Morning highs / dawn phenomenon?

[annamillhouse]

There's quote a few posts about the comparative benefits of Levimir and Lantus, the effects of dose splitting and timings etc, but I can't quite find an answer to my specific problem - wondered if anyone could offer any advise?!

I'm T1, have been for 27 years. I take Levimir and Humalog, and split the Levimir in half taking it at 10.00 and 22.00. My issue is not so much with highs when I wake up (if they do occur they're easily explained by looking at what I ate the night before!) but later in the morning.

So I get up with a normal BM, and as the Levimir runs out a bit before I take the next dose it steadily rises from say 5/6 up to 10/11, but after taking both insulins (Humalog to try to bring down the BM, and Levimir as normal), it'll still be between 14 - 17 by 11.30. Even if I don't eat anything - if I do it's worse. Tried giving up caffeine as I heard it can cause spikes, was inconclusive...

So I can end up taking about 7-10 units of Humalog despite having no breakfast! I wondered if there was a delay to the Levimir kicking in, but then I don't have the same problem at night?

Any thoughts? Am hoping to get a pump eventually, but in the meantime no coffee or brekkie is no fun!

Thanks,

Anna

 

[Snodger]

I don't know whether this (rather medical jargon filled) pdf might be of use.
http://www.novo-pi.com/levemir.pdf

One thing I noticed in it was that the length of action is related to the dose -
"The mean duration of action ...ranged from 5.7 hours at the lowest dose to 23.2 hours at the highest dose (sampling period 24 hours)."
But if you are splitting the dose in half that shouldn't make a difference?
It also says it's at maximum effect from 3 to 4 hours up to approximately 14 hours after you take it.

Could it be that
a) your body has a slightly delayed 'dawn phenomenon' effect?
b) your night time dose is running out just as the dawn pheneomolskjskj can't spell it, just as your bg rises in the morning, but your 10am dose hasn't kicked in yet? And that's why it's different at night, because the dawn thingy isn't adding to your overall sugar load?

What happens if you move your morning dose by a few hours so your morning Levemir is injected at 7 and starts kicking in at 11am? And see if that is a problem later at night, or if actually you are ok then because there is no dawn phenomenon involved?

 

[Levy]

Did you use to have breakfast before? I notice the same thing if I don't have my breakfast. I get up at 7 and wait with having my breakfast until about 8.30 or 9 when I get to work. In that time, my BG rises from 6 to 13 or 14 even if I do take some insulin to correct it in advance.
If I do have my breakfast however things do tend to work out. I used to be on Levemir as well when this happened and I took it at 7.30am and 10pm.

 

[donnellysdogs]

I used to be exactly the same as you, except I could be 15 within 1 hour of getting up at 8am, at 7.30 am my reading would be around 5 and by 8.30 I would be 15. I was told to have quick acting to bring it down without food (of course this went against everything that I had been instructed previously), and by doing the extra jab at 8.30am it still toook to midday before it even came anywhere near normal....

The only thing that has sorted it out for me is going to a pump. I never expereince highs in the mornings now. My basal rates are huge from 6am onward till 10am, and then drop by 75%!!-but unfortunatley on MDI you can't manage these rises like you can when on a pump.

I hope somebody else out there has come across a solution, but I never did with 25 years of MDI, and I was always the same.

 

[annamillhouse]

Thanks everyone - sorry for not posting back sooner, had a really hectic weekend looking after my friends children!

But these are really helpful suggestions which I'll work through one by one... Nice to know that the pump in the long run might adjust the situation, but I've not idea what the waiting list will be like, so definitely worth trying some solutions in the short term.

Thanks again!

Anna

 

[lizstar]

Sorry this is a little off the subject but i have a question to ask.
Does dawn phenomenon only happen in those insulin-dependant? would LADA diabetics experience this?

 

[cugila]

Here is an explanation of the Dawn Phenomenon :

http://www.brist.plus.com/what-dawn-phenomenon.htm

Basically anybody even a non-Diabetic can experience DP....it is a natural function of our body and not dependent on medication or being a Diabetic of whatever type.

