Get Up and Go Syndrome Issues

Thanks for sharing, Stephen. You've got nice ratios going for you, and good basal rates. My lowest basal rate at any point during the day is 1.5 U/hr with the highest being 2.2 U/hr. I go through 40U's of insulin via basal rate alone over the course of a 24-hr period. My doc says this is on the high side for Type 1's, but it is apparently needed by my body to get the job done.

If I ate 40-60 grams of carbs for breakfast, it would ruin my BGs for the rest of the day. While your mileage may vary, it appears that your BG reacts to morning carbs like mine does. My carb limit for breakfast is about 20, with 6-12 preferred.

Low carb dosing for protein/fat is not hard. I ate like you describe for many years. I ended up giving correction after correction and my insulin sensitivity diminished. It got to a point where corrections would have no effect; until they did and I came crashing down. My A1c topped out at 8.5% and my standard deviation was north of 60. Today it's sub-30; sideways BG lines are less dramatic and don't drain my energy. I'm glad those days are over.

Have you looked at the low carb dietitian site that I linked to? Maybe you're not interested. That's OK. We all need to find our own way. Good luck.

Thanks, Terry. I have not yet looked, but will definitely check it out. What you describe is what I'm going through currently. Last A1C was 8.9%...completely unacceptable to me. I like to lift weights, and need protein/carbs primarily as my source of energy and muscle nourishment. I tend to eat a lot of fresh fruit for carbs. I stay away from bad fats, and take in the better ones as I described (unsat + omegas). Everyone's body needs good fat to build new cells. The protein helps with muscle building/toning, and the carbs fuel the fire.

I am very fortunate as a type 1 for nearly 30 years I do NOT have dawn phenomena. I'm also not very sensitive to carb intake, and most meals I might average around 50-60 carbs per meal. I don't really limit what I eat, although I do try to watch serving sizes. The only time my basal rates seem to get stubborn is with hormonal changes. I'm approaching 40, in a couple of months, and the last two months around ovulating and my cycle, my bg gets more aggravating, and I was taking around 1.5 units an hour until my cycle started, then as you describe it's like a switch flips and I'm back to my normal rates. Currently I'm running a flat basal rate of .850 units an hour all day, and blood glucose levels are pre-meals anywhere between 70-100, and 2 hour post ranges are around 140's. It's really incredible how we can all have the same disease but all react differently to it, and the medication we need to control it. Last a1c was 5.9 as well. So, even though my "care" really isn't the norm I see a lot of you doing on here, it works well for me.

dwallersv,

LOL it SCARES me the crazy amounts of insulin type 2's can inject. On average as a type 1 I might take around 45 to 46 units of Insulin ALL day and that includes for what I eat too. LOL and I am def NOT a low carber.

My IC is 1:10 and right now I'm runing a flat basal rate of .85 units/Hour. But yes the wind can blow in a different direction and all that might go out the window as a type 1.

You sound similar to me. My Dawn phenomena does not appear to be as severe as yours, but it is ever changing and requires me to re-adjust and aim at the moving target. My CGM really helps me with my overnight basals (assuming I dont sleep on it and disconnect it). If I go back over my CGM graph and see that my BG started spiking at 6AM, then I will raise my 4AM basal rate to compensate. This works well until, the next change... I have heard of some DP sufferers bolusing a unit or 2 'before their feet ever touch the floor' in the morning. They figure that that DP will kick in once they move and this is the best method to attack.

Food before 10AM is very difficult for me. I have had many conversations with Docs and RDs that tell me I need to eat breakfast because... I flat out tell them I cannot dose accurately for a meal and my BG spikes immediately out of a range I am comfortable with. This often slows them down. I rarely eat breakfast these days (just black coffee or soda) and prefer it that way. I think breakfast is one more variable for difficult mornings that I can avoid. I don't think there is any right answer to this problem.

I have found that when I have frequent, recurring highs at the same time of day that it is much easier to raise my basal, rather than bolus. A small increase in basal approximately 2 hours before the spike happens helps my BG stay more level, leads me feeling better overall, and less rage bolusing! Good luck, DP has always been dificult for me and always seems to be changing.

