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RE:[IP] morning highs

>> Cari wrote:
>> We have always had difficulties in the morning. Our situation seems a bit
>> different than most though so I'd love to hear from anyone that has the
>> same thing happen. He will wake up with great #'s (love that pump!) and
>> will stay level (even for a couple of hours) until he eats.

I used to have the same trouble with my son. It is much better now. It used
to be that his first meal of the day would send him sky high (300s or even
400s). My son has "anti-dawn phenomenon". If I don't lower his basals
between 4 to 6am his BGs will drop like a rock. As a result, he has very
little insulin in him around breakfest time. He would still pass a fasting
basal - if I delayed breakfest he would not go high (if anything he would
drop more) - but once he ate he would shoot sky high - even if I doubled his
bolus ratio. We tried changing the timing of his bolus, giving him half
before, or even dividing it into thirds (before, during, and after). That
worked sometimes, but never consistently.

Finally I tried increasing his basal 30 mins before breakfest and for an
hour and a half after (using a temp basal since we eat at different times
each day). Once I wake him we set a 2 hour temp basal. Then 30 mins later he
eats, and I bolus him right afterwards. It works pretty well most of the
time. He still needs a higher bolus ratio at breakfest, but is now using
less insulin in the morning and we have much better results. I'm pretty
happy with a 140-160 two hours after a Pokemon Poptart!!

>From talking with his endo, it sounds like he was insulin resistant in the
mornings from having such a low basal. On the other hand, we couldn't
increase his normal basal rates without sending him low. So it seems like
using the temp basal was the best solution for us. YMMV 

Mom to Ryan (4 years old and pumping since 8/17/00)
and Celia (7 and non-diabetic).
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