Would like some help with BG level rise in mornings

General
1

I'll try not to be too lengthy here, but it will require some explanations.

For the last four months I've noticed a severe change in my BG level in the mornings after I arise. I usually arise about 6:00 am and my BG level at that point is normally between 80 to 120. It does vary on occasion depending on what I've eaten the previous night, but for the most part my morning BG level is fairly consistent. I take Novolog insulin injections during the day before meals and Lantus at bedtime.

The change that has been occurring is that after I get up my BG level starts rising fairly rapidly even without eating any food. I use a Dexcom CGM so I can monitor my BG levels and determine whether it is rising, falling, and by how much or staying steady. Even if I do not eat my BG level will often rise to around 200 or so before it begins to drop. (I've only done this on occasion to see what happens) The BG level rise begins to occur rapidly within fifteen minutes of arising. I usually eat breakfast about an hour after getting up and have always taken my morning Novolog about 15 minutes prior to eating. I'm now finding that even if I eat a fairly low carb breakfast my BG level can easily exceed 250 about an hour or so after eating even though I've taken my normal insulin.

My Endo has blamed this on the foods I'm eating, but I'm not eating any differently than I have within the past couple of years. This situation is relatively new and I cannot figure how to deal with it.

In order to combat this I've started taking my insulin soon after arising even though I don't eat until a little later. The problem with that is this can result in a rapid drop in my BG level to a dangerous level before I can ingest food; however, on most occasions that doesn't happen. In fact, it will keep rising even though I take my normal imsulin injection as much as an hour before eating in the morning.

I'll provide a description for this morning that also happens and occurred again today.

I awoke early about 5:15 am with a very low BG level of 45, so I drank 8 oz., of orange juice to combat that. (This low BG level in the morning is unusual for me). Within 15 minutes my BG started rising rapidly and within 45 minutes was at 185, so I took 8 units of insulin since I could not eat for another 45 minutes. I normally take 10 units pre-breakfast. Before I ate I took another 5 units. I ate breakfast at about 7:00 am and at about 9:00 am, my BG level was 120 when tested. I thought this was good.

The problem starting occurring sometime between 9 and 11:00 am. My BG level started rising again sometime after 9:00 am even though I had not eaten anything else and by 11:30 am it was up to 245. It's almost as if I had a delayed reaction to my food intake. I then took an additional 5 units insulin. By 12:15 pm my BG was at 293 so I had to take another 10 units and then eat a very light lunch. Even with the light lunch my BG level rose to 326 and did not start dropping off until around 2:00 pm. It's now down to 175 and falling rapidly so I probably took too much insulin and didn't eat enough. This has happened quite often lately and it usually doesn't matter what I eat unless it's something very high in calories, fast-acting carbs, or sugar. I'm pretty consistent in what I eat for breakfast and lunch and it's normally fairly low carb foods.

My normal morning goes something like the following which shows the BG levels that have been occurring.

Awake at 6:00 am with a fairly normal BG reading, BG level starts rising rapidly, take insulin at 6:45 am and BG level is already well over 150, eat breakfast at 7:00 am. By 11:00 am my BG level can easily exceed 225 and often even higher and I do not eat anything additional in the morning.

This is now driving me crazy and I'm experiencing so many ups and downs in BG in the morning because it's difficult to know how ro react and I can easily misjudge how much regular or additional insulin to take. I'm sure switching to an insulin pump would help and I'm serioulsy considering that but would like to get back to a more normal rise and fall with multiple daily injections as I used to have before and after meals before I take such a step. I don't know how my Endo could determine a basal rate with what is happening.

I wuld really apprceiate it If anyone can provide some insight into possibly why I'm experiencing these morning BG level rises or if you are encountering something similar and how you deal with it.

Thanks

 

2

Hi Ron,

I have a few ideas about what may be happening, but before I go into that, I'd just like to respond to what you said about being interested in an insulin pump.  I think it's good that you're using a CGM already.  The fact that you're already accustomed to using this kind of technology means that it'll probably be an easier transition for you to begin using a pump, if you decide to.  I know you mentioned that you'd rather get yourself regulated on injections before beginning pump therapy, but in my opinion, having these kinds of fluctuations is an excellent reason to begin pumping ASAP.  If you experience a rise in blood sugar at the same time every day, your basal rates within the pump can be adjusted to match your increase in blood sugar at those exact times.  By looking at your CGM data, your doctor or dietitian/pump trainer will be able to figure out what your basals should be at different times during the day.  Having the correct basal rates can be an amazing thing.

Okay, now that I'm done talking about the pump, here are some of my hypotheses about what might be making your blood sugar rise at the same time each day:

1. There is a biological factor that is causing your liver to produce more glucose after waking up in the morning.  This is described as the dawn phenomenon.  http://www.mayoclinic.com/health/dawn-effect/AN01213  As I said above, this could be controlled by adjusting your basals if you were pumping, but I'm not sure if there's a better way to control it with injections (sorry, I was 12 the last time I used injections, so I don't remember much about them! :)  However, if it is the dawn phenomenon, I'm not sure why you would just suddenly be effected by it.  Hormonal changes?  Stress?

