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Dawn Phenomena

Karenchq

Well-Known Member
Messages
84
Location
Bruxelles
Type of diabetes
Type 1
Treatment type
Insulin
I am fairly new (diagnosed t1 in March, 2016) and would like some advice. About 25% of the time my morning bg is higher than when I test before going to bed and this is happening with more frequency. It is not at all crazy out of control, but I am wondering if it indicates that my Lantus (6 units/night) or NovoRapid (2-3 units/meal) dosage need to be adjusted. Here are some examples of night and morning readings: 6.9-8, 5.3-8.9, 5.1-6.9, 5.3-7.5. The occurrence seems to be within this narrow range. I have read about dawn phenomena and think that is most likely the situation. I have gotten up in the night to test on several occasions and am not going low in the night. To be honest, I am paranoid about complications and maybe over reacting.


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I've been IDD for 45 years, I spent maybe 30 of those years trying to manage my dawn BG's with different insulin regimes and doses, I had some short term successes but nothing that I could say was a real answer.

I moved to a pump 4.5 years ago and the dawn issue was resolved, I needed more insulin from around 3am till 6am which my long lasting 12hr would not support but my pump would. I then added a self funded CGM and it all fell into place.

I no longer have any dawn related issues I'm pleased to say.

I may not be normal but - after 40 years without effective dawn control I have no complications.
 
Sounds like you're currently on set dosage for the time being - you're not carb counting at the mo are you?

Your example readings are actually very good! I suggest you speak to your DSN if you are worried, but I'm sure you're probably due an other review/consultation soon anyway. Your Basal dose may need upping but you may find the morning highs are following a particular type of food in the evening? or it's just a anomalies of the honeymoon period!

What are your reading like during the day?

All the best
 
Hi @Karenchq
Although this isn't a massive overnight rise it sounds like you could perhaps need to review your current dosages. Do you have a review coming up with your DSN? You would be worth keeping a detailed food/insulin/BG diary so that your DN can get a detailed picture of what's going on to help her in adjusting your dosages.
I think it's safe to say though...that dawn rises are the curse of most diabetics and it can take a long time to get this right...don't be too hard on yourself...its still early days and it takes time to get it right.
 
hi there @Karenchq
those examples look pretty impressive
I think talking to your DSN is a good idea
 
At the moment, I am on a set dose as prescribed, but I have done some slight adjustment (not always successfully) if I am eating quite a lot of carbs. I will be moving to the United States in August and will connect with an endocrinologist and dietician to formulate a nutrition plan with carb counting.

Overall, I think my management is pretty good, but definitely spiky. Here are my rough statistic from May until now:

Average BG 7
Highest 15
Lowest 2.3
60% between 4.4-7.9
29% between 8-12
8% between 2.3-4.3
3% greater than 12

The 12+ was all about enjoying some excessive and I can definitely reduce that with better self control. My goal for August is to have zero readings greater than 12 and reduce less than 4.4 by half.



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Thank you so very much for those who responded and encourage me. You have given me more confidence and valuable advice.


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Hi @Karenchq,

They say if your basal insulin is set at the right dose then bg levels should fluctuate by more than 1.6mmol/l during periods of fasting, but in the real world we know it doesn't always work like that and others factors can effect our bg levels so don't get too upset with the occasional high.

As your on quite low doses of basal insulin do enquire about using a half unit pen, a half unit pen can make all the difference.
 
Thanks, I did get the half unit pen at the last consultation and that does help with the fine tuning.


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