# High BM Readings in A Morning



## weblar83 (May 30, 2013)

Hi all,

I've just recently registered with this site so please, be gentle with me.

I'm actually posting on my girlfriends behalf who has been a type 1 diabetic for the past 15 years. I will admit to her not being a good diabetic and for the past year and a half (the period of time we've been together), I've been trying to help her to get back on track with managing it rather than ignoring it.

Yesterday she had corrective laser surgery for background retinopathy and hopefully, with her improved control, this will be something she won't need to have done again for a while - she's 26 by the way.

One thing I would like to ask for advice on is high morning readings. Having seen several diabetes "specialists" and having given them several months worth of BM readings with 90% of these having high morning readings, they're still none the wiser as to suggest what we can do. 

My girlfriend has another appointment to discuss this with her team in a few weeks time but I'm hoping for some advice a little sooner so we can really get on top of this.

During the day, her BM levels may fluctuate from 4.5 to about 8 whereas the morning reading can be anywhere from 15 through to about 22. As an example, last night before bed, she was 6.7 but this morning she was 19.

Neither of us really do hearty breakfasts, which I know is a mistake but could something this simple make a difference? There have been a couple of occasions where she wakes in a morning and has normal readings, this only seems to be the morning after a couple of glasses of wine. I don't know why that would make a difference.

I'd be really grateful if someone could share their experience or provide some advice. So far I feel she's doing really well and (courtesy of an iPad app) BM reading-wise is now averaging around about the 7 mark - lower than what has been expected of her by the diabetic specialists.

Thanks in advance for any help.

K


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## everydayupsanddowns (May 30, 2013)

Hi Weblar

Good to have you hear.

Congratulations to your girlfriend on her improved levels - and brilliant that you are supporting her.

Has your GF done much in the way of testing throught the night to see what is happening between bedtime and waking?

For high morning BGs in a T1 there are two usual suspects...

1. Dawn Phenomenon. Everyone gets this to some extent, part of the body's natural rhythm. Often said to be a throwback to our cave dwelling ancestors who needed a bit of 'get up and go' first thing in order to rush out and hunt woolly mammoths. Essentially your body has a good supply of glucose stored in the liver and muscles, and in the before dawn/just after waking (depending on the individual) you can get a little or a lot of extra glucose without having to eat anything.
2. Hypo rebound. Somewhat controversial and uncertain (some members here with continuous monitors fail to see this happen overnght), but the body does appear to have an 'emergency' mechanism that dumps glucose in the event of very low blood glucose levels. So if you sleep through a hypo and your liver decides to 'help out' overenthusiastically you can end up waking high and with a thumping headache.

The best way to find out what is happening is to set an alarm at say 3am, or perhaps 2am and 4am to check what her levels are then.

If it's DP there are a number of things that might help - the most obvious being altering dose/timing to increase basal (background) insulin to cover the rise. Some people have success with low carb snack to tame DP too.

If it's a hypo rebound it's usually because of *too much* basal, so more testiong and tweaking.

Let us know how you get on.


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## weblar83 (May 30, 2013)

Hi,

Thanks for your speedy reply and also thanks for the welcome message.

I'm proud of her so far and considering where she has been with her control, she's doing well and I'll do whatever I can to keep her going.

She hasn't done much by way of testing during the night although we have discussed waking up at 3 to do a test with correction if necessary. This was mentioned to the diabetic team but they decided that it wasn't really practical to be doing this. Possibly not the best advice but still.

We have read about the dawn phenomenon thing before. Would a more hearty breakfast get the body away from this cycle - more to do with knowing that it is going to get some food in it to give it the get-up-and-go? A low carb snack sounds like a good idea, this may have a similar result to what we've seen with a glass or two of wine.

I don't think it would be a hypo rebound given that the BM reading before bed is a long way from hypo - I could be completely wrong though.

Tweaking the basal insulin might be a good idea but what with having good readings throughout the day, I think she's a little reluctant to make changes.

Thanks again for your advice.

K


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## everydayupsanddowns (May 30, 2013)

I know from my own experience that it is very possible to drop into an overnight/early morning hypo with just a little too much basal (and the amount of basal that she needs is likely to ebb and flow throughout the year). This can be partly compounded by a drop-off in secretion of cortisol in the early hours (which helps keep BG up). So you can end up in a situation where your basal is very active at the time when your BGs are dropping, only for them to bounce back up with DP later on. Gaaaah!

