FOTF and other Spikes


Although I have only experienced this before for a very brief time, it has come back and seems like it is around to stay. My endo was not particularly helpful with suggestions, but one that I took sometimes works and sometimes doesn’t. When I wake up in the morning, (use to experience the DP, but I corrected that with my pump basal rates. Problem solved.) But this FOTF problem has a mind of its own. I thought that if I would wake up at the same exact time every morning, I could set my pump to give me a very low waking BG, so that this would compensate for the spike after I got out of bed. but the problem pursists. I set my pump so that I would wake up at 7am with a BG of 50ish, so that when my BG started spiking (within 5 minutes) I would level off at a decent TR. But what if I oversleep? What if I have a bad nights sleep and I wake up with a BG of 100 and I quickly spike to 160?

How can I get around this? Does anyone have any suggestions? Anything that has worked for them? The one thing my endo suggested was to give myself a small bolus upon waking to fend off the spike. But I eat bfast within an hour after I wake and I am afraid of layering my bolus.

Please chime in and help me out here. I need all the help I can get. I am willing to try anything at this point. :crazy_face:


I don’t have any experience with DP to share. I’ve never had it, in fact I have the opposite. I wake up relatively low and once I get up, I continue to go down. I know it’s probably due mostly to my basal (MDI, Lantus and Novalog).
Forgive my ignorance, but can you use a basal insulin when you are on a pump? In other words, can you take a basal shot at night, and then suspend your pump for some period, and allow the basal to work, and then start the pump back up? I know it would take a lot of experimentation. Maybe that’s a dumb idea.


FOTF also randomly hits me…I hate it. If uncorrected it causes a spike that seems to hit right as I am getting ready to eat breakfast. That messes with my meal bolus timing and amount, potentially screwing up the most important meal of the day! Boo FOTF!!

I think that is worth a try…a correction bolus when you awake, maybe on the aggressive side. Then you can decide if/how to adjust the breakfast bolus using trial and error.


Oh God how I HATE trail and error! :rofl: :weary: I think I may have to try this experimenting though bc I cannot stand they way its going right now. its impossible; and, you’re 100% right: I end up giving myself too much bolus insulin for my bfast and then I pay dearly for it later, drinking quarts of juice to bring my BGs bk up.

What is up with this? For years I didnt have it, and then out of seemingly nowhere it returned.


I wish I could be helpful answering this question. I know that there are many people on this forum who could defffinately answer your question. My best suggestion is to write a Thread of your own, asking exactly what you just did. I guerentie you’ll get hundreds of replies!!

1 Like

I can usually increase my basal in the 6am zone, about 90 minutes before I get up, to prevent the morning spike. But if I have a lazy day or lazy evening, or if I overeat in the evening, it’s almost like my body stores up some insulin resistance to punish me the next morning! But like I said, a well timed correction bolus in the AM is worth a try.


Sometimes I do have some sort of FOTF, but the spikes usually aren’t that high. Sometimes they’re phantom spikes. In that case, my BG returns to the pre-wakeup level within about 15 minutes.
When the spikes are higher, there’s often a problem with the infusion site.


I have spikes whether or not my infusion site is good or not. If I am waking up with a BG of 45 or 50, I know pretty much there is no blockage in my tubing or my site. And the spike happens REALLY fast (within 15 minutes can shoot up 60 points !!!) (and I am NOT taking any glucose when I wake up at 45 !!! I shake for about 5 minutes from the low, and then my BG starts climbing and the shakes go away quickly).


Does your FOTF happen on the mornings that you wake up lowest? Like your body trying to make up for the low?

FWIW, I was told that you’re not damaging your body if you’re 160 and below. So the spike is large for your awesome numbers, but it sounds like it keeps you south of complications.

And might I take a moment to say how impressed I am with your control! I spike so frequently and erratically throughout my days and nights that 60 points wouldn’t indicate anything amiss in my world. So kudos to you!!


