This is driving me crazy

Overall scenario:

Wake up at 8 at a good level, say 107. No breakfast and test at 182 at noon. I have been spiking like this in the morning for a couple of weeks. Even spiked once from 95 to 285 in the same scenario above. Stopped drinking coffee/caffeine completely and there has been no change in this pattern.

Basal: my a.m. basal is the highest of the day at .6 from 6 am to 4 pm, when it drops to 2.5 during drive time. I upped it to .7 from 6 am to 11:30 am when it goes to .6

Other part of the day: Go to bed with a BG of 91 at 9, three hours after the meal. By 10:30, my pump starts to buzz that I am low. I treated with 8 oz of apple juice (32 carbs) and even with the juice, BG continue to go down and am 53 at midnight. Eight oz more juice and starts to go up slowly and I hit 98 at 1:00 am. Woke up with the 107 noted above.

Now bolus and basal. I bolused 1.5 units with a 30 minute square wave (tried square to see if tat helped)last night for about 20 carbs. normal C:I is 1 u to 10 carbs. So I took 25% less than normal. My basal goes done to a minimum .375 at 6:00 and then up to .4 at midnight.

First, I don't get how I can drink 64 carbs of juice over a two hour time period (that is more carbs then I eat in a normal day) and still crash. I am going to lower the 6 pm basal again to .35 and see if that helps.

This has happened in various degrees for the last three weeks. I was traveling, and afraid to make changes on the road. Sound like the right changes? My husband is getting really irritated with the night ones, as they are happening as I go into REM sleep and do not react well to the timing. Suggestions? Ideas?


1) You need to eat something in the morning, preferably soon after you get out of bed. You're experiencing the dawn phenomenon, which will cause your blood sugar to increase all morning, or until you eat. If you won't eat breakfast, you'll need to up your basal drastically. I go from 0.4u/hr all night until 5:30am (an hour before I usually set the alarm) when my basal jumps to 1.0u/hr. If I don't do that, then my blood sugar shoots up within minutes of waking up. I keep it there until about the time I eat breakfast, when my basal drops back to 0.5u/hr.

2) You may need much less basal around the time you go to sleep. I have about 6 different basal rates during a typical day, one of them being 0.05u/hr. It is possible that your dropping at bedtime is a result of too high a basal rate.

You should read up on all of these things in "Think Like a Pancreas". Can't remember the author's name, but somebody around here should. It's basically the insulin-user's bible.

Very interesting. I have many of the same issues. Many would cite the dawn phenomenon as reason for your BG rising in the morning. I think it may have something to do with a glycogen release, due to your stomach being empty. I can't confirm this, though.

I have had the late night drops as well. No idea why.

I admire your control. How long have you been pumping?

For 10 years, with D for 50. Last A1C was 5.6. And I have rarely eaten breakfast since I got my first pump. Actually had plain yogurt yesterday morning and had the same spike. The spike isn't gradual over the morning, but occurs suddenly. Today it began to rise from 110 at 10:30 to 135 at 11:50 and was 182 ar 12:30.

I am going to try eating something in the morning for a consistent time period and see if that helps.

I totally understand dawn phenom, and this is new, so I would discount that theory as it doen't fit with my history, unless something has changed....

Oh, and Think Like a Pancreas is a very good book for any diabetic to read.

I think that "spike" is a misnomer here. "Spike" somehow implies that it's a temporary excursion and an excursion that self corrects. That's simply not what happens to me at least in the mornings if I don't eat.

Your bg is drifting up as your liver converts glycogen into carbohydrates... what it's supposed to do if you don't eat. Without insulin to cover these liver-produced carbs, it won't come back down.

Best way for me to defeat this: eat when I wake up. If I don't eat when I wake up, I end up using far more units of insulin in the morning, than if I do eat. Again, this flies in the face of the textbook "bolus for food" concept, only because that concept is way too simplistic.

For the morning issue, it sounds like you have DP. Your blood sugar will continue to rise until you eat. The solution? Eat some breakfast, even if it is small to stop this effect.

For the nighttime issue: If you are going to bed at 91 three hours after the meal you probably still have some active bolus insulin on board. I would suggest putting more time between dinner and bedtime. Yeah, sometimes it happens that the low treatment just doesn't take effect.That is definitely a lot of carbs! You might see if it works better with glucose tablets. But again, the problem is in part because you still have bolus insulin on board.

