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Fasting/Prebreakfast Blood Sugars are always High
Hello,
Ever since the beginning of summer, I've been waking up a few hours later than usual (usually 9:30 instead of 6:00 am)... Ever since, I've noticed that my morning blood sugar is very high (350-400). I take one dose of Lantus at 6:00 pm (But only 5 units, as I've constantly dropped it in the past to stop from going low during the day), and I inject Humalog before meals (1 unit for every 10 grams of carbs I eat). I am wondering what I can do to control my morning blood sugars? What if I gave me Lantus at 10:00 pm instead of 6:00? Also, am I giving myself enough Lantus? I've heard of other people giving more like 15 units of Lantus, but I think I would constantly go low during the day if i raised my unit intake. Could my weight have something to do with my lack of Lantus injections (I only weight 118 pounds or so)? Thank you so much for all of your help!
-Gary
Ever since the beginning of summer, I've been waking up a few hours later than usual (usually 9:30 instead of 6:00 am)... Ever since, I've noticed that my morning blood sugar is very high (350-400). I take one dose of Lantus at 6:00 pm (But only 5 units, as I've constantly dropped it in the past to stop from going low during the day), and I inject Humalog before meals (1 unit for every 10 grams of carbs I eat). I am wondering what I can do to control my morning blood sugars? What if I gave me Lantus at 10:00 pm instead of 6:00? Also, am I giving myself enough Lantus? I've heard of other people giving more like 15 units of Lantus, but I think I would constantly go low during the day if i raised my unit intake. Could my weight have something to do with my lack of Lantus injections (I only weight 118 pounds or so)? Thank you so much for all of your help!
-Gary
Now is the time, as stated by others, to do a nightime "Reality Check" of your Blood Glucose.
When I suspected I may be hitting a low (night sweats, waking up in the middle of the night for no reason, a few nightmares) - I scheduled my alarm clock one night to go off every two hours to test and track my BG.
I agree with everyone else, my dawn effect is never much higher than say 110 when I sleep in.
What do you eat as a snack before bedtime? Personally - my weakness is lightly salted roasted Peanuts. Although protein, if I eat more than the recommended 39 pieces, the effect of these little tastey treats can slightly spike my BG as much as 3 hours later.
Just for your information (from S. Robert King's website (Mr. Metabolism):
The dawn effect is an increase in insulin resistance (or decrease in insulin sensitivity) caused by hormones released about two hours before you wake. These hormones are under the control of the pituitary gland, and thus the brain. The dawn effect is influenced by testosterone and tends to be more significant in men. It is highly variable from person to person. Your overnight insulin is taken to counter the dawn effect, and on average, diabetics take 20% of their insulin overnight.
The Symogi effect is the tendency of the blood sugar to rise as a result of low blood sugar. Low blood sugar can trigger release of hormones such as glucagon that raise blood sugar.
The liver would normally respond to declining blood sugar by increasing glycogenolysis, as I discussed above. But insulin inhibits glycogenolysis, and as you may have observed, low blood sugar occurs most often near an insulin peak.
Diabetics store slightly less liver glycogen than non-diabetics, but the difference is not thought to be very important. In well fed people, the carbohydrate stores are:
Muscle glycogen...1,700 calories
Liver glycogen..........500 calories
Plasma glucose...........12 calories
When I suspected I may be hitting a low (night sweats, waking up in the middle of the night for no reason, a few nightmares) - I scheduled my alarm clock one night to go off every two hours to test and track my BG.
I agree with everyone else, my dawn effect is never much higher than say 110 when I sleep in.
What do you eat as a snack before bedtime? Personally - my weakness is lightly salted roasted Peanuts. Although protein, if I eat more than the recommended 39 pieces, the effect of these little tastey treats can slightly spike my BG as much as 3 hours later.
Just for your information (from S. Robert King's website (Mr. Metabolism):
The dawn effect is an increase in insulin resistance (or decrease in insulin sensitivity) caused by hormones released about two hours before you wake. These hormones are under the control of the pituitary gland, and thus the brain. The dawn effect is influenced by testosterone and tends to be more significant in men. It is highly variable from person to person. Your overnight insulin is taken to counter the dawn effect, and on average, diabetics take 20% of their insulin overnight.
