Dealing with Dawn Phenomenon

[ljwilson]

I would say your 2.9 at 02:30 is the problem,
Somogyi Phenomenon - Rebound Hyperglycemia

Lorna

 

[fairylights]

@jack412 I have done DAFNE - only in July - so I can change my dose if required. Tues when I was 6.2 going to bed, I had been swimming and had had a snack and a little insulin a couple of hours earlier - I had been a bit low after swimming so maybe I should have had the snack and no insulin. I did a lot of basal correcting on DAFNE and I take 18u of levemir - any more and I hypo - but having had 3 night time hypos in the last two weeks perhaps I need to check this. (I am still not great at dealing with exercise!)

Last night I was 5.1 when I was going to bed - had just played badminton - so I had 1.5 CP's and woke up on 14.5. Didn't do any overnight check though. I also don't want to do any overnight checks tonight as I have a longish drive tomorrow so want to get a decent nights sleep if possible - if I have to get up to go to the loo then I will check!

@ljwilson - you would think that wouldn't you - except I have been doing quite a lot of night time testing and invariably if I hypo in the night then I have a lower BGL in the morning that if I don't. This doesn't make much sense to me! My DSN (who I really like and seems to be much on the ball) has told me that there have been some studies recently which disprove Somogyi - although I don't know where.

 

[jack412]

going by this, I'd split the levemir and that may stop the night hypo, which as @ljwilson also suggested, may be a reactive and the cause of your high...either way, they say you always fix the lows first, then fix the highs
I'd get back to a full basal test, as per the link I gave before or your preferred method..you could also ask for the use of a CGM for a week

http://www.dafne.uk.com/uploads/223/documents/PU04.009, Version 1 - September 2013 - Insulin statement.pdf
The DAFNE Executive Board has recently issued a statement clarifying current best practice regarding background insulin (BI) and DAFNE. The statement has resulted from an audit of the DAFNE Research Database which shows a statistically significant reduction in HbA1c 12 months after DAFNE occurs only in patients taking background insulin twice daily.

 

[fairylights]

@jack412 My levemir is split 8am and 11pm already - do you mean further split?

Last night I was 5.1 to go to bed so I had a yogurt 2CP just in case that was going to mean I would hypo.
I did wake up to go to the toilet at 0315 - BGL was 9.7 - I took 5U humalog (most I dared to take) and when I woke up was 7.5 - best reading for ages!
Then I had to take my husband to the station before I had a chance to eat and when I did eat was up to 8.2 - but still better than any other day.

Drinking wine tonight so probably won't test during night and will make sure I'm on the higher side when I go to bed.

 

[jack412]

@noblehead et al may be able to shed some light. I can't help other than point you to links.
you really need to make an appointment with your nurse and work it out. it may help if your team will give you a CGM for a week

I've read hard exercise can affect your BG for the following 24hrs, so until this is sorted I'd do light exercise.
you are already splitting, it's normally twice a day from what I've read...when you test you stop eating at 5- 6.00 pm, so there is no bolus left when you go to bed and if your BG isn't right, you cancel the test and eat or bolus
http://www.diabetes-support.org.uk/info/?page_id=120

if you are carrying weight, it's important to cut your carbs to tackle that too, which can help with insulin resistance