Insulin Resistance

Dawn Phenomenon, Spring Style.

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My levels have been a bit of a mess over the past couple of weeks.

A few weeks ago, I began to notice my blood sugar levels slowly but steadily rising through the night. I found myself waking up to blood sugars of 8 or 9 at around 2am and giving a correction, only to find it had little effect by the time morning rolled around.

After I had ruled out any after effects of afternoon snacking or evening meals, I began increasing my overnight basal rates until I had curbed that steady rise.

But I still hadn’t quite managed to clean up the spill.

To add to my woes, the FreeStyle Libre sensor I’m wearing at the moment to fine tune those rates has been producing long flat red lines through the night – the kind of ‘LO’ readings that make me a walking talking miracle. Thankfully, multiple finger prick readings quickly confirmed that Libre is at fault, and not me.

I’m usually quite tuned into carb counting, protein and how I bolus for my meals when I’m on my feet at work. Yet morning after morning, I would bolus for my breakfast and find my blood sugar spiking into the teens. Those highs would carry through into my morning tea and lunch.

Eating is something that I can’t really afford to be skipping at the moment. I’m working on packing more into my meals to fuel my active days so that I don’t feel so dreadfully exhausted and limping into bed at night. I’m a better person for it.

As I was setting up the basal profiles on my brand new tslim over the weekend, a mental lightbulb flicked on in my head.

If I had increased my basal rates through the night to cover my dawn phenomenon, why hadn’t I increased them to cover my insulin resistance the moment I wake up?

I have been tinkering my overnight basal rates back and forth since I began pumping insulin two and a half years ago.

I have a theory that the lighter mornings during Spring and Summer enhance that insulin resistance in the wee hours of the morning, compared to the darker days of autumn and winter.

After upping my waking basal rates by 25%, in line with what I had done through the night, I’m hoping I have a better week in store for me.

Insulin Resistance, and Bolusing for Protein

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Last night I had Duck for dinner. Roast duck. With a side of Chicken salad.

It’s not often that I have a meal completely free of carbs. Or a meal that is Duck. But my blood sugar levels were looking decent, so I decided to opt out of having anything else after dinner. I set an extended bolus on my insulin pump for the protein portion of my meal (I usually bolus for 50% of the protein amount over 2 hours), and sat down to watch the latest episode of A Place to Call Home.

As my blood sugar level climbed into the 8s, I decided to give a correction bolus with my pump, overriding the insulin on board subtraction. As I sat on the couch for the next hour, I watched my blood sugar level continue to climb into the 9s and 10s, before finally levelling off at 11.

Although very tempted to give another correction bolus, I decided to wait until an hour had passed and that extended bolus had definitely kicked in. When I checked my reading again at the end of the episode, I was hovering at around 15 with upward trend arrows.

At this point, I gave up all logic and set a temporary basal rate of 200% on my pump. I gave another correction bolus, once again overriding my pump’s insulin on board subtraction.

I’ve been experimenting with the effect of protein on my blood sugar levels quite a lot in recent weeks. This means I am weighing the meat on my dinner plate, and paying attention to the nutrition info on my can of tuna or bag of Burgen Pumpkin Seed Bread. Most of the time, an extended bolus over 2 hours for 50% of the protein seems to do the trick for me.

I thought my protein bolus last night was very generous. My duck pieces were fairly small, and I didn’t think that the protein on my plate would add up to much at all. Yet it strangely led to hours and hours of insulin resistance that only temporary rage-basal rates could bring down.

So what was the difference?

According to this very useful article (thanks, Google), this meal was consumed in the absence of carbohydrate.

To quote the article “Protein’s effect on blood glucose is minimal when it is included as part of a complex meal. But when protein is consumed in the absence of carbohydrate, upward of 50% of the protein may be converted into glucose within a few hours, resulting in a moderate blood glucose rise.”

I am consciously trying to incorporate more protein in my diet. Eggs for breakfast. Almonds for morning tea. Steak or tuna with lunch. Not so much as a way to forgo carbs, but more as a way to build my energy levels. But I almost always eat my protein with a source of carbohydrate. A slice of toast, or a piece of fruit.

I understand that people on Low Carb High Protein diets would likely combat the insulin resistance with increased basal rates. But because my diet is not purely protein, I think I need to make sure that there are some carbs next to the protein on my plate.