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Re: [IP] morning highs, lack of sleep

> My 6 yr old son Andrew  was dx @ 14 mo. and has been pumping almost
> 2 yrs with the Disetronic and Rapid 6 sets. 
> Regardless of what time he wakes up or eats, his first meal
> always requires twice as much insulin as he takes the rest of the
> day. It usually takes about 2 hrs and then I have to watch for the
> drop. Higher protein in the mix does seem to help (and cereal is
> always brutal, even the low glycemic)  but after 5 yrs we've just
> come to accept that he'll wake up @ 100, eat breakfast and hit a 300
> before he's back to 100 within 3 hrs. Does that make sense? Any one
> else?

Yes, I've posted about this in the past. There is a technical 
explaination for it but it is a bit arcane and I don't remember all 
the details. It comes and goes depending on your schedule, the amount 
of rest, etc... Lily has had it off and on for a number of years, 
though not in the last couple.

We found that fasting number were stable and that the rise only 
occured after a meal and only on certain days. If she slept in, the 
rise did not occur. Any meal, regardless of carb content would 
trigger the rise in bg's and the rise was fairly consistent. Our 
solution was a fixed morning bolus administered just prior to 
breakfast on non-sleep in days. Lily's was just under 2 units, but 
you should not use that as a guide, YMMV.

You should be able to confirm this by doing a fasting morning bg 
profile, then a bg profile with a no-carb breakfast i.e. eggs, xtal 
lite, then a normal "vanilla" breakfast of toast or ceral + milk or 
something where you know the carb content and the expected bg 
behavior. All of these breakfasts should yield appx the same bg rise 
when you exclude the carb content with the appropriate meal bolus. 
Fiddling with this procedure should help you establish an appropriate 
morning bolus.

This is not dawn phenomena, but is related to some hormone release 
that is triggered in buy the circumstances. Sorry I don't remember 
the details. You may be able to find a better explaination in the 
mail archive as I know I've described it in the past but my memory 
fails me now.

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