The best bet IMO if she wants to fine tune control is to get basal insulin working as accurately as possible. This does involve a bit of work in terms of working out what the general 'pattern' is, but once that has been done subsequent tweaks can take place on a more ad-hoc basis.

This page is very helpful to get basal adjusted properly: http://www.diabetes-support.org.uk/info/?page_id=120

In terms of tackling DP, if that is what is causing it, I think breakfast is unlikely to help waking levels (though D is so individual it might work for her!) but is does seem to stop the liver dumping and reduce the overall rise, so certainly a good idea. Some people need to eat nothing after dinner the night before. Others need a low/no-carb snack at bedtime (some nuts, cheese or cold meats are possibilities). As with all things D, you just have to try out a few options, and see what works for the individual.

Good luck with it!


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## DeusXM (May 30, 2013)

> There have been a couple of occasions where she wakes in a morning and has normal readings, this only seems to be the morning after a couple of glasses of wine. I don't know why that would make a difference.



It sounds to me like your girlfriend's basal isn't covering her nighttime glucose output. Alcohol prevents your liver from releasing glucose. She'll need to test to confirm what's going on but my gut feeling is she'll need to take more of her background insulin - how exactly she'll need to do this will depend on the insulin she uses and the time she injects.


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## weblar83 (May 30, 2013)

Thanks for both your responses.

I *think* she takes her basal insulin as soon as she wakes in a morning and I also last thing at night before bed. I'm not sure exactly how much she takes but I've heard her mention 22 units before, I don't know whether that number is the same for both.

I guess in the short term, before her next meeting with her diabetic team, it would be worth persisting with the low-carb snack before bed. If that makes no difference - say over a week - then maybe increasing her night time basal would be worth trying. 

Would that be a sensible way to go at this?

K


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## DeusXM (May 30, 2013)

She should do some nighttime testing first to rule out whether it's dawn phenomenon because this will inform your approach.

If she finds that her readings are persistently increasing overnight, then the solution is hopefully pretty simple - more basal insulin before bed (assuming she is using Lantus or Levemir). If it's dawn phenomenon, it's a bit more complicated. A 'hearty' breakfast might not necessarily be the answer. Most people benefit from definitely having a breakfast but some people respond better to a high protein and fat/low carb start to the day, while others do much better on a carby start. Others might have the luxury of a pump, giving them an adjustable basal rate. I would also say that a daily glass of wine before bed isn't actually a bad idea at all.


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## weblar83 (May 30, 2013)

Funnily enough, I said that she should stick to the glass of wine theory before bed but I don't think she thought I was being serious. You never know, it could be the solution.

She uses Levemir insulin for basal.

We'll give the overnight testing a go to see if we can get an idea of whether the rise is gradual or just suddenly happens. Either way, the responses on here have given me good information to feed back to my girlfriend and hopefully a nudge in the direction to help her get her BM under tighter control.

Thanks for your advice.


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## DeusXM (May 30, 2013)

The other benefit is by getting her morning readings back to normal, she will feel much better. I can barely get out of bed if my BG goes over 9 and I've had morning readings in the teens which make me feel utterly dreadful. I'm not a morning person at the best of times (actually, things don't really get any better after lunch either!) but starting the day is much easier with a normal BG.


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## bennyg70 (May 30, 2013)

I have terrible trouble with morning readings if I have a barely naughty meal the night before. 

Fatty meals - Anything above around 20gs of fat will delay a spike untill 4 - 6 hours later Ie when Im asleep and then im high all night till morning. 

High protein - Even if im eating a high protein meal (Ie too much chicken) with carbs, I find some of the protein will convert hours later ie. when Im asleep.

Just another suggestion. Along with making sure that basal is set at the right amount


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## weblar83 (May 30, 2013)

Thank you for your suggestions.

I guess we're going to have to have a trial and error few weeks or so.


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## avantgardaclue (May 30, 2013)

I was told a long long time ago that if you suffer from the dawn phenomenon then take a 2 inch (ie Domino sized) chunk of cheese before going to sleep.


