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LaRue

Question about morning syndrome

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LaRue

Hello all. First post here. I've been doing some reading on this forum, and ya'll seem like very intelligent people.

 

My question is about elevated blood sugar upon waking.

 

Some background. I'm 58, female, diabetes runs in my family. My A1c was tested in October 2016 at 6.1. My wake up call.

 

in 2015 it was 5.8, in 2014, 5.4, so trending up.

 

I do exercise in moderate range by swimming/treading water and yoga. 

 

In the past month (almost exactly) I feel I've made a very good start in adjusting my diet.

 

That elevated A1C alarmed me, and I took a closer look at the carbs I was eating. Like a lot of people, I was amazed at the high carbs in foods I thought were very healthy, like orange juice. I could and would drink 2 or 3 glasses a day. Other foods that have a low glycemic load, like dried beans, which I love, but was eating portions twice or 3 times what I should have been. Too much of a good thing.

 

I went through the feeling awful stage, and survived, nay prospered. I wasn't prepared for feeling bad, as I avoid packaged foods. Of course once the carbs were put in order, I lost that carb water weight, and now, although I haven't (and won't) weigh myself, I know my weight is creeping down. I can admit it here, my weight had crept up to 200 pounds, from 140 two decades ago. If I loose 30 lbs over the next couple of years, I'll be proud.

 

My diet now has anywhere between around 100 and 120 carbs daily. It comes from dried beans I make from scratch, vegetables (red pepper, brocolli, cauliflower, mushroom, tomato, onion, sweet potato, peas, jicama) cashews, peanuts, peanut butter  a glass of milk every 2 or 3 days. Also some cheese, chicken, lean beef, eggs. For fats I am using VOO butter, plain yogurt, butter. No more than 1 slice of whole grain bread at a time.

 

I've gotten the hang of balancing the carbs of each meal, getting 20 to 35 eating 4 or 5 times a day.

 

Calorie wise, I know that too has decreased, between smaller servings, rarely eating fruit (maybe an apple with peanut butter) and upping the vegetables.

 

I'm really quite happy, no cravings past a passing fancy which I know means I need to eat some real food, and see no reason not to continue this forever. 

 

I had a friend visiting from out of state for an entire week, which involved me eating out at least once a day, and I managed fine. In fact sometimes my choices felt very self indulgent, like choosing 2 appetizers as my meal, getting  deviled eggs with truffle oil, and an amazing Maryland crab cake, so fresh it sang in my mouth.

 

I'm recording all I eat so I can't lie to myself. All in all I know I'm doing better.

 

My problem is in my fasting blood sugar. Out of the 23 recordings of my fasting blood sugar (forgot some days in the beginning) only 5 have been at 100 or below. 

 

Some days it might only be slightly over at 103, other days 114, 116, and one day 125. 

 

The day before that 125 reading I felt I actually ate too few carbs, only 89. I wondered at the time if that caused the higher than normal reading.

 

During the day my glucose would hang between 90 and 100 pre meal, and would always be under 140, usually below 120, 2 hours later.

 

I take an apple cidar vinegar, 500 mg, tablet before going to bed, and today I bought some ceylon cinnamon capsules to take twice a day.

 

Ok, so considering this background information, does anyone have opinion on why my morning reading is higher than I'd like?

 

Oh, one other thing, that may be important. I'm not a 8 to 5 person. I retired maybe 2 years ago, and my normal body rhythm since then has been going to bed between 2am and 3am getting up between 9am and 10am, and maybe an hour nap in the afternoon (not as often now that I've cut down the carbs).

 

This is natural for me, and it's my great joy to not have to struggle getting up at 5am to be at work at 8am. All my life it would take me that long to get functional. Now when I get up, after less sleep, I'm rested and refreshed.

 

Could this have an effect on when I take my fasting reading?

 

Because I go to bed late, I do eat something around 11pm. I keep that to between 10 and 20 carbs. My 11pm is someone elses 7 or 8pm

 

My questions are...

 

 

Has anyone had success with the ACV and cinnamon?

If when I get my A1c check in a few months, if it's within range, does it matter if my fasting glucose is high?

What can I do/eat a couple of hours before bed that would be the best choice?

Is it just a matter of time, and a month isn't enough time for morning stabilization?

 

Thanks for reading, looking forward to responses. 

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adiantum

Welcome to the forum LaRue, what a great proactive approach you have taken.

