Huge dose required on waking

My “feet on the floor” issue is concerning me. I use Toujeo and Fiasp. When I wake, the number of units of fiasp I need is basically equal to my BG reading in mmol. If I wake at 7mmol, I need 7 units just to keep from rising like crazy. I might rise 1 mmol but then it slowly drifts back down.

Is this likely bad insulin resistance at that time of day? Or a huge rush of sugar production. Maybe both? At other times 1 unit corrects 2 or 2.5 mmol (which even that seems high).

Could be Dawn phenomenon

It’s normal to have to inject when your feet hit the floor. I’ve found I need a lot more Fiasp when using it to counteract the rise vs. NovoRapid/Novolog, and it’s not always consistent. I’ve also seen rises that start again if I have coffee when using Fiasp, but don’t see this (or at least anywhere near as significant) when using NovoRapid. I read on another blog where someone was using Fiasp in a pump, that these issues were more significant for whatever reason. Also, when do you inject Toujeo? It could be wearing off in the morning, or you just need more basal at those hours (as many people do). As a side note, every time I’ve tried Fiasp, on pump or MDI, I end up going back to NovoRapid. I don’t know what it is about it but just when it is working great it starts behaving strangely.

Pump users sometimes try and beat this by starting to increase insulin in the early morning, before waking up. You might just have a harder time as a manual injection person. It may go away eventually.

P.S. When I have significant DP, I also notice that I am super energetic and productive in the morning. My brain is sharp - I’m full of energy. I think that natural output of energy is kinda nice. At least until my BG = 350 and I feel like crap. Do you you find that to be true???

Interesting about Fiasp… I have noticed it will sometimes halt a rise, but then it seems to lack enough energy to bring me back down. I guess maybe I need to adjust ratios.

I don’t feel any big energy boost (unfortunately). If I creep above 10, I take another couple units on top of the huge dose and that usually kick starts the decline.

My dawn/feet on the floor effect with Toujeo was awful (I had to switch from Tresiba due to Rx formulary changes). Adding Victoza at 8pm helped blunt this from 4am-8am which was the worst time.

I want to switch to Triseba too, but it takes FOREVER to get an appointment with my endo.

I have feet on the floor in the morning also, plus my insulin takes 2 hours to begin reducing my BG. This lasts until about lunch time. For rest of the day it only takes an hour to start reducing BG after a bolus, so yes in my experience I have feet on the floor plus strong insulin resistance in the morning.

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