Dealing with Dawn Phenomenon

[fairylights]

Does anyone have any good tips on how to manage this? I have an horrific dawn phenomenon and it's really starting to get me down, just don't know what I can do to help things...

 

[diamondnostril]

Hi fairylights,

I suffered from out-of-control Dawn Phenomenon for many years. I followed a Low-Carb diet, which kept my levels/averages within boundaries that some might consider reasonable. But I never felt in control of my levels and was always irritated by the seeming "randomness" of my levels, particularly in the mornings.

After I discovered the Ketogenic diet, things totally changed for me. I adjusted my diet to restrict BOTH Carbs AND Protein. And that made all the difference. Amount of Carbs I always knew about; amount of Protein was an important point I had never fully appreciated before.

Excess Carbs and Protein (Carbs that are not needed right now for energy; Protein that is not needed right now for growth and repair) are sent to the liver to be stored as Glycogen. (Until Glycogen stores are full).

Gluconeogenesis is the process whereby the liver creates Glucose in the blood from stored Glycogen. Dawn Phenomenon is simply Gluconeogenesis that happens in the early morning. Many people find that it spikes at this time. I found that if I restricted my Carbs AND Protein intake, Gluconeogenesis would never get out-of-control and spike my blood-sugars. Dawn Phenomenon disappeared.

Because I am on a very Low-Carb diet, I still rely on Gluconeogenesis to provide Glucose to my blood. But it stays under control.

My interpretation of my own results and experiments, is that when Glycogen is plentiful (and the body has learned that plenty more is always on the way) then the body is quite liberal with the use of this resource. But when Glycogen is restricted, the body will be very guarded with the use of this resource. Glycogen is protected so that there is always a supply available in the liver, because this is used for immediate blood-glucose in the case of fight-or-flight situation. If the body learns that Glycogen is in general in short supply, it won't waste this resource on the simple act of getting up in the morning.

This is only my interpretation of my own experiences. On this forum I have seen many different interpretations of how Dawn Phenomenon interacts with diet and with routine (breakfast or no breakfast in particular). I am just a sample size of 1 and I don't know if my experience is typical. There may be other very successful ways of dealing with this problem. Nevertheless, hopefully this Post might give you something to think about / to try.

Best wishes,
Antony

 

[novorapidboi26]

Interesting take on it Anthony............

So you have trained your liver to not spit out excess amounts in the morning?

Going by your logic, to have plentiful amounts of glycogen [full liver store] and therefore result in a liberal response, you would need to have excess carbs and protein, yeah?

Having excess amounts of these wouldn't happen on a carb and protein restricted diet, would it?

your doing something right with those HbA1c results.........

@fairylights , when I was on injections and suffering from the Dawn Phenomenon I done a few things which helped most of the time......

I had a split basal injection which was taken immediately before bed and when I woke up, thus giving an overlap effect in the morning

I got up as early as possible and had a low GI carb with insulin and correction in order to get the digestive juices going and therefore tell the liver to stop

Some folk choose to have a slowly absorbed snack at bed time, like cheese or peanut butter so that digestion is still taking place into the small hours and so the liver will think its services are not required......

that's my interpretation of it, now on a pump, so can handle it much easier......

 

[LucySW]

Have a scan of this thread:

http://www.diabetes.co.uk/forum/threads/pesky-dawn-phenomenon.57672/

 

[Kaha]

In my case timing of dinner ( usually late around 10PM) is the cause of high morning readings, trying to compromise ,but difficult

 

[fairylights]

Thanks folks.
Interesting Anthony - not sure I can do without carbs and protein but definitely food for thought. Perhaps I could start by cutting the carbs down, at the moment I eat around 100g a day.
Novarapidboi I do split my basal levemir - which I have in the morning when I get up and as late as possible before I go to bed. I think I would have to get up at 4:30 every morning and I'm just not sure I can do that. I usually get up about 7am. My readings then are usually in the range between 18 -22, I do often set my alarm for 4am ish and take my BGL - sometimes it is 4 and I still get up 3 hours later on 22. If it is above 4 I take some humalog and this helps a little - so if I was on 6 I would take 2 units humalog and might get up at 7am on 10 or 12. Last night I was at 2.5 at 2:30 had 1CP and woke up only on 9.6 which is a great morning reading for me but I can't go hypo every night! Even just waking to take BGL at 4am has me exhausted though.

I can take a correction at breakfast and my lunch time reading are nearly always good in the 4s and 5s.

