Getting very frustrated chasing morning sugar highs - help!?!

Type 2
1

So here's my situation. I am a type 2 diabetic taking glipizide (10mg twice a day), and also taking a long acting insulin (levemir, 100 units)

I'll test my sugars in the morning, and I might be in the 150 to 170 range.

I'll have a breakfast, typically a protein - lately its been some lean body drinks that are 40g proteins, 0 net carbs (9g carbs total), and I will take a dose of short acting insulin (humalog, 20units)

Two hours later I will find that my sugar has shot up to the low to mid 200s. If I take a correcting dose by the doctors suggested formula (15 more units), I will get back down, then about an hour later crater with a low in the 70s to 80s. I just went through one of those about an hour ago and I had to get some sugar in me to get back up to functional.

Its almost the short term insulin somehow sat in the subq region, and took its sweet time getting into my system, and then hit all at once.

I have noticed that if I don't take the second dose of short term, I will fall in a good range, but thats 5 to 6 hours after a very low carb meal, instead of the desired 2 hours after a meal

The doc is on my case about being "out of control", and of course the A1C backs him up.

Anyone have any ideas as to what I can do better?

Do I do smaller correcting doses?

I changed taking the long acting insulin from just before bedtime to just as I wake up to see if that might help, but it doesnt.

2

when do you eat before bedtime? what are you sugars like before bedtime?

3

Levemir will not cover 24 hours. By taking the Levemir in the morning you will very likely have a gap in coverage before your injection. Thus your BG will rise in the morning. Please talk to your medical team about splitting your Levemir into two 50 units shots every 12 hours.

4

First and foremost I suggest you get the book Using Insulin by John Walsh to help you with dosing much more than your doctor will! Second of all if you are waking up with blood sugars 150-170 perhaps you need a higher Basal dose. It might also help to split it in two doses rather than just one. When you wake up that high you are kind of fighting a losing battle. Do you do an Insulin:Carb ratio for your breakfast? This is the best way to dose rather than a set dose. You will need to figure your I:C ratio (the book has instructions or you can start with 1:15 and work back or forward until you get good results. Starting that high I would either correct it first and then wait until you are in range before breakfast. If you don’t have time to do this, then add in a correction to your bolus for breakfast. Again, you need to figure out your correction factor (how much one unit drops your blood sugar) which I basically did by trial and error. Just taking a set dose for this doesn’t work well either. If you end up high after two hours and take a correction, don’t forget to figure in your insulin on board as it is still acting in your system after two hours or you will end up too low.

By the way a blood glucose in the 70s or 80s is not a low, it’s ideal. But you are used to being so high that it feels like a low to you! I wouldn’t correct (take sugar) for those numbers. Some people take glucose tabs under 70, some only under 60.

5

A high protein snack at bedtime, with some carb in it… like 4 oz of milk, and not trusting anything that says “net carb.” Do not treat net carb foods like free meals.

6

I concur with Zoe. When i first started getting my BG in control, i would experience what felt like lows (shaky, sweaty and an increased pulse). it took my body a couple weeks to adjust to lower BG and the “phantom” lows to subside. Now i feel great in 70’s and 80’s and only experience a low feeling at <65.

7

I don’t know what is going on, but maybe you are not getting enough protein going to bed to stop the spike or you are going low during the night and that is resulting in a morning spike - this is something I’ve been dealing with while we find the right dosage of Lantus for me to take over the past year and change (started off at 10 units am now up to 30 units, and thinking i’ll be hitting 40 on my next visit since my waking numbers are still a little high though not by that much - but my daily levels are better then they where 4 months ago).

8

Bedtime sugars are usually pretty good, The night time sugars are down in the 120s

9

I discusssed splitting the levemir dose with my doctor - he said it doesnt matter
In reading their (the manufacturers) material, the said it comes into maximum effectiveness at the 6 hour mark, but its supposed to be good for 24.

10

Thank you for the book information. I was begging my doc for more information on stragegies to manage the sugars more accurately, and he was less than helpful. I knew there had to be a bible somewhere.

Its only been in the last year that I went to insulin therapy - but I gained weight again.
Working on getting that back off.

Oh and I take sugar at the 70 mark because if I don’t, I will keep going lower.
I got down to 47 once. Ive learned that when I fall, I fall very fast for some reason.

