Morning spike in sugars

[taxiforone]

I'm having trouble managing my morning sugar levels. I go to bed comfortably within range, and if I check my sugars while still in bed in the morning they’re also within range, but they shoot up within about 5 minutes after getting out of bed. I have tried increasing my basal dose of my insulin (Lantus Glargine) but any higher and I have a low overnight. At the moment before I get out of bed I’m having to give a correction dose of novorapid before getting up.

At the suggestion of my nurse I have been giving my basal dose later at night. I used to give it at 9pm but now I give it at 10:30pm, this has reduced the severity of the spike but aside from giving it even later (which is after I go to bed) I’m not sure what else to try. I go to the gym three times a week, and eat minimal carbohydrates with my evening meal as historically this has helped my overnight readings. I have not seen a change in my insulin requirements during the day. Any other suggestions would be greatly appreciated.

 

[Robin]

Classic 'Foot on the floor' syndrome, closely allied to 'Dawn Phenomenon'! Suffered by a lot of us, me included. When we all had to get up and go out of our caves and hunt woolly mammoths for breakfast, the liver released extra glucose first thing in the morning (Foot on the floor) or from the wee small hours (Dawn Phenomenon) to give us the energy to do that on an empty stomach. Fast forward many generations, and the liver still thinks it needs to help out.
The problem with basal insulin is that it is designed to produce a nice flat trickle of insulin into the body, but what our bodies do is anything but produce a nice flat trickle of glucose. So living with it and managing it is the strategy I've adopted, which involves giving myself a couple of units of Novorapid before I get out of bed, or doing my breakfast bolus plus a couple of extra units, also while I'm still in bed. I then wait at least 45 minutes before eating, so the spike in my glucose levels has started to tail off and fall, before I add breakfast to the mix.
(People with pumps have the advantage, or course, in that they can set a variable basal rate, so can start increasing their basal just before they get up.)

 

[rebrascora]

My strategy is exactly the same as @Robin 's I inject breakfast bolus +1.5-2 units before I get out of bed, then I potter on with my morning routine of getting washed and dressed cup of coffee, make my breakfast etc and then 45mins later I eat my breakfast as my Freestyle Libre shows that my insulin has started to overcome the FOTF and my levels can be seen to be coming down. I now get a slight dip on my graph most mornings and then a slight rise rather that a huge spike into mid teens and then a crash.

I would say that I very cautiously experimented with the timing by extending it 5 mins each day until I found the perfect timing and actually for me when I was on Novo(not so)Rapid it took about an hour and a quarter whereas I now use Fiasp which is a bit less slow at 45mins. Some people would hypo long before 30mins prebolus time, so you do have to cautiously experiment and find the timing that works for you. If you have Libre it is easier because you can keep scanning until you see the arrow change direction and the numbers start to come down.

 

[taxiforone]

Ah thank you both, I didn’t realise it has a name. I’ve been injecting insulin prior to getting out of bed to cope. I was hoping there would be a way to avoid another injection but it seems I’m not the only one. Thank you for your help!

 

[rebrascora]

Depends when you usually have breakfast but in case you didn't quite pick up on it Robin and I combine our breakfast bolus with that Foot on the Floor insulin before we get out of bed, so no extra injection.

 

[taxiforone]

Ah yes I did pick up on that thanks for double checking though, I appreciate it. Timing wise I usually walk the dog before I have my breakfast so I think the timings are a little different. But I might see how it works out if I switch up my schedule too.