Pondering DP and FOTF strategies

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everydayupsanddowns

everydayupsanddowns

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Good old Dawn Phenomenon (and its hilarious fickle cousin Foot on the Floor)!

For members who get a significant hike in BG levels from a liver dump, either in the early hours (DP), or soon after you get out of bed (FOTF), I was pondering strategies today.

Do people have a sort of FOTF bolus approach that they administer on waking? Or a mini DP bolus overnight? Or rely on insulin pump basal rate changes?

Or something else?

Mine is pretty well tamed these days, but I thought it might be useful to share strategies for new members 🙂
 
First things I do when I wake up.
Swipe the Libre.
If as expected I’ve got an upwards curve, immediately do my basal, and give myself 2 units of bolus, irrespective of what I'm going to be having for breakfast, (plus whatever I'll need for the carbs in what I’m having, if I'm planning eggs, then just the 2 units.).
Have a cup of tea, read the forum, shower and get up, then eat about three quarters of an hour to an hour after I injected, by which time my levels have stabilised and probably begun to come back down a bit.
 
everydayupsanddowns said:
Good old Dawn Phenomenon (and its hilarious fickle cousin Foot on the Floor)!

For members who get a significant hike in BG levels from a liver dump, either in the early hours (DP), or soon after you get out of bed (FOTF), I was pondering strategies today.

Do people have a sort of FOTF bolus approach that they administer on waking? Or a mini DP bolus overnight? Or rely on insulin pump basal rate changes?

Or something else?

Mine is pretty well tamed these days, but I thought it might be useful to share strategies for new members 🙂
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I get both, usually one or the other - but annoyingly not always. Probably 5 mornings in any one week. So I don't have a strategy and I've complacently accepted that it happens inconsistently so I just take a correction when it occurs.
My BG usually raises by 2 or 3 mmol/L, but bear in mind those are Libre snapshots which for me is in itself unreliable; usually Libre is higher and the differential between actual and interstitial is neither linear nor consistent. Yesterday at an actual 7 Libre showed 10.5, today the difference was 7actual to 12 interstitial - in effect almost useless info, apart from the trend arrow.

I am curious, @everydayupsanddowns about how you have yours pretty well tamed. That infers yours is fairly consistent in happening and you can reasonably predict what the change is going to be (within reason). I think this thread could be both revealing and useful for many of us.
 
Proud to be erratic said:
I am curious, @everydayupsanddowns about how you have yours pretty well tamed. That infers yours is fairly consistent in happening and you can reasonably predict what the change is going to be (within reason). I think this thread could be both revealing and useful for many of us.
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Well, like yours mine is a bit of a mixed bag and unreliable. These days it’s mostly pretty modest, but there are days when it can double my waking BG 🙄

Plus, of course, with my hybrid closed loop… I can cheat!

So generally a kick in my basal profile, plus adding approx 5-10g of uneaten and fictional ‘carbs’ to my breakfast does the job without overdoing it, and the tSlim can do the rest 🙂
 
I just accept that I can’t predict what my body will or won’t do on any given morning - will my liver dump glucose, will my pancreas make some insulin to deal with it, will I be awake an hour before that happens to prebolus an advance correction to flatten it out… and correct later on if I need to
 
Mine usually spikes around 3am. I try to go to bed with levels around low 6 but if not (as is the case tonight where levels have risen through the afternoon and evening and corrections aren't working) i shall see how things go. It may mean if i wake in the middle of the night i have another correction or if not and levels are still high in the morning, another correction then.
 
My FoTF is incredibly dependent upon my exercise levels the previous 48 hours. It is rare for me to go so long without exercise and it is rare for me to experience FoTF. So rare I don’t consider it.

Until it happens.

Then I realise I have had an inactive couple of days.

I always realise the reason in hindsight so never came up with a strategy apart from making sure I exercise on days when I FoTF to avoid it tomorrow.
 
freesia said:
Mine usually spikes around 3am.
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I see the readings at their highest at midnight. They continue to stay high all night and I usually wake up to double numbers.
freesia said:
I try to go to bed with levels around low 6
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my numbers are never this low at bed time.
freesia said:
but if not (as is the case tonight where levels have risen through the afternoon and evening and corrections aren't working)
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what do you do when the corrections are not working?
freesia said:
i shall see how things go. It may mean if i wake in the middle of the night i have another correction or if not and levels are still high in the morning, another correction then.
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My correction doses rarely work.

I would like to applaud each and every one out there for knowing so much and keeping your cool. I on the other hand still find myself grappling with the basics. More I read about this condition, more confused I get. The whole thing is a proverbial minefield and at times I want to throw caution to the winds and live normally.
 
I tend to wing it in the mornings. I rarely eat brekkie within an hour of getting up (that's reserved for coffee time 😉 ).

