The morning blood sugar dilemma

[pingham]

Hello All,

New to the forums, wasn't sure if this was the exact place to make this post, but I believe it kind of relates to food.

I was diagnosed about 10 years ago when I as 13 and in my entire time as a Diabetic, I've started to notice something only over the last 3 or 4 months, that has left me stumped.

I inject 4 times a day (sometimes 3, if I skip breakfast), 3 lots of Humalog with meals and a dose of Glargine (which I believe is being discontinued over the next few months, but that's a different subject) with supper.

Each night, by blood sugars for supper are usually between 3 and 6 mmol. I have 2 weetabix, with sweetener. When I wake up, my blood sugar is also between 3 and 6 mmol.

Now, if I don't have breakfast in a morning, between 9 and 12, my blood sugar rises. So say I wake up with a blood sugar of 4 or 5, I sometimes skip breakfast. Before 12, it reaches high 9's.

Is this due to not eating on a morning or down to the glargine dose for supper? I've tried bumping my supper time injection by a few units and I've not seen any change.

I'm just not sure if this is a diet, or insulin related problem. It's starting to drive me insane, as I start to feel quite groggy and sick once I hit this time on a morning due to this.

Any ideas?

Paul 🙂

 

[Copepod]

Welcome Paul / Pingham

Could be a Dawn Phenonenom issue - liver kicks out sugar in response to "starvation". If you don't have problems when you have breakfast, then that sounds like the solution 🙂

 

[everydayupsanddowns]

Hi Paul

I've moved this to 'General' so it will get a bit more attention...

A couple of questions (because parts of your post confuse me a bit)...

Am I right in understanding that you have 2 Weetabix just before bed, and then wake up with roughly the same BG that you went to bed on? What happens if you don't have those? Have you run any/many overnight tests to see what is heppening to your levels during the night.

You are having +20g of fairly fast-acting CHO & it seems to be disappearing. This suggests that your basal (Lantus/glargine) might be too high, and that this excess of Lantus is processing those carbs overnight.

On days when you skip breakfast your BGs seem to rise gradually during the morning. If this happens throughout the day (eg if you skipped lunch not breakfast) it suggests that your basal might be too low (unless as Copepod suggests it's DP/liver-related shenanigans)

Have you ever systematically tested your level of Basal insulin? There's a method for doing this here.

Interested to hear you say that glargine might be being discontinued - where did you hear that?

 

[Northerner]

Hi Paul, welcome to the forum 🙂 As far as I know there are no plans to discontinue glargine which has a trade name of lantus and is what I take for my basal insulin - I believe it is the market leader, followed by levemir.

As Copepod suggests, this sounds like dawn phenomenon - exactly the same thing happens to me if I skip breakfast. People tend to be more insulin resistant earlier in the day - certainly applies to me, as I need much more insulin per 10g of carbs in the morning. If you don't want to eat carbs/inject in the morning, some people find that having a small protein snack stops the liver from producing so much glucose.

I would be a little concerned if I was regularly waking up in the 3s, or even low 4s - it would suggest that my lantus needed reducing. If you wake at 3.x then there is every chance that, during the night, you dropped much lower which if you don't wake could be very dangerous, and if you are increasing your glargine to try and overcome the DP then this is even riskier - it might be better to ask your DSN about splitting your lantus into 2 injections. I would suggest discussing your targets with your DSN as your supper levels also seem low if they are in the 3s and could be due to either too much glargine or too much humalog with your evening meal. Have you ever done a carb counting course, like DAFNE?

p.s. I see from your homepage you are from Brighouse - so am I! 🙂

 

[Natalie123]

As mike said, I was a bit confused about the supper situation. Do you inject for the weetabix or are you having it as a snack. If you are not injecting for it and you need it to prevent a night time hypo, your glargine is too high. Your glargine should keep your blood sugars constant and you shouldn't be needing such a large snack before bed without injecting for it.

When you skip breakfast, it sounds like a dawn phenomenon thing, I recently found out I have this too, the liver starts to output sugar in the morning until you eat something. It sounds like you need to start being a breakfast lover like me!

 

[pingham]

Hi Paul

I've moved this to 'General' so it will get a bit more attention...

A couple of questions (because parts of your post confuse me a bit)...

Am I right in understanding that you have 2 Weetabix just before bed, and then wake up with roughly the same BG that you went to bed on? What happens if you don't have those? Have you run any/many overnight tests to see what is heppening to your levels during the night.

You are having +20g of fairly fast-acting CHO & it seems to be disappearing. This suggests that your basal (Lantus/glargine) might be too high, and that this excess of Lantus is processing those carbs overnight.

