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Dawn phenomenon

O

ollyb

Member
Messages
5
Hi all

I'm a recently-diagnosed type 1, and am just getting the hang of lantus and novorapid. Working out what I need to jab is gradually getting easier, but one thing still eludes me, which is increasing blood sugars over night. Last night as an example...

9pm - 14 units lantus
10pm BG 12.2
10:15pm 12 unit novorapid
10:30pm low-gi granola (40g carbs)
5:30am BG 7.4
8am BG 8.8

This is really frustrating, as I thought my 5:30 reading was OK, then back to bed, up at 8am and it's increased. Could this rise be down to the dawn phenomenon, or would the expected rise be a bit lower than that?

Thanks in advance!
 
Hi Olly,
Firstly it's usually not a great idea to eat so close to bed when you are figuring out your Lantus dose. You can tell if your Lantus is correct by comparing your before bed and before breakfast readings. If they are out by more than 1.6mmol/l, then you should adjust your Lantus by 10% accordingly. Novorapid lasts around 5 hours in your system, so to make sure that your before bed reading is not going to be affected by anything you've eaten, or by any Novorapid in your system then you shouldn't eat or inject Novorapid for around 5 hours before bed.

For this reason, it might not be the dawn phenomenon, because the insulin you gave at 10.15 could've reduced your readings to, say, 5 mmol/l and if your Lantus dose was too low, your BGs could have been steadily rising throughout the night.

Also, did you wash your hands and change your lancet before your morning tests? I have found that unless I wash my hands (even in the morning), my meter readings are more variable. In addition, most meters are accurate to only around 15% with washed hands and changed lancets, they will be even less accurate otherwise. So it could be that those readings are consistent with each other. If you wanted to go for an accurate meter, the MyLife Pura is supposedly one of the most accurate.
 
I agree with SamJB. I wouldn't inject my Novorapid that late or even have measurable carbs normally that late. I have my Novo with my evening meal around 7-8pm and then just do the Basal at 11pm. This makes it easier to determine how many units of Basal to take. I was told to aim between 5 & 7mmol fasting reading but in practice go for 4-5 fasting (yes, a bit tight)
 
ollyb said:
This is really frustrating, as I thought my 5:30 reading was OK, then back to bed, up at 8am and it's increased. Could this rise be down to the dawn phenomenon, or would the expected rise be a bit lower than that?
Click to expand...


I would say yes Olly that's its DP. If I'm not mistaken DP takes place between the hours of 4-8 am and in some it will be quite profound and in others less so; I'm awake by 6-6.30am most morning and eat on waking which limits the effect of DP, however if I were to over-sleep and awake at 8 am as you did I would expect to see a similar rise in bg.

Is there any particular reason why you eat so late in the evening, I wouldn't be too keen on going to bed with 12 units of Novo still circulating in my system, would it not be possible to have your evening meal later in the evening around 7-8pm so your less inclined to be hungry later in the evening?
 
Thanks for the replies everyone.

Currently the family meal is 6pm ish, so by 10pm I'm pretty hungry. I do have protein shake in the cupboard, so will give that a go. Fewer carbs at that time of night does seem like a better idea than even low-gi carbs.

I think my Lantus is OK. I started at 8 and increase to 14 over the last few weeks. At 14 I find that my BG remains broadly constant when jabbing a fixed amount of novorapid for the amount of carbs I'm having. When I was on lower amounts I was seeing an increase throughout the day.

Good advice about clean hands, etc, too - thanks for that. Will see how I go over the next few days!
 
I also see a rise in my bs in the morning, usual it kicks in at about 5 am. I only really noticed as I had to get up early for travelling with work a few times. So now I know during weekdays it's about 1-2 mmol by the time I get up at about 6:30 which brings me up to 8 mmol. On the weekends I get up later and so tend to see a 2-3 mmol rise (although I notice on weekends If I've had wine the night before it is much less). Any excuse for a glass of wine eh :-)
It was worse before at about a 4 mmol raise but it's helped that Ive started to take my levemir later but I can see you already take yours pretty late.
Personally I'm ok thinking that for 1 or 2 hours I'm a bit higher than I would like rather than take more and run the risk of upsetting the balance during the rest of the day. But thats my preference.
I've just got into the habit of taking a little more morning insulin to adjust, not sure if that's the best approach but seems to work ok.


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As a random aside comment.
It's great amusement to my my boyfriend when I talk about dawn phenomenon who (as a lot of people I expect) just makes me sing the muppet song!
He knows its a really serious topic but you know you have to try and be happy and light hearted sometimes.


Sent from the Diabetes Forum App
 
Thought I'd finish it off

Phenomenon de do de do do de do do de do do do do do

That is so hard to write, can't decide if I've got too many de do dos or not enough!!!
Prob could do with a few more for luck :-)
...do do do do


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