To change or not to change?

Hi! So i need advice on feet on the floor syndrome. My sugars are good when I wake up, but the second my feet hit the ground I slowly start climbing. If I eat right away, I can avoid the spike, but that’s not always something I want to do right away. I’ve tried basal increase of 10% but then I go low. If I wait until I’m 130+ I usually spike fairly high even though there is some correction in there and my IC is accurate as on days I eat right away. Anyone else deal with this and what do you do to fix it? Thanks!

Sounds like Dawn Phenomenon. Not sure how you’re managing your diabetes. If you’re using a pump, you can try a more modest increase to your basal rate, perhaps 5%, starting about two hours before your usual wake-up time. For suggestions on managing with MDI, check out Christel Oerum’s blog at Diabetes Strong.

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Thanks! I thought about that too, however, I have a DP spike from 1-3 am typically go down (not to low levels but down) from 3-6 and then rise again when I get up. Would that still be considered DP? I literally do not see the second spike until I get moving in the morning.

I’m not a doctor, but I think 1-3 is too early to be considered DP. If you’re not eating late, then I think your basal insulin needs some adjustment. If you’re using injections, I’m not sure what a good approach would be - I’ve been on pumps for over 20 years, so I’m not familiar with the newer long-acting insulin’s. I’m currently using Tandem t:slim + Dexcom G6, which is awesome for managing night time and DP blood sugars. BTW, our bodies change from time to time, for no apparent reason, and basal rates often need adjustments. I recently started experiencing “feet on the floor” highs like you’re describing - going up to as much as 140 without eating, after over a year of perfect mornings. Had to change my basal rate, starting 5:30 AM. Good luck!

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Hi Taylor @Tee25 , as @mikefarley has said it is difficult to offer thoughts without knowing your insulin management technique and the type of insulin you are using. Using a pump, with Rapid-Acting insulin, it is relatively easy [with lots of trial & error] to manage the two “peaks” that you mention. Keep in mind that “Dawn Phenomenon” is a natural event occurring in all mammals to get us moving so we don’t lapse into hibernation state; your body determines the time by looking at your particular pattern of living.

Of particular interest in making suggestions for “basal adjustment” is the type of insulin you are calling basal a “Long-Acting” insulin formulation or, a “Background Insulin” formulation which has a duration life after injection of up to 42 hours? Long-acting insulin have peak & valley while background insulin [supposedly] has level action for its entire lifespan.

I had never heard of feet on the floor syndrome so thanks for introducing me to a new term. Lately I’ve found that simply tidying up the kitchen before I fix breakfast (putting away dishes, wiping the counters) starts me rising, even if it’s 7am one day and 9am another🤪 although my basal segment goes until noon. I usually level or around 180 but don’t want to be there when I’m ready to eat. The other day I did a basal check, increased mine by 0.1 unit, and started the segment a little earlier than before. I know from experience that that small tweak can be very helpful for me but everyone needs to find what works best for them. The change had me very level all morning but I’m m giving it a couple more days to settle in. Off to a promising start though!
Of course what I just said applies to pumps. From what I’ve read some people find changing the timing of their background insulin helps depending on which one they use. I can’t speak on that but hopefully others will chime in.
Wishing you all the best with this very annoying mystery.

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@Tee25 , @Dennis , @wadawabbit , @mikefarley

Feet on the floor syndrome is a variant of Dawn Effect. It is weird in that the individual may be know to have Dawn Effect elevations of BG. However, it does not manifest itself literally until the feet are on the floor and then the CGM will start reporting an elevating BG.

Go figure… Blew me away until I saw the CGM screen shots.

Thank you for the info. “Feet on the floor” made me think of something I was diagnosed with a while back. I’m not a medical professional and connecting the two may be a stretch, but a couple of years ago I was diagnosed with orthostatic hypotension (OH) - a mouthful of a term that means my bp drops, making me dizzy if I get up too fast. Although I take medication for high blood pressure, there were occasions when I would get out of bed or a chair and have to catch my balance, although my blood sugar was fine at the time. There was no need to change my bp medicine - simply waiting a couple of minutes before getting out of bed, or standing slowly when getting out of chairs did the trick. So my theory (do with it what you will) is that maybe you’re getting up too quickly, your body considers it some sort of shock of stress to your system, and the stress causes the dreaded :arrow_up:(:arrow_up:).
I’ve only had a handful of instances of OH and never looked for a correlation with my glucose numbers, but the “feet on the floor” term got me thinking. Even if you’re not feeling symptoms of OH it might be worth checking - or perhaps something else is stressing you and causing your numbers to rise.
Just tossing out a crazy idea in the interest of brainstorming - you never know what you might hit on. I imagine that’s how Reece’s Peanut Butter Cups, chicken & waffles, and creamed spinach for their starts (not to mention the mystery baskets on Chopped!).

