[drummingfool]

This is about what happens every morning.

I woke up this morning, 5:45 @ 120 exactly. I had 8oz of milk and my vitamins and took my novolog for the milk. At about 10-10:30 my BS was in the 260's.

I take 52u Lantus every night, and at about lunch time my levels come back down. I HATE this spike in the morning. what should I do?

Help! This really, REALLY sucks.

[rzrbks]

Sorry, 52 of Lantus seems just a little high---but that's twixt you and your Dr.

As for breakfast, what is your normal ratio?

For me, I use 1:15 for ANY time Except breakfast, there it's more like 1:8 or even 1:6 depending on what I have.

And by breakfast, I mean the first meal of the day. It doesn't matter if I eat at 5am or 12pm. Whatever the first meal of the day I eat when I first wake up is always gonna be somewhere around 1:6--1:8.
Now, If I intentionally skip break fast and go about a normal day and then eat lunch or supper after having been up many hours, my ratio is it's normal 1:15.

Many folks have to adjust their ratios according to the meal, the time of day, what the meal consists of and what phase the Moons of Saturn are in.

Part of The Joy of Diabetes.

I'd start with a 1:10 ratio and then adjust it either up or down based on Several days readings 2 hours after you eat.

[fgummett]

Milk for breakfast? What percentage fat? Higher fat milk will have a lower proportion of lactose per volume, and a higher proportion of fat to moderate the postprandial BG spike

I agree that 52u Lantus all at one go sounds high... do you inject it all at once or break it up into multiple sites... or consider discussing with your Doctor to break it into two doses at different times of the day.

A fasting of 120mg/dl... I wonder what you would have tested 1/2 or 1 hour later even without eating... maybe your BG was already on the way up?

Do you do basal testing?

[BlueSky]

Originally Posted by drummingfool

This is about what happens every morning.

I woke up this morning, 5:45 @ 120 exactly. I had 8oz of milk and my vitamins and took my novolog for the milk. At about 10-10:30 my BS was in the 260's.....

It sounds like your DP effect overwhelms the Lantus action in the mid-morning. I have the same issue. You could try eating a low-carb breakfast (no milk), and covering it with Regular (eg. Actrapid, Humulin R) . In addition to covering your breakfast, the Regular makes up the shortfall in Lantus action. It acts over a much longer period than Novolog. It takes 45 minutes for regular to get up to speed, so you need to inject it as soon as you wake up.

You could also try using a basal insulin with stronger peak action, like Levemir or NPH. You need to time it so that the peak from the before-bed shot coincides with your increased insulin need. You may need to split the dose between morning and bedtime shots to get good 24 hour coverage. You can also mix and match. Take NPH before bed to deal with the DP, and Lantus in the morning for more consistent daytime cover.

To help work out what would work best for you, consider the action profiles of these insulin in the graph (Lantus = Glargine, Levemir = Detemir).



As you can see, Lantus has a weak peak action. While this is good for most people, for some of us it is a problem. Levemir has a somewhat bigger peak, and NPH has the biggest one.

Before you do anything, you really need to do basal testing. Skip breakfast and test you BG every hour until lunchtime. You will then be able to see if your morning basal action is adequate or not.

[lorilei]

Hey D,
Hope this a.m. stuff gets under control so you can enjoy the new job! It must be frustrating!

[jenb]

My bg tends to rise after I awaken, but before I've eaten. For instance, it may be 85 when I get up at 6:00a.m., but used to rise to 120 by the time I'd fussed around and measured again prior to breakfast at 7:15. After lots of trial and error, I've found that breaking my Levemir into 3 doses (5 units at 7:15 a.m., 5 units at 3:15 p.m. and 6.5 units at 11:15 p.m.) almost eliminates that morning rise. I also inject my bolus about 20 minutes before I eat. This seems to keep my BG from spiking more than 20 - 30 pts 45 min to 1 hour post meal.

Don't know if my experience with small basal amounts is helpful for someone using higher doses, but it might give you some food for thought.

[Kat]

I have the same problem and it's been going on a long time. Wake up high, eat and no matter what I eat (that has carbs) my blood goes up super high. So I'm doing basal testing and all but I still need to I guess adjust my bolus for breakfast and basal for morning. =p
MAJORLY sucks!!
Hope you figure it out!

[walleyedave]

I don't understand how people can say that your dose of lantus is high.
I have been told to keep upping my lantus untill my morning BG's(fasting) are normal. How do these people know your dose is high. I don't get it. I would love to hear there thoughts on this, as well as why they feel this dose should be split.
I don't know whats going on with your Bg. The more I read your other posts, the more you remind me of me. I have gone through some of the exact things you have. The weight loss and gain issues. The morning Bg issues. etc..
I can eat zero carbs for breakfast and still skyrocket in an hour..
I hope you get the answers your after bro, we'll both get some questions answered. I'll be subscribing to this 1 for sure.

[drummingfool]

Thanks for your help, all. It is extremely frustrating to have my BG at 260 when I get to work and try to setup a complicated virtual Linux server when I cant concentrate.

I'll do basal testing, prolly on saturday. I dont want to go without breakfast on a day I have to work. I'll just have eggs or something until then. Nothing but eggs, all day. lol

Walley, I hope I get these answers too. Its really annoying, isnt it? I take 1u/5c in the AM when the rest of the day is 1u/10c. Perhaps I should lower it more. We'll se what happens in the mornings to come. Stick with me, yall! I love the support!

