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Any advice welcome.

MrNigel

MrNigel

Member
Messages
13
Hi.
Just joined the forum about 5 mins ago. Really struggling here and not sure where to start. I’ve been suffering from dawn phenomena for about a year now and have been trying to avoid an insulin pump which according to health care professionals is the only solution? I’ve tried setting my alarm for 4 am every morning and having 4 units of fast acting to head it off (with some success) however it gets confusing when your half asleep so gave that up. Recently I think I’ve been potentially injecting fast acting instead of my basal (by mistake). Resulting in me producing high level ketones for over a week. Since I’ve changed the basal cartridge my levels are back to bouncing around from 19 in a morning to having hypos In the afternoon. No ketones though.
I’ve admitted defeat and will accept a pump but can’t get an appointment for a while as the consultant is off. I’ve not seen any Dr’s about this. My big issue is even though I’m back at work now I still feel awful with zero energy. Can anyone give me any advice. Thank you.
 
Hi @MrNigel, what basal are you using, and what bolus insulin? They all tend to perform differently so our own experiences with them may help if we know what they are. Maybe your basal needs a tweak? Have you done a basal test?
It sounds like a difficult situation and I’m not surprised you’re finding it hard to keep going.
Personally, I’d leap at the chance to get a pump, but we’re all individuals and have different desires.
 
Hi @Fairygodmother. Thank you for your response. My basal is tresiba. I’ve tweaked from 14 units down to 12. Settled on 13.5 for while and now on 13. I use novorapid as my fast acting and have 2 to I ratio in the morning always with a 4 unit correction dose die to high levels and then 1 to 1 for evening meal.
I have no idea what a basal test is. Please could you tell me more? Guess I could look it up.
I understand feeling awful when producing ketones but as not had them for 4 days. wondering if it’s effected me somehow having them for over a week?
 
Go for the pump. I have been on the pump for just over a year. I had all these preconceived ideas of what a problem it would be especially in bed. I was wrong. The pump is a game changer. I have had D for over 10 years and 8 have never managed a HbA1c of under 7.3%. With the pump 6.4 and that was without any real effort on my part. The pump can be programmed to give you a slight increase starting at 4am and increasing over time, then backing off at the appropriate time. There is a small percentage that don’t take to a pump, it nearly everyone that is put on one, never looks back.
 
Hi. Most of us suffer from the Dawn Phenomena so I'm wondering why it is a big concern for you? Is your Basal balanced? When do you use the Basal and I assume you carb count when using it unless doing a correction dose. You may well need a pump but it's not clear from your post what's the cause of your control problems?
 
Chowie said:
Go for the pump. I have been on the pump for just over a year. I had all these preconceived ideas of what a problem it would be especially in bed. I was wrong. The pump is a game changer. I have had D for over 10 years and 8 have never managed a HbA1c of under 7.3%. With the pump 6.4 and that was without any real effort on my part. The pump can be programmed to give you a slight increase starting at 4am and increasing over time, then backing off at the appropriate time. There is a small percentage that don’t take to a pump, it nearly everyone that is put on one, never looks back.
Click to expand...

Thanks Chowie.
Appreciate your response. Think it’s just down to vanity. Also practicality’s. Like you say where do you but it when in bed etc sauna? On the beach sunbathing? How sexy I’ll look? I’ll get over myself though as I’ve felt so Ill recently that all of the above is insignificant compared to my health.
Thanks again though.
 
