Dawn Phenomenon

[Iain Byrne]

Hi all,
I was diagnosed as type 1 at the age of 5 and now at the grand old age of 71 I think I maybe suffering with the dreaded dawn phenomenon or foot on the floor thing.
When I wake my sensor reading is about 5 get up and move around and it shoots up to 10+
I have increased my Novorapid from 10 to 15 but by the time I have had breakfast my readings are up to 14-15 and a pain to get down. I am allowing 30 minutes between my insulin and breakfas.
Spoke to DNS briefly and she more or less told me to ignore it, have my normal insulin and don’t bolus until it’s above 17. The speed Novorapid works my readings would be 20+ by the time the insulin takes effec.
Any advice would be gratefully received
Iain

 

[Zinadane]

Fiasp is faster than novorapid. I find it much better to manage my bolusing.
For me I usually take 4 units of fiasp on getting out of bed. Just to to prevent the dp from getting my numbers up.
If my bg gets into the teens I find my insulin sensitivity dramatically reduces.

 

[Iain Byrne]

My GP suggested Fiasp may help but DSN at infirmary said there was no reason to change from Novorapid. GPs here don’t get involved with diabetes management and leave it to infirmary.

 

[Zinadane]

uhm, well, I find it very debatable sometimes on what my (non-diabetic) dsn or doctor may want to recommend depending on which way the wind may be blowing from day to day .
Fiasp is faster than novorapid which for bolusing is what I need.
Btw, I took 4 units an hour ago on getting up. Sat at pc having first coffee and BG is now at 11.
So another 4 units going in. No plans on breakfast just yet.

 

[Iain Byrne]

My DSN told me not to bolus until BG reached 17 if I did that BG would be 20+ by the time Novorapid worked. Crazy advice imho

 

[Zinadane]

Agree, that would be completely wrong imo.
You know what's going to happen as soon as you go over 10.
Sensitivity is reduced and it can take ages to get it back down.
I don't expect my dsn to give me any useful advice on my daily battle of balancing my levels

 

[CheeseSeaker]

It can be a challenge to deal with in Dawn Phenomenon using MDI.

Novorapid doesn't really kick in for 1-2 hours in most of us (so your 10+ rise wouldn't be controlled by the insulin activity unless you could inject an hour before you're awake (which is simply impossible)

Fiasp is Novorapid with 'stuff-in' to make it work faster - it can kick in at about 10-20 mins (sometimes a bit quicker too) so would be a good way of hitting that rise (you'd have to play with the amount though as insulin without food in your system needs experimentation).

In the pump world we set a background rate of insulin (thats fast acting insulin but dribbled in every hour) so programme for the high before 'foot-on-the-floor' occurs to ensure it stays within range,

 

[Zinadane]

I think the problem with the professional advice. Is that they will always be thinking, that whatever they say, they do not want to be telling you something that may cause hypo.
For me it's a case of, it's my body, thanks to libre etc I can see my trends and can predict which way I will be going, well maybe 80% of the time. I then make my own insulin decisions.
Agree, closed loop pumps should be the end of dp. I still prefer MDI, at the moment anyway.

 

[Fairygodmother]

The person with Type One is more likely to know how their own Type One responds to blood sugar affecting situations than anyone else will. We’re all different.
I find it a little odd that the DSN advised not blousing until you’re 17 @Iain Byrne but I’m judging that on the known factors of my own Type One experience.
Are you extra sensitive to a bolus? Have you had frequent hypos?
Do you use a sensor? I find being able to spot blood sugar’s direction of travel often tells me when I need to correct.
Foot on the Floor’s a real nuisance, especially as for me it often needs either 1.5 or 2 units of Fiasp to tame it, and whether it’s a 1.5 or a 2 day is only known after the correction dose has acted.
Yes, Fiasp. I find it, plus a sensor, make it easier to manage blood sugar levels and aim for readings between 4.8 and 8.6.
Good luck in your battles to own your own Type One.

