I’m having trouble how to best handle this “phenomenon”. Not dawn phenomenon, but waking phenomenon. I’ll test my blood sugar upon waking and immediately after, it will start rising. I’m guessing it goes up about 2-3 mmol before I get around to breakfast (~45 minutes).
I pre-bolus (~20 minutes) for breakfast, waiting to eat until Libre sensor shows upward trend has stopped, but how do I correct for this initial spike? I’m usually at a good number before lunch, but wonder if I can do better. Also, if I wake with a higher than normal blood sugar it just takes forever to get in range and I’m hungry!
I’ve already adjusted my carb ratio for breakfast and basal levels during breakfast time. Basal level not high enough? What if I increase the basal right before breakfast? I might end up having to change the carb ratio… Am I being anal?!
You may want to pre-bolus as soon as you wake up as it takes about 30 minutes for insulin to kick in. That would allow the insulin to help appease your spike. You will most likely find that you will need to increase your pre-bolus as well but this needs to be taken 1 step at a time or you will not be able to pinpoint your exact needs and correct your issue.
If you have predictable wakeup time, and using pump, you can program in the higher basal rate. If on MDI, some people take small bolus as soon as they get up.
This is called “feet on the floor”, and affects some stronger than others. Newer pumps can help address this by automatically increasing basal when integrated cgm is providing BG readings.
I feel this “feet-on-the-floor” effect every day. I take 1.5 units of insulin via the pump as soon as I wake up. (Your needs will differ.) That helps. I also delay my first meal until mid-day but I realize that may not work for everyone.
If my blood sugar still rises above 6.7 mmol/L (120 mg/dL), I will often add 4 units of Afrezza. One tactic that I’ve not tried but I suspect will help is to go out for a brisk 15-20 minute walk right after waking.
What is your typical blood glucose level when you wake up? If it’s over about 5.6 mmol/L (100), you might ensure that you eat your last food the evening before at least three hours before sleeping.
Making your last meal of the day more modest in size and avoiding evening snacking can help with the next morning’s FOTF phenomenon.
Your solution is best arrived at with trial and error. Keeping some notes helps here. That way you will identify what works for you.
This is a good exercise since diabetes is dynamic and knowing how to find the solution is just as important as the solution itself.
I “like” the idea of exercising before breakfast and one of my family doctors highly recommended it. I mentioned it to a diabetes nurse and dietitian and you could actually hear the intake of air as they gasped. “You have to eat something!” It’s a habit, however, that my instincts shy away from. Ever since I was a wee baby, the first thing I wanted to do in the morning was eat. I’ll keep an open mind and first see how the insulin experiments go.
I have a Medtronic 630 pump and use the FreeStyle Libre sensors.
How did you come up with the number 6.7 as a limit? Just curious.
When I stick to my schedule, my numbers are between 5-6 mmol. My last “feed” is at 9 p.m., 20g of carbs, some apple and cheese is a favourite. So it’s about 2 hours before sleeping. I can’t sleep when I’m hungry. I could look at lowering the carbs.
I’ll ask my endo again about Afrezza, but I seem to remember that my government drug plan won’t cover both Humalog and another short acting insulin at the same time. Worth looking into though.
The Freestyle app logbook isn’t perfect, but I could definitely add more notes.
I arrived at this number from trial and error. If I add insulin at a lower number, my risk of hypoglycemia goes up. But if I don’t add some insulin at this level then I risk a higher glucose level and the burden of adding correction doses later. I find as my glucose level rises, it’ll take more insulin total to correct it than it would if I took the correction around 6.7 mmol/L.
There are few hard and fast rules with diabetes treatment. Many diabetes medical professionals are so fearful of hypos, it clouds their judgment and common sense. Instead, I would counsel doing your own experiment, taking note, adjusting and trying again. I would carry some quick acting glucose and watch my CGM for safety’s sake.
No worry, however. If you’re not inclined to exercising in the early morning, there are other tactics. I actually exercise in the afternoon and my first interest in the morning is my coffee! I just thought that this might deaden your FOTF glucose rise.
You could experiment with your 9 pm snack with eating a hard-boiled egg. As I’m sure you know, the protein acts much more slowly on the metabolism and doesn’t require as much insulin.
I encourage you to consider the idea of experimentation as a valuable tool. When I experiment, I don’t think of it as permanent change of habit, just as a way to see how my body responds to that change.
I realize that we as humans love our routines and resist changing them if we can avoid it. I found, however, that I made the biggest gains in glucose control when I put every cherished habit up for examination and dispassionate analysis. Turns out, for example, that bagels are not essential to my well-being and happiness!
I’m sorry to read that your drug plan does not cover Afrezza. I recently lost my insurance coverage of Afrezza and I will start buying it “out of pocket” as soon as my buffer stock runs out. It’s a valuable tool that I don’t want to give up. I realize that this option is not economically open to everyone but there are discount plans that uninsured people can use.
I had to start taking basal at night around 9:00pm. Taking Basaglar and it only lasts about 18 to 20 hours in my opinion. so if I take it at night it is in full swing when I wake up. I still get dawn and waking effects but start around 90 when I get up instead of 120. I was able to reduce morning bolus to 1 unit instead of 2 but I swim immediately after breakfast. High carb breakfast of flax, hemp seed and chia, then two turkey sausages.
After swimming down to about 100 it continues to fall to 90 or 80 then jumps back up in about 15 minutes( rebounds back) still digesting to maybe 120 to 130. I also had to wait up to 15 or 20 minutes before eating breakfast and one time I had someone at the door and guess what, can’t wait 40 minutes without eating, lol. I will be learning my whole life but some breakthroughs will be had.
