How high is the dawn phenomenon ?

[jaywak]

It's probably been happening to me for years but since using the Libre I noticed when and how high the dawn phenomonon takes me , it usually starts at about 4 am and when I test at about 6 am it's not unusual for me to get a reading over 10 , I then inject my 8 units of Trurapi and shower get dressed have my 20 g breakfast of toast and poached egg while I watch my bg go up to 13 - 14 , I then go for my usual 2 mile walk when it will still rise to even 15 , it then slowly drops and 2 hours later i'me in the normal zone , it's probably been doing this for years and I used to compensate the early morning highs with extra insulin and then fighting off the lows later on , with the finger pricks 6 - 10 times a day I never even noticed this was happening , I wondered if changing the timing of my Basel from morning to night might make a difference , I have increased the dose but that didn't make any difference , anyone gone through a similar experience any thought ideas would be much appreciated as it has started to get me down a bit .

 

[In Response]

My first suggestion is to check the 15 with a finger prick. Libre (and all other CGMs) are designed to be more accurate at "normal" levels and often over estimate highs.
A few approaches to dealing with the rise
- bolus for breakfast earlier. If your levels are returning to normal, then you don't need any more insulin you just need to match the peak of the insulin with the peak of the BG rise
- if your levels are not returning to normal, it is not uncommon to take an additional bolus to cater for the DP rise as soon as you get up
- I find my DP is far worse when I do not do any intensive exercise the previous day. I appreciate this is not possible for everyone but, the morning after a Spin class, I barely see a rise at all.

 

[LivingLightly]

- I find my DP is far worse when I do not do any intensive exercise the previous day. I appreciate this is not possible for everyone but, the morning after a Spin class, I barely see a rise at all.

I'm Type 2, but when Dawn is doing her phenomenal worst, exercise the previous day is the best possible antidote.

 

[jaywak]

Thanks for the replies I am pretty active most days I would say the very least a two mile walk which I do every morning and as much as ten miles during the day , the dp starts at around 3 - 4 am rising to at least 10 by 6 am when I usually inject and it slowly rises to maybe 13 by 7am when I've showered , dressed and then eat my 20 carb breakfast and then go for my 2 mile walk and it will slowly rise again to 15 or sometimes higher , you're right about the Libre in Response that 15 figure can sometimes be about 12 on a finger prick but obviously still too high , I really don't know what to do or should I just leave it alone as after 48 years of this I have had no diabetic problems and maybe since starting the Libre i'me getting a bit paranoid about it .

 

[Westley]

What basal are you on?
I think timing the doses can help a little with DP. Not much, because basals usually have a fairly flat peak compared to the speed of the dawn glucose rise, but with the shorter duration of Levemir I find taking my second dose just before bed can slightly reduce it compared to doing it earlier in the day.

Some people find eating even a very small amount of something non carby soon after waking can help stop the liver dumping glucose, as it realises the the body is being fed and it can calm down.

Also, if I was consistently going high at the same time like that and for that long I think I'd up the waking bolus dose even if it meant needing a mid morning snack to prevent lows later.

 

[jaywak]

My Basel is Semglee but recently changed back to Lantus due to a shortage , my night time Libre chart can be around 5 - 6 when I go to bed at 10 - 11 o clock and will stay there until 3 - 4 am when it starts to rise up to about 10 and rises obviously without me eating anything at that time of night and then rises more even though I have injected and peeks at about 10 am then will drop depending on what activity i'me doing ,this morning it dropped like a stone when I cut the grass and needed the jelly babies to stop the low , I think my liver must be wired up wrong and is dumping to much glucose into my system , it seems odd but it seems to be getting worse since I gave up alcohol 3 months ago .

 

[In Response]

@jaywak when do you take your Lantus?
I found it did not last the full 24 hours. I was able to cover this with extra fast acting insulin as I took my basal in the evening. But if you are taking it in the morning, you may be running out at a similar time to the Dawn Phenomenon which is exacerbating the rise.

With regard to exercise helping, for me, this is intensive exercise which really gets my heart pumping. If I just walk two miles, it will have no affect on my DP.

Finally, I do find exercising with a high BG (for me this is over 10) will push my BG higher as it is putting a strain on my body.

 

[jaywak]

I have an appointment on 1 st November at our diabetic clinic and will ask if there is a Basel that will last longer than the Lantus / Semglee that I am prescribed ," I think there is " I will have to see what they say .

