Fighting the Dawn effect!!

[Postleneo]

Anyone else having a nightmare with the early morning Dawn Effect?? - if so I would really appreciate comments on how you combat or deal with this ..... been getting a nightmare for me over past few months - always seems to raise between 3.5 and 7 mmol's for me within 2 hours of waking but the total rise is never fixed...aarrgghhhh!!! - so frustrating!

 

[himtoo]

this is a very common issue for a lot of type 1's ( me included )

as you are recently diagnosed about 13 months ago you may possibly be still producing some of your own insulin sporadically which won't help , but one thing that could be looked at is adjusting the time of day that you take your Lantus.

it would be something to discuss with your care team before making any changes.

 

[azure]

I have DP and a waking rise too. I control the DP with my pump, but the waking rise I control by not delaying breakfast. I find if I get up but don't have breakfast pretty soon, my BS will go up and become hard to get down.

On days when I can't eat my breakfast because I'm rushing or whatever, I either have a small bolus without food to stop the rise, or I eat something very small eg a small biscuit and bolus for that. Both those things stop a rise from a delayed breakfast.

 

[Kristin251]

I too need to eat right away. Not eating makes it worse. I bolus for BF which has very few carbs ( one piece of lettuce with mayo and thin slice of turkey and 1/4 avocado. Protein will spike me in the morning as well as crabs of course so BF is mostly fat. Then after 2.5-3 hours I test and take a small correction and the rest of the day I stay flat. It's that darn morning!

 

[noblehead]

always seems to raise between 3.5 and 7 mmol's for me within 2 hours of waking but the total rise is never fixed...aarrgghhhh!!! - so frustrating!

Likewise, I find this to be the case when I fast for my annual diabetes check-up where bloods are taken which includes a full lipid breakdown, to avoid the liver dump I eat breakfast with 30mins of waking which shuts the mechanism off.

 

[tim2000s]

Likewise, I find this to be the case when I fast for my annual diabetes check-up where bloods are taken which includes a full lipid breakdown, to avoid the liver dump I eat breakfast with 30mins of waking which shuts the mechanism off.

WHy not adjust your basal for that occasion so that you avoid it? Pre-progamme the "Clinic" pattern

 

[noblehead]

WHy not adjust your basal for that occasion so that you avoid it? Pre-progamme the "Clinic" pattern

That's what I do

I was talking in the absence of a bolus dose/basal adjustment.

 

[Kristin251]

Just to understand, 3.5-7 above fasting? So 63-126 points?

I have no idea how high I would have gone but a few weeks ago I inadvertently fasted. I wanted to see when my insulin started lowering me so tested every ten-20 min and I had to keep taking insulin. At 3 hours I had already injected an entire days worth Andy still didn't start dropping until I ate. Crazy fasting makes it worse even with insulin.

 

[Postleneo]

Thank you all for taking the time to respond you have given me food for thought( pardon the pun!!). This morning I thought I would experiment - Before bed reading last night at 10:30 pm was 6.4 mmol. At 5am reading was 6.1 mmol - injected 2.5 units to cover 2 weatbix (28g carbs) at 5am ( carb ratio 1:11.5) and ate at 5:15am. Tested at 7:15am (at 2 hr mark) and reading was 14.8, at 8:30am (3 hr mark)13.9 mmol at 9:30am 9.6 mmol (4 hr mark)then at 10:30 a rise to 12??? (5 hours from taking insulin) - even with eating it appears I still get a rise of 3.5 mmol followed by a 2 mmol rise within an hour of having no IOB- back to drawing board I think - tomorrow I may inject a small correction either .5 or 1 unit on waking followed by breakfast at 7am see how that goes

 

[donnellysdogs]

I do not have breakfast.

My levels will be normal 5-7 pre bed and till 4pm. They then start to climb. I used to drop hypo at 3am but sorted that out.
At 4am everyday I have a pre waking bolus of 2 units. If levels have started to climb meter recommends probably1/2 unit so I give 21/2 units of bolus.
Then at 8.30 I have to have a 4 unit correction bolus an hour before I get up.

A basal shot increase at night really messes me up at 3am with hypo's. If I have my basal later than 5pm it impacts even more on 3am.

My nurse did suggest adding another different extra basal shot in but its enough for me to cope with two pens and times, let alone 2 different basal shots.