You have identified the A1c as an increase & am doing something about it.

 

Many of us have the dawn phenomenon but there doesn't seem to be a one method of control fits all.

Keeping that diary might identify  your best method.

Some enjoy alcohol , others a fatty supper.

Ive found having a cheat meal or over exertion  can still show up on my DP 3 or 4 days later.

89g carbs in a day isn't too low & wouldn't affect the DP, many here consume much less then that.

Looking forward to you becoming a regular contributor.

Lee

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meyery2k

LaRue - Welcome!  It is good to see that you are acting on this now before it becomes full blown diabetes.  Many of us that are diabetic eat 50 grams of carbs a day or less.

 

It does take time to get the glucose down.  When first diagnosed, my first morning reading was 291.  It took about a month to 6 weeks to be consistently around 100.  Now, almost 1 year later, I am rarely over 100.  Usually in the 80's somewhere.

 

Overindulgence for a day will put me in the 90's. 

 

Some test very early in the morning to try and catch a reading before DP. ~ Mike

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jims_forum

y questions are...

 

 

Has anyone had success with the ACV and cinnamon?

If when I get my A1c check in a few months, if it's within range, does it matter if my fasting glucose is high?

What can I do/eat a couple of hours before bed that would be the best choice?

Is it just a matter of time, and a month isn't enough time for morning stabilization?

 

Thanks for reading, looking forward to responses. 

OK, here we go:

 

Dawn phenomenon results from natural body  actions by liver to preload the body with glucose in preparation for wake up. This starts slowly around 3:00 am and gets rolling in earnest by 4:00 am and runs to 9:00 am every day. On a regular normal - non diabetic body; the liver is kept in check by proper working of pancreatic islets and insulin secretion. Unfortunately the liver is watching insulin levels in the  blood and as long as sufficient insulin response is proper - Liver will cut back the glucose it releases . Unfortunately if Liver does not see insulin response sufficiency - body /liver assumes you need more glucose. Frankly this is a human body cheat on the control feedback system. Had liver been looking at glucose level itself it would have seen - holy crap - shut down the glucose!

 

Not unusual to see glucose levels in AM of 150 to 300 even if you did not cheat and eat late night snack. Worse yet depending on how bad the liver insulin signalling is; the liver has lots of power to dump its whole buffer out.

 

So far I am aware of 3 fixes as follows:

 

a) wakeup at 4:00 am and inject some liquid insulin. For those with smart insulin pumps on board ; they simply program pump to load a shot of Insulin at 4:00 and sleep through.

 

B) for me I take advantage of metformin and take a 750 mg pill at 10:00 pm and one at 12:00 am that will keep the liver shut up from 12:30 am through 5:00 am. 

 

c) the other choice is to eat a snack at around 2:30 am  and hopefully your islets can fire in a bolus of insulin sufficient to snag

liver and tell it to stop hammering the glucose. 

 

This matter is badly documented and explained properly. This part of Indiana Jones treasures is hidden in the government warehouse! 

 

Lastly always before you try this, contact - your Doctor to be sure your safety officer is aboard and approves!

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Kit

Hi LaRue, welcome to the group.

 

Wow, someone else who has an alternative circadian clock like I do.  For most of my life my body's "normal" was sleeping from about 4am til around noon.  Your words definitely resonate with me and I can completely relate.  My brain just does not function very well before noon.  :)

 

As others have mentioned, you are experiencing Dawn Phenomena, which is a very normal body process, but as we are diabetic, we don't handle it well.

 

I do recommend that you confirm this however.  Test yourself 2 hours after dinner.  Then, test yourself right before going to bed.  Then, a couple of times during your sleep cycle, make yourself get up and test again.  I found two or three times during the course of the night was enough for me to identify exactly when things were happening.  And last, make sure you test yourself when you get up in the morning as well.

 

This testing schedule will help you determine where the rise is coming from.  On me for example, 2 hours after dinner I would be at a certain place, lets say 90.  Bed time, which is usually not too long after that, would be about the same.

Midnight it might be 88.

2am - 89

4am - 118

6am - 110

 

After a few nights of confirming the behavior and tweaking my timing, I found that might spike hit around 3am and would go into the mid 120s or so.  As this was around 7 or so hours after dinner, I knew it wasn't directly dinner related.

