Hi all, thought I'd throw this out there. I've never pumped prior to Omnipod, and hope I'm just doing something stupid, but when I wake up with a morning high BG, (which by the way totally infuriates me and ruins my day) why when I correct, and keep checking, and then correct again, and yet again, does it take like 6 hours until I can reach a normal level again? I suspect dawn phenomenon is adding to the lovely mix, however, am I doing someting wrong by just correcting with bolus? Should I increase my basal? Any tips for getting it down sooner? Thanks everyone!
Do you use a CGM at all? If not, maybe talking to your doc to get a trial for 72 hrs or something might give you some insight.
I suspect that your basals through the night (or at least pre-dawn) are maybe not set correctly. But that may only be part of it. Personally, I notice that if I’m really high, I have a severe insulin resistance. I have my correction factor set at 1:28 or 1:29 right now (I can’t remember off the top of my head) and so if I were to wake up at 250 (shooting for 125) then my pump would say to give like 4 or 4.5 units. I often will have to bolus more than that for it to correct though. I know that my correction factor is right at lower levels though b/c if I’m only at 180 and I correct, it brings me down appropriately. Maybe your body has the same insulin resistance issue.
One other tip for getting a BG down sooner is to bolus w/ a shot rather than letting the pump click away at .05 or .1 u every 5 seconds. I find sometimes if I will bolus w/ a shot, I come down quicker…but maybe that’s just in my head
Good luck w/ finding a plan that works to bring down your morning BGs!
I used to have a similar problem before I got my CGM. Once I went on the CGM my doctors realized that I was actually dropping really low overnight so my liver was starting to release glucose into my bloodstream. This meant that even though I was giving insulin and not eating I was still getting more glucose in my system than insulin for a couple of hours. Since I’ve figured out my overnight basals the high glucose values have come down faster. You could test this by waking up a couple of times during the night and checking your sugars. It wouldn’t be fun but if it is the problem then you want to find and and stop it!
Thanks Bradford. I do suspect I have a similar issue. If my sugar isn’t so high, the correction works. If it is high, doesn’t seem to “kick in” like I’d like it to! I’d like to get a cgm to see what exactly is going on. do you have one? If so, which do you use? I’ve also recently started metformin to “help” with the insulin resistance. Not sure if I’ve seen a difference yet, but I’m on a low dosage. See the endo tomorrow, I’m hoping she can work some magic? Thanks again!
Thanks Rebecca. I don’t think I’m dropping low overnight, and it’s so frustrating b/c some mornings, my waking BG is great, and some, it isn’t? I can’t seem to figure out the trend? And then midmorning, I seem to have a rise. I see the endo tomorrow and am hoping we can see some trend, and upping the mid morning basal has some effect. Wish me luck! Thanks again
I have both a MM CGM and a navigator. I never had great success w/ the MM so I stopped using it. Then last spring I purchased the navigator. I’ve had pretty good success w/ it, and found it to be very useful (and for me, much less painful than the MM one was). So for me, the navigator is the way to go. I know others have posted success w/ the MM version, so I would investigate all of them (including the Dexcom) and see which one might be “for you”. I’d also ask your doc, b/c he/she will probably have a preference as to which he/she recommends.
There are a number of things that could be helping to cause your problem.
(1) Your overnight basal rate may not be set right, and your dawn phenomenon is pushing your BG high. I’ve got a wicked bad DP that requires me to more than double my bedtime rate (0.4u/hr) during the wee hours of the morning (0.9u/hr). If your not getting enough basal insulin, then the liver dumps glucagon and up your BG goes.
(2) Some people have to increase their correction boluses by a % depending on how high they are. For example, any BG reading under 200 might only require your “regular” correction bolus. Any BG from 200-250 might require you add 10% on top of your “regular” bolus. Any BG from 250-300 might require you add 20% on top of your “regular” bolus.
(3) Another possible factor is that some people’s insulin sensitivity varies throughout the day. So you might need a lower carb:insulin ratio and a lower correction ratio in the morning, so that you get more insulin for your boluses during that part of the day. If your more resistant to insulin in the morning, then you’ve got to put more into the system for the same net result. Later in the day, your current settings might work just fine.
