Morning lows

Another question…V is getting morning lows. About 2 hours after he eats, seemingly regardless of how much of a bolus he takes and what his starting point is, his BG drops to between 50 and 60. Then he corrects (15 carbs) and it by noon sometimes it’s high; sometimes it’s good… (He has the same breakfast every morning.)

Has anyone else experienced this?

It could be that his morning dosage requirements are different (or changing). It could also be his long acting insulin is spiking during these hours. Has he changed his routine at night when he takes his long acting (maybe injects at a different time than usual)?
I know I’m starting to sound like a broken record here, but could it be that he is injecting the morning dose in a different spot (one that has no or less scar tissue and therefore he is receiving more insulin than when he injects in alternate spots)? Unless he’s using a pump in which case most of the above mentioned is irrelevant. In that situation, however, he might need to set a different basal rate for those hours. The basals he needs from one hour to the next can differ greatly which is why most (if not all, I don’t know) pumps give the option of setting up many different basals throughout the day.

These are just some thoughts I can offer based what you wrote. I agree with Dave that you should check with an Endo because lows can be dangerous at any time of the day.

Check with your endo, might be time to check his basal rates…

Actually that book arrived this afternoon. We also have Think Like a Pancreas. So far, no clear answers, tho.

I hate to say it, but, yes, he has a pretty set routine, but it’s only been 3 weeks on the Basal/Bolus approach. Before he was on mix. We’re still trying to figure everything out - thus the question. Never thought about the injection location though… and I didn’t realize that the basal needs can vary. So much to learn! Thanks for the suggestions.

Easier said than done, here. A simple question like that would put him in the hospital for a week while they got it sorted out to their satisfaction. Then they would release him back into the world and we’d be right back in the same place again. That’s what happened when he switched from the mixed. It worked fine in hospital - where he did nothing and ate awful food.

Another factor to consider is the timing of V’s breakfast bolus. People have different digestive rates & timing is important. V can check this by testing at 1 hour after breakfast, as well as at 2 hours & 3 hours.

The 15 carb “rule” is a general guideline. It depends of course on how much BG needs to be raised to reach the target BG. It’s also dependent on what he’s eating for those 15 carbs. Fast acting sugar should be used to correct lows quickly & V needs to know how much fast acting sugar (glucose, dextrose) raises him how many points. Just as an example & I’m a small person, 1 gram of sugar raises my BG 10 points. If I need to correct a low of 50 to get to my target of 90, it would take 4 grams of sugar. People use different things to correct lows (glucose tabs, candy, high sugar drinks, etc). I use jelly beans because 1 jelly bean contains 1 gram of pure sugar. Easy to count, easy to control to prevent overdoing the correction.

hi katie. in that book using insulin-chapter 11, it will tell you how to test his basal, etc. so you don’t have to go through all of that hospital business again. hope it works out for ya’ll.

I have two different basal needs during the day and two during the night (for a total of four). Without checking my pump off the top of my head I think my first basal runs from 9 am to 5 pm, second 5 pm to 12 am (midnight), third 12 am to 3 am, fourth 3 am to 9 am. Without the different basals I would be running high or low (depending on the time of day) regardless of diet/bolus intake (in other words if I did the same thing every day).

Injection sites can be a very important factor. If I understand your situation correctly V is new to this so he shouldn’t have any problems with scar tissue yet. For future reference (or if I’m wrong and he has been pumping/injecting for a while) you need to consider rotating sites, changing sets every 2-3 days (a lesson I learned very recently) and paying attention to any bumps or other signs of scar tissue build up. Injecting insulin in scar tissue means less insulin absorbed. If you get use to that and continue increasing the dose to compensate and then one day inject in an area with no scar tissue you will get a massive dose that is way more than needed.

I am on a pump, but find that my insulin sensitivity is more touchy in the morning. If he is on an insulin to carb ratio of 1:15, try knocking it down a bit. If he eats say 45 carbs in the morning, instead of taking 3 units try knocking it down to 2 1/2 units instead. Test a little more often to check that his BG isnt sky rocketing. Another reason his BG might be getting too high in the afternoon, after a low, is because our bodies have a natural defense to low glucose. It begins producing glucose to correct itself. So the higher blood sugars after a low are called a bounce back. If you correct it with food, and your body corrects it itself, the BG goes too high.