BI and morning BG

Hi all

This is my first post having completed Dafne last week. I must say the experience was life transforming and I wish I had known this 18 yrs ago when diagnosed.

I have almost cracked the regime, getting stable sugars generally in daytime, however I am consistently between 10-13 on a morning even if sugars are in range before bed. I take one dose of lantus before bed, 43 units (was 56 before dafne). I did fast in the morning a couple of times and sugars seem to hold steady which indicates the right BI dose.

I have seen on here reference to dawn phenom, could I be experiencing this? If so how do I combat it as I really want to get my morning reading nearer to range.

I still have some way to go to getting a really good consistent measure across the board but I already feel better for the new regime. My HBA1C in Jan was 59 which for me was good, but even with this and in hindsight I realise that my stability wasn't as good as it could be so Dafne should help lots.

I haven't uploaded any data yet as I have a weeks worth from last week to upload from my paper diary

Welcome PVT1.
Hope you find plenty good support here from your fellow diabetics.
I've learnt many things, over the time that I have used the forum.
Other people's postings on here can give us a supporting insight into how others deal with the joy of being a type 1.
Like you, I used to take a single Lantus dose of something over 60 u....I looked back to my first diary entry on here 23/11/2009 to try and tell you an accurate number...but did not get the answer to my own question...as even then I was using split dose, as for me Lantus lasted 16 to 18 hours and not the claimed duration. My current split is 30u before breakfast and 26u before dinner as I find this usually keeps the BI doses about 12 hours apart.
Please use your online Diary. It can provide you with plenty of help and you will be surprised how much information you can drag out of it to support your efforts.
Regards
Garry

Garry
Thanks for the warm welcome.
Would a split dose potentially stop this morn high? I guess I need to wake myself at around 4am and see what my sugars are doing.

Will upload my results this evening

Logically no. It wouldn't. Your BI is active and more or less...depending on your individual response to Lantus...in the middle of its delivery time. If you rise by say more than 1 or 2 mmol/L overnight it would be one of two things: - too little BI, or maybe or if you are like the majority of us on here, more insulin resistant on a morning. To wake us up, at some time during the early morning, our body secretes adrenalin or Epinephrine - it's proper name. This makes us insulin resistant, some of us more resistant than others and this slows the absorption and effect of the BI that you have taken. Once the BI is held back, your BG rises as a consequence.
For a night check most of us look to use 3:00 am.......an unGodly hour I know. But this has been chosen, I guess, as it is probably before the start of the impact of any early morning adrenalin.
I'll look out for your diary posting. You are able to share your diary with an individual too using the link at the top right of the diary page under Tools and click Shared Diaries. This also allows Health care Professionals to stay in touch with your ongoing results too.
Regards
Garry

Hi
One other quick question, when having a snack do you stick to your dose ratio or just match it 1:1? Therefore if a snack was 5cp would you take 5 units or 10 units if your mealtime ratio is 2:1?

Regards

As promised here is my diary

Frustrated im not cracking it yet, would be so grateful if someone could offer advice

The basic strategy of DAFNE is to get the BI right first, and then tackle QA ratios. Trying to do it any other way just gets frustrating.

I'll ignore Saturday, when you had a hypo before bed and carbs and so it will have affected the morning readings.

The rest of the readings show that your morning readings are always higher than your before bed readings. There can be two reasons for this:

1) Your BI is too low and increasing it will fix this.

2) You have Dawn Phenomenon (along with most of the rest of us), and if you increase your BI, you will likely hypo during the night while waiting for DP to begin about 3-4 a.m.

Given that you already increased your BI recently, you may want to wait another few days to check whether things change for the better or not. If they don't, then I recommend putting up your BI by another couple of units.

If you could do a couple of 3 am tests too, it would be helpful in identifying if your BGs are good at 3 am and about to spike due to DP, or if they are high then too, in which case it should be safe to increase your BI.

Make getting your BGs before bed and before breakfast within 1.5 of each other, and you can then worry about ratios etc after that.

Do you have good hypo awareness? Do you wake at night when you have a hypo?

Cheers,
Warwick.

Warwick

Agree and understand everything you say. I am confident it is DP, as my week doing DAFNE actually lowered my BI from a previous dose of 56 units and the reason for this was a pattern had emerged which showed it was oulling sugars down in the daytime. However, to validate I will do a couple of 3am tests.

I do have good hypo awareness and yes I do wake at night when having a hypo although I am usually quite severe. Having said that it is very rare when this happens.

My results in the daytime are really confusing at the minute, sometimes they are hovering in the early teens and then seem to drop before tea. But I agree, getting the BI cracked is the key to everything else. If it is the DP, what do I need to do to get better morning readings, or do I just accept it for what it is?

Also would be grateful for any advice on my question of snacking and ratios from an earlier post.

Thanks all for the advice so far, really appreciated.

For me, a snack is normally less than 2 CPs and depending on my result immediately before would determine what to do.
If normal, or little lower BG at time of snack, I'd usually let it ride to the next meal and if necessary compensate then. I do the pre-meal blood and...for me...pre-meal insulin. I find I need take my insulin before a meal in order to get the Humalog QA active enough in my system, to trim off post-meal spikes in BG.
If high before, when contemplating a snack, I wouldn't have the snack.
If taking an extra meal I would use the ratio appropriate for that time of day. My ratios currently are: - 2, 2.2 and 2:1, breakfast, lunch and dinner respectively, so not much varaition at the minute. In the past however they have been plenty of changes, the widest range used was 3, 2.5 and 1.5:1 across the day. You will find that you may need adapt and make many changes over time. As long as the results are good...that's fine.
Bear in mind though that if you take matching QA for an extra meal and then eat your normal meal within 3 or 4 hours you have to expect an elevated BG. Don't add any compensation QA for the normal meal as you'll likely to be stacking QA doses up which may crash you later.
Regards
Garry

If you go back to your diary you can edit individual entries by clicking the time of the entry which gets you into an edit screen. Please take little notice of between meal BGs.
These are good for information, as they may help you understand your normal QA uptake times, but if you compensate for these additional results you will stack up QA doses with the outcome that you see. Slowly, slowly. Wait until the meal time and compensate then, if necessary.
Try not to make lots of changes.
Change one thing at a time and see what happens over a few days and then decide whether or not the change is beneficial. The graphs produced by the diary can be helpful here.
Keep up the Ketone checks too, if greater than 13 or 14 mmol/L. You can enter the actual value from your meter but your diary only shows true. Keep an eye on them as a run of high BGs, plus ketones, normally give me forewarning that I'm going to feel sick tomorrow or the day after.
Regards
Garry