Consistently High in the AM

[Clint]

Ok, I am getting a little peaved... I think I am going to have to switch to 2 shots of Lantus, 1 in the AM and 1 in the PM as I am waking up over 200 after being normal after dinner...

Does this sound right?

[archimeech]

I had crazy highs, they call it the dawn phenomena. That is one of the major reasons I switched to the pump. Keep saving money for that pump, grumpee. Mine was always in the 300s when I was on NPH, now I wake to a lot of 100-180s.

[Clint]

hopefully I will hear from Minimed this week on my pump... <crosses fingers>

[sc0]

Yep - I know exactly what you're talking about, because I have the same problem.

I take a shot of Humalog after dinner, then a shot of long-acting mix (Humulin-I) before bed. My pre-sleep BG is usually around 6 or 7 mmol. Wake up in the morning and I can be at 11+ mmol, and occasionally much higher. It's been a problem for a number of years actually, and causes problems like sleeping in for work, or if at the weekend, sleeping through the morning and waking up in a pool of sweat at like 2pm, BG over 20mmol. (Before you ask, my partner takes the line that my diabetes is MY problem, not hers, so she doesn't wake me up unless she wants me to do something).

I took advice from my consultant, who asked me to eat dinner earlier in the evening, say 6-7pm instead of later (which frequently happens since I commute 110miles a day for work), and to eat some form of complex carbohydrate before bed, like an oatcake or a slice of wholemeal bread to make sure I don't drop too low during the night.

When are you eating your evening meal? If you're eating carbs late at night, it's possible that there isn't enough insulin remaining in your body to cover those and so during the night your BG is simply rising and rising.

sc0.

[HeatherP]

Splitting the shots into two won't hurt, so you can certainly give it a try. I also found that I was still waking up high and so now I take a few units of NPH before bed. I have found that injecting insulin in 7 units or less increments improves my control greatly. You might want to give it a try and see if it helps you.

HeatherP

[Clint]

I ate dinner lastnight @ 530pm and @ 730 I was 120... when I checked this AM my BS was 247..!!!!

[sc0]

One more thing...

I'm confused as to why everyone is advocating pumps as the solution to any and all problems with highs and lows. Exactly how is buying a pump supposed to solve the problem of morning highs? I mean, the pump doesn't automatically test your blood, it doesn't automatically administer the insulin, and it doesn't automatically notify you as to whether or not you were high (or low) in the first place. How are you better off dealing with "the dawn phenomenon" by spending $250+ on something you would have to do manually when (if?) you wake up with testers and pens anyway????

So far, noone has convinced me that pumps are any use whatsoever other than to make the administration of insulin slightly more convenient, and even then, I'm not entirely convinced of that either given that the convenience appears to be offset by the fact that you now have an open cannula site that can get infected, an attachment that can catch on things (or get popped out by an over-zealous 8-yr old for example).

Anyhow, I'm not an expert on pumps or even diabetes, so it's probably better not to listen to my experiences. All I can say is that the problem with morning highs for me appears to be more about timing my evening meal, the carb portion size and what your insulin regime does to take account of the fact that you will continue to digest these carbs throughout the night, releasing glucose into your bloodstream all the while.

Sorry for not being particularly positive, but I've never had a decent (workable) answer from anyone on this subject, other than "Buy a pump!" which as I've already pointed out is something I'm entirely unconvinced about.

sc0.

[HeatherP]

I believe in this instance, a pump would be helpful by programming it to deliver a proper amount of basal insulin to combat the trends of high blood sugar levels. Once you spot a trend you can prepare for it. There are always other factors that can influence sugars and having a pump doesn't fix everything. However, as do others, I was having sugars in the 200's every single morning no matter what I did. At the moment I'm not interested in a pump but that may change in the future.

HeatherP

[Clint]

Like Heather, no matter what I do, I am always hi... there have been instances that I have taken a *night* dose of Lantus, but that was when I ate something late....

I want a pump badly as my lifestyle and conditions would be helped with a pump.. and my Dr agrees... I just got off the phone with the ins and my pump request is being reviewed.. so I may know by Friday whether or not I am getting it <hopes!>

[HeatherP]

Good luck Grumpee! I hope they come through for you! :thumbsup:

[Clint]

Good luck Grumpee! I hope they come through for you! :thumbsup:

so do I! it would help so much!

[mark-TN]

I ate dinner lastnight @ 530pm and @ 730 I was 120... when I checked this AM my BS was 247..!!!!

