I’ll tell you up front I could really use help with this so if you’ve experienced something similar or have some ideas, shoot 'em out.
I can't seem to stop my blood sugar from skyrocketing early in the morning. Yes, I know about the "dawn phenomenon" and growth hormones being released in my body between 5 and 7 AM to get me ready for the day shooting glucose into my blood.
It's all well and good to tell me I've got a sound growth hormone system. But it's not good that I have to jump out of bed by 6:30 AM, weekday and weekend, to blunt the BS rise with rapid-acting insulin.
So, going on the theory that my Lantus isn't giving me a full 24 hours coverage, as is true for many people, I have been experimenting:
1. first I switched from taking my dose in the morning to before bed. Beside the fact that I hate the thought of having to take one more shot before going to sleep, especially those nights when I fall asleep by 10 PM on the couch, it didn't seem to help.
2. it was recommended to me that I split my dose and take one injection in the morning and one in the evening. That put me on such an unpredictable curve of highs and lows and not knowing how and what to prepare for that this idea didn't last long.
3. My last attempt, recommended by an endo who's ear I caught while in Bangor, Maine giving a presentation, told me to take most of my dose in the morning and 1/4 of it after dinner to give an extra flood of Lantus to stand up to those pesky growth hormones. Obviously, 3 units of Lantus didn't consider themselves a flood and once again were overwhelmed by sneaky glucose combat fighters. Or that's how I visualize it.
I'm up to my last experiment. I'm taking one injection of Lantus around lunchtime. If my Lantus really is petering out in 21 or so hours, if I take it around noon or 1 PM, I should think I'd at least get enough efficiacy out of it so I wouldn't have to blunt a rise until perhaps 8 AM. And finally get some sleep.
I don't know yet if this is working. I just started and I'm giving it a week as my endo told me to give most changes. What a pain.
This is the single reason I would switch to a pump, but then with all the furor over pat downs at the airport pumps are looking less convenient than more.
Have you considered switching to Levemir? You do have to take a split dose with Levemir, but the peaks are really minimal. Once you experiment with and get the right timing for the injections, I’ll bet the problem would be solved. As for the pump, you could always revert to MDI for the length of time you are actually on the plane, keeping the pump in your carryon. You still need to have some long lasting insulin on hand at home and on trips, while on the pump, to take care of emergencies–and there always are emergencies.
As I understand it, the liver is responsible for most of the insulin clearance overnight. I have had good luck with darn phenomenon drinking a glass or two of good red wine at night, thus keeping my liver busy overnight (bad red wine also works, but is not as enjoyable).
Another thing is that exercise can cause a significant surge in growth hormone, particularly if you do resistance exercise, so it may be good to avoid exercising at night (this is one of my problems).
The only other thing I could think of was to change the location of where you inject (if you don’t already) to a different part of the body since they can have different absorption rates.
I take my largest injection of my split dose of Levemir (and before that Lantus) at about 9:00 pm, which covers my dawn phenomenon of 2-3:00 am. I suppose if I were having your problem, I’d take it at 11:00 pm and hope for the best, but I have no idea if that would work for you. Just incidentally, Levemir works so much better for me than Lantus did.
Are you sure you’re not dipping around 3? When I was on Lantus, I would find that I dropped significantly around 3 and then the Smogyi effect would take over and I’d wake up with a BG in the 300s. I would take my Lantus at bed time (about 9:30 or 10:00). It does have a slight peak about 6-8 hours after injection. I went to the pump before I started trying to split the dose. I dread the airport security thing but I am much happier with the pump. Consider the pump. Maybe the TSA will come to their senses in the next few months.
Agreed on the wine - 2 glasses will have me wake around 60 mg/dl, but then you skirt being too low. And no it’s not the Smogyl effect. I wore a CGM for 5 days and saw my bs continually drops til around 5:30 AM when it’s around 55 and then begins to slide up, it’s just the “up” between 6:30 and 8 AM is fast!
I know it seems strange, but you actually might consider metformin. One action of metformin is to reduce the production of glucose by the liver and metformin is metabolized by the liver, keeping it busy (just like wine). It is easier to take a metformin when brushing your teeth for bed (as opposed to the 2 glasses of wine). .
I would be interested in hearing how your new experiment is going. I, too, have the same problem, but my doctor has assured me it is nothing to worry about as I don’t go that high, but as you know when, someone tells you not to do something, that’s all you can think about. I have split my Levemir into two doses, one in the am and one at bedtime. I found I had to increase the dose slightly because of splitting it.
My son had your same problem. He wakes at 200+ most mornings. I wake up at 5:30 and correct him before he even gets up. How is it working for you now? We tried moving from AM to PM and even split, but no luck.
I moved my Lantus to lunchtime, of course, since it’s a new time for me it’s hard to remember. I haven’t missed a dose yet, but sometimes I’m a few hours late. I can’t figure out yet if it’s made a difference - too many variables. But I plan to keep it at this time a week longer and see if I can tell.
