Help! Morning Insulin Resistance


(efeinste) #1

Why am I so insulin resistant in the morning? What are people who experience morning insulin resistance doing to treat it?

I've increased my basal 150% from 8am-noon. I've also increased my boluses for the two meals I have in the morning. By the way, I'm waking up with perfect sugars, usually around 80-100. It's only after eating that my sugars go up to the high 200s, sometimes mid-300s.

I read recently about the dawn phenomenon, but the article I read stated that the phenomenon was attributed to growth hormones released during sleep and that it caused diabetics to wake up with high blood sugar. But like I said, I'm generally waking up with good blood sugar. So what's going on? Does anybody else have this problem?

Oh, one other factor that I shoud mention is that I do high intensity exercise almost every day around noon. It drastically increases my insulin sensitivity for the rest of the day, so much so that I usually have to take my pump off for several hours and not inject for meals. I'm not sure if this has anything to do with it, but there ya go.


(jennagrant) #2

You probably already know this, but Dawn Phenomenon is when your liver dumps glucose in the blood stream in the early morning.  It's thought that the extra energy helps us wake up and get going.  The timing and amount of glucose dumped probably varies for everyone.

It's best not to increase basal need by percentage to acommodate DP, but instead to test and set basal rate to exactly what you need.  For example my basal now is:

10pm  0.6u

12am  1.15u

3am  1.35u

6:30am  1.5u

10am  0.7u

For the rest of the day I stick between .6 - .7u.  If I wake up in the middle of the night I test and I also know my basal is accurate for me because my blood sugar is about the same when I go to bed as it is when I get up in the morning.

If I eat breakfast I use a lower carb ratio (so instead of my 1u insulin for every 15g of carb, I take 1u for every 10g carb in the morning).  

A lot of us also avoid high carb food (even cereal and milk) in the morning because it skyrockets blood sugar, where at other times of day it doesn't.  If you drink coffee it can cause insulin resistance too, so you may need to take a couple extra units to cover it.  I also notice higher blood sugars on work mornings.  Think stress contributes to the morning insulin resistance.


(efeinste) #3

Wow, thanks for the great response. I'm not sure what you mean when you say it's better to test and set basal to exactly what you need. Is there some kind of formula you're using? I was just going to experiment a little and hopefully be able to finetune it over the next couple of days through trial and error.


(AZ2) #4

Elie, I have the same issue. Mine is not dawn phenomenon as I wake up with perfect sugars. As soon as I eat breakfast things go haywire. I have even tested it by eating at different times (7am, 9, 10). I'm stable until breakfast and then all hell breaks loose. The only time things don't get crazy is if I eat an all protein breakfast...but I am not about to eat eggs everyday. So I'm trying out different things......still on MDI (going on a pump tomorrow) but I have played around with my I:C ratio as well as timing. The latter really seems to help. I wait (if possible depending on morning BG) 30 mins after taking insulin and then eat. I pretty much stick to whole wheat toast, steel cut oatmeal or cracked wheat cereal. Both help and even though I still go up....it's not super crazy high. I just went to a conference this past weekend where Gary Scheiner (Think like a pancreas author) spoke and he said for one of his clients who had this issue he advised her to split breakfast/dosing...so basically eat half your breakfast early wait 2hrs eat the rest. Haven't tried that yet.....sounds a little cumbersome. But I will be trying everything......another person suggested symlin but I don't want to take that at all. You are not alone and I'm frankly fed up with my roller coaster mornings. Good luck, let me know what you hear and try and if something works/helps pass on the info. TC


(jennagrant) #5

Elie-

Sorry for any confusion.  

I meant, confirm your basal by taking one night where you have a normal blood sugar before going to bed, then set your alarm to wake up every hour between midnight and 8am test.  Or you could test a few hours one night and the rest another time.  I do this every once in a while if basal seems off.  Based on the test results I tweak the basal rate until my blood sugar is spot on for the whole night.

Or, you could be much smarter than me and ask your doctor to set you up with a 24 glucose check.  Can't remember what the machine is called... but it's like a CGM that you wear for 1 day and then it downloads the test results for you and your doctor to review.


(efeinste) #6

Oh, okay. I might do that, but I'm only having trouble with my sugar after my first meal so I guess I'll check more often starting around 8am instead of throughout the night. Thanks again!


(R009) #7

As a new member I’d like to reply to this as it ranks high up in Google under ‘early morning insulin resistance.’

jenna - I think you have completely missed the point of the original post. Read the question carefully as new diabetics such as myself rely on this kind of expertise. The question was not about dawn phenomenon - it was waking up with perfect sugars and insulin acting poorly where it does not at other times in the day.

I have this too. Like the OP I take mine 30 mins before breakfast, and I’ll eat a tiny portion size. Sometimes all I have is a salad or an egg and no injection. 2 hours after eating insulin resistance is normal. Seems insulin resistence is linked to hormonal changes in sleep and is corrected after a meal of any size. I read a study suggesting it was because of not having much insulin in your system after 6-8 hours. Have not found this is the case.


