Dawn Phenomenon... Behave Yourself!

[GrantGam]

So over the last few months it would seem that my overnight BG's have just gone totally bananas...

There's been no changes to my lifestyle that I can think would be of any significance to warrant this other than the effects of DP...

My day time sugars are typically good, and in range enough to warrant a respectable enough A1c of 45mmol/mol at the last check. My I:C ratios are sound and my basal seems to be set right as any increase from my current dose (day and/or evening) causes hypos. Those wee hours in the morning are causing a lot of trouble for me just now!

I also wouldn't attribute that small <4mmol/l reading to result in a liver dump as I get the same sharp rise even when in range.

Anyway, I just thought I'd just share this for those who may have thought they were alone in having disastrous overnight BG's

 

[steve_p6]

Now that's what you call a DP. What basal are you on? How come it took so long to turn it around, is it not responding to corrections?

 

[himtoo]

that is a huge jump -- assuming you are not pumping ??

 

[GrantGam]

that is a huge jump -- assuming you are not pumping ??

Yes I'm on MDI @himtoo.

If I wake up early enough then I can usually get on top of it with a correction bolus. But if I sleep in for any length of time, then this is the result unfortunately...

 

[GrantGam]

Now that's what you call a DP. What basal are you on? How come it took so long to turn it around, is it not responding to corrections?

Levemir is my basal insulin and I take a split dose.

It wasn't too long to turn around was it? I think going from 17.3 to <7.8 in around an hour is alright? I'd be hard pushed to get any quicker of a turn around without injecting into muscle I think - my BG also continues to rise (from whatever value) as soon as I'm up and start moving around. Bit of a pain...

 

[steve_p6]

Levemir is my basal insulin and I take a split dose.

It wasn't too long to turn around was it? I think going from 17.3 to <7.8 in around an hour is alright? I'd be hard pushed to get any quicker of a turn around without injecting into muscle I think - my BG also continues to rise (from whatever value) as soon as I'm up and start moving around. Bit of a pain...

No you've answered it above, if you had caught it at 8 it would not have been so dramatic. I am guessing you missed the morning basal too which wouldnt help. Looking at the fact the slope is consistent all morning it makes me think your basal may have ran out about 4am?

 

[GrantGam]

Looking at the fact the slope is consistent all morning it makes me think your basal may have ran out about 4am?

It looks that way doesn't it. But it seems that regardless what time in the evening I take my basal, I'm still sharply rising upwards from 3-4am until whenever I bolus on waking.

 

[steve_p6]

We could all be detectives the amount of timevwe spend hunting down whatdunnit!

 

[tim2000s]

@GrantGam1337 - what are your timings and doses for Levemir? It would be interesting to see how that relates. Also, just looking at your graph, the timing of your drop seems fairly normal. It took about 3 hours from your insulin dose to hitting the bottom of your trough.

One of the things I found with Levemir was that it was helpful to do an AM and PM dose (indeed, the NICE guidelines and most of the literature and Clamp studies support this too), although with DP like that, you really need a pump as Levemir just isn't going to cut it.

But that's why we have Libres. To give us the evidence to deal with it and ask for better treatment.

 

[novorapidboi26]

When I was on Levemir sleeping in caused the exact same effect........

A later AM basal and the absence of digestion cause it to sky rocket......

getting up early, keeping one eye closed, testing and bolusing with something small to eat helped........

it was that very effect that got me put on the pump.....

 

[GrantGam]

@GrantGam1337 - what are your timings and doses for Levemir? It would be interesting to see how that relates. Also, just looking at your graph, the timing of your drop seems fairly normal. It took about 3 hours from your insulin dose to hitting the bottom of your trough.

One of the things I found with Levemir was that it was helpful to do an AM and PM dose (indeed, the NICE guidelines and most of the literature and Clamp studies support this too), although with DP like that, you really need a pump as Levemir just isn't going to cut it.

But that's why we have Libres. To give us the evidence to deal with it and ask for better treatment.

Just now I'm on 22u which I split into two doses of 11u at around 9 or 10 AM/PM.

It seems that 'normally' I don't need more basal at night than I do during the day. If I were to take more evening basal in an attempt to offset any rises from DP - I would hypo around 5hrs post Levemir dose without fail...

For now, I can live with waking up a little earlier on my days off to bolus for this sharp rise.

 

[noblehead]

When I was on Levemir sleeping in caused the exact same effect........

It was the same for me on lantus, but bolusing and eating as early as possible put a halt to the bg rise.

@GrantGam1337 , didn't you mention a few weeks back that your consultant was considering you for a pump, as you know you can have multiple basal rates programmed throughout the day and night and this would be ideal for your DP issues, show them your graphs as evidence to support your funding for pump therapy.

