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Morning spikes

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Morning, so this morning decided to up nova rapid 1 unit, as went to 11.4 yesterday morning. Same breakfast went to 12.3, decided to jump in shower when came out 14.2. Is this just the way it’s going to be, or am I doing something wrong. Did mention to docs at hospital, she said was ok but sent letter to my local docs saying I wasn’t excepting off going high at times, which isn’t true just wondered why
 
What was your BG when you injected your breakfast bolus? If it is high, then generally I need a much longer prebolus time.
 
There are just some days when things don't make sense and you have to just do your best and accept that you get highs sometimes.
My levels hit 15 the other night despite an almost flat Libre graph all day. Went to bed on 8.1 and sloping upward arrow, so I jabbed 1.5 units plus my Levemir and went to sleep, half expecting the low alarm to wake me later! Couldn't believe it when I woke just after midnight on 15!! Jabbed another 5 units and went back to sleep and woke up in the morning on a very nice 5.1. Didn't have anything controversial for tea but I did get a little stressed about something before bed, so maybe that was the reason. Sometimes you just have to accept that it has a mind of it's own! Was just odd after the best daytime results I have probably ever had, for things to go so haywire after I went to sleep!
 
Yeah a just think it’s odd, that usually same bg in morning same insulin either high or just in range. It’s hard trying to get right when working. How long have you had diabetes
 
5.5 years for me. Diagnosed at 55.

There are so many things which impact BG levels and many of them, you have no control over, that you learn spend a few mins trying to figure it out and then move on. If it happens repeatedly then you know you need a new strategy, but one offs are just part of the fickleness of diabetes!

It could be that you have lost a few more beta cells and insulin needs are increasing as they can do in the honeymoon period.
 
Just 6 months for me age 58, was quite a shock as none off my family have it, but had bad chest infection they think that kicked it off. A get mad with myself when it goes high, think I need to cut myself some slack as 90% in range. Don’t know much about the honeymoon period
 
90% TIR is excellent so you do need to cut yourself some slack and accept that levels go high and low sometimes despite our best efforts. That is why 70% TIR is considered to be a really good result and all that you need to achieve. This is long term and if it is taking too much mental effort to maintain 90%, then you really need to accept that it is absolutely fine to get 80 or 70% or even less very occasionally.

The honeymoon period is when we are relatively newly diagnosed and we still have some of our own insulin production. For some people this helps and kind of buffers the highs a bit because your own body produces some itself to bring you down, but for other people it can cause things to be more erratic and kick out some insulin when you have already injected enough meaning you go low. Sometimes your remaining insulin producing beta cells will have a last hurrah, especially if they had been struggling for a while and getting worn out, but with injected insulin, for a few weeks or months, they start to pick up production again and you have to reduce your insulin doses and sometimes people find they need almost no insulin for a period of a few months in the middle of their honeymoon period and then have to reintroduce it. For me, I just gradually needed more as my remaining beta cells were killed off. I think the average for the honeymoon period is about 2 years but it can be shorter or longer and you can never be quite sure if it is completely over. For me it seemed to be almost exactly 2 years, but there were 3 stages when there was a drop off in my own production and I needed to increase my basal insulin at these times. The final time was 3.5 years ago and my basal insulin needs gradually doubled in the space of about 2 months. Interestingly, it happened after my first Covid vaccination and I think that may have triggered my immune system to wipe out my remaining beta cells. Since then my basal doses have been fairly stable give or take seasonal adjustment and adjustment for exercise. I have more or less continued the 1:10 meal ratio that I have have used since diagnosis, but I add an extra 1.5-2 units on a morning to cope with "Foot on the Floor" syndrome where the liver releases extra glucose when you get out of bed. My levels can rise by as much as 6mols in 45mins if I don't inject that extra bolus insulin before I get out of bed.
We are all different in how the honeymoon period affects us and how long it lasts. We are also all different in the strategies we find to manage things like Dawn Phenomenon or Foot of the Floor and exercise and alcohol and of course our tastes and diet varies and how our particular body responds to different foods and let's not forget stress, so it is all about fguring out how our bodies respond to different circumstances and experimenting to see how we can improve management of certain situations where we see clear trends.

