Type 2 Does somebody recognize this graph?

[EBe66]

Hi all,
I'm a type 2 diabetic on pills (metformin and gliclazide) and are self funding my Freestyle libre 2 sensors. My GP practice is not really familiar with these sensors, I was actually the first one there. The advice they give is solely based on sober finger pricks and a yearly hba1c test. By following an insane diet I can manage my sugar levels reasonably well now in combination with the sensor.
This diet means I eat only 1 time a day, in the evening. So no breakfast and no lunch most of the time (but I am human so...)
My problem is that my sober blood test is always high at the doctors so they started upping my meds which resulted in hypo's in the rest of the day so a year ago I decided to start with the freestyle libre 2 sensors which imho is a real eyeopener.
As a result I can now see that as a rule my BG rises fast at the moment I start to wake up until 9-12 depending on the time of year.
Despite of not eating anything!
So high sober BG level at the doctors explained, but they insist on using it.
I have tried changing the time I take my medication to catch this but that does not help. Neither does exercise. I have a (work)daily commute by bicycle of 12km one-way. If anything my day curves show my body reacts to this by releasing more glucose. When I exercise after the "peak" in the graph exercise does help and BG does go down by it.
My question: Is this just the "normal" dawn phenomenon or is it something different? If so any idea what it is or what could help me other then insulin?

 

[Lamont D]

Hi and welcome to the forum.
If I may ask a couple of questions to confirm your description of the start of the day.
You don't eat at all before evening?
What do you drink?
What time do you take the glicizide?
You refer to hypos, but it isn't on the graph, what time do these occur?

It is quite common to have dawn phenomenon and those levels which are not particularly high. If it is the bike ride, that brings it down or the glicizide that has the effect, which?
I would suggest what your sensor is showing is another talk to your doctor to see if the glicizide is necessary.I

Many on here would be happy with those readings if you're susceptible to dawn phenomenon.

 

[Fenn]

Hi, welcome.

I suffer from dawn phenomenon, weirdly, eating something like a piece of cheese can help with the spike, no idea why it works but it seems to. Maybe our natural glucose “get up and go” liver dump is fooled by eating. Best of luck, I hope you get the numbers you want.

 

[EBe66]

Hi, welcome.

I suffer from dawn phenomenon, weirdly, eating something like a piece of cheese can help with the spike, no idea why it works but it seems to. Maybe our natural glucose “get up and go” liver dump is fooled by eating. Best of luck, I hope you get the numbers you want.

Thanks. I had heard of eating something like a tea biscuit before going to bed. Tried it and was a complete fail (for me). I will give cheese a try sounds more logical then a biscuit.

 

[EBe66]

Lamond,

Thanks for answering.
- You don't eat at all before evening?
Normally I don't eat anything at all before dinner. Why the normally? Because the last 2 weeks I was trying homemade milk kefir for other afflictions I have but found out yesterday that it causes an extra bump on my morning peak. And last week I started doing some serious bike riding again with 2 rides in the 75-80 km range. When I do that I take an apple at the halfway point. Other then that, nothing before dinner.
- What do you drink?
Tea with stevia, the real stuff not the supermarket ones, and neem powder. Neem powder is one of those Indian herbs that would regulate your blood sugar. Does not seem to do anything for me but I got used to the stuff . Black coffee. Some hard liquor mainly in the weekend. Sometimes herbal tea, water kefir, diet coke and waiting for my first real ginger beer ferment to finish... (with the plant, not the bug)
- What time do you take the glicizide?
10 AM. According to our national health database (Netherlands) that would mean the effect is on its peak shortly after dinnertime. But I tried taking metformin and/or the glicizide at different times of the day, also just before going to bed.
- You refer to hypos, but it isn't on the graph, what time do these occur?
Should have elaborate a bit there I guess. The attached graph is not a day curve but a period of 7 days presented as one. The black line is the median value, the darkish blue is the 25-75 percentile and the light blue is the 10-90 percentile. I'll try to add some more graphs of the last 90 days of which I wore a sensor for 49 days. They cost an arm and a leg so I don't wear them full-time.
The hypo graph shows that I mainly have hypos in the evening (after my dinner!) but never ever in the morning.

Regarding the last part: I understand that a lot of people would be very happy with an average curve like mine but there is also a lot of work involved in getting it like that. Like practically switching to a low carb high fat diet.
I feel like if I could beat that morning spike I would be where I want to be.
During my last talk to my doctor there was actually talk about reducing my meds but I am hesitant about that.

What I am basically am asking I guess is is this type of graph typical for dawn phenomenon?

Sorry for the long read!

