I've been struggling with eating breakfast for years, and nothing that I've found online has explained my problem. My endocrinologist has no idea what it is either. It isn't dawn phenomenon. I want to find some way to eat carbohydrates in the morning. Has anyone figured out some way to overcome this? Does anyone besides me have this problem? My control is excellent at all other times of the day, and I can eat just about anything, but breakfast seems impossible to control.
Here's what I have tried so far:
(When I say “Normal meal” it can include anything. Example: toast/fruit/granola/nuts/anything else with carbs. Assume 30g per meal unless otherwise stated.)
Normal meal – normal bolus
Result: blood sugar spikes above 200 very quickly after meal and takes an hour to go down. Requires dangerous levels of insulin to bring down. Trying to make a correction with any affect will always result in sudden low blood sugar after the hour is up.
Normal meal – double bolus
Result: blood sugar spikes very high, but does not usually reach 200. After about an hour, drops low.
Normal meal – triple bolus
Result: Unreliable. Blood sugar may stay near 100 or reach 150. after an hour, drops very sharply.
Carb free meal – No bolus
Result: Blood sugar rises as if carbohydrates had been eaten. Mild high occurs. Correction bolus may result in a low after the hour is up.
Carb free meal – ~2 unit bolus
Result: Blood sugar remains under control for an hour. Slight dip in blood sugar may occur after but is easily corrected and not dangerous. Without fail, I will start to hate whatever it is that I ate and may even start to feel sick from eating it.
Delayed normal meal 20+ minutes – immediate bolus.
Result: Sometimes this bypasses the morning insulin resistance but causes a low from having waited over 20 minutes to eat. Sometimes it doesn't and the usual extreme high occurs. The safe spot in between lasts only a few minutes and cannot be predicted. The exact amount of time required to overpower the resistance with a bolus varies Can take only 10 minutes or (rarely) the entire hour.
1/3 of meal immediately, 2/3 later – immediate bolus.
Result: Varies wildly. Because insulin resistance is not entirely predictable, 1/3 may still be too much or too little. Trying to predict the time that resistance ends down to the minute for eating the other 2/3 of breakfast is also extremely difficult. The remainder of breakfast is usually only taken once blood sugar has begun to drop, and by then it's arguably brunch.
Skip breakfast – No insulin
Result: Insulin resistance does not occur at all, and blood sugar remains stable. Sucks though for other obvious reasons.
Breakfast milkshake (30g banana 60g vanilla ice cream) – normal bolus
Result: If blood sugar is above 100, blood sugar high usually occurs. Otherwise, blood sugar remains stable for hours. Causes extreme lethargy as if blood sugar was low, even when blood sugar numbers are perfect. Most of the insulin used to cover the ice cream is left unused. Blood sugar drops periodically throughout the day as there is extra insulin in the body somehow delaying its reaction. Sugary foods and soda can be consumed during this period with no ill effect, but it's a gamble as to how much leftover insulin remains in the body to cover it.
Conclusions:
Insulin resistance always occurs after waking up, but the exact time and amount of sleep makes no difference. Basal rate is unaffected. Resistance goes away after about an hour, but can sometimes go longer. Exact intensity and length of insulin resistance varies each day. Resistance is stronger when blood sugar is above 100 and weaker when lower, but otherwise cannot be exactly predicted. Overcoming the resistance requires about 3 times as much insulin as normal to prevent highs, but the extra insulin is not actually used during this time and will always cause a low after the period has ended. Resistance only has an effect after eating, and it makes no difference what is eaten. (10g and 100g both require a random amount between 2.5x – 3.5x insulin to cover) Fatty foods like ice cream can drastically slow the onset of blood sugar lows, but cause an unknown amount of insulin to remain in the blood during this time. Dormant insulin causes extreme lethargy and random small lows. All breakfasts seemingly must be entirely carb free to safely avoid high or low blood sugar.
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