Dawn phenomenon

[Sharrryn]

Hi
For those on injections how do you cope with dawn phenomenon. I was on the pump but I've switched back to injections. I take levemir twice a day at 6am and 6pm and novorapid for bolus. My overnight blood sugar is good but from about 4:30am it starts to rise. I'm usually awake by 5:30 for breakfast but then need to correct and wait before breakfast. I'm suffering from anxiety also and find my sugar rises on waking from morning stress..... vicious cycle.
I'm starting to wonder if I should inject a dose around 4:30 to stop these pre breakfast increases.
Any ideas ???
Sharrryn

 

[novorapidboi26]

I have been discussing dawn phenomenon on another thread and have it myself, although my pump takes care of it now......


A tactic I employed when injecting was to move the evening dose of Levemir to later on, before bed.....this meant that the dose was in a stronger position by the time the bod clock kicked in and the liver spat out its glucose contribution....this increased the risk of the morning dose running out early evening, but I compensated that by adjusting my bolus ratios for evening meal....it worked OK....

Also, breaking the fast as soon as you can will let the liver know that fuel has been put in the tank and its help is no longer needed...this will allow the continual rise into the morning to stop....but not the initial rise.....

trying to do a correction before it happens is an option I suppose but if you continue to do this regularly your body clock will readjust to your new waking time and start the DP process earlier....

Can I ask why you don't pump anymore....?.....this would help tremendously you se....

 

[Sharrryn]

I have been discussing dawn phenomenon on another thread and have it myself, although my pump takes care of it now......


A tactic I employed when injecting was to move the evening dose of Levemir to later on, before bed.....this meant that the dose was in a stronger position by the time the bod clock kicked in and the liver spat out its glucose contribution....this increased the risk of the morning dose running out early evening, but I compensated that by adjusting my bolus ratios for evening meal....it worked OK....

Also, breaking the fast as soon as you can will let the liver know that fuel has been put in the tank and its help is no longer needed...this will allow the continual rise into the morning to stop....but not the initial rise.....

trying to do a correction before it happens is an option I suppose but if you continue to do this regularly your body clock will readjust to your new waking time and start the DP process earlier....

Can I ask why you don't pump anymore....?.....this would help tremendously you se....

Thanks for your informative reply. Much appreciated.Yes the pump is great for dp. I was on the pump for 9 years but now have so much scar tissue and absorption issues and many site failures due to air lines in tubing and kinked cannulas I was having so many highs and ketones I need a break for a while. Needles allow many more areas to inject. I hope to return to the pump at some stage.

 

[novorapidboi26]

Thanks for your informative reply. Much appreciated.Yes the pump is great for dp. I was on the pump for 9 years but now have so much scar tissue and absorption issues and many site failures due to air lines in tubing and kinked cannulas I was having so many highs and ketones I need a break for a while. Needles allow many more areas to inject. I hope to return to the pump at some stage.

That sounds horrific with the pump, sorry to hear that....what cannulas were you using?

A break from it sounds just what you need though...

There are ways as I have described to try and dampen the severity of the dawn rise as I have previously mentioned but it wont go away unfortunately....

I always thought I was doing OK if I managed to wake up on a single figure.....

 

[Sharrryn]

That sounds horrific with the pump, sorry to hear that....what cannulas were you using?

A break from it sounds just what you need though...

There are ways as I have described to try and dampen the severity of the dawn rise as I have previously mentioned but it wont go away unfortunately....

I always thought I was doing OK if I managed to wake up on a single figure.....

I was using quick sets with Medtronic 640g pump. Great when it worked but caused too much stress when it failed. I've had type 1 for 35 years . The body is a bit battered from it all I guess.

 

[novorapidboi26]

I was using quick sets with Medtronic 640g pump. Great when it worked but caused too much stress when it failed. I've had type 1 for 35 years . The body is a bit battered from it all I guess.

That's a shame.......its the quick set I use too.....6mm.......

I prefer to use my upper thighs, but do use my stomach and buttocks from time to time....

 

[SallyEzra]

Hi Sharryn,

When I took basal/bolus injections, as novorpaidboi26 has already said, I found that taking the basal just before bed & eating breakfast soon after waking seemed to keep my blood sugar within a good range. However, I was on a different basal insulin, Lantus & then Tresiba, and I only took the one injection of basal pre-bed. If I were to delay breakfast because I was wrapped up in something else, this is when I could potentially see the dawn phenomenon really take hold.
For the way my body responds, I personally found Tresiba much more fitting with my lifestyle, as on Lantus, like you, I had to inject basal twice a day in order to avoid overnight hypos. And the super long acting profile of Tresiba (around 38hrs I think from memory), meant that I didn't have to be quite so regimented about timings, whilst maintaining an OK blood sugar.