(system) #8

I really try to eat a “medium” glycemic breakfast (cereal with lots of fiber, low-carb yogurt–Siggi’s), some blueberries) plus some protein (e.g., Applegate chicken breakfast sausages) and usually do OK with that. If I am going to have a treat (like a 3 ounce bagel from our local bakery) I need to use 1:10 for my bolus injection or really get moving (and not sit around reading the paper or work at my desk).


(jem77) #9

Wow- I thought I was the only one with this problem! Docs always seem doubtful when I talk about it. It was really terrible in my pregnancies. I agree with taking the bolus a 1/2 hour before eating- as well- for me it’s trying to get water in. I’m a coffee drinker and if I have more than one ish it seems to cause a lot more trouble. I have very different insulin resistance based on different work mornings and days off. Sometimes I just bottom out all morning b/c I’m chilled:). If I exercise in the morning before breakfast I can go from 5-25 (90-400) especially if it’s intense. My carb ratio I’ve adjusted to 1:8 and have done major tweaking of basal rates starting at 5 am. It is so great to hear that I’m not alone w this issue, love hearing how others have adjusted for it


(system) #10

I’ve always thought this has to do more with insulin absorption, we’re injecting or have our pump catheter in fatty tissue rather than making it in our body which is directly released into our blood stream. So I usually bolus 15-20 minutes (or even half an hour like many have suggested) before eating any meal, depending on time of day and what I am eating as well as my bg before eating will determine how long I wait between bolus and eating.
I figured since it’s the morning our blood isn’t pumping as fast as it is through out the day so it’s not going to travel as quickly through our system in the morning and it will take longer to get started and get in our system. If you have no stomach problems your digesting is going to start working immediately as you’re eating and since they say the fast acting insulin only starts working in 15 minutes that’s going to be 15 minutes of digestion and glucose release into your system raising your bg. You’ll have to see what works for you but maybe if you don’t have the ability to take your insulin half an hour before eating you can try 15 minutes before and do a few jumping jacks or something to get your blood and insulin pumping through your body before eating.


(matthewgates) #11

Absolute simplest way of correcting this is to eat a low cardb breakfast. Eat eggs and bacon eat six eggs if you need to feel full. With this three or four gram carb breakfast your BG will not change. Perhaps take a minute bolus to anticipate the small rise as you awake.

I would do some reseach on the glycemic index as well its an unfalsifiable way of countng carbs and can confuse actual results.


(R009) #12

Anonymous (who suggests that early morning insulin resistance was about insulin absorption) I can confirm this is NOT the case.

I use MDI in different spots and this resistance before breakfast always happens

Water helps but I have found exercise and water does not solve insulin resistance even when I fast and only drink water til midday after waking up on time for work.

It is literally any type of food that fixes this issue. A peanut. A mint tablet. A fish oil vitamin supplement. 2 hours later the resistance is gone and I can eat normally.

It must be hormonal. I cannot think what else it is. All I know is once I have gone into R.E.M. Sleep overnight then it kicks in.

I have tried everything. Now when I wake up at 6am I have a mint or a peanut and 2 hours later (if I’m not intermittent fasting) I am good to eat a normal, carb happy breakfast.


(joe) #13

@R009,

stress hormones are highest in the morning, and that is what causes the insulin resistance. for folks without t1, it’s a nice little helper to boost blood sugar to normal-high, to help you wake up. for us it can be irritating or a nightmare depending on how severe this is. I find it easier for me to control with a pump than MDI, but you can make anything work with effort. good luck.


(R009) #14

Thanks joe

But how do you explain fasting until afternoon and taking water exercise and relaxation etc? The resistance lasts until a small meal is consumed no matter what time of day.

if the insulin takes half an hour instead of instant it doesn’t matter if you’re using a pump or MDI


(gwudiabetes) #15

@R009
I do not know your situation… but your observation could represent native insulin production from residual islet cell function.
A small meal could trigger a native insulin release, which primes your system against the soon to come meal. It would not work against a full on carb onslaught. Not enough reserve function for that.
So this strategy might be highly variable for each individual.
I some times continue to drift down 6-7 hours after a reasonable bolus, despite no exercise and only a miniscule basal rate. This does not happen all the time, but the best we can come to is some native islet cell activity.
( I am Adult Onset Type 1 but now after 4 years supposedly make no insulin )
I would be a good candidate to test your theory, as there is some small evidence of residual (inadequate) function.
I have a large morning resistance, using basal rate of 0.3u all day from 11 AM to 4 AM, but need 1.0u/h from 4 AM to 10 AM to maintain a flat line with no food intake during those hours.


(R009) #16

Yeah I reckon give it a go.

I am also a 4y adult t1 onset.

i can’t think that it’s a natural residual islet cell thing. Only because I have none left and the meal itself triggers all insulin to work (just delayed and late etc) including my Lantus and novorapid etc. it’s really weird. How I found it was after a meal the BS would shoot up to impossible heights and the insulin was delayed hours so really strong hypos would hit me at 2 hour mark when there was no food to digest. The insulin seems delayed and resistant for no reason I can test, and it’s not related to time of day as I have tried a first meal in the evening, exercise etc

But we both have the same thing that the original poster mentions, so see if those tiny meals work for you (even a mint tablet or piece of broccoli!), as I’ll be interested to see!