2. Are you taking medication for thyroid disease?  I take levothroxine (generic for synthroid), and my blood sugar always seems to go up a little after I take it.  My doctor denied that this was possible, but I looked at the official medical information about synthroid from the drug company and it did say that it could exacerbate diabetes symptoms.

3. Do you eat very late in the day or late at night?  Do you eat a snack before bed?  Do you sleep on your right side?  I'm asking because the stomach empties on the left side.  Sometimes if I lay on my right side while sleeping, I'll wake up with indigestion.  If I lay on my back or left side after that, I feel better because my stomach contents can then empty correctly.  I'm not sure if this is possible, but could there still be food in your stomach in the morning, which then digests when you wake up and begin moving around?

Hope this helps somewhat, and good luck!

Moly

3

In addition to what Molly said, it is also common for people (both diabetic and non) to experience some insulin resistance first thing in the morning. It's a very common occurence, actually. In the diabetes clinic I used to work at, we recommended our patients who have troubles with this eat a small breakfast (<30g) and then eat a larger snack (around another 30g) in the mid-morning to combat hunger. Usually, by the time the mid-morning snack rolled around, the body was awake and able to better utilize the insulin in the system.

This could be what is happening to you. If it is, you can try having smaller meals/snacks in the morning and consuming more low-carb/carb-free foods to try to help control your blood sugar.

 

Good luck :o)

4

Thanks much for your suggestions. I've considered the dawn phenomenon, but discounted it because my morning glucose readings are usually around 100 or less unless I was bad the night before and ate the wrong things. I'm certainly not immune to that. From all I've read about the dawn phenomenon it has more to do with morning high glucose readings. My problem occurs after waking. I also don't take many medications. I've been real lucky in not having any complications. My overall health is very good even with my type 1 condition. I usually sleep on my back or on my left side so I don't think that has anything to do with it.

It's almost as if I'm also now having a resistance to my insulin intake and especially in the morning hours. However, that doesn't explain the rapid rise in BG in the morning. At times after taking my shot it seems a long time before my body begins reacting to it even if I do not eat. At other times, it acts very fast so I really have to be careful of that and that was the primary reason for getting the CGM. It has been tremendous.

I do think it may have something to do with what I eat at night and when. I think my body is somehow storing sugar during the night and it gets released soon after rising. I've also noticed it's more severe after a fairly high carb evening meal that's eaten fairly late; i.e., around 8:00 pm or so.

I'm also frustrated with my Endo over this, but also because of a few other reasons. Like he doesn't want me to give him my CGM charts when he wants a couple weeks of data and only wants glucometer readings. Well duh! I don't test before and after every meal as I used to. Inherent in using a CGM is not having to do that. I do test more than the required two times daily. The darn thing is not always rright, so I find constant calibration makes it fairly accruate for the most part. He has been very nonchalant about me using the CGM as well as me getting a pump. He does not believe the BG readings from a CGM are accurate. As for my morning BG rise he seems to think it all has to do with the foods I eat and I don't think he really believes me when I say it rises even though I do not eat. He says that should not happen consistently. Well, I'm living proof now that it can! I think I'm discovering he's just too old school and I'm not happy about it. It's going to be difficult to find a new Endo that's not overwhelmed with patients and is also good, but I'm now looking.

Thanks also for your coimments on using a pump. I've been considering this for some time, but have always been leery of being what I call "being tethered to the thing". I've spoken to several people in depth who use them and do well and I'm reading posts on many sites such as JDRF from people who are delighted with them. I travel in my work 5 to 6 days a week and often overseas so I have lots to consider in getting a pump. I'm now seriously considering the Omnipod pump and really like the idea of it, but I also know it's not perfect.

5

As I commented to Moly I'm begiinning to think insulin resistance is exactly part of what is happening, but if so it's a question of why is this occurring now and what's changed to cause it. So thanks for your comment and suggestion. This has become a real struggle and my Endo does not seem to be helping much either since I think he's convinced I'm not admitting to doing something incorrectly. And also as I replied to Moly I think my body is somehow storing sugar at night and it takes off in the morning.

6

you are right.

 

the body stores glycogen (glucose) in the liver and muscles. as you are sleeping and not eating, your body releases these sugars to provide the energy it needs. unfortunately, it often spits out too much, causing a rise in blood sugars. combine this with your possible insulin resistance and you have some tricksy blood sugars.

i hope this information is helpful to you somehow. good luck with your blood sugars and your endo. i understand how frustrating it can be.

7

Thanks for your affirmation. That helps.

Ron