Hi,

This is long, so if you can weed through it and understand I will appreciate it.

This just began this week. I wake up at 5-6am and my bs is fine (100-115). By 7-8am it has gone up (Dawn Phenomena) and this is before Breakfast. At breakfast (7am) I eat nothing but 1/2 cup of egg beaters and 1/4 cup of fiber one or oatmeal.

At noon my ps is 180-190. I even exercise in the morning walking 4mph on the treadmill for thirty minutes or lifting weights.

I take Junuvia (150mg)and glimepiride ( 4mg - breakfast. 2mg- supper). I took 6mg of the glimepiride this morning at 7am with the same breakfast, but at noon my bs was 190. I was told not to miss a meal so I eat at 1pm so it drops a bit, but not much.

Then throughout the afternoon it begins to drop. Eat supper at 7pm by 11pm it is often 225-250, but almost always over 200.

It was not like this the last few weeks. Even the exercise is not bringing it down in the morning.

I called my doctor and he goes by the A1C. Last time it was under 7. I believe it was 6.8. He told me to wait until I had my A1C taken again which is 5 months.

Could it be that I am not eating but a small amount of carbs for breakfast? I would think it would drop very low with the small amount I eat. I do eat a larger supper. Any advice or help would ease my mind. - Sam

Hey thee,
yes it could very well be that you are not eating the correct amount at breakfast. I know what it's like, but you really should eat a bit more at brekfast to get through the day. It will help you very much

It sounds as if your blood sugar is going way up in response to carbohydrates. Since Type 2 is a progressive illness, it's possible that you've just reached the stage where you may have to add some insulin before meals.

Try testing two hours after each meal (start the timing when you START the meal, not when you finish.) Keep a log, and if it's staying up near 200 all the time at the 2-hour post prandial, then contact your doctor again and tell him you don't want to wait 5 months for another A1c...he could do it again in 2-3 months (from when you last had it done.)

Ruth

Ruth,
I am not on insulin. Could it be possible that I eat to many carbs at night. Even though at 6am it is normal. What I mean will bs go back up from what is in your system the night before even though it is normal around 6am. Also, do you agree with post above I need to eat more for breakfast if my bs is somewhere around 135. I take my meds and eat so little at breakfast and it is 190 at noon. I don't even eat a table spoon of carbs at breakfast take meds, eat little, and it is 190 six five hours later. It doesn't make sense. I even took an extra 2mg of the glimepride this morning. It did no good at all.

I have a stress test and new pm implant coming up within the next six weeks. I don't want to experiment with new meds until that is over with and I am recovered. - sam

Hello Sam,

I seemingly have a laundry list to discuss, but please understand I may not have the solution.

1. First off, as a diabetic it is best if you space out your nutrients (quantity and quality) throughout the day in many meals. Never “load” one meal – as it’s the diabetic’s Cardinal sin.

2. Do you take a multi-vitamin? I recommend one that is complete such as a men’s “active” vitamin. (minerals, amino acids, etc.). Initially I suggest daily for a few weeks, but then wean to 3-4 times a week at most.

3. I don’t know if your insurance covers such a thing, but I get a FULL blood work-up once monthly. By that I mean that I have many things checked for MY records:

A1C
Fasting blood sugar
Full liver panel
Triglycerides
Cholesterol (HDL/LDL ratio…)
Iron
Protein
Vit B
Ammonia
Sodium
Phosphorus
… and about 300 others (literally)

There is a great deal of information with the results that you can investigate on “your time” which I promise will teach you more than all your health care professionals together can tell you.

4. In your situation, I would strongly suggest that you NEVER eat a high-carb meal. Also, pay attention to which carbs you do eat that are high in the glycemic index.

5. Testing is very important. If not already, test frequently now. At minimum I would direct you to test 4-6 times a day, always being consistent and recorded.

Morning (fasting)
Just prior to a meal
One hour following a meal
Two hours following a meal
Nightime (prior to bed)

With these numbers over time, health care professionals (and you) will have the necessary data to suggest treatments (or change).

