How high is the dawn phenomenon ?

I take 12 units of tresiba with a snack every night but my bs often drops to alarm levels overnight then shots up to double figures by the morning. I'm not convinced that tresiba is slow enough for me.

jaywak said:

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 .

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I noticed the same thing with my morning levels after using a cgm. I moved my long acting from first thing in the morning to lunch time and it fixed the issue. I Still get a rise when I get out of bed but I stay in the green zone most mornings now.

RTI said:

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.

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Same here ....was on split dose and they suggested a third one hadn't I switched to the pump. Since then I will never go back. I couldn't get my HBA1C under 9 now it's 6.8 which I'm pretty happy with

jaywak said:

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 .

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Hi ,being type 1 for 40 years now, with a pump for 35 of those years , 2 years ago the DP started even with freestyle since 2017 , never had nor heard of DP before.
Anyway the pomp is easier to manage the DP , my pomp Basel is :
Segment u/hr
00:00 - 02:00 0.75
02:00- 06:00. 0.05
06:00 - 09:00. 1.80
09:00 - 13:00. 0.25
13:00. - 19:30. 0.60
19:30. - 24:00 0.85

15.80 units per 24 hrs I also have an insulin action of 5 hrs , so each bolus will work in my system for 5 hrs
Also an insulin to carb ratio that can be changed , mine is giving me less bolus at breakfast because my Basel is high then suddenly drops down ( normal with this dose ) so I don’t have the 10 am after breakfast drop down .
If I’m under 8.00 before going to bed 12. 30 pm I have a small, drink of milk , or juice 2 mouthfuls , and that stops the low
at 3am .

jaywak said:

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 .

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I’m not an expert on alcohol becuase I don’t drink it, but I do know that it lowers blood glucose. (that’s the main reason I don’t drink it; nearly fifty years ago at diagnosis I decided it would be yet another variable I didn’t want to have to deal with) So if you were having sugar free stuff then that might be why you were staying a bit lower then. I don’t know enough be able to relate it to the DP.

For the DP I can only tell you my own experiences. I find that if my BG is showing an upward trend on the graph on waking, a very tiny bolus dose can do the trick before injecting the carb balancing dose for breakfast. But I mean tiny: no more than 2 units. I also find that if I exercise straight after breakfast the BG usually climbs sky high, no matter what type of exercise. I ride a horse at random times of day, and I never know doing that whether I’m just going to have a lovely time using up energy and therefore carbs and have to guzzle fruit juice during the ride, or if I’m going to be a bit nervous or stressed (which is not unusual), and despite the vigorous exercise my BG goes sky high. I don’t know how much extra adrenaline might be pumping into your system on your walk, but as an experiment it might be worth changing the time of day of your walk and see If it makes a difference to your DP. I think of adrenaline as the crazy idiot leaping unpredictably from one end to the other of our carefully balanced seesaw. You can’t tell when it’s going to be there and when it isn’t.

EllieM said:

I thought tresiba was supposed to last 42 hours?

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I think the comparison was with Lantus which lasts less than 24 hours.
This is why I was advised to take it in the evening not in the morning so it doesn't "run out" at the same time as DP kicks in whilst I am asleep.

jaywak said:

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 .

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I do the same but set my libre alarm a little higher at 9.5 and take one or two units of bolus if it goes off during the dark hours. I also sometimes get the DP around 8am and take a couple of units of bolus to halt further increases. I then have a shower and take my breakfast dose of bolus at 8.30am and monitor my BG on my Libre until it drops to 6 and then eat breakfast, always a medium GI cereal. If my BS then begins to rise quickly I jump on my rowing machine and do 6 minutes (equivalent to 1 km) hard rowing which brings my BS down to a steady 5 to 8 until lunch. If its not raining (I live in the Scottish highlands on the west coast) I will go for a steady 2 mile walk instead of rowing, which also works for me.

I love this thread! It gives me hope and makes me feel that its not just me. DP is very hard to deal with, not only physically trying to keep it under control, but also mentally. I constantly feel like I'm failing. Lots of ideas here, tried most of them. Some days are good, some are not. The reasons between good and bad days are sometimes inexplicable, and definitely unpredictable.
Haven't tried a pump yet, think it might be my next move