High BG in the mornings..

Bunkins · #1 (**permalink**) 01-09-2008, 08:38 AM

Here lately I've my BG's have been in the 250's in the mornings.. I woke up around 1 am this morning and checked myself and I was 130, at 9am I was 247... Been tweaking my Lantus a bit, and been having a few lows during the day.. So I'm guessing splitting my Lantus will be the best thing to do.. Just not sure how I should go about it... I take 21 units of Lantus in the morning, as far as the lows I think I can probably just take a little less Humalog during the day.. I'll just have to play around with a night time dose of Lantus to figure it out..

Yall think thats the best way to do it? My BG's have always been a bit high during the mornings, I just correct it with Humalog and forget about it.. But I've really been focusing on getting my A1C's down ( currently a 8 ).. I'm just not sure if I should take a little less Lantus in the morning or stay where I'm at then take some at night, say starting out with 5 units? As far as the lows I've been getting throughout the day, I may tweak my sliding scale a bit and see if that helps.. Any suggestions? I'm just not 100% sure how I should correct my morning highs, it's the daytime lows that are making me doubt what I should do, either a tad bit less Lantus in the morning, or a little less Humalog.. I plan to get on the pump sometime around March, so I'm really trying to figure myself out, I've never really done a good job of that in the past..

Scratch · #2 (**permalink**) 01-09-2008, 09:18 AM

Lows on just your basal in the day?

If I were you and having those kinds of numbers, I'd set some alarms for overnight. Get up 2 hours after falling asleep. See what your number is. Get up again in an hour or 2. Test. Repeat.

Doing so will help you figure out if your liver is outrunning your basal dose, or the other possibility of morning high numbers that you are going low and the liver kicks in to pull you out of hypo while you sleep.

The fact that many peope's basal metabolisms ebb lowest between midnight and 3 AM is probably the most difficult challenge for type 1 diabetics and regulating dosing.

xMenace · #3 (**permalink**) 01-09-2008, 09:24 AM

I fixed it with a pump.

If I was going back to mdi, I'd seriously consider waking at 5am every day and shooting some Humalog to cover that ****ed DP. Another option is to up your Lantus to match your DP and take a midnight snack to counter-act that 2am dip. But feeding the disease is fundamentally wrong.

Let us know how splitting works out.

Bunkins · #4 (**permalink**) 01-09-2008, 04:28 PM

Thanks for the responces...

Yeah I'm going low during the day on the basal normally around 4pm, I didnt today it held pretty steady.. I didnt do anything different today than I do any other day, ate the same thing at the same time, same dose of Humalog.. Kind of odd..

I think I'll do what yall suggested, waking up several times during the night and see whats happening.. I might get woke up by a low once every 2 weeks or so, but I'm always high when I wake up getting ready for work.. So it is possible my liver is pulling me out of a low that I'm not feeling.. I dont normally snack at all, but I think I might start having one at 3pm, and before I go to bed... I didnt really even think about what you guys brought up, gives me more to think about rather than just adjusting what I'm taking in for insulin..

Another question while I'm at it.. It's never been brought up between my endo and I.. Today 2 hrs after lunch I checked my BG and it was 87, I felt fine so I just left it being curious to see if it went lower ( expecting the 4pm low ).. Never did.. Checked my BG when I got home tonight at 6pm and it was 94.. I thought about eatting something to bring it up a notch, but I really didnt see the need... Am I alright leaving it like that, or should I try to stay a little above 100?? Really hope I can keep this up though, been really happy with what I've been doing, other than the morning highs and the daytime low's, even then it's still tons better than I've done before..

BlueSky · #5 (**permalink**) 01-09-2008, 05:06 PM

The fact that go high before you inject Lantus in the morning suggests that the Lantus may not be lasting the full 24 hours. You can try shifting the dose to the evenings and see what happens. If you go high in the evenings, splitting the dose evenly between morning and evening shots would give more even insulin action over the day. If none of that works, the morning highs could be because of the DP effect, and injecting a few units of NPH before bed should sort it out.

xMenace · #6 (**permalink**) 01-09-2008, 05:45 PM

Quote:

Originally Posted by BlueSky

If none of that works, the morning highs could be because of the DP effect, and injecting a few units of NPH before bed should sort it out.

I'm curious about how this might work. It appears plausible. Does anyone here do it?