 

[Lamont D]

Lamond,

Thanks for answering.
- You don't eat at all before evening?
Normally I don't eat anything at all before dinner. Why the normally? Because the last 2 weeks I was trying homemade milk kefir for other afflictions I have but found out yesterday that it causes an extra bump on my morning peak. And last week I started doing some serious bike riding again with 2 rides in the 75-80 km range. When I do that I take an apple at the halfway point. Other then that, nothing before dinner.
- What do you drink?
Tea with stevia, the real stuff not the supermarket ones, and neem powder. Neem powder is one of those Indian herbs that would regulate your blood sugar. Does not seem to do anything for me but I got used to the stuff . Black coffee. Some hard liquor mainly in the weekend. Sometimes herbal tea, water kefir, diet coke and waiting for my first real ginger beer ferment to finish... (with the plant, not the bug)
- What time do you take the glicizide?
10 AM. According to our national health database (Netherlands) that would mean the effect is on its peak shortly after dinnertime. But I tried taking metformin and/or the glicizide at different times of the day, also just before going to bed.
- You refer to hypos, but it isn't on the graph, what time do these occur?
Should have elaborate a bit there I guess. The attached graph is not a day curve but a period of 7 days presented as one. The black line is the median value, the darkish blue is the 25-75 percentile and the light blue is the 10-90 percentile. I'll try to add some more graphs of the last 90 days of which I wore a sensor for 49 days. They cost an arm and a leg so I don't wear them full-time.
The hypo graph shows that I mainly have hypos in the evening (after my dinner!) but never ever in the morning.

Regarding the last part: I understand that a lot of people would be very happy with an average curve like mine but there is also a lot of work involved in getting it like that. Like practically switching to a low carb high fat diet.
I feel like if I could beat that morning spike I would be where I want to be.
During my last talk to my doctor there was actually talk about reducing my meds but I am hesitant about that.

What I am basically am asking I guess is is this type of graph typical for dawn phenomenon?

Sorry for the long read!

Lamond,

Thanks for answering.
- You don't eat at all before evening?
Normally I don't eat anything at all before dinner. Why the normally? Because the last 2 weeks I was trying homemade milk kefir for other afflictions I have but found out yesterday that it causes an extra bump on my morning peak. And last week I started doing some serious bike riding again with 2 rides in the 75-80 km range. When I do that I take an apple at the halfway point. Other then that, nothing before dinner.
- What do you drink?
Tea with stevia, the real stuff not the supermarket ones, and neem powder. Neem powder is one of those Indian herbs that would regulate your blood sugar. Does not seem to do anything for me but I got used to the stuff . Black coffee. Some hard liquor mainly in the weekend. Sometimes herbal tea, water kefir, diet coke and waiting for my first real ginger beer ferment to finish... (with the plant, not the bug)
- What time do you take the glicizide?
10 AM. According to our national health database (Netherlands) that would mean the effect is on its peak shortly after dinnertime. But I tried taking metformin and/or the glicizide at different times of the day, also just before going to bed.
- You refer to hypos, but it isn't on the graph, what time do these occur?
Should have elaborate a bit there I guess. The attached graph is not a day curve but a period of 7 days presented as one. The black line is the median value, the darkish blue is the 25-75 percentile and the light blue is the 10-90 percentile. I'll try to add some more graphs of the last 90 days of which I wore a sensor for 49 days. They cost an arm and a leg so I don't wear them full-time.
The hypo graph shows that I mainly have hypos in the evening (after my dinner!) but never ever in the morning.

Regarding the last part: I understand that a lot of people would be very happy with an average curve like mine but there is also a lot of work involved in getting it like that. Like practically switching to a low carb high fat diet.
I feel like if I could beat that morning spike I would be where I want to be.
During my last talk to my doctor there was actually talk about reducing my meds but I am hesitant about that.

What I am basically am asking I guess is is this type of graph typical for dawn phenomenon?

Sorry for the long read!

Hi again, after reading your answers and seeing your other files, I do agree with your doctor about reducing your meds especially the glicizide this medication is designed to lower your blood glucose levels over time and it is a drug to come off once your blood glucose levels normalise. It is definitely not a lifetime medication. The glicizide is probably causing the hypos.
Be careful binge drinking at the weekend, this bout of alcohol, depending on what you drink, is likely to spike your blood glucose higher for a period that your body is ill prepared to cope with.

I do really believe that the dawn phenomenon you are experiencing is but a side issue. The problem with T2 is the imbalance in blood .mainly after food and drink but not always. Avoiding the spikes derived from carbs and sugars.

