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High BM Readings in A Morning

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weblar83

New Member
Relationship to Diabetes
Type 1
Hi all,

I've just recently registered with this site so please, be gentle with me.

I'm actually posting on my girlfriends behalf who has been a type 1 diabetic for the past 15 years. I will admit to her not being a good diabetic and for the past year and a half (the period of time we've been together), I've been trying to help her to get back on track with managing it rather than ignoring it.

Yesterday she had corrective laser surgery for background retinopathy and hopefully, with her improved control, this will be something she won't need to have done again for a while - she's 26 by the way.

One thing I would like to ask for advice on is high morning readings. Having seen several diabetes "specialists" and having given them several months worth of BM readings with 90% of these having high morning readings, they're still none the wiser as to suggest what we can do.

My girlfriend has another appointment to discuss this with her team in a few weeks time but I'm hoping for some advice a little sooner so we can really get on top of this.

During the day, her BM levels may fluctuate from 4.5 to about 8 whereas the morning reading can be anywhere from 15 through to about 22. As an example, last night before bed, she was 6.7 but this morning she was 19.

Neither of us really do hearty breakfasts, which I know is a mistake but could something this simple make a difference? There have been a couple of occasions where she wakes in a morning and has normal readings, this only seems to be the morning after a couple of glasses of wine. I don't know why that would make a difference.

I'd be really grateful if someone could share their experience or provide some advice. So far I feel she's doing really well and (courtesy of an iPad app) BM reading-wise is now averaging around about the 7 mark - lower than what has been expected of her by the diabetic specialists.

Thanks in advance for any help.

K
 
Hi Weblar

Good to have you hear.

Congratulations to your girlfriend on her improved levels - and brilliant that you are supporting her.

Has your GF done much in the way of testing throught the night to see what is happening between bedtime and waking?

For high morning BGs in a T1 there are two usual suspects...

1. Dawn Phenomenon. Everyone gets this to some extent, part of the body's natural rhythm. Often said to be a throwback to our cave dwelling ancestors who needed a bit of 'get up and go' first thing in order to rush out and hunt woolly mammoths. Essentially your body has a good supply of glucose stored in the liver and muscles, and in the before dawn/just after waking (depending on the individual) you can get a little or a lot of extra glucose without having to eat anything.
2. Hypo rebound. Somewhat controversial and uncertain (some members here with continuous monitors fail to see this happen overnght), but the body does appear to have an 'emergency' mechanism that dumps glucose in the event of very low blood glucose levels. So if you sleep through a hypo and your liver decides to 'help out' overenthusiastically you can end up waking high and with a thumping headache.

The best way to find out what is happening is to set an alarm at say 3am, or perhaps 2am and 4am to check what her levels are then.

If it's DP there are a number of things that might help - the most obvious being altering dose/timing to increase basal (background) insulin to cover the rise. Some people have success with low carb snack to tame DP too.

If it's a hypo rebound it's usually because of *too much* basal, so more testiong and tweaking.

Let us know how you get on.
 
Hi,

Thanks for your speedy reply and also thanks for the welcome message.

I'm proud of her so far and considering where she has been with her control, she's doing well and I'll do whatever I can to keep her going.

She hasn't done much by way of testing during the night although we have discussed waking up at 3 to do a test with correction if necessary. This was mentioned to the diabetic team but they decided that it wasn't really practical to be doing this. Possibly not the best advice but still.

We have read about the dawn phenomenon thing before. Would a more hearty breakfast get the body away from this cycle - more to do with knowing that it is going to get some food in it to give it the get-up-and-go? A low carb snack sounds like a good idea, this may have a similar result to what we've seen with a glass or two of wine.

I don't think it would be a hypo rebound given that the BM reading before bed is a long way from hypo - I could be completely wrong though.

Tweaking the basal insulin might be a good idea but what with having good readings throughout the day, I think she's a little reluctant to make changes.

Thanks again for your advice.

K
 
I know from my own experience that it is very possible to drop into an overnight/early morning hypo with just a little too much basal (and the amount of basal that she needs is likely to ebb and flow throughout the year). This can be partly compounded by a drop-off in secretion of cortisol in the early hours (which helps keep BG up). So you can end up in a situation where your basal is very active at the time when your BGs are dropping, only for them to bounce back up with DP later on. Gaaaah!

The best bet IMO if she wants to fine tune control is to get basal insulin working as accurately as possible. This does involve a bit of work in terms of working out what the general 'pattern' is, but once that has been done subsequent tweaks can take place on a more ad-hoc basis.

This page is very helpful to get basal adjusted properly: http://www.diabetes-support.org.uk/info/?page_id=120

In terms of tackling DP, if that is what is causing it, I think breakfast is unlikely to help waking levels (though D is so individual it might work for her!) but is does seem to stop the liver dumping and reduce the overall rise, so certainly a good idea. Some people need to eat nothing after dinner the night before. Others need a low/no-carb snack at bedtime (some nuts, cheese or cold meats are possibilities). As with all things D, you just have to try out a few options, and see what works for the individual.

Good luck with it!
 
There have been a couple of occasions where she wakes in a morning and has normal readings, this only seems to be the morning after a couple of glasses of wine. I don't know why that would make a difference.
Click to expand...