11

I ignore the net carb number. I just added it for reference. The 9 grams of carbs in their total came straight off the packaging. I feel bad for the people who are dieting based on “net” carbs. I use total carbs for carb counting

12

I dont know what to do if the carb count on the packaging is off. The only other thing this could be is a caffeine boost. However I see the same thing with or without coffee, and my doc didnt think caffeine could be responsible for a 100 point rise with no carbs in the middle. Heck I even thought it might be the coffeemate, but if I calculated correctly, thats only putting in 4 carbs.

13

Oh I forgot to ask - what’s a CDE?

14

Some of us Type 2’s are very, very carb sensitive in the morning because we are the most insulin resistant then. I have to have that nightly milk snack, or I have higher morning blood sugars in the AM. A 30 pt rise for me from breakfast, in the morning, is normal… What I ensure, by having the snack, is that my morning blood sugars are low enough to handle breakfast. If you were at 170, and went to 200… that was about a 30 pt rise. There are a few tricks to controlling this Dawn Phenomenon thing…

  1. Monitor what you eat, how late you ate it… and how far out it’s spiking you. Some dishes like pasta can spike us much, much later than we realize.

  2. Have a protein snack, like a piece of cheese, (for me, milk is actually more effective than the cheese), a couple of hours before bed, and then don’t eat anything else.

  3. Consider having some apple cider vinegar, 2 tablespoons, right at bed time. Yuck, I know, but some swear by this, and the pills.

  4. Make sure you’re having enough water throughout your day. I struggled, personally, a lot, with getting dehydrated overnight, as I slept. I started slowly adding more water to my day, and things like Powerade Zero to retain electrolytes, particularly during exercise…

  5. Get a good night’s sleep. If you’re not going to bed on time, or tossing and turning a lot… It can drive morning sugars up. Issues like Sleep Apnea need to be taken care of before anything like this can be resolved. In the meantime, if this is an issue… Sleep on your side, not your back.

  6. Have a 5 oz glass of red wine with a sensible, low carb dinner.

  7. Find your ideal carb intake amount. I don’t know how well you meet your other goals, but I also found that when I cut carbs too drastically, my liver would dump glucose a lot in my system. I’m not sure why… Most people do fine, but I somehow, need a few more in there.

  8. If you can work a brisk walk 30 minutes after you take your first bite of food, that does wonders to that morning resistance and rise… It’s also good when we exercise at night, a few hours before bed… I’ve done that, and then had a 4 oz glass of milk, with wonderful numbers in the morning, 20 pts lower than usual.

  9. Consider how you handle your medications, and perhaps an adjustment. In this point, other TuD members can provide more insight than me, but consulting with your doctor or CDE doesn’t hurt.

I hope all this helps. There’s been a really long, ongoing discussion on the Mendosa site about this… and I’ve been following it for a while: http://www.mendosa.com/blog/?p=232. People post comments with new insight all the time…

15

My team of endos is specialized in diabetes. They would not go by the textbook instead they would argue with experience. So they have seen patients where the split has helped. They would just suggest to try that for one week. Then they would look at the result to decide whether or not this is a path to follow. Splitting is harmless because it is just the same dosage distributed on two shots.

16

I have to give about 2/3 unit fast acting insulin for every 1.5 oz protein due to its changing to glucose over time. This is based on an equivalency to Bernstein’s recommendation, Diabetes Solution, p. 291. He speaks of regular insulin. I use Humalog so use 2/3 unit per 1.5 oz. protein. At least count the protein amount in the calculation.

17

One thing that will definitely help is to split your long lasting insulin in 2 hoots per 24 hours, this is necessary as neither levemir nor lantus lasts exactly 24 hour so you will overlap it if last longer in your body or you will have none on board if it lasts less that 24 hours in your body. Splitting the 24 hour dose in 2 greatly mitigates these problems.

I do not see the logic of using levemir and glipizide at the same time, how the Ch–st are you going to control such an un-holy combo, the more so if you use fast insulin for corrections. It will be a zoo. If your doctor knows about this he is partially to blame for the poor control.

Get a book like :“using insulin” and learn your self to optimize your levemir and your fast for best results.

Your daily insulin dose seems to be sky high which is not good. you are super insulin resistant.

Sometimes if you are lucky metformin does wonders for some people in fighting insulin resistance. Ask your doc for some and try it. cut your insulin dose by half when you do in case it really works well which would be good. some people like I cannot tolerate it. But it’s worth a try.

Otherwise you have to do as much exercise as your body can stand.

Best of luck and sorry if this sounded like a lecture.