From what I take from your post you do take quite a few unnatural sweetners, and no supplements will control blood sugars, but some may help if the rest of your dietary intake is low carb approach is sufficient enough to keep in check your imbalance of hormonal response.

Have a word with your doctor.

 

[Antje77]

The hypo graph shows that I mainly have hypos in the evening (after my dinner!) but never ever in the morning.

It's worth confirming those hypos with a fingerprick. Seeing as you're only 3% of the time hypo and the hypos don't show up on your 'dagelijkse trends' they don't seem to be long lasting or very low hypos. They might even not be hypos at all, for some of us Libre tends to read lower than a fingerprick.

Would you like sharing what you usually eat?
It looks like you're starting to rise around midnight with a sharper spike in the morning. I;m wondering what is causing the rise throughout the night.

And a practical tip on forum use: If you highlight the part of a post you want to reply to, it shows a little pop up reply button so you can reply to just that part and have the other person's text appear as a quote, much easier to work out who said what that way.

 

[LaoDan]

Kinda similar to my graph? I eat a big breakfast, do a crushing workout, then a big lunch, and a light dinner.

 

[EBe66]

Kinda similar to my graph? I eat a big breakfast, do a crushing workout, then a big lunch, and a light dinner.

Are you sure you are in the right forum with such a curve and eating excercise pattern!
As an example I've attached last friday. Before leaving for work 1 cup of milk kefir which seems to give the bump a little extra oempf so as of this weekend I now take that after my lunch time walk. Then note 1 is after cycling 12km (and no, the drop in the BS peak is not because of the exercise, it varies) at 15:20 I took of for a 77km bike ride of almost 4 hours. At about 6 you see a litlle raise which is from an apple I took And the bump at about 9 is from dinner consisting of, how do you call it over there, a bag of mixed vegetables for the wok (frying) with a chicken filet from the airfryer and as a treat a can of kidney beans through the vegetables.

 

[EBe66]

Would you like sharing what you usually eat?
It looks like you're starting to rise around midnight with a sharper spike in the morning. I;m wondering what is causing the rise throughout the night.

Thanks for the tip! And sure. Normally I eat absolutely nothing until diner! But for the last ~2 weeks I was taking a cup of home-made milk kefir before leaving for work in an attempt to solve some other issues. But as it seems to make the morning bump even higher than it was I am now trying eating it after my lunch time walk. This is the first day, but it seems to work, hardly a any rise at all. Last week I started some longer bike rides again (>50km) after an accident last year and then I try to take an apple with me. A typical dinner consists of a vegetable packet (pakketje wokgroente) with some kind of meat. That's it. Sometimes I take a raw carrot or two. If I really must have something to eat in the evening, which is rarely, I eat some raw sauerkraut.

Having said that I'm only human and I do sometimes faul up of course but the above is typical, vegies and meat once a day. Last weekend I had my now yearly treat of Chinese food for example. Don’t have to show you that curve I guess…

Just today I finally found some reference to a scientific study describing the dawn phenomena completely and it fits my results to the tee.

“The poster, “Morning Hyperglycemia: Breakfast or Dawn Phenomenon,” tells us more about the dawn phenomenon than we ever knew before. In the past we understood that it began about 4 a.m. and ended about 8 a.m., the typical start of breakfast. The new study by Dr. Allen King, an endocrinologist practicing at the Diabetes Care Center in Salinas, California, and two of his associates there, had 37 subjects skip their breakfast to see what happens.

The subjects used a basal insulin, Lantus, and a continuous glucose monitor. The CGM showed that in fact the dawn phenomenon doesn’t stop at 8 a.m. The dawn phenomenon does rise at 4 a.m., but it peaks at 10 a.m. and doesn’t return to baseline until 1 p.m.”

I'm aware of the libre possibly showing lower than actual values but it's hard to determine which is the correct value. I have two fingerprick BS meters and on multiple occasions tried comparing readings but with a normal accuracy of +/-15% I can't figure it out. Sometimes the libre is the lowest another time with the same sensor it's in the middle and then it's the highest and even the fingerprick meters results vary.

But I do have longer periods of hypo's but indeed most are short and I’m sure there not real hypo’s. Usually with a curve like LaoDan my sensor stops working...

 

[Antje77]

Back to the first graph.

So you're usually eating very little carbs.
You rise throughout the night with a sharper peak upon waking.
You start dropping from 8AM, which coincides with a serious amount of physical activity.
You have a lot of exercise throughout the day.
(Let's discount the light blue peak between 5 and 8, I bet you had a single cheat meal during that week and it's not part of your trend.)