I will have a read of that thread Lucy although I think it is talking about a tiny rise overnight compared to what I have.
I can try a late night snack of cheese or something...

Also I am on the waiting list for a pump but it will probably be another 6 months before I get it.

 

[noblehead]

My experience is the same as Novorapid, I have to get up by 6.30 and have breakfast to pre-empt the DP otherwise my bg starts to climb throughout the morning, it's a pain as sometimes I would like to sleep longer, such as on a weekend after a late night, hoping if I do get started on a insulin pump all this will be a thing of the past

A pump might be a good option for you too fairylights if you can't overcome the morning bg increases.

 

[fairylights]

I should be getting a pump, I've been assessed and I'm on the waiting list but it will probably be another 6 months.

In the meantime - I realised today (writing it down must help) that I don't take my BGL until after I've showered etc, so tomorrow I will try and take it and my morning insulin before I get out of bed and see if that helps at all.

 

[emiliano]

I've experimented a lot in order to keep my BG down in the mornings:
at the end of the day the only thing that works for me is to eat a very light and early dinner (no CHOs, and preferably not much proteins) or ideally to fast.

 

[PaulinaB]

I should be getting a pump, I've been assessed and I'm on the waiting list but it will probably be another 6 months.

In the meantime - I realised today (writing it down must help) that I don't take my BGL until after I've showered etc, so tomorrow I will try and take it and my morning insulin before I get out of bed and see if that helps at all.

Please do take a reading right after you wake up! You may find that your bg rises after you get up and before breakfast - if you go around, take a shower, etc, etc before eating, your liver may be realising glucose to keep you going. Easy solution is to eat breakfast before doing anything else

 

[Wurst]

I'm on a low carb/protein diet and high exercise regime and I don't have DP problem. When I was first diagnosed it was a nightmare to get my head around and only the low carbing and lots of exercise really brought it under control.

 

[Juicyj]

Hi I also suffer from insulin resistance in the morning so my DSN changed my carb ratios so I take 1.5 units to 10g of carb, then switch back to 1:10 in the afternoon.

I also eat protein only in the morning and still take a few units of insulin,

It's really trial and error his May help, I hope so

 

[fairylights]

I have been taking my BGL before I lift my head off the pillow in the mornings - the last few days have all been 18.8 - I then take both levemir and humalog before I get up and have a shower etc.

Since doing this my lunchtime readings have been 6/7 instead of 4/5.

So the only way I can seem to get a morning reading in single figures is to hypo in the night!!!

Think I need to try setting the alarm for 4am again and try taking some humalog then ......


Also I had been trying humulin S with dinner, as it lasts 6 hours and my DSN thought it might help, but the last few days I have been back on humalog - as the humulin S lasts for 6 hours and it is usually less than 4 hours after dinner before I go to bed, if I am a bit high the temptation to take a correction dose at bedtime is very high and then I have a hypo etc etc.

 

[jack412]

ask your Dr, he may suggest you correct with a fast acting of a morning for the DP, if you hypo overnight with an increase and you are splitting your basal dose,
you may still be hypo now and having a reactive liver dump...I would do a lot of overnight testing to see if I could spot a drop


I think T2 is 80% diet, 20% drugs and exercise
I would agree with your suggestion of 100g carbs... I think every T2 need to cut carbs, if nothing else it will help stabalise your BG for your insulin doses, and help with insulin resistance

http://www.dietdoctor.com/lchf it’s a long page and a video

For me, the more carbs we eat the more carbs we want. they don’t give up easy.

http://lowcarbdiets.about.com/od/lowcarbliving/a/Food-Cravings.htm http://lowcarbdiets.about.com/od/lowcarb101/a/firstweek.htm

http://www.lowcarbdietitian.com/blog/carbohydrate-restriction-an-option-for-diabetes-management


blood testing

http://www.phlaunt.com/diabetes/14045524.php

http://www.homehealth-uk.com/medical/blood_glucose_monitor_testing.htm

food counting

http://www.myfitnesspal.com/


Newcastle diet aims in 8+ weeks to mimic the rate of ~70% remission, for surgery T2

“It is now clear that Type 2 diabetes is caused by abnormal fat storage. Research on how this may be reversed is available. “click that link on this page http://www.ncl.ac.uk/magres/research/diabetes/

http://www.diabetesforecast.org/2010/mar/weight-loss-surgery-and-type-2-diabetes.html


American diabetic association ( http://www.professional.diabetes.org/)

http://www.professional.diabetes.org/admin/UserFiles/0 - Sean/dc132042 FINAL.pdf

Evidence is inconclusive for an ideal amount of total fat intake for people with diabetes;

therefore, goals should be individualized; fat quality appears to be far more important than quantity.