6. Oh, and I am not certain it will help you, but I always recommend a high protein breakfast to start the day. There’s lots of data behind this, so maybe give this a shot. Keep in mind though that I believe it is an extreme mistake to make the morning meal a high-carb meal.

7. Exercise / sleep / lose weight – all of which you already know.

8. Water, drink often, then more. If you are drinking alcohol or caffeine, try to quit or cut down as much as possible. This is really important.

If your numbers still remain high, as stated, you may need insulin. I hope that you can get a grip on this soon. I wish you well.

~ Mark

I relate to you. Same was going on with me. Endo told me you get to a point where you have to take insulin. The meds are not working, and especially for morning highs.

I have been in insulin 5 months now and am feeling better, however the insulin needs a bit of a tweeking still, the mornings are still a bit high.

I take rapid before meals according my readings and Levemir ( long lasting) at bedtime.
My A1C was 8.4 before the insulin and now it has dropped back down to the 6 level which is good, but could be better.
Taking insulin is so easy now. The pens are great....:angel:

I relate to you. Same was going on with me. Endo told me you get to a point where you have to take insulin. The meds are not working, and especially for morning highs.

I have been in insulin 5 months now and am feeling better, however the insulin needs a bit of a tweeking still, the mornings are still a bit high.

I take rapid before meals according my readings and Levemir ( long lasting) at bedtime.
My A1C was 8.4 before the insulin and now it has dropped back down to the 6 level which is good, but could be better.
Taking insulin is so easy now. The pens are great....:angel:

Thanks for this response. I think you are correct. My doctor told me to wait until my next A1C test. I have some other issues coming up so I think I will. - sam

Hi,

This is long, so if you can weed through it and understand I will appreciate it.

This just began this week. I wake up at 5-6am and my bs is fine (100-115). By 7-8am it has gone up (Dawn Phenomena) and this is before Breakfast. At breakfast (7am) I eat nothing but 1/2 cup of egg beaters and 1/4 cup of fiber one or oatmeal.

At noon my ps is 180-190. I even exercise in the morning walking 4mph on the treadmill for thirty minutes or lifting weights.

I take Junuvia (150mg)and glimepiride ( 4mg - breakfast. 2mg- supper). I took 6mg of the glimepiride this morning at 7am with the same breakfast, but at noon my bs was 190. I was told not to miss a meal so I eat at 1pm so it drops a bit, but not much.

Then throughout the afternoon it begins to drop. Eat supper at 7pm by 11pm it is often 225-250, but almost always over 200.

It was not like this the last few weeks. Even the exercise is not bringing it down in the morning.

I called my doctor and he goes by the A1C. Last time it was under 7. I believe it was 6.8. He told me to wait until I had my A1C taken again which is 5 months.

Could it be that I am not eating but a small amount of carbs for breakfast? I would think it would drop very low with the small amount I eat. I do eat a larger supper. Any advice or help would ease my mind. - Sam


Hi Sam,
I'm not sure what's going on here, either. If you're testing at 100-115 at 5-6 AM and then going higher by 7-8 AM, it could be Dawn phenomenon, but it could also be that you're going too low during the night, and that you're having a rebound high. The way that would happen is if, at some point (probably between 2-3:30 AM) your blood sugar is dropping below 70, and probably even lower than 60...the body then pumps out glycogen from the liver, which will raise the blood sugar levels. Of course, the bg's go up gradually, not all at one moment, so even the 5-6 reading could be on the rise, and it's still going up at 7-8. Only way to rule this out is to test a few nights at 2-3:30 AM. Set an alarm, keep your test kit right by the bed, and test. If no lows overnight (and you should test this out on at least 2-3 different occasions at slightly different times, say 2:30, 3:00, 3:30, 4:00, etc.), then it's definitely Dawn Phenomenon.

