High BG mid morning

9 posts, 5 contributors

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Colin McC DAFNE Graduate
Lewisham and Greenwich NHS Trust
7 posts

Been a diabetic for 50 years & still around, & for the past 10 months been taking QA (Humalog) 15-20 mins before eating. Had no problems for 8 months, but these past 8 weeks I have been getting high mid morning BG levels, approx. 2 hours after breakfast, which then quickly falls about 1-2 hours later. Found this out as I use the Abbots freestyle libre. Been increasing my BI (Lantus) at night from 10u to 15u gradually & my pre-breakfast QA, but this has not solved the problem. Maybe a case of dawn phenomenom but this seems to be a bit later than dawn! Most of the time my 3am & pre-breakfast BG is on the rise. Anyone out there had this kind of problem? I am booked in to se my Diabetic nurse next week.

Warwick DAFNE Graduate
Diabetes Australia-Vic, Melbourne, Victoria
477 posts

Has the types of food you consume at breakfast changed since 8 weeks ago? If not, then as your BGLs are already rising from 3 am, perhaps take an extra unit or two of QA s per the DAFNE principles about 2 hours before breakfast. This should cover the rise until 2 hours after breakfast without adding to the drop 2 hours after breakfast.

pmason DAFNE Graduate
Knox Community Health Service, Victoria
10 posts

Exactly the same has been happening to me lately; although I've only had diabetes for the last 35 years. I use Humalog, (1-1+2 ratio) and eat the same breakfast each day However, in the past couple of months I too have found my QA doesn't start working until about 45 minutes to an hour after injecting. HAS THIS BATCH OF HUMALOG CHANGED (use by date 03 2018 ). I too can see this happening since using the Abbots freestyle libre. I have breakfast around 6am and inject just prior; so I can't have an extra unit or two 2 hours before brekkie. (as suggested by Warwick) I also take my BI (Levermir) 12 hours apart at 6pm & 6am. If I sleep in 'til 7am, my levels are definitely on the rise. I have increased my BI from 12 at 6pm to 13 then 14 and I'm checking over the next week if this helps. I see my Endo next month to discuss the matter. My DAFNE diabetes educator has suggested I maybe should try Nova rapid instead of Humalog because it can work quicker for some. (i'll ask my Endo).
DAFNE says if levels are ok before brekkie and before lunch, all is fine. But if i'm going up to 16 or 17 two hours after brekkie I feel it is not fine. In fact one feels lousy until ones sugars come down again. Cheers............

Jos2 8 posts

My daughter found that giving her insulin 40-60 minutes before breakfast eliminates this increase, but I wouldn't recommend attempting this without a continuous BG monitor of some kind. Also, it's not often practical time wise, especially for breakfast when it's most often an issue.

marke Site Administrator
South East Kent PCT
630 posts

Hi neither of you say if how long you have been using you Abbott devices ? Is it possible this has always happened but that you were never aware of it because you never had the tools to monitor it before. Also you have to accept you don't have a normal pancreas anymore, so your BG's are never going to be like a normal persons. There are a number of other possible factors but you should discus this with your Diabetes Team to get a proper answer. Some cereals will have a longer lasting effect on BG's, a lot of people are more resistant to insulin in the mornings due to Dawn phenomenon related issues. finally the Abbott Freestyle is an inter-cellular BG measure NOT a blood glucose measure and is only a guide not the same as a BG reading. As I say things to discuss with a Diabetes Team.

pmason DAFNE Graduate
Knox Community Health Service, Victoria
10 posts

Yes, good advice. Thanks Marke, BG monitoring however is not the issue for me. I use to do nearly as many tests when finger pricking and I understand the difference between the two methods. I will be looking at all factors with my Endo.

Jos2 8 posts

Hi Marke,

My daughter has been using the Dexcom G4 system for about 6 years, though she has just lost funding for this so she will be back to using just a normal monitor soon. I've no doubt that her BG did go high before she had the CGM, and still does when she doesn't have time to wait - or is too hungry. The NICE guidelines recommend a level of between 5 and 9 at 90 minutes after eating. This is rarely achieved. How practical do others find this target?

marke Site Administrator
South East Kent PCT
630 posts

The problem for me with the NICE guidelines are they cover ALL diabetics and as ALL diabetics know we are all different ! Personally I would never worry about the 90 minutes target. I may experiment with a CGM to change Bolus times to move them further before a meal but thats about as far as a would or could go. If I miss the target cest a vie I wouldn't worry about it. As I said in my first post, we have a bit missing so with current technologies we are never going to be the same as 'normal' people, we can aim to be but if our aim is not true its just the way it is.

Colin McC DAFNE Graduate
Lewisham and Greenwich NHS Trust
7 posts

Thanks all. As Marke quite rightly stated all of us diabetics are different & you only find out what is happening now I have the freestyle libre tools. Yes it may have always been happening & I was unaware as to take blood every 2 hours would play havoc on your fingers! . So my story to date. Having raised my QA (IHumalog) by @ 2 units extra each meal time & BI (Lantus @ 10pm) from 10u to 15u, my high BG reduced significantly, to the point in this past week to lowish BG. (ave past 7 days is @ 4.5!. Went to see my diabetic specialist yesterday & she said my morning Humalog may be working too quick in relation to my breakfast digestion, thus the reason why my BG was high mid morning. As my BG is now on the too low side she advised to lower my BI gradually & to try & take my QA after I have eaten, which is what I use to do 10 months past. My Hba1c was 6 , weight, injection sites, feet, BP all sound so no problems there. Will you let you know how I get on if of interest to anyone.