On days when you skip breakfast your BGs seem to rise gradually during the morning. If this happens throughout the day (eg if you skipped lunch not breakfast) it suggests that your basal might be too low (unless as Copepod suggests it's DP/liver-related shenanigans)

Have you ever systematically tested your level of Basal insulin? There's a method for doing this here.

Interested to hear you say that glargine might be being discontinued - where did you hear that?

Excellent, cheers. Didn't think to put it in General.

Yep, 2 weetabix before bed, the blood sugar reading is pretty much the same when I wake up.

I've not tried skipping the supper, I always had it drilled into me when going to the hospital youth clinics when younger that it was a essential to eat supper? I guess not, so in that case I'm going to give it a go and run the evening test in the link you provided.

Answer to your final question coming up after the next quote..

Hi Paul, welcome to the forum 🙂 As far as I know there are no plans to discontinue glargine which has a trade name of lantus and is what I take for my basal insulin - I believe it is the market leader, followed by levemir.

As Copepod suggests, this sounds like dawn phenomenon - exactly the same thing happens to me if I skip breakfast. People tend to be more insulin resistant earlier in the day - certainly applies to me, as I need much more insulin per 10g of carbs in the morning. If you don't want to eat carbs/inject in the morning, some people find that having a small protein snack stops the liver from producing so much glucose.

I would be a little concerned if I was regularly waking up in the 3s, or even low 4s - it would suggest that my lantus needed reducing. If you wake at 3.x then there is every chance that, during the night, you dropped much lower which if you don't wake could be very dangerous, and if you are increasing your glargine to try and overcome the DP then this is even riskier - it might be better to ask your DSN about splitting your lantus into 2 injections. I would suggest discussing your targets with your DSN as your supper levels also seem low if they are in the 3s and could be due to either too much glargine or too much humalog with your evening meal. Have you ever done a carb counting course, like DAFNE?

p.s. I see from your homepage you are from Brighouse - so am I! 🙂

I work in Manchester so find picking up prescriptions a little difficult so my mother picks them up. When she went to place a prescription a month or so ago, she was told that my evening injection would be discontinued and an alternative would be discussed and decided at my annual review with the Doctor in December. I don't have any more information about it, apart from her saying she had been told it was being discontinued.

What protein snacks would you recommend? Carb counting sounds appealing, and is something I'm starting to enquire about and look into as I think it would definitely be of value. Where abouts in Brighouse are you from? I'm from around the waring green area.

As mike said, I was a bit confused about the supper situation. Do you inject for the weetabix or are you having it as a snack. If you are not injecting for it and you need it to prevent a night time hypo, your glargine is too high. Your glargine should keep your blood sugars constant and you shouldn't be needing such a large snack before bed without injecting for it.

When you skip breakfast, it sounds like a dawn phenomenon thing, I recently found out I have this too, the liver starts to output sugar in the morning until you eat something. It sounds like you need to start being a breakfast lover like me!

Yep, I'm injecting with the weetabix. This is going to sound terrible, but the skipping of breakfast for me is just pure laziness. I seem to have formed an opinion that by skipping breakfast I get an extra 10 minutes to snooze (bad, I know).

Thanks for all the answers so far, it's genuinely given some real food for thought. Tonight I'll skip supper and take a regular dose of glargine and see what my blood sugar is like at 2:30am.

I'll report back with my findings. 🙂

 

[Steff]

Hi and a warm welcome to the forum Paul

 

[Northerner]

Perhaps your doctor is planning a switch to levemir for you and the message has become confused? Know Waring Green very well! I'm from Lane Head originally, then Smith House, then Woodhouse 🙂

If you're planning on changing your routine tonight by not having the weetabix and injecting for it then I would suggest setting your alarm for 3 am so you can take a reading, or even better wait until you can discuss it with your DSN - it's a pretty major change to your routine and can therefore be problematical at night because you won't know whether your lantus might be too high or too low without the snack.

Bacon and egg is a good protein breakfast, yummy too! 🙂

 

[pingham]

Could be, I'll let you guys know in December once the annual review comes up.

That's cool, there's a chance we've probably passed each other in Brighouse somewhere in the past.

So I went to bed with a blood sugar of 6.2 last night. I ditched the weetabix and did my usual 30 units of glargine (not the higher amount I previous mentioned) and set my alarm for 3am. When waking at 3am, my blood sugar was 2.4, so I obviously had my supper then. Woke up and it was 11mmol so I'm guessing the spike is the problem and is more than likely the cause of my morning issues and therefore I need a lower amount of glargine than 30?

 

[Northerner]

Could be, I'll let you guys know in December once the annual review comes up.

That's cool, there's a chance we've probably passed each other in Brighouse somewhere in the past.

