# Counteracting DP



## Unicornz (May 17, 2011)

Hi all 

I've been messing around with my basals for a while now trying to counteract the DP I'm experiencing every morning (except for weekends when I sleep in). Basically, my levels are fine when I wake up (usually between 6 and 8) but then when I get to work 1.5 hours later they have shot up to around 14. 

What I've been trying to do first is to set my basal up to try and counteract it, which seems to go wel for a few days. After that, it always seems as if my liver is having none of it and starts kicking out more glucose just to be a pain in the ass and my levels start going up again! 

What I've thought of now is to maybe give a preventative correction bolus when I wake up instead. I was just wondering if anyone else does that and which type of bolus would be best to use? I tried a normal bolus yesterday and a square wave today. So far, the normal one seemed more effective but because the period between waking and breakfast is 1.5 hours I thought a square wave one over 1.5 hours might be better? 

Any thoughts would be greatly appreciated!


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## Adrienne (May 17, 2011)

Hiya 

When do you have the higher basal kicking in to counteract the mid morning spike? (or whenever it is 

For my daughter her highest basal is between 5 am and 9.30 am.   It has to start at 5 am purely to counteract the 10 am spike.   I started at 8 am and slowly it moved back and back till we hit 5 am and it also went up and up and is now the highest.   Generally it works.

Also we bolus for breakfast at least 20 minutes before eating it.   A friend of mine bolus' 1.5 hours before breakfast to get the best effect and no spike so this is similar to what you are saying.   I would go slowly on this in case a bolus has the effect of just hypos instead.  Good luck, this is the hardest part of the day for most I think.


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## novorapidboi26 (May 17, 2011)

DP is a strange beast...........

But my understanding is it happens in the small hours/few hours before your internal clock expects you to get up............

And also the theory that giving yourself carbs at breakfast will then shut off the liver or at least slow down this process is being proven correct, well for me anyway.....

Im not on a pump, but if I woke on target and continued to be high before lunch I would expect a bolus ratio change at breakfast to correct it.........was this your first consideration............................have you got a higher basal rate in the small hours?


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## Unicornz (May 17, 2011)

My basal rates at the moment are as follows: 

12AM to 3AM - 0.9 u/h
3AM to 6AM - 0.85 u/h 
6AM to 11AM - 1.1 u/h

It's around 0.7 u/h the rest of the day. 

I have to stress that it's ONLY the period between when I wake up and when I have my breakfast at work that's the problem at the moment, which is a total period of 1.5 hours between 7AM and 8.30AM. After I have my breakfast and before lunch my levels have returned back to normal again so I don't think any ratios need changing at the moment  Thanks for the ideas!


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## novorapidboi26 (May 17, 2011)

A Basal increase in that time is a consideration then......such as short time frame, but one thing that the pump can help you with.........


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## Pumper_Sue (May 17, 2011)

Bottom line is you need to do some proper basal testing and see exactly when the rise occurs. It is obviously a basal problem as you haven't eaten.
I am assuming you have a work basal and a wekend basal.


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## everydayupsanddowns (May 17, 2011)

I guess the difficulty in this particular case of using a basal pattern change would be the onset/duration.

The rise does not start to happen until rising, but then happens rapidly over the next 1.5 hours. By lunchtime (what would that be 5-6 hours later?) levels are restored. Presumably because your breakfast ratio is higher than you need and is squashing the spike? Or are you including a predictive correction?. 

Basal pattern would be a gradual release over the hour wouldn't it? So micro-units of insulin all with their own 4 hour profiles releasing over x hours. Whereas what you actually seem to want is a bit more of a splurge of insulin since your rise is so steep, and in 5 hours you've normally sorted it.

I suppose you could programme a hefty basal increase 1 hour before you rise, but would you then risk waking low?

Have you tried eating something high protein/fat on waking (can't remember where I read it, but I think some find it can persuade their livers to behave themselves)

Sounds like you've done quite a bit of testing - would be interested to see what your average rise was, and if you whacked in a bolus for that on rising how fast it appeared to start working (might need to test that on a weekend!). Similar to Adrienne's friend I need to leave a good 45 mintues to an hour for my 'rapid acting' to be seen to get going in the mornings .


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## Pumper_Sue (May 18, 2011)

As I have said previously uni's basal is out. She needs to do some basal testing on work days find out when the rise starts adjust basal to suit.
As she is then dropping down to normal at a later time obviously that basal is to high for that period. Hence basal testing is needed.
This is why having the ability to think ahead when using a pump is vital.


