[drummingfool]

I'm stumped. Maybe someone can help me out here.

I take 50 units of Lantus every night around 10 PM. In the morning, I wake up with sugar levels around 100. Perfect! But then, if I eat breakfast, my sugar skyrockets.

I've been taking 1u / 8g of carbs. If I stay with that at breakfast, my sugar rockets but then comes back down after about two or three hours. If I lower it to taking more insulin, I stay normal in that period of time but then drop like crazy.

Any suggestions?

[jillrapp]

Can I ask.. what time do you get up in the morning and what time do you eat breakfast?

[mortis505]

Also, how long after eating are you testing? 1hr, 2hrs, or more. Many of us wait until the 2 hour mark and test then. Whats for breakfast?

[Subby]

Originally Posted by drummingfool

If I stay with that at breakfast, my sugar rockets but then comes back down after about two or three hours. If I lower it to taking more insulin, I stay normal in that period of time but then drop like crazy.

Assuming you are correct about those two facts, at around the two hour mark, it's pretty good bet that one or a combination, of three things, are happening.

1. You are getting a release of hormone/adrenaline etc (for example dawn syndrome) that coincides with your breakfast time. The equivalent of having an influx of quick acting carbs than you don't bolus for. But not so much as to keep you high, the presence of sufficient insulin soaks it up in the end.

2. The action of the food is too fast. You are eating too high GI/fast simple sugar, for breakfast. So you technically have the right dosage, but the action of the carbs is much faster than the insulin, leading to a definitive high but then a definitive return as the carbs burn out early.

3. The action of the insulin is being deferred. You are having resistance OR absorption problems at that time. Both potential tricky and complex issues to deal with.

Background resistance and absorption issues seem to be areas with little knowledge about how they work, especially in type 1s. I suppose we are talking about characteristics of the blood that interfere with the action of the insulin. I know I seem to get it. Wish I could comment more than that.

The first practical thing to look at is local absorption: injection technique and injection site, although unless you have particular areas you use only for breakfast, it's strange you are not getting problems during other meals.

Whatever way it goes, modifying your breakfast would be a generic way to minimise this problem. Less carbs, lower GI carbs/wholegrain etc alternatives, skip the juices, etc, will help prevent such a big spike.

[drummingfool]

a usual bfast for me consists of some kind of whole grain cereal, toast with sugar free jelly and a glass of milk or just water. Its just very odd, and frustrating. I know that I've had issues with insulin resistance, but that was all the time. Its gone down alot since making sure to get regular exercise, but is i possible to only have resistance in the AM?

I would chalk it up to dawn phenomenon, but if I dont eat anything my sugar stays fine. And Im not eating "high impact" carbs like juices or simple grains, so I dont think thats it.

[mortis505]

Originally Posted by drummingfool

a usual bfast for me consists of some kind of whole grain cereal,

Carbs

Originally Posted by drummingfool

toast with sugar free jelly

carbs

Originally Posted by drummingfool

and a glass of milk

lactose is a very fast acting sugar/carb source

Originally Posted by drummingfool

or just water. Its just very odd, and frustrating. I know that I've had issues with insulin resistance, but that was all the time. Its gone down alot since making sure to get regular exercise, but is i possible to only have resistance in the AM?

I would chalk it up to dawn phenomenon, but if I dont eat anything my sugar stays fine. And Im not eating "high impact" carbs like juices or simple grains, so I dont think thats it.

If you are sticking to recommended portion sizes, my guess would be about 45-60 carbs for that breakfast. Your I:C ratio is 1:8, so approx 5.5-7.5u? Is that about right?

Once again is your after meal test at 1hr, or 2?

I dont know alot about IR, but my guess would be that its at it highest shortly after waking. I may be wrong.

[Subby]

Originally Posted by drummingfool

a usual bfast for me consists of some kind of whole grain cereal, toast with sugar free jelly and a glass of milk or just water. Its just very odd, and frustrating. I know that I've had issues with insulin resistance, but that was all the time. Its gone down alot since making sure to get regular exercise, but is i possible to only have resistance in the AM?

Yes. Well, I'm going by the fact that people can certainly have a very distinct basal profile that generally repeats day to day. I'm an example. Given most of my morning as my "normal basal", 12pm - 4pm my basal needs get almost 30% higher, then drop back to something like -30% sharply sometime about 5pm over the course of about 30 minutes, then climb back to normal in the evening. That's my unique daily resistance/absorption profile, if you like.

You're right, this does seem unlikely to be the cause seeing that you maintain stability if you don't eat breakfast. (However,I find that during those +30% periods if my basal is not really on the generous side of things, any carbs will blow me out, bolus or not. Just food for thought).

I would chalk it up to dawn phenomenon, but if I dont eat anything my sugar stays fine. And Im not eating "high impact" carbs like juices or simple grains, so I dont think thats it.

I think you're right in that you are not scoffing coco pops and pop tarts. But still quite some carbs, it's all relative of course. And if x carbs give no spike and y carbs give a spike then an acceptable meal of carbs is z. Which equals somewhere in between x and y. It's still a logical step to decrease your carb intake and see if things improve, if you want to make progress.

From what you've said, I'd guess delayed action is a real candidate for the cause (the details of which I'm not sure, again, I used to get that in the mornings a lot when on injections). Prebolusing would be what I would personally try, to see if I can better match the meal.

[xMenace]

Your a very common case Mr. Fool.

Your DP raises your insulin need in the early mornings but this need plummets by noon. Your tailing bolus and basal doses are likely double-strength late in the morning compared to early morning which is what is dropping you.

I treat this by superbolussing - cutting my post-prandial basals. As you are not on a pump, a typical solution is to eat a mid-morning snack. If you want to ward off weight gain, perhaps borrow the snack from your breakfast.

[Gary_W]

Originally Posted by xMenace

Your a very common case Mr. Fool.

Your DP raises your insulin need in the early mornings but this need plummets by noon. Your tailing bolus and basal doses are likely double-strength late in the morning compared to early morning which is what is dropping you.

I treat this by superbolussing - cutting my post-prandial basals. As you are not on a pump, a typical solution is to eat a mid-morning snack. If you want to ward off weight gain, perhaps borrow the snack from your breakfast.

I agree with John. The only way I can keep my 2 hour post breakfast number sociable is to super bolus. As you can't do that, eat less breakfast, hit it hard with the insulin and ensure you snack at the 2 hour point. It sucks, but it works. If you DO try this, ensure you test extra frequently during the mornings until you get how it works for you just to be on the safe side and set an alarm for the snack. What you are doing is setting yourself up for a hypo intentionally and then eating to ward it off, so all precautionary steps need to be in place to ensure you keep safe and happy

Apidra helped as well in my case. It's a lot more effective with the peaks than Novorapid ever was and the shorter tail stops the hypo at hours 3 or 4 in most cases. It's evil, unforgiving stuff but I've found it helpful....

[drummingfool]

Its such a simple solution, but sounds remarkably effictive. I'll give it a shot tomorrow morning. I've got a phone interview @ 10 AM, so I wanna be right where Im supposed to be.