Early insulin to reduce dawn phenomenon

[Flakey Bake]

Hi Folks,
Over this last 6 months I have developed really nasty dawn phenomenon (DP); immediately upon waking I am often around 8mmol, an hour later when I sit down to breakfast I have shot up to around 16mmol. I feel like I am been set up to fail before the day even starts, it is very demotivating and I had basically given up trying to keep a good BG. These big swings in BG and also making me tired and grumpy. I know I need to get a handle on this now. I am trying a few thing to combat DP, for example, not eating after dinner or a small cheese snack at bedtime, and I have stated taking metformin. So far nothing has helped. I think my basal lantus dose is ok because my BG remains stable up to the point I start to wake. I am now trying a dose of fast-acting insulin as soon as I wake. My question is how much do I take? I currently take 2 unit for 10g carb, and I think 2 unit reduces my BG by 3mmol. DP puts my BG up by around 8 mmol, so I have tried 5 units up on waking. Does anyone have experience of manual dosing for DP? If you can offer any advice it would be appreciated.
Cheers and a happy New Year

 

[forge]

Is it slow release metformin if not then it is woth a try.

 

[Blackers183]

Are you having breakfast (low GI of course) when you get up?

 

[lcarter]

Hi Folks,
Over this last 6 months I have developed really nasty dawn phenomenon (DP); immediately upon waking I am often around 8mmol, an hour later when I sit down to breakfast I have shot up to around 16mmol. I feel like I am been set up to fail before the day even starts, it is very demotivating and I had basically given up trying to keep a good BG. These big swings in BG and also making me tired and grumpy. I know I need to get a handle on this now. I am trying a few thing to combat DP, for example, not eating after dinner or a small cheese snack at bedtime, and I have stated taking metformin. So far nothing has helped. I think my basal lantus dose is ok because my BG remains stable up to the point I start to wake. I am now trying a dose of fast-acting insulin as soon as I wake. My question is how much do I take? I currently take 2 unit for 10g carb, and I think 2 unit reduces my BG by 3mmol. DP puts my BG up by around 8 mmol, so I have tried 5 units up on waking. Does anyone have experience of manual dosing for DP? If you can offer any advice it would be appreciated.
Cheers and a happy New Year

Morning.

I am in a similar situation to you in regards to this. My bgs can go up 5-8mml in the morning- you are right it is demotivating. I spoke to my dsn about this too and I also don't eat after my tea at night and I wake up pretty normal. But before breakfast its shot up. I have to correct upon waking, I use my normal correction dose which is 1 unit brings me down 2mml. I then check it pre breakfast (either an omelette or weetabix) take my normal bolus for breakfast and a few hours after that my bgs are normal again.

I will not correct if I am active though (learnt that the hard way!) Otherwise I go too low.

Hope that helps. . Either way you have my empathy

 

[CarbsRok]

Hi Folks,
Over this last 6 months I have developed really nasty dawn phenomenon (DP); immediately upon waking I am often around 8mmol, an hour later when I sit down to breakfast I have shot up to around 16mmol. I feel like I am been set up to fail before the day even starts, it is very demotivating and I had basically given up trying to keep a good BG. These big swings in BG and also making me tired and grumpy. I know I need to get a handle on this now. I am trying a few thing to combat DP, for example, not eating after dinner or a small cheese snack at bedtime, and I have stated taking metformin. So far nothing has helped. I think my basal lantus dose is ok because my BG remains stable up to the point I start to wake. I am now trying a dose of fast-acting insulin as soon as I wake. My question is how much do I take? I currently take 2 unit for 10g carb, and I think 2 unit reduces my BG by 3mmol. DP puts my BG up by around 8 mmol, so I have tried 5 units up on waking. Does anyone have experience of manual dosing for DP? If you can offer any advice it would be appreciated.
Cheers and a happy New Year

Some people find using Insultard/Isophane/NPH (think that's all the names it has) works well as it has a very def peek to it. Other option is that you ask for a pump.

 

[noblehead]

Its a cause of frustration. I find this too if I get up late (as with this morning) or don't inject and eat upon waking.

 

[Flakey Bake]

Is it slow release metformin if not then it is woth a try.

No it is the bog standard metformin. I was originally prescribed it because was worried that insulin resistance was starting as my insulin:carb ratio had doubled. I will ask about changing to the Met SR. Thanks for the tip.

 

[Flakey Bake]

Are you having breakfast (low GI of course) when you get up?

Hi yes but usually about 30-40 mins after get up, by then the damage is done :-(
Breakfast is low GI, but still carbs, I try and moderate/low GI carb.

 

[Flakey Bake]

Some people find using Insultard/Isophane/NPH (think that's all the names it has) works well as it has a very def peek to it. Other option is that you ask for a pump.

Thanks CarbsRok. I will keep that in mind. I am going to do some intensive monitoring, carb free day night-time measures etc. next week once things have settled down after Christmas and go back to the DN with data. Then I can talk about insulin switching and pumps etc.
Thanks

 

[Flakey Bake]

Morning.

I am in a similar situation to you in regards to this. My bgs can go up 5-8mml in the morning- you are right it is demotivating. I spoke to my dsn about this too and I also don't eat after my tea at night and I wake up pretty normal. But before breakfast its shot up. I have to correct upon waking, I use my normal correction dose which is 1 unit brings me down 2mml. I then check it pre breakfast (either an omelette or weetabix) take my normal bolus for breakfast and a few hours after that my bgs are normal again.

I will not correct if I am active though (learnt that the hard way!) Otherwise I go too low.

Hope that helps. . Either way you have my empathy

Thanks Icarter, it does help. Unless the DN has a better solution I will try a routine similar to yours. I think, in the absence of a pump, that this is the only way to start the day with reasonable numbers. My main worry was what to do if active and the general rule of dosing prior to food. So thanks for replying, it has reassured me that I am not doing daft

 

[Flakey Bake]

I have found it depends on what I have fore my evening meal, chips, mash, bread will put my bg up before bed sometimes too high but it always comes down by dawn but if I have rice it works the other way round and can be a bit low before bed but I can guarantee it will be high by dawn.

No matter what I eat or what my BG is before bed I can guarantee by the time I eat breakfast I will be 16-18 mmol :-( It seems to be my morning default BG, darn it!

 

[lcarter]

Thanks Icarter, it does help. Unless the DN has a better solution I will try a routine similar to yours. I think, in the absence of a pump, that this is the only way to start the day with reasonable numbers. My main worry was what to do if active and the general rule of dosing prior to food. So thanks for replying, it has reassured me that I am not doing daft

Well for example today I woke with 16.8. I took my correction and two hours later I was 11.3. An hour after that I had weetabix and pre breakfast was 13.4 (this is what my dsn refers to as my dawn phenomenon it happens to me at about 7am you see) so I took the bolus for the breakfast and then corrected again. (3 hours after previous correction) two hours later im at 8.1 which is acceptable to me.

You are not alone!! Its a pain in the rear.

 

[noblehead]

No matter what I eat or what my BG is before bed I can guarantee by the time I eat breakfast I will be 16-18 mmol :-( It seems to be my morning default BG, darn it!

That is extreme, you should talk with your diabetes team about the possibilities of moving over to a pump.

 

[lcarter]

That is extreme, you should talk with your diabetes team about the possibilities of moving over to a pump.

Hmm see if my levels are good going to bed, they are good waking up. But mine can go as high as 5mml above what I wake up with. Deffo worth chatting to your dsn. Im on first name basis with mine now! Haha.

 

[smidge]

Not sure if this will help either of you @Flakey Bake and @lcarter, but I have to take my morning Apidra at least 30 - 40 minutes before breakfast or the insulin simply doesn't keep up and my BG rise and keep going. This morning, I forgot to take it early and didn't want to delay breakfast, so I jabbed my normal amount just before eating and my BG rose to 12+ so I had to take a correction. It seems that if my insulin is not working before breakfast it never really catches up.

