Hyper's in the morning (dawn effect)

[marr_mite]

Hi all!

Brand new to the forum, my partner has T1 and I try help and support wherever possible, he has a hard time accepting he has it still. He's 24, had it since he was 16.

He struggles with high readings in the morning, he'll go to bed on around 6 but can wake up with high readings. This morning it was 22. The night time reading is settled (well over 2 hours since last meal etc), there are no carb heavy evening meals and no mid night snacking. I have a feeling it's the Dawn effect - has anyone here experienced this? Were your readings as high as 22? He takes his basal (lantus) of a morning, when does everyone take theirs?

Any help in resolving this would be much appreciated, it's incredibly distressing for him and I'd love to be able to help him out.

Thanks!
Andy

 

[azure]

Welcome @marr_mite

You sound like a great support to your partner

Has he tested during the night to see when the rise starts? It could be Dawn Phenomenon, or it could be his morning Lantus isn't lasting as long as he hopes. Has he tried changing the time of his Lantus injection or splitting it into two injections, one morning and one evening?

 

[donnellysdogs]

He needs to test during night to find out when his levels start rising.

I also have (had) horrible dawn and waking phenomen.

Now if I take tresiba at tea time, and starting tomorrow I will be taking insulatard in the morning to combat rises. Taking tresiba in evening is fantastic until 7am (was 4.30am if I took it in the morning)... it keeps my levels totally at 5 and doesnt shift now till 7.30am when it climbs horrendous.

It depends when the rises start... as to what needs to be done to fix the problems.

He really needs tondona couple nights testing every 2 hours.. say 12,2,4, 6,8 am one night and 1, 3,5,7 the next night....

Once it is established when rises occur then alternatives with insulin doses can be tried.

It depends what insulin he has and how often...

 

[TheBigNewt]

I don't think it's the dawn phenomenon that's always been sort of a fairy tale to me. Rising to 22 AM and going to bed normal means his basal doesn't last through the night. He might need to split the basal dose like people who use Levemir do. I agree checking it every hour or 2 during the night to see when the rise starts might be helpful.

 

[marr_mite]

Thank you everyone. We tried splitting it but that made things more unsettled. He used to take it in the evening but that made it tough because we weren't always home but I think that could be the problem. He's going to love the 3am alarm i set for him..!

I've been able to help with most things and together we can mainly get it under control but this morning thing is just impossible it seems.

 

[Felly]

It would appear to be caused by a lack of background insulin on a night. As others have suggested testing to discover when the rise is occurring would be the first step. You mention that splitting the dose made it more unstable. I would consult with your diabetic nurse specialist and try to look at it again. It may not