Dawn Phenomenon made simple please ;)

[Dragonflye]

well people here sure are going to get annoyed with the amount of posts I put on BUT I'm very easily confused and as the only other T1 diabetic I know is my cousin who is not on a pump, she wont be able to help me!!!!

OK well I've seen the recent post by Unicornz re DP and changing basal amounts to compensate and have been following it... I'd never even noticed I suffered from the wonderful phenomenon until I went onto the pump... probably due to now testing 3x as much as i did before much to my doctors annoyance :lol:

When I go back to work next week I am planning on doing some fasting tests and making alterations etc HOWEVER I was a bit worried... I do my BG (Does anyone else call it BM? I really have to concentrate when I'm typing to not slip up as everyone here seems to call it BG whereas I grew up BM - blood monitoring - ok so a bit off topic) and when I wake up it's usually about 6... when im at work I usually have my brekky around 8am by which point the reading has risen to about 11+...

I know this has more than likely been answered somewhere so please dont be annoyed with me but my concern is this... dependant on how hungry I am or how much money I have I sometimes eat brekky early (ie before I leave the house to go to work) would this not mean i'd then go hypo?

unfortunately I dont think it will be as easy to sort on my days off because I have no routine - sometimes ill wake at 6 and eat at 8, other days i may not wake up until 8 and eat maybe 9am or 10am (depends on how nice my hubby is feeling, he'll more often than not take the kids down and let me sleep) but i'll cross that bridge when i come to it

Janet xx

 

[Unicornz]

Hi Janet!

First of all don't apologise for asking questions it's what you should be doing

I wish I could answer your question but as you can tell from all my questions that went before I'm not an expert myself! Cheryl has helped me loads with all my questions and things are a lot clearer now, so hopefully someone will pop their heads around soon to answer yours as well.

I just wanted to let you know I feel your pain! As if a non-functional pancreas wasn't enough, our livers think that for some reason they should make things even more difficult for us as well lol!

 

[donnellysdogs]

If your bolus and basals are set up right for that time period...mine are from 5.00am to 10am, Then from 10am to 4pm I have different bolus rates again, and my basal rates are different for every single hour of the day.

Why should you go hypo for altering times that you eat?

To me, I tried getting my DP sorted out first by basal testing and delaying eating my breakfast, I did this for weekdays and weekends...and watched how things changed for both.....it now doesn't make any difference at all on anyday, or anytime what I eat.....

Now, I have a weekday basal and as of Fri 10pm through to Mon 8am my machine runs at 90% basal, and this allows me to have lie in's and to do the different things like having a glass of wine that I don't on weekdays.....

If your basals are set for DP correctly and your bolus ratio is correct, then it really shouldn't matter what time you eat in the mornings....same with weekends...you may well find a pattern that at weeknds you run higher or lower...so you may well get away with using a TBR or you may need a different basal rate programme set up....but for the moment I would certainly get your basals for mornings sorted to handle the DP without eating until later if this was possible....

 

[Dragonflye]

Thank you I only know a little about DP and my biggest concern was if BG raises until you eat, you eat earlier but your basal is based on your sugars raising etc it would send you hypo lol

I unfortunately have to put the idea of testing regular to find a pattern on hold as I don't have enough test strips to test 1x a day until next month (a completely different story which ive posted somewhere else in the forum)

I will revisit this post once I have got things sorted but thank you

 

[jopar]

The only way you will find out if you have DP, is by fasti testing to see what is going on with your basal rate..

This way you will also find out if your breakfast insulin/carb ratio is out or not, if your basal is correct then your insulin/carb ratio is out!

As to your test strips, I would order some more from your GP, if you are having problems with securing enough from your GP to meet your testing then contact your pump clinic they will be more than happy to write/contact your GP for you to recify this,

As with pumping more so as you sorting out basal rates, insulin/carb ratios and how your food/exerise is reacting you do need to be testing frequently and regularly. Otherwise you sort of end up getting nowhere with it all, then the pump becomes a wasted bit of kit..

 

[Dragonflye]

I tried getting some from my GP but they turned around and said a downright NO i dont have a pump clinic, just my DSN who ive sent a text but she's on holiday

with the fasting tests... how long do i have to fast for...? lol stupid question I know and i pressume I do correct for the higher levels? again stupid but the fasting tests is to find out when the DP starts and slowly increase my insulin to stop levels increasing over the period of time required? and once i have that I can tidy up my bolus?

 

[donnellysdogs]

So sorry that you are having such a **** time with your GP receptionist with blood strips.......I would ask chemist if he could give you some against your next order....if you use the same chemist each time.......that way you may stand a chance of not having to apy for some.......

Going back to DP and testing.....from 7.30 (obviously not needing a bolus or hypostopper during night) right through to 11am or 12 noon depending how hungry I am......I don't suffer from hunge at any time though,,,so this may be easier for me than others......the only meal I find it really difficult to basal test for is my dinner with my husband ..as i can't stand watching him have a good meal and me eating nothing....or no carb food if I have to.....

