Basal testing/dawn phenomenon

[samantha13]

How do i check my basal daytime dose is correct if I'm always correcting when I wake due to dawn phenomenon? I understand we need to have had our last bolus injection 5 hours prior to beginning so should I take my correction earlier around 3am? Or do I just have to miss the morning section of the check?

I seen my dsn about my DP couple of weeks ago. I'm taking levimer 22u at bedtime and 6u in the morning. I go to bed around 7mmols but wake in the teens. Each time I increase my night time levimer I hypo so i feel I'm stuck with managing it by the morning correction.

Sorry I guess there is two questions there..do I correct earlier and is how I'm managing my dp OK?

 

[azure]

I'd say it depends when your rise starts. You don't want to correct too early and risk a hypo.

I have both DP and a waking rise so I don't basal check that section of the day because I'd just go high, but others may have found strategies that work.

For managing the DP, I have a pump. I could never get things right on basal but I believe @TorqPenderloin boluses early to stop DP (hope I'm remembering that correctly).

 

[samantha13]

The rise starts around 3-4am I normally wake around 6am and correct then. What is waking rise? I sometimes go higher when I get up and start getting ready but assumed I didn't correct enough?

 

[azure]

The rise starts around 3-4am I normally wake around 6am and correct then. What is waking rise? I sometimes go higher when I get up and start getting ready but assumed I didn't correct enough?

Waking rise is as you've described - when getting up puts your BS up. Eg if I get up with a BS of 5.5 and delay breakfast too much, my BS will start climbing.

You could experiment with a small correction earlier, but be cautious and see how it goes.

I found only a pump helped my DP. I can't remember if pumps have been mentioned before but they are excellent for controlling the DP.

 

[samantha13]

My consultant and dsn have both recommended a pump last March due to the DP and my numbers on work shifts but I asked for more time to try and work with mdi. I'm really bad with numbers/ratios etc and it takes me a while to get the hang of things so I've been very reluctant to go forward with the pump as I feel it might be wasted on me. I have my clinic review in Jan so I might try for it. I'm desperately trying to get my numbers lower so we can apply for adoption and if the pump helps then it's time to put my insecurities behind me. I will try early correction in the mean time to try and check my basal. Thanks so much @azure xx

 

[azure]

I'm sure a pump won't be wasted on you. You're clearly dedicated and working really hard to control your diabetes

There are plenty of features to help you on a pump

 

[Engineer88]

Best thing about a pump is it works out all your doses ect!

Seriously, I would try and go for a pump, it will probably be much easier than you think and will especially deal with DP

 

[noblehead]

I have both DP and a waking rise so I don't basal check that section of the day because I'd just go high, but others may have found strategies that work.

@azure , I've always found basal testing on a morning problematic due to the waking rise, since starting on a pump I've found a way that works for me.

What I do is make sure the night-time basal is correct then once that's confirmed start on the 7am to lunch check, I do this by waking around 3-4am and have my breakfast/bolus as I would at 6.30-7am.

I have my clinic review in Jan so I might try for it.

Definitely go for it Samantha, it will be one of the best decisions you've made

 

[emilyj17]

Are there recommendations for catching/ stopping DP? Would I have to wake myself up every couple of hours to test?
I'm getting so tired of waking up and feeling awful! I went to bed at 5.3 last night and woke up at 18.0 this morning ! :<

 

[Type1Bri]

A pump really would help you I think. I started in November and my DP is gone now, it's a real game changer.
It doesn't work everything out for you though, it takes commitment to testing and changing settings until it works right for you.
I look at a pump as simply an insulin delivery device, just like a pen but much better

 

[mentat]

About a year ago when I was at the end of my tether I tried metformin extended release in the evenings—the morning rise almost disappeared. Unfortunately this has reversed in the last month but metformin is known to help reduce the dawn phenomenon.

 

[samantha13]

About a year ago when I was at the end of my tether I tried metformin extended release in the evenings—the morning rise almost disappeared. Unfortunately this has reversed in the last month but metformin is known to help reduce the dawn phenomenon.

I take metformin 500mg twice a day

 

[donnellysdogs]

Hi

I have DP and WP (waking).

I have had pumps and they are good and you would be able to fix yours problems and manage them.

Unfortunately for rare reasons I cannot continue with a pump and have been back on MDI On and off (inbetween retrying pumps) and have now found that Tresiba insulin is the best one for not making me low at 3am but it cannot stop me waking up high without a pre-emptive bolus at 4am and another one an hour before getting up.

I have tried every basal insulin, and 3 pumps.

My advice to you would be to have a pump.
Or other than that you initially need to do testing at 3, 5 and 7am and 4, 6 and 8am another morning..

Having a libre and jyst scanning arm is or looking at graph makes it quite easy.

You are trying to find our whether you are dropping between 2am and 4am. And wheat time the rises start.

If you ever have lie ins at weekends etc... you need to do it from about 5 hours before you plan to wake every two hours till your later waking time.

I am currently trying various other options but so far my 4am injections are remaining necessary and to be honest. I dislike them as I end up waking hubby and we do not sleep until very early hours of morning.

 

[samantha13]

Thanks for your reply @donelleysdogs. I'm sorry to hear the pump etc are not working with you that must be very frustrating.

I have done basal tests and have the libre on currently. I'll add a pic of my graph last night. If I wake around 4am and correct it works very well but then I also have to take a correction on rising as I'll shoot up again.

I guess I just have to accept this is what I need to do until/if I get a pump. Thanks so much for your reply.

 

[donnellysdogs]

Pretty much the same as me... i was taking at 4am
But just experimenting at 7am now for a few days. Since being on degludec the levels over night have been flatter longer.. sometimes until
7am and then going up!!
Overall for me though I am thinking that the 4/5am and again at 8am is pretty much the only way to
Keep the stupid DP and WP under control.

I have found last week a huge change and improved levels since stopping my anti cancer tablet. I couldnt take the side effects any more so thought I would stop for a month. After jyst two days I know I will never go back on them. Coming off them has also flattened my levels too.

 

[jonniey]

I take 13 morning and 6 evening and it seems pretty stable for me if I go to bed on a 10 it will drop 2 to 4 or stay at 10 depending when I took it morning time is also pretty stable. My humalog is the main issue but it seems I need about 1.5 or 1.6 humalog/carb. slowly getting my sugar lower.

 

[jonniey]

Iv always noticed an increase of blood sugar early hours of the next morning if I only took 1 dose the previous morning....that's why I split my dose and the split dose is working, took some time to find the correct ratio though.

 

[donnellysdogs]

I take 13 morning and 6 evening and it seems pretty stable for me if I go to bed on a 10 it will drop 2 to 4 or stay at 10 depending when I took it morning time is also pretty stable. My humalog is the main issue but it seems I need about 1.5 or 1.6 humalog/carb. slowly getting my sugar lower.

The bed levels you are mentioning are high. The drops you mention are also quite large. Waking at 10 to me is totally inaccepfable. Thats why I get up at 4am to stop high levels like that!! Going to bed at 10 is not acceptable either.

 

[jonniey]

Thats because of not correcting with the humalog. And I prefer that my basal drops me abit otherwise I'll be high most of the day. 4 is acceptable I think.

 

[donnellysdogs]

The best control to be aimed for us to be sat nicely at a good level of 6 at bedtime.

Going to bed at 10 is too high especially when you are reluant upon corrections that may or may not drop you 4.

The idea of good control is to go to bed at 6ish and wake up at 6ish with no more of a drop or rise of 1.8.

You seem to have accepted your own way and your own set levels of control and ignoring what is actually the basics..