Good point, and I think we miss the point that it isn’t unusual for non-diabetics to spike to 160-180 although for brief periods of time.

I’m done chasing the perfect bs and focus more on TIR.

Having said that breakfast is very difficult for me my insulin resistant is sky high.


I’m also going through a FOTF phase after not being bothered by it (though sometimes noticing a small one, perhaps ephemeral) for quite a while. I’m 75, diabetic since 1955 and pumping since 1998 or so, now on Tandem Control-IQ, which usually keeps the spike down somewhat. I still have the pump basal set for a DP, but, looking at the CIQ action history, may also be changing a bit.

This morning, my husband was in the kitchen making breakfast when I woke up, so I took a pre-bolus for breakfast within a couple minutes of getting up, and stayed in range – so, the FOTF doesn’t seem to be, for me at the moment, an additional insulin need unless I have a period without food (or bolus). Since I can’t count on my husband doing that and with such perfect timing (smile), I sometimes have luck with an 0.5 bolus before, or very soon after, putting that first foot on the floor (I use a 1 to 10 carb bolus at breakfast), which is what I do for my currently-again-pretty-regular morning cup of coffee (with unsweetened almond milk) when not with a meal. If I do let BG go up, I am currently wondering if I need less to get it down if it is part of a meal bolus than if I am not eating. So I try to keep an even more careful than usual eye on it for the next couple hours. But, if BG goes up when I get up, it will continue going up for a while until I bolus or CIQ gets it down with increased basal (I usually keep my CIQ on sleep mode, so doesn’t bolus in response to highs). If this continues for long, I probably will just raise the basal rate, and count on CIQ to avoid lows, paying more attention to getting up at the same time – I usually am better at that as the season progresses and the sun comes in my window more strongly.

You said “And the spike happens REALLY fast (within 15 minutes can shoot up 60 points !!!)”

After all these years, I had thought I had lost my Somogyi effect, of highs from glycogen storage in the liver following lows, which was clearly very much around in my childhood, but have thought it had pretty much pooped out. But I had wondered recently in another kind of issue whether the more recent years of so much better control might have revived it. And, the CIQ almost always is taking care of nighttime lows for me – my BG is almost always well within range when I wake up – so this is not what’s happening with me with FOTF. But it MIGHT be what’s happening on the occasions when you go so quickly from a 45 BG up 60 points?


Dxin, thank you so much for this. it was extremely helpful info for me. I hadn’t taken into account my overnight lows (which are many). I think I will adjust my overnight basal rates that I can stay level throughout (as much as God is on my side :pray: .) I will do it as an experiment (I do A LOT of experiments , generally until I find patterns.)

I’ll keep you all posted! And again, thank you!

Daisy Mae

EDIT/PS: I just lowered my overnight basals (12am,3am, 5am, and 8am) I also changed my ICRs for the breakfast hours (till noon). We’ll see. Fingers crossed :crossed_fingers:



so I changed all my overnight lows, reducing all of my overnight basal rates. I didnt go low once and I woke up perfectly in target. I didnt have any problems with FOTF!!! Holy cow.

I cant thank you enough. Problem solved. :+1:


If you are using a CGM, it is possible that some of the FOTF is the CGM sensor waking up after being in stagnant body fluid during the night when you are not moving much. Would have to do a finger stick before the feet hit the floor to be sure. Maybe a spouse could do that instead of making breakfast. :wink:


I am not on a Dexcom. I rely soley on finger sticks. I was on the Libre for a couple of years but it was so inaccurate I just stopped wearing it. I do wish that the Dex worked for me, and I do wish the Dex were as easy to put on and use as the Libre, but until I find a CGM that works for me, I’m left sticking my fingers all day and night. (UGH).

That would b wonderful. I think I will teach him how to cook. :rofl:

Here is interesting info on sleep, and changes due to seasonal changes, and diabetes.