I have been taking metformin (ER) for around six months now and have found it’s been fantastic for helping with FOTF. I had rises similar to @Dfji that would go up quickly after getting out of bed and just not stop (as well as extreme insulin resistance in the morning). Those rises have stopped since I have added 1000mg metformin ER at bedtime (actually more like late evening). My blood sugar will actually tend to trend down once I’m active in the morning, which is unheard of for me. I’ve had type 1 for 30+ years, work out v regularly, am not overweight, have a healthy vegetarian diet, but am guessing that insulin resistance gradually came on for me. Might be worth considering?
5 Likes
You take Metformin AND insulin? Dont you need insulin as you are a T1 D ?
If the Metformin works for you, im going to ask my endo to give it a try for me!!!
So happy that youve found a solution 
3 Likes
I’m sure @JessicaD is using insulin with the addition of Metformin. This not unheard of in those with type 1. Now I am a type 2 on a pump and taking Metformin.
Since Metformin is not an insulin secrretagogues, that is, stimulating insulin secretion it can be of benefit to those with type 1.
Metformin works in 3 ways:
- Decrease glucose release from the liver.
- Reduces the absorption of glucose from the digestive system.
- Increases cellular insulin sensitivity, which improves glucose uptake by the body’s cells.
I’m not sure but I think is someone has gastroparesis Metformin may cause a problem. The most common side effect is gastric distress. This often clears after a bit of time on the drug.
6 Likes
@daisymae I do take both metformin and insulin and it’s been GREAT for me. I know one of the features of the drug is that it slows digestion and that could be a big problem for you, so approach with great caution!!! I think it probably does slow digestion for me, b/c I am seeing a rise in overnight blood sugar that I hadn’t really seen before – am guessing it is release of dinnertime carbs that’s now happening in the middle of the night (ugh-- I now need a solution to this (@Eric I may yet need NPH)). If there is a way you could build this into your arsenal, though, it could be a great solution to morning time FOTF rises. (I really, really wanted to try Ozempic b/c it seems to offer a more comprehensive solution than metformin alone, but that’s a battle I will continue to fight!)
@daisymae how are you feeling??? xoxo
4 Likes
Sometimes I have DP and sometimes FOTF, sometimes both. Right now I am having mild DP and extreme FOTF. Sometimes it is within 15 minutes of getting out of bed, sometimes it is an hour later. I have an increase programmed into my pump for both, mild for DP and major for FOTF. I am having a lot of site issues, but it is one reason I don’t want to go off a pump. And since I don’t know exactly when it’s going to hit I automatically give myself more insulin as soon as I see my numbers start to rise after I am awake.
And @daisymae I have an exaggerated response to food if I try to eat in the morning. I prebolus earlier before I eat and give myself more than usual. My numbers can stay stubborn for hours so I have a tendency to be pretty aggressive in treating. That can catch up to me by 12-2 pm, but some banana or pineapple usually solves that. I am more conservative about it if I’m not going to be at home. And of course the requirement is a Dexcom to keep an eye on my BG level.
5 Likes
yeah its changed for me like that over time. I used to be much more insulin sensitive in the morning, getting up and running round would send me low. But now, this FOTF and no breakfast, or a breakfast of 15g carbs makes me so high for hours. . . I only just heard of this FOTF and just told my daughter (age 12). She recommended staying in bed if it’s getting up that is causing a problem 
Anyway, today, my alarm was 6.40 and I stayed in bed for nearly an hour and just woke up without the crazy adrenaline get up, unload dishwasher, get kids up etc etc. . . . Blood was 5, slowly gone up to 8 only so far. . . . . .My daughter has the solution!!! Stay in bed and ignore the kids 
4 Likes
do you have a pump which is auto correcting or you doing it manually? My doc always says dont cheat the pump algorithm, but it’s not working so what the hell am I supposed to do?
3 Likes
I cheat the algorithm all the time whenever i go high. I also have a tricvk that works well for me as far as treating the high BGs goes: I do a bolus correction AND i turn on an elevated TB for a couple of hours. When I start to see a downward trend, I just turn off the TB. Works like a charm.