Bunkins · #7 (**permalink**) 01-10-2008, 07:58 PM

Well I took 3 units of Lantus last night before bed, 9am this morning my BG showed 180.. Pretty big drop from the 250's with only 3 units

So I'll do the same tonight and see if I get the same results.. I wanted to do some testing throughout the night, but I ended up having to go to work on a callout around 8pm last night and didnt get home till kinda late, so I needed all the sleep I could get.. All the tests today were pretty close to the same throughout the day as the past few days.. I figured atleast half the day I'd see some lower numbers ( which wouldnt be good cuz they are already pretty low ), but it never happened.. So I'll probably keep doing what I'm doing for a few days and see what happens.. I'm sure I'll have to make some adjustments to my morning dose of Lantus, I shouldnt need that much in the morning when I'm taking some at night, but one day isnt going to tell me much.. I hate to slit up the morning and night time doses evenly since I've got my morning dose spot on, so I'll make small changes every few days..

BlueSky · #8 (**permalink**) 01-10-2008, 08:37 PM

It sounds like you were in fact running out of Lantus in the early hours of the morning. You will probably need to reduce your morning shot as you increase the amount you are having in the evening.

When I split the dose, I did it all in one step. I was taking it in the evening, so on the night in question, I simply halved the dose. I got up in the middles of the night and corrected a high blood glucose with Novorapid. And I injected the other half of the Lantus in the morning. I needed to do another correction in thye morning, but that is all that making the transition required. The results were quite dramatic, and making the transition was a lot easier than I expected it to be.

alilpita · #9 (**permalink**) 01-10-2008, 09:02 PM

I too fixed mine by going on the pump in December but before that was on Humalog and Lantus for a few years. I always took my Lantus at night and took my Humalog to bolus for my meals depending on carb count. You should really consider a pump as it's sooooo much easier. by the way had diabetes for 33 yrs and just went on the pump in October, the CGMS in December. I'm in heaven now, well at least it feels like I am. My last A1c was 7.7 getting blood drawn tomarrow to see where I am now? cannot wait to see!
Good Luck!

Bunkins · #10 (**permalink**) 01-11-2008, 04:47 PM

Yeah I'm just going to split it in half.. I'll start tomorrow, I picked a good time to do it too, on the weekend..

This morning I was at 200, so yeah that confirmes that the Lantus isnt lasting 24hrs.. It's odd too, with the slightly lower numbers in the morning I feel a lot better in the mornings.. I jump out of bed, get ready for work and I'm out the door in no time, where as before I'd lay in bed for a while and slowly start moving around.. My attitude is much better too, not so cranky..

The pump is sounding better and better all the time.. I might call the doc up next week and see if I cant get the ball rolling a bit faster. My insurance company is trying to play a few games, so I need to get that straightend out first as well..

Thanks for the suggestions

REDLAN · #11 (**permalink**) 01-12-2008, 12:50 AM

good luck with the split

I too have exactly the same problems, but with Levemir - it doesn't last anything like 24 hours.

Originally I took mine in the evenings. and had a similar problem to yours except the other way round - hypos in the early hours of the morning, and galloping blood sugars in the early evening.

the split made things much much better - the trick is to time the split such that the holes are covered with fast acting - I now have the following timings....

I take my first shot at 12noon, along with my lunch time fast acting - this was to ensure that I had active basal covering me over that critical breakfast time, and also to lessen the risk of hypos before 12noon, which I'm very prone to. My lunch time fast acting now has to cover the delay in my basal starting (about 1 and half hours for it to peak). In the evening I inject at 9pm, and usually eat dinner between 7 and 8, so, I should have an insulin peak covering me during this hole.

Bunkins · #12 (**permalink**) 01-12-2008, 09:56 AM

Yeah I need to figure out the timing, shouldnt be to difficult.. I went ahead and started last night, figured the Lantus was wearing off at night anyways.. Took 11 units last night at 11:00, had a snack at 1am woke up with a 112 at 9am

I've only seen it that low a handful of times in the morning.. Took another 11 units at 11:30 today, checked my bg and it was 123. I corrected with 1 unit of Humalog, see if I can maintain the 90's I've been hanging out in all week.. So it looks like it's going to work out pretty well.

We'll see how my numbers look throughout the day, I've been fasting all day, wish I could all day but I've got a ton of work to do, to stay away from the lows I'm sure I'll have to have a snack... We'll see though, pretty excited about what I'm seeing so far.. Maybe my endo will be happy with me for once