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DP and pumps

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Unicornz

Well-Known Member
Messages
107
Is there anyone on here suffering from Dawn Phenomenon? If so, how did you tackle it with your pump? I've been trying to sort mine out for three months with basal increases but no luck, for some reason it keeps coming back after a week or so. I've more than doubled the dose now compared to the rest of the day and I've started getting hypos in the morning (might just have to adapt the times slightly).

Did it take anyone else this much time to get it right? Or do you have a different solution? Any ideas would be welcome :)
 
I hugely have dawn phenomen and am on a pump...or should I say I had it.....my base levels were all set at .47 I think initially...

On MDI I could wake at 5.0 and within one hour would hit 15+.

On pump I can wake at anything between 5 and 7 and stay at it.

However....to get this far...my levels of basal are FAR different to what I was set up with.
At 00.00-3am between 0.42 and 0.44 an hour
At 4am 0.64
At 5am 0.84
At 6am 1.15
At 7am 1.45
At 8am 1.20
At 9am 1.25
At 10am 0.84

So you can see that I have had a lot of exploring to do with my basals before getting them so good. Generally I wake at 7.30am. I did test myself every hour and alter horly rates only to get this...for example...I tested at 7, 8, 9, 10 and 11am. and I was altering my 4am level if my 7am was too high, I altered my 5am level for my 8am reading, I altered my 6am level for my 9am.

I have to add that the new drugs for different illness that I am on have put my basals up hugely throughout the 24 hour period...my daily dose was 14 approx and is about 18 now...That is wholly the drugs....

I hope this helps...also....having to go without breakfast on these days too......as having a bolus obviously makes things doubly hard to work out...get your basals right and then your bolus...
 
Mine is pretty much like DD's, on MDI i would spike from 5-7mmol at 3-5am then it was upwards from there, and fast! Which would result in me tackling highs all day, then they'd come down by teatime, then come early morning i'd be high again, very vicious circle and certainly frustrating!

I'm still working on mine, i've cracked my basal overnight, it's just the mid morning rise now. i wake with BG's of 5-7 (test when i wake) then 1-2 hours later when i have breakfast i'm in the 8's nowhere near as bad as it was but still needs tweaking, i think between the hours of 3-9am i have about 20-30% basal increase compared to the rest of the day which works out pretty good as an almost flatline for the rest of the day.

I agree with DD's that get your basal right first, then the bolus, if your basal is wrong it could mean your over or under compensating with your bolus ratios.

I did various fasting tests through the morning to see when the rise started (hence why i pinpointed 3-5am as the first start) then i tackled it hour by hour, and slowly the rise is getting later and later so eventually it should dissapear if that makes sense.

So when i figured out i was starting to rise about 3am i upped the basal by 0.05uph, waited 2-3 days and tested again if i was still rising then i upped it again. I did this until i no longer rose as 3am, then i moved onto 4am, then 5am, funnily enough when i cracked 5am, 6am was perfectly fine, and so was 7am! weird but i think that's because those are the times i usually get up. i'm currectly tweaking 9am-11am.

It certainly has taken its time though and is a tough job. It's taken me almost 3 months to get where i am now, but i'm slowly getting happier and happier with the results.

I think i'm lucky though as i've never seemed to have overdone it yet and hypo'd at night, but i am quite careful.

0.05uph might seem alot to some people to raise a basal by but my insulin requirements are a bit on the high side, i take about 28u in basal alone and my ratios are average of 2.5u:10g (varies).

Hope this helps a little, if anything given you encouragement that if you take it slow and are patient you will get there. DP is certainly a pain in the *ss! :lol:
 
My consultant told me never to raise my basals by more than 0.2....when I was altering due to my DP's I calculated all the rises and times and I did actually change mine by up to 0.5 at a time...but when going up by 10mml in an hour, I knew that 0.05 was never going to touch the increase. Bit naughty, and I only changed it once like that, and I was lucky that it worked for me...

Nowadays I stick to my consultants rules, and generally if tweaking my tweaks will be by 0.05.

