T!D Consistently High Blood Levels in the mornings

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Fred M

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Hi all,
I am at my wits end, for months now I have been waking with high bloods, between 26 and HI on my Libre majority of days. I was hospitalised in Aug, Sep, Nov for DKA. During the September DKA my team kept me in to ascertain how much insulin my body required and they identified that I needed around 80 units of Basal (was at that time taking 45 units each day).

Quite a few days each month I find I have Ketone of around 2 - 2.6.

Med team do not seem to be able to agree as I am currently with Paediatric Team with a hand over to Adult Team due to begin in January. Adult team want to increase basal but PT do not.

I am worried as I have just started a new job and this is affecting me working, I have for the last two weeks increased Basal to 60 units and again made no difference. I carb Count properly, I never miss my basal and stick to the same time each day, I have tried not eating after 6pm, I have tried eating later, I wake at 6am most mornings, weekends later around 10am, this appears to not make any difference.

Is there anyone out there that has experienced this and resolved the issue?

Thanks
 
Welcome @Fred M 🙂 What basal insulin do you take and when? Do you have a Libre? Are you high all night or shooting up during the latter part/early morning?
 
Logic would suggest insufficient basal or the basal you're taking isn't the right one for you. If the hospital identified a need for 80u of basal in September, why have you only recently increased to 60u & why only 60u?
 
Inka said:
Welcome @Fred M 🙂 What basal insulin do you take and when? Do you have a Libre? Are you high all night or shooting up during the latter part/early morning?
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Basal is Tresiba, no I can go to bed around 12am at 7 and wake up at 6am HI, yes I have a Libre
 
RBZ5416 said:
Logic would suggest insufficient basal or the basal you're taking isn't the right one for you. If the hospital identified a need for 80u of basal in September, why have you only recently increased to 60u & why only 60u?
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Med Team did not want to increase to 80U, they increased to 50U in August, in November (after appointment) they increased to 53U, I got fed up with the situation and increased myself 2 weeks ago.
 
Fred M said:
Basal is Tresiba, no I can go to bed around 12am at 7 and wake up at 6am HI, yes I have a Libre
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Perhaps Dawn Phenomenon is having an effect? I’m on a pump and for those last few hours of the night, my basal needs go up significantly. Have you been offered a pump?
 
Fred M said:
Basal is Tresiba, no I can go to bed around 12am at 7 and wake up at 6am HI, yes I have a Libre
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The readings show my bloods shoot up early morning between 3am and when I wake up.
 
Inka said:
Perhaps Dawn Phenomenon is having an effect? I’m on a pump and for those last few hours of the night, my basal needs go up significantly. Have you been offered a pump?
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I have requested a pump but have been told whilst my bloods are high there is no chance, also I am on a waiting list for a training course, they told be it could be as late as end of 2024 before I can get on it.
 
Fred M said:
I have requested a pump but have been told whilst my bloods are high there is no chance, also I am on a waiting list for a training course, they told be it could be as late as end of 2024 before I can get on it.
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I asked the team about Dawn Phenomenon and they did appear to know what I was talking about. I read about it on line they keep telling me it is down to hormones.
 
Fred M said:
I asked the team about Dawn Phenomenon and they did appear to know what I was talking about. I read about it on line they keep telling me it is down to hormones.
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You do not mention what bolus insulin you are taking as that may be having some impact on what is happening.
 
How long does it take for your morning high to come down into range? Maybe a morning bolus correction would help, at least until you're transferred in January.

How are your levels for the rest of the day? Obviously if levels otherwise are fine, you've got to be careful increasing basal as that may well send you hypo. Have your team suggested a basal routine where you split the dose? I don't think you can do that with Tresiba so would mean a switch to another insulin.

The notion that you can't have a pump to correct morning highs because you have morning highs is just moronic, but unsurprising in this age of "Computer says no & I'm incapable of independent thought". Hopefully that will change when you're transferred.
 
RBZ5416 said:
How long does it take for your morning high to come down into range? Maybe a morning bolus correction would help, at least until you're transferred in January.

How are your levels for the rest of the day? Obviously if levels otherwise are fine, you've got to be careful increasing basal as that may well send you hypo. Have your team suggested a basal routine where you split the dose? I don't think you can do that with Tresiba so would mean a switch to another insulin.

The notion that you can't have a pump to correct morning highs because you have morning highs is just moronic, but unsurprising in this age of "Computer says no & I'm incapable of independent thought". Hopefully that will change when you're transferred.
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Hi, it does vary greatly when I come back down, yesterday I was still HI 4 hours after giving correction at 8am, my bloods then started to drop about 1/2 hour later. Had lunch around 1.30pm (out at TGI Fridays) and had a low of 3 whilst waiting for starters. At end of the meal around 3pm was 12. Went to bed around midnight and was 9, woke this morning at 7am and was 28 with keytone of 2.8. Reading just now is 12 with ketone of 1.2.
 
Fred M said:
I asked the team about Dawn Phenomenon and they did appear to know what I was talking about. I read about it on line they keep telling me it is down to hormones.
Click to expand...

Maybe they call Dawn Phenomenon “hormones”? Either way, if it’s DP a pump would sort it.
 
Do you still have any contacts for the dept that treated your DKA? I wonder if they can help accelerate your transfer, given that paediatrics don't appear to have an answer to your continued risk of further DKA.
 
Inka said:
In what way?
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When I commented, the OP hadn't mentioned they were actually using a bolus insulin (which seemed odd) and if they were relying on basal that might explain the high levels. Unless I missed it.
 
Ah, right. I just read the opening post as a basal issue and took the bolus insulin as read, if you see what I mean. Type 1s quite often discuss basal and don’t mention bolus as that’s the foundation of good control, and relevant here, of course, due to the time of the highs.
 
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