 

As for your off schedule, go by your body's clock.  Morning is when you get up, night is when you go to bed.  Its the same as the average person, just shifted.  Its the body's clock that determines when these things happen, not the sun.

 

DP (dawn phenomena) is a royal pain in the rear end.  Even after almost 3 years, I still struggle with it here and there, though it has improved for me.

 

Some things that helped, a small snack at bed time.  As I am not retired and have to work on a daily basis, planning on interrupting my sleep every night was not an option.  The best options seemed to be a small piece of cheese or some nuts like pecans.  It didn't make it totally go away, but it did minimize the affect.

 

Some people say one of the best ways to avoid liver dumps (at any time) is to go into dietary ketosis and basically keep the liver's glycogen stores from refilling.  However to do so, you have to seriously limit your protein as well as carbs.  (The liver can convert excess protein into glucose.  I swear, my liver is a pain in the rear sometimes.)

I won't go into details on dietary ketosis here (there's tons of info out there) but it means really limiting your carb intake (around 20g a day) and moderating your protein intake.

 

89g of carbs is certainly not too low.  I average about 30g total a day (counting fiber).  It does mean I have given up on all grains, no fruit other than occasional berry, avocado, or zucchini (both fruits), no root vegetables with the exception of things like onions, garlic, radishes, etc.

 

Anyway, you are certainly on the right track.  Keep track of what you eat, test yourself before and after those meals so you have an idea of how they affect you, and then tweak your diet to eliminate those things which cause problems and adding in more things that don't.

 

Oh, and yes, it takes time.  For some reason I feel like the guys here have a better time than the women in this area.  Small splurges on my end (an unexpected 10g or carbs extra) can not only significantly raise my numbers, but it can take me a week to get back down to normal again.  And then my body will seem to be extra sensitive to everything.

 

After almost 3 years, I am still unable to keep my morning numbers consistently under 100, though its there more and more often than it used to be.  Keep patient, keep working on it, and give yourself time.

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LaRue

Thanks for the welcome everyone.

 

Yes, I am a proactive person. I like to meet things head on. Full steam ahead!  :D

 

I am going to try a cheese or nut snack immediately before going to bed. 

 

Of course, non diabetic people are always warned not to eat anything before bedtime. It's nice to know that advice can be reversed for me.

 

kit, good to know that the clock doesn't dictate when my morning starts. I think given the least bit of incentive, I'd be up until 4am too. There's just things that need to get done during business hours that muck that up for me.

 

However, I'm confused by what jim said about the liver starting to dump at 3am.

 

Is that independent of when someone goes to sleep? 

 

Oh, re the ACV and cinnamon, I'll take that with my right before bed snack between 2am and 2:30am

 

I going swimming now, but this evening I plan on doing some forum reading. Very interesting stuff.

Thanks

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Kit
However, I'm confused by what jim said about the liver starting to dump at 3am.

 

Is that independent of when someone goes to sleep?

 

As far as I have been able to tell with myself, yes and no.  Its not dependent on when you go to sleep, but it is dependent on you body's internal clock, and our body's internal clock doesn't necessarily agree with what the clock on the wall says or what the sun is doing.  Now, for most people, the sunlight actually helps to keep their internal clocks adjusted.  For myself and other with circadian rhythm disorders, it doesn't to it properly.  For most of my life, my internal clock ran about 6 hours slow.  If I went west a couple of time zones (so I was only 4 hours slow) I would, after a couple of days, adjust right back so I was 6 hours behind again.

 

So, I would initially assume that my body's internal clock is going to dictate when these happen.  However, that overnight (or over sleep) testing can help you determine exactly when it is happening.

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Uff Da

However, I'm confused by what jim said about the liver starting to dump at 3am.

 

Is that independent of when someone goes to sleep? 

 

I'm a type 1.5, so not everything about our diabetes situations will be alike, but I do have a dawn phenomenon (DP) and I also happen to have a body that prefers going to bed late and sleeping late. However, I'll admit that since I became diabetic, about half the time I get up, bolus insulin, eat breakfast around 4 AM, then go back to bed to get the rest of my "night's" sleep. 

 

My tests have shown that my DP starts between 3 and 4 AM and if I don't eat or inject insulin, my BG typically increases about 40 or 45 points between then and 11 AM. You'll have to do your own tests to see how large the increase is for you and what hours are typically involved.