Grumpee- One suggestion. It is great that you checked 2hrs pp, however you may want to check again at 4-5 hrs pp. Carbs and protein take longer than 2 hrs to digest. By 5 hrs (if you do not have delayed stomach emptying) almost 100% of the food you ate will have been digested and the action of your meal bolus will be complete. This is a good time to test if you had any further increase in BG and by this time it will be safe to take a correction bolus if needed (according to your docs instructions of coarse).

Mark

[Clint]

Grumpee- One suggestion. It is great that you checked 2hrs pp, however you may want to check again at 4-5 hrs pp. Carbs and protein take longer than 2 hrs to digest. By 5 hrs (if you do not have delayed stomach emptying) almost 100% of the food you ate will have been digested and the action of your meal bolus will be complete. This is a good time to test if you had any further increase in BG and by this time it will be safe to take a correction bolus if needed (according to your docs instructions of coarse).

Mark

the bad thing is, I am usually asleep 4-5 hours after dinner... but i will check that here the next few days

[bel4_20]

Hey grump been there still doing that. I can go to bed with a perfect reading and wake up with numbers like 361 (20.1) pretty much every day Im up to 65 units of NPH for bed time still no luck. but like yourself I got a pump thats sitting right here just waiting for my training Jan 14th . Hope you get it soon.

[Clint]

ya me too... I am hoping to know by the end of the week :)

[nantomsuethom]

Grumpy, I agree that the pump will help. :thumbsup:

Thomas is using a pump. He has been waking up with fairly high bgs, 200-250 range depending on what he is when he goes to bed. For that past few nights I checked his bg through the night, found out when he spiked (2:30am). He would go to bed with a bg of 75-80, I checked him at 12MN he was the same, checked him at 1am still the same, checked him at 2:30 and he was 125 and then would wake up with a bg of 200+. Last night I increased his basal at 2:30. This morning he was a little lower than usual (180). I will give it a few days and if it doesn't come down to bedtime #s then I will increase it again.

Thomas is a typical 11 year old boy, climbs trees, skateboards, rides his bike like he is some kind of dare devil, etc. he has never had a problem with his tubing kinking or getting snagged on anything and his site has never just come off except for when he is swimming all day. ;)

I know you will love your pump and the freedom that goes along with it. Hopefully the insurance will come through soon and you will be on your way to being a "pumper". :thumbsup:

[Maria]

3 years ago I had highs in the morning. It was dawn phenomenon. I have found out that this problem was starting at 5.30 A.M. My doctor has advised to inject 1.5 units of short-acting insulin at 5.00 A.M (before blood sugar started high). I began to do so. My morning blood sugar became good. Then this doze became less.(1 unit, 0.5 unit)I took this early injection about 2 month. Afterwards this problem has gone. And I have canceled that uncomfortable early injection.

Also cause of high morning blood sugar can be hypos at night. You can't feel it because you are sleeping. And blood sugar rises in itself and very very badly. I test my blood regularly at night in order to exclude hypos

[mark-TN]

Grumpy, I agree that the pump will help. :thumbsup:

Thomas is using a pump. He has been waking up with fairly high bgs, 200-250 range depending on what he is when he goes to bed. For that past few nights I checked his bg through the night, found out when he spiked (2:30am). He would go to bed with a bg of 75-80, I checked him at 12MN he was the same, checked him at 1am still the same, checked him at 2:30 and he was 125 and then would wake up with a bg of 200+. Last night I increased his basal at 2:30. This morning he was a little lower than usual (180). I will give it a few days and if it doesn't come down to bedtime #s then I will increase it again.



This is a very typical pattern for DP. I found I needed an increase at 3:00am and the increase stays in effect until 10:00am. John Walsh describes this very pattern in his book Pumping Insulin. It sounds like you are on the right track. Good luck.

Mark

[buzzborne]

grumpee... I agree that the pump would probably help, but you have to think of your situation this present day...

You mentioned about splitting your lantus into 2 doses, have you started doing this? or have you left off?

Have you spoken to your Dr/nurse about the situation? that may be a good idea, and maybe they can help you out.

[Clint]

I do take 2 doses, sometimes, but not all the time...

Lastnight I woke up around 1230am and was low... I ATE TOO much so I took a dose of my humalog to correct and still was high when I got up...

[Clint]

good news - I was @ 111 this AM when I got up - WOOOHOO!!! :cool:

[buzzborne]

Thats great news Clint :D :thumbsup: