Type 1-Spiking in the morning. help please?

alsunrise

So my daughter is consistently spiking in the morning as soon as she gets up. Her BG will be steady all night and as soon as her feet hit the floor she starts spiking. It's not a gradual increase through the night.... it is as soon as she wakes up and starts moving and it'll run high for about the first 3 hours of the day. The only suggestion that her doctors make is to keep increasing her Lantus. But she runs normal during the day time, usually by lunch and if we keep increasing the Lantus then she starts dropping low during the day/especially in the evening.

We're trying to get protein and water in her as soon as she wakes up and that has seemed to help a little, but not a whole lot. Anyone else have trouble with this and have any advice?

23rochelle23

It’s called the dawn phenomenon - known physiological response to noradrenaline, adrenaline and cortisol spike (same stuff for fight or flight) that encourages you to go from sleeping to wakeful.
Lots of people get it, particularly diabetics

My understanding is that limiting carbs, adjusting the TIMING of medication (rather than continuously increasing it because as you said that often results in hypoglycaemia) or using an insulin pump to regulate during the night are the most effective ways. I don’t think there is any ‘true’ way and your daughter needs to discuss any changes with her specialist before making them.

http://care.diabetesjournals.org/content/36/12/3860

alsunrise

23rochelle23 wrote: »

It’s called the dawn phenomenon - known physiological response to noradrenaline, adrenaline and cortisol spike (same stuff for fight or flight) that encourages you to go from sleeping to wakeful.
Lots of people get it, particularly diabetics

My understanding is that limiting carbs, adjusting the TIMING of medication (rather than continuously increasing it because as you said that often results in hypoglycaemia) or using an insulin pump to regulate during the night are the most effective ways. I don’t think there is any ‘true’ way and your daughter needs to discuss any changes with her specialist before making them.

http://care.diabetesjournals.org/content/36/12/3860

This actually isn't the dawn phenomenon according to her doctors/educators. Dawn phenomenon is usually a gradual increase that happens while you are still sleeping. Her spike happens after she wakes up. The diabetes educators told me that it's happening because she smells the breakfast that I'm cooking and her body is anticipating food and that there really isn't a way to prevent it.

tcunbeliever

When your body anticipates food it releases insulin, which would reduce blood glucose levels, not increase them, so that doesn't make any sense to me, I can't do that math on that.

So, in theory, consuming protein and/or fiber should help bring blood glucose levels down (because they stimulate the release of insulin)...ditto for exercise, particularly HIIT.

I like the idea of tweaking the timing of medication too, that seems like a great idea.

Regardless of what you call it - she's not eating anything and her blood glucose is going up, it's got to be some kind of internal cortisol, etc response just like dawn phenomenon, because the boost in blood glucose isn't coming from consumed food. So I would think that any methods used to offset dawn phenomenon would likely be relevant here too. That's mostly an adrenal process, so adrenal supporting foods might be helpful, or something like licorice root (assuming blood pressure is not high) or nervous fatigue (a traditional chinese herb blend) might be helpful to support the adrenals and maybe get them to calm down if they are overstimulated.

nvmomketo

My dawn phenomenon hits around 8am. I have no idea how gradual the rise is, because I don't test often.

I would think it was DF too. Cortisol goes up and BG rises. Maybe it's linked to getting moving in the morning? He liver is pumping out more BG because her body is moving and anticipating using more BG?

I can't see how eating protein would help. It requires some insulin to process too, I believe. I eat protein in the morning to help deal with DF in the morning. It seems to raise my insulin but I'm not T1D. I make insulin.

I've heard vinegar at night (or alcohol) helps limit DF because of the effect it has on the liver. It's an old T2D trick. Perhaps a shot of apple cider vinegar at bedtime? <-- This is just a guess. I have no idea how that would affect a T1D's BG at night.

@midwesterner85 Any ideas?

Sunny_Bunny_

Try having her take some salty broth or pickle juice or even pickles right before bed. I agree that it sounds like a cortisol related spike. Her body is creating the glucose. Cortisol is higher in the morning, especially upon waking.
If it’s due to stressed adrenals, it could be related to low sodium. Correcting a sodium imbalance might give some relief to the cortisol reaction if that’s the case.

T1DCarnivoreRunner

There are 3 situations that are slightly different, and I am pretty sure you have already identified it based on your terminology:

1. Dawn phenomenon
2. Symogi Effect
3. Feet on the Floor (not sure if there is a technical term, but that is what everyone in the T1D community calls it - or they call it something very similar). This is obviously what is happening... I get it too.

The solution? There are 2 possibilities:
1. Insulin pump with basal rates set to deal with this (my suggestion, depending on your daughter's age...)
2. Bolus insulin to supplement Lantus during this time.