The other thing is that I was having issues whereby my evening Levemir wasn't holding me steady overnight. At about 3ish my BG would start rising and just keep going so I was waking with BG at 14+. Once in that situation, the Apidra just seemed totally ineffective. I've now changed my evening basal to Insuman Basal which is an NPH. It has a very pronounced peak at about 5 - 6 hours. I'm finding that by taking it at 10pm, it peaks at about the right time to stop that early morning BG rise so I'm waking at about 5.5mmol. I then take my Apidra immediately and eat about 30 minutes later. The Apidra seems to do a good job if I start at a reasonable level and give it time to get working.

I do feel for you both because I've been going mad with it until the change of insulin in mid December. It's amazing the difference it makes to your outlook when you wake on a good level and manage to keep it there.

Smidge

 

[rosscortb]

Bottom line is that only way you can truly combat dawn phenomenon is on an insulin pump unless you want to wake up at a god earthly hour and give yourself a shot of basal.

 

[noblehead]

Hmm see if my levels are good going to bed, they are good waking up. But mine can go as high as 5mml above what I wake up with. Deffo worth chatting to your dsn. Im on first name basis with mine now! Haha.

The beauty of a pump is that you can set different basal rates for different times of the day, so you can deal with things like DP more easily than you can on MDI.

 

[Flakey Bake]

Thanks to everyone for there replies. After listening to you all I have a plan of action. I will try the early morning dose. If I cannot get sufficient control with that, I will speak to my consultant regarding change of insulin and possibly a pump. Happy New Year and thank you

 

[lcarter]

Not sure if this will help either of you @Flakey Bake and @lcarter, but I have to take my morning Apidra at least 30 - 40 minutes before breakfast or the insulin simply doesn't keep up and my BG rise and keep going. This morning, I forgot to take it early and didn't want to delay breakfast, so I jabbed my normal amount just before eating and my BG rose to 12+ so I had to take a correction. It seems that if my insulin is not working before breakfast it never really catches up.

The other thing is that I was having issues whereby my evening Levemir wasn't holding me steady overnight. At about 3ish my BG would start rising and just keep going so I was waking with BG at 14+. Once in that situation, the Apidra just seemed totally ineffective. I've now changed my evening basal to Insuman Basal which is an NPH. It has a very pronounced peak at about 5 - 6 hours. I'm finding that by taking it at 10pm, it peaks at about the right time to stop that early morning BG rise so I'm waking at about 5.5mmol. I then take my Apidra immediately and eat about 30 minutes later. The Apidra seems to do a good job if I start at a reasonable level and give it time to get working.

I do feel for you both because I've been going mad with it until the change of insulin in mid December. It's amazing the difference it makes to your outlook when you wake on a good level and manage to keep it there.

Smidge

Thanks for advice.

I have decided to combat my high levels by injecting a correction dose that I calculate based on how high they are. Today and yesterday it worked; its not ideal injecting as soon as I wake up but it is a plan that I have come up with after speaking to my consultant and dsn about. Im happy enough to do it but the minute it stops working I shall be darkening their door again!

@noblehead just an update you might be proud of..for the first time in a long time I have managed a 7.7 pre meal reading. Woooooo!

Good luck with correcting it @flakeybake.

 

[noblehead]

Thanks for advice.

I have decided to combat my high levels by injecting a correction dose that I calculate based on how high they are. Today and yesterday it worked; its not ideal injecting as soon as I wake up but it is a plan that I have come up with after speaking to my consultant and dsn about. Im happy enough to do it but the minute it stops working I shall be darkening their door again!

@noblehead just an update you might be proud of..for the first time in a long time I have managed a 7.7 pre meal reading. Woooooo!

Good luck with correcting it @flakeybake.

Great news, perseverance is paying off