The Symogi effect is the tendency of the blood sugar to rise as a result of low blood sugar. Low blood sugar can trigger release of hormones such as glucagon that raise blood sugar.
The liver would normally respond to declining blood sugar by increasing glycogenolysis, as I discussed above. But insulin inhibits glycogenolysis, and as you may have observed, low blood sugar occurs most often near an insulin peak.
Diabetics store slightly less liver glycogen than non-diabetics, but the difference is not thought to be very important. In well fed people, the carbohydrate stores are:
Muscle glycogen...1,700 calories
Liver glycogen..........500 calories
Plasma glucose...........12 calories
Gary,
High morning blood sugars normally mean one of two things : inadequate insulin during the night or a re-bound.
The dawn phenomenon often causes somewhat elevated morning blood sugars. But, especially because you inject your Lantus at night, it wouldn't normally cause the blood sugar to go as high as 350-400. Up to 200 would be more in line with the DP effect.
A re-bound occurs when your blood sugar drops during the night to the point where your liver comes to the rescue. It releases glycogen into the bloodstream. And this causes a very rapid rise in the blood sugar to the kind of levels you have been experiencing.
The only way to find out what is happening is to set your alarm and test a few times during the night. Alternatively, get hooked up to a continuous glucose monitoring system for a few days.
I have found that my blood sugar doesn't have to fall so low that I wake up for a rebound to occur. Youyr liver can also dump glucose into your bloodstream simply because you haven't eaten for a long time.
Either way, you can avoid this effect by having a snack before bed. Eat something that is low GI, like an apple. It should keep you going until the morning.You could also try shifting your Lantus shot from 6pm to first thing in the morning.
Cheers,
Mark
High morning blood sugars normally mean one of two things : inadequate insulin during the night or a re-bound.
The dawn phenomenon often causes somewhat elevated morning blood sugars. But, especially because you inject your Lantus at night, it wouldn't normally cause the blood sugar to go as high as 350-400. Up to 200 would be more in line with the DP effect.
A re-bound occurs when your blood sugar drops during the night to the point where your liver comes to the rescue. It releases glycogen into the bloodstream. And this causes a very rapid rise in the blood sugar to the kind of levels you have been experiencing.
The only way to find out what is happening is to set your alarm and test a few times during the night. Alternatively, get hooked up to a continuous glucose monitoring system for a few days.
I have found that my blood sugar doesn't have to fall so low that I wake up for a rebound to occur. Youyr liver can also dump glucose into your bloodstream simply because you haven't eaten for a long time.
Either way, you can avoid this effect by having a snack before bed. Eat something that is low GI, like an apple. It should keep you going until the morning.You could also try shifting your Lantus shot from 6pm to first thing in the morning.
Cheers,
Mark
Dear Gary,
If you were on the pump they would have you increase your nightime basal rate. So increasing your Lantus might be adviseable but a question like that would be best answered by your doctor. i try to keep in pretty good contact with my doctor to have someone who can help with such questions like that. But taking your Lantus before meals may have been what had kept your morning blood sugars more normal in the past. Diabetics go through a period in the morning known as the dawn phenomenon which raises the blood sugar. And using the pump as i do it calls for increasing the basal rate during that time period. Which is why you should check with your doctor as he may have you take a little extra humalog for it instead of increasing your Lantus. Good luck, bret
If you were on the pump they would have you increase your nightime basal rate. So increasing your Lantus might be adviseable but a question like that would be best answered by your doctor. i try to keep in pretty good contact with my doctor to have someone who can help with such questions like that. But taking your Lantus before meals may have been what had kept your morning blood sugars more normal in the past. Diabetics go through a period in the morning known as the dawn phenomenon which raises the blood sugar. And using the pump as i do it calls for increasing the basal rate during that time period. Which is why you should check with your doctor as he may have you take a little extra humalog for it instead of increasing your Lantus. Good luck, bret
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