 

[Zinadane]

I normally get DP, usually have my my first 2-3 units at my first wake 5am in order to keep levels flat. Then doze back off.
Bizarrely last couple of days though very little or no DP. Just starting a shallow rise now at 8.30 (no insulin taken) but will now take 12 units and then eat in 1/2 hour I reckon.
Nothing has really changed.
But just another example of how day to day, things can change just like the weather.
One I would say though. For me correct basal rate is crucial.

 

[In Response]

I have an appointment on 1 st November at our diabetic clinic and will ask if there is a Basel that will last longer than the Lantus / Semglee that I am prescribed ," I think there is " I will have to see what they say .

The other option is to split your Lantus/Semglee dose and take it both morning and night.
The downside is an extra jab but the added advantage is that you can adjust your morning and night doses if your needs vary at different times of the day which is common. Unfortunately, it will take some trial and learning to find out the best split for you.

 

[jaywak]

I think what I will try tonight is to give myself a couple of Basel units before I go to bed and then reduce tomorrows dose slightly and see how it goes , thanks for the advice .

 

[EllieM]

The other option is to split your Lantus/Semglee dose and take it both morning and night.
The downside is an extra jab but the added advantage is that you can adjust your morning and night doses if your needs vary at different times of the day which is common. Unfortunately, it will take some trial and learning to find out the best split for you.

I split my lantus for a number of reasons, including the fact that it may not last the full 24 hours. But am not convinced that changing the split makes that much difference to the amount of basal in your system at any time of the day other than 23 hours after a dose. Given it is flat over most of the 24 hours, you're going to have the total of the two doses in your system for most of the day, irrespective of how you split the dose. (Well, that's my logic anyway, I may be misunderstanding).

 

[jaywak]

I'me getting exited about trying the split to see how it works , it seems logical

 

[jaywak]

I went to bed at 10 - 30 last night and gave myself 4 units of Basel with a bg of 6 I woke this morning at 6 - 30 to see that my bg during the night had drifted between 6 -7 all night the dawn phenomenon then kicked in and took me up to 12 but quickly dropped down to the green zone , I gave myself half my bolus and had my brecky and i'me now looking at my Libre showing 8 . 5 , so far it's looking good , thanks for your advice .

 

[RTI]

Hi,

If you still read it. I had similar problems as yours.
I have tried everything from single Basal lantus, split Basal lantus,(improving a little bit) other Basal insulin. But finally switched to a pump. After some testing, try's (~2 month for obtaining the right basal-profile (pump inject every 5mn a small dose of insulin) I finally got my strong dawn effect perfecty under control.

I have never regretted since to switch to a pump. Improved Hba1c by ~20% and have only libre 2 andɓ one remote control for Bolus injection and predefined Basal.

 

[karen8967]

I always take a couple of units of bolus upon waking and this tends to stop the dp rising further till ihave my breakfast seems to work for me most of the time.

 

[jaywak]

I saw my consultant last week " himself a type 1 of 49 years " and he said he sets his Libre alarm to a high of 8 and if it wakes him during the night he gives himself 1 unit of bolus and it seems to sort out the DP , I have tried it all this week and so far so good .

 

[mmdrew75]

My Basel is Semglee but recently changed back to Lantus due to a shortage , my night time Libre chart can be around 5 - 6 when I go to bed at 10 - 11 o clock and will stay there until 3 - 4 am when it starts to rise up to about 10 and rises obviously without me eating anything at that time of night and then rises more even though I have injected and peeks at about 10 am then will drop depending on what activity i'me doing ,this morning it dropped like a stone when I cut the grass and needed the jelly babies to stop the low , I think my liver must be wired up wrong and is dumping to much glucose into my system , it seems odd but it seems to be getting worse since I gave up alcohol 3 months ago .

I used to take Lantus in the mornings and DP was getting me down. I was switched to Tresiba basal, which has a flatter profile and lasts 24 hours. I take it before bed and, whilst I do still get DP most mornings, it’s less severe and easier to manage. I have a couple of units of Novorapid when I wake, if my BG is higher than 6.0 and wait half an hour before having a low carb breakfast (Greek yoghurt, berries and low carb granola usually) with a second dose of bolus to match the carbs. Seems to work for me.

 

[EllieM]

I was switched to Tresiba basal, which has a flatter profile and lasts 24 hours

I thought tresiba was supposed to last 42 hours?

 

[mmdrew75]

I should have said it lasts ‘at least’ 24 hours. It can last longer but in reality, a daily dose provides a much more stable cover than Lantus used to. For me at least.