Struggling with dawn phenomena...

[ljmercer]

Hi everyone.

I've been diabetic for almost 13 years when I was diagnosed at the age of 7. All throughout my teenage years and still now, I have had a constant battle with dawn phenomena and insulin resistance.

My diabetic team are struggling to help bring my HbA1c down because of my dawn phenomena. We've tried all sorts of different basals (I'm on the Omnipod pump), and even Metformin (which I had severe reactions to so my diabetic team have advised me to stop taking it), and I'm still getting nowhere.

My diabetes frustration is at an all time high and I don't know what else to do... it's starting to affect my control all the time as my motivation is suffering.

If anyone has any advice or tips... I'd greatly appreciate them... I'm at my wit's end...

 

[Antje77]

Can you tell us more about what is happening and when? Do you go high at the same time of night every night while sleeping? Does it happen sometimes but not always? Or is it more a sudden rise after waking up every day or only sometimes? Are you using a glucose sensor like Dexcom or Libre to see what's happening or do you use a glucose meter?

Sorry for all the questions. The answers may give us some clues as to where you could change things.

 

[ljmercer]

Hi, thank you for your quick response @Antje77

There is no direct pattern as to what is happening. I do have a Freestyle Libre however I'm waiting to hear from my diabetic team currently as my monitor that reads the sensors has broken and won't turn on, so I haven't been able to use my sensors in a while.

When I was wearing the sensors, my sugars would start to rise as soon as I fell asleep, irrespective of the time that was. This did not always happen every night. Sometimes they would rise in the early morning, but this was less often.

If you need more information, just ask

 

[Antje77]

I do have a Freestyle Libre however I'm waiting to hear from my diabetic team currently as my monitor that reads the sensors has broken and won't turn on, so I haven't been able to use my sensors in a while.

Do you have a smartphone that's compatible? Even the old Samsungs work for that, as do cheap Huaweis.

When I was wearing the sensors, my sugars would start to rise as soon as I fell asleep, irrespective of the time that was. This did not always happen every night. Sometimes they would rise in the early morning, but this was less often.

That sounds like a difficult one to combat.
I find my sugars rise at night when I've had stuff like pasta, pizza, fries and the likes, so both high carb and high fat. Could the rises be related to the kind of foods you ate that night?

 

[ljmercer]

Yes, I have a Huawei phone. I forgot about using that as the sensor reader.

Potentially, as unfortunately there aren't many low carb options that I like to eat/have tried. However, it is strange as when I'm awake the insulin works much better than when I'm asleep. Even on my finger prick tests, it isn't obvious why my sugars are rising.

Just the other night, I tested at around 2am and I was hypo, 3.8, including my usual symptoms. I had dropped from 4.7 around half an hour before that. I didn't treat myself as I was lazy and didn't get out of bed, but 15 minutes later my sugars were 5.9 on their own. I have a lot of inexplicable events with my sugars...

 

[ert]

I hope your diabetes team gets to the bottom of what is happening. You may have already tried skipping dinner or have an early low carb dinner, not eating in the 5-hour window before bedtime, to see if your basal is correct?

 

[novorapidboi26]

So are you saying there is no pattern to your blood glucose rises overnight then.....?

if its happening when you go to sleep thats not dawn phenomenon, which I suppose gives some hope as you cant really stop DP, but the pump normally deals with it....

When was the last time you done a full 24 hour basal test?

 

[ljmercer]

I hope your diabetes team gets to the bottom of what is happening. You may have already tried skipping dinner or have an early low carb dinner, not eating in the 5-hour window before bedtime, to see if your basal is correct?

I hope so too. It's driving me mad...

I've not done that since having the libre. Might be a good idea to test out to see what's happening/where it goes wrong.

 

[ljmercer]

So are you saying there is no pattern to your blood glucose rises overnight then.....?

if its happening when you go to sleep thats not dawn phenomenon, which I suppose gives some hope as you cant really stop DP, but the pump normally deals with it....

