Dawn phenomenon

[Besty W]

Hi All, does anyone have any advice on dawn phenomenon. I can have a very steady night but on getting up and particularly after a shower I notice a rapid rise, I now anticipate this and use 8 units to counter each day with no food.

Does anyone else encounter this? Is there a better was of dealing with it?

 

[Antje77]

I inject for it before getting out of bed.
On NovoRapid I still saw a similar pattern you have on your graph because it took time for the insulin to start doing something. For me, the problem was solved when I switched to Fiasp, which works quicker and allows me to keep a straight-ish line after waking up.
I had a try with Lyumjev as well, which worked just as well as Fiasp.

 

[SimonP78]

I also get this, I take 3U as soon as I'm up and about to cover the dawn effect and extra for what I'm going to eat, etc.

Taking a shower can also produce an increased reading, which is generally not a real change (it's more that interstitial fluid flow increases I think) so this then drops back once you're out of the shower. Hot showers/baths can create a real drop in BG as they also increase blood flow to the tissues where you've injected, though I think this is less common. My point is that perhaps you're also covering part of a rise that isn't real, see what you get if you delay your shower perhaps.

 

[SherwoodT1]

I have this, albeit not as pronounced. After speaking with my DSN team, they've recommended changing the time of my basal insulin to a night to try to counteract my mega insulin resistance in the morning.

If you take your basal in the morning, and use an older form of basal insulin e.g. abasaglar, maybe speak with them about this issue?

 

[vic hill]

many year s
GO I DID HAVE A VERY TOUGH TIME WITH DAWN PHEN had to try all sorts of thinks to combat it but it was when on one insulin and a long acting insulin via jabs
think i had to change my long acting insulin all trial and error sorry can help help now been on a PUMP FOR LAST 16 YEARS
VIC

 

[Prancy]

I‘m on a pump and stay in auto mode almost all the time. Mornings I have to fake bolus . 8 units of Novolog. I usually have 1 cup if coffee too, but I take the bolus even if I don’t drink the coffee.

 

[Marie 2]

This is what a pump is really good for. My DP ebbs and flows, right now it's being major again. Between 4:30-6:30 I have programmed 4 extra units of insulin.

 

[IanA123]

Hi All, does anyone have any advice on dawn phenomenon. I can have a very steady night but on getting up and particularly after a shower I notice a rapid rise, I now anticipate this and use 8 units to counter each day with no food.

Does anyone else encounter this? Is there a better was of dealing with it? View attachment 63650

Dawn phenomenon only ever occurred for me when they forced me on to tresiba and apidra. Dosages trebled and weight went spiralling out of control. Kicked off and back on insulatard and humilin s, dosages down and weight stabilising nicely. Will get the weight off if they leave me alone.

 

[ifield4862]

Oh, this has been a really helpful thread for me, thank you - I have the dawn phenomena too and thought I was getting something wrong, I tried working out what was going on (I won't embarrass myself by sharing my tin-pot theories!). I have a review soon, so I might ask about a pump - I changed recently from insulatard to tresiba but that seems to have been ok. Thanks for talking about this, I really appreciate it.

 

[Ria]

Hi All, does anyone have any advice on dawn phenomenon. I can have a very steady night but on getting up and particularly after a shower I notice a rapid rise, I now anticipate this and use 8 units to counter each day with no food.

Does anyone else encounter this? Is there a better was of dealing with it? View attachment 63650

Check that increase is real by using finger prick test. My sensor readings go up to 9 or above when I have a bath while finger prick only shows 6.5-7.

 

[dtriggs]

I used to have this terribly for years - and use 6-8 units of Novarapid to correct each morning - having a cgm has helped enormously to see it in detail. But i have now changed to Tresiba and the problem is solved ! Its such a relief - and i use about 2/3rds the dosage i was using on Levemir too.

 

[Alan-58]

Hi All, does anyone have any advice on dawn phenomenon. I can have a very steady night but on getting up and particularly after a shower I notice a rapid rise, I now anticipate this and use 8 units to counter each day with no food.

Does anyone else encounter this? Is there a better was of dealing with it? View attachment 63650

I've had Dawn Phenomenon for many years with, I'm sorry to say little meaningful support from my DSN until recently. Previously I was told to increase my basal insulin by about 10% for about 4-5 days. I've now found that raising my dose by about 5% and leaving it for 10 days gives my body more time to adjust. Its still nit perfect with typical fasting at about 9.0 ish with a similar level overnight. My libre2 tells me that I occasionally dip to about 3.5 for 30inutes or so around 3.00 but, as I'm asleep and my fasting bloods are no.longer between 13 and 15 I'm happy with that compromise. My hba1c has reduced from 68 to 52, part of which can only be this adjustment.