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Hi Taylor and it is interesting to hear that eating helps avoid a spike. Anyway, I have a similar situation as my sugars tend to increase around 9:30-10:30am - so thankfully avoiding the overnight dawn phenomenon while I am sleeping. For me the solution is simple. I wait until my sugars get to about 125-130 and then I do a 5 unit bolus. This usually always keeps me in range through the am and early afternoon. Depending on the different factors you use for bolus dosing you can figure it out and also see how your sugars react to the different doses used. Good luck and I am sure you will have this corrected quickly.

Super interesting that you say this. I was recently diagnosed with afib (young person with it go figure) but one of the things I’ve noticed since my diagnosis is that I do have episodes of dizziness when standing up. I’m actually meeting with my gp to discuss they low blood pressure thing you mentioned. I’ve lost 50 pounds on person and my blood pressure is naturally on the low side of normal. I can get as low as 90/70 so maybe that is part of it. I’ll definitely ask at my check up!

Yes exactly! I found this online and that’s where I found the term. The interesting thing is on paper I do have the typical dawn phenomenon which my basal overnight covers, tend to drop a little between 5-6 and then around 7-8 my sugars slowly but surely start to climb. The only thing that’s annoying is when I’ve played with my basal on it I drop low.

Mine does the exact same thing and I have just learned to either eat or take a correction bolus. If you should come across a better solution please share.

I do similar to BrunsickP, bolus and monitor and hour or so before eating.
Probably is a solution not recommended by your physician.

What I mostly want to say is Don’t Sweat it! 130 is still a great number!

I agree with the 130 part I just don’t like it if I wait an hour from starting at 130 and then I’m up 160-170 before breakfast. I mean I’ll still eat low carb at this point but I’ve learned to be careful this high when eating or I spend my entire day chasing highs which stinks

Taylor @Tee25 , have you had the opportunity to validate the basal rates you have programmed into your pump? The real purpose behind pump therapy, with the availability to set basal rates for individual “timed periods” is to compensate for the natural fluctuations in body glucose levels - natural fluctuations that occur in both people blessed with diabetes as well as the other type of people.

You should be able to program your pump to carry you for prolonged periods - 18 hours or greater - without need to eat or to eat or to bolus insulin. You have a sophisticated insulin pump, an expensive medical computer, with which you can easily manage your BGL levels.

I have not yet! I had a crazy busy week so going to get through the weekend (not always the best representation of my normal every day) and then start Monday!

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One question for you though! I did notice a pattern the last few days with just my cgm. 3 hours after eating I’m usually about 30-40 points from where I started my meal. By hour 4 I’m always within 30 points so definitely think my IC is right. But the one thing I’m not certain on is if this would indicate my basal needs to be adjusted a bit (still need to try your chart and the fasting test to be sure). If I for example was 118 at the 4 hour mark, my basal should keep me fairly close to that? The reason I ask is I had 6 hours between lunch and dinner with no snack other than a beef stick. I was 118 at the 4 hour mark and 84 before dinner. That appears to be an aggressive drop, but I was also 87 before lunch so maybe that’s spot on?

Maybe “Yes” and, maybe “No”, Taylor. I’ll explain my thinking later, but First - I like how you are observing what is happening while writing The Taylor Diabetes Management Manual; as Becky @BKN480 mentioned under another Topic we must reach a point where we trust our own observations. I’ll add to that, don’t be afraid to make changes at a later date as your body changes.

Now back to your I:C Ratio question: Your I"C Ration appears to be very close to being correct - in that with your Tandem pump once the divider in the ration reaches 10 only whole numbers can be entered. Now, before you “lock-in” this ratio on a permanent basis for lunch-time ICR, see if it works for a couple of days. Yesterday there may have been another factor - emotional or physical stress that helped you be spot-on.

A couple of other bits, if incorrectly programmed in your pump, may help your ICR look better than it actually might be. Insulin Sensitivity Factor [ISF] / Correction factor at time of bolus and to what Target were you correcting, plus basal rates during the 6 hours between lunch and supper. Assuming your lunch-bolus had left your body by 4 or 5 hours, a little to much basal MAY have helped you drop below your Target. A reason to get basal as best as you can - but I know bolus ICR is also very important and helps us feel better.

Keep up your great work, I wish that I was as advanced as you are now when I was many years younger.