So, I've been getting big blood sugar spikes that start when I wake up (8am) until I bolus for lunch (1:00). Post meal BG also reaching 400.
I took a desk job where we sat all day and I gained 20 lbs in 3 months, which isn't super unheard of for me. My weight fluctuates about 20 lbs. between the seasons. I might be 150 during the winter and 170 during the summer, but after taking that job (even after I quit), I have had this dawn syndrome and I don't know how to treat it. I'm taking syringe Humalog and Lantus.
My doc says that 35 units of Lantus is too much, but if I drop it at all, then I wake up high. She also says I'm taking too much Humalog at 2 units/carb, but I still get these dramatic post meal spikes.
Having a hell of a time. Any suggestions that don't involve a pump? I don't think I could figure out how to adjust bolus dosages on a pump the way she wants me to. Seems complicated and I cant figure out how to decrease the peaks without dropping myself into severe lows?
Sometimes I think in Humalog is just a bad insulin for my particular physiology somehow. Is that possible?
I get wicked DP if I eat significant carbs (30g or more) before bed.
Treating it's very difficult. DP is one of the most insulin resistant aspects of diabetes for me. Only advice I can offer is lost of insulin. However, if you don't have a CGM to watch your BG closely, and track IOB with either a pump or a smartphone app, there's really no practical way to get it in line as fast as possible. You have to ride it out.
And was that 2U/carb a typo? I have insulin resistance, and my ratio is 1:4. Did you really mean 1:2 and not 2:1?
I have a huge dawn phenomenon in the early hours of the morning (starting around 3:00 AM). Before I went on the pump I could go to bed at 110, be 110 at 3:00 AM, and wake up at 7:00 AM at 250. It was like that almost every morning, and the only way to stop it was to get up at 3:00 AM and take 2-3 units of Humalog. With the pump, I have it programmed to deliver more insulin during those hours so I no longer have that issue.
I do have an issue of rising after I wake up if I don't eat right away (within the first hour or so). My endo thinks this is partly related to stress since, usually, the days I don't eat right away are the days I'm running late. I've had far fewer issues since I've started to make sure I always eat right when I get up.
Even with my best efforts I still have Darn Phenomenon (DP). I do a correction bolus upon waking. I do this even if I my blood sugar is perfect because the correction is to offset the impending rise. And if I don't eat a breakfast soon after waking my body just rebels by dumping even more blood sugar. So you may need to eat a good breakfast.
And your meals just seem messed up. How is your low carb diet doing? If you keep your meals below 15-25 grams you shouldn't be seeing such high blood sugars. High blood sugars in themselves can make you more insulin resistant and cause weight gain.
And I really don't understand your doctor saying 35 units of basal is too much. If you are ICR ratio is 2:1 and you are eating high carb you must be using up a pen a day of Humalog. On a high carb diet you should have about a 50/50 basal/bolus split.
I meant 2 units of Humalog for every 15 grams of carb. Does that seem off? What smart phone app do you recommend? I have never tried this, but recently my brother gave me his android smart phone. I have a CGM, but I dont use it unless I am having bad problems that I just cant figure out. I think it has made some patterns pretty obvious, like the pre-lunch climb to 400 and the post meal spikes. Really helpful. Thanks. Whats IOB?
Thanks, I have never heard some of that. I would guess that I eat a pretty high carbohydrate diet....and not very 'good' carbs. I have never eaten meat, so I get most of my calories through carb. I have always wondered what the impact of that was. Your right, maybe thats a problem. I am often eating 60 gram meals. I am using a pen. How do you manage eating only 15 grams per meal? I would think you would be very hungry. Do you eat much more frequently on low carb meals? More info would be greatly appreciated. Thanks.
3:00 is tough. I've had that before, but it went away and then resurfaced at the time I wake up. Do you find that your physiology changes over time so that during some periods the DP starts at 3am, and during other periods you might not see it at all, and other months it might pop up at 10am or something? Thats what makes me a little nervous about setting the basal rates, because there seems to be some 'physiological drift' for me. Do you get that?
I think many of us have been told that we can eat and just bolus insulin and it will be ok. But every gram of carbs we eat raises our blood sugar 5-10 mg/dl. If you eat a 60 gram meal then your blood sugar will rise 300-600 mg/dl. It is easy to see that a "slight" mistake in carb counting and insulin dosing can leave you with a bad high or a bad low.
If you limit your carbs more you will have less of a blood sugar rise at meals and any errors that you make counting carbs and dosing insulin will result in less problems with high blood sugars (as well as lows).
I have just accepted that what I eat has a major effect on my blood sugar and I cannot just eat whatever I want. So I limit carbs. Although I do eat meat I also eat of lot of non-starchy veggies. Seafood, dairy, nuts all are good core low carb foods. Getting sources of good fats is also important so I use lots of butter, olive oil and coconut oil. I also really limit grains, sugar and many processed foods. We all have to find our ways. You may never choose to eat meat but I bet if you chose lower carb options for your meals and snacks you would see a real benefit in your after meal blood sugars.
ps. I am certainly not hungry. I was often hungry on a carb rich diet, now on a low carb diet things are even and constant. I can actually skip meals and not be hungry.