In people with type 2 diabetes, a Mediterranean-style, MUFA-rich eating pattern may benefit

glycemic control and CVD risk factors and can therefore be recommended as an effective alternative to a lower-fat, higher-carbohydrate eating pattern.



SD codefree meter

http://www.homehealth-uk.com/medical/blood_glucose_monitor_testing.htm

if you buy extra boxes of strips there is a discount code

5 packs 264086

10 packs 975833

 

[Nyxks]

Before going gluten free (do to celiac) my morning numbers where always high (12+) didn't matter what I was doing before going to bed or the rest of the day - after going gluten free numbers went to normal (4 to 5) for waking turned out that the gluten was part of the issue .

 

[ljwilson]

I suffer with bad early morning insulin resistance, I do not have overnight lows. Tried upping the levemir but that resulted in hypos in the night so I wake before 6 and take a large dose of Novarapid to counteract the high blood sugar. My consultant started me on
Linagliptin, a drug meant for type 2's, and these have helped. I still have to take an extra early morning dose of novarapid but only half as much as before. Has you doctor suggested Metformin? This has helped a lot of Type 1's with morning highs, unfortnately I can't take it because of my Stage 4 CKD

 

[fairylights]

So set the alarm for 4am BGL 4.4, proper alarm 7am - before getting out of bed 12.4.
I'm going to try setting the alarm for 5am this morning and see what it is then - going to bed on 6.2 - now.

@jack412 - I do take a correction does as soon as I wake up at 7am - I would have taken one at 4am but I feel that 4.4 is a bit low and if I took a correction does I may end up hypo.
@Nyxks - that's interesting - I have felt at times that gluten does affect me and I was tested last year for celiacs as it was so bad - but that came back negative and things have improved (gut wise) but maybe cutting out gluten is something I should try.
@ljwilson - I already take 1000mg metformin morning and night - maybe I just have to wake up earlier - but will test at 5am and see what is happening then

Thanks for all suggestions - food for thought!

 

[fairylights]

So 5am didn't happen.
I was 2.9 at 2:30 - couldn't face waking up again at 5am. Then 12.4 at 7am. sigh

 

[jack412]

I'm T2 and clueless and I would ask your DR when you give him the results, I assume you had 5 hrs after bolus before you went to be with 6.2
it looks like you hypoed at 2.30 ..from what I've read here the T1's would have had glucose and canceled the test. it sounds like you could be having a reactive liver dump to the low and your liver may be dumping sugar for the morning high....the Dr may suggest you reduce your basal.
basal test
http://www.diabetes-support.org.uk/info/?page_id=120

these other links might be worth reading too
There is an online course for background and an idea to it. Free to register
http://www.bdec-e-learning.com/

This set of workbooks are worth reading and practising working examples of carbs and doses and corrections. Don't change dose without nurse approval
Workbook 1
http://www.diabetesinscotland.org.uk/Publications/9225 Carbohydrate Counting.pdf
Workbook 2
http://www.diabetesinscotland.org.uk/Publications/9226 Carbohydrate Counting the Next Steps.pdf

Carb list
http://www.diabetesinscotland.org.uk/Publications/9227 Carbohydrate Tables A6.pdf

Diary
http://www.diabetesinscotland.org.uk/Publications/9228 Free Diary Portrait A4.pdf

Sick day rules
http://www.diabetes-support.org.uk/info/?page_id=141
http://www.diabetes-healthnet.ac.uk...flet_-_Sick_Day_Rules_for_Type_1_-_Nov_13.pdf

Sick day rules flowchart
http://www.leicestershirediabetes.org.uk/uploads//documents/Type1 Sick_day_rules_InsulinV3.pdf


A workbook with USA numbers and math rules, but it has a good troubleshoot at the end
http://www.bd.com/us/diabetes/download/insulin_adjustment_workbook_complete.pdf

 

[PaulinaB]

So 5am didn't happen.
I was 2.9 at 2:30 - couldn't face waking up again at 5am. Then 12.4 at 7am. sigh

If you're going low at night, that would explain why you're waking up high. Are you split dosing your basal? If your basal is too high and you go hypo at night, your liver may be kicking in. You could try going to bed higher than usual (to prevent any hypos at night) and see if this helps or reduce your basal.
Just a guess though!