It sounds to me like your girlfriend's basal isn't covering her nighttime glucose output. Alcohol prevents your liver from releasing glucose. She'll need to test to confirm what's going on but my gut feeling is she'll need to take more of her background insulin - how exactly she'll need to do this will depend on the insulin she uses and the time she injects.
 
Thanks for both your responses.

I *think* she takes her basal insulin as soon as she wakes in a morning and I also last thing at night before bed. I'm not sure exactly how much she takes but I've heard her mention 22 units before, I don't know whether that number is the same for both.

I guess in the short term, before her next meeting with her diabetic team, it would be worth persisting with the low-carb snack before bed. If that makes no difference - say over a week - then maybe increasing her night time basal would be worth trying.

Would that be a sensible way to go at this?

K
 
She should do some nighttime testing first to rule out whether it's dawn phenomenon because this will inform your approach.

If she finds that her readings are persistently increasing overnight, then the solution is hopefully pretty simple - more basal insulin before bed (assuming she is using Lantus or Levemir). If it's dawn phenomenon, it's a bit more complicated. A 'hearty' breakfast might not necessarily be the answer. Most people benefit from definitely having a breakfast but some people respond better to a high protein and fat/low carb start to the day, while others do much better on a carby start. Others might have the luxury of a pump, giving them an adjustable basal rate. I would also say that a daily glass of wine before bed isn't actually a bad idea at all.
 
Funnily enough, I said that she should stick to the glass of wine theory before bed but I don't think she thought I was being serious. You never know, it could be the solution.

She uses Levemir insulin for basal.

We'll give the overnight testing a go to see if we can get an idea of whether the rise is gradual or just suddenly happens. Either way, the responses on here have given me good information to feed back to my girlfriend and hopefully a nudge in the direction to help her get her BM under tighter control.

Thanks for your advice.
 
The other benefit is by getting her morning readings back to normal, she will feel much better. I can barely get out of bed if my BG goes over 9 and I've had morning readings in the teens which make me feel utterly dreadful. I'm not a morning person at the best of times (actually, things don't really get any better after lunch either!) but starting the day is much easier with a normal BG.
 
I have terrible trouble with morning readings if I have a barely naughty meal the night before.

Fatty meals - Anything above around 20gs of fat will delay a spike untill 4 - 6 hours later Ie when Im asleep and then im high all night till morning.

High protein - Even if im eating a high protein meal (Ie too much chicken) with carbs, I find some of the protein will convert hours later ie. when Im asleep.

Just another suggestion. Along with making sure that basal is set at the right amount
 
Thank you for your suggestions.

I guess we're going to have to have a trial and error few weeks or so.
 
I was told a long long time ago that if you suffer from the dawn phenomenon then take a 2 inch (ie Domino sized) chunk of cheese before going to sleep.
 
I would certainly do some overnight testing as it will give you a much clearer picture and you don't want to be increasing the insulin until you have checked it's not a night time hypo resulting in a high reading in the morning. It has happened a lot to me in the past. Hope you can get it sorted soon. it's very annoying to get those highs first thing.
 
Some overnight testing was done last night.

At 1:30am BM was 5.3, at 3:30am BM was 7.9 and at 7:20am this morning it was 16.9!

I think we're going to repeat the same exercise for the next couple of days but with a slight increase in the basal insulin - from 22 units up to 24 or 26 units to see what effect that has.
 
Yikes! That is quite some DP spike :(

Early days to be thinking about this, but one of the very best ways to combat DP is an insulin pump. There are other benefits too, but they are a bit of work especially to start with. Has your GF ever been offered pump therapy? Would she be interested?
 
Those spikes are an almost every day occurrence.

I don't think my girlfriend has considered a pump and I'm not sure its ever been mentioned to her. I'm sure with a bit of analysis and tinkering, we can get the spikes under control without the need for a pump.
 
weblar83 said:
Those spikes are an almost every day occurrence.

I don't think my girlfriend has considered a pump and I'm not sure its ever been mentioned to her. I'm sure with a bit of analysis and tinkering, we can get the spikes under control without the need for a pump.
Click to expand...

An insulin pump has really helped combat my DP, something that I always struggled with on MDI, I often used to put my morning highs down to night time hypos (as did my D Team) but since using a pump I now know that my insulin requirements from 5am to 8 am are 3 times greater than the afternoon!
 
Its definitely food for thought and something to ask about next time she goes to see the diabetic team.

We've got a few plans of attack for the next couple of weeks so hopefully the morning spikes can be reduced if nothing else.

Thanks,
K
 
weblar83 said:
Its definitely food for thought and something to ask about next time she goes to see the diabetic team.

We've got a few plans of attack for the next couple of weeks so hopefully the morning spikes can be reduced if nothing else.

Thanks,
K
Click to expand...

Good luck....but also if a pump is what she wants a strong case would be supported by evidence based basal testing.....dawn phenomenon etc,etc. It can be very difficult to get a pump and you might have to fight hard to get one, but in my opinion well,well worth it!
 
Thanks for the extra information.

We'll see how we get on over the next few weeks. The diabetic team are already aware of the morning spikes so hopefully, should she decide to try for a pump, this will help her case.

K
 
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