Hey guys, new to the forum and have a lot of info to share and also questions to ask. I'll start with this one. I am finding when I wake up I am getting high reading, usually from 9.0-10.5. My sugars are usually fine when I go to bed and if I check overnight they have been fine (6.4, etc). So here is my problem, I am currently taking (experimenting) between 4-7 units of lantus at bedtime (11pm-12am). Now there doesn't seem to be much difference in the sugar reading when I wake up, but the higher dosage of lantus i use, the more i go low after breakfast. Now I only use 2 units of novorapid with breakfast for roughly 50g of carbs.
So to put that rambling together I'll give an example of what happened yesterday and today.
Yesterday: Dec 9
4 units Novorapid bedtime the night before (Dec 8)
8:32 am - Dec 9 - 10.7mmol/L - 2 units with breakfast
10:16 am - Dec 9 - 5.6mmol/L - So I had a glass of orange juice and seemed to be ok then.
Today: Dec 10
5 units Novorapid bedtime the night before (Dec9)
8:41am - Dec 10 - 10.3mmol/L - 2 units with breakfast
I felt like ■■■■ so checked it out of curiousity,
9:19am - Dec 10 - 14.2mmol/L - so I took a unit to bring it down/now it spikes down
9:45am - Dec 10 - 11.1mmol/L
9:58am - Dec 10 - 10.3mmol/L
So now I am going to go low and will need to have some oj again I'd say lol.
It's all really confusing I know, but I'm wondering should I jack the Lantus to like 9 units and just accept the lows after breakfast?
1) You're probably experiencing dawn phenomenon. DP occurs to most people, it's just that they have normal insulin production to balance it. DP is the release of glucose from the liver in the early AM hours - it prepares your body for the day. I am on a pump and my basal rate from 5:30-7:30am is about 4 times higher than my previous basal rate. The only way I found to counteract DP is to go on the pump.
2) Lantus has a peak. You may be experiencing that peak when you have morning lows. You should discuss with your doctor about either changing the time you inject Lantus, or splitting your dose in 2 and taking them 12 hours apart.
3) Are you really taking rapid-acting insulin without eating? You mentioned "5 units of Novorapid the night before" - I'm wondering if this was with food. If so, then that seems very high if your I:C ratio is 1:25 (that's 125 carbs so I guess it's possible). If not, then you could very well be going low in the night and rebounding, which could be another cause for morning highs.
To combat the AM highs, you should eat first things upon waking. It will stop the glucose response from your liver.
As Kimberly said - Dawn Phenomenon. It's the reason I got a pump 20 years ago when they were still "experimental". Even with the pump, the first thing I do when I wake up is take a bolus. I only have to do this because I have a variable schedule. If I always got up at 6 am, then I could set the pump to increase my basal at 5 am. Honestly, with shots, I think your best bet is to get up and take a rapid insulin shot, or if you usually get up at 8:30, set your alarm to 7 am, take a shot, and get another hour's sleep. But, like I said, never being able to solve this issue is why I got a pump!
The other thing is to eat something small, and OJ isn't it! I can't drink juice at all, too much too fast. I can have a candy bar more safely, but that's just me. have an orange instead.
I'm confused why you had orange juice when you tested at 5.6mmol/L....... I use mg/dl, but I checked the conversion and a 5.6 is around 100mg/dl.............which is like PERFECT.
I agree with the others that you probably have DP and that a pump is the easiest way to manage your increased basal requirements in the early morning. Increasing your nighttime basal from 4 units to 7 units is to increase your total basal by 25% (since you split 4-5) which is very big change and it is no suprise that your are going low after breakfast and later in the day if you use 7 units at night.
To know for sure what is going on, you need to do some basal testing overnight so that you can see when your blood sugar starts to take-off. You could then plan on waking at the right time to test and correct. Or you could check out a pump which is a lot easier.
I guess we're all different! A drop like that, in almost 2 hours, isn't that much by my standards. Also, knowing my own body and reactions to insulin I'd know that most of the insulin would have done it's work already so I'd be almost done dropping.
Thanks for the advice guys, I'm starting a new job this week that is going to require me to get up a lot earlier so I'm going to see how that effects everything and I'll let you know! I'm also going to do some more overnight testing. Cheers!