[Gary_W]

Originally Posted by walleyedave

I don't understand how people can say that your dose of lantus is high.
I have been told to keep upping my lantus untill my morning BG's(fasting) are normal. How do these people know your dose is high. I don't get it. I would love to hear there thoughts on this, as well as why they feel this dose should be split.
I don't know whats going on with your Bg. The more I read your other posts, the more you remind me of me. I have gone through some of the exact things you have. The weight loss and gain issues. The morning Bg issues. etc..
I can eat zero carbs for breakfast and still skyrocket in an hour..
I hope you get the answers your after bro, we'll both get some questions answered. I'll be subscribing to this 1 for sure.

The 'keep upping the lantus until your morning BG's are normal' is standard advice from docotors who fail to back it up with two other important questions

1. What is your BG before you go to bed?
2. Are you sure you aren't going hypo in the night?

The purpose of Lantus is to cover the output of your liver and to keep your BG stable in the absence of food or bolus insulin. Too often it is given in excess amounts and causes the BG to tick down slowly. If this happens in the night, you can have a nice night hypo. Your liver then has the decency to save you life by putting out everything it can. Some folks are high in the morning because of a liver dump and keep on upping the Lantus to keep the morning numbers down. It's a really good way to vanish up your own rear end. A place where I lived for quite some time and wondered where all the spikey numbers during the day came from.

The reason folks are thinking it's a lot of lantus is because it is a lot for a T1 acording to the general rules of thumb (such as they are). These rules of thumb obviously are there as a rough starting point from which to get to where you actually need to be. But looking as an average, a 50/50 split of bolus to basal is a reasonable starting point. So if Drummingfool fits this profile, his total daily dose is around 104u. Another little guideline I've seen as a starting point is that 0.5u of insulin is given per kilo of body weight. Again, only a guide but this would suggest that Drummingfool weighs 208 kilos which is almost 460lbs.

Again, everyone varies from this rule of thumb. But if there's even a tiny bit of truth in it then something else must be going on here, hence thoughts of either night hypos or absorbsion problems. If you put loads of insulin in one place at one time, you can get really bad absorbsion problems. For this reason, it's fairly common to split larger doses into smaller shots.

Splitting to dose between sites and also some overnight basal testing would be a good start on the road here IMO.

[gettingby]

Originally Posted by drummingfool

Thanks for your help, all. It is extremely frustrating to have my BG at 260 when I get to work and try to setup a complicated virtual Linux server when I cant concentrate.

I'll do basal testing, prolly on saturday. I dont want to go without breakfast on a day I have to work. I'll just have eggs or something until then. Nothing but eggs, all day. lol

Walley, I hope I get these answers too. Its really annoying, isnt it? I take 1u/5c in the AM when the rest of the day is 1u/10c. Perhaps I should lower it more. We'll se what happens in the mornings to come. Stick with me, yall! I love the support!

Dude, we will stick by you through thick and thin, good and bad. We ain't gonna desert you.
Now, with the basal dose, there is no set amount or limit on what anyone takes. We are all different and different things work for different people. I hope you find what works for you very soon.

[VinceF]

Are there any carbs in your vitamins? Some vitamins use sugar as a binder. I was having the same type thing happening and found some extra carbs (we changed bread) then switched to vitamins without sugar added.

Dave

[DanG]

Originally Posted by Gary_W

The 'keep upping the lantus until your morning BG's are normal' is standard advice from docotors who fail to back it up with two other important questions

1. What is your BG before you go to bed?
2. Are you sure you aren't going hypo in the night?

I have been thinking about the DP that I have read about from BlueSky and now drummingfool. Interesting thing, DP.

I wonder if the lantus in the evening is becoming more and more of a problem for us. I quit doing evening lantus a couple years ago. I take lantus in the morning and am usually fine the next morning - I split sites for my 22 units lantus. I am thinking that perhaps the body mechanism is a bit lantus resistant and "seems" to need more and more lantus. Whereas, perhaps you can wean the body off lantus resistance by lowering the dose and switching to morning dose - a suggestion if that....

These are my suspicions - no experience to back them up, except that I quit taking lantus at night. My reasoning is that I am doing nothing from 10 PM to 7 AM and thus need no real sugar processing, therefore no need for lantus - give the body an insulin rest for a short period each day, as it is said that lantus is 20 hours duration or so.

Another lantus experience I have from time to time - always logical and generally miscalculation by me - the low that lantus produces is wicked. It is wicked loooong, sneaky, and quite resistant to sugar feeding, it seems to me. I don't like lantus low at all.

[jenb]

I don't have experience with Lantus, but do use Levemir. I wonder if the duration of action of your basal is shorter than you think...what time do you take it at night? I don't know the Lantus protocol, but perhaps you could split the dose and take it in 2 12-hour segments. This might cover what might be a lapse in basal coverage.

[xMenace]

Your DP sounds a lot like mine. Levemire nor Lantus will treat it well. You also need another insulin to attack that DP. If you drop hard in the night like I do, getting up at 5am or 6am and bolussing may be the only option. If you rise from midnight on, then some NPH before bed is likely the ticket.

Try to build a profile of overnight activity, but for now get up early and shoot some extra Novolog.