 

One thing that can throw your tests off is eating too much protein the night before your tests. Protein takes a long time to digest, and a high-protein meal can take five, six or even more hours to digest. Digestion for many people slows when they are sleeping. I recall one time I was shocked to see how high my BG was about 4 AM. I forget exactly how much it had increased after my 10:30 PM reading, but it was something like 30 or 40 points. And my bedtime reading had been more than five hours after dinner. Usually my BG stays very level from about 10 PM until 3 or 4 AM if I don't eat a bedtime snack. Then I remembered that I'd had an unusually heavy protein dinner that night, so am almost certain that the extra protein was the explanation. 

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Kit

I have found for my body that DP will be a sudden quick spike where lets say a large amount of protein will be either a somewhat slower but steady increase, or, in my situation, I will sit somewhat steady at a higher level and stay there for a while before coming back down.

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jwags

My DP usually happens after I wake up. my bg will be stable all night and I wake up in the 90-100 range. if I don't eat it will rise to 140160. I have this documented my lots of fasting glucose labs. I do chemo every week so I have blood tests every week before chemo. My doctor can't give me a reason for the rise. Now if I eat my bgs go up but then go back to my true fasting. It is almost like my liver releases way too much glucose when I don't need it.

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jims_forum

Excellent comments by all. I had a Dexcom CGMS that allowed one to watch 24/7 and how I saw how my body was running re dawn phenomenon. On my body it seemed repeatable and in fact I saw on my body the blood glucose would elevate slowly around 1:00 am and then at 3:00 am to 4 am it would hit the glucose on harder  and keep increasing  till 9:00 am. Typically on my body my Blood Glucose would be 150 by 4:00 am and by 8:00 am would be 238! Outright nasty!

 

Regarding Metformin, one could watch and see the clamping action of metformin on liver and time it reliably. 2.5 hours after ingestion of metformin on my body my liver  would flatline  (500 to 750 mg doses) the blood glucose - shut the port on liver used to throw glucose at body. This effect would last 1.5 to 2 hours on my body and then liver would be rogue again! If dosage is insufficient liver ignores metformin. Nasty liver dumps could also be shut off by this effect. This story is not really documented widely or loudly. That said work done by Salk Institute and research teanmin France and US by direct observation in 2013 confirmed this effect and stated metformin of strong enough dose in blood to liver will bypass the liver ampk chain and signal liver to shut up directly! Interestingly the continuous keep alive of low level glucose to body is not effected as best as I could tell watching CGMS.. As an aside it is a shame we do not have low cost easily available cgms. Currently very expensive tool and sensors! Cheers!

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LaRue

Too early to call it a success, but....woot!

 

I had to get up early this morning (for me) at 8am, so went to bed at midnight last night.

 

I woke up at 2:15am, so got up and at a slice of sharp cheddar cheese.

 

Took my BG a few minutes ago, and....96!

 

Good way to start the day.

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meyery2k

La Rue - I remember those days.  Very good!  It is an accomplishment to see results!  You will soon learn how your body works and will adapt to diabetes. 

 

I would encourage you to post your morning readings in the forum set up for this.  I have made good friends there and I find it keeps me accountable to myself and to them.  You will observe first hand real life diabetes because we honestly share our reading and any slip we have.  We ALL have them on occasion, that is essential humanity. ~ Mike

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LaRue

That's a good idea meyery2k.

 

For the next couple of days I won't have a lot of time, but I've been looking around the forum, and enjoying it.

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adiantum

This is really great news LaRue.

I'm pleased you are enjoying the forum & look forward to you posting often.

 

Lee

 

..................... I've been looking around the forum, and enjoying it.

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LaRue

poooofff.....

 

Well, the elevated morning glucose continues....112 this morning.

 

However, I have made some significant changes, which brings up a question.

 

Maybe this is still just my body adjusting to changes I'm making, I don't know. 

 

Since my last post 10 days ago, I've been doing a lot of reading and watching videos about a keto diet.

 

I had always thought that was only done by body builders, and people with weight obsessions, almost like anorexic.

 

However, I soon found this way of eating is done by "normal"  ;) people as well, and found videos on Youtube done by women, who, more than anything else, just exuded good health. Not the painfully scuplted people who worry about the slightest deviation of a millemeter in their physique. 

