Low BG after breakfast

[kalakida]

Hi everyone. A computer problem :mad: kept me away the forum for a long time.
I have a problem with my BG usually in the morning and I'm wondering if you could help (my doc sure didn't!!!).
I usually have breakfast at 07:30, 220gr of low fat milk and 2 slices of toast without being injected (Novorapid). My BG before is 102-107 mg/dl but 2 hours afterwards I have 74-81 mg/dl and around midday I have hypoglycemia (54 mg/dl). As for exercise I just do a light housework (no stress at all).
Can anyone please tell me how is this happening? :confused:

[Subby]

So are you taking insulin at other times, kalakida? What about a long acting insulin?

[kalakida]

I was supposed to have Novorapid 3 times a day, before breakfast, lunch and dinner. As for the long acting insulin I have 16 units of Lantus Solostar every night at 23:00.

[Subby]

Ok well some very rough points for you to explore.

First, people can find that their insulin requirements do change through the day. So it's not that unusual to find that different amounts of both basal (Lantus) and bolus (Novorapid) insulin are needed at different times of the day. What you are probably finding is that your long acting dose is peaking at that time/or too high. That is the rational explanation as to why someone on insulin, goes low on a regular daily basis away from boluses.

The dose of your Lantus may be simply too high, or, you might be getting the full effect of it, kicking in at this stage. While it is marketed as a "flat" 24 hour effect, it surely does have a peak, which commonly lasts around the 6 to 12 hours after injection.

Often people have insulin resistances in the morning, caused by their body releasing hormones. You may well be the opposite and insulin is more effective in the morning. There is no reason why not, I have a very atypical "basal profile" as well. The key is to find out what is going on for you.

You might be getting a combination of the two. Low basal insulin requirements in the morning, coupled with the evening Lantus weighing in strongly. It may well be enough to give you a low even if you eat breakfast with no short acting - just as you are finding.

It could be something else going on, these are just ideas.

There are definitive and pretty straightforward things you can do to see if you can somewhat solve this. I will leave you to explore this.

To be honest, seeing as you seem to be very much in the process of getting a grasp on your insulin therapy, my reaction is "get a new doc" and make it a good endo, as the possible connection between the Lantus dose and the morning lows should have been very apparent to your doc.

[kalakida]

I sure thought I should get a new doc. I forgot to tell you that I used to have 20 untis of Lantus and after a conversation I had in this site I reduced it to 16 units which helped me a lot. Furthermore, I don't exercise at all. Just thin; if I did, what..... I don't even want to think about it
Thank you for the reply, you gave a different perspective

[Subby]

No problem. Remember that you may come up against this issue: because Lantus is quite flat for most of the day, a dose might be appropriate for some of the day but not the rest of the day.

So for example, it's possible you might lower your dose, find that your mornings are better, but you go high in the afternoon sometime because the right Lantus dose for the morning is the wrong Lantus dose for the afternoon.

Look out for that. If it occurs, there are a few other things you can do apart from just change your dose, to try and help such situations.

[kalakida]

Fortunately, I don't get high the rest of the day. From what I've read the BG after the meals should be 145 mg/dl even for those not suffering from diabetes. I usually have 150 or 170 the most. I forgot to mention that, too. That's why I'm so confused.
But let me ask you one more thing. What about the Lantus hour? If I changed it, would it make any difference? I mean if I make the injection earlier than 23:00 would it help?

[Subby]

Fortunately, I don't get high the rest of the day.

Right... but what I meant was that if you decide to reduce your dose to stop the effect being so strong in the morning, THEN you might see highs in the afternoon because of the same dose reduction. Does that make sense? If not, let me know!



But let me ask you one more thing. What about the Lantus hour? If I changed it, would it make any difference? I mean if I make the injection earlier than 23:00 would it help?

Good thinking... you could certainly try that - but watch very carefully for going low during the night if you do. What is commonly tried and may make the most sense is to actually switch to the morning. I know that sounds a bit crazy considering the problem is in the morning, but think about these two things:

- The effect of Lantus tapers off significantly towards the end of the 24 hour period (if it even lasts that long)

- The effect of a Lantus dose usually takes at least up to 4 hours to get to full effect from time of injection.

Put that together, and you'll find that taking it in the morning instead, may well change things to make the morning the time of "least Lantus".


From what I've read the BG after the meals should be 145 mg/dl even for those not suffering from diabetes. I usually have 150 or 170 the most. I forgot to mention that, too. That's why I'm so confused.

OK, that's getting out of the scope of this particular issue a bit... I take it you mean after the meals that you take novorapid? It does sound like you are spiking perhaps more than desirable. You should look into this further - the dose, how it is arrived at, the food, the carbs, the timing.... It is by no means a simple issue... :) Perhaps posting in detail about your specific mealtime issues might be a way to go about it.

[kalakida]

You're right. I'll do it later though as I have to leave now. Thank you for you replies and hope we talk again soon

[Subby]

Just remember... if you do decide to change your doses or the time of your doses, take extra care, and take extra BG tests.

Think long and hard about the "double up" effect if for example you moved your Lantus from the evening to the morning. If you took your Lantus one night, then moved to the morning and took the same dose in the morning, you would have double the Lantus effect for about 12 hours that day! Very bad news!

Ways you can do it more safely is to take half the dose one night, then half in the morning, then wait for the next morning and take the full dose from then on. Or alternatively, take it one night, skip the next night, then take it that next morning. Obviously you need to treat that night with a lot of care and lots of BG tests to make sure you don't go too high during that uncovered night.

If any of it sounds too much, wait until you have better knowledge and confidence. Take care.