Do you know what happens if you have a lazy non exercise day? Do you drop below 7 on days like that or do you simply start high and stay high?
If you stay high, it looks like the exercise is the reason you're managing healthy numbers.
I would expect the gliclazide to cause more hypos during the daytime but you seem to be fairly stable (as long as you stay away from the carbs).
Have you considered asking for a C-peptide test to see if you produce enough insulin? Not easy to get one, your GP can't order it so you'd need a referral to an internist.

 

[EBe66]

So you're usually eating very little carbs.

I try to...
The drop starts around 9 but also depends on time of year it seams. Later light equals somewhat later rise/peak. The sharper rise is mostly when I, first, wake up. As an example I included the curve of last wednesday (my lazy work at home day as in no cycling/walking). Don't remember if there was a peticuliar reason for the higher night values but I started the night with a BS of ~ 7 you see me waking up at ~6, staying in bed until I had to absolutely get out ~8 then it spikes and has the same rapid fall as almost everyday without the exercise ending in low values even after dinner.
I never heard of a c-peptide test I'll research tonight. About 15 years ago I was used told I had IR type 2 diabetes based on what, no idea... I asked for a referal to a internist last time because I want to get rid of this peak but was told no not needed. I'll try again next time.
But, I'm now pretty sure it's the dawn phenomenon (something my diabetes caregiver at the GP had never heard of...)
Thanks for all the answers/tips

 

[Antje77]

As an example I included the curve of last wednesday (my lazy work at home day as in no cycling/walking). Don't remember if there was a peticuliar reason for the higher night values but I started the night with a BS of ~ 7 you see me waking up at ~6, staying in bed until I had to absolutely get out ~8 then it spikes and has the same rapid fall as almost everyday without the exercise ending in low values even after dinner.

In that case I'd say it's the gliclazide doing it's job, and not the exercise.

Would it be possible to play with the timing of the gliclazide?
A quick google search says action time of gliclazide is between 10 and 24 hours (not very helpful) so timing might make a lot of difference.

 

[LaoDan]

Are you sure you are in the right forum with such a curve and eating excercise pattern!
As an example I've attached last friday. Before leaving for work 1 cup of milk kefir which seems to give the bump a little extra oempf so as of this weekend I now take that after my lunch time walk. Then note 1 is after cycling 12km (and no, the drop in the BS peak is not because of the exercise, it varies) at 15:20 I took of for a 77km bike ride of almost 4 hours. At about 6 you see a litlle raise which is from an apple I took And the bump at about 9 is from dinner consisting of, how do you call it over there, a bag of mixed vegetables for the wok (frying) with a chicken filet from the airfryer and as a treat a can of kidney beans through the vegetables.

Oh yeah sorry, I thought you were complaining about the spike during exercise.

 

[EBe66]

Would it be possible to play with the timing of the gliclazide?

I'am at work so can't check but there is a difference between gliclazide 40 and 80mg, the 40 being the time-release variant so they say it works 24 hours. I looked it up in our national medicine database thingy a while ago (again no link because at work) but the effect should be at the highest after ~9 hours. That's why I take them at 10am so the effect is maximum at ~7pm normally just after dinner. I have tried taking them before going to bed. But if what I have is the dawn phenomenon which I'm now pretty sure I do then one thing is known about it and that is that no pill helps with it, only insuline and/or liraglitude (victoza) and the likes.
Now I have included another two graphs, one of yesterday to show it was not a real typical day (see the evening low) and the second one is today sofar because yesterday I read that eating a green apple (granny smith) and/or apple cider vinegar capsules and/or a piece of cheese can help take the top of. Now it's to early to tell but yesterday evevening I ate the apple and a piece of cheese before going to bed and it looks promising. Much lower peak and shorter!

 

[Lamont D]

I have had a look at the graphs, and in my opinion, as you said the low blood glucose reason is it you take glicizide at 10a.m. The response is about the time your blood glucose levels go below.
it is the glicizide, and nothing else will help if the meds will do what it is supposed to do.
speak to your GP about lowering the dosage or coming off the drug completely.

I repeat myself, it is the glicizide!

 

[EBe66]

I repeat myself, it is the glicizide!

I know! But my question is about (lowering) the peak, not the lows. They don't bother me atm. The Glicazide will be a point of discussion with my GP the next time anyway (should be any day now) we already talked about it 3 months ago because I expected to go and do more exercise.
Concerning you earlier answer, thanks for that btm, but I'm not using excessive amounts of artificial sweeteners (I hope). My last diet coke was 5 days ago. I drink in the weekend but don't binge drink. The effect my ocasional whisky or jenever (predecessor of gin) has is that it LOWERS my BS significantly.