 

I would in particular like to point out a youtube channel under the name of "healthful pursuit". I just really clicked with Leanne, who makes the videos, to the point of quickly thinking, "I could do this"

 

Since Sunday, I've been changing my style of eating, it's been really painless. Actually I feel decadent. This morning, checking with a urine ketox stick, I was for the first time in mild ketosis. 

 

I went to bed last night around 2:45am. I check my BG and it read 84. I then ate a small piece of cheese, took ACV and cinnamon capsules, and went to sleep.

 

I woke up around 9:15 and took my BG right away. It was 112. I immediately ate a teaspoon of peanut butter, and and 4 or 5 minutes later, checked it again. It was down to 105. Does that even make sense that it went down so quickly?

 

I got to thinking. If it could go down so quickly from eating just a bite of food, maybe I should keep a small piece of cheese by my bedside, and when I wake up for a few moments in the wee hours, like between 5 and 7am, before falling back to sleep I could just pop it in my mouth?

 

I'm going to try that starting tonight, but curious as to ya'lls experience and opinion.

 

My logic is since I believe if I ate at any time during the day, then fasted for 8 to 10 hours, my BG would be below 100. Why not just short circut the liver dump by feeding it?

 

Or is this just crazy talk?   :P

 

I'm going to be taking my post dinner BG in about an hour, I'll be back.

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Kit

There's a possibility that you were already heading downwards from your spike by the time you tested yourself.  I found that was what happened to me.  That can very likely be the reason your numbers kept dropping after you ate.

 

As far as I've seen, the whole lchf thing is becoming more and more popular.  It really helps as the popularity of paleo diets become more prevalent.  I remember heading a commercial on the radio one day about a local nice restaurant who was offering a zoodle alfredo dish.  yay!  :)

 

I don't have any more suggestions for your issue.  It seems everyone is different enough that different solutions apply to different people.  Keep on trying different solutions and testing.  You'll eventually find what you need.  Just keep on working on it.  :)

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LaRue

Thanks Kit.

 

Actually, kind of a grudge I held against paleo is that it seemed so "flavor of the month" It seemed like something that just made people want to go out and buy the book, or get new kitchen gadgets, the profits going into someone's pocket.

 

It's marketed to be the lastest sexy thing. Like, "all the cool kids are doing it this way."

 

I like nice things, but I'm a really simple person, including the way I eat. I've never had any interest in receipes that take something really simple, and changing it all around to make it seem like something else. 

 

For instance, I really get a lot out of chia seeds. Been using them for years. I just put some in a little water, wait until they expand, add my own loose leaf prepared tea, or just ice and water. Done.

 

Practically every time someone has seen me sipping it through a straw while out in public, or while working, I'd get the following.  "You can put that in your yogurt you know. Or I've got this great receipe where you blah blah blah." I'll listen to it all and say "What's wrong with just drinking it in some water or tea?"

 

Seeing the meals people were eating, and in not the usual "you must eat this for breakfast, this is a breakfast food" really interested me. 

 

There doesn't seem to be the concern that it has to look so perfect, and this shouldn't go with that. I've found meal prep to be very simple. 

 

AND! I can keep my chia seeds, they have practically zero net carbs!

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Kit

Most of my meals are pretty simple.  Some protein, some low carb veggies, and various fats depending on what I'm making.  Most of the time its about 15 minutes from start to finish.  Some times I make a big roast or a pot of soup, but the time involved with those is usually in the cooking and not the work to put them together.  I have to admit I adore Sausage and Pepper soup when the weather gets cold.

 

Whether or not Paleo is a fad, its popularity does benefit me, so I will happily take it.  :)

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Carol_42

Kit wrote: "As for your off schedule, go by your body's clock. Morning is when you get up, night is when you go to bed. Its the same as the average person, just shifted. Its the body's clock that determines when these things happen, not the sun.

 

DP (dawn phenomena) is a royal pain in the rear end. Even after almost 3 years, I still struggle with it here and there, though it has improved for me.

 

Some things that helped, a small snack at bed time. As I am not retired and have to work on a daily basis, planning on interrupting my sleep every night was not an option. The best options seemed to be a small piece of cheese or some nuts like pecans. It didn't make it totally go away, but it did minimize the affect."

-------------------------

Kit~ I can not thank you enough for this information. My body clock is anywhere from 2PM & 4PM to 11PM & 2 AM. I am so hoping the before bed snack on the cheese and/or pecans will help me get closer to becoming the morning owl I use to be for most of my life. Many thanks and hugs.

CB

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