I think the tweaks have to be in relation to the timings of highs, how high!!! how quickly!!! and of course how much background basals you are having in the first place....
 
donnellysdogs said:
My consultant told me never to raise my basals by more than 0.2....when I was altering due to my DP's I calculated all the rises and times and I did actually change mine by up to 0.5 at a time...but when going up by 10mml in an hour, I knew that 0.05 was never going to touch the increase. Bit naughty, and I only changed it once like that, and I was lucky that it worked for me...

Nowadays I stick to my consultants rules, and generally if tweaking my tweaks will be by 0.05.

I think the tweaks have to be in relation to the timings of highs, how high!!! how quickly!!! and of course how much background basals you are having in the first place....
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I was never told anything like that! My nurse knows how much i raise my basal by, if i wanted to tweak a slight rise i think i would consider starting lower but the rise at first was so significant that i had to tackle it head on!! :lol:

Thats why i mentioned maybe most people wouldn't rise it by that much at a time as i know some people are on very small basal's so i didnt want Unicornz to take my experience literally and go too far!!

Is your consultant very aware of what you do with your pump? i love my consultant as he's very nice, friendly and always listens but he's not very pump aware so ihe might not know to advise me like that but my DN says its okay :)
 
ebony321 said:
Thats why i mentioned maybe most people wouldn't rise it by that much at a time as i know some people are on very small basal's so i didnt want Unicornz to take my experience literally and go too far!!
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Lol thanks Ebony :lol: I've had some trial and error with it too and I've settled for changing basals with 0.1 u/h at a time because I know 0.05u/h won't make much of a difference for me personally.

Anyway, I know for sure that my DP starts pretty much exactly when I wake up (which on weekdays is 7am) and I think it stops when I have my breakfast although I don't actually have any evidence for that. I have had to set up a different pattern for weekends because that's when I sleep in and it doesn't happen then.

At the moment my basal rates are:

12am - 0.9 u/h
5am - 1.3 u/h
9am - 0.6 u/h
2pm - 0.7 u/h
6pm - 0.9 u/h
10pm - 0.7 u/h

I wake up at 7am and I don't have breakfast until I get to work at 8.30am. In the span of 1.5 hours my BG will go from normal (4-7 mmol/l) to double digits (12-15 mmol/l).

The 5am to 9am one should theoretically be taking care of the DP. The problem is that since I upped it to 1.3u/h I usually wake up in the lower 4s (and this morning I actually had a 3.4) so I'm thinking I might have to knock back the 5am to 5.30 to 9am perhaps? It hasn't made much of a difference to the 1.5 hours after I wake up though because I am still rising by the time I get to work.

I'm just a bit confused at the moment :roll:
 
Sorry Ebony ......I too have a brilliant consultant and DSN... and they know exactly what I do.....and did this as I stated on a one off......what I was actually trying to say....was just once I had to change by a larger amount, as I knew my levels rose so high and so quickly like Unicornz I bit the bullet and did a increase of 0.5...just once, as I knew that my levels going up by 10 in one hour would take an age to come down to within a normal range by changing at 0.05. I was trying to say that the amount that you change by and the times will be different for everybody...

As I said I now only change them by 0.05 at a max...however with the combo pump when you go above 1unit an hour you can't do any less than 0.05 an hour which is a bit of hinderance.

That's why it so depends on what your correction factors work out to be, what your hourly rate is etc, how quick your levels go up etc, etc....I wasn't advocating to do what I did....

Going back to Unicornz...you may well have to change more than 1 hourly rate...I am exactly the same as you...at weekends when I don't get up at 7.30am, my levels don't raise....and your insulin working time may also be be longer or shorter at this time of the morning as the liver kicks in and does it's bit..yes you may be finding that it isn't just 1 hourly rate to change....

I was also told that if my levels started to go up at 7.30 am I would need to adjust moderately (no more than 0.2!!!!) the three hours up to that time, but with the 3 hourly one being the greatest...however....our bodies are all so different to how much we need, and how much we can change our rates by etc....so yes...please bear in mind this is what I was told, and what worked for me!!!!! My breakfast isn't until 11am....which is also why I need to lengthen out the time of my basals being higher....if I had breakfast at 9am, I too would probably find I wouldn't need such a long time of the basals being increased...but that is just the way that I live and my routines......

Sorry, didn't want to alarm anybody Ebony....
 
I think it is me who confused this you know!!

I read your 0.2 as 0.02 so i thought it was me who was talking about the higher increase if that makes sense? So i thought it was me that got it mixed up! I think i also read your 0.5 as 0.05 too. You'll have to excuse me as i'm very tired today!

I was trying to say the same as you that not everyone will need a bigger increase and because i thought i'd said the higher one i didn't want anyone reading to make a mistake because they'd seen someone alter by their personal needs if that makes sense.

I also know what you mean about you can't adjust by less than 0.05 when going over 1unit, which is a bit odd.

I hope i do make sense :oops:
 
Total sense....can I say this...PMSL!!!!! LOL!!!!! Think we all do this at some time when thinking about all these rates!!!!!!

You have cracked me up...sure that Unicornz will think she has two dippy females here!!!!!! You have really lightened my thinking!!!!
 
donnellysdogs said:
Total sense....can I say this...PMSL!!!!! LOL!!!!! Think we all do this at some time when thinking about all these rates!!!!!!

You have cracked me up...sure that Unicornz will think he has two dippy females here!!!!!! You have really lightened my thinking!!!!
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HAHA! add a few of these if you like :lol: :lol: :lol:

Believe it or not i usually read things a few times before i reply and before i post to make sure i am making sense as sometimes my mind tells me to type things in backwards way that my brain thinks is normal but everyone else sort of does this -> :shock:

We do know what we're talking about really unicornz :)

... Well DD's does, i'm still waiting for my brain to kick in :twisted:
 
Brain doesn't kick in before breakfast at 11am!!! Only just coming to life at time of this last response!!!

Unicornz...sure somebody else will also be coming along with advice that makes real sense!!!!!!! Hope that you can make some sense out of both our messages!!!!!LOL!!!!Sorry!!!!
 
Hi unicornz,

Don't know if this will help but i was told to change the basal 2 hours before you need to. E.G i was having problems after running round picking kids up from school (probs started at 4.30pm) adn DSN told me to alter basal on the 2-3pm hour for it to take effect at 4.30- 5pm (hope this makes sense).

If you are getting dp then why are you upping you basal. Based on what i was told if you are increasing your basal at 5am then it will take effect about 7/8am.

Chat to your DSN about it

Josie
 
josie38 said:
Hi unicornz,

Don't know if this will help but i was told to change the basal 2 hours before you need to. E.G i was having problems after running round picking kids up from school (probs started at 4.30pm) adn DSN told me to alter basal on the 2-3pm hour for it to take effect at 4.30- 5pm (hope this makes sense).

If you are getting dp then why are you upping you basal. Based on what i was told if you are increasing your basal at 5am then it will take effect about 7/8am.

Chat to your DSN about it

Josie
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Hi Josie

Thanks, that's what I have been doing. I worked out that if my BG starts rising at 7am when I wake up, I'd have to start changing it at 5am and go from there.

I have spoken to my DSN about it a lot but she doesn't really know how to do it either, she just advises me to keep upping my basal by another 0.1 u/h if the changes don't have the desired effect.

Going back to the hospital on the 11th of July and they will probably put me on a CGM for a week so maybe something will come out of that. In the meantime I'm planning on doing a proper basal test this weekend (I completely forgot last weekend, stupid me :oops: ) to see if there is anything I can change to smooth out my night pattern!

It's just really frustrating at the moment :|
 
Hi Ubicornz,

I think that you need to figure out what time in the night your blood sugars go low and try adjusting he time two hours before that and then see what blood sugars are like in morning and going from there really.


Good luck with testing.......keep updates coming xx

josie
 
Yep you're right, can keep on speculating but in the end all I need to do to be sure is a basal test. Will do it Friday night and report back afterwards :)
 
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