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Dawn phenomenon and pumping

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sarah88

Active Member
Messages
34
Hi everyone!

I am really struggling with getting my levels sorted throughout the night and first thing in the morning.

When I get up I can be anything from 5-17. I have stayed up/set my alarm every 2 hours to test and can't seem to identify the time that my sugars start to rise, it's different every time. (and I'm mega grumpy the next day from the broken sleep! :) )

I have increased my profile from midnight to 6am ( I've woken up at 7/8am being low when it went past this time) in line with the 'stepped' profile that I have currently, increasing it by .05 each time and seeing how I go for a couple of days. My DSN recommended I might need more of a hike in insulin when the rise starts then a drop off when it's stabilised...but seeing as I can't find the right time to do this I'm a bit lost!

I have been on the Aviva accu chek combo for 2 months now and have been using the computer software which has been helping me visualise it a bit more.

I try not to eat too late in the evening, But I am a sucker for a lie in, which does tend to do things to my sugars!

Does anyone else have a big jump in their insulin at a certain point in the night or is everyone on a stepped profile?

Any tips?

Thanks, Sarah :)




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Hia - i do have a big jump but mine is at around 8pm until midnight (go from 0.65 to 1.10 units per hour). I used to suffer with dawn phenomanen but since having my pump I have managed to get rid of it. I'm not quite sure what you mean by a 'stepped' profile but if you just mean that you have different hourly rates through the night (and in your case it seems to be increasing each step) then yes that's what I do. From midnight I drop to 0.675, then drops to 0.625 at 2am, drop again to 0.650 at 3am, drop again to 0.550 at 4am and then rising up to 0.650 at 7.30am until 10.30am.
Not sure if this helps but it does give you an idea of how much the basal rates CAN vary through the night .....and day for me. All the best :thumbup:
 
Sarah

I too am a bit like Riri so have different basal rates going for different hours of the day and have also got the Combo. Basal rate testing is never an easy thing to do especially when it involves broken sleep and getting up the next day to get to work etc.

If you can though, try to do some basal rate testing tonight even though its Friday and you might want to go out. If you can, eat a small amount of carb at about 4pm and do a bolus but don't eat another meal with a bolus. Start basal rate testing about 10pm every hour onwards until 3am in the morning but don't drink any cups of tea or coffee with milk in them after 11pm or when you would normally go to bed as the milk can make bg levels change. If you feel that you need to eat something after 6pm just eat a salad (l ettuce, etc, lemon juice as dressing) and some sugarfree jelly to keep you going.

I don't use any software on computer to log my bg levels. Instead I just use the Accuchek Pump bg diary as that has everything I need to sort myself out and has columns for everything including hourly basal rates, bg levels, carb, correction dose and TBR.

When changing my basal rates, I look at my bg levels and then make changes to the existing basal rate programme that I am using but before I do that, I write down all my existing basal rates first and then change so that I can see by bg testing the next day what effect the basal rate change has been. I note that you are changing some of your basal rates by 0.05u. That's quite a steep change so can see why you are swinging a bit. Don't be worried that you may end up getting a different basal rate for nearly every hour. Mine are somewhere near to 0.50u per hour that I was started off with by dsn but over time my midnight basal rate drops to 0.30u until 2am, then its 0.43 and slowly rises upwards from then on and then drops a lot mid afternoon from 0.53 to 0.18 at 3pm then rises again at 4pm and so on, rising to 0.90 during the evening and then dropping again from 11pm onwards..... So don't worry about making the changes. The Combo by default will use the target level between 4mmol to 8mmol so is meant to level people to 6mmol so make sure when you do your basal rate testing that the targets are set to be the same as the target you are using to get your bg levels ok every hour when you do your basal rate testing.....

Rome wasn't built in a day and all that. You'll get there in the end..... :)
 
I had the strangest experience with my night levels when going on the pump. I often did my testing overnight which was always fine and stable, however when I wasnt waking myself up they just kept rising. The nurses dont seem to understand why it happens but the waking up seems to prevent them rising...almost as if REM sleep affects my sugars?!?!

To prevent this we took the alarm of the TBR and used it for a few hours in the night and it worked.

However since coming off the pill this has completely stopped and I dont have any problems with this anymore! Weird...
 
Sounds like you have a good understanding of what to do, adjusting, fasting etc. Sorry it's not straightforward for you.

You may have already thought of this, but have you considered the carbs you are eating in the evening. There's some suggestion that certain carb heavy foods like pizza can have an effect on blood glucose for upto 24hrs.
Personally, i don't eat much pizza, but do struggle with pasta a little. It takes a long time to be absorbed for me, and definitely is still affecting my glucose levels 12hrs later. I've tinkered with multi wave bolus for this, and seem to be winning.
Potatoes on the other hand. Absorbed reasonably quickly, and don't seem to have a prolonged effect on me.

Its certainly something worth considering. Looking at the types of carbs you eat for dinner/evening and looking at how you bolus for them. Lots of trial and error really...


Hope that helps. Altho it may be something you've already thought of..

Sent from the Diabetes Forum App
 
i found laying off starchy carbs after lunch helps. For dinner, I only have veg that grows above the ground and protein. Limit your carb grams per meal too. I try not eat more than 50 grams of carb per meal now.
 
My basal rate at nights is hugely different from DP.

My rates at night are currently:
12-1. 0.47
1-2am. 0.54
2-3 0.69
3-4 0.47
4-5 0.97
5-6am 0.64
6-7am 1.05
7-8am 1.10
8-9am 0.95
9-10am 0.89
Then they drop straight down to 0.30. And stay within 0.30-0.45 all day.

I generally wake around 5am for 4 weeks and 7am for 4 weeks, but can keep this profile for lie in's until 7am. So some people do have huge differences in their basals every hour when waking...

Me personally, if I test I do it over two nights... And from 3am onward. I will do 3am, 5am and 7am and the next night 4am 6am and 8am.

Easy enough on combo pump to set alarm clock and I have mine next to my pillow and have masterd doing tests in the dark!!
 
I used to have really bad dawn phenomenon. My diabetes specialist changed my background insulin from Lantus to Degludec which I now only take once a day at 13:00. I have since woken up with fasting levels between 4 and 8.

degludec is the newest insulin on the market. Also called Tressiba.
 
Thanks for everyone's replies. Donnellysdogs my profile is very similar to yours but mine peaks a little earlier. I've done quite a lots of testing and trialling over the last couple of months and I seems to have it fairly sorted, morning bs of 6 :) I'm borrowing the hospitals CGM to make sure it's how I think it is.
Sw11bloke, thanks for your advice but on a pump you only use a short acting insulin, but I'll look out for that if I ever have to go back to mdi.


Sent from the Diabetes Forum App
 
Good to hear from you. A cgm can be good to see just when you are dipping or rising, make the most of it as a guideline to the way the patterns go that you would not be able to do just from testing every 2 hours...
 
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