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Early insulin to reduce dawn phenomenon

I used to have really bad DP. My DS changed me over drom Lantus to Tressiba. It lasts longer and is peakless.
I take the Tressiba at 2pm every day (Just 1 shot a day) and i wake up between 4 to 7 now. When i do wake up, The first thing i now do is eat 4 almonds and take 3 units of fast acting. This way I stay under 7.7 (my highest BG target)

I am finding that my Humalog is taking about 30 mins to start working so now its all about timing too. if Im closer to 7, i wait the 30 mins before eating or even having a coffee so avoid a spike.

I heard that a much faster acting insulin is coming out soon. Anyone know about that?
 
I thought I would give you a wee update.
I have gradually been increasing my early morning dose and have found a shot of 7 or 8 unit of novorapid as soon as a wake, followed by my pre-breakfast bolus seems to have done the trick. For the first time in months I have managed to get a 2 hour post brekkie read of 7-9mmol and 5.2 before lunch. Text book! Feeling so good! I have found that if I can get a good reading before bed and do the early morning shot, the rest of the day seems to drop into place, so long as I don't eat too much ****. So thank you all for the advice. The worry I have is the amount of insulin I need, I'm up to 80-90 units a day arghhhh.
 
Flakey Bake said:
I thought I would give you a wee update.
I have gradually been increasing my early morning dose and have found a shot of 7 or 8 unit of novorapid as soon as a wake, followed by my pre-breakfast bolus seems to have done the trick. For the first time in months I have managed to get a 2 hour post brekkie read of 7-9mmol and 5.2 before lunch. Text book! Feeling so good! I have found that if I can get a good reading before bed and do the early morning shot, the rest of the day seems to drop into place, so long as I don't eat too much ****. So thank you all for the advice. The worry I have is the amount of insulin I need, I'm up to 80-90 units a day arghhhh.
Click to expand...

That's a lot of insulin, wonder if you also have some insulin resistance going on, you might want to discuss with your gp/consultant about taking the drug Metformin to help with this.
 
What are people's average daily insulin needs??
 
Flakey Bake said:
I thought I would give you a wee update.
I have gradually been increasing my early morning dose and have found a shot of 7 or 8 unit of novorapid as soon as a wake, followed by my pre-breakfast bolus seems to have done the trick. For the first time in months I have managed to get a 2 hour post brekkie read of 7-9mmol and 5.2 before lunch. Text book! Feeling so good! I have found that if I can get a good reading before bed and do the early morning shot, the rest of the day seems to drop into place, so long as I don't eat too much ****. So thank you all for the advice. The worry I have is the amount of insulin I need, I'm up to 80-90 units a day arghhhh.
Click to expand...

Hi, although i am on much smaller amounts of insulin (under 20 units) this sort of thing is what i have done. When first Type one i found 13 blood glucose on waking too high (though my consultant then - it was a very long time ago!! - thought that ok and told me many of his patients woke with blood glucose at 18 - not really an answer!) . I sort of sorted it with a 'for no CHO" bolus on waking, and waiting to eat or, more usually, having no breakfast at all other than the pure bran virtually no CHO crisp breads that were available then with peanut butter on. Later i worked out that a fairly low CHO and low protein evening meal helped. But all sorts of things could confuse, like any exercise the previous day, stress, minor illness, hormones - i was never textbook, no two days were - or are now - ever quite the same.
The pump, in my experience, is very useful, but does not really solve this entirely. Yes, i can - and do - increase my base rate as morning approaches, but it is very risky to increase it much, as things always change. An increase can work very well one day, or several days, then you wake at 10 . Or more, Or go low. So i now marginally increase the basal for 3 hours before waking, and accept i will be between 8 and 11 when i get up. I then have a estimated bolus 'for no CHO' on waking along with whatever correction dose is needed, and add some insulin to cover CHO for breakfast also. If i did wake at 10 plus i just have no breakfast and no breakfast bolus, or just a 10CHO breakfast with a 10 CHO bolus. But i still test more in the morning, as i have to hypo avoid now - after 35 plus years of Type one i cannot tolerate even minor hypos as i once could.
One final thought - you mention this has happened over the last 6 months. Are you a new type one? If so, that might be expected, if not, are you under more stress, or have you recently gained a bit of weight? My own experience is that the heavier i am - even a single kg gain makes a big difference - the more difficult it is to estimate/sort the DP. Hope your current regime continues working well.
 