If I have woken up high (around 10+) I will do a correction with my coffee to try and keep a lid on things if FOTF shows up too otherwise I will check again with brekkie time and see where we are at and deal then. I prefer to do corrections at brekkie so I'm not stacking them.

Breakfast choice depends on levels too. I often have poached egg on toast and the number of slices will depend on levels too 🙂
 
I am pretty much a carbon copy of @Robin. Inject bolus insulin for breakfast plus 1.5 or 2 units (depending upon my waking reading) and morning Levemir dose before I even sit up in bed and then get up and potter about for 45 mins getting washed and dressed and coffee and Wordle etc before I eat my breakfast. If I am not having breakfast or if breakfast is going to be later in the morning then I just inject to 1.5-2 units for FOTF. I am quite lucky that I almost never get DP, just FOTF, which is much easier to deal with.

I did go through a stage of setting an alarm to inject my morning Levemir an hour before I got up, to see if that would work better, but it doesn't and the novelty rapidly wore off, so I am back to my original strategy above, which works pretty well perfectly for my body. In fact, it is probably the only consistency I have with my diabetes.
 
Illustrating just how maddeningly variable T1 can be: Unlike Helli, my DP and FOTF do not seem to be related to my exercise levels! In particular, even when I've had a lot of exercise in the previous day or previous two days, I get pronounced DP/FOTF.

If I've gone to bed with BG fairly high (and haven't corrected), I won't get DP. But, if I've gone to bed with BG 5 to 7ish-- my BG drifts down, even if last bolus was long before bedtime, until 3 or 4 am and then starts to rise. (I aim for 5-7 at bedtime to avoid hypos at night.) And then, either way, there will be a further jump when foot hits floor.

I hugely admire people like Barbara and Robin who can bolus and then wait 45 minutes or more for breakfast! I have had to work hard and suffer (sob!!) to get myself to the point of being able to wait 15 minutes. ; )

But that, with Fiasp, plus using an ICR of 8 for breakfast, has helped. And, on the rare occasions that Libre has shown 10 or more first thing, adding a half or whole unit.

Very interested to see other people's strategies! But I suspect, for DP, a pump is really the only solution.

Anyway, Mike, thanks for starting a very useful thread!
 
I seem to be able to rely on my pump basal adjustments most of the time.

I still see a rise if I don’t have breakfast soon after getting up, but usually bolus for breakfast as I get up and then shower and have breakfast. That seems to work Most of the time.
 
Basal rate goes up from 2am onwards for 4 hours, not by much but it deals with any hormone issues.

Find best solution to deal with FOF is to eat, even if its is just slice of toast, seems to turn off mechanism from own experience.
 
Its rare that i don't get DP, always around 3am, but with MDI its hard to get right. FOTF doesn't usually affect me.
 
nonethewiser said:
Basal rate goes up from 2am onwards for 4 hours, not by much but it deals with any hormone issues.

Find best solution to deal with FOF is to eat, even if its is just slice of toast, seems to turn off mechanism from own experience.
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Pardon my ignorance pls, do hyper readings not reflect high BG levels? Eating while there is already excess glucose - does not make sense to me.

Or have I got it all completely wrong?
 
Purls of Wisdom said:
Pardon my ignorance pls, do hyper readings not reflect high BG levels? Eating while there is already excess glucose - does not make sense to me.

Or have I got it all completely wrong?
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Eating in the morning stops your liver putting out extra glucose to help you catch your breakfast
 
Purls of Wisdom said:
Pardon my ignorance pls, do hyper readings not reflect high BG levels? Eating while there is already excess glucose - does not make sense to me.

Or have I got it all completely wrong?
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It doesn't make sense to me either. ; )

That said: The 'foot on the floor' phenomenon-- blood glucose rising when you get out of bed-- is, if I remember correctly, due to a surge of a hormone called cortisol, a stress hormone that helps you wake up and get going; the release of cortisol triggers your liver to release stored glucose, so BG goes up.

It may be that, for some people, eating a bit helps to relieve the stress, which reduces the cortisol, which reduces the liver's release of glucose-- more than the glucose released by digesting what has been eaten ... But, personally, I wouldn't try it.
 
Spathiphyllum said:
It may be that, for some people, eating a bit helps to relieve the stress, which reduces the cortisol, which reduces the liver's release of glucose-- more than the glucose released by digesting what has been eaten ... But, personally, I wouldn't try it.
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I believe that anyone who is insulin dependent will be injecting for that food (slice of toast or whatever) eaten straight away to stop the liver dump (FOTF) and probably at a higher insulin ratio than other times of the day so effectively, the insulin is still going in early to tackle it, whilst at the same time the food is switching off the liver dump.

That last part of your sentence that I have highlighted is a shame. What I have found most important in learning to manage my diabetes well is being prepared to try different things in order to find what works best for me.
 
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