Changed hosp and got cgm funded for a while and hospital going to try me back on a pump. If I continue to have set failures then there is a chance of a diaport.

Was better on pump for DP and waking but not with occlusions and hypers.

Frustrating as tried tresiba, lantus, levemir and find Insulatard is better but extra waking and injecting means we don't ever get more than 4 hours sleep as hubby works permanent late shifts and very rare to go to slepp before 12.30am

 

[himtoo]

- even with eating it appears I still get a rise of 3.5 mmol followed by a 2 mmol rise within an hour of having no IOB- back to drawing board I think - tomorrow I may inject a small correction either .5 or 1 unit on waking followed by breakfast at 7am see how that goes

that experiment suggests a look at basal - I believe in an earlier thread looking at basals was suggested.
getting basal right is the first cornerstone in good control.

 

[donnellysdogs]

Basal does not cure everything for everybody, some of us do have to a bolus pre waking or waking to combat DP.

I would just check your levels at 3am...jyst to make sure not going low and liver kicking in...

 

[Postleneo]

Thanks for the advice guys - one question.... in order to see what's going on etc i.e basal testing which I believe is done fasting over set times and checking BS levels every hour or two.... are there any monitors available on the NHS (on loan or prescription) that can continually monitor blood sugar levels whilst sleeping as I am worried that this 'Dawn Effect' may kick in prematurely when waking to test blood - or is that the idea? I have looked on line and have noted there is a freestyle libra system but are quite expensive - can this system be used to do basal testing or is it more accurate to check the old fashioned way by doing finger pricks and checking blood sugar levels? 13 months in and still fairly confused - not even been on DAFNE course yet ... cant wait to also consider GI values, fat content, fibre etc etc :-(

 

[donnellysdogs]

Some hospitals are giving patients a sensor and reader for a Libre to trial. Therafter you have to pay. One sensor lasts two weeks so if your hospital could give you a "trial" it would enable you to view whats happening to your bloods easier.

If your levels drop or increase quickly the Libre does lag behind so you could not accurately use them for bolusing etc.

For over night checks its great for me. I have limited blood test sites and it enables me to scan rather than test and when I wake properly I can see whats happened.

Proper CGM's are limited even more than libres for availability. Their costs are more but tgey will alarm if going low or high.

The libre does not alarm for lows or highs.

 

[Postleneo]

Thanks for that will ask my diabetes team - doing the bolus testing while fasting could be a bit problematic during the night with considering work etc - so a monitor would be ideal .. even if it is just for he fasting and checking through the night will ask about that thank you

 

[richyb]

when i was on 2 injections of Levimer it used to happen to me also. I found that the solution was to inject my before breakfast(bolus) dose about 22 minutes before the food. This allowed my bolus to take up some of the short fall. I was carefull in doing this as I only increased the time by a couple of minutes each day till I found 22mins was ideal. This was my solution, that worked with me. Yours may be different, so take care what you do.

 

[Kristin251]

I can't UP my basal or I hypo during the night

We are MOST insulin resistant in the morning and gain sensitivity as the day goes on. Taking insulin and not eating does nothing for me. I still rise. I need to split my morning bolus. I take the same amount at all meals and BF is the smallest but I get the biggest rise. I have tried everything and the only thing that works is to take a small correction 2.5 -3 hours later. Insulin without food is a nightmare in the morning. No clue why but it is

 

[noblehead]

.... are there any monitors available on the NHS (on loan or prescription) that can continually monitor blood sugar levels whilst sleeping as I am worried that this 'Dawn Effect' may kick in prematurely when waking to test blood - or is that the idea? I have looked on line and have noted there is a freestyle libra system but are quite expensive - can this system be used to do basal testing or is it more accurate to check the old fashioned way by doing finger pricks and checking blood sugar levels?

Ask your hospital diabetes clinic as they can loan out CGM for a week, however there can be a waiting list which isn't helpful if you want to get on top of things now, you can basal test with a Libre but I would still do some finger prick test just to check the accuracy of the sensor.

 

[himtoo]

Basal does not cure everything for everybody, some of us do have to a bolus pre waking or waking to combat DP.

I would just check your levels at 3am...jyst to make sure not going low and liver kicking in...

agreed @donnellysdogs but the OP is newly diagnosed and it is a starting point