Feet on the floor BG impact

Type 1 and LADA
#1

I just want to get a feel about what people experience with their BG when they physically get up from their bed. I’ve had a feeling for a long time that my BG sudden increases once I get out of bed. I can lie in bed for another hour and my BG is steady however as soon as I stand up (shortly after) I see a rise in my BG. I recently learnt this is a real thing and is coined “feet on the floor”.

My question is, do you experience this and if so is it consistent every day? I think for me most of the time I get it, but sometimes my BG is still steady. I’m not sure what causes it to happen and what causes it to not.

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#2

Lol… @tedos Type 1 is predictable that it’s not going to be predictable!

I’ve had DP, FOTF, DP and FOTF combo and nothing at all in the past. It’s usually been consistent until it stops and it usually ebbs away. Currently I have a complete mix up going on though. It is not being consistent.

But right now when my FOTF kicks in, it’s about an hour after I’m awake, I have my basal increased for when I first awaken so it can kick in in time. And I have to reduce basal sometimes when FOTF decides not to appear.

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#3

I increase my basil about 2 hours prior to getting out of bed, so I really don’t have an issue anymore.

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#4

:sweat_smile: haha yeah that’s true. Interesting, my feet on the floor blood rise starts to happen within the first 30 mins after standing up. I don’t basal for it because it’s not based on a set time. I just find I need to include a bit more in my morning bolus. It’s easy to see now when I have a sensor, but previously it was just a suspicion it was happening.

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#5

@tedos A CGM is wonderful. I also didn’t know I had dp/fotf until I had my first Libre. I just knew sometimes I would wake up with a 250 and sometimes I would be 120 when I tested and then I would wonder why I was 350 in the early afternoon.

It turns out I always shot up, sometimes it was before I woke up and sometimes it was after and that would be after I tested, hence then the 350 I ended up at in the early afternoon with no adustment shot given.

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#6

I go through phases where I have DP or feet on the floor. Right now, I have both. But, sometime one or both will go away. That might be in 3 months or 6 months.

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#7

CGM has been my lifeline to this phenomenon. Some days I have it and some days I don’t. So I look at my phone before I get up and than again after 30 minutes. If the arrow is angled up, I take a correction bolus to head it off. If it’s flat, I know it’s not one of those days. Unfortunately for me, there is no rhyme or reason to it. But thank goodness for my CGM. Knowledge is power. A quick glance and I can fix something that could mess up the rest of my day.

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#8

I always have it unless I had alcohol the night before. If I don’t bonus for it my blood sugar will raise about 100 mg/dL or higher if my blood sugar is already a little high for any reason. It’s not tied to time - it doesn’t happen until I’m up and out of bed. I’m also pretty high strung/high energy and I feel like this is related to that. I have untreated adhd so there are probably physiological differences going on that could cause more of a jump here as well…I don’t know much about adhd (diagnosed as a child and not told about it until I was in my late twenties) so this is just a guess.

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#9

Same

#10

I have this if I am not low when I wake up. Even if I just get up to go to the toilet and go back to bed!

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#11

@pancreaswanted You’re no alone, my CGM does this often.

I’m one of the people that regularly sees lower CGM readings than actual blood sugar at night, without any compression lows (I don’t put sensors in areas I roll or sleep on).

For some reason the glucose transfer from my blood to interstitial fluid doesn’t function the same at night. Perhaps it’s inadequate blood flow as per the article posted by @Tim12 ?

#12

I’ll definitely go with the predictable unpredictability. My doc calls it Dawn Syndrome, but sometimes it’s there and sometimes not. I’ve also had it happen that BS goes up only AFTER I give a bolus, even before I have eaten anything.

Weird stuff, and most every morning is a “let’s see what happens today” game.

#13

Dawn phenomenon and feet on the floor are actually two seperate BG impacts.

DP occurs while you are still asleep around the early morning around 3-4am. I’m actually not sure if you are awake during the time, whether it happens so sleep may have nothing to do with it but it happens during the dawn period.

FOTF happens when you are awake and set foot on the floor. If you were awake and just lying in bed for an hour it doesn’t happen, the increase in BG only happens after you completely stand up.

That’s my understanding from what I have read. Happy to be corrected.

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#14

I have found that I get a stronger FOTF response if I am tired and haven’t had a full or good night’s sleep. It will rise about 50 points when I am up for about 30 minutes. I get up at 7 am to look after animals, but if I can I try to go back to sleep for an extra 1 to 2 hours. I don’t need to bolus for the full amount, just half of what I would normally do, and then with the exercise of chores it brings me back to where I want to be when I head back to bed. When I finally get up for the day then I am fine with no further FOTF. If I have to stay up, then yeah, I will end up having to do a full bolus for the amount and it will take a few hours to regain my insulin sensitivity. I understand it is basically a cortisol response to get you 'up and at ‘em’, rather than the dawn effect ‘dumping’ to prepare for the day.

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#15

That’s good to know. I haven’t worked out what it is for me yet. I get a good night sleep and still see it rise :sweat_smile:.

#16

@tedos There is no sure fire way for any of us. If there was we could prevent it lol.
For me, my thyroid is a little wacky and while I have maintained it working within a decent range, it’s not okay. I say that because I take supplements for it every night and Vitamin D. Lacking vitamin D for a while I notice my DP will start to get worse, but skip my iodine for even one night and I usually guarantee DP.

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#17

My goodness my FOTF is erratic this week. For the last two mornings i went up 3 mmol (54 points). The highest it peaked was around 7.3mmol (131mg) and it took about 1 h 20min for my prebolus to drop back down to the 5.6mmol (100mg) range.

URGH… It usually doesn’t rise that big of a gap. :sob:

It throws all my timing out. Luckily I didn’t need to leave the house for work. If it did I’m not sure what I would have done. I needed to eat since I bolused, but if I did, I was sure to go high because my prebolus hasn’t had enough time (I couldn’t have waited the 1+ hour). If I don’t eat, I would have possibly hypo’ed before I reach work. And I can’t eat during transit since I’m on public transport. :roll_eyes:

#18

FOTF. Oh Yes. It is a thing. I can look at my CGM readings some nights (not all) and it spikes up perfectly with each trip to the bathroom overnight. I will see an immediate 15-20mg/dl increase that does not go down. It’s crazy. DP doesn’t seem to adequately describe it for me. I see that too where my sugar will slowly rise on my CGM from @ 4am until I get out of bed. But on nights I experience FOTF my AM CGM readings can be 80 mg/dl higher than when I went to bed.

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#19

Correct. Basically, the Dawn Phenomenon involves a ‘liver dump’ of glucose into the body as part of the process of preparing for the new day, along with other hormonal adjustments; FOTF involves a cortisol release based upon imminent activity upon waking up. Cortisol is a ‘stress’ hormone so it means your body is getting ready for action. Unfortunately, cortisol also sets up insulin resistance, hence the rise in BG values. They are two different causes but both having the same effect - rising BG values.

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#20

Just want to share with you a pattern I saw today. I woke up around 5am and my sugar was quite low. I knew if I stood up and waited 10 minutes the FOTF will kick and without me needing to treat and so I did. Sugar went back up to normal range and I went back to bed.

Woke up at 8 and wondered whether FOTF will happen again? Well, it didn’t. I don’t know how it knew it happened before earlier but the second time round, my sugar didn’t rise. Go figure.

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