When was the last time you done a full 24 hour basal test?

There isn't a pattern that I've figured out at least. Probably need to keep a diary of some sorts to notice a pattern.

It mostly starts to rise when I sleep but it's a steeper increase in the early hours of the morning before I wake up/until I wake up if I sleep in.

I haven't ever done a full 24 hour basal test since starting on the pump 6 and a half years ago if I'm honest.

 

[novorapidboi26]

I would recommend doing a test in the evening right trough till morning, do that for a few nights and note down the readings as it makes it much easier when making adjustment decisions....

have you established your own basal rates in the time you have had the pump?

have you added on any extra for example...?

 

[Streather \m/]

I suffer from the same inexplicable nighttime spikes and it drives me mad, it also rises furiously when i wake up regardless of cho input, db team look at me like its somehow my fault. It has destroyed my mind and body over the years.
I've completely changed my diet of late and omit carbs after 6pm, the ones previous are all simple such as bran/oatcakes/ryvita and stick to salads,veg and fruits, proteins and fats.
I have a degree of gastro paresis and pretty burnt out insulin sites but there is no reason i have yet come across that adequately explains the patterns. It even happens when I'm fasting or not eating due to illness.
Basal rate changes are not an option as 1ui more sends me into hypoglycemia and 1ui less sends me into hyperglycemia all day/night long, and as i live on my own, this is not an option.
I believed the glargine insulin family is at fault with myself and this i intend to change to tresiba, which i have been previously blocked from doing, while I'm waiting for a **** pump, which I've also been blocked from having for years now. From what you have said though a pump has made difference to the anomalies in yourself.
Any solutions ideas people have would be much appreciated by myself as well.
I'm also off to acquaint myself more with dawn phenomenon...

(edited by mod for language)

 

[ljmercer]

I would recommend doing a test in the evening right trough till morning, do that for a few nights and note down the readings as it makes it much easier when making adjustment decisions....

have you established your own basal rates in the time you have had the pump?

have you added on any extra for example...?

Thank you for your suggestion! It sounds like a basal test is something I need to do.

My bolus rates have been established for a long while. For breakfast I have 1 unit per 5 grams of carbs, lunch it's 1 unit per 7 grams of carbs, and for the evening it's 1 unit per 6 grams of carbs. My diabetes team and I have tried to play around with various basal rates but none being totally successful. I'm trialling a new one over the next two weeks before my next clinic appointment to see if this one works better for me.

Also, what do you mean by "added on any extra"? That part didn't fully make sense to me.

 

[ljmercer]

I suffer from the same inexplicable nighttime spikes and it drives me mad, it also rises furiously when i wake up regardless of cho input, db team look at me like its somehow my fault. It has destroyed my mind and body over the years.
I've completely changed my diet of late and omit carbs after 6pm, the ones previous are all simple such as bran/oatcakes/ryvita and stick to salads,veg and fruits, proteins and fats.
I have a degree of gastro paresis and pretty burnt out insulin sites but there is no reason i have yet come across that adequately explains the patterns. It even happens when I'm fasting or not eating due to illness.
Basal rate changes are not an option as 1ui more sends me into hypoglycemia and 1ui less sends me into hyperglycemia all day/night long, and as i live on my own, this is not an option.
I believed the glargine insulin family is at fault with myself and this i intend to change to tresiba, which i have been previously blocked from doing, while I'm waiting for a **** pump, which I've also been blocked from having for years now. From what you have said though a pump has made difference to the anomalies in yourself.
Any solutions ideas people have would be much appreciated by myself as well.
I'm also off to acquaint myself more with dawn phenomenon...

(edited by mod for language)

Honestly... I would have been in the same boat as you if I was still on injections. The Glargine/Lantus didn't work out for me, and now I'm only on Novorapid constantly. The pump only requires one insulin that's given in small amounts every hour. It works better as you can adjust when in the day you need more or less background insulin.

