Hello-
Someone that I know has recently been diagnosed. Her sugar levels get really high after having breakfast. Her numbers can go as high as 300 and she usually needs some extra insulin to help those numbers go down. Any advice so that her blood sugars don’t rise so high? It seems as if no matter how much insulin she receives before having breakfast, nothing helps.
Hi, and welcome to Type One Nation! Lots of folks more experienced than I am on this site, but I know how frustrating it can be! It’s totally normal to need more insulin in the morning. Is your friend taking shots, or on a pump? Presuming it’s shots (most docs want patients to get the hang of this without technology first, for two reasons: 1, there’s a lot to learn, and taking it slowly helps keep the information flood from being overwhelming; plus 2, machines break and power goes out, so knowing how to manage manually is truly a non-negotiable life/health/safety requirement), your friend probably needs more insulin per carb in the morning than later in the day. The endocrinologist or diabetes nurse educator are the ones to ask for specifics.
Your friend can also try giving the insulin a head start — food can raise BG faster than most insulin can start to lower it. Again, the medical team can give more specifics, depending on what kind of insulin and whether the carbs are fast- or slow-acting, etc.
And it matters what order food gets eaten in, too. Believe it or not, starting with a protein or a fat before eating the carbs really does matter. Basically, that’s another way to give the insulin a headstart.
Lastly, your friend can experiment with how many of what kind of carbs, and adjust accordingly. Juice and fruit raise sugar fast and burn out fast, too. Yogurt is slower to release, so it rises more slowly and sticks around longer. Things like eggs, meat, nuts, cheese, and veggies have almost no carbs; those will have the least effect on BG, and they slow down the carbs that accompany them (so peanut butter toast will raise BG more slowly than straight toast, for example, and a handful of nuts followed by toast will raise it more slowly still). Some people eat fewer carbs, period. Again, the endo, nurse educator, and nutritionist are the best resources.
If your friend is on a pump, a higher basal rate in the early hours might be the thing. And you guessed it: the doctor and educator are your friend’s best friends right now.
As people get more comfortable and more experienced, they make these decisions more and more on their own. Diabetes is very much managed by the people who have it themselves directly, once they get comfortable with how the disease affects them — but it’s completely expected to lean on the experts especially heavily at the beginning. And ask the wonderful people here, too.
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Thank you so much for the advice and tips we are going to give them a try!
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I didn’t see any mention of her numbers before breakfast. My thought is, if her numbers were good overnight and prior to the meal, her insulin:carb ratio may need to be changed. Someone has already stated how important it is to work closely with her doctor since she is new and learning. Those of us with more experience have a good idea of how to “tweak” their pump settings or injection doses. But since she is new this is something she will want to discuss with her doctor.
I’ve found it very helpful to download my device/s - pump, stand-alone CGM, or BG meter - and share the results with my doctor’s office. Taking a look at the patterns, she can make recommendations by phone without me having to go on for a visit.
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Hi Alexa @arodric5002, my first recommendation is that your friend share her COMPLETE diary [foods, activities, insulin, and emotions] with her physician and receive professional advice. Your friend, should request diabetes basic training which will discuss timing of insulin and effects that differing foods will have on her glucose levels.
@srozelle, gave a very good explanation and effective education for matters to consider based on how she has effectively helped her daughter manage diabetes. My thoughts are very similar to what she wrote. A “higher” BG is quite common after breakfast, for a number of reasons. Two of those reasons, could be: ONE, the insulin she took before beginning eating had not started working before she ate: and TWO, the normal adrenaline dumped into her body to assist “wake-up”, effectively elevated blood sugar - called “dawn-phenomenon”.
Thoughts posted here are opinion based on experiences encountered while living with diabetes, and should NOT be used in place of professional medical advice.
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@arodric5002, Welcome to the JDRF Nation. There are many people here with mountains of knowledge. If you have questions, there are people here with answers once they see your question.
In regard to high blood sugars in the morning, check out “DAWN EFFECT” or “DAWN PHENOMENA”.
What is happening here in MOST cases is the person has not eaten for hours and the liver releases glucose into the blood stream. The person does not have enough insulin to cover the release of glucose into the blood stream. Then, first measurement of blood sugar (usually before breakfast) is high. People on insulin pumps work with their endocrinologist for a little boost in the amount of insulin their pump gives in the early morning hours (0430 - 0800) or what ever time they get up.
Hope this helps. Stay safe. Ask any question you may have. There are no questions you should not ask. All of the people here are here to learn and share.
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Breakfast can be hard because you’re READY TO EAT. It took me a while to find a breakfast that didn’t spike my BG too much. For me, it was substituting almond milk for regular skim milk. I also know that I need more insulin in the mornings than I do for other meals or snacks.
A food/insulin dosage diary with Bg 2 hours after eating would be useful. Your friend’s doc can help adjust dosages based on that.
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Hi, I just read about the high sugars in the AM and the “Dawn Effect.” This effect (DE) is real and it has plagued me since the mid 70s when I was diagnosed. I’m currently using a Medtronic 670 G in auto mode. The pump has been working well for me. However, I notice in the mornings after a very stable glucose in the normal range throughout the night, that my glucose will begin to rise without eating anything. So, when my glucose approaches about 150, I give myself a bolus to attenuate the rising glucose. Even if I don’t eat anything, I have to bolus (or exercise) to prevent my glucose from hitting the stratosphere. And I can only get away with bolusing and eating minimal carbs. I am also not as sensitive to insulin as I used to be and this exacerbates the situation. Advice - be consistent in your approach to managing this condition. Know what you can or can’t get away with. Importantly, work closely with your endocrinologist or CDE as they will guide you in the right direction. Whatever you might be facing that’s challenging, they’ve seen this before.
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This is pretty basic advice, but cereal really spikes my son’s blood sugar, so he eats more protein-rich foods in the morning like eggs or yogurt, and try to bolus at least 15 minutes prior to eating.
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