Hi, Newbie here . .

[Dunc1]

I am T2D for the past 25 years or so, diagnosed in 2000. I have managed the condition as follows: Years 1 to 7 Diet and exercise. 8 to 24 Diet, exercise and oral medication 100mg Metformin, 25mg Alogliptin. Previously Gliclazide 80mg.
Moved to Basal/Bolus insulin regime during March 2025 - Basal - Semglee, Bolus - Trurapi. I am currently on 10 units Basal (24 Hour) and pre-meal 6 units Bolus three times per day. I am currently struggling to stop post-breakfast BG spikes to between 13 - 16. Probably 'Dawn Phenomenon' !!!

 

[mashedupmatt]

Hi @Dunc1 and welcome to the forum - sorry to hear the oral medication hasn't worked out but hopefully the insulin will do the trick - for many (myself included) a bit more insulin is required in the morning to cover breakfast compared to an evening meal for example - as you've only just gone on to insulin, you've probably been advised to take more conservative doses to start with, to lower the risk of hypos too - I can't advise on actual doses but it's worth keeping an eye on it, and perhaps mention it to your healthcare team, who may look at tweaking your mealtime ratios - are you on a fixed amount for meals, or are you carb-counting?

 

[Ieva DUK]

Hi @Dunc1 and welcome to the forum! It sounds like you’ve done an incredible job managing your diabetes over the years and have been really proactive in adjusting things as needed. Transitioning to a basal/bolus regimen is a big step, and it’s great to see that you’re already dialling into patterns and trying to understand what might be causing the spikes.
Those post-breakfast rises can definitely be frustrating, especially when you’re doing everything right. The dawn phenomenon could well be playing a role - that natural early morning hormone surge that can make blood sugars rise even before eating. Some people find that even eating a relatively low-carb breakfast still results in a spike due to insulin resistance being higher in the morning.
Here are a few things that I've noticed others in similar situations have tried (alongside medical advice, of course):
- Adjusting the timing or dose of basal insulin slightly (though always best to check in with your team first).
- Pre-bolusing earlier than usual for breakfast — sometimes 20–30 minutes before eating, depending on how your insulin works.
- Looking at breakfast choices - even slow-acting carbs can sometimes hit hard in the morning. Some people find higher protein/fat breakfasts help ease the rise.
- If you’ve recently switched to Trurapi, it might be worth keeping an eye on how quickly it kicks in for you - sometimes a different rapid-acting insulin can behave slightly differently.
It’s clear you’re engaged and knowledgeable, and that really goes a long way in fine-tuning things. Hopefully, with a few small adjustments, those morning readings will start coming down a bit. Keep us posted on how you're getting on - you’re definitely not alone in this!

 

[rebrascora]

Hi and welcome.

Generally the way to stop post breakfast spikes is to carefully experiment with extending the time you inject before you eat.

How far in advance of breakfast do you currently inject your Trurapi?
Do you have Libre or Dexcom or some other Constant Glucose Monitor or are you relying on finger pricks only?

What I did was increase my prebolus timing (the time between injecting and eating) by a few minutes each day until I found the point at which the peak of activity of the insulin and the release of glucose from the food (and yes your liver will also be contributing glucose with Dawn Phenomenon/Foot on the Floor Syndrome) more or less coincided resulting in the spike being much lower. You have to be a bit careful not to increase it too much all at once otherwise you risk a hypo whilst you are eating or just afterwards, so just extend the time very carefully every few days until the spike comes down to what you consider an acceptable level. Just to give you an idea of how much that timing can vary from one person to another, some people can inject and eat straight away but I found I needed 75 mins most mornings with NovoRapid which is similar to Trurapi. At lunch and evening meal I only needed 20-30 mins, so it can vary by quite a significant amount. I moved to a faster acting insulin (Fiasp) because 75 mins was just impractical!
The time you need can also vary with your waking BG level as if you are low when you wake up, perhaps in the 4s or 5s, your insulin can kick in a lot quicker than if you wake up at 8 or 10, so you have to take that into consideration too.

Hope that makes sense.

 

[helli]

Welcome @Dunc1
You mention that your BG "spikes". As an engineer, I think of this as a graph where there is a "spike" - an up and a down. Whereas, I have read some people describing an "up and stay there" as a spike. I call that a "plateau".
The way to treat a "spike" and a "plateau" are different.
If you are finding it is a spike, you have enough insulin but the peak activity of the insulin is later than the peak activity of your digestion - so the glucose from the food (and liver thanks to DP) is getting to your blood before the insulin does.
If you are finding it is a plateau, you do not have enough insulin so may need to increase your dose, or change what you eat for breakfast.
This is the problem with fixed doses of insulin - they assume you eat the same amount of carbs every meal every day.
If you are interested, it may be worth carb counting and adjusting your insulin accordingly.

 

[Dunc1]

Hi @Dunc1 and welcome to the forum - sorry to hear the oral medication hasn't worked out but hopefully the insulin will do the trick - for many (myself included) a bit more insulin is required in the morning to cover breakfast compared to an evening meal for example - as you've only just gone on to insulin, you've probably been advised to take more conservative doses to start with, to lower the risk of hypos too - I can't advise on actual doses but it's worth keeping an eye on it, and perhaps mention it to your healthcare team, who may look at tweaking your mealtime ratios - are you on a fixed amount for meals, or are you carb-counting?

