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Old 07-12-2006, 01:11 AM   #1
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Oscar22 HB User
Unhappy High Morning Sugars...Help!!

Hi there All,

Its my first post, and by the looks of the forum, and as they say in the States, Where have you been all my life!!?

I was diagnosed with T1 in Oct 01, and have since been pretty well controlled, with HBa1c's of around 6.3-6.4. I take novorapid 3 times a day, and Lantus at night.

Recently however, although I can control my day time levels pretty well, my morning, and overnight levels are seemingly beyond my control! The last 3 nights for example I have had pre-bed levels of 8, 6 and 11 (not perfect I know) and then having tried to vary pre-bed snack, have woken myself up at 3am to try and see what is happening, and have found levels of 23, 19 and 18, which only I have tried to reduce by morning by taking a small dose of Novorapid.

I have recently increased my lantus intake from 15 to 19 as recommended by my consultant, to absolutely no avail. I have also tried eating nothing, when my level increased from 11 - 19 in 5 hours, I have tried eating more than normal (to maybe counteract dawn phenomenom), and less than normal, with no success! Its driving me crazy!

Any help really would be much appreciated.

Oscar22

Last edited by Oscar22; 07-12-2006 at 01:13 AM.

 
Old 07-12-2006, 03:02 AM   #2
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Mark1e HB User
Re: High Morning Sugars...Help!!

Welcome to the forum. Hope you find all the info you need here.

You could be running out of insulin. Lantus is supposed to last 24 hours, but many of us find it runs out of steam after 18-22 hours. And it takes a couple of hours after injecting Lantus for it to get up to speed. As you are injecting your Lantus at night, this could explain your rising blood sugars before going to bed and the high levels at 3am.

If Lantus isn't lasting the distance for you, splitting the dose between morning and evening shots could do the trick. Doing this evens out the action of the insulin. It also reduces variability of action due to variation in absorption rates for different injections.

If after splitting the dose you are still going high at these times, it could mean that your requirement for basal insulin increases during the night/morning hours. I have dealt with this problem by having half my basal as a Lantus shot in the morning and and the other half as NPH before bed. It works very well.

Cheers,

Mark
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Type 1 since 1977. On Lantus, Novorapid and Actrapid.

Last edited by Mark1e; 07-12-2006 at 03:08 AM.

 
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Old 07-12-2006, 03:48 AM   #3
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Oscar22 HB User
Re: High Morning Sugars...Help!!

Mark,

Thanks for that, it is definitely worth a try. In your last paragraph you mention that you have dealt with this type of problem ''by having half my basal as a Lantus shot in the morning and and the other half as NPH before bed'' What is NPH?

Oscar

 
Old 07-12-2006, 06:25 AM   #4
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vikingirl HB User
Re: High Morning Sugars...Help!!

Hi, Oscar. Having had similar problems as you describe, I tried splitting my Lantus dose as Mark describes. Unfortunatley, it didn't work out for me, but we're all different. :-)
One thing you may want to try is taking your Lantus dose around dinner time, rather than bedtime. That way, if it is taking its sweet time getting working, you'll have your dinner's Rapid dose to carry you through until it does. Also, if it is running out around the 18-22 hour mark, that would make it afternoon time and dinner (with its shot of Rapid), is just around the corner. If is is running out before the 24 hour mark, you'll see possibly higher "before dinner" test results but, I think it's easier to deal with by using a "fix" dose of Rapid with dinner than the more wild fluctuations at a time when you're sleeping.
For the past couple months I'm now on Levemir split 2xday, 11 units at 7:30AM and 14 units at 7:30PM and still trying to get better control by tweaking the basal doses and adjusting meal ratios. I just keep working at it.

Good luck! Cheers,
- Vikingirl

 
Old 07-12-2006, 08:11 AM   #5
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bluejbirdie HB User
Re: High Morning Sugars...Help!!

Quote:
Originally Posted by Oscar22
Hi there All,

Its my first post, and by the looks of the forum, and as they say in the States, Where have you been all my life!!?

I was diagnosed with T1 in Oct 01, and have since been pretty well controlled, with HBa1c's of around 6.3-6.4. I take novorapid 3 times a day, and Lantus at night.

Recently however, although I can control my day time levels pretty well, my morning, and overnight levels are seemingly beyond my control! The last 3 nights for example I have had pre-bed levels of 8, 6 and 11 (not perfect I know) and then having tried to vary pre-bed snack, have woken myself up at 3am to try and see what is happening, and have found levels of 23, 19 and 18, which only I have tried to reduce by morning by taking a small dose of Novorapid.

I have recently increased my lantus intake from 15 to 19 as recommended by my consultant, to absolutely no avail. I have also tried eating nothing, when my level increased from 11 - 19 in 5 hours, I have tried eating more than normal (to maybe counteract dawn phenomenom), and less than normal, with no success! Its driving me crazy!

Any help really would be much appreciated.

Oscar22

Pre Bed of 8 and 6 are not bad. did you do anything to correct the 11? IF i am a bit high before bed I will take a bit extra Short acting insulin.

I also wouldnt be too worried about 3 days worth of results....there are so many things that can affect Levels it may just work itself out on its own. Stress and Sickness can really through things out of whack.

the Solution may be to just take a small shot of Fast Acting before your bedtime snack.
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Old 07-12-2006, 06:38 PM   #6
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Join Date: Jul 2006
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Mark1e HB User
Re: High Morning Sugars...Help!!

Quote:
Originally Posted by Oscar22
Mark,

Thanks for that, it is definitely worth a try. In your last paragraph you mention that you have dealt with this type of problem ''by having half my basal as a Lantus shot in the morning and and the other half as NPH before bed'' What is NPH?

Oscar
Oscar,

NPH stands for Neutral Protamine Hagedorn and is the generic name for what for many years was the standard basal insulin. Popular brands are Humulin N and Protaphane. They have been superceeded by Lantus and Levimir, which were designed to act more evenly over the 24 hour cycle.

Lantus is supposed to act evenly over 24 hours, whereas NPH only really gets going after 2-4 hours and peak action is 6-10 hours after injection. Which means that, if it is injected at 10pm, it will peak at 4am - 8am in the morning. If this is the period when your blood sugars are rising, an evening shot of NPH should counter-act this. The other advantage is that the NPH peak action should fill the gap in Lantus action from a morning shot.

Cheers,

Mark
__________________
Type 1 since 1977. On Lantus, Novorapid and Actrapid.

Last edited by Mark1e; 07-12-2006 at 06:46 PM.

 
Old 07-13-2006, 12:00 PM   #7
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Oscar22 HB User
Re: High Morning Sugars...Help!!

All,

Thanks for all your advice, I'll try some or all of them and see how we go!

Oscar

 
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