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## Flutterby (May 30, 2013)

I would certainly do some overnight testing as it will give you a much clearer picture and you don't want to be increasing the insulin until you have checked it's not a night time hypo resulting in a high reading in the morning.  It has happened a lot to me in the past.  Hope you can get it sorted soon.  it's very annoying to get those highs first thing.


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## weblar83 (May 31, 2013)

Some overnight testing was done last night. 

At 1:30am BM was 5.3, at 3:30am BM was 7.9 and at 7:20am this morning it was 16.9!

I think we're going to repeat the same exercise for the next couple of days but with a slight increase in the basal insulin - from 22 units up to 24 or 26 units to see what effect that has.


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## everydayupsanddowns (May 31, 2013)

Yikes! That is quite some DP spike 

Early days to be thinking about this, but one of the very best ways to combat DP is an insulin pump. There are other benefits too, but they are a bit of work especially to start with. Has your GF ever been offered pump therapy? Would she be interested?


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## weblar83 (May 31, 2013)

Those spikes are an almost every day occurrence.

I don't think my girlfriend has considered a pump and I'm not sure its ever been mentioned to her. I'm sure with a bit of analysis and tinkering, we can get the spikes under control without the need for a pump.


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## Phil65 (May 31, 2013)

weblar83 said:


> Those spikes are an almost every day occurrence.
> 
> I don't think my girlfriend has considered a pump and I'm not sure its ever been mentioned to her. I'm sure with a bit of analysis and tinkering, we can get the spikes under control without the need for a pump.



An insulin pump has really helped combat my DP, something that I always struggled with on MDI, I often used to put my morning highs down to night time hypos (as did my D Team) but since using a pump I now know that my insulin requirements from 5am to 8 am are 3 times greater than the afternoon!


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## weblar83 (May 31, 2013)

Its definitely food for thought and something to ask about next time she goes to see the diabetic team. 

We've got a few plans of attack for the next couple of weeks so hopefully the morning spikes can be reduced if nothing else.

Thanks,
K


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## Phil65 (May 31, 2013)

weblar83 said:


> Its definitely food for thought and something to ask about next time she goes to see the diabetic team.
> 
> We've got a few plans of attack for the next couple of weeks so hopefully the morning spikes can be reduced if nothing else.
> 
> ...



Good luck....but also if a pump is what she wants a strong case would be supported by evidence based basal testing.....dawn phenomenon etc,etc. It can be very difficult to get a pump and you might have to fight hard to get one, but in my opinion well,well worth it!


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## weblar83 (May 31, 2013)

Thanks for the extra information.

We'll see how we get on over the next few weeks. The diabetic team are already aware of the morning spikes so hopefully, should she decide to try for a pump, this will help her case.

K


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## weblar83 (Jun 3, 2013)

So after a visit to a dietitian late last week and some weekend basal tweaking, my girlfriends BM was a reasonable 8.5 this morning. Sunday morning's BM was much higher at 13.5 but still a lot less than it has been (16 plus) so I guess it shows a nudge in the right direction.


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## Phil65 (Jun 3, 2013)

weblar83 said:


> So after a visit to a dietitian late last week and some weekend basal tweaking, my girlfriends BM was a reasonable 8.5 this morning. Sunday morning's BM was much higher at 13.5 but still a lot less than it has been (16 plus) so I guess it shows a nudge in the right direction.



Dawn phenomenon is a tricky beast.....my weekend morning readings are much lower than my weekday readings.....during the working week my liver is dumping glucose early morning to get me ready for my working day.


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## weblar83 (Jun 3, 2013)

Ah, that's interesting. I guess the next few days with the increased basal insulin will give us a better indication of whether its helping.


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## Phil65 (Jun 3, 2013)

weblar83 said:


> Ah, that's interesting. I guess the next few days with the increased basal insulin will give us a better indication of whether its helping.



The accelerated rise in my levels first thing in the morning due to my DP (some call it "feet hitting the floor") used to rise so quickly no basal increase would match my profile, I found that setting my alarm for 5 am on MDI and taking a bolus injection would cover the rise....real pain! .....not any more Hoorah for the pump!