All of this is explained exceptionally well in Walsh and Roberts Pumping Insulin. It’s so well written that even a dummy like me can understand it.
Cheers and good luck,
Mike
p.s. - Another option is to do a “revenge bolus.” With this, you take a larger dose of insulin than recommended, so that it starts to bring your BG down faster. Then an hour or two or three later, you have to eat some carbs to account for the extra insulin bolus.
Thanks Mike. That all totally make sense. I’m beginning to think that a) I need to tweak my basals mid morning, and b) also that my correction factor does change depending on how high I am. I am totally going to mention this to my doctor. Thanks so much. You’ve been a big help!!! You’ve all been so helpful. Can’t believe I didn’t know about TuD from the start
Thanks! Based on what I’ve read, I’m sort of leaning toward the navigator, though I’m having a heck of a time with customer service (they say they currently don’t have a rep in my area.) I will inquire further. Thanks again!
Good Luck Gina! When I was on shots, I definitely had problems with morning highs, and I knew if I woke up high, the whole day I would be chasing bs. It was confusing, because I wasn’t consistantly high. Since I switched to Omnipod, I have a 15% basal increase from 4 - 8 am, and then a 50% decrease until noon, with a more sensitive carb insulin ratio for breakfast. That is just what worked for me, as we are all so different, of course. This is the biggest thing I LOVE about my Omnipod - no longer waking up high!!! A few months before I started the pod, a minimed rep had fitted me with a CGM for the weekend for “diagnostics” for my dr. ( I really think it was part of a sales pitch, but free for me, so I went with it = )! ) I think the results of the CGM were really helpful for my endo to see exactly when my dawn phe. was kicking in.
Do you eat the same breakfast when you are high as when your levels are normal? There are certain foods that my normal bolus just doesn’t take care of, like a half an NSA corn muffin. I was just thinking that if you eat a different breakfast when you are high to try to compensate for the high, it might be making matters worse. It’s unlikely, but possible. Also, I am sure you know that fat and protein can affect how the carbs kick in.
Gina, You could try running a temporary basal and figure out where you need to increase. You very well know diabetes is a rollercoaster. One night my daughters blood sugar starts going up between 2 - 3 am and the next night she may run the lowest basals since starting insulin. When I see a two to three day pattern, I’m ready to change settings in the PDM then all of a sudden the numbers go the opposite way. This is a crazy life.
I would check blood sugars during the night and try to figure out where to change the basal. Have you ever done a basal test?
Gina, have you tried doing an overnight basal test? It’s a pain having to get up every hour to test but it could help you figure out if you need to raise your overnight basal. You may also want to try doing a morning basal test also to see if you might need to raise your basal during a certain time in the morning.
Like Bradley I too have to give myself extra insulin when I eat plain oatmeal for breakfast. One extra unit helps keep my BG where I want them.
Here is another suggestion. If you find out when your blood sugar is rising you want to go back a least 1 hour and start the increase there.
We have had problems with correction after correction taking 6 hours to reach normal level. My theory is when the blood sugar goes over 250 it takes more of a correction to correct. Over 250 a person may start having ketones and ketones eat up insulin. You can have ketones and it not show up in your urine for hours after the fact. This is why I believe the body needs so much more insulin over 250.
I will look at your profile, I don’t know how long you have been pumping. One thing I have learned with OmniPod is the importance of insulin being at body temperature prior to filling the pod. I put the insulin bottle in a plastic bag and put it in my pocket for hours prior to a pod change. When you draw up a syringe the air bubbles that are there will expand when they get to body temperature. I thump the air bubbles I see to the black plunger and leave the syringe in an upright position until I fill the pod. Again, before I fill the pod I look to make sure I don’t see any air bubbles and if I do I thump until they go to the black plunger.
Thx daisycolors! Haven’t done a basal test yet, but plan to soon. I hope it gives some sort of clarity–if that is a term that can be used in dealing with D!
