "perfectly".

Not suggesting anyone else follows these timings themselves as they may well hypo because 45 mins is excessive, but cautiously experimenting with the pre bolus timing at breakfast (by extending it by 5 mins every day until you find your sweet spot) and getting that quick acting insulin into your system as soon as you wake up, can really help to deal with this problem in my experience.

Thanks much appreciated will try this approach out