Morning Bloods climb steadily

8 posts, 4 contributors

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keith bohanna DAFNE Graduate
St Luke's Kilkenny
5 posts

Confused right now. Almost every day for the last 2 weeks I have seen my pre-breakfast blood sugars be within range, eaten a normal measured carbo intake and taken normal insulin against that. So established routine. But within 2 hours seen my blood sugar rise to 12 to 15.

This morning with a pre-breakfast blood sugar a little high I took 12 units of Humalog (I am on 3:1 ratio) and ate nothing, just had a cafetiere of coffee.

06:14 - 11.4 (took 12 units Humalog)
07:34 - 9.8
08:43 - 10.6
09:43 - 11.9
10:48 - 12.4

So with standard nighttime Lantus taken yesterday my sugars briefly lower and then start climbing with no carbo intake. Even if the Humalog is peaking after 2 hours why might the steady climb be happening?

How do I go about making sense of this? Thanks! Should say I am going to eat nothing and take no further insulin to see how this plays out until 1pm

> 10:53
Just added 10:48 reading and as it continues to climb going to take 9 units of Humalog so that I have the prospect of eating lunch without spiking it further.

Seems that I will need to increase night time Lantus dose to counter this?

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

Hello Keith,

Are you able to share your diary with this thread? (See the "Include my Blood Glucose Diary entries between..." fields below.

It is always difficult to make suggestions without seeing this, knowing what kind of insulins you are on, when you are injecting, whether you are exercising etc.

It does sound like your basal could be increased, but I'd want to see your diary before actually stating that.

Thanks,
Warwick.

keith bohanna DAFNE Graduate
St Luke's Kilkenny
5 posts

Thanks Warwick. I went ahead on raising basal and now monitoring to see how it impacts over 2 or 3 days. I was using a different system for logging my diary but have now switched to the Dafne software so I can do as you suggested in future :-)

Gerryvbc DAFNE Graduate
North East Essex
3 posts

Hi Keith

Just to assure you that you are not the only one with this issue. I have heard something like it called 'Dawn Phenomenon'. Some medics do however deny it exists.

My sugars have always followed the pattern you describe. I keep my levels very tight and to maintain them I start the day with my usual 14 units of Levemir (background) and 4 units of Humalog - assuming I will eat no carbs for breakfast. If I do eat carbs for breakfast, which is rare, then I take additional Humalog (1.5 :1) to compensate. My last HbA1c was 51 so I must doing something right.

I hope you find the answer.