No good doing basal testing if you go hi or low within the 5hour before hand, apart from that....even if initally I went up to 15 I would not correction bolus until at least 11am...and I would test every hour...as basal adjustments are done every hour on the accuchek combo.....after 1st day you should be able to make some changes to correct DP and should be done ok within 5 days total......and then when sorted weekdays out...give yourself a break..enjoy the weekend and the following week and see what happens...and then do basal testing the following weekend.......at least...that's what I would do.......but we all have to find our way about our basal testing and adjusting and working our diabetes around our own life's........what worked for me, may not work for you.....

 

[Dragonflye]

Thank you

i dont think ill have too many problems with the fasting business i only eat brekky most of the time because of habit, ive easily skipped it in the past - lunch i cant see being a big issue either... evening meal fasting times i can plan on when my hubby is working late, that way i dont have to watch him eat

I've been lucky since going on the pump, ive had to do very little alterations from what i was set up on initially I just think the only issue i seem to be having is this wonderful DP which i honestly never noticed before and this would be great to "sort it"

It is however going to have to wait to do but hopefully I'll be able to start fine tuning after next week I never had any issues self adjusting when I was on MDI, now on the pump I'm a little more cautious and I have NO idea why!!

 

[iHs]

I tried getting some from my GP but they turned around and said a downright NO i dont have a pump clinic, just my DSN who ive sent a text but she's on holiday

with the fasting tests... how long do i have to fast for...? lol stupid question I know and i pressume I do correct for the higher levels? again stupid but the fasting tests is to find out when the DP starts and slowly increase my insulin to stop levels increasing over the period of time required? and once i have that I can tidy up my bolus?

Hi

If you haven't got a pump consultant at hospital, then you need to telephone your PCT and report your GP's failure to prescribe you sufficient teststrips to them. Your GP is not adhering to his/her duty of care towards your medical condition and is putting your health at grave risk especially as you use insulin to control bg levels. All diabetics using pumps need about 250 to 300 strips per month and not the pathetic quantity that your GP is issuing you with. I had to report my GP to my PCT over teststrips and the matter quickly got resolved. As Jopar said....... without sufficient strips, it makes using a pump useless and it even makes using twice daily regime or MDI dangerous as well.

Regarding basal testing , this a fairly good easy to understand guide http://www.leedsteachinghospitals.com/s ... lRates.php

 

[Dragonflye]

Thanks iHs I have just spoken to NHS Direct who have given me some good advise which I will be acting on on Monday... Re number of strips I had to fight my hardest to get the 150 per month I have (it was initially 50) I've been fighting for it to be increased to 300 since I got pregnant and fighting even more since I went on the pump it wouldnt bother me if it was the receptionist who refused, but the actual doctor and they neglected to tell me!!!

I will have a look at the link!!! Looks like leeds is more up on insulin pumps than where I am with info etc although that's probably a bit harsh - just bad experience

 

[iHs]

Hi

If you phone your PCT, ask them to send you a copy of the letter that they have sent out to all their GPs regarding the prescribing of teststrips. The PCTs ask GPs to use their discretion. Unfortunately, lots of GPs think that insulin is a bit like taking a tablet and that if you keep to set doses, eat at set times and eat the same amount of carbohydrate, then bg levels should stay ok all day long and that diabetics should not need to test more than 4 times a day. Unfortunately for us......... they have a lot to learn.

Regarding the link to Leeds hospital ......... it was Phoenix who first posted the link so she's the one to thank

 

[jopar]

Dragonfly

Ring your consultant and get him to write a letter to your GP, your GP can't over rule your consultant if your consultant says you need xxx strips per month then your GP has to provide this whether they like it or not!

 

[clarentina]

@Dragonflye

One thing I have been doing to combat the DP as I simply haven't had the time/inclination to test my morning basal.

Two breakfasts!

As someone who breakfasts at work I would suggest:
Have a banana or something really little as soon as you wake up- bolus for it. This should fix the DP.
(20carbs around 7am)

Then have some cereal/toast once you get to work (+bolus)
(30 carbs around 9-10 am)

As someone who's suffered quite badly with DP in the past- this seems to work for me.

Clare bear

 

[Dragonflye]

ooooooh i LIKE that idea a LOT :lol:

it certainly would be worth a try thank you

 

[cjw]

I've not read all the replies so apologies if I am repeating. Not sure about DP but it's important to get basal rates correct as another poster said. I have had zero carb meals eg bacon and egg/salad as appropriate and checked BG (or BM! - I have been diabetic since 1975 and I believe it is BM due to Boerhinger-Mannheim being the first company to create blood testing strips) every hour for a number of meals over a few months. I have been doing this since about January and my DSN/doctor have advised basal alterations accordingly. It has taken a while but my basal now seems good. You can then check bolus rates when you are happy with basal but until basal is right it won't work. Every one is an individual and has different lives - I have 8 different basal rates throughout the day. You do need to ensure you have enough test strips to do this as it is ESSENTIAL. Easy for me to say as I have a great health service here. Good luck and I hope it all works out for you.