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## everydayupsanddowns (May 18, 2011)

And MDI 

Out of interest... what is the maximum you can set as a basal rate? Could you set 4u/hour for 15 minutes (thereby giving yourself the 1u all at once to rather than 1/4 of a unit every 15 mins)?


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## Pumper_Sue (May 18, 2011)

everydayupsanddowns said:


> And MDI
> 
> Out of interest... what is the maximum you can set as a basal rate? Could you set 4u/hour for 15 minutes (thereby giving yourself the 1u all at once to rather than 1/4 of a unit every 15 mins)?



Maximum depends on what you have set your pump to deliver. (safety settings)
Some pumps can set the basal for every 1/2 hour others are by the hour.
The insulin is trickled in every 3 mins at the rate you set for the length of time required. Obviously you have temp basals to play with as well


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## Unicornz (May 18, 2011)

I will be doing some proper basal testing soon, thank you! 

Another thing I was wondering which ties in with that, if DP only lasts until you've had your breakfast, how does that work when you do fasting basal testing then? Will it just keep rising all morning?


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## everydayupsanddowns (May 20, 2011)

I've had liver dumps that have gone on for hours after overnight hypos - certainly into the afternoon, so I suppose it's possible.


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## novorapidboi26 (May 20, 2011)

Unicornz said:


> I will be doing some proper basal testing soon, thank you!
> 
> Another thing I was wondering which ties in with that, if DP only lasts until you've had your breakfast, how does that work when you do fasting basal testing then? Will it just keep rising all morning?




From my testing last week, I would say yes..........

By having no carbs for breakfast my blood sugar continued to rise and in fact knocked the whole day off, following this I increased my morning dose of Levemir and have went back to having carbs.......

Its annoying, but make sense I suppose..........


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## trophywench (May 20, 2011)

Not only do you not have breakfast - or whatever meal it is you are testing - you aren't supposed to actually do anything either.  I find no problem doing knob all for hours on end so that hasn't been an issue for me!  LOL

However if you must 'do stuff' after the missed meal instead of not eating at all you could try just having a small amount of protein and nothing else.  The body only converts protein and fat to glucose if it hasn't got any carbohydrate and if it has nothing it will draw on its stores aka liver dump.  Now some people do have to have insulin to deal with protein and fat but I find I usually don't.  Anecdotally it seems that the needing insulin with protein and fat happens more where the whole diet is lower carb - because the body has got used to having to get its glucose from those sources instead of carbs.  I can't explain this scientifically but perhaps it's worth a try? - nothing to lose from it anyway!


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## Pumper_Sue (May 20, 2011)

trophywench said:


> Not only do you not have breakfast - or whatever meal it is you are testing - you aren't supposed to actually do anything either.  I find no problem doing knob all for hours on end so that hasn't been an issue for me!  LOL
> However if you must 'do stuff' after the missed meal instead of not eating at all you could try just having a small amount of protein and nothing else.



Where ever did you get that idea from? 
The idea of basal testing is to have a normal day and test as you go along.
If you do nothing then your basal does not match your normal day.
Which equals a complete waste of time and and a missed meal for nothing.
Please also note you must not eat protien or fat durring the test either.
The only thing that is recomended if starving is SF jelly. But do check the carb values as some flavours have carbs.


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## Adrienne (May 21, 2011)

Yep 100% agree with Sue.   When basal testing, you must not eat anything, its hard for some children so SF jelly but no protein or fat or anything at all otherwise  and adults can deal with this.   Also you must carry on with your normal routine.   If you don't then you can't test your basal compared to what you would normally be doing even if it is slightly different each day.  

Good call Sue.


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## Unicornz (May 21, 2011)

Tonight is the basal testing night! Won't be eating or taking any insulin after my tea but jut wondering do you guys think I'll be allowed to drink caffeine free tea without milk or sugar?


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## Adrienne (May 21, 2011)

So long at it is caffeine free as that affects levels.  I don't know really though, I would think so.    Having a child I have not had that question before.   

Hopefully someone else can come along to answer better than me.


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## Pumper_Sue (May 21, 2011)

Unicornz said:


> Tonight is the basal testing night! Won't be eating or taking any insulin after my tea but jut wondering do you guys think I'll be allowed to drink caffeine free tea without milk or sugar?



Here you go Uni,
http://www.diatribe.us/issues/13/learning-curve.php

I hope the artical helps you.


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## Unicornz (May 21, 2011)

Thanks Sue, that does help  bookmarked it straight away!


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