So I can't seem to get my morning blood sugars down. When I wake up- they are perfect, but as soon as I start moving around they go up. I was assuming my morning metabolism is really slow, but part of me feels like I have insulin resistance in the morning. My pump basal rate in the am is 2-3x what it is for the rest of the day. When I bolus for food, I have to do it again 2-3x and don't even eat much to try and avoid a big swing. I read littel tidbits about caffeine affecting blood sugars, and I am a diehard morning coffee person. I have a little trouble understanding this though, because afternoon caffeine doesn't seem to affect my blood sugars. Does anyone else have morning issues? Oh and one more thing, I started on Apidra, seems to work great after lunch and on.
[quote user="ginny"]
part of me feels like I have insulin resistance in the morning.
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this is exactly correct. it happens to almost everyone, even non-diabetics. for whatever reason, insulin isn't utilized as well in the morning. do you work out at all? if you do and wouldn't mind mixing around your schedule a bit, you can try to move the exercise to the morning hours to try to encourage that insulin to work more efficiently. or, you could try eating a lower carb breakfast and adding in a morning snack somewhere, after your body wakes up and the insulin starts working better, to keep you from feeling starved.
Any breakfast suggestions? I had been trying veggie sausages- they are quick and I can eat them on my way to work, only 6 carbs, but still needing a lot of insulin. I do exercise at night. There is probably no way it is going to happen in the morning- I get to work by 7:30am, it seems like my body doesn't get up til about 10:30! Anyway- I appreciate the input, and if I can get up earlier I'll try a quick walk, and see how much I need to do to help. If anyone has some good hearty non-blood sugars raising breakfast ideas, please share!
protein and fatty foods or "free" foods like eggs, meats/seafoods, low-fat dairy, nuts, veggies, SF jello... those would have minimal impact on the blood sugar. there is a thread on juvenation somewhere about "free foods" and another one about "low-carb snacks". you can do a search for those topics and try some of the foods people suggested.
I've been hooked on a fairly low-carb, low calorie breakfast for the past few weeks: egg white omeletes with spinach and feta cheese. Use a little olive oil on medium heat to wilt the spinach, then add the rest. I also do one slice of toast - so, 11 carbs... and this has been working pretty well for me. Plus, it's super yummy! (Of course, it takes a little big, and some mornings it makes me late for work - lucky for me I have a super cool boss who doesn't care about a few minutes.)
Yep - C is right. The reason is that there are certain hormones that work against insulin that peak in the morning. Cortisol is the main "counter-regulatory hormone" that spikes each morning and as its increasing, we become more insulin resistant and produce more glucagon. This leads to more glucose released from the liver. One thing to make sure, however, is that you aren't becoming very low at night and your blood glucose is spiking in response (Samogyi response).This is more typical of type 2 diabetes and less likely if you use a pump but still. . .
If you are a pumper, it can be remedied with a change in basal rates. To really assess your insulin needs, you should talk with your doctor about performing a basal check. It involves fasting after dinner and for as long as you can the next day with glucose checks at least twice overnight. Using a CGM device can be really helpful for delineating the glucose trend and most endocrinologists have one that you can wear for 3 days to get the readings. This helps to determine whether the basal insulin you are using is sufficient and if not, at which points in time you need more.
Thanks- very helpful info! I am trying to pay more attention to my monthly cycles and the effects on my insulin resistance. I have a CGM and perpetually get overnight lows, and have been slowly adjusting my basal rates accordingly. This past weekend I had 2 nights that I ran higher- so I did a temp basal rate for those nights (oh and I was working over the weekend). The following day was on a controlled burn (very intense exercise), and that night decided to leave my basal rates alone. Perfect all night! That next day had some field work, not prolonged, probably done by noon. Did go for a lazy run that evening. That night woke up with a low, but tweaking the basal rates definately curbed the intensity.
So days I am in the office I have a much higher am basal rate, and feel more of that resistance versus days I am in the field (even doing minor work), I am sometimes either turning the pump off, or doing a lower temp basal rate. It seems like a substantial difference- but I guess appropriate? Does anyone take a birth control specifically to help curb the hormone fluctuations? I am 31 years old, so my body is probably wondering why I haven't had a kid yet.....
I read that this rise in blood sugar in the morning is a natural adaptation of humans. We tend to forget that we are animals and mammals that sleep at night need to go hunting/foraging for food after "breaking the fast". To do that you'll need energy and hence the liver dumps Glycogen into the blood streaming to give a boost of energy.
http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=stryer&part=A2911