Level rising after waking

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Rosie95

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Type 1
Hello, I’m new to the forums and looking for a little advice If anyone can shed some light!

I’ve been type 1 for 15 years, recently changed basal insulin to humalin in two daily doses (there’s good reason for this so switching again isn’t preferable). I find that when I wake up and am lying in bed my level is between 5-9. Without consuming any food or drink, the act of simply getting out of bed, washing my face or walking around my home results in my level spiking to anywhere between 11-15. I often now bolus as soon as a I wake in anticipation, but the spike still occurs before the insulin kicks in and I don’t know how to combat this. I work mixed day/night shifts and this happens any time I wake from sleeping whether it’s morning, afternoon or following a nap. Has anyone else experience this? How can I overcome it?
I asked my dr but they didn’t seem to have much of an idea either.

Thanks in advance!
 
Rosie95 said:
Has anyone else experience this?
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Yes, most of us do. It's to do with stress hormones as we wake up. I've heard people use terms like dawn phenomenon and foot to the floor syndrome, perhaps referring to slightly different things (I think some people find they rise some time after waking either instead of or as well as just before waking).

Do you know when this is happening or are you relying on test strips? (And if you're relying on test strips is that from choice or haven't you been offered Libre yet?)

People talk about things like changing what you eat before bed to eating something really soon after waking (something like nuts, in the hope of fooling your system that you're waking up so it doesn't need to give a boost), but really it's hard to do much more than injecting a little as soon as possible, I think. With a pump I guess it's possible to do better: you could have a timed increase at the right time? Obviously a closed loop ought to handle it better, when we get those.
 
Heya, I have a libre2, it happens as soon as I start getting out of bed. If I’m awake and in bed it’s fine, it’s just once I start moving around and happens pretty quick- within the first 5-15 minutes. It’s hard as with the shifts I may wake up at 5am or it could be 4pm between nights. I havnt heard of foot to floor before so will do some research though thanks!
 
@Rosie95 - FOTF was a phrase invented comparatively recently over on another diabetes forum between a couple of its members. You won't find anything about it in medical literature.

Those two people never worked shifts and both use insulin pumps.
 
First thing I do when I wake up is stick two units of short acting in! otherwise, as you say, I’m in double figures by the time I've got up and gone downstairs.
If I've had a couple of glasses of wine the evening before, it doesn’t seem to do it so badly, but I only drink wine at weekends, so that isn’t a permanent fix!
Also, if I have a lump of cheese before bed, it seems to damp down the rise the next morning, but again, I don’t want to do that every night, so the best solution for me is having my short acting by the bed, and injecting a couple of units as soon as I wake up.
I also have the luxury, being retired, of adding in my breakfast bolus, then watching my Libre graph, and only eating breakfast when the line stops rising, and begins to drop.
 
Robin said:
First thing I do when I wake up is stick two units of short acting in! (snip)... adding in my breakfast bolus, then watching my Libre graph, and only eating breakfast when the line stops rising, and begins to drop.
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Putting the Libre to work and riding the curve.
 
Benny G said:
FOTF vs Dawn phenomenon.
diabetesstrong.com

How to Avoid High Morning Blood Sugar

Why your blood sugar tends to rise in the morning and 4 simple strategies you can use to avoid high morning blood sugar.
diabetesstrong.com diabetesstrong.com
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I can assure you it was several years before 2018 we noticed it and being on pumps, just both increased our basal rates to accommodate it. Every man for himself on MDI of course - and I expect most will either find their own way or if not, maybe it would be one of the things that swings their mindset over to pumping. I just got sick of tweaking here there and wherever and then finding it needed tweaking again somehere else within 7 days. At least I get a month or 3 sometimes pumping before I have to change anything - and of course that's when the jolly ole trends of Libre etc come into their own.
 
trophywench said:
I can assure you it was several years before 2018 we noticed it and being on pumps, just both increased our basal rates to accommodate it. Every man for himself on MDI of course - and I expect most will either find their own way or if not, maybe it would be one of the things that swings their mindset over to pumping. I just got sick of tweaking here there and wherever and then finding it needed tweaking again somehere else within 7 days. At least I get a month or 3 sometimes pumping before I have to change anything - and of course that's when the jolly ole trends of Libre etc come into their own.
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It was only when I started using Libre that I noticed 'foot on the floor' as a separate thing from 'dawn rise'
Dexcom has been making CGM for 15 years, I would assume that some of their early adopters put 2 and 2 together.

@trophywench, you are right, a quick google search for 'FOTF foot on the floor' shows few links. The link I posted was for the benefit of the OP and other recent CGM converts.

Now that CGM is being made more widely available, some new users are recognising trends on the graph and are trying to make the necessary adjustments, other new CGM users are still groping in the dark
 
For me, I find exercise helps reduce FoTF.
If I have been to the gym, had a long hike, done some climbing, participated in a spin class, ... the previous day, I don't see the rise. Thankfully, this is most days for me as I feel sluggish but restless when I don't raise my heart rate.
 
This is something that I 'suffer' from Monday - Friday, but not at weekends. I have always put it down to the fact that mornings are stressful - rising at 6am, getting ready for work, getting my daughter up and ready for school, mind racing about who is picking her up at the end of the day and at what what time, what I need to do when I arrive at work etc. I have always put it down to my body preparing itself for the day - kicking out some adrenaline, glucose etc.

The only thing that I have found works, is taking my basal and bolus as I wake up and head to the shower. Allowing about 25-30 minutes prior to eating prevents major post prandial spikes, but it is always tricky.
 
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