Lowering morning levels

[Ikey the tinker]

I'm type 1, on insulin and generally well-controlled. However, my waking levels have always been above 7 and are now rising to around the 8.5 mark most mornings. How would you go about reducing this? I'm experimenting with increasing my evening meal ratio, and even taking a shot or two as a corrective before bed, which doesn't quite seem to be working.
Any ideas?

 

[Northerner]

Hi, sounds like dawn phenomenon where your liver starts increasing output of glucose in response to you waking. Do you check the moment you wake, or after you've been up a bit and before your breakfast? I find that if I test immediately on waking I'm fine, but if I don't inject and eat then my levels will have climbed within the hour. I don't think your evening meal ratio will help unless you are normally quite high before bed - what are your bedtime levels like? Some people find a small protein snack before bed can help reduce the morning rise, or you might want to consider splitting your basal insulin so you have more at night and less through the latter part of the day when you tend to be more sensitvie to insulin.

 

[novorapidboi26]

When do you take your background dose(s)...........?

I would increase this in the first instance, taking 3 am blood glucose readings to make sure you avoid hypo overnight.......

I personally have a split dose which helps me strategically time my doses so I have the maximum safe amount possible at the time the DP starts to kick in......


what levels do you go to bed on.......?

 

[Ikey the tinker]

Thanks. I usually test about 15 minutes after waking...will try doing it as soon as I wake and see if there's any difference.

I go to bed with my bloods around 7. Split my basal 15 units morning and evening. May well experiment with 20 at night and 10 in the morning to see if that has any impact...thanks for the ideas...

 

[everydayupsanddowns]

Thanks. I usually test about 15 minutes after waking...will try doing it as soon as I wake and see if there's any difference.

I go to bed with my bloods around 7. Split my basal 15 units morning and evening. May well experiment with 20 at night and 10 in the morning to see if that has any impact...thanks for the ideas...

If it were me I'd adjust more cautiously (no more than +/- 2u) then wait 2-3 days for the new dose to settle before reviewing again. You don't want to drop yourself into overnight hypos while trying to correct a small morning rise.

If you are going to bed on 7 and waking up at 8.5 that suggests your basal is very nearly right to me. (a rise or fall of 1.7 is often thought to be acceptable)

 

[Northerner]

I'd agree with Mike, you'd be making a 33% change in dose to combat a very small percentage rise, so I'd be much more cautious about adjusting the split.

 

[Ikey the tinker]

Right...I generally split the basal 15-15, but will experiment with 17 at night and 13 in the morning. Seems obvious now you've mentioned it! Hopefully that should smooth things out on a morning. Thanks.

 

[novorapidboi26]

You should just concentrate on increasing your evening dose as this is responsible for your morning highs, you will probably still need that 15 during the day.................

and its best to change only one thing at a time, so you can observe/record the effects and then move on.........

 

[Northerner]

You should just concentrate on increasing your evening dose as this is responsible for your morning highs, you will probably still need that 15 during the day.................

and its best to change only one thing at a time, so you can observe/record the effects and then move on.........

Good thinking NRB 🙂

 

[Ikey the tinker]

Excellent. The 17/15 split starts tonight, cheers 🙂

 

[FM001]

Excellent. The 17/15 split starts tonight, cheers 🙂

This is what I would do but increase the evening dose by only one unit at a time, if you are taking lantus then give it a couple of days before adjusting again.