Help or advice for Dawn phenomenon

[Robabz]

Hello all,

Firstly thanks for all your comments everywhere, I have learnt a lot reading around the forum!

I am however having issues at the moment waking up high. It doesn't seem to matter what I do either! During the day I can hold the 5-8 range.

However, if I go to bed at 8, I can test at 230 or 3 am and still be the same, then whn I wake at 530 it will be around 10-11 then at 6 (breakfast) after morning wash etc another 1 higher! I have tried increasing my Levemir overnight, but to no avail, I am concerned about increasing further as it would drive my bg down at 3 correct? So I would possibly wake up correct but risk a night time hypo?

Hope some of the above makes sense, I am on humalog during the day (1.5u to 10g cho) and the 15 levemir in the morning and 18 at night before bed. I'm 27 and was diagnosed on 4th Jan this year.

Thanks
Rob

 

[weeezer]

As per replies in your other thread, still sounds like you need MORE levimir. Just up it by one unit and monitor what happens. Set an alarm for 2-4 if you are worried. Will be worth it in the long run when you wake up in range.


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[weeezer]

Rob...my sincere apologies, please ignore my previous post, I thought you were another poster, posting the same question but in a new thread!!!! I was referring to someone else (Carlos37 I think) - did you read their post? Also trouble with DP. Hope things improve...


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[weeezer]

...altho saying that, if it were me, reading your comments again with fresh perspective, I'd still up nighttime dose by 1 unit and monitor for 3 days, if that hasn't brought you into range then up it by another unit and monitor for 3 days again before making further adjustments. And set alarm to check where you're at in the early hours.


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[Robabz]

Thanks Weeezer, no worries about the mix up, literally posted mine, went back out and saw the other post! I'll try upping it again but have already gone from 15 to 18 at night, which is why i wasnt sure, worth a try tho!




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[noblehead]

I too would increase the levemir at night by 1 or two units, just remember to test 2 hourly throughout the night to see what your bg is doing.

 

[Robabz]

Have given it a bonus unit and will have a look thru the night, i'll pop the results on here tomorrow just in case it interests any body!


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[Robabz]

Morning,

Went to bed at 8.1, injected 20 units levemir instead of the previous 18.

woke up at 240 - 9.8

Woke up at 520 - 9.9

Before breakfast at 6 - 11.8 (double checked incase of anomalous reading, second reading was 11.9)

Which is better than other days where i would be at 9.x at 230 then before breakfast be in the 14s. Will give it one more night then throw in a bit more.

Cheers


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[weeezer]

That's encouraging! Yeh don't increase too much too soon, but if that was me I'd try another unit or 2 on tonight. Fingers crossed this time next week you'll be waking up within range!


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[Robabz]

Shall do Weezer, thanks for the help, still learning at this diabetes game!

Do you think the levemir is just being used up, hence the fairly rapid rise (or seems rapid to me) in the morning?

I thought that the levemir was slow release so if i didnt have enough there would be a steady rise over time, hence my concern was that putting in more would drive down my numbers at the 2-3am mark.

However the results from last night shows that isn't the case, just trying to understand it all in my head a bit better!

 

[weeezer]

Ha, I'm almost 13 years in and still learning! [FACE WITH STUCK-OUT TONGUE AND WINKING EYE]

I used to use insulatard, a cloudy background insulin, not as modern as levemir/lantus (was pregnant/trying to get pregnant so never moved on to the modern stuff!) I somehow ended up on 24u in the morning and 18u at night, this is reverse to most people, usual was to have more at night, but things adjusted over time and this ended up working well for me (on a pump now so only deal in fast acting) So don't stress about numbers (not that you are...!), just tweak til it works!

I expect someone may come along with details about levemir's 'lifespan' but I didnt think it was slow release, more 'steady' and flat release? It's your body's insulin requirements that increase more during early hours that creates DP (liver creating/releasing glucose? Again, somebody more sure of these facts may confirm that???).

But all this talk of dawn phenomenon...you may not be that affected by it, it really affects some...but tbh your numbers look like your levemir just needs edging up a bit! Not, in my opinion, that DP is causing the higher numbers (but i'm not an expert).

Keep posting your findings, all v interesting!


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[Robabz]

Ended up having to take a customer out last night so ruined the results from a repeatability point of view, but just for information, went to bed with 11.2but also some alcohol in the system at 2220, at 0030 at 6.4, thought that was trending a bit low so threw in a chocolate digestive, 10g CHO. At 250 i was 7.3, so all looking ok, then 530 suddenly 11.5, then 615 a gentle.... Rise to 14.0!

Will have a sensible night tonight and see what i get.


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[donnellysdogs]

Have you thought about changing time of levimir?

Cant recall what time you are taking it...

 

[Robabz]

Take it before bed, so at 10pm most nights, try to keep it constant.

What are you thinking on the timing? Pull it earlier in the evening? I also do 15 with breakfast at 6am too.

BR

Rob


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[Phoebe13]

Hi Rob

I was having real trouble with this as well, I found splitting my Glargine exactly in half (so 18 in the am and 18 in the pm) really helped.

I also started eating my dinner much earlier - I was eating around 9pm at night, so I now try to eat by 7.30pm, to make sure my Novorapid is taken much earlier too. I don't know what your mealtimes / food regime is like but that might be worth a try too?

Good luck!

 

[weeezer]

If levemir is supposed to be flat then maybe it's better to have it 12 hours apart? To cover the whole 24 hr period consistently? But I'm by no means a levemir expert so don't know that is necessarily the case??? Sure other experts can pitch in...

Yeh try your increased dose tonight without the social variability and see what happens. A great example of life getting in the way! I'm so good at tight control when there's not much going on, but then life happens!


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[Robabz]

Went to bed at 8, extra unit of levemir and now 11.2 at breakfast, so getting there! Thanks for your help/patience



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[weeezer]

Well that's encouraging, but still too high ay? I know you've got to give it a chance, see what happens tonight, but looks like there's still room for a couple of extra units. (I'm only saying what I'd do in that situation)


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[Robabz]

Yeah i was going to give it another one and then hold for a day or two, by the theory it should get in around the high 9.x-10 mark, then check that it works for a few days and add another. I meant to say earlier I checked at 330 this morning and was 7.0 so deffo still room with out bottoming out.