Hi @Dunc1 and welcome to the forum - sorry to hear the oral medication hasn't worked out but hopefully the insulin will do the trick - for many (myself included) a bit more insulin is required in the morning to cover breakfast compared to an evening meal for example - as you've only just gone on to insulin, you've probably been advised to take more conservative doses to start with, to lower the risk of hypos too - I can't advise on actual doses but it's worth keeping an eye on it, and perhaps mention it to your healthcare team, who may look at tweaking your mealtime ratios - are you on a fixed amount for meals, or are you carb-counting?

Hi Matt,
Sorry for the delay in replying, thanks for your information. I am having problems contacting my healthcare team at the moment, but have upped my breakfast bolus to hopefully cater for the breakfast issues. I haven’t tried carb counting yet as I think I need to understand the basics of starting insulin first. Thanks again for your response.

 

[Dunc1]

Welcome @Dunc1
You mention that your BG "spikes". As an engineer, I think of this as a graph where there is a "spike" - an up and a down. Whereas, I have read some people describing an "up and stay there" as a spike. I call that a "plateau".
The way to treat a "spike" and a "plateau" are different.
If you are finding it is a spike, you have enough insulin but the peak activity of the insulin is later than the peak activity of your digestion - so the glucose from the food (and liver thanks to DP) is getting to your blood before the insulin does.
If you are finding it is a plateau, you do not have enough insulin so may need to increase your dose, or change what you eat for breakfast.
This is the problem with fixed doses of insulin - they assume you eat the same amount of carbs every meal every day.
If you are interested, it may be worth carb counting and adjusting your insulin accordingly.

Hi Heli,
Thanks for your reply and apologies for the late response. I am attempting to modify my breakfast bolus to bring the ‘spikes’ under control. However, I really am struggling to find breakfast content that doesn’t send my BG seriously northbound. Only poached eggs at the moment, no doubt will discover others by process of elimination. I do miss my breakfast cereals

 

[Dunc1]

Hi and welcome.

Generally the way to stop post breakfast spikes is to carefully experiment with extending the time you inject before you eat.

How far in advance of breakfast do you currently inject your Trurapi?
Do you have Libre or Dexcom or some other Constant Glucose Monitor or are you relying on finger pricks only?

What I did was increase my prebolus timing (the time between injecting and eating) by a few minutes each day until I found the point at which the peak of activity of the insulin and the release of glucose from the food (and yes your liver will also be contributing glucose with Dawn Phenomenon/Foot on the Floor Syndrome) more or less coincided resulting in the spike being much lower. You have to be a bit careful not to increase it too much all at once otherwise you risk a hypo whilst you are eating or just afterwards, so just extend the time very carefully every few days until the spike comes down to what you consider an acceptable level. Just to give you an idea of how much that timing can vary from one person to another, some people can inject and eat straight away but I found I needed 75 mins most mornings with NovoRapid which is similar to Trurapi. At lunch and evening meal I only needed 20-30 mins, so it can vary by quite a significant amount. I moved to a faster acting insulin (Fiasp) because 75 mins was just impractical!
The time you need can also vary with your waking BG level as if you are low when you wake up, perhaps in the 4s or 5s, your insulin can kick in a lot quicker than if you wake up at 8 or 10, so you have to take that into consideration too.

Hope that makes sense.

Hi Barbara,
Thanks for the valuable feedback. I use Dexcom 1 which I have been comparing with finger-prick tests to ensure compatibility. It does seem to be generally OK. From what you have said, I’m a bit concerned that my healthcare team didn’t raise the issue of bolus/breakfast timing. The Trurapi documentation recommends 10 - 15 minutes before meals. I will attempt to contact my diabetic nurse this week to discuss the issues in general but I don’t see much of a problem in increasing the time gap between breakfast bolus and actual breakfast. As yet, I haven’t experienced any hypos since starting (and modifying doses) insulin. Lowest has been overnight twice at 4.5 mmol/l.

Thanks again for your help.

 

[Dunc1]

Hi @Dunc1 and welcome to the forum! It sounds like you’ve done an incredible job managing your diabetes over the years and have been really proactive in adjusting things as needed. Transitioning to a basal/bolus regimen is a big step, and it’s great to see that you’re already dialling into patterns and trying to understand what might be causing the spikes.
Those post-breakfast rises can definitely be frustrating, especially when you’re doing everything right. The dawn phenomenon could well be playing a role - that natural early morning hormone surge that can make blood sugars rise even before eating. Some people find that even eating a relatively low-carb breakfast still results in a spike due to insulin resistance being higher in the morning.
Here are a few things that I've noticed others in similar situations have tried (alongside medical advice, of course):
- Adjusting the timing or dose of basal insulin slightly (though always best to check in with your team first).
- Pre-bolusing earlier than usual for breakfast — sometimes 20–30 minutes before eating, depending on how your insulin works.
- Looking at breakfast choices - even slow-acting carbs can sometimes hit hard in the morning. Some people find higher protein/fat breakfasts help ease the rise.
- If you’ve recently switched to Trurapi, it might be worth keeping an eye on how quickly it kicks in for you - sometimes a different rapid-acting insulin can behave slightly differently.
It’s clear you’re engaged and knowledgeable, and that really goes a long way in fine-tuning things. Hopefully, with a few small adjustments, those morning readings will start coming down a bit. Keep us posted on how you're getting on - you’re definitely not alone in this!

Hi leva DUK,
Many thanks for the welcome and advice suggestions.
Kind Regards.