So I went to bed with a blood sugar of 6.2 last night. I ditched the weetabix and did my usual 30 units of glargine (not the higher amount I previous mentioned) and set my alarm for 3am. When waking at 3am, my blood sugar was 2.4, so I obviously had my supper then. Woke up and it was 11mmol so I'm guessing the spike is the problem and is more than likely the cause of my morning issues and therefore I need a lower amount of glargine than 30?

If you dropped to 2.4 in the night then you definitely need to reduce your glargine dose. I struggled for a while after diagnosis and eventually realised that I was injecting far too much lantus/glargine - I was on 20 units then and I gradually reduced it until I became steady overnight and it came down as low as 3 units at one point! When you say you had your supper, do you mean you ate two weetabix? That's probably not the best treatment for a nighttime hypo, you should have something fast-acting that is around 15g carbs - three jelly babies does it for me. Two weetabix would be too slow to treat the hypo properly, and it would also be overtreatment in terms of the amount of carbs eaten (about 38g instead of 15g). The normal rule is to have 15g and then wait 15 mins to see if levels have risen, if not - more carbs.

Good job you set your alarm! Can you call your DSN to discuss before December?

 

[Blythespirit]

Hello Pingham and a belated welcome to the forums. Sorry I can't advise regarding your insulin doses, but it's good to see you've had some excellent advise from fellow type 1's so far. XXXXX

 

[everydayupsanddowns]

I'd suggest the first thing to try to get settled is your basal dose (speak to your DSN for support on this). Going hypo overnight can bounce you high in the mornings, and too much Lantus sloshing around is going to make meal doses behave erratically.

Good luck with it and keep asking questions.

 

[ChristineBee]

Dawn Phantom!

I was suffering from the dawn phantom....I was going to bed 6mmol, checking at 3am, and I was still around 6mmol (that eliminated nocturnal hypos which cam make you wake up high) And then at 7am I would be 15mmol upwards. No matter what I did I could not get my morning reading down, this was a dawn phenonemom. My consultant suggested I change my background insulin and thankfully it is beating the phantom for now!! I spotted somewhere on here a comment about high ratios, well Im on a 5:1 ratio in the morning, I am very insulin resistant at that time of day.
Good luck

 

[trophywench]

Belated Hiya - Dawn Phenomenon occurs i everybody not just diabetics, just that we know about it and non-D's don't LOL

It can start pre waking or it can start post getting up, or it can do both. Breakfast of only protein will stop it in its tracks. Doesn't have to be carbs at all. Have the extra 10 minutes if you must then grab a slice of boiled ham or a lump of cheese on your way past the fridge - but far better to allow for it really.

Have a good read of the link Mike (EveryDay etc) gave you - it also gives info on both Lantus and Levemir. And there is shedloads of other info on that website too. (just happens I contributed to that partic article when it originally appeared because I was utterly gobsmacked at the time to discover exactly how much doing all that boring testing basals 🙂D) helped me. And still does. I had also been on Lantus and then Levemir so could speak about both with the benefit of personal experience)

When you are an adult whether Diabetic or not, male or female, your calorific intake requirements will be different to what they were as a Yoof.

You sound like me - they gave me info years ago, then they moved on to summat newer and better and forgot to tell me. And the next NHS person assumed I already knew it. And the next person and the next ..... right up to 3 years ago when I joined 'that other' site and this one (this one was an infant so I concentrated on the other) and it shook me to discover exactly how much I hadn't a clue about. And all the 'old hands' on my carb-counting course said exactly the same thing. It rocks your foundations when that happens. But the New Ways work. And actually work one helluva lot better than the Old Ways. So don't be scared of it. However do bear in mind that sometimes stuff has to go through a period of seeming to be worse, before they start to look better and don't be put off by that either.

Good luck!

And if there isn't any local carb-counting course near you, there's an Online one you can do, so either find it from links on that other website or shout up.

 

[FM001]

Try reducing your glargine again tonight and set your alarm and test at 2,4 and 6am to see what your blood glucose is like. One lesson I learnt long ago was to never ever miss breakfast, the body's reaction is to liver dump thinking your body is in starvation mode and this pushes bg up throughout the morning, try and make time for breakfast no matter what how small or convenient it is..

 

[Robster65]

Hi pingham (and hi pazza too!).🙂

I don't I've ever missed breakfast in all my years unless I've been so ill that I couldn't keep it down.

Like Trophywench, I discovered I'd been left behind by the information train until I joined here last year.

You'll catch up soon enough.🙂

Rob

 

[Kwaka1]

Glargine (Lantus) isn't being discontinued, NovoNordisk are just discontinuing some of their pre-filled pens. I now use Solostar, different pen - same contents.