 

[Fairygodmother]

Are you in Scotland?
Maybe you’d like to show the DSN this: the govt recommendation is that someone with Type One should aim for blood sugars between 48 mmol (6.5) and 58 mmol (7.5)

https://www.diabetesinscotland.org.uk/wp-content/uploads/2021/02/575776_SCT0221023700-001-P3.pdf

 

[Zinadane]

Uk targets are hba1c below 48 (6.5) with TIR (time in range between 4-10) above 70%
For me with CGM is possible without it taking over my life (too much)

 

[Juicyj]

Ok i'd try eating something soon after waking, what you're trying to do is to trick the liver from dumping glucose into your blood so eating upon waking is sending a signal to your liver that another source of glucose is online, however eating something low carb instead so plain yoghurt and for me 1-2 large spoons can do the trick, otherwise carbs will start to send your levels north. You may want to take insulin too for this, but it's definitely trial and error.

In regards to not taking a correction until 17 is absurd, even DAFNE (Dose adjustment for normal eating) I believe suggests to correct at 10-12 mmol/l. Personally I aim to keep within the range of 5-10 mmol/l so I would definitely be correcting at 10+.

 

[SimonP78]

Novorapid doesn't really kick in for 1-2 hours in most of us (so your 10+ rise wouldn't be controlled by the insulin activity unless you could inject an hour before you're awake (which is simply impossible)

Bit of a sweeping generalisation! It certainly works faster than that for me - ~20min seems about right. I get FotF, like the OP, if I take insulin (3U if I'm at or around 5, more if I'm higher) as soon as I wake up and basically as I put my feet on the floor and before I drink any coffee it will remain below 11ish assuming I do go and do something within about 45min of waking up (driving my children to school, going for a walk.)

If I'm higher it's much harder to bring it down, which is typical (insulin is less effective when you're high) and if I segue straight into morning meetings without the school run it will also tend to not come down.

Large amounts of alcohol and/or exercise the previous day and/or running close to hypo overnight help to reduce FotF for me - not that these are necessarily recommended (aside from the exercise that is!)

I'm torn on the whole eating something approach, I've never consistently tried to see how well it works, but my feeling is that it does have a beneficial effect, but it's certainly not a "night and day" difference for me.

 

[ang.helen]

Hi all,my bg also raise when I get out of bed and before I have breakfast can take a while to get it back down again

 

[Captain_Sensible]

Hi all,
I was diagnosed as type 1 at the age of 5 and now at the grand old age of 71 I think I maybe suffering with the dreaded dawn phenomenon or foot on the floor thing.
When I wake my sensor reading is about 5 get up and move around and it shoots up to 10+
I have increased my Novorapid from 10 to 15 but by the time I have had breakfast my readings are up to 14-15 and a pain to get down. I am allowing 30 minutes between my insulin and breakfas.
Spoke to DNS briefly and she more or less told me to ignore it, have my normal insulin and don’t bolus until it’s above 17. The speed Novorapid works my readings would be 20+ by the time the insulin takes effec.
Any advice would be gratefully received
Iain

Hi Iain! I'm similar to you T-1 65 years but I'm 81. I'm on the old porcine. I think your nurse is right. I've experienced this Dawn Phenomenon thing for years now and my HBA1c is around 7.2 mmols old money and my doc is happy enough. I just take my insulin as normal and take a few pips up or down as necessary keeping an eye on things with my Libre. You have to have faith that your insulin dose is effective versus your carb intake which we both know over the years it's unnecessary to get too technical about anyway imho. I've learned over the years that if you've got an HBA1c around 7- 7.5 for a Type 1 insulin dependent diabetic - you are doing just fine ! As the Nurse said-,Don't worry ! We've done well to get to our age anyway

 

[Cropwalker]