Hi @MrNigel, First we get diabetes, and as if that is not enough, along comes the pesky Dawn Phenomenon (DP)?!
As a diabetic, not as professional advice or opinion:
If you go to the Forum page and type Dawn Phenomenon in the Search box Right upper screen there is a description of DP and the various things that can be tried to deal with it. You will see that an insulin pump is one of them, but there are a few other things to try. Like no carbs near bedtime, change insulin types etc.
And I know of some including myself who I like you have done the 4 am shot of short acting insulin !!
Basal testing is about testing BSLs to see what effect your basal insulin (= Tresiba in your case) is having. This is just the sort of way I do it. Please check with your DSN before trying it.
So for example., taking Tresiba as usual:
testing BSLs every 2 hours from midnight to 8 am, ( no supper.)
To do the rest of the 24 hours the following can be done, but I am not sure it will inform you much more about DP, just about the rest of the day.
On a weekend, skipping morning Novorapid and breakfast and testing BSLs every 2 hours from 6 am to 12 midday, then have Novorapid, lunch ect.
Then having morning Novorapid + breakfast, but skip lunchtime Novorapid and lunch. Test BSLs every 2 hours from 12 md til 6 pm, then have Novorapid before dinner then dinner.
Lastly: skip dinner and Novorapid before it and check BSL every 2 hours, 6 pm til 12 mn.
Why not do Tresiba , no Novorapid and a 24 hour fasting and get it over with in one go??
Because, in my case, possibly others, 24 hours of fasting time without food puts my ketones levels up. Ketones are from the body breaking down fat stores to provide energy and these ketones can make insulin less effective thus skewing BSL results.
The problem with long acting insulins that I found was that its steady action, compared to short-acting insulin, makes it difficult to control and rise in BSL as in DP.
The only long-acting insulin that held back my DP for a while was one called Levemir. In my case I was taking one dose in morning the other at 10 pm. That way I could adjust doses better to suit both 12 hours of the 24 hour day.
That seemed to work for a while but eventually I could not control DP and prevent night-time hypos.
The insulin pump was the answer. And looking back on things, I should have started the pump sooner.
I say that having been on the pump now for 7 years but a total of 52 years on insulin.
Best wishes>>:):):)
 
I had similar excuses, water sports and Skydiving. Guess what no issue. I’m a red head and live in Australia so I can’t relate to sunbathing
 
Daibell said:
Hi. Most of us suffer from the Dawn Phenomena so I'm wondering why it is a big concern for you? Is your Basal balanced? When do you use the Basal and I assume you carb count when using it unless doing a correction dose. You may well need a pump but it's not clear from your post what's the cause of your control problems?
Click to expand...

Hi Daibell.
Don’t think I used to suffer with dawn phenomena. Hadn’t even heard of it till my dietician explained it. So don’t understand why it’s started to happen. I get the hormone production but ponder why now? I use my basal at 19.30. Do you think changing the time could make a difference? I do carb count however still find it difficult to get good management.
Wish I knew what the cause of the control problems was then I could fix it. Guess my concern is waking up with levels every morning if 15 to 20.
 
kitedoc said:
Hi @MrNigel, First we get diabetes, and as if that is not enough, along comes the pesky Dawn Phenomenon (DP)?!
As a diabetic, not as professional advice or opinion:
If you go to the Forum page and type Dawn Phenomenon in the Search box Right upper screen there is a description of DP and the various things that can be tried to deal with it. You will see that an insulin pump is one of them, but there are a few other things to try. Like no carbs near bedtime, change insulin types etc.
And I know of some including myself who I like you have done the 4 am shot of short acting insulin !!
Basal testing is about testing BSLs to see what effect your basal insulin (= Tresiba in your case) is having. This is just the sort of way I do it. Please check with your DSN before trying it.
So for example., taking Tresiba as usual:
testing BSLs every 2 hours from midnight to 8 am, ( no supper.)
To do the rest of the 24 hours the following can be done, but I am not sure it will inform you much more about DP, just about the rest of the day.
On a weekend, skipping morning Novorapid and breakfast and testing BSLs every 2 hours from 6 am to 12 midday, then have Novorapid, lunch ect.
Then having morning Novorapid + breakfast, but skip lunchtime Novorapid and lunch. Test BSLs every 2 hours from 12 md til 6 pm, then have Novorapid before dinner then dinner.
Lastly: skip dinner and Novorapid before it and check BSL every 2 hours, 6 pm til 12 mn.
Why not do Tresiba , no Novorapid and a 24 hour fasting and get it over with in one go??
Because, in my case, possibly others, 24 hours of fasting time without food puts my ketones levels up. Ketones are from the body breaking down fat stores to provide energy and these ketones can make insulin less effective thus skewing BSL results.
The problem with long acting insulins that I found was that its steady action, compared to short-acting insulin, makes it difficult to control and rise in BSL as in DP.
The only long-acting insulin that held back my DP for a while was one called Levemir. In my case I was taking one dose in morning the other at 10 pm. That way I could adjust doses better to suit both 12 hours of the 24 hour day.
That seemed to work for a while but eventually I could not control DP and prevent night-time hypos.
The insulin pump was the answer. And looking back on things, I should have started the pump sooner.
I say that having been on the pump now for 7 years but a total of 52 years on insulin.
Best wishes>>:):):)
Click to expand...

Thank you so much for your detailed reply. I think I will try the test after checking with specialist and just do the 24 hour choice.
I’m so impressed with the responses on here. Think I’ve realised I need to talk about this more and also see if I can get a pump.
 
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