Thank you also for your information about the pump re: scar tissue/absorption issues. Based on your experience of a pump, did you learn any advice on how to help avoid scar tissue/absorption issues, beyond normal rotation of the sites for cannulas?.
The reason I ask is that I love my pump & the level of control it provides me with and want to make sure I can keep it going as long as possible. (Pump uses Novorapid)

 

[Sharrryn]

Hi Sharryn,

When I took basal/bolus injections, as novorpaidboi26 has already said, I found that taking the basal just before bed & eating breakfast soon after waking seemed to keep my blood sugar within a good range. However, I was on a different basal insulin, Lantus & then Tresiba, and I only took the one injection of basal pre-bed. If I were to delay breakfast because I was wrapped up in something else, this is when I could potentially see the dawn phenomenon really take hold.
For the way my body responds, I personally found Tresiba much more fitting with my lifestyle, as on Lantus, like you, I had to inject basal twice a day in order to avoid overnight hypos. And the super long acting profile of Tresiba (around 38hrs I think from memory), meant that I didn't have to be quite so regimented about timings, whilst maintaining an OK blood sugar.

Thank you also for your information about the pump re: scar tissue/absorption issues. Based on your experience of a pump, did you learn any advice on how to help avoid scar tissue/absorption issues, beyond normal rotation of the sites for cannulas?.
The reason I ask is that I love my pump & the level of control it provides me with and want to make sure I can keep it going as long as possible. (Pump uses Novorapid)

Hi. Thanks for replying. My only advice is what we are all told as you mentioned which is to rotate sites regularly and use correct size cannula. I was using a 9mm for a few years and had pain all the time when i changed to 6mm that helped. My many years of injections pre pump also left me with scar tissue and lumpy stomach before I started the pump which didn't help. I didn't rotate as well as I should have.

 

[SallyEzra]

Thanks Sharryn. That is helpful. I do have a fair bit of stinging when I insert a cannula & I just checked & mine are 8mm, but I can see that I can also get these in 6mm, so will give Accu-Chek a call a bit later to see if I can trial a box of those instead. And I can totally empathise with the effect of 'lumpy stomach' which is what I had managed to create on my lower tummy after almost 30 years of injections, despite believing I was rotating sufficiently - thankfully my legs seemed to fare better!. Lumpy stomach is still on my radar as something I want to get resolved medically, but first I need to (hopefully!) complete my current pregnancy, then lose any pregnancy weight gain, before I am sure anyone will want to see me!.

Waking at 4.30am simply to do a correction dose of bolus probably needs to be balanced out in your mind in terms of what is best for you - e.g. would setting an alarm for 4.30am have a significant effect on your lifestyle/tiredness etc or would knowing that you have taken a correction dosage actually give you greater peace of mind?
I do hope however that your body will heal quickly & you can return to your pump asap as that would obviously provide exactly the control you require at 4.30am without interrupting you.

 

[LooperCat]

I’m on MDI, and DP kicks in most mornings (but not every day, because that would be too predictable) some time between 4 and 7am (again, a little predictability would be nice, but that’s T1 for you), so there’s no point setting an alarm to try and deal with it.

But.... most mornings, I seem to wake naturally with a bit of a jolt when it’s just starting (I think it’s the cortisol that the liver chucks out along with the glucose) - I scan my Libre and see it’s just beginning to rise. After a bit of experimenting, I’ve worked out how much to inject, it depends on my BG at the time. Most times, it nips the rise in the bud.



However, if I sleep through the hepatic alarm clock, it’s hard to get back into range - this is a perfect example of missing it...



No brilliant solutions, I’m afraid, do you have Libre or are you fingerstabbing?

 

[novorapidboi26]

I’m on MDI, and DP kicks in most mornings (but not every day, because that would be too predictable) some time between 4 and 7am (again, a little predictability would be nice, but that’s T1 for you), so there’s no point setting an alarm to try and deal with it.

But.... most mornings, I seem to wake naturally with a bit of a jolt when it’s just starting (I think it’s the cortisol that the liver chucks out along with the glucose) - I scan my Libre and see it’s just beginning to rise. After a bit of experimenting, I’ve worked out how much to inject, it depends on my BG at the time. Most times, it nips the rise in the bud.

View attachment 26619

However, if I sleep through the hepatic alarm clock, it’s hard to get back into range - this is a prefect example of missing it...

View attachment 26620

No brilliant solutions, I’m afraid, do you have Libre or are you fingerstabbing?

Love the wee cloud addition to the libre pic......

So do you find that a correction only and not the introduction of something into the stomach aswell, deal with the rise in BG?

 

[LooperCat]

Love the wee cloud addition to the libre pic......

So do you find that a correction only and not the introduction of something into the stomach aswell, deal with the rise in BG?

A correction only deals with it. I very rarely eat until early afternoon. I keep this crib sheet by the side of the bed, with the doses I worked out (bit of trial, error and dextrose required), so I can just scan my BG, see the start of the rise, refer to it, inject, roll over and go back to sleep. Very little thinking required, which is just as well, as I’m not terribly good at maths first thing.