Gerry

lucytaylor_ DAFNE Graduate
North East London Foundation Trust (Havering)
2 posts
Sat
26/09
Time 13:30 13:45 14:40 15:00 15:40 16:20 18:50 20:45 22:15
CP 8 5 - - - - 10 3 -
BG 9.4 20.0 17.7 10.4 5.4 4.5 7.2 4.0 6.6
QA 8+2 - - - - - 10 - -
BI - - - - - - - - 20
Ratio (QA:CP) 1:1 1:1 1:1 1:1 1:1 1:1 1:1 1:1 1:1
QA Site - - - - - - - - -
BI Site - - - - - - - - -
Type LUNCH LUNCH LUNCH LUNCH LUNCH HYPO DINNR AFDIN BED
Ketones - - - - - - - - -
Sun
27/09
Time 11:00 11:45 12:20 12:40 13:30 14:30 15:30 17:40 21:30
CP - 8 - 12 - - 2 16 2
BG 4.8 6.1 13.9 12.4 14.2 6.7 3.9 7.7 3.8
QA - - 12+3 18+2 - - - 16 -
BI - - - - - - - - 20
Ratio (QA:CP) 1:1 1.5:1 1:1 1:1 1:1 1:1 1:1 1:1 1:1
QA Site - - - - - - - - -
BI Site - - - - - - - - -
Type LUNCH BFAST LUNCH LUNCH LUNCH LUNCH LUNCH DINNR BED
Ketones - - - - - - - - -
Mon
28/09
Time 07:55 09:15 10:00 11:30 12:53 16:30 18:10
CP - 8 - - 9 - -
BG 9.5 11.8 15.5 13.1 8.4 5.1 6.5
QA 1 12+2 - 3 8 - -
BI - - - - - - -
Ratio (QA:CP) 1.5:1 1.5:1 1.5:1 1:1 1:1 1:1 1:1
QA Site - - - - - - -
BI Site - - - - - - -
Type BFAST BFAST BFAST AFBF LUNCH DRIV DINNR
Ketones - - - - - - -
Tue
29/09
Time 07:30 09:16
CP - 6
BG 6.3 10.7
QA - 9+2
BI - -
Ratio (QA:CP) 1.5:1 1.5:1
QA Site - -
BI Site - -
Type BFAST BFAST
Ketones - -
Wed
30/09
Time 12:28 17:34
CP 1 -
BG 4.3 8.7
QA - -
BI - -
Ratio (QA:CP) 1:1 1:1
QA Site - -
BI Site - -
Type HYPO DINNR
Ketones - -
Thu
01/10
Time 10:02
CP 10
BG 9.4
QA 15+1
BI -
Ratio (QA:CP) 1.5:1
QA Site -
BI Site -
Type BFAST
Ketones -
Fri
02/10
Time 07:30 09:54 16:12
CP - 8 3
BG 10.9 14.9 -
QA 0+2 16+2 3
BI - - -
Ratio (QA:CP) 1.5:1 1.5:1 1:1
QA Site - - -
BI Site - - -
Type BFAST BFAST DINNR
Ketones - - -
Sat
03/10
Time 00:18
CP -
BG 5.1
QA -
BI 20
Ratio (QA:CP) 1:1
QA Site -
BI Site -
Type BED
Ketones -
Sun
04/10
Time 12:00 15:28
CP 9 2
BG 9.0 8.4
QA 14+1 2
BI - -
Ratio (QA:CP) 1.5:1 1:1
QA Site - -
BI Site - -
Type BFAST LUNCH
Ketones - -
Mon
05/10
Time 07:30 10:00 13:18
CP 2 4 10
BG 5.1 12.7 5.1
QA 4 8+2 10
BI - - -
Ratio (QA:CP) 1.5:1 1.5:1 1:1
QA Site - - -
BI Site - - -
Type BFAST BFAST LUNCH
Ketones - - -
Tue
06/10
Time 07:30 09:03 11:00 13:20 13:45 18:40 19:15
CP - 7 - - 8 2 12
BG 7.1 10.0 13.8 5.1 3.4 2.8 7.3
QA - 17+1 - - 7 - 12
BI - - - - - - -
Ratio (QA:CP) 1.5:1 2.5:1 1:1 1:1 1:1 1:1 1:1
QA Site - - - - - - -
BI Site - - - - - - -
Type BFAST BFAST AFBF LUNCH LUNCH DINNR DINNR
Ketones - - - - - - -

i have exactly the same problem for the past 2 weeks as well. For example this morning i woke up at 7 and did not eat anything. i got to work at about 9 and did another test and i was 10...i injected for my breakfast and 1 additional unit to bring myself down and i did another test at 11am and i am 13.8!! i dont understand why this is happening and why all of a sudden it has changed.

when i left dafne i was on a 1.5 units to 1CP ratio, but i also decreased my background lantus from 24 units to 20 as this was too high, so thought maybe this would explain the higher readings after breakfast. I increased my ratio to 1CP:2.5units this morning and still this has not helped.

keith- what is your CP to unit ratio? have you thought about increasing this?

p.s i have attached my blood glucose diary for the last 10 days, but i sometimes forget to make a note, so not sure this will be very helpful...

keith bohanna DAFNE Graduate
St Luke's Kilkenny
5 posts

Thanks Lucy and Gerry. Time for me to start logging properly.

It is kicking in again (the steady climb of morning sugars) and my ratio is 3:1 so I'm at the top of the normal ratio range. I took 6:1 this morning with an 8.5 blood sugar reading and eating measured amount of porridge (very low GI) and it still climbed to 14.1

Took 9 Homolog, went for 45 minute stroll and it dropped to 13.3 only.

The maths just doesn't make any sense

lucytaylor_ DAFNE Graduate
North East London Foundation Trust (Havering)
2 posts

My problem seems like it is exactly the same as yours. I was thinking of emailing my specialist nurse who took my DAFNE course this afternoon.

It may be the case that i need to increase to a 3:1 ratio as well, but seeing as I have gone from a 1.5 to 2.5 ratio and nothing has really changed I am not too sure if it will help. If she replies with anything useful then I will let you know!

keith bohanna DAFNE Graduate
St Luke's Kilkenny
5 posts

Thanks Lucy.

The overview since 7am is started with 8.5, ate 2 carbohydrate exchanges, took 27 units of quick acting insulin across 4 injections and 15 minutes ago came in at 9.7.
That should be enough insulin to kill me!