 

[Gjimmy]

In my experience the dawn phenomenon is enhanced considerably by the analogue insulins Lantus and Levemir and to a lesser degree by Novorapid and Humalog. The Lantus especially when taken in large doses prior to going to bed acts as a super concentrated growth hormone which enhances the dawn phenomenon.
Since I've been taking animal insulin, my dawn phenomenon is now negligible with much less insulin taken at bedtime.
Because the Lantus or Levemir has a flat profile, large doses are required to counteract the effect of the dawn phenomenon which of course creates high levels of growth hormone. Making Lantus or Levemir the cause and also the cure for the dawn Phenomenon. Which is actually a medical paradox which nobody should be in.
Anybody can test this theory by simply not taking your Lantus before you go to bed (THIS IS NOT RECOMMENDED HOWEVER) . I did this and woke up to horrendous blood sugar levels over 25, because the dawn phenomenon had been exacerbated by the effect of the growth hormone during the day, but Lantus was not present during the night to correct the sugar levels.

 

[jopar]

It's our hormones that cause DP's, They fluctulate in a cycle over a 24 hour period, our lowest ebb of hormone activity is around 2-3am in the morning this will also be our lowest point for our blood glucose overnight, hence why we test at this time to check nightime dosage..

A lot of people won't notice it, and a different insulin/carb ratio in the morning is more than enough to sort it our, but for some it's more dramatic and they will have problems with contol..

Mine until I got my insulin pump were a nightmare to say the least I could shoot up 8/9mmol/l's in less than an hour and they was no way around it even with splitting insulin, and using different carb/insulin ratio's more so because even through this period I used to get a fluctuation which would plumet the other way.. If I got the timing wrong or what I expected to be my morning wasn't I was knackered completely.. I end up swimming in insulin or be massively short of it..

Insulin is part of our growth hormones, but the growth hormones side of it doesn't effect our blood sugar levels, it may cause Lipohypertrophy (fatty lump where you inject) but it doesnt cause DP's

 

[robertconroy]

I have morning highs and my Endo and I are trying to figure it out. She wants me to do 15 units of Lantus before bed and then increase 1 unit every four days until I get lower am readings. I was over 250 some mornings, now I'm usually under 200 at first check so I can get it down from here by diet and exercise by afternoon. If I'm still high at noon I have a greek salad with vinegar dressing. This will nock it down 100 points, about the same as what Byetta does to me. Try eating an egg and a half grapefruit for breakfast. This might surprise you too. It's the acid that does it's magic.

 

[annamillhouse]

Long term reply to my own post for last year... with some new observations, for anyone else out there experiencing the same thing!

1. Taking the levemir just an hour earlier in the morning has helped, whilst keeping the evening dose at the same time (09.00 and 22.00)

2. Breakfast is essential! Now I know I've been told this hundreds of times, but I guess actually making the comparisons yourself helps... no breakfast can lead to BG shooting up, but a bowl of porridge made with full fat milk with (yes I know it's weird) a teaspoon of peanut or almond butter really helps... the fattiness of the milk and pb slow the carb spike from the oats, but somehow the intake of food halts the DP in its tracks

3. Obvious again, but walking to work or part of the way not only keep the BG low across the morning, but all day - it takes a while so it's not always practical, but I have my smoothest BGs all day if I walk 4 or so miles to work... until a month ago I would never have thought I could walk that far, but even a couple of miles is really helpful...

Anna x

 

[ljwilson]

I got my last HBA1c result last week, 7.9 so a bit high. I saw my diabetic nurse and we decided it is because I am waking up with very high levels, in the high teens. We have concluded that this is due to my liver dumping and she has suggested eating porridge before bed, which I am now doing and is seem to be working. I am trying to lose weight and would rather reduce my insulin but she is against this. I currently take 24 units of Levemir twice a day and approx 60 units of Humulin S throughout the day, which dose should I be reducing to prevent my lows in the middle of the night?

Also, I am not convinced that my liver is dumping, if I wake up and my level is say for example 8 if I do not take my Humulin S pretty much straight away then my levels will shoot up in to the high teens without me eating anything.

Lorna

 

[noblehead]

Long term reply to my own post for last year... with some new observations, for anyone else out there experiencing the same thing!

1. Taking the levemir just an hour earlier in the morning has helped, whilst keeping the evening dose at the same time (09.00 and 22.00)

2. Breakfast is essential! Now I know I've been told this hundreds of times, but I guess actually making the comparisons yourself helps... no breakfast can lead to BG shooting up, but a bowl of porridge made with full fat milk with (yes I know it's weird) a teaspoon of peanut or almond butter really helps... the fattiness of the milk and pb slow the carb spike from the oats, but somehow the intake of food halts the DP in its tracks

3. Obvious again, but walking to work or part of the way not only keep the BG low across the morning, but all day - it takes a while so it's not always practical, but I have my smoothest BGs all day if I walk 4 or so miles to work... until a month ago I would never have thought I could walk that far, but even a couple of miles is really helpful...

Anna x

Great news you got sorted Anna :thumbup: