Tresiba, Dawn Phenomenon, Split Dosing

Applenerd81

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Sorry I said cardio, I meant to say exercise, something that gets your muscles going like weighted squats for example.

So you tried fasted cardio and it raises your blood sugar?

My sugars climb before I’d get the chance to even start! Even morning “bedroom” cardio has a tendency to cause blood sugar to climb!
 

Brendon.Dean

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My sugars climb before I’d get the chance to even start! Even morning “bedroom” cardio has a tendency to cause blood sugar to climb!

What are you eating at what time between 8 hour prior to bed leading up to bed? This sounds more like it could be the culprit
 
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scotteric

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What are you eating at what time between 8 hour prior to bed leading up to bed? This sounds more like it could be the culprit

Nope, this is normal for a lot of type 1s. It is part of the dawn phenomenon, has nothing to do with what was eaten the night before. Your body dumps its glycogen stores at an accelerated rate to fuel you for physical activity, requiring more insulin.
 
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LooperCat

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Nope, this is normal for a lot of type 1s. It is part of the dawn phenomenon, has nothing to do with what was eaten the night before. Your body dumps its glycogen stores at an accelerated rate to fuel you for physical activity, requiring more insulin.
My levels start to soar around 4-5am no matter what I’ve had to eat the day before. Insulin is the only way to deal with it.
 
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Kbarbaracollins_

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Have only just started splitting doses this weekend (yesterday), so I am perhaps a little keen! Tresiba is stated to last up to 36 hrs however, that number is based on dosing of 0.4-0.6iu per KG bodyweight - which for me equates to around 32iu - 48iu per day, my basal needs are around 18-24 per day - so I'd doubt it would ever last thta long, plus im not keen on injecting so much insulin in one site.

I split my doses of Tresiba as recommended by Dr B. It seems to work fine but I’ve never tried it as one dose.
 
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MinaRotter

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For what it's worth, my opinion is to get a pump. I have had type 1 for 40 years and had dawn phenomenon from before it was given a name.

You can't treat Dawn phenomenon with long acting insulin. You can only treat it with short acting - that means waking up at 5 am (ish - depending on when your BG starts to rise) and throw in some fast acting. Or use a pump to automatically adjust your basal rate for you - my preference.

Long acting is intended to give a flat basal. Some people have a flat basal requirement and it works well for them - many don't and it doesn't.

If you increase your long acting (basal insulin) to the point where it is covering your peak insulin requirement (ie the dawn phenomenon) then for the rest of the 24 hr period your BGs are going to be falling as your basal insulin is in excess of requirements and you will either go hypo or have to take on carbs to cover it.

Get a pump. I speak from experience and not an insignificant amount of medical knowledge.
 

donnellysdogs

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Well, I have made a couple changes....and so far so good. I had one low yesterday after breakfast..only shown by tests and gaps in lines as sensor was charging up and disconnected...

So, the changes are:
1.5 units now in the morning of tresiba.
And, a mixture of:
1oz glutenfree steel cut oats, soya milk, goats yogurt, 10 blueberries, 4 cherries, teaspoon of flaxseed and chia seed and 2 teaspoon of hemp seed soaked overnight. Made 3 portions up for each morning for 3 days. Oh and a few coconut strips, almonds and walnuts.

Unbelievable improvement...

IMG_8821.jpg
 

scotteric

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For what it's worth, my opinion is to get a pump. I have had type 1 for 40 years and had dawn phenomenon from before it was given a name.

You can't treat Dawn phenomenon with long acting insulin. You can only treat it with short acting - that means waking up at 5 am (ish - depending on when your BG starts to rise) and throw in some fast acting. Or use a pump to automatically adjust your basal rate for you - my preference.

Long acting is intended to give a flat basal. Some people have a flat basal requirement and it works well for them - many don't and it doesn't.

If you increase your long acting (basal insulin) to the point where it is covering your peak insulin requirement (ie the dawn phenomenon) then for the rest of the 24 hr period your BGs are going to be falling as your basal insulin is in excess of requirements and you will either go hypo or have to take on carbs to cover it.

Get a pump. I speak from experience and not an insignificant amount of medical knowledge.

I have significant experience on and off a pump. I agree for many it is the most practical and, perhaps, only option to slay DP. However, there are ways to do it on MDI too, even using basal insulin. What you said applies to Tresiba - if working correctly, it provides a constant 24-hr dose and thus shouldn't in theory tackle DP. However, Levemir can be split to take a higher dose at night and less during the day, solving the problem of having to take basal at a higher dose and be stuck with it for 24 hours. It also has a slight peak which can be timed to coincide with when DP kicks in.
 
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LooperCat

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Well, I’ve shifted my Tresiba dose from morning to evening. I didn’t have DP this morning, or my usual late afternoon slump. I’ve had just the reverse... literally a 12 hour shift.
 
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MinaRotter

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Yeh. I've not used the newer long acting and I guess they never give a perfectly flat basal but it's going to be pot luck to try and get the long acting peak to coincide with your dawn phenomenon at the correct dose. I guess if you're dead against pumping it's worth a try but it's not a logical or neat solution.

I find a pump gives a very clear insight into diurnal insulin requirements that can be very closely matched with CSII via a pymp throughout the day. Once correctly set up it gives infinitely more leeway and freedom with all other activities and meals vs injections. Alongside much better control, generally. I appreciate it might not be for everyone but if there is also a strong clinical indication for it (ie with Dawn phenomenon) then it is certainly worth considering. Not many change back to injections after trying a pump.
I have significant experience on and off a pump. I agree for many it is the most practical and, perhaps, only option to slay DP. However, there are ways to do it on MDI too, even using basal insulin. What you said applies to Tresiba - if working correctly, it provides a constant 24-hr dose and thus shouldn't in theory tackle DP. However, Levemir can be split to take a higher dose at night and less during the day, solving the problem of having to take basal at a higher dose and be stuck with it for 24 hours. It also has a slight peak which can be timed to coincide with when DP kicks in.
 

donnellysdogs

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Yeh. I've not used the newer long acting and I guess they never give a perfectly flat basal but it's going to be pot luck to try and get the long acting peak to coincide with your dawn phenomenon at the correct dose. I guess if you're dead against pumping it's worth a try but it's not a logical or neat solution.

I find a pump gives a very clear insight into diurnal insulin requirements that can be very closely matched with CSII via a pymp throughout the day. Once correctly set up it gives infinitely more leeway and freedom with all other activities and meals vs injections. Alongside much better control, generally. I appreciate it might not be for everyone but if there is also a strong clinical indication for it (ie with Dawn phenomenon) then it is certainly worth considering. Not many change back to injections after trying a pump.

Some of us have to change back... and I have known at least 2 children to do so as well as 2 adults. This isnt via virtual forums, its real life people I have around me. Its not that rare...
There are definite ways to get over DP on mdi, its just having the courage to do something different to what the standard text book says that the consultants cannot advise you to do because its outside of their NICE guidelines and the instructions from manufacturers.

Its balancing when your peak needs for insulin are, when they wear off and knowing the timings for how the basal insulins peak (or not).

Yes, it takes faffing around... but I've been off Pump for 3 years and I had 5 great years before it all went wrong with my body and pump.

Do I miss it, 100% no. Would I go back to it? No, the CGM is a far better tool for me to manage my bloods by.
 

scotteric

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Yeh. I've not used the newer long acting and I guess they never give a perfectly flat basal but it's going to be pot luck to try and get the long acting peak to coincide with your dawn phenomenon at the correct dose. I guess if you're dead against pumping it's worth a try but it's not a logical or neat solution.

I find a pump gives a very clear insight into diurnal insulin requirements that can be very closely matched with CSII via a pymp throughout the day. Once correctly set up it gives infinitely more leeway and freedom with all other activities and meals vs injections. Alongside much better control, generally. I appreciate it might not be for everyone but if there is also a strong clinical indication for it (ie with Dawn phenomenon) then it is certainly worth considering. Not many change back to injections after trying a pump.

I agree pumping makes a lot more sense and I did it continuously for 11 years. My issue with it is not wearing the device, or the maintance it requires, but inconsistent and erratic absorption, especially after years of pump use, and the fact that pump companies have done nothing to improve infusion sets. I also think CGMs, half-unit dosing pens and modern basal alternatives have changed the game, and eliminated much of the differences between MDI and pumping.
 
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EllsKBells

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Well, I’ve shifted my Tresiba dose from morning to evening. I didn’t have DP this morning, or my usual late afternoon slump. I’ve had just the reverse... literally a 12 hour shift.

That's really interesting, because I take my Tresiba in the evening, and yet I had my usual DP this morning to the tune of 15.6.

Don't you just love the human body.

That said, really glad it's working for you :)
 
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LooperCat

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That's really interesting, because I take my Tresiba in the evening, and yet I had my usual DP this morning to the tune of 15.6.

Don't you just love the human body.

That said, really glad it's working for you :)
Woke up with a 6.3 at 8am, which rose to 7.1 in half an hour, so took my usual DP correction dose, and I’m back in the 6s again. Be interesting to see what happens this afternoon and whether I get the slump I’ve had until the other day, or the rise I had yesterday!

T1 sucks sometimes. Well, most of the time. All the time, if I’m being honest, but I do get a certain sense of satisfaction on the rare occasion I get it right.
 

Applenerd81

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For what it's worth, my opinion is to get a pump. I have had type 1 for 40 years and had dawn phenomenon from before it was given a name.

You can't treat Dawn phenomenon with long acting insulin. You can only treat it with short acting - that means waking up at 5 am (ish - depending on when your BG starts to rise) and throw in some fast acting. Or use a pump to automatically adjust your basal rate for you - my preference.

Long acting is intended to give a flat basal. Some people have a flat basal requirement and it works well for them - many don't and it doesn't.

If you increase your long acting (basal insulin) to the point where it is covering your peak insulin requirement (ie the dawn phenomenon) then for the rest of the 24 hr period your BGs are going to be falling as your basal insulin is in excess of requirements and you will either go hypo or have to take on carbs to cover it.

Get a pump. I speak from experience and not an insignificant amount of medical knowledge.
I had a pump for 2 years, and whilst I agree it provides the best option for DP, it was also great to learn my basal pattern. However, I quit the pump for a number of reasons - I didn't like the constant reminder of my diabetes and the feeling of wearing a pump (had Cellnovo). I hated the set change/IC change process and inconvenience in the event of any kind of error. Felt surprisingly liberated when I switched back to MDI!
 
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Applenerd81

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Some of us have to change back... and I have known at least 2 children to do so as well as 2 adults. This isnt via virtual forums, its real life people I have around me. Its not that rare...
There are definite ways to get over DP on mdi, its just having the courage to do something different to what the standard text book says that the consultants cannot advise you to do because its outside of their NICE guidelines and the instructions from manufacturers.

Its balancing when your peak needs for insulin are, when they wear off and knowing the timings for how the basal insulins peak (or not).

Yes, it takes faffing around... but I've been off Pump for 3 years and I had 5 great years before it all went wrong with my body and pump.

Do I miss it, 100% no. Would I go back to it? No, the CGM is a far better tool for me to manage my bloods by.

Couldn't agree more!
 
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MinaRotter

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Type 1
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Pump
Some of us have to change back... and I have known at least 2 children to do so as well as 2 adults. This isnt via virtual forums, its real life people I have around me. Its not that rare...
There are definite ways to get over DP on mdi, its just having the courage to do something different to what the standard text book says that the consultants cannot advise you to do because its outside of their NICE guidelines and the instructions from manufacturers.

Its balancing when your peak needs for insulin are, when they wear off and knowing the timings for how the basal insulins peak (or not).

Yes, it takes faffing around... but I've been off Pump for 3 years and I had 5 great years before it all went wrong with my body and pump.

Do I miss it, 100% no. Would I go back to it? No, the CGM is a far better tool for me to manage my bloods by.
Yeh there's always the exception that proves the rule.

I've never met anyone who's changed back except on these forums and I worked as a GP with special interest In diabetes and knew the lead consultant for Diabetes pump therapy in Liverpool that at the time was one of the few centres that offered the service and covered the West Midlands, Wales and most of the North Western HA's and he told me NOBODY had changed back from pump therapy.

Admittedly that was 5 years or so ago and I've been retired for the last 10, so I'm sure these mythical beasts exist but pretty rarely. Incidentally, I did say "not many' change back. I didn't say no one does.

From my experience with the dawn phenomenon, the only thing that resolved it was the pump. I've tried monotard, leo mixtard, ultratard, glargine in single bolus and split bolus. None of which coveted it and most of the time I ended up having to time my meals to coincide with the lows I got as a result.

Guess it depends how bad the DP is. Not sure why you're so against pumps - especially if it hasn't been tried
 

scotteric

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Yeh there's always the exception that proves the rule.

I've never met anyone who's changed back except on these forums and I worked as a GP with special interest In diabetes and knew the lead consultant for Diabetes pump therapy in Liverpool that at the time was one of the few centres that offered the service and covered the West Midlands, Wales and most of the North Western HA's and he told me NOBODY had changed back from pump therapy.

Admittedly that was 5 years or so ago and I've been retired for the last 10, so I'm sure these mythical beasts exist but pretty rarely. Incidentally, I did say "not many' change back. I didn't say no one does.

From my experience with the dawn phenomenon, the only thing that resolved it was the pump. I've tried monotard, leo mixtard, ultratard, glargine in single bolus and split bolus. None of which coveted it and most of the time I ended up having to time my meals to coincide with the lows I got as a result.

