Mayhem in the mornings is a common complaint in my clinic – and it’s not about mismatching socks! My patients are often baffled by why they can wake up in their target range, but then have sky-high blood glucose after a breakfast they carb-counted and dosed appropriately for. There are lots of reasons why highs happen in the morning - let’s look at how we can combat them. A note before we go any further: this Clinic Chat is about post-breakfast highs. Waking up with high blood glucose could be due to other things, such as dawn phenomenon, basal rates, or last night’s dinner – save that for another Clinic Chat! Morning insulin resistance Many people find their bodies require more insulin in the mornings than any other time of the day. Hormones, lack of movement overnight, caffeine consumption with breakfast, and high intensity exercise in the morning are all factors that can cause you to be more resistant to the action of insulin in the morning. Strategies to help the highs Control the carbs One way to combat post-breakfast spikes is to cut down what causes spikes in the first place. Common breakfast foods include bread, cereals, and juice, and the tsunami of glucose can make it tricky to calculate an accurate insulin dose and time it well. Focusing on adjusting the carbohydrate content at this meal can really help you achieve more stable post-breakfast blood glucose levels. Consider scrambled eggs and avocado, omelettes, or unsweetened greek yoghurt with nuts and berries – or if you’re stuck for ideas, I have a ton of breakfast ideas up my sleeve – visit me in clinic for help. Lower the glycaemic index If you’re keen to eat a carb-rich breakfast, then try and work with the glycaemic index (GI). A lower GI means a slower carbohydrate release, and a slower rise in blood glucose. Unfortunately, many breads and cereals have a high GI. If you lower the GI by choosing high fibre carbs carefully, you may be able to slow the spike down to better match your insulin peak. Try it, and test often after breakfast or watch your CGM to see what works. Add healthy fats Adding fat to toast or cereal can slow down the absorption of the carbs, slowing the release of glucose into the blood. Try adding some healthy fats and proteins to breakfast carbs, such as peanut butter, avocado, or cheese on toast, or add nuts and greek yoghurt to cereal. Slow insulin, fast food Despite being called ‘rapid-acting’, rapid insulin really isn’t that fast. Many foods we eat, particularly some common breakfast foods, are digested and absorbed very quickly, before insulin starts really working properly. This can cause blood glucose to climb quickly soon after eating. Think about giving your morning rapid-acting insulin a head start with a pre-bolus. Start conservatively, by giving your breakfast bolus 10-15 minutes before breakfast. Do this for a few days, eating the same breakfast and recording your 1, 2, 3 and 4 hour readings. Assess and make adjustments to the timing. It’s best to try this at home rather than on a school day, and have hypo treatment ready to go in case blood glucose drops more rapidly than you expect. Get up and at em’ Exercise is a great way to boost morning insulin sensitivity, and there are plenty of ways for all members of the family to get some exercise in the morning! Walk the kids to school, get off the bus a stop early or park a little further from the office. If your child is riding high post-breakfast, let them ride or scoot once they are dressed and ready for school, or get to school 10 minutes early and play on the outdoor equipment. Exercise can definitely help bring down blood glucose, but requires close monitoring. Keep an eye on intensity too – some people find that high intensity exercise like interval training, spin classes or sprints can make morning sugar spikes worse – you have to find what works for you. Morning madness no more As always with trying new ways to manage type 1, it’s best to pick one strategy and keep all the other variables unchanged so you can see the impact of the change you made. Whether it’s trialling a pre-bolus, eating a lower-carbohydrate or higher-fat breakfast, or getting out for some morning exercise, it’s within your power to make those morning spikes a thing of the past. I'm here to help - contact the Family Centre on 9446 6446 to book in to our dietetics clinic!