Yea, its tough to figure out. I'll try hitting the beans pretty hard. I guess I should be eating a primarily legume diet, or something. I have to believe your right. Ive cut out the dairy, due to cholesterol concerns and I struggle to get enough protein and fat - but I eat a lot of leafy veggies. Thanks for the perspective. I've recently had a friend get his gallbladder removed and he got pancreatitis (spelling?). Makes me think that any type of diet restriction means that you have to pay a lot of attention to ensure that you make full, balanced meals out of what you can eat. I started eating a real sugar-rich diet after sliding scale bolus was invented. But, I am often really, really hungry and its really bad on my blood sugars. Diabetes really should represent a restricted sugar diet. But, american highly-refined sugars are no good. I have only found one good brand of bread, its $4.00 a loaf, but totally worth it. Thanks for the good perspective. Quite helpful.
I have that, I get both dp and overnight(sleeping) lows- it is very difficult to treat both because I never know what will happen for sure. My CDE suggested eating something before I sleep to help stop dp: 1 T flaxseed plus fat like peanut butter etc. I add 1 T chia seed, stevia and almond milk. It has helped keep me flat and stop lows but it doesn't always work. They metabolize very slowly so they won't spike you alot if at all and they trick the liver into not releasing glycogen. Once DP sets in I have to eat and bolus a lot usually to get a hold of it, even without a big dp I usually need more insulin with my first meal although sometimes not. I'm taking a lot less insulin that you are-tiny doses by comparison.
I wasn't really able to fix DP until I got a pump and just put in a heavy wave of insulin early in the AM, 2:00 or 3:00 AM. I had a brief pump vacation this summer and it was hard work. I think some people have found a way to work to combat the tons of basal not in the right spot by splitting doses, taking some in the AM and some in the PM, maybe there's a whiff of a peak on the basal insulin that can be "aimed" to the dawn hours where it's needed. Or if a dropoff in efficacy of long-term is contributing to the DP, adjusting one's shots that way can help? Unfortunately, the only way to figure it out is with trial and error, unless you have a CGM...
My personal advice is to not obsess with the cholesterol thing. Despite claims, dietary cholesterol has very little effect on your blood cholesterol levels. And the thing that causes the worst cholesterol problems for those of use with diabetes is high blood sugars. I would really try to include dairy. And if you can rethink your diet to include higher sources of fat (and protein) you could cut back on the carbs and probably feel better and less hungry all the time.
Insulin on board (IOB) is how much insulin is still working after you dose. If you have a pump, after you dose insulin the pump will tell you how much insulin on board you have still working based on your duration of action of insulin and how much you dosed. I have my duration of action for my Apidra set for 4 hours. This is really helpful so you don't stack insulin thinking you need more to lower your blood sugar.
Some people also take NPH at bedtime. I don’t know whether you have used insulin long enough to have used NPH. We used to nickname it as “Not particularly helpful” because it has a strong peak 5-7 hours after injecting. But in recent years I have read of some people who have used a few units at bedtime to help tame dawn phenomenon. You can buy NPH at Walmart without a prescription for about $25 to $30. Of course you really should talk to your doctor before doing this.
I often do what Brian BSC mentioned and take a bolus upon rising to stop the morning rise and then try not to delay breakfast too long. If I don’t eat breakfast I require about double the amount of insulin to stop huge peaks through the morning, I can easily skip lunch or dinner and not have the same effect.
That sounds about the same result as for me. I do remember the ol' NPH, that's an interesting solution that I have never heard of. Thanks. No Rx needed for the long term insulin. I always wonder why we need one for short term. I would like to lobby for some kinda permanent Rx for chronic illness meds, so I dont need a new Rx every 3 months. Thats a pain in the butt. I like this NPH idea.
I have had a similar problem with highs after meals and highs in the mornings. There are several things I did to adjust for it, and none of them involve an insulin pump. First, instead of taking one giant shot of Lantus once a day, I take it in two doses every 12 hours. If you’re taking 35 units daily, you could try one shot of 17 units at dinner time and then another shot of 18 units in the early morning. I take mine at 8 am and 8 pm. The timing of your lantus is very important and you might need to play around with it until you find what works for you.
If you’re high in the morning, but your numbers are good after dinner/before bed, you might need to increase your lantus overnight to counteract that problem. The after meal spikes could mean several things, too. Your insulin to carb ratio might be off. You might not be taking enough insulin. You might also need to add a basal amount of short acting insulin to your carb to insulin ratio. So, say you take 1 unit for every 10 grams of carbs and your numbers are 400 after meals, you might need to take 1 or 2 units of short acting on top of your carb counting to prevent the spikes.
If you haven’t seen a dietician, I would highly recommend it. S/he can help you figure out the best meals and exercise regimen to help you control your numbers. I don’t know what you eat, but if breakfast is coffee and donuts, I wouldn’t be surprised if your numbers are super high afterwards.
I hope I could offer some words of wisdom! Keep us posted on how you’re doing.
@Dave, What do you mean, "as fast as possible," or "ride it out?" You mean, just wait until it goes away? I think that will happen, eventually, but I've had consistent DP for 3 months. You take 4 units per 15 grams carb? Thats double what I take. I'm a 20-year, type I diabetic, 175 lbs, 32 yr old female, 5'9". I don't think I'm insulin resistant, but I could see how it might start to look like it if I bump my basal up high enough to ward off the DP. I think I might have to raise it up 5 or 10 u of basal. I could try that, and then just take tiny dosage of bolus the rest of the day and eat snacks.
