Dawn Phenomena

[Harrysdad]

Most mornings my blood starts going sky high (upto 17 ish mmol/l) before I wake up from about 5 am and I spend most of the rest of the day chasing it down again. I went onto Levimir (AM and PM) from Lantus in an attempt to solve this however, I not having much success. I've read that some people have had success with reverting back to 1 basal dose in the evening on Levimir?

What are other peoples experiences/successes/strategies to combating Dawn Phenomena?

 

[librarising]

Are you happy your basal is sufficient ? Perhaps time to test it.
17 doesn't strike me as Dawn Phenomenon. Sounds like you may be asking your bolus doses to do your basal's job.
I take Levemir a.m. and p.m.
Geoff

 

[Harrysdad]

My basal seems ok, I use Libre and up until about 5 or 6am all is usually stable and then my BG just starts rising. I have tried increasing my evening basal and I just end up Hypoing over night.

 

[Deleted Account]

Sounds like a classic case for a pump so you can alter your basal just before your DP starts.

If that is not an option, have you tried increasing your basal AND going to bed with a slightly higher BG to counteract the fall?
For example, (before pumping) I used to aim to go to bed between 7 and 8 with a basal dose that gave me a BG of about 5.5 when I woke.
I confess this was before there was an option of a Libre so I did not have details of what was happening whilst I was asleep although my body wakes itself when my BG goes above 10 or below 3.

Another thought is whether your night time hypos were really hypos.
Are you taking the value just from your Libre or are you waking and taking a finger prick reading?
Others have mentioned their Libre reads low during the night and is something do with pressure as you lie on it causing it to under read.
If you have all the hypo symptoms and a finger prick reading, just ignore that last bit.

 

[Harrysdad]

A pump would be lush however, an HBa1c of 6.4 is deemed "to good for a pump" in Oxfordshire.

I was double checking the libre with finger pricking as I too had heard about the pressure thing, but the lows were real.

 

[gwai84]

Sounds like absolutely classic dawn phenomenon - mine used to sit at 4-5 all night then climb steeply from 5am until 10am, usually to 10-14 but if I had a lie in it could easily go to 18-19.

Unfortunately the only thing that properly fixed this for me was a pump - the dawn phenomenon was the reason I qualified for it. By increasing my Lantus to counteract it, I was having nocturnal hypos - so I qualified even though my HbA1c was ok.

I did find a solution whilst I was waiting for my pump- I would wake up at 4am (my cat would wake me up for food then anyway!), about an hour before the dawn problem kicked in, and take a 2 - 4 unit bolus of Novorapid. This meant I woke at 8am with sugars of 6-7. Better control but not ideal to have to wake yourself up at 4am...

 

[charleym]

I do exactly the same, starts going up at 6am and is around 12 by 9.30am when I eat and take the Novarapid. If I increase the lantus my sugars hover around 3.5 for several hours during the night. Have tried the lantus am, pm and split with no difference.
After being told numerous times that I must be doing something wrong I went to the consultant and dsn last week with a month of charts, mysugr printouts and freestyle libre printouts so I could argue/disprove everything they said.
Half an hour later they said they had no answers and I'm getting put forward for a pump.

 

[Antje77]

Last week I had a slight cold and the same thing happened to me, although I normally don't suffer from a very clear dawn-phenomenon. I do have feet on the floor effect though, which I bolus for before getting out of bed, so I'm not afraid to bolus without food. So after two nights of ridiculous sugars at 5 in the morning I woke up at 5.30 to check BG and took a bolus when highish on a fingerprick and rising according to libre before going back to sleep. Worked fine for me. Now back to normal.

 

[becca59]

Yep, have the same problem. I often don’t eat tea but the Libre shows a flat line all evening and night, then 4am and off it goes like a rocket. Also rises quickly just putting feet out of bed. As you say Harrysdad you are then playing catch-up. My solution is to have 1 or 2 units at 4/5am. A pain but it solved the problem.

 

[Lynz84]

Hi Harrysdad
I changed from levemir to toujeo as the levemir was doing dang all for my dawn phenomenon. Toujeo lasts 36hrs so you dont really get drop off. Might be worth trying!

 

[District_Line_Diabetic]

Funnily enough I was planning to post about this tonight and then saw this thread. I have the same issue. I'm still in the honeymoon period so my basal and bolus doses are relatively low in comparison to most and my rise in blood glucose in the morning isn't as extreme as others on this thread but it's definitely still there and annoying me. I'm really stable overnight with no hypos, staying within my target range (I've also got a Libre) then as I start waking up it climbs rapidly and will continue to do so all morning.

Have resorted to taking NovoRapid when I get up but I don't like having to do the extra injection just for one/two units when I'm not even eating.

I must admit that during the week I don't eat breakfast and I wonder whether that makes a difference. I think I read somewhere that eating can sometimes help.

Has anyone found that eating in the morning as soon as they wake up and not taking any short-acting insulin makes a difference? (e.g. let's say you have something like only eggs).

Will continue to inject fast-acting in the morning to counteract as I consider that the lesser of two evils (rather than considering a pump), but as others have noted it's a bit of a pain.

 

[donnellysdogs]

I had pump for 5 years for pproblems and my DP was completely resolved.

Now off pump but I have to wake at 3.30 for 1 or 2 injections (depeending upon arrows from my cgm and activity the day before and also another 2 injections at 8am when I wake and now trialling splitting my 8am bolus and having another jab at 9am too.

My leveks rise at 4amright theough to midday. Levemir and lantus and tresiba didnt manage at all.

I now take insulatard at 3.30 and a shot of bolus 0.5 if I think I need it.

8am Insulatard and 1.5 bolus

9am currently 2 unit bolus

4pm 1 unit tresiba...

Crazy but so far its the only way to manage my DP and waking phenomenon.

 

[Harrysdad]

Thanks for all the responses everyone it's always a surprise and oddly comforting to me to know that there are so many others going through the same trials and frustrations as me .