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[IP] re: Carb to Insulin Ratio Fluctuations

Susan R. wrote:
I proffered to my endo recently that clearly the dawn phenomenon is at work
here re: a.m. ratios and my difficulty in stabilizing/standardizing them.
He said it was more to do with my a.m. basal being incorrect, ie., I
increased my basal appropriately, my CHO to insulin ratio should be
consistent at 10:1 at breakfast as it is for other meals.  I took his advice
and recently changed 3:00am to 9:00am basal from .5 to .6/hour.  It is still
not working. Pre-lunch today was 198 - breakfast was slice of brown bread
with some tuna fish = 2 units (8:1).

Does this basal profile adjustment theory wash with you guys out there or is
there simply an underlying resistance that requires and increased amount of
insulin to cover an a.m. meal?? <<

I'm surprised that your endo said that. As far as I understand it, there are
at least three different problems that account for high blood sugars in the
morning: 1) your liver putting out glucose in the wee hours to jump-start
your day ("the Dawn Phenomenon"); 2) increased insulin resistance
during the morning (I don't know if this has a name); 3) a rebound from
an overnight low (which has a name that I can't spell).  A higher basal
rate should take care of the Dawn Phenomenon, but if your problem is
greater insulin resistance during the morning, you're going to need to
use a higher insulin-to-carb ratio at breakfast than at other times of the

I'm new to the pump, but I've had diabetes for nearly four years, and
as far as I can tell, I don't have Dawn Phenomenon (blood sugar usually
drops overnight, and I sometimes even have rebounds), but I *do* have
higher insulin needs between about 7:00 and 10:00 am.

YMMV, of course.

/Janet L.

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