If you don't believe me that you are not alone: https://forum.diabetes.org.uk/boards/threads/high-morning-bgs-possible-causes-and-solutions-from-deusxm.57534/#post-578674

https://forum.tudiabetes.org/t/do-you-take-when-feet-hit-the-floor-insulin/57637/4

margbarco

My daughter sometimes experiences morning spikes as well, but hers are more gradual. If I’m up early enough I’ll do a finger prick while she’s sleeping and give her a small bolus.

Can you/your daughter administer a bolus the instant she wakes up? Eyes open, sit up in bed, bolus, then feet on the floor?

alsunrise

@23rochelle23 @tcunbeliever @nvmomketo @Sunny_Bunny_ @midwesterner85 @margbarco

Thank ya'll for your responses, sorry that I'm just now responding to them. We've had another issue going on. We started a new bolus pen on Thursday and every since then around lunch time she starts running low, so we've got to do some adjusting there. Anyone else have trouble with their pens seeming to lose it's effect? We're in Alabama, so of course it's been hot, but we keep her pen in a bag made for diabetics and we try to keep it out of the heat as much as possible.

We still have the morning spike, but it's not as bad. This morning it spiked to 234. And we're trying to have breakfast ready to go as soon as she gets out of the bed. I guess I could try breakfast in bed. lol (she'd love that) And I don't understand the theory of 'it's rising because she smells the food' either, because then she would spike every time we went into a restaurant right? I'm going to try the pickles/vinegar this week and see what happens.

Thanks for putting up with my crazy questions.

cricketpower

I will repeat what was said above. Insulin rises in anticipation of a meal. Not glucose. You don't understand the theory, because it makes no sense.

https://www.ncbi.nlm.nih.gov/m/pubmed/21550357/

T1DCarnivoreRunner

cricketpower wrote: »

I will repeat what was said above. Insulin rises in anticipation of a meal. Not glucose. You don't understand the theory, because it makes no sense.

https://www.ncbi.nlm.nih.gov/m/pubmed/21550357/

That's quite an interesting study.

Since type 1's don't make insulin, it doesn't apply here... but it is still fascinating.

cricketpower

midwesterner85 wrote: »

cricketpower wrote: »

I will repeat what was said above. Insulin rises in anticipation of a meal. Not glucose. You don't understand the theory, because it makes no sense.

https://www.ncbi.nlm.nih.gov/m/pubmed/21550357/

That's quite an interesting study.

Since type 1's don't make insulin, it doesn't apply here... but it is still fascinating.

I thought so, too!

I wasn't sure if OP's daughter was T1 or T2.

I like your new pic -- almost didn't know it was you!

T1DCarnivoreRunner

@cricketpower The pic is not 'new.' It's from a zombie frenzy trail run I did 3 years ago... there were 3 categories (runners, stumbler zombies, and chaser zombies). Stumblers hid in the woods before-hand, runners were let out in waves and wore those flags used for flag football, and chasers were let out in waves a few min. after runners. The idea was that zombies tried to take flags from runners and runners tried to keep all their flags. It was a ton of fun, and the make-up was done by volunteers from a local cosmetic school.

cricketpower

midwesterner85 wrote: »

@cricketpower The pic is not 'new.' It's from a zombie frenzy trail run I did 3 years ago... there were 3 categories (runners, stumbler zombies, and chaser zombies). Stumblers hid in the woods before-hand, runners were let out in waves and wore those flags used for flag football, and chasers were let out in waves a few min. after runners. The idea was that zombies tried to take flags from runners and runners tried to keep all their flags. It was a ton of fun, and the make-up was done by volunteers from a local cosmetic school.

Yep, that sounds like a blast! Too bad you don't get to do it every year?

AND SORRY OP -- you have "Type 1" right in your title. It's an off day for me.

T1DCarnivoreRunner

cricketpower wrote: »

midwesterner85 wrote: »

@cricketpower The pic is not 'new.' It's from a zombie frenzy trail run I did 3 years ago... there were 3 categories (runners, stumbler zombies, and chaser zombies). Stumblers hid in the woods before-hand, runners were let out in waves and wore those flags used for flag football, and chasers were let out in waves a few min. after runners. The idea was that zombies tried to take flags from runners and runners tried to keep all their flags. It was a ton of fun, and the make-up was done by volunteers from a local cosmetic school.

Yep, that sounds like a blast! Too bad you don't get to do it every year?

AND SORRY OP -- you have "Type 1" right in your title. It's an off day for me.

Right, that was the last year. I'm not sure what happened because it was so much fun. It was for a small charity - orphans in some foreign country (Bhutan?). Anyway, I'm guessing the organizers have been too busy in that foreign country to do it again.

alsunrise

@cricketpower it's fine. It was interesting to read anyway.

@midwesterner I've never done a run or marathon, but you chase me with zombies and I might just finish that one. lol Sounds fun.