Hi Iain! I'm similar to you T-1 65 years but I'm 81. I'm on the old porcine. I think your nurse is right. I've experienced this Dawn Phenomenon thing for years now and my HBA1c is around 7.2 mmols old money and my doc is happy enough. I just take my insulin as normal and take a few pips up or down as necessary keeping an eye on things with my Libre. You have to have faith that your insulin dose is effective versus your carb intake which we both know over the years it's unnecessary to get too technical about anyway imho. I've learned over the years that if you've got an HBA1c around 7- 7.5 for a Type 1 insulin dependent diabetic - you are doing just fine ! As the Nurse said-,Don't worry ! We've done well to get to our age anyway

 

[Cropwalker]

I have had T 1 diabetes for 55 years and just turned 70 so in a similar situation, I have been pumping for quite a while probably 14 years and thought things could not get much better , even being able to give a large basal rate before getting up I still had raised glucose levels. I have been on the Medtronic pump and there glucose monitor( smart guard) for the last 11 months and what a transformation! Still a slight rise in the mornings but nothing like they used to be . Currently time in range 90% of the time and last HbA1c about 4 months ago was 5.9! It took about 4-5 months to get the hang of things but I would not be without this system.

 

[Rowgirl]

Hi all,
I was diagnosed as type 1 at the age of 5 and now at the grand old age of 71 I think I maybe suffering with the dreaded dawn phenomenon or foot on the floor thing.
When I wake my sensor reading is about 5 get up and move around and it shoots up to 10+
I have increased my Novorapid from 10 to 15 but by the time I have had breakfast my readings are up to 14-15 and a pain to get down. I am allowing 30 minutes between my insulin and breakfas.
Spoke to DNS briefly and she more or less told me to ignore it, have my normal insulin and don’t bolus until it’s above 17. The speed Novorapid works my readings would be 20+ by the time the insulin takes effec.
Any advice would be gratefully received
Iain

Hi Iain,
I was diagnosed just 3 years ago as type 1 diabetic, so a novice compared to others. I’m now 60 and still trying to work out the workings of this disease. I to have the ‘dawn effect’, with the added interest of insulin resistance in the morning. First thing I do in the morning is give a bolus of 2-3 units of fiasp. My blood sugar will not go down but will stop rising, if I don’t give it, my blood sugar will 20mmols within half an hour and stay up all morning. I’ve tried not eating but that can worse for my blood sugar, i’m also on metformin which does help with my insulin resistance. Good luck.

 

[TonyBlue]

Hi all,
I was diagnosed as type 1 at the age of 5 and now at the grand old age of 71 I think I maybe suffering with the dreaded dawn phenomenon or foot on the floor thing.
When I wake my sensor reading is about 5 get up and move around and it shoots up to 10+
I have increased my Novorapid from 10 to 15 but by the time I have had breakfast my readings are up to 14-15 and a pain to get down. I am allowing 30 minutes between my insulin and breakfas.
Spoke to DNS briefly and she more or less told me to ignore it, have my normal insulin and don’t bolus until it’s above 17. The speed Novorapid works my readings would be 20+ by the time the insulin takes effec.
Any advice would be gratefully received
Iain

No way I’d wait until over 17 you know what’s best for your body and to me 17 is too high.
Morning novorapid takes around 1 hr to kick in lunchtime around 30 mins and dinner around 30 mins.
We are all so different which does make it slightly more challenging and of course the dreaded colds etc.
hope you can sort it out

 

[Iain Byrne]

Hi,
Thank you all so much for all your very useful replies and apologies for a very late reply but holidays got in the way.
I am finding things quite varied at the moment, sometimes DP will kick in and I take 5iu of Novorapid to stabilise things, then take my morning breakfast dose and when my BS starts dropping I eat. This usually works well, when no DP just take breakfast dose and wait until BS starts to drop before I eat.
can get a bit complicated but I’ve survived 64 years with type 1 so sure I can mana a few more