It felt really wrong at first to be injecting when I was already in range, but my daft looking system really works! For me, anyway.

​

 

[novorapidboi26]

A correction only deals with it. I very rarely eat until early afternoon. I keep this crib sheet by the side of the bed, with the doses I worked out (bit of trial, error and dextrose required), so I can just scan my BG, see the start of the rise, refer to it, inject, roll over and go back to sleep. Very little thinking required, which is just as well, as I’m not terribly good at maths first thing.

It felt really wrong at first to be injecting when I was already in range, but my daft looking system really works! For me, anyway.

View attachment 26621​

Interesting, so how long from correction until you officially get up.....and what's the graph like from that point onwards...?

 

[LooperCat]

This isn’t the same day, as I don’t always think to take photos of my scanner at sparrowfart o’clock, but it’s pretty standard. I usually get up around nine (the joys of being self employed ), but don’t always eat breakfast. The little apples here showed where I logged some food. I eat very low carb though, so please don’t get the impression I’m balancing insulin and carbs perfectly (I can’t. So that’s why I don’t eat them!).

 

[jlarsson]

Those straight lines are witchcraft.

 

[becca59]

I find it a problem and Adrenalin when exercising, but as @Mel dCP says I can have it for a number of days and then nothing. I tend to wake up early so always check blood levels/Libre if awake and react accordingly. Also inject first before putting feet on floor. Then always eat a small breakfast. It can continue rising until about 2pm.
On the whole because it is unsolvable I have stopped worrying about it and just do my best.

 

[SallyEzra]

Wow @Mel dCP what an amazing straight line to have on your libre profile!. Your diabetic consultancy team must be so pleased with that. I have seen a non diabetic profile of a friend on freestyle libre that naturally couldn't hold a straight line like that!
And it sounds like you have now really found a way of working with your T1 Diabetes that works for you, carb free etc.

After more than 30yrs as a Type 1 diabetic, I have found these forums really helpful in making me more aware of different approaches to try & also the different responses on different bodies, which I have needed more than ever in the past few years after going through a pregnancy where my body did nothing I was told it would & by the end of my first pregnancy my basal rate was less than a third of my non pregnant basal rate. Initially I was like a rabbit in headlights (in addition to incredibly hypo around the clock!) but eventually it was online forums that made me realise that, whilst an uncommon response to pregnancy, I was not alone.
I can at least be grateful it seems that my DP starts at roughly the same time every morning, so the pump is programmed to deal with it & always ends when I eat some breakfast with the first bolus.

 

[novorapidboi26]

This isn’t the same day, as I don’t always think to take photos of my scanner at sparrowfart o’clock, but it’s pretty standard. I usually get up around nine (the joys of being self employed ), but don’t always eat breakfast. The little apples here showed where I logged some food. I eat very low carb though, so please don’t get the impression I’m balancing insulin and carbs perfectly (I can’t. So that’s why I don’t eat them!).

View attachment 26623

Well, yeah, the absence of regular carbs will help with any dawn rise, or make it hard to spot at the very least...

Those straight lines are witchcraft.

Also agree with this statement....lol...

 

[LooperCat]

Those straight lines are witchcraft.

I’ve been called a witch on more than one occasion

@novorapidboi26 - actually I’ve found that the absence (well, max 30g a day) of carbs has made all these things easier to spot rather than the other way around. For me at least, they’ve been masking what’s going on. With my basal at exactly the right level now, I can see what happens, if that makes sense. I was so rollercoastery before making the switch to low carb that I couldn’t spot any patterns. Now, I’ve noticed (and can counter) DP pretty reliably, and I’ve also seen that I’m quite insulin resistant at certain points in my monthly cycle, and need to increase my Tresiba by a unit for a few days. Still trying to nail that one down, as I’ve only been eating this way for four months. Not applicable to the blokes, but might be helpful to any women reading, who might have similar issues! I’m recording my temperature every morning, so I can work out at which point to start increasing the Tresiba, as it takes a couple of days for the extra to kick in. I think my science background helps,with this - I’m pretty confident experimenting on myself to figure out what suits me best. Also being self employed means I don’t have to answer to anyone!

Effectively, I’ve (mostly) taken food out of the equation and I can see exactly what the processes are doing in the background. And once I’ve got that foundation sorted, the rest is just fiddling around the edges, I think. It seems to make the anomalies T1 throws at us a little easier to counter.

 

[Sharrryn]

I find it a problem and Adrenalin when exercising, but as @Mel dCP says I can have it for a number of days and then nothing. I tend to wake up early so always check blood levels/Libre if awake and react accordingly. Also inject first before putting feet on floor. Then always eat a small breakfast. It can continue rising until about 2pm.
On the whole because it is unsolvable I have stopped worrying about it and just do my best.

Good point. Sometimes things that are unsolvable just requires us to try our best and stop worrying. I like that !!!