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chronic Issue with the rebounds somogyi ..could you give me some tips?

Discussion in 'Parents of Children with Type 1' started by ecure, Dec 9, 2014.

  1. ecure

    ecure Approved members

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    Hi

    I have chronic issue with the rebounds. ( somogyi ) I have between 1 to 3 rebounds daily. I even catched some rebounds daytime.... As I see, you should not go lower than 72(cgms) if you are sensitive to rebound..Right? or you should not go lower than 82 , 74 ? etc I started recently to use dexcom cgms. I noticed clearly the pattern of the rebounds and induced insulin resistance by the rebounds. I noticed with cgms as soon as liquid interstitial is low, insulin resistance is triggered in interstitial liquid. More your low is severe more the resistance is severe..its what I noticed with my dexcom cgms. as I see it's survival mechanism.. if you would have not this mechanism, we could die from a hypo easily or severe complications. I dont use newer version of dexcom g4.. I think the accuracy is around 13% with the hypo.

    One thing I could not find any information on internet what you should do to correct fasting hyperglycemia resulting of one night rebound ? The best solution to eliminate insulin resistance as fast possible.. I notice usually I have strong insulin resistance till noon. and after noon the insulin resistance continue till evening sometimes.

    1- Fasting till you bg is back to normal without any blood glucose insulin correction?
    2- Fasting till your bg is normal..but give you normal blood glucose insulin correction ratio. ( or another ratio 20% 10% off your ratio or + 10% 20% from your normal ration)
    3- Eat your breakfast with your normal meal ratio(or percentage added or removed from your normal meal ratio) but dont take any blood glucose insulin correction ratio.
    4- Eat breakfast with your normal meal ratio(or percentage added or removed from your normal meal ratio) + your normal blood glucose insulin correction ratio.. ( or another ratio 20% , 10% off your ratio... or + 10% +20% from your normal ratio.)
    5- Combine option 1 or 2 with some sport at very low intensity level.. ( I tested the sport and it looks like when I had strong night rebound, it didnt help. it seems to increase resistance more short-term.)
    6- any other ideas or options?

    thank you for your Insights and help...
     
  2. Mimikins

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    Personally, it honestly depends on the situation.

    If I have an elevated fasting BG and have time to wait until my BG drops to an acceptable range, I will take a correction and not eat until I am at a decent level. I am the most insulin resistant in the morning, so combining a food bolus for a moderate-carb meal with a correction will send me sky-high. If I need to run out the door quickly, I'll take my correction, eat a meal lower in carbs (Atkins protein shake, plain Greek yogurt, cheese and nuts), and tack on an additional 4-6g for protein.

    In relation to Somogyi, are you making sure that you are not over treating your low? If I were to eat the recommended 15-20g sugar for a 65 low with no IOB, I could expect my BG to spike to 130-140 before accounting for my post-low snack. If I am low and raid the kitchen of all the sugar we have, I can surely expect to have a rebound high. Instead, I might take 4g of sugar for a low in the 60's, come up into the upper 70's, and have a bolused snack without fears of spiking above 150. If it is not an issue with over treating the lows, could you temp increase your basal after coming up into a safe range to account for your liver dumping a boatload of glycogen after a low?
     
  3. ecure

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    so ideally mimikiin , you will fast with your normal blood glucose insulin correction ratio? or its modified ratio -10% -20% +10% +20% compare to your normal ratio? ETC.. or no change.. it likes option 1 you do ideally?

    I dont overtreat my low bg.. I have only dexcom cgms but no insulin pump. Levemir 9PM + humalog before meal..
    I notice insulin resistance induced by the rebounds could induce morning hyper as high as 4times more than it would be without rebound.
    Thanks
     
  4. Mimikins

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    If my BG is above target and have ruled out issues related to pump failures, I bolus a normal correction and fast until my BG comes into a more desirable range before I begin eating. I tend to go low due to over correcting, so I try to avoid bolusing more than I should for corrections (unless I am correcting to get to a 100 BG instead of 120, but then it is a .33 unit override on my pump).
     
  5. jenm999

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    Are you sure it's not the Don phenomenon?

    I am dictating this on my phone, and I am leaving that typo because it makes me laugh. :)

    Seriously though, if you are not pumping, you might be getting too much basil at night, when needs are lower, and then experiencing the Don phenomenon that is not actually a rebound.
     
  6. ecure

    ecure Approved members

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    Sure I analyzed data carefully and it's a rebound. The rebound occuring immediately after hypo. NO delay tilll morning dawn phenomon.. insulin resistance is really strong till 12:00 PM after night rebound.. I noticed even sometimes it will last strong resistance till evening. I even had rebound daytime...
    I even had total insulin blood test that confirmed fasting hyperinsulinemia.

    As I see, you need to catch hypo very early and correct the most fast to avoid rebound... more I wait or correct in late my hypo more it induces rebound and lasting insulin resistance afterwards,
    I currently set my hypo alarm to 72.. should I set my hypo alarm higher during night to avoid rebound? Im not sure.. I dont always Wake up with vibration alarm ...so I Wake up later with beep. I keep my mejdool dates my fridge... do you think it would be better keep beside my beside.. so it will be more fast.

    Im asking.. what is the average grams of sugar you consume hourly while you sleep?

    Thanks
     
  7. Sarah Maddie's Mom

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    Half of what's been written in the thread makes no sense to me, but I'd really be stunned if you are seeing actual rebounds at 70 (meaning your bg spikes from 70 to >280 like a rocket with no treatment for the low)
     
  8. ecure

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    Yes I already seen a rebound like you described and it saved my life!
     
  9. Sarah Maddie's Mom

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    because you would die if you go below 70??
     
  10. ecure

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    Yes if no rebound and I would have stayed in severe low bg long time..
     
  11. Sarah Maddie's Mom

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    So you consider a 70 a "severe low"?
     
  12. ecure

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    no I dont consider severe low 70...
     
  13. mmgirls

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    If you are having 1-3 rebounds a day then your insulin doses are off either your basal is to high or your mealtime insulin dose. you need to fix that before anyone can help you, you are in a never ending cycle that needs to be broken.

    But I truly doubt that you could be in a "rebound" state1-3 times daily, our bodies only "store" enough glucose (available for rebound) for 2 days.

    It is very possible that you are treating a mealtime bolus that is too strong while having a basal too low and it appear that it is a "rebound".

    I only have 1 true experience tha I am willing to call a rebound, every correction sent her BG higher and it only stopped once I stopped correcting and her BG fell on its own many many house later. Because a rebound is barrowed glucose, that is in limited QTY.
     
  14. wilf

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    Try switching your Levemir to mornings.
     
  15. hawkeyegirl

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    If you are having 1-3 rebounds a DAY, you need to completely overhaul...everything. We've been at this for 7 years, and have never had a single one.

    I assume you are an adult. Why not set the Dexcom threshold higher and treat before you hit 70?
     
  16. ecure

    ecure Approved members

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    Hi

    sure I could put higher bg low alert.. Could you suggest me a threshold ? I use dexcom g4 with 13% accuracy.

    thank you
     

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