How to Treat Foot to Floor Phenomenon

Dear Dr. Edelman,

I need some help managing “foot on the floor”, NOT dawn phenomenon.  My blood sugar is great when I wake up, but as soon as I start moving around it starts rising and continues to rise, even if I don’t eat anything.  I am on a pump.  I know I need to increase my basal.  How far ahead of waking up should I increase my basal?

Dr. Edelman: Rising glucose levels after awakening is very common. It may be just the act of waking up as it raises your counterregulatory hormones (hormones that elevates your glucose values) like glucagon, epinephrine, growth hormone, etc. Raising your basal could be a solution, but you should test to see if your BG goes up if you sleep in. If it doesn’t, then raising your basal is not the answer. You may need to give a small bolus when you wake up, even if you do not eat or drink anything. It’s a very common problem. A hybrid closed loop system will help because the basal rate will increase to compensate for the rising glucose levels. For anyone not on a sensor augmented pump like the Control IQ, Medtronic 670G or Looping, you will need to give yourself a small bolus when you awaken.

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    I am on Control IQ and still do take a small bolus upon rising because otherwise my BS goes up without eating a thing. This can occur immediately or an hour or two later. I find the added basal from Control IQ doesn’t start early enough or is not sufficient to avoid the incease in BS. Occasionally my small bolus isn’t enough! So a second small bolus is needed to cover the increase. This is unpredictable and requires a degree ov vigilance to avoid this peak.

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    Thanks! I also have bg go up when I get up. I assumed it was from my 1 cup of coffee, and since I am not hungry for a while, didnt worry abt it. This makes more sense!😊

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