Any Ideas

[robert Phillips]

I have a postprandial spike mid morning, generally followed by a bg crash and hypo. This is inclined to make me feel exhausted for the rest of the day. I have been struggling with this since first being diagnosed T1D in 1997. Alleged experts contribute nothing save for advice to opt for the least bad option 😡. Is there any advice from the collective brain please? g'luk, bob

 

[Lanny]

I wonder if you have one dose of basal insulin a day?

I used to be like that when on just one dose of basal insulin, Levemir, a day at lunchtime midday, when my waking & after breakfast readings were high then when my one big dose of Levemir went in with lunch I’d hypo after! Splitting my Levemir dose to 12 hours apart, midnight & midday, really helped on both those fronts: brought my waking & after breakfast readings down; & no more post lunch hypos! It wasn’t split evenly either, doesn’t have to be, with midnight dose about half of my midday dose.

 

[robert Phillips]

Thanks but I am on a pump and all the many variations that I have tried don't seem to work.
The spike seems to be initiated by being physically active, which leads me to think that there is an adrenaline influence here. Haven't traced quite how that works yet.

 

[Inka]

Hi @robert Phillips When (ie how far I need advance of eating) do you bolus for breakfast? I find breakfast is my most insulin-resistant time and I need to bolus more in advance. If I didn’t do this, I’d need more insulin and then spike and crash as you describe.

 

[robert Phillips]

Thanks Inka, I do bolus for breakfast and immediately before eating too. You may have hit on something here - brilliant, thanks. I'll try it. How for in advance of eating your breakfast do you bolus?

 

[Inka]

With Humalog and a normal blood sugar, I need to bolus 30mins in advance of breakfast. The best thing to do is to move your bolus time 5 mins earlier each day. You should find the ‘sweet spot’ and when you do, you might even find you need to reduce your bolus amount a little (I did).

 

[robert Phillips]

With Humalog and a normal blood sugar, I need to bolus 30mins in advance of breakfast. The best thing to do is to move your bolus time 5 mins earlier each day. You should find the ‘sweet spot’ and when you do, you might even find you need to reduce your bolus amount a little (I did).

I think you might be a bit of a star.........thanks again 🙂

 

[Inka]

You’re very welcome - I hope it works 😉

 

[Pumper_Sue]

Agree with @Inka have a good look at your meal time bolus timing. Also double check your basal rates to make sure they are as good as you can get them. As you crash with exercise later try thinking ahead and perhaps pop on a temp basal a couple of hours before exercise start or have a snack before the exercise.

 

[robert Phillips]

Agree with @Inka have a good look at your meal time bolus timing. Also double check your basal rates to make sure they are as good as you can get them. As you crash with exercise later try thinking ahead and perhaps pop on a temp basal a couple of hours before exercise start or have a snack before the exercise.

Thank you too Sue. I have tinkered with tbr but basal or bolus, it seems to be the total insulin does that is affective no matter how delivered. Have done fasted testing and basals are good in all time bocks. May have another tinker after trying the breakfast bolusing further in advance of eating. 🙂

 

[Pumper_Sue]

Thank you too Sue. I have tinkered with tbr but basal or bolus, it seems to be the total insulin does that is affective no matter how delivered. Have done fasted testing and basals are good in all time bocks. May have another tinker after trying the breakfast bolusing further in advance of eating. 🙂

When you sort the timing out, you will probably find a snack or a temp basal rate will be required on exercise days. If the exercise is every day then I suspect you will have to make a slight adjustment to basal.

You might even find you will need to lower your insulin to carb ratio once your timing is sorted. Good luck 🙂

 

[robert Phillips]

When you sort the timing out, you will probably find a snack or a temp basal rate will be required on exercise days. If the exercise is every day then I suspect you will have to make a slight adjustment to basal.

You might even find you will need to lower your insulin to carb ratio once your timing is sorted. Good luck 🙂

Thanks again. Good fun init?

 

[everydayupsanddowns]

I share your pain @robert Phillips

My morning BGs are currently complicated by...

1. Liver dump on rising (feet hit the floor phenomenon). Sometimes major, sometimes next to nothing
2. Dose timing - variably needing to be 20-45 minutes between dose and eating breakfast
3. Extremely high sensitivity to ‘insulin on board’ when active (even a gentle dog walk requires 0% TBR and precautionary carbs)
4. Activity lag - BG only begins to drop after 30-40 minites of walking and can continue to drop for an hour after stopping

It’s a bloomin nightmare some mornings, and without a sensor I would be completely lost!

 

[everydayupsanddowns]

Oh... for exercise related BG rises, this typically happens with ‘anaerobic’ exercise - full on sprints or heavy weights where you can’t breathe. YDMV, of course!

 

[robert Phillips]

Oh... for exercise related BG rises, this typically happens with ‘anaerobic’ exercise - full on sprints or heavy weights where you can’t breathe. YDMV, of course!

YDMV??

 

[everydayupsanddowns]

YDMV??

Your Diabetes May Vary 😛

 

[robert Phillips]

got it.

Going back to the Dawn Phenomenon/ liver dump. I did suggest to my endo consult that perhaps there might be such a thing as "liver grab" - perhaps the liver grabs back the sugar released to the bold earlier. It drew no response. 😡
I feel somehow that adrenalin plays a part in all this!? But this may be where I run out of brain.....

 

[grovesy]

got it.

Going back to the Dawn Phenomenon/ liver dump. I did suggest to my endo consult that perhaps there might be such a thing as "liver grab" - perhaps the liver grabs back the sugar released to the bold earlier. It drew no response. 😡
I feel somehow that adrenalin plays a part in all this!? But this may be where I run out of brain.....

I suggest you do a Forum search of Dawn Phenomon.

 

[rebrascora]

There are many of us here who find that the timing of breakfast bolus needs to be significantly in advance of food. It is 45 mins for me with Fiasp and over an hour with NovoRapid. I have just changed back over to NR from Fiasp and this morning I forgot and only gave the NR 40mins. It didn't help that I was at a rather shocking 10 this morning to start with (evening basal needs an increase), but 20 mins after eating porridge made with 30g jumbo oats, I had gone up to 16.... so much for porridge being low GI!
The way I figured it out was to inject my bolus and then wait for my BG to start falling before eating. It only needs 15-20 mins at other times of the day but breakfast needs much longer.
Hope this strategy sorts the problem for you too.

 

[robert Phillips]

There are many of us here who find that the timing of breakfast bolus needs to be significantly in advance of food. It is 45 mins for me with Fiasp and over an hour with NovoRapid. I have just changed back over to NR from Fiasp and this morning I forgot and only gave the NR 40mins. It didn't help that I was at a rather shocking 10 this morning to start with (evening basal needs an increase), but 20 mins after eating porridge made with 30g jumbo oats, I had gone up to 16.... so much for porridge being low GI!
The way I figured it out was to inject my bolus and then wait for my BG to start falling before eating. It only needs 15-20 mins at other times of the day but breakfast needs much longer.
Hope this strategy sorts the problem for you too.

thanks. all this has been very helpful. certainly going to trial bolusing more in advance of breakfast.