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Re: [IP] Breakfast meal & other weird bg responses

On Sat, 15 Nov 1997, Susan Jordan wrote:
> I have eaten the same breakfast for about the last 6 months or so it is
> 1 serving of bran cereal (no table sugar at all) and one serving of
> regular (sugar) cereal. 50% of the time I have an acceptable 90-120 post
> meal test and 50% its at 170+.  I have no idea what to think other than
> I should consider something else for breakfast.  Any suggestions?

If your wake time varies or your previous day's exercise varies, that may 
account for the difference. However read on...

You should be able to eat anything you want for breakfast not just one 
set thing.  I assume you Carbo Count.  Lily may eat 30g or 80-90g for 
breakfast depending on what we have. This has never affected her bg's 
much except when she has mis-counted the carbs.

The problem you describe has more to do with a good nights sleep and the 
prior day's to week's activity.

My daughter is bi-modal.  That is she switches from one metabolic 
response to waking to another depending on how rested she has been over 
the preceeding period of time.  We are not sure what the time frame is or 
the the details of the switch.  But to give some examples ....

Lily needs a bolus of about 2 units of insulin to stabilize (flatten) her 
bg's upon waking.  If she gets up very early (6:00am) this is not usually 
needed, however anything later 8:00, 10:00 whatever -- and the 2 units is 
required.  Her waking blood sugars are usually ok, she just zooms up 
after waking.

HOWEVER, in the summer when she gets a couple of hours more sleep every 
night than during the school year, this phenomenum goes away.  She can 
get up anytime and no MORNING BOLUS is needed.

NOTE: that because the bg rise is timed to the wake up time, it can NOT 
be programmed into the basal rate.

The doc has a name for this kind of thing and the similar nite time one.  
It can make life difficult if you do not understand what it is and adjust 
your bolus/basals accordingly.

Lily's evening/night time basal requirements jump from awake about 
0.3u/hr to 1.0u/hr when her head hits the pillow.  Since bed time may 
vary from 9:30 to 12:00 depending on homework, social stuff, etc... 
this is another item which can not be programmed into the basal rates.

The work around for this problem for the last 3 years (her whole diabetic 
life) has been to set the 00:00 basal rate to 0.3 (waking basal) and 
switch to 1.0 unit at 1:00 am since she is always in bed before that 
(except for sleepovers).  Then when she retires, she sets a temp basal 
that runs until 1:00am that is nominally 1.0u/hr.  She adjusts it up or 
down depending on her bedtime bg.  If she is low, it goes down 0.1u for 
each 10bg points below 100.  If high, she does a hbs bolus, boluses the 
next hour's basal rate and then spreads the remaining total basal until 
1:00am over the time until 1:00 am.  This gets her down considerably 
faster but does not cause a low.

There have been some problems with 3:00am bg's, but it appears to be more 
related to adolescence and endocrine control than anything an adult would 
worry about. Also, mac& cheese or Pizza, almost always make her high 
about 7 - 8 hours after eating it, not your usual food response.

At 4:00am, her basal switches to 0.8u/hr (I think) and stays that way 
until late morning when it drops back to the 0.3u/hr until bed..

Of course!!, all of this works great except on the days that it doesn't.
I suppose everyone has that problem.

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