4 Likes
@daisymae I’ve often had issues with spiking post-meal since diagnosis, to the 170-180 level, once in while higher. I’ve mostly faulted myself for not bolusing more in advance of meals (not noticeable on low carb meals, definitely noticeable on moderate to high carb meals). I don’t aim for as low a BG as you, my target is 100. I’ve noticed a marked improvement over the last month+ since I switched from Loop to try iAPS and use the fat/protein portion of its algorithm (either I didn’t use Loops algo correctly or it didn’t work for me). I’ll still rise but not much beyond 150. I do have iASP’s UAM (unannounced meals) turned on and have SMBs (micro boluses) on as well. I’ve alwasy envied those reporting they’re able to stay flatter (relatively no BG rise) after eating, but my reading of IDS/Schiener and other sources indicates a rise of 30-50 pts with a return to target in about 2 hours is a reasonable goal. I also attribute the improvement to having kept a log of my iAPS trial (what I changed and how much, what worked, what didn’t), so much better than “guess and try it.” I do use MyNetDiary to count carbs, fat, protein and it works for the most part at home (watch for duplicate entries with significantly off numbers). When we go out to eat, it’s often a guesstimate (so many places have no/little nutrition info available) so my results are a work in progress (started keeping track of locations, what I ate, how much I dosed and result). I sometimes over/under estimate and end up treating or eating a bit more or correcting.
5 Likes
Yes, exactly! I use DIY Loop main branch with auto-bolus enabled. Of course, I am still constantly monitoring and often need to do correction boluses post meal, primarily dinner. But I think that is just me. My dinner often but not always will cause a spike 5 hours post meal. So I am always monitoring for that spike. DIY Loop helps greatly with the monitoring though. It will give me small boluses if my BG starts to rise and will head off an unexpected spike. Not totally for dinner though but a huge help!!
Thanks, Tom, for this mention. I’ve been looking at the other Loop apps. I don’t think DIY Loop has a protein/fat algorithm, unless it is in the dev branch? I am going to move to the Loop dev branch (what will be released as v3.4) and see how the newer algorithm features effect me.
3 Likes
@trying You’re right, I was thinking of the future/delayed carb entries, like for pizza or steak (high fat/high protein). I know the Dash pod controller could apply a delayed dose, usually due to to something like those mentioned, over a set period. My understanding is Loop has something similar but boluses up front for the future impact…not nearly the same thing.
2 Likes
Yes, I use “Absorption Time” on the Bolus page for that. You can enter as long as 8 hours which I will often do for something like nuts or other slow acting foods. Not exactly an extended bolus on a pump but works fairly well.
I’m interested in how FPU works. Do you have to do anything special to indicate your meal has fat/protein?
1 Like
@Trying In iAPS (Trio too unless the dev’s change it), the user can choose whether to display the fat and protein entry fields on the carb entry screen to allow use of the FPU part of the algo. There are four settings the user can set in preferences that impact the calculation:
Delay in Minutes - for the first future carb entry/insulin dose
Maximum Duration in Hours - the hours (5-12) over which the dose should be spread
Interval in Minutes - # minutes between doses (allows for smoothing)
Override Factor - an adjustment factor between 0 and 1 of how much of the original Warsaw method fat/protein dose should be provided, 1=the original Warsaw method calculated dose
On the carb/meal screen entry screen, the user then enters the carbs, fat, protein and selects done. The algorithm applies the Warsaw calculation using the parameters the user entered and recommends an initial bolus. The user enters the initial bolus desired and the program schedules other bolus entries based on the user’s preference entries. At the interval’s set, the algo doses the amounts calculated per those settings. I have not tested whether the algo will dose me if my BG is predicted to go below my target…probably need to figure that part out or ask the devs.
2 Likes
Thank you so much for the details. It really sounds like a nice feature. I may try it, too!!
2 Likes
@Trying I meant to include a screen pic. The attached is my iAPS screen; the dotted vertical line is the time of day, the green dots = BG, the blue dots = SMB’s with the numbers in units; the red dots = FPU doses given/projected based on a snack with, the numbers are carb equivalent grams; yellow dots are carbs, numbers in grams.
My apologies for diverting from the stream title.
4 Likes
Wow, thanks, Tom!! That is a nice clean chart! I just installed the DIY Loop dev branch yesterday (from main) and will try that out for a while. I have not yet activated the two Algorithm Experiments, but so far Loop is keeping in range with no manual corrections 
3 Likes
@TomH I am testing Trio on my Mac in the Simulator as I would like to see how it works before I actually install it. I am using the Simulator pump, and my Nightscout URL for CGM. BG readings are being displayed but in mmol/L not the expected mg/dL! I don’t see a way to switch to mg/L from mmol/dL. Any idea how to switch Glucose Units??
https://docs.diy-trio.org/en/latest/settings/configuration/preferences/trio.html#glucose-units
1 Like
This thread has been a lightbulb moment for me!! 
I had never heard of FOTF! I used to think it was my coffee sending me up each morning… Now that I’ve had a CGM for several months, I know the rise happens regardless of whether I eat/drink anything. And whenever I actually get out of bed, whether that’s 6:00 a.m. or 9:00 a.m.!
I literally bolus in bed now. I take a multivitamin gummy in the morning, so I bolus for its carbs plus a “correction” in anticipation of a ~40 point rise. It’s helped a lot!
5 Likes