Advice needed

[Ant1983]

Hi All

I have been diabetic for over 30 years, and not really a great one at that but have been trying to improve a lot the last year. I have started to experience the "dawn phenomonon" so when I wake up I take take my fasting novorapid shot, now depending on where my blood sugars are at, I may take 12 units, this then corrects my bloods and I allow them to drop before taking food. I then take the correct amount of insulin to cover the food taken and a little extra and when I then eat my bloods rise quite quickly and can take two hours to start returning to normal.

This is quite worrying but I am looking to know does anyone else experience anything similar?

I may have to increase my Lantus at night but I find my bloods can run low at night when I do.

Any help or advice would be greatly appreciated.

Thanks
Ant

 

[Antje77]

Hi @Ant1983 , welcome to the forum from anothe Ant!

I have started to experience the "dawn phenomonon" so when I wake up I take take my fasting novorapid shot, now depending on where my blood sugars are at, I may take 12 units, this then corrects my bloods and I allow them to drop before taking food. I then take the correct amount of insulin to cover the food taken and a little extra and when I then eat my bloods rise quite quickly and can take two hours to start returning to normal.

This is quite worrying but I am looking to know does anyone else experience anything similar?

I always dose for Dawn Phenomenon or Foot on the Floor.

I experience FOTF (where you rise as soon as you get out of bed) every day, so I take some quick acting insulin before getting out of bed even if my blood glucose is fine at that point.
I know my liver will dump glucose in my blood as soon as I get up to help get me going for the day, and that glucose needs insulin just the same as glucose from food.

I experience DP (where you rise in the early morning when still asleep) sometimes. I use a Libre with alarms so at night I set the alarm to wake me up as soon as I start to rise to catch it with a little insulin before I actually go high.

I then take the correct amount of insulin to cover the food taken and a little extra and when I then eat my bloods rise quite quickly and can take two hours to start returning to normal.

Many of us found NovoRapid pretty slow. How long before eating do you inject? General advice is 15 or 20 minutes but for some they need to dose much earlier to prevent high spikes.
Still, going back to normal in two hours is pretty good, depending on how high you spike. (A short spike to 12 or so is not the same as a spike to 20 of course.)

There are quicker acting insulins available as well, I'm very happy with Fiasp, others prefer Lyumjev, both act quicker than NovoRapid.

I may have to increase my Lantus at night but I find my bloods can run low at night when I do.

Have you considered splitting your Lantus in a morning/night dose?
Lantus doesn't have a completely flat profile and it doesn't completely cover 24 hours either for everyone.
Splitting it maks the action profile flatter, which might help with avoiding it's peak action during the night.
There are also people who take their Lantus in the morning, which may help as well.

You could also consider a different long acting. Tresiba is very stable, which is great but has the downside that dose adjustions (with illness, extra active days, or just because your basal needs vary) take 3 days to take full effect, by which time the situation might have changed again. Still, I love this insulin.

There's also Levemir, with a profile that works a little shorter than Lantus. This one's usually taken twice a day, perfect for people who have a different basal need during the day and night, or people who need to regularly adjust their basal. A dose change has immediate effect.

Good luck!

 

[Ant1983]

Thank you for the advice I really appreciate it.

I have been on Lantus for 15-20 years and same with Novorapid. I recently moved my injection time for Lantus to around 4pm-5pm to see if that benefited me, but still running low (between 3 and 4) most nights between 1am and 6am. I take between 28 and 30 units, and not sure if I am going to have to split the dose out like you said and increasing the amount I take because of DP I am now taking more Novorapid than I ever have before. Not even sure how it would work, as I have always been a 1 dose of Lantus person...

 

[EllieM]

Hi @Ant1983 and welcome to the forums. I've been taking lantus for at least 15 years and decided to split it two years ago (haven't had a hospital appointment since then but not expecting them to complain). I do find it slightly less erratic now but my clinic did offer to put me on a pump to help with the dawn phenomena. Is that something that might appeal to you?

 

[Ant1983]

Hi Ellie

Thanks for the input, I am considering the pump, but I have now increased my lantus by two units and am taking it in the afternoon at about 4pm which seems to be helping at the minute rather than splitting it out which I have considered.

The thing with the pump im just not sure about it, I feel there maybe a lack of control with it, not even sure how it fully works tbh but will discuss it at my next appt, though not sure when thats gonna be (thank you tory government!)

 

[Cal M]

Thanks for this thread, I have increasing dawn phenomena or FOTF (liking that name). Was anxious about dosing with insulin without food so not tried yet. However some morning I have been 15mml on waking so need to start dosing before breakfast. I am on Tresiba background insulin and Lyumjev as my fast acting.

 

[Ant1983]

It is one of those things that you need to try and test and see what works for you. Since moving my lantus DP has not been as much of an issue except that now during the night my bloods run consistently between 3 and 4 so its just a matter of tailoring the dosage, I will probably start splitting the dosage out to see if it helps in the long run.

I miss the good old days of lantus and actrapid whilst the insulin was slow to act I always felt I had better control with those types of insulin...