I use a pump and a CGM, which equips me pretty well for troubleshooting my basal rates, but now I’m wondering if I’ve been addressing the problems in a way that makes them worse.
My old plan of attack was: I would notice, over the course of a week or two, that my blood sugar was rising out of range during a certain time of day; 6am-11am, for instance. So, I would fast during that part of the day for a week while I made small adjustments to my pump’s basal rate settings. Lately, this hasn’t been working quite as well for me.
Now, I wonder if the fasting itself was causing my blood sugar to rise, compounding the dawn phenomenon.
There’s a lot of semi-scientific stuff on the internet that talks about what your body does when you skip breakfast. The gist of it seems to be that your metabolism goes into a kind of famine mode; triggers the release of certain hormones (cortisol, and insulin if you’ve got it), and prepares you to store fat.
My theory is that skipping breakfast also causes your body to start dumping glucose into your system.
So far, my experience has sort of borne out the above hypothesis. I don’t even have to consume carbs at breakfast - a simple meal of scrambled egg whites with salt and pepper (and nothing else) eaten within 20 minutes of waking seems to keep the dawn phenomenon at bay.
Of course, I’m only experimenting on myself, which doesn’t exactly hit the standards of scientific rigor. I’d really like to know if others have had similar experiences.
I’ know that problem very well… had to deal with it for years.
I would wake up at a normal or even low bg and after getting up, it would rise.
An example I remember was the day I went to my Endo’s for my annual tests. Knowing that my bg would rise on its own, I got on my bicycle at 56. 1-1.5 hours later, I almost passed out after they took a blood sample, so they checkt if my bg was low and it was 186!
Somehow, this problems seems lo be solved by switching insulins…
I my experience, breakfast did not help. Eating something I don’t have to take extra insulin for did not keep my bg from rising. Eating something I had to take a shot did - but actually it did not since I simply had a different ratio for brakfast than for the rest of the day. So it looked like I was taking more insulin for less carbs but really I tookabout the same amount as during the day + some insulin to get/keep my bg down.
Would be interesting to know how others deal with it and if they found a way around.
Hey Andrew, I’m a type 1 but I don’t use a pump so I can’t really say anything re that, however, I do have random spikes of blood sugar. After yrs of issues, long story short I was diagnosed with severe gastroparisis, a G.I. motility disease. This causes odd highs and lows because the food isn’t being absorbed at the “normal” rate, even a slight G.I. issue might be causing this for you. This is just a thought for you, I know when the random highs and lows started I had no G.I. symptoms yet.
If I get up and start moving around, my liver will dump unless I take my Symlin within about 45 minutes, eat my breakfast and bolus insulin for it. I have different insulin to carb ratios for each of my meals throughout the day. Insulin needs differ throughout the day but the liver will definitely “help you out” if you don’t eat when it thinks you should. I look at my BG patterns in relationship to my schedule of eating and exercise and adjust accordingly. Instead of fasting. Having the CGMS really helps look at the trends. About the time I get it figured out, another area changes so it is a constant process. Hope you get it figured out.
I suffer from a wicked case of Darn Phenomenon (DP). In my case, if I don’t wake with a perfectly normal BS number, then any attempt at fasting for basal testing is an exercise in total futility. Fasting makes my blood sugar rise. What is slightly bad only gets hugely worse. It is fighting “chaos.”
And further, I always found that eating first thing in the morning “resets” my system , stopping any ongoing hormone actions and blood sugar rise.
In the end, what I decided was that my goal was to get my overnight basal set so that I would wake with a perfect blood sugar. Then, my morning basal should be set so that when I ate my normal breakfast, that I did not get an inappropriate rise or fall later in the morning. It was futile to fast around breakfast and try to set my basal during that part of the window. It is like the Heisenberg uncertainty principle, not eating breakfast disrupts the experiment.
And understand that everyone is different. DP is highly variable. Often I think that it is caused by aliens. Below is a picture of me being given a wicked case of Darn Phenomenon.
