diabetes dawn phenomenon

[robert Phillips]

Hello, bob Phillips (newby ) is me.
71 years old
diagnosed 1997
Novorapid insulin by pump

I've struggled with controlling a spike in blood sugar levels a couple of hours or so after breakfast. Steady BG overnight, correct bolus for breakfast carbs and whoosh up it flies to high teens or sometimes twenties. I've tried most things. Anybody else's suggestions would be mighty welcome.

Somebody suggested I might try using the Multiwave bolus on my Roche Accu-Chek Aviva Insight Pump- 1/3 immediate and 2/3rds over two hours???

 

[SB2015]

Good morning Bob and welcome to the forum.

Like you I discovered that I was spiking after breakfast (shown up by use of the Libre) and followed advice on here changed that to a blip, by a variety of strat3gies that might be worth a try.

Altering the timing of my bolus.
The Novorapid takes a bit of time to get active, whilst breakfast is happily converting all the carbs into glucose.
I gradually moved the bolus forward and now deliver my insulin up to 30 min before I eat, but adjust this based on my glucose reading when I wake up. If I am below target on waking I delay my delivery until after the shower or even with breakfast if I am very low. There is no fixed timing for everyone, and it is important to work out what suits you.
I use this strategy, where possible, for every meal. However I don’t chance it when I am out for a meal as I have no idea when it will arrive.

Reduced the number of carbs at breakfast (and other meals)
I realised that I was eating quite a lot of carbs (60g)We both decided we would reduce this and I now aim for a max of about 30g of carbs at any meal. This has worked well to reduce the size of the blips.
I used to think I was eating well with the high fibre cereals, but as someone pointed out to me, a bowl of cereal is just a bowl of sugar in disguise.

Change to lower GI
The foods with a lower GI will convert more slowly to glucose, so that is when I would use a multiwave bolus. At breakfast I include some up front to deal with morning rise.

I hope that those ideas are of some help. Come back with any other questions. There are plenty of people on here very happy to help.

 

[SB2015]

PS.
I have read your post again, and realised that I have misread it. I though your were spiking for the two hours after breakfast, rather than spiking two hours after your meal. So further thoughts

Multi wave
If the spike is due to your breakfast, the multiwave idea is a good one. They have given you a starting point and then you could adjust it to suit you for different breakfasts.

Basal rate check
It could be that your basal rate at that time is insufficient.
I always find it best to check the basal rate first as otherwise carb ratios, varied delivery can hide an incorrect profile.

 

[robert Phillips]

Good morning Bob and welcome to the forum.

Like you I discovered that I was spiking after breakfast (shown up by use of the Libre) and followed advice on here changed that to a blip, by a variety of strat3gies that might be worth a try.

Altering the timing of my bolus.
The Novorapid takes a bit of time to get active, whilst breakfast is happily converting all the carbs into glucose.
I gradually moved the bolus forward and now deliver my insulin up to 30 min before I eat, but adjust this based on my glucose reading when I wake up. If I am below target on waking I delay my delivery until after the shower or even with breakfast if I am very low. There is no fixed timing for everyone, and it is important to work out what suits you.
I use this strategy, where possible, for every meal. However I don’t chance it when I am out for a meal as I have no idea when it will arrive.

Reduced the number of carbs at breakfast (and other meals)
I realised that I was eating quite a lot of carbs (60g)We both decided we would reduce this and I now aim for a max of about 30g of carbs at any meal. This has worked well to reduce the size of the blips.
I used to think I was eating well with the high fibre cereals, but as someone pointed out to me, a bowl of cereal is just a bowl of sugar in disguise.

Change to lower GI
The foods with a lower GI will convert more slowly to glucose, so that is when I would use a multiwave bolus. At breakfast I include some up front to deal with morning rise.

I hope that those ideas are of some help. Come back with any other questions. There are plenty of people on here very happy to help.

PS.
I have read your post again, and realised that I have misread it. I though your were spiking for the two hours after breakfast, rather than spiking two hours after your meal. So further thoughts

Multi wave
If the spike is due to your breakfast, the multiwave idea is a good one. They have given you a starting point and then you could adjust it to suit you for different breakfasts.

Basal rate check
It could be that your basal rate at that time is insufficient.
I always find it best to check the basal rate first as otherwise carb ratios, varied delivery can hide an incorrect profile.

Brilliant thanks very much. I identify with a whole load of that and indeed use just those tactics and achieve a degree of control by so doing.
I have done fasted basal rate checks and clearly the spike occurs without breakfast. I can increase the insulin dose either by basal amount, basal ratio or bolus either way it's more insulin that then results in a hypo afterwards.

Surely by using the 1/3 x 2/3 multi wave bolus and therefore less insulin on the approach to the spike would surely accelerate it?

 

[trophywench]

If you are having a spike without brekkie, then to me, it's a basal issue not a bolus one. That being the case you need to find out when it starts to rise and increase your basal from 2 hours prior to that. I've found that the teeniest increases to base rates (as little as 0.01u/hr) given for a couple of hours prior to the BG hike makes a huge difference - nowhere near 10% of those rates. The advantage is of course that it's also nowhere near enough to send that BG plummeting down, whereas doing it by 'correction bolus' it most likely would be.

 

[robert Phillips]

brilliant advice. I can't believe I've not done it before but I'll certainly give it another go. Many thanks.

 

[SB2015]

Brilliant thanks very much. I identify with a whole load of that and indeed use just those tactics and achieve a degree of control by so doing.
I have done fasted basal rate checks and clearly the spike occurs without breakfast. I can increase the insulin dose either by basal amount, basal ratio or bolus either way it's more insulin that then results in a hypo afterwards.

Surely by using the 1/3 x 2/3 multi wave bolus and therefore less insulin on the approach to the spike would surely accelerate it?

As TW said, if you are getting a spike without breakfast, it is definitely basal insulin that needs changing. If the basal is wrong then it is hard to get the bolus right.

A lot of people get a spike when they wake up with the liver dumping some glucose to get us giong first thing. Some have found a tiny snack as they wake can head this off, for those of us on the pump we can use changes to our basal insulin, although that does depend on your waking at the same time each morning.

I know I could set an alarm but what is retirement for if not for some flexibility!!

 

[trophywench]

Well you can do it to some degree SB, by increasing your base rate between the hours of X and Y BUT not by enough to actually stop it completely. It calms it down a bit, if it doesn't cure it. There again - that's as much as we can get from a pump isn't it? More hours of every day with better BGs - never going to be perfect!