Blood sugar spikes in the morning, hypos by lunch time. T1

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Katie Kerr

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Type 1
Hi all,

I know this is not something I'm alone in experiencing, but I'm not sure how to fix it. Background, I have had T1 diabetes for four years in August. Recently I've been doing a lot more exercise so my carb counting ratios have changed, I'm currently trying to work out what my new ratios are (any advice on that I would also be very grateful for). I take Humalog (short acting) and Lantus (long acting, 30 units last thing at night).

My problem is my breakfast in the morning (6am). I have my cereal, 30g of carbs including milk, and I take 8 units of insulin (trying with 1 to 4 in the morning). Two hours post breakfast when I test, my blood sugars are between 12-17 mmol. I feel like crap. But then at lunch time (12), I nearly always have a hypo.

I'm assuming this is some interaction between my long-acting and my short-acting insulin. How would anyone go about fixing this? I have tried increasing my long-acting to 35 units, but that results in pretty consistent night time hypos, even if I go to bed with bloods 10 mmol and over, compounded by how I exercise in the evenings.

So very very very confused. Any help appreciated!!
 
As far as I am concerned, the most important thing any Type 1 diabetic can learn how to do, once they get going on a version of MDI either with jabs or a pump, is Basal testing.

Basal and bolus do work together - how can they not when they are in your body at the same time! Only difference is that they last for different periods of times. Plus Lantus can last for longer than 24 hours and there is a peak in its activity roughly 5 hours after injecting it - please read this article, then look at 'Insulin profiles' by clicking on the menu on the left hand side of the same page. https://www.diabetes-support.org.uk/info/?page_id=120

Basically unless your basal insulin dose(s) and the timing thereof are correct for your particular body, your body clock and your activity then bolus ratios will be based on guesswork not science! Every single one of us is different!
 
What sort of cereal are you having?

One possibility is that the carbs from that are hitting your blood before the insulin is peaking.

I would agree with @trophywench in that you need to check your basal first.
 
@trophywench Thank you for sharing that article on Basal insulins, that's very helpful. I am going to try the regime from tomorrow to make sure I'm on the correct dosage. It is interesting you say that it peaks 5 hours after taking it, I take mine at about 10pm and if I have a hypo it's always at around 2am!

@khskel I'm eating plain cornflakes and 125ml milk. (31g of carbs). I know I should avoid carbs altogether but cereal is the easiest choice in the morning.
 
Well if you can organise the timing of your Lantus jab to match the + 5 hrs to the time your body needs more basal then of course it might be OK - but until you actually KNOW for a fact what time that is, you can't.
 
Hi Katie, welcome to the forum.🙂

Like trophywench and kshkel, I think this is the basal that’s causing the problems. It may simply be the time you take it, and taking it in the morning rather than at night could make the difference. With Lantus, because of its long action it doesn’t matter when you take it, as long as it’s the same time each day, and as long as you take consideration of that peak in its activity around 5 hours after injecting.

That said, you should never change things like that until you have discussed it with your DSN.
 
My thoughts...

The regular hypo at 12 means there is too much insulin (either bolus, basal or a combination of the two).

The big spike to 12-17 can't be down to not enough insulin (because you are going hypo later) so it seems most likely down to insulin timing to me. Rapid acting insulin usually takes quite a while to get going, and cornflakes are notoriously fast-acting (on average according to GI tables you'd be slightly better off having spoonfulls of sugar at GI 60 than cornflakes at GI 75).

How long are you leaving it between your dose for cereal and actually starting to eat the cereal? It may be that you need to leave 15-20 minutes or even longer after you've injected before you take your first spoonful. Would be well worth starting with a smallish delay and throwing a few strips at it before/after eating to see whether you need 10, 20 or 30 minutes wait before eating to reduce that spike.

Alternatively a slice of seedy toast (eg Burgen) might be similarly fast to prepare, but more BG friendly? It all depends on how hard you want to work to find a system that suits foods you really want to eat :D
 
I would also look at the timing of your bolus insulin most inject about 20 mins before they eat to counteract the spike.
As others have said though check your basal out first.
 
I would agree about the timing of the bolus in the morning. Cornflakes are so speedy converters and it is likely that your insulin is not keeping up and then causing problems later once the glucose is used up. I now bolus between 30 and 0 minutes before breakfast depending on what I am giong feat and my BG when I wake up.

With basal insulin, I found it very helpful when I switched to Levemir for my basal, which I was then able to spilt morning and evening. It gave me the flexibility to reduce the day time without reducing the night time dose. (There is no point in splitting Lantus as it lasts for over 24 hours, whereas Levemir does not last as long)

Whatever you do the only way to find out you need to change is to do fasting tests to sort the basal rates. Once those are sorted the ratios for bolus can be sorted, along with corrections ratios.
 
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