I also wonder if you're going low sometime during the later morning, and if that's also causing a rebound high at lunchtime. You are eating a very healthy and low-carb breakfast. Even though it includes oatmeal or fiber one, if you're truly eating ONLY 1/4 cup, that's a very low-carb breakfast. You're right that it might not be enough, especially since you're taking the glimeperide at breakfast. Again, the way to find out is to test every 1 or so between breakfast and lunch to see if your blood sugar is going too low. It's possible that the exercise, combined with the low-carb breakfast, is causing you to go too low. If it's not a low causing a rebound high, then it's possible that your diabetes is progressing and you may need more than just the Januvia and glimeperide.

I suspect, though, that it may be more a case of rebound highs, especially since it happens so far AFTER the meals. If it were a high due to too many carbs, you'd be more likely to be extremely high two hours after eating, but less high four hours later when it's time for your next meal.

I think the only way to sleuth this out is to test, test, and test some more.

Ruth

Hi Sam,
I'm not sure what's going on here, either. If you're testing at 100-115 at 5-6 AM and then going higher by 7-8 AM, it could be Dawn phenomenon, but it could also be that you're going too low during the night, and that you're having a rebound high. The way that would happen is if, at some point (probably between 2-3:30 AM) your blood sugar is dropping below 70, and probably even lower than 60...the body then pumps out glycogen from the liver, which will raise the blood sugar levels. Of course, the bg's go up gradually, not all at one moment, so even the 5-6 reading could be on the rise, and it's still going up at 7-8. Only way to rule this out is to test a few nights at 2-3:30 AM. Set an alarm, keep your test kit right by the bed, and test. If no lows overnight (and you should test this out on at least 2-3 different occasions at slightly different times, say 2:30, 3:00, 3:30, 4:00, etc.), then it's definitely Dawn Phenomenon.

I also wonder if you're going low sometime during the later morning, and if that's also causing a rebound high at lunchtime. You are eating a very healthy and low-carb breakfast. Even though it includes oatmeal or fiber one, if you're truly eating ONLY 1/4 cup, that's a very low-carb breakfast. You're right that it might not be enough, especially since you're taking the glimeperide at breakfast. Again, the way to find out is to test every 1 or so between breakfast and lunch to see if your blood sugar is going too low. It's possible that the exercise, combined with the low-carb breakfast, is causing you to go too low. If it's not a low causing a rebound high, then it's possible that your diabetes is progressing and you may need more than just the Januvia and glimeperide.

I suspect, though, that it may be more a case of rebound highs, especially since it happens so far AFTER the meals. If it were a high due to too many carbs, you'd be more likely to be extremely high two hours after eating, but less high four hours later when it's time for your next meal.

I think the only way to sleuth this out is to test, test, and test some more.

Ruth
Ruth, I know I have DP in the morning. My bs at around 5-6am is as low as 80 at times. It may be going lower because I have had what feel like my muscles tighten up feelings sometimes around 3am. Similar to what I have read about withdrawl. But the one thing I have not done is check my bs a few hours after breakfast. I always check it around 12-1pm when I eat. I also have a pretty low lunch, but eat more in the evening. It is like I crave food at night. - sam

Ruth, I know I have DP in the morning. My bs at around 5-6am is as low as 80 at times. It may be going lower because I have had what feel like my muscles tighten up feelings sometimes around 3am. Similar to what I have read about withdrawl. But the one thing I have not done is check my bs a few hours after breakfast. I always check it around 12-1pm when I eat. I also have a pretty low lunch, but eat more in the evening. It is like I crave food at night. - sam

Sam,
If your blood sugar is going lower than 80 at 3 AM, then it is NOT dawn phenomenon, but rather rebound that is making your numbers so high in the morning. The cure for rebound is to eat a small snack containing some protein and some fat (like a couple of peanut butter crackers, or crackers with cheese) before bedtime so that you don't have the lows in the middle of the night which cause the rebound highs. That's why I've said you MUST test at 2:30-3AM to see what's going on.

And do try to remember also to test a couple of hours after breakfast (or even 1 1/2 hours afterwards)...it's quite possible that you're taking too much glimeperide for the amount of carbs you're eating at breakfast. You may need to reduce the dose for that meal. But again, the ONLY way to find out is to test, test, and test some more so you can see exactly how you're reacting to insulin, food, lows, etc.

Ruth

Ruth