 

[SimonP78]

I've had Dawn Phenomenon for many years with, I'm sorry to say little meaningful support from my DSN until recently. Previously I was told to increase my basal insulin by about 10% for about 4-5 days. I've now found that raising my dose by about 5% and leaving it for 10 days gives my body more time to adjust. Its still nit perfect with typical fasting at about 9.0 ish with a similar level overnight. My libre2 tells me that I occasionally dip to about 3.5 for 30inutes or so around 3.00 but, as I'm asleep and my fasting bloods are no.longer between 13 and 15 I'm happy with that compromise. My hba1c has reduced from 68 to 52, part of which can only be this adjustment.

If your dip is that short and abrupt it's likely to be a sensor artefact rather than a real low - if you lie on the libre sensor (or any other interstitial sensor) it will eventually read low (because the pressure reduces interstitial fluid flow to the region you're lying on) it's known as a "compression low".

 

[Alan-58]

If your dip is that short and abrupt it's likely to be a sensor artefact rather than a real low - if you lie on the libre sensor (or any other interstitial sensor) it will eventually read low (because the pressure reduces interstitial fluid flow to the region you're lying on) it's known as a "compression low".

Thanks, that's really helpful to know.

 

[Mets]

Thanks for sharing this topic. I’ve had T1D for 36 years. I still remember when they told me @ age 11, then said I needed to quit competitive sport. I proved them wrong and went on to play professionally in my 20’s LOL.

For 20 years I kept asking my diabetes Dr why I had to battle with my BS every morning, I always got the same reply: your hba1c looks good, everything is OK.

Thanks to Teresa May, I then spent 3 years pursuing a CGM with the NHS and they eventually gave in (changed my local NHS trust policy) and allowed me to obtain a Libre in 2021. This opened my eyes to dawn phenomenon (I experience a sharp rise in BS EVERY morning at 4am, I’m guessing this is my internal waking mechanism prepping me for a 6am wake up). I take 26-30 units of Novorapid every morning and eat 2 pieces of toast to get my BS back into the right range for the rest of the day….until 4am rolls around again.

I’ve noticed some interesting points here such as Tresiba/ Fiasp or a pump (I’ve been on Levemir & Novorapid for 18 years).

Switching insulin is a big change, but I’m going to speak to the diabetic nurses (who are great!) about how to try this. It appears it is worth a shot.

There are some very valuable points made here, thanks again for raising this.

 

[Alan-58]

If your dip is that short and abrupt it's likely to be a sensor artefact rather than a real low - if you lie on the libre sensor (or any other interstitial sensor) it will eventually read low (because the pressure reduces interstitial fluid flow to the region you're lying on) it's known as a "compression low".

I should also point out that if I increase the basal (Toujeo) from my current 70 units by 2 (to 72units) my fasting bloods dip to 3.6 to 4ish on an almost daily basis. I find it odd that about 3% ish change has that affect but another reason to be happy with my "9".

 

[charliebarker]

Anyone know how to counter this for a Type II on no medication........

 

[Good sense]

Me too.
LibreLink shows up what’s happening .I get a rise on waking,no shower or food yet.Long acting Toujeo has no apparent effect.I also inject Insulin (Humalog) and the day begins.

 

[GavvyMc]

I also get it as I wake up, but just build it into extra bolus Humalog at breakfast

As others say the shower spike is only temporary due to the heat around sensor

I split my basal Lantus between breakfast time and super time which helps. But I think that's about keeping liver glucose flat, not Dawn or showers.

Hope this helps!

 

[David Paul]

I inject for it before getting out of bed.
On NovoRapid I still saw a similar pattern you have on your graph because it took time for the insulin to start doing something. For me, the problem was solved when I switched to Fiasp, which works quicker and allows me to keep a straight-ish line after waking up.
I had a try with Lyumjev as well, which worked just as well as Fiasp.

The complexity of this chronic disease never ceases to amaze & mystify me: I find you always end up with more questions than answers! That said, I find that having an inquisitive mind helps in the diabetes journey. I try to look at each problem encountered with a 360 holistic approach; just like an artist has to approach his painting from all four sides to capture the subject in view from all angles.
One approach to attempting to regulate the morning glucose reading is to have your evening meal a protein & fat meal only: no carbohydrates! Also, I would endeavour to eat this meal between 5 & 6pm: avoid all alcohol, if possible. I take a bedtime sounding at 9pm so as I can anticipate my morning reading. By concentrating on the 9pm reading, I find I can work on maintaining a lower morning reading.