morning blood sugar rise

hi all. I have my background dose in the morning, my morning ratios are 3:1. if I skip breakfast my BG rises. today it went up from 7 on waking to 12.2 at lunchtime. it doesn't do this if I have breakfast with insulin. should I have some QA insulin in the morning even if I don't eat?
Liz

Hello. From personal experience, I find that I will see a rise by lunchtime if I don't take a small amount of QA if I have not eaten earlier. A 1u dose appears to do the trick for me to maintain the status quo although I have found that this approach is fine in the first part of the week but not, seemingly, in the second half. If it is a Thursday or Friday, I generally don't bother with the dose at all if I haven't eaten when I wake up. Not sure what that could be attributed to but I won't go off topic.

Are you confident that your BI dose is as correct as it ever will be? I split my dosage (of Lantus) between breakfast time and evening meal. I believe the theory is that you should be able to go a whole day without eating and not see a change in readings if your BI dose is right but we are all different and therein lies the fun.

Hopefully some other people will pipe up with their views too, I wouldn't want to be the lone voice on this for your sake. It'll probably come down to experimenting. Start small, 0.5u if you have that option and ensure you have the hypo-remedy of choice to hand, just in case.

thanks. its good to know its not just me. I am going to check my BI dose, although I have to be careful as i tend to get night time hypos

Since doing DAFNE and knowing what to look out for, I've found the same. Yesterday I skipped breakfast. I was 7.8 when I woke up. I was 18.1 a couple of hours later! An increase of 10. I know if I have breakfast and use a 1.5:1 ratio, i'm level at lunchtime.

I saw my DAFNE leader earlier this week and someone else mentioned the same thing. She suggested it was the dawn phenomenon (and the same reason many of us take a higher ratio with breakfast) - so on days we are going to skip breakfast, test with a couple of units of insulin to see if that keeps you level (but make sure you've got hypo treatment, just in case).

Before doing DAFNE I rarely tested, and rarely ate breakfast. Since doing it, and realising I need to take extra QA in the morning anyway, I've stuck to having muesli or at least belvita biscuits every morning, and now things are much more level.

I forgot to add - as James mentioned, splitting your BI into two doses can be a huge help. I used to take all of mine in the morning, and was often going hypo overnight, but waking up high on days i wasn't. Since splitting I've bene able to balance it and it's also reduced the total I take by over a third, because I can work out whether I'm taking too much int he morning or at night. It would definitely be worth talking about doing this with your DAFNE leaders.

It is an extra injection each day, but you'll be able to avoid night time hypos by reducing your night time insulin, and hopefully also avoid them during the day too. A carb free day will teach you if your day time one is at the right level, and then monitoring overnight with a 3am check and then what level you are at breakfast will teach you about the night time dose too.

It's one of those things I'd never have even considered without doing DAFNE! Good luck

Hi Caspar, I'm not sure that I understand. I thought that the point of splitting BI into two doses was to even out the effect over 24 hours. i.e. BI doses are supposed to last 24 hours, but sometimes the impact can wear off before 24 hours is up, or you can end up with more or less than your dose for a short period if you do not inject at precise 24 hour intervals. Are you suggesting that injecting different amounts of BI on your splits will vary the total amount in your system at different times of the day?

Stew

Hi Stew,

When you split, you typically will find you're able to take a lot less - as you're able to work out exactly how much you really need. When you're taking one big batch, you can't tell how long it's lasting, if your body is absorbing a lot while you sleep, or during the day when you're active etc. I've gone from 40 a day down to 28 (and am soon to try reducing it even further) thanks to splitting it and figuring out when in the day I'm going hypo (lots of overnight and early in the morning, so my night time dosage is too low, whereas I was also previously going low later in the afternoon, which was a hint to reduce the morning dose).

Your diabetes clinic/DAFNE team are the best to advise you based on your own circumstances, but without splitting I'd never have been able to work out how and when to reduce my dosage (and start abolishing those pesky night time hypos!).

Hi Caspar,
I have split my Lantus dose for some time now, but take equal doses at bedtime and in the morning. Revisiting the course handbook, I see that the "profile" for Lantus shows a drop-off over the last few hours of it's 24 hour duration, hence the levelling effect of the split dose. I still don't understand how injecting different amounts can have an impact at different times of day when the amount of Lantus in the system is constant over the 24 hours? I can't find any mention of this in the handbook.

Stew

Hi, Sorry but must disagree with Caspar, splitting your BI does not mean you can take less. You body doesn't absorb BI quickly because its not able to quickly so timing of dose is not really relevant in that respect. With BI its in your system but is not 'active' fully the whole time, the idea is it has a slow 'release' profile to be in your blood over an extended period. It is not totally consistent over time for everyone true but is largely a lot slower than QA. I would never advise anyone to split their dose without consulting their Diabetes team. One thing often recommended if you want to split doses is a switch to Levemir, since Lantus does have a longer profile even though both are supposedly 24 hour insulins. If you skip breakfast and your BG raises by 10 then its pretty clear your BI is not correct, you can use QA to try to adjust but its a constant battle, its better to try to get your BI right, which means if you skip meals it stays roughly the same. Also although Dawn Phenomenon can to a degree alter your BG during the morning its effects are generally more noticeable overnight, your BG rises just BEFORE you wake up. Again its true everyone is slightly different so there is no one answer.

Hello Liz. How is the experimentation going? As you have seen, you are not alone in experiencing similar behaviour so it is always good to share your notes with others irrespective of the actual results. We are all ultimately trying to get a handle on things of a diabetic nature so anything that can be added to the collective knowledge can only be a good thing.