I am a type two diabetic on insulin and metformin. I take 80 units of Lantus each day (40 at night and 40 in the morning) and I also take Novolog at meals. As you probably already guessed I am extremely insulin resistant. My blood sugars during the day are good. The problem is my waking blood sugars are almost always between 150 and 190. I can go to bed with a perfect blood sugar and have no snack and I still wake up in this range. I really want to have better morning blood sugars, but am afraid that if I increase the Lantus that I will have lows during the day. Short of bolusing in the middle of the night, I do not know what to do. Any suggestions?
Hi Aimee, I understand exactly what your going through. Although I am a Type 1 I often fight my Dawn Phenomena. I know you don't want to increase any long lasting insulin because you don't want lows during the day. But maybe increasing by just a half unit it might work. I am not a doctor giving medical advice, just a fellow diabetic with high morning Blood Sugars. It has helped me to increase my long lasting insulin.
Good Luck! I know it's tough!
Well, Lantus has a long action profile and with larger injections that profile is further elongated. So increasing your nightime Lantus shot, while it might suppress the DP, may cause you to go low during the day. And you probably need more than a half unit, you might need another 10-20 units at the right time. I actually use NPH and take a nightime dose of NPH that is twice my daytime dose. NPH only lasts like 12-14 hours (as opposed to 24 with Lantus). It does a pretty good job of suppressing the DP without causing daytime lows. So one option might be to discuss with your doctor the option of augmenting with NPH.
ps. Bernstein recommends waking at 3am and bolusing. I don't like that option either.
Hello Aimee,
Perhaps you may try glipezide that will help down your blood sugar down. Please check with your doctor about this first.
What did you find out Aimee? Trying to regain a normal balance now and am running into the same problem.The Doctor told me to increase insulin(thought he ment just fast acting, because messing with both might mess things up) as well as watch diet but did not tell me any specifics.I take Lantus once a day (75 units) as well as Humalog 3 times a day. Now that I am checking sugar 4 times a day I am finding my morning sugar is still around 200 even though I am not having a snack after dinner. I have been increasing the humalog but not the Lantus. Until it finally dawned on me that this is probably what I should be doing.I guess tonight I will start injecting 78 units and see if improves. Good luck to you Aimee!
Craig
It has taken me almost 5 years to get my fasting bgs where I want them to be. To do that I had to increase my metformin to the maximum 2550 and experiment when to take it. I now take 3 , 850's per day. I also had to cut my carbs to 10-15 per meal or less. I find when I go above that I tend to store more glycogen in my liver which is available to dump early in the morning with DP. When I am strict on my LC diet, my bgs are right where I want them. Even going up 10 or 20 carbs per day will raise my fasting.
Hi Aimee, have you been exercising lately, i find with jacob it has a long lasting affect on his numbers and helps his morning numbers 56 again today yikes, i know it is totally different than your situation but if you are not consistently exercising already it might be a big help i would recommend a combo of aerobic and weight training as they have different effects on your blood sugar i wrote a paper on type 2 and exercise in college it was a while ago but adding in the weight training adds more muscle and helps regulate blood sugars even more than cardio because there is s longer lasting effect, ( jacob has been doing lots of pull ups and push ups lately) if you need any more ideas let me know i hope things get better! Amy
Why don't you try to lower the morning dose while you add more units of lantus in the evening ?
Your total lantus will be the same, but you would get a higher basal rate at night, as you wish.
If you didn't take so much units (100?) of lantus I would suggest a try with levemir: it lasts 12 hours as you like, so you can take a stronger dosage at night without fears of lows during the day.
But usually levemir requires more units than lantus.
Last thought: did you ever consider a pump ? One of the benefits is to fine tune your basal.
Hi Aimee,
I have been struggling to deal with this same problem, though I am a newly diagnosed type 1. I take Lantus as well (4 units in the morning). The only thing that has helped me is to first have breakfast right away, then an hour later go running or do some yoga - it has to be enough exercise to get my heart rate up. I find that at the 2 hour after breakfast check will be below 6 (in mMol).
Now that I've broken my toe however, I can't have my usual fresh juice or smoothie and stick to higher protein, low carb breakfasts (egg / chicken sausage / veggie omelette with gluten free bread). If you figure it out please let us know!
Thanks!
Jodi