 

[GrantGam]

@GrantGam1337 , didn't you mention a few weeks back that your consultant was considering you for a pump, as you know you can have multiple basal rates programmed throughout the day and night and this would be ideal for your DP issues, show them your graphs as evidence to support your funding for pump therapy.

Yeah that's right @noblehead, still waiting patiently though as I imagine that these things take time

 

[steve_p6]

Yeah that's right @noblehead, still waiting patiently though as I imagine that these things take time

Having been on similar Levemir rollercoasters, as it is in no way flat at low dosage levels I would suggest trying Tresiba, it just makes life so much easier.

 

[GrantGam]

Having been on similar Levemir rollercoasters, as it is in no way flat at low dosage levels I would suggest trying Tresiba, it just makes life so much easier.

That's something which I'll be discussing at my next review

 

[steve_p6]

That's something which I'll be discussing at my next review

And if they argue cost it is now only +30 % more expensive than Levemir and every chance you will drop dose anyway in the switch. At 22u you are already low cost for basal insulin. Google the graphs on Levemir profile at low dosage to show it peaks and then turns to water!

 

[GrantGam]

And if they argue cost it is now only +30 % more expensive than Levemir and every chance you will drop dose anyway in the switch. At 22u you are already low cost for basal insulin. Google the graphs on Levemir profile at low dosage to show it peaks and then turns to water!

Thanks for the input @steve_p6, I appreciate it

I'm very lucky in the respect that I have a great diabetic clinic and lovely Dr's who seem to want to do nothing but help. That should mean for me that there won't be too debate on the subject.

On a better note, NHS Scotland has just been pledged £10m by Nicola Sturgeon so I'm hoping that:

-best case scenario; I'll qualify for NHS funding for pump therapy.

-second best scenario; they won't mind the +30% increase for a better basal insulin

 

[donnellysdogs]

I have dawn and waking phenomenon. I have to inject at 4am and 8am everyday. No matter what insulin. Had them all.

Pump was superb at getting rid of both. I dont tolerate new cannulas and now had a consultant suggest a diaport. This would involve a totally different insulin as well.

My levels on tresiba do stay level till 4am. Then by the time 8am and waking I would jump from 5 or 6 up to 11-20 without 4am jabs. But tresiba is not good at 4pm either.

My best mixture is insulatard. 4am
Insulatard and novorapid, 8am same insulins different doses and again insulatard tiny amount at 4pm. Food mainly daily at 5-6pm and then just the novo shot.

Pain waking daily and never getting a lie in. Pump cannulas just not work for 15 hours after a change and highs even worse and needing pen corrections so in agreement with hospital I came off pump till discussions in Jan ref diaport...

 

[GrantGam]

@donnellysdogs, it sounds like my issues are nothing compared to what you've experienced... Sounds like a right nightmare for you...

Does your body reject both stainless and synthetic cannulas out of interest? I hope to start a pump in the near future, but I'm not getting too excited as I fully appreciate the difficulties that can be faced regarding eligibility and qualifying.

Last night I had no DP, just the usual rise on waking which I can bolus for and keep within reasonable limits. Interestingly enough, it was because I was awake until 0330 drinking beer and eating pistachio nuts. Not quite what we'd call a permanent fix though, it's not "sustainable" for overall health and wellbeing

 

[donnellysdogs]

I pumped superbly for 5 years. Best thing going. I loved my pump.

Then all of a sudden by March 2015 I was having huge problems with levels and occlusions... had fantastic relationship with Accuchek. Had 2 of their pumps. They nor me could work out cause. Along with consultant agreement stopped May 2015.

Cancer diagnosed Sept 2015. Now this really un nerves me....

All sets fail.. every single type. I tried twice to go back to Accuchek and once on a 640g. All failed but realised it was my skin.

I am thin. No fat. People say to me but children have pumps and there are tjin adults on them.... which really makes me think is this cancer related... I don't know of any other person having a pump with full blown cancer diagnosed whilst using the pump...

The sites.. my stomach was not used except in sort of emergencies when I couldn't get to bum, legs or arms. So not over used at all. If any where should work it should have been there. Nope.
I am absolutely worn out from 4am jabs as I very rarely get back to sleep. We dont sleep till 1am either cos hubby works late shifts...

I hope you get a pump. You would find it brilliant for DP or waking. My trouble is as soon as I stand up in morning after waking. I inject at 8am to get up at 9am.

Trouble is the 4am insulin is tailing off by 7am so by 9am levels have raised because otherwise I would have to also inject at 6am and that really is OTT!!