ann34+ said:
Hi, although i am on much smaller amounts of insulin (under 20 units) this sort of thing is what i have done. When first Type one i found 13 blood glucose on waking too high (though my consultant then - it was a very long time ago!! - thought that ok and told me many of his patients woke with blood glucose at 18 - not really an answer!) . I sort of sorted it with a 'for no CHO" bolus on waking, and waiting to eat or, more usually, having no breakfast at all other than the pure bran virtually no CHO crisp breads that were available then with peanut butter on. Later i worked out that a fairly low CHO and low protein evening meal helped. But all sorts of things could confuse, like any exercise the previous day, stress, minor illness, hormones - i was never textbook, no two days were - or are now - ever quite the same.
The pump, in my experience, is very useful, but does not really solve this entirely. Yes, i can - and do - increase my base rate as morning approaches, but it is very risky to increase it much, as things always change. An increase can work very well one day, or several days, then you wake at 10 . Or more, Or go low. So i now marginally increase the basal for 3 hours before waking, and accept i will be between 8 and 11 when i get up. I then have a estimated bolus 'for no CHO' on waking along with whatever correction dose is needed, and add some insulin to cover CHO for breakfast also. If i did wake at 10 plus i just have no breakfast and no breakfast bolus, or just a 10CHO breakfast with a 10 CHO bolus. But i still test more in the morning, as i have to hypo avoid now - after 35 plus years of Type one i cannot tolerate even minor hypos as i once could.
One final thought - you mention this has happened over the last 6 months. Are you a new type one? If so, that might be expected, if not, are you under more stress, or have you recently gained a bit of weight? My own experience is that the heavier i am - even a single kg gain makes a big difference - the more difficult it is to estimate/sort the DP. Hope your current regime continues working well.
Click to expand...
Hi Ann,
Thanks for sharing your experience. Dosing is a lot of guess work, but I am beginning to get a feel for it now. The answers to your questions are. Yes I am a relatively new type 1. I have slow onset type 1 (originally mis-diagnosed for 2 years as type 2). I have been diagnosed with diabetes for about 4 years in total and I think some of the rise in insulin requirements are due to the end of a prolonged honeymoon. And yes, you are also correct, the rest of the insulin requirement increase is probably due to weight gain (mostly my own fault). I have always been overweight, and gained weight far too easily. The only time I have been a healthy weight was just prior to my diagnosis. I thought my dieting was finally working :-(, instead it was the start of diabetes. I am trying to get a handle on this now. I don't want to do the ultra low carbing, I don't think it would be sustainable for my lifestyle. instead I am trying to up my exercise and carb-moderate. Even managing to keep a steady weight would be a big improvement for me.
 
noblehead said:
That's a lot of insulin, wonder if you also have some insulin resistance going on, you might want to discuss with your gp/consultant about taking the drug Metformin to help with this.
Click to expand...
Hi noblehead. I am fairly certain there is insulin resistance. I was diagnosed with poly cystic ovarian syndrome 20 years ago, which I am sure you are aware it linked with insulin resistance, weight gain and other fun things. I have just started taking metformin (again), though it is the bog standard version and does not appear to have helped any. Someone suggested the slow release metformin might be a better option as it might help with the dawn rise. I will see my consultant again in a couple of months and will ask if there is other medical options available (besides weight loss/exercise etc, which I am doing anyway).
Ta
 
Flakey Bake said:
Hi noblehead. I am fairly certain there is insulin resistance. I was diagnosed with poly cystic ovarian syndrome 20 years ago, which I am sure you are aware it linked with insulin resistance, weight gain and other fun things. I have just started taking metformin (again), though it is the bog standard version and does not appear to have helped any. Someone suggested the slow release metformin might be a better option as it might help with the dawn rise. I will see my consultant again in a couple of months and will ask if there is other medical options available (besides weight loss/exercise etc, which I am doing anyway).
Ta
Click to expand...

Thanks for the reply Flakey Bake. Y

es your consultant is the best person to offer advise, perhaps the slow release Metformin may be a better option, good luck anyway and hope it all works out well.
 
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