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## Josco (Jun 9, 2013)

You sound as though you are both beginning to get on top of the DP.  I had severe dawn phenomenon for a long time (waking BGs of 25 - 27) and until I got my pump, which has resolved the issue, the only way I could stop the steep rise was, like the previous poster, to take my morning Levemir in the middle of the night.  Not good but I had it down to a fine art and could fall asleep again straight away.  Mind you I always left it ready to use with the dose already dialled up and separate from my Novorapid pen so as not to get muddled when I was essentially still asleep!  However I only took a single injection of 96u of Levemir (no, not a typo!!) a day as any Levemir at night caused me to have a hypo.  It is all very much trial and error unfortunately.  Well done to your girlfriend for taking control of her diabetes and to you for giving her the support she needs.


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## bev (Jun 9, 2013)

Hi Weblar83,

You sound like a brilliant partner to have - well done for being such a support to your girlfriend - it makes all the difference when your partner is involved.

My son (15) also suffered with DP and nothing we tried ever helped - so he went onto a pump as he was also insulin sensitive and needed really tiny amounts of basal at times and now has 6 or 7 different basal rates going throughout a 24 hour period. We could never have gained good control using injections - it just didnt work for us and now if he gets high levels on waking we just alter his basals accordingly which is quite a lot as teenage growth hormones also play havoc!

The best advice I can give is to test test and test again throughout the night to help build up a picture of whether this really is DP or something else. Once you have the data you can act on it as knowledge is power and all that. Like others have said there are things you can do on injections to try to help - its about timing and only when you know what your dealing with can you work out the solution. If it doesnt work then maybe apply for a pump if your girlfriend is interested in one - but having the data will help show her team what she is up against and also that she is committed to gaining good control.  A pump initially is hard work and you have to be patient - but it is worth it and my son would never go back to injections now as its so much better dealing with issues on a pumpBev


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## Maryanne29 (Jun 14, 2013)

*Try this for morning highs*

My blood sugar can be very high in the morning, despite being good when I go to bed. My dietician suggested it could be because it is dropping very low during the night and as the body tries to compensate for this, a rebound high is the result in the morning.

She suggested checking my BM during the night to see if this is showing low and if so adjust the insulin taken before dinner - or have something to eat before bed. I only saw her yesterday so haven't had a chance to try this out yet but I will.

See if it works for your girlfriend.

Maryanne


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## Josco (Jun 14, 2013)

Maryanne29 said:


> My blood sugar can be very high in the morning, despite being good when I go to bed. My dietician suggested it could be because it is dropping very low during the night and as the body tries to compensate for this, a rebound high is the result in the morning.
> 
> She suggested checking my BM during the night to see if this is showing low and if so adjust the insulin taken before dinner - or have something to eat before bed. I only saw her yesterday so haven't had a chance to try this out yet but I will.
> 
> ...



I discovered that as well as DP as I was also having problems with overnight hypos which my body was dealing with.  I then had high BGs in the morning but they way that I knew that they were not being caused by the  DP was that I felt extremely unwell for several hours after getting up in the morning.  I would feel very sick, have a splitting headache and generally felt "toxic".  I used to thing I was coming down with something but eventually realised that there was a pattern in terms of timing and duration of the symptoms.  Once my Levemir was sorted out at night i.e. stopped! then my symptoms did not recur


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## Pattidevans (Jun 14, 2013)

weblar83 said:


> Some overnight testing was done last night.
> 
> At 1:30am BM was 5.3, at 3:30am BM was 7.9 and at 7:20am this morning it was 16.9!
> 
> I think we're going to repeat the same exercise for the next couple of days but with a slight increase in the basal insulin - from 22 units up to 24 or 26 units to see what effect that has.


I know this was posted a while back, I was just going to say that with Levemir even a half unit makes a huge difference, I'd never increase by 2u.  Get your g/f to ask for a half unit pen.  I take 12.5u at night and 11u in the morning.  When I tweak I do it by half a unit and this nearly always works.

My other suggestion is to get a copy of Gary Scheiner's book "Think like a Pancreas".  It is easy to read and gives you a real grip on what you need to do to gain good control.

FWIW I too suffer DP and it drives me mad!  I can go to bed in the 5s and test up to about 6am in the 5s and get up in the 10/11 range and it will continue to rise and rise until I eat something and take a correction dose with the meal dose.  It was this that pushed me to ask for a pump and thankfully I am getting one next month 

I'd also like to say how great it is that you are supporting her like this!


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