I'm the same way. My morning basal doubles from 0.4u/hr to 0.8u/hr (used to be 1.0u/hr) at 5:30am and continues until about an hour after my alarm goes off (which happens to correspond to when I eat breakfast). And just FYI - my afternoon basal is 0.05u/hr, so I have a serious spell of insulin-sensitivity every day. For years I tried to figure out how to eat breakfast, because breakfast for me meant some sort of cereal or oatmeal or something like that (dx at 32, so I had a routine by that point). I finally gave up and now breakfast is egg fried in butter, sausage, cheese and a few cherry tomatoes. That's about 6g of carbs. Every. Single. Morning. I finally adjusted to it and now I can have a flat line on my CGMS for the entire night-into-morning period. Also, my cholesterol levels have never been so good, so I guess the butter and eggs and meat aren't as bad as I thought they were.

It totally sucks. I highly suggest cutting out any and all fruit- or grain-based carbs in the morning. And you may possibly need to raise your basal.

What I do... is get up and eat breakfast and the bolus early every morning. This almost always keeps dawn phenomenon in check. Sleeping in, or getting up and not eating, is the worst thing I can do. If I don't get up and eat early, I end up taking much more insulin than if I do eat a carby breakfast and appropriate bolus.

What I do... is get up and eat breakfast and the bolus early every morning. This almost always keeps dawn phenomenon in check. Sleeping in, or getting up and not eating, is the worst thing I can do. If I don't get up and eat early, I end up taking much more insulin than if I do eat a carby breakfast and appropriate bolus.

Thank you for your info, Christy. I'll be turning 40 in Jan of next year. I've definitely got my good days and bad days. Overall, I go through 40 units in basal rate alone during the day (not including what I eat). It looks like you've been doing quite well with a nice A1c. I working on getting a better grip on things with life's changes. Not sure if 35-40 is some sort of a changing point for me, but it seems to be the case given my fluctuations being more sporadic over the past few years and bumping my A1c up into the range of 8-9.

Thanks, Capin101. I agree completely with your approach. I find it very difficult to not eating anything when I wake up, since my body has been starving for 7-8 hours worth of sleeping. The CGM helps quite a bit. I've gotten the DP squared away with no problems anymore, but the aspect of actually waking up and moving does require me to bolus a little. However, over the past day or two, I've been doing well with a high basal kicking in around 6:30 a.m. (2.2 U/H). I've also noticed that if I eat a high-fat/high-protein meal for dinner the night before (and it occurs a little later...maybe around 7-8 pm), then my bathroom issue is worse in the morning, even though I was successful in managing my BG for the rest of the evening after eating and throughout the night. A square wave of 1-1.5 U/H for about 2-3 hours after eating such a meal works well for me. I think maybe it's the fact that the food virtually stops moving in my intestine when I go to sleep. When I wake, things start kicking into gear again. This adds additional complication to my mornings, especially if I'm interested in eating breakfast. Good luck to you too. :)

Thanks, Kimberly! You are much more sensitive to insulin than me. I replied above with a note about my high basal (2.2 U/H). Runs from 6:30 a.m. to 10:30 a.m., then drops down to 1.6 U/H. I've actually had good success with eating Greek yogurt mixed with fresh blueberries (this fruit isn't too high in sugar) or crunchy oatmeal cereal. As much as I like to have other fruits and juices for breakfast, I think that the high sugar in these beasts are a major contributing factor to my BG sky-rocketing after I eat breakfast. I'd love to have a banana in the morning, but I can't touch one of these until the afternoon hours.

Has anyone had a problem giving incorrect dosage in comparison to remaining insulin in body. I having been guessing dosage and sometimes it works and at other times it doesn't. How do you figure out sensitivity, mine is only on one setting and it is obviously wrong because wizard tells me to take too much insulin.

After having diabetes for 57 yrs. I can't figure out sensitivity for different times of day. The educator my pump hasn't helped a whole lot when received new pump to fix this proproblem.

It's all about trial and error, Marion. To figure out your ISF, when you are high take a conservative dose, let's say at the rate of 1:50. So if you are 175 and want to get to 125, take one unit. Keep track of your results. If you are not coming down after 3 hours, try reducing your ISF to, say, 1:40, etc. Do this for day and night and when you get results narrowed in they will give you a working ISF. Trial and error, trial and error!