I definitely think people can develop DP if they didn't have it before just like Type 1's can develop IR. It sure sounds like that to me, so don't totally discount it, but keep trying out different breakfast options to see if it stops the reaction.

I guess it's more of a rise than a spike, unless you're spiking a football into the crowd. Nothing really self corrects when you're T1.

The liver action is the same thing I'm talking about. Does it have a name? Can we identify the chemical reaction which triggers it? Are we sure it's real?

I've done some searching and can't find any thing about it, other than a couple of anecdotal mentions.

The liver action is the same thing I'm talking about. Does it have a name? Can we identify the chemical reaction which triggers it? Are we sure it's real?

Colloquially we call it "liver dump" here. But more technically, GLUCONEOGENESIS Gluconeogenesis
From Wikipedia, the free encyclopedia
Not to be confused with Glycogenesis or Glyceroneogenesis.
Gluconeogenesis (abbreviated GNG) is a metabolic pathway that results in the generation of glucose from non-carbohydrate carbon substrates such as lactate, glycerol, and glucogenic amino acids.

Gluconeogenesis is a ubiquitous process, present in plants, animals, fungi, bacteria, and other microorganisms.[2] In vertebrates, gluconeogenesis takes place mainly in the liver and, to a lesser extent, in the cortex of kidneys. This process occurs during periods of fasting, starvation, low-carbohydrate diets, or intense exercise and is highly endergonic.

That's a good point about the IOB. I usually attribute night time lows to a delayed exercise drop matched up with a some remaining insulin in my blood. The last one I had, though, was really dramatic, and at least 4 hours after I ate.

According to this, your liver can stop making glucose while you sleep. That may be a factor:

Other than that, maybe some kind of infection?

Thanks, Tim.

Yes, I've had two unexplained drops down down down at least 5 hours after dinner, one reached 28 and in the process I took 10 glucose tabs! All I can think in that case is odd absorption which I've suspected a couple times before - but even that doesn't make a lot of sense. Those damn D gremlins. I always look for the logical explanations first before I delve into the

Ooh - sorry. I didn't realize you are an experienced pumper.

I have nothing to give you except that I think everyone gets hit with random insulin need changes. I have all of the sudden had to change my late AM basal because the readings just started rising from breakfast to lunch. Why? I have no idea. And I've also had several instances in the last few weeks of my blood sugar dropping crazy-like during the night. With no IOB. Thankful for the CGM when those occur. Nothing different going on with my life, but for some reason the body decided to change things up on me.

Although I still think it's a good idea to eat something in the morning. Breakfast is the most important meal of the day, after all!

I have pledged to eat breakfats (yuck!) but I will.

I found out I have to eat at least enough carbs to warrant taking a single unit of insulin in the morning.. so that I can help fix that stupid dawn phenomenon... It seems almost like I have to eat at least 7 carbs so I can take 1 unit. My I:C ratio seems about 1:15, so that 7 carbs give me like, a half unit adjustment for the fact that my BG is going to go up regardless..

But you can take what I say with a grain of salt, I've only been dealing with D since Feb.

I doubt everyone's that way... but as someone who HATES eating in the morning, it's very annoying...

I found myself looking for the 'like' button on this post. I have to remember this isn't FB. LOL.

But anyway, thanks for a helpful post :)

No problem. We all need new input and I took yours to heart, Kimberly, and will try breakfast as a new daily alternative.

I really hate to eat in the morning. I think it has to do with being on such a strict diet as a kid--I had to get up 7:00 am everyday (try that consistently at 12, 14, 16, OH! and 18!), take my Lente and eat my prescribed morning meal: 1 bread, 1 milk, one fat, one fruit.

One time, in college, I actually toasted a sponge (low BG, but who knew with no monitors, added jelly amd stood in the kitchen and tried to eat it.... Obviously, toasting the sponge woke my roomies up and I was saved...) :>) Diabetes has really changed.
Thanks for the input.

See above! I have gained great knowledge, as I always do on this board. I will eat!

Thanks, Zoe. I have been addicted to juice for years, as it works quickly. Soda, with carbonation, is my go to with a real low. But the tabs are a thought. I will experiment.

Actually, palomino, there is a form of like button, located above, right under the original post. You will then find this post on your own Likes Page, which you'll find a little ways down from your Profile Pic.