I was half expecting you to say that you had hypoed in the shower this morning because usually a hot shower drops my levels. If it does the same tomorrow and the day after, then you might need more insulin. If you are trending higher throughout the day, then it may be your basal insulin that needs increasing or perhaps like me, you need a little extra bolus on a morning to deal with a surge of glucose from the liver when you get up.
 
Thank you for explaining the honeymoon phase. I also get the foot on floor in the morning, tend to go bit higher in morning about half hour after eating, but by the time I get to work going down fast, snacks keep it up. Don’t tend to be high through the day or night. Alcohol is another mystery not that I drink much, but have tried a couple off drinks went high both times, but was at a party had buffet and other time Chinese. I was quite surprised with levels after shower, usually go down a good bit
 
rebrascora said:
What was your BG when you injected your breakfast bolus? If it is high, then generally I need a much longer prebolus time.
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During my DAFNE course I mentioned that I needed to extend my planned pre-bolus period, if I was high, particularly at breakfast time. The DSN running the course challenged why and I patiently explained that if I didn't start eating at a reasonable level (certainly below 8) my BG would run away into high and there's a limit to how much I can put up with the high alerts PLUS I feel lethargic when even in the mid teens and I struggle to motivate myself.

She asked the others (5 out of 10 had been T1 for years) and they all said they'd previously been told to up their bolus correction in this circumstance, rather than wait. I asked by how much and the replies didn't help me: generally up by a guess. Since they were doing this originally without CGM, I presumed they then waited for hypo symptoms if the guess had been wrong. Then, knowing 4 out of those 5 had CGM, I asked if this made a difference to how they guessed and realised they barely took advantage of their CGM to help their BG management. At that point (not for the 1st or last time) the DSN said since CGM was not included in the DAFNE syllabus (Nov '22) we were not going to digress and talk about any aspect of CGM.

I offer this observation, since if you can't wait a lengthy time for pre-bolus, I presume some trial and learning with increased bolus correction to compensate for starting high is an alternative. I am fully retired so can afford the luxury of extending my pre-bolus timing; but have added extra correction if I have a following commitment and can't delay too much. I guess it's all part of using the tools we've been given, to find a solution that can work for us individually.
 
Proud to be erratic said:
During my DAFNE course I mentioned that I needed to extend my planned pre-bolus period, if I was high, particularly at breakfast time. The DSN running the course challenged why and I patiently explained that if I didn't start eating at a reasonable level (certainly below 8) my BG would run away into high and there's a limit to how much I can put up with the high alerts PLUS I feel lethargic when even in the mid teens and I struggle to motivate myself.

She asked the others (5 out of 10 had been T1 for years) and they all said they'd previously been told to up their bolus correction in this circumstance, rather than wait. I asked by how much and the replies didn't help me: generally up by a guess. Since they were doing this originally without CGM, I presumed they then waited for hypo symptoms if the guess had been wrong. Then, knowing 4 out of those 5 had CGM, I asked if this made a difference to how they guessed and realised they barely took advantage of their CGM to help their BG management. At that point (not for the 1st or last time) the DSN said since CGM was not included in the DAFNE syllabus (Nov '22) we were not going to digress and talk about any aspect of CGM.

I offer this observation, since if you can't wait a lengthy time for pre-bolus, I presume some trial and learning with increased bolus correction to compensate for starting high is an alternative. I am fully retired so can afford the luxury of extending my pre-bolus timing; but have added extra correction if I have a following commitment and can't delay too much. I guess it's all part of using the tools we've been given, to find a solution that can work for us individually.
Click to expand...
Thank you only work 4 days, don’t seem to go as high them mornings, probably more active. I do notice the nights I don’t have good sleep seem to go higher, don’t know if this is just a coincidence
 
Woodywoodpecker said:
Thank you only work 4 days, don’t seem to go as high them mornings, probably more active. I do notice the nights I don’t have good sleep seem to go higher, don’t know if this is just a coincidence
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Others may explain this better. Being sleep deprived, even a little, can result in elevated BG as a response to stress from the lost sleep. Our bodies are very sophisticated and have numerous response mechanisms, so many of which can alter one's BG. That's the first part of the complexity of Diabetes; the next part is when responses can be different from one day to another, under what seem to be otherwise similar days!
 
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