Guess it depends how bad the DP is. Not sure why you're so against pumps - especially if it hasn't been tried

I don't think there would be any reason to switch back to MDI if a pump is working well, and agree it is probably rare. I'm pro-pump, I think they are a logical way to manage diabetes and should be available to anyone who wants one. At the same time, as a long time pump user, I've also come to realize that MDI can be just as good and sometimes better, and I am angry with the pump companies for not bringing about meaningful improvements. Ive had negative experiences with every type of infusion set that exists, including steel sets which I hate the most. Medtronic cancelled the implantable pump which was being developed by MiniMed in the 1990s and early 2000s and is still beloved by the few users left using them. Instead, they just keep releasing models that are larger, more complicated to use and still rely on 1980s and 90s infusion set technology. That's my beef with pumps personally.
 
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donnellysdogs

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Yeh there's always the exception that proves the rule.

I've never met anyone who's changed back except on these forums and I worked as a GP with special interest In diabetes and knew the lead consultant for Diabetes pump therapy in Liverpool that at the time was one of the few centres that offered the service and covered the West Midlands, Wales and most of the North Western HA's and he told me NOBODY had changed back from pump therapy.

Admittedly that was 5 years or so ago and I've been retired for the last 10, so I'm sure these mythical beasts exist but pretty rarely. Incidentally, I did say "not many' change back. I didn't say no one does.

From my experience with the dawn phenomenon, the only thing that resolved it was the pump. I've tried monotard, leo mixtard, ultratard, glargine in single bolus and split bolus. None of which coveted it and most of the time I ended up having to time my meals to coincide with the lows I got as a result.

Guess it depends how bad the DP is. Not sure why you're so against pumps - especially if it hasn't been tried

I loved my pump... thoroughly tested and tried before having to give it up. Ended up in A&E so many times when two separate hospitals... including a leading one in Cambridge insisted I kept trying pumps...tried 3 different ones and practically every cannula..
Was very, lean and muscly... still am.

Incidentally, with Medtronic when their cgms fail, they ask your weight.... why?? Is there a certain weight of people that cgms could fail more for?

I am very pro pump...but for some of us it is not the best tool.

Its ok trying different basals in split scenarios... but that is not identifying or working to when you need your peaks actioning most... thats working to the NHS guideline...... not to our individual bodies....

Only by realising when you need peak insulin and less insulin etc do you stand a chance of looking at the different types of insulin to suit it....

I was lucky, I had my pump basal profile photographed and could see the hige rises needed in morning that went from 0.37 up to 1.35 units within 2 hours and then dropped off.... and evenings till 3am need much, much less. By timing Insulatard around this with its peaks of actually working and when it is out of my body, then it was me that established that I needed a very small dose of tresiba to carry me through..

If doctors just keep doling out the standard instructions and cant help beyond this thinking for looking at different regimes for peaks and troughs other than pumps... its pretty poor in my thoughts. I had to look up insulatard and all the different insulins... not my specialist consultant..

I am very much for pumps but honestly, the people I know are real, and not virtual from forums. One teenager in particular was really upset by feeling different with pump and living... really quite horrible to be honest, especially as I had helped her and mum to go on the pump... another young lady, laye teens went from mdi to pump, hated it, and also had difficulty afterwards going back to MDI because she had been made to feel so bad by consultants and nurses.. she then gave up with going to hospitals..lost every ounce of caring for herself as she considered she had been made to feel a failure, as 1) every body raved about pumps and how lucky at the time she was to get one, 2) she was then nagged by her dad and her hospital about giving up pump, made to feel bad about going back to MDI and just gave up looking after herself.
This is all withon last 3 years...thats just youngsters- let alone people like me whose skin just rejects the cannulas for the first 15 hours, and causing absolute total hell for me with hypers and having specialists just pushing me through hell and back...

Sorry steering off.

We are all individual... but I dont think the true peaks of DP and waking phen are really appreciated by hospital staff and the drops that can occur before them... these can be hard to deal with on the standard split doses....
 

donnellysdogs

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I even had a consultant at specialist hospital in Cambridge suggesting the trial for me for the artificial pancreas pump....

He couldnt even realise that the cannulas were the problem.... not the pump, not the way it worked.

Discussing with another consultant at the hospital... when I asked about the algorythyms for dealing with my problems etc... he actually agreed that it was not a good idea.... and algorythms could not over ride skin not accepting cannulas....

Sorry, I have been pushed through hell and back these past 3 years with pumps, mdi and consultants and CCG exceptional case funding.... thats the trouble... we are not handled as individuals and some staff are just regimented in their approachs without thinking about the individual..

Yes, feeling quite angst about NHS but as I'm still waiting for my dead husbands "serious incident investigations" to be given to me for why they failed to treat him and dumped him in a corridor to die .. well, its a fraught time.. sorry...