Most of the time my blood sugars will rise if I skip breakfast. It does not happen with other meals.
As you commented, it’s not really a basal issue. If I don’t eat, there is probably no amount of basal that would hold my BG steady. If I eat, dose properly, and then go on my morning walk, 90% of the time I have a good result. Today was one of those odd days. I had one of my normal breakfasts, pre-bolused as normal, went on my normal walk, and then my BG went high up into the 200’s and didn’t come down for a few hours. After 35 years of this disease, I’ve not yet been able to understand the oddball days. I don’t stress about it. I just correct and move on.
The only thing that I can correlate with morning excursions is the tendency to go lower if I’m already slightly low, the tendency to go sky high if I’m slightly high, and the variability of what happens if I’m in a normal range. I can’t over-correct highs, because then I set myself up for lows.
My endo has mentioned more than once that we only understand part of what influences blood sugars with Type 1. Our regimens are built on what works most of the time and even with CGM, pumps, and frequent testing, we can’t control every variable every day. One reason is that we don’t know what all the variables are.
Post-breakfast exercise is a great tool for me and I am lucky to have a dog who needs/wants a morning walk. I live in a hilly area, so our walks are a pretty good work-out. I am also lucky that I usually start work at 10:00 so I have ample time to eat breakfast, exercise, and shower.
I have a great A1c, but very rarely do I have days without some low or high excursions. I always joke that if I had the same lack of perfection at work, I would have been fired years ago.
I think that for many of us this post-out of bed rise in BG is not a programmable basal issue. For me it doesn’t start until I get up. If I get up at 6:00, it starts then. If I get up at 9:00, it starts then. Plus, it doesn’t happen if I eat and bolus.
I think that some people with dawn phenomenon have a fairly constant time during the night when BG starts to go up. If that’s the case, programming a basal increase can help. In general, I don’t have this kind of dawn phenomenon. On the other hand, this week I tested 3 nights in a row at about 2:30 AM. Each night it was approx 70-80. One morning, I woke up at 188. One morning I woke up with a low in the 60’s. And one morning I woke up at about 100. Kind of makes it hard to change my basal rate. Actually I think my basals are OK. I usually wake up with OK numbers.
I do not pump but I am intrigued by your theory. Before I go to sleep my BG is normal, I do not eat anything and I always eat a few hours before bed. When I wake my BG is almost always high and I am starving as if I have not eaten in days. Somtimes if I wake throughout the night my BG is still normal so it only seems to spike in the early morning maybe when its time to eat again. My morning highs have never been explained by any doctor but I am starting to think there is a connection to fasting and high BG…
My Endo found it weird that it doesn’t matter if I get up at 6 or 10 or 12 or what other time. It starts when I get up. Not necessarily when I wake up but when I actually get up.
And it’s not Dawn’s - it’s not in the morning hours and not before I wake up.
It didn’t happen if I ate since the rise in bg level was calculated into my bolus:carb ratio…
I say “didn’t” since (as mentioned further above) most of the problem seems to be solved with a different insulin.
I think it is very difficult and individual to find the right way of treating morning highs, especially if they are independent of time.
I experience this same conundrum even though I’ve done extensive basal testing and programmed in the overall DP effect. For this reason I do not think it has anything to do with the DP but instead is a stress/hormone reaction to getting out of bed. My antidote is to bolus as soon as I get up even though I have not eaten - this seems to deal with the intial blip upwards that I see on my Dexcom when I get up in the morning.
I do have the opportunity to get fasting basals when she sleeps in on the weekends or on holidays, she will sleep until noon. If basals are set correctly she will not rise. Of course her basals do change frequently, but in the same general range this time of day. Once breakfast comes into the picture, however, it is another story. She has a very high ICR at breakfast. And if she wakes at noon, or if she does not feel like eating until 2pm, which has happened, the first meal of the day must have that high ICR. It is the food eaten at breakfast that is more of a problem. She needs more insulin for the carbs eating the first meal of the day, whatever the time of day that is.
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