I hope you can get your hands on a pump. It provides so much freedom and generally better control. I just wish my diabetes would behave itself so that I could get a better HbA1c result!

 

[novorapidboi26]

Also, what do you mean by "added on any extra"? That part didn't fully make sense to me.

I suppose it is a confusing question, I just meant have you added any additional rates on to the one or two that you started on......

I have 10 you see, which was slowly added to as I down basal tests over the years to deal with certain highs and lows I had seen during basal tests.

Mine are as follows:

00:00 - 1.4
01:00 - 1.45
05:30 - 2.3
07:30 - 1.45
09:00 - 1.70
10:00 - 1.60
11:00 - 1.0
16:00 - 1.9
19:00 - 1.4
22:00 - 1.5

 

[annagorsuch]

@ljmercer I am 18 and have had type one since the age of 5. When I was 13 or 14 years old, I started to develop a resistance to insulin. It felt like no matter what we changed my basal rates and carb to insulin ratio to, nothing helped. My endocrinologist put me on a medication that is actually meant for type two diabetics, but he was testing the medication on some of his insulin resistant type one patients. The medication is called Invokana, and it has been under some scrutiny over the effects it can have on your body, but while I was on it, I found it helped keep my blood glucose levels locked into a better range. I recently had to stop taking it, as I went into DKA (I had been so busy that I was paying no attention to my levels) and the medication actually locked me into that high range, causing me to go into DKA. However, I highly recommend if you are good about watching/testing your levels regularly.

 

[english66]

In my own experience and based on dialogue with mty consultant I think dawn phomena may for many be a myth.

 

[Antje77]

In my own experience and based on dialogue with mty consultant I think dawn phomena may for many be a myth.

Mine is perfectly predictable (luckily the variety known as 'feet on the floor' which happens directly after getting out of bed). Predictable enough that I inject a substantial amount of insulin for it before getting out of bed, even when no breakfast is involved.
So while it may not be happening to you and others, for many of us it's reality and by no means a myth.

 

[english66]

Mine is perfectly predictable (luckily the variety known as 'feet on the floor' which happens directly after getting out of bed). Predictable enough that I inject a substantial amount of insulin for it before getting out of bed, even when no breakfast is involved.
So while it may not be happening to you and others, for many of us it's reality and by no means a myth.

Noted, and thank you for your insight. I indicated that the so called dawn phomena may be a myth for many, not a few.

Have you had your diabetic consultant verify the 'phenomena' ? They would surely be the ultimate arbiter.

 

[Madmaureen]

Hi everyone.

I've been diabetic for almost 13 years when I was diagnosed at the age of 7. All throughout my teenage years and still now, I have had a constant battle with dawn phenomena and insulin resistance.

My diabetic team are struggling to help bring my HbA1c down because of my dawn phenomena. We've tried all sorts of different basals (I'm on the Omnipod pump), and even Metformin (which I had severe reactions to so my diabetic team have advised me to stop taking it), and I'm still getting nowhere.

My diabetes frustration is at an all time high and I don't know what else to do... it's starting to affect my control all the time as my motivation is suffering.

If anyone has any advice or tips... I'd greatly appreciate them... I'm at my wit's end...

Hi I have been 50 yrs type 1 but over the last few months or possibly longer dawn phenomenon is making me struggle tried everything but one foot oit if bed and its off!!!
So frustrating isnt it!

 

[Juicyj]

In my own experience and based on dialogue with mty consultant I think dawn phomena may for many be a myth.

The Dawn Phenomen is no myth, surprised your consultant has taken this poorly informed view, you only have to search through this forum and the sheer volume of threads on the subject matter to confirm its very real for many, unless your consultant is against the belief that the liver can produce glucose too then they could do well to review their research on endocrinology to understand the subject matter better.

The simple way to study this is to record blood glucose results every hour upon waking whilst fasting and without taking any quick acting insulin, because it doesn't happen to you doesn't mean it's a reality to others.