Foot On The Floor Syndrome - Any Solution?

[Delyadave]

Hi all,
I have just started using the Libre2 monitor and have discovered at all is not well. My morning reading is in range 3-6 but as soon as I get up rises to 13-17 and does not start coming down for 2-3 hours even if I inject and don’t eat. From research I believe this is called ‘foot on the floor syndrome’ but I can’t see any solutions being offered?
I am really concerned as I need to keep my levels in range to protect my eyesight which is starting to deteriate. Any suggestions appreciated.

Dave

 

[rebrascora]

Hi and welcome

Since it sounds like you are using insulin, it would be helpful to know which insulin(s) you are using. If you are on a basal/bolus system with long acting insulin to cover background needs and a quick acting insulin to cover food, then I inject 1.5-2 units of QA insulin as soon as I wake up (before I get out of bed) to cover FOTF.

If you are on mixed insulin then that won't be possible. Have you tried having something to eat as soon as you wake up as the rise is due to the liver releasing glucose into the blood stream to give you energy for the day ahead. Eating something straight away should switch off this liver function. Something low carb like a piece if cheese or some nuts or a boiled egg. If not, you may want to discuss changing to a basal/bolus insulin regime with your health care professionals to tackle the problem.

 

[rebrascora]

Another thought is regarding the timing of your insulin as sometimes it is running out right when your body needs it most so understanding the profile of release of your insulin and overlaying that with what the Libre shows your body is doing, can mean that adjusting the timing of your insulin injection may improve such situations.

 

[Delyadave]

Hi Barbara,
Thanks for your reply. I am using Humulin I KwikPen insulin Which I believe s slow acting. I have been type 2 for 15 years and only recently put on insulin so still learning. I had not considered eating to reduce my levels but it makes sense so I will give it a try. If that does not work I will request a quick acting insulin. My diabetic nurse is on a 30 day wait for a telephone consultation which is why I am trying to address this myself!
Thanks again.
Dave

 

[rebrascora]

When do you take your Humulin I Dave?

 

[Delyadave]

Hi again,
the profile of the Humulin I KwikPen is a peek effectiveness of 2 hours After taking and to take this earlier would need a 6am alarm call! I also get vey close to a hypo (3) most nights at 4am so get woken by the Libra then. It looks like this is not going to be easy.
Dave

 

[Delyadave]

Hi,
I have been experimenting since I got the Libra and currently take 6-10 on waking and 2 hours before my evening meal (5-6pm).
Dave

 

[rebrascora]

So twice daily injections?
Have you tried taking a bit less in the evening and taking it later ie bedtime and more in the morning when you wake up? That works well for me on Levemir to balance out the lower basal needs at 3-4am but give me maximum impact when I need it in the morning. You could set an alarm for 6am and inject then and see if that works and then go back to sleep for an hour or two if you don't normally get up then. I keep my insulin by the bed and inject whilst still in bed so that FOTF doesn't kick in and then I can roll over and snooze a bit longer if I like. I have even perfected the art of injecting in the dark so that I don't have to put a light on although it is light enough in the mornings at the moment.

 

[EmmaL76]

I have FOTF. It’s encouraging that you have good numbers on waking, I also am usually between 4-6 when I’m in bed then the second a pinky toe hits the floor I shoot up. I usually have a few nuts but it’s so frustrating when your libre looks like you had a maccys breakfast before you even start your day !

 

[Inka]

Hi Barbara,
Thanks for your reply. I am using Humulin I KwikPen insulin Which I believe s slow acting. I have been type 2 for 15 years and only recently put on insulin so still learning. I had not considered eating to reduce my levels but it makes sense so I will give it a try. If that does not work I will request a quick acting insulin. My diabetic nurse is on a 30 day wait for a telephone consultation which is why I am trying to address this myself!
Thanks again.
Dave

There’s your answer probably then. Humulin I is an isophane insulin that’s usually used as a basal/background insulin. You’d need an injection of fast insulin to deal with your Foot On The Floor.

If you can’t get that, eating something as soon as you get up or as close as possible should help.

 

[Delyadave]

I will let you know how I get on with the 6AM injection and eating as soon as I wake up. I may also try going to 3-4 smaller injections over the day/evening to try and flatten the graph.
Thank you.
Dave

 

[Inka]

If the 3-4 smaller injections you’re referring to is MDI using both basal (slow) and bolus (fast) insulins, you’ll find you get better results and that it’s a more flexible regime @Delyadave 🙂

 

[Delyadave]

Thanks Inka I will request this from the doctors.
Dave

 

[everydayupsanddowns]

Hope the seating soon after rising helps to switch off your liver dump @Delyadave - DP and FOTF can be a real nightmare

Let us know if you are going to be able to switch to MDI too, as this will give you a powerful tool to combat that daily rise.

 

[Lucyr]

Not eating in the morning may also be causing problems, I find better bgs eating something when I get up as it seems possible for your body to panic and release more glucose if you don’t eat.