The wizard only tells you what you program it. As they say, garbage in, garbage out. You can change your settings in light of your experience.

hey zoe, can I ask you a question as you always give very sound, reassuring advice (sorry, Todd..hope I'm not taking over your thread too much, maybe it will help someone else, too???). Trial and error, indeed. So, again, waking up to near 200 Monday Morning..I decided to put a pod back on at .45 basal rate, well of course I'm ALWAYS high in the AM - middle of night on MDI - Levemir, so I did corrections. Stayed rather high 170's so turned it up to .50 around 5pm. I turned it down to .40 around 8PM (2.5 hours after bolus for dinner) and again, around 9PM dropping, dropping, arrows down on CGM - 70's, turned it down to .35 and still, after eating glucose, etc...was dropping. Levemir doesn't work for me or can't find correct dose or won't manage DP. However, I become extremely insulin sensitive on the pump, my I:CR's change too back to like 1:20 and 1:100+ (ISF). I freaked out, it's getting close to bed time and I don't know what to do so I took POD off, again and took shot of levemir, I continued to slowly drop until around 1AM ate something (just cheese) and woke up 3am high. What would you suggest I do when I'm dropping like that at night with new pump start? Not sure how long a change, i.e., deduction or increase in basal rates take effect? Not sure what basal rate will keep me safe at night, at least until the DP hits, if that's what I have. Where do I start? I saw new Endo today, he's set me up w/pump nurse. But, I just feel like I don't know how to navigate through this pump start and 'stay' safe or at least feel like I'm safe. It's all so different. THANKS, ZOE! :)

For me, exercising in the morning requires extra insulin and complicates bg control. I still like to do it sometimes, but I need to take a bolus equal to about 1/2 of my normal breakfast bolus to keep from spiking.
I also find that fasting until lunch will keep my bgs pretty much flat, contrary to what others on here experience.

Hi Sarah. Yeah, it takes awhile to get it straight. If I understand you correctly, though, you were pretty much reacting to what was happening in real time to make basal changes, which isn't very effective, though I can understand the temptation with a CGM. But I would stick to corrections in the moment and work on a more long term plan for basal rates. The best way to tweak basals is based on history, where you can see overall patterns and not just respond to one or two time events which can leave you chasing your own tail! But I know you don't have much pump history yet. I know you are afraid of lows during the night so start conservative and see how you do. I don't basal test but it might help to start out (again). But for overnight you can also just set alarms and see when you are low and when you go high. (I can't recommend how to use your CGM for this as I don't use one). Then you will start to see a pattern - for example you drift down till around 3AM when you start to rise and start going high around 5AM, or whatever. When you've done that for a few days you can start setting separate time zones based on that pattern. But remember to change it two hours in advance of the need. So if you start to go high at 3AM, you want to set the rate up at 1AM. Coincidentally 1AM is when Walsh recommends starting to counter DP, but we are all different so just see what YOUR pattern is.

Another suggestion, commit to the pump and don't take it off if you get nervous. You can always treat lows or highs, you need to start accumulating ongoing data to get your settings worked out, you just confuse the issue by inserting Levemir in the mix. If you are worried, again, start conservative. The highs that might result are also useful information which is what you want right now.

As for more specific info on starting rates, I was started at a 25% reduction of my long acting basal divided evenly into 24 hours. I don't know if something like this would work for you, but it's a decent ballpark, unless you've already found out that that's way too much for you, then start out based on what you know. Where you start isn't as important as accumulating data for several days then slowly make changes based on what you see (2 hours ahead). Patience is a key!

THANK YOU, ZOE! I will soak in what you've said...yes, I need to commit to this or I'm gonna be doing 'this' for another year...back and forth..ugh! it's just the night time that scares me and double arrows down on CGM (which means I'm dropping very fast) and don't know what 'basal rate' I should be at on pump. Yeah, we did the 25% less levemir for basal on pump..but my calculations are so wrong from going to Pump from MDI because I haven't really ever gotten good numbers from levemir. UGH! I need to just accept 'high's for a few days or correct very little. Thanks again, Zoe. Endo told me this morning, who was actually great, T1's who strive for a 80 - 140 range typically have to do a lot of corrections on MDI or he/she goes on pump. He also had no problem with that range and was totally understanding in terms of how much 'management' this disease takes. nice man.

No problem at all Sarah! :)

My doctor suggested I switch to crisp breads in the morning. I tried Wasa bread and my blood sugars have Been perfect, if a little low now. They taste terrible, partly because I am too lazy to put anything on them and just eat them plain. One of the marketers at my job gave me some samples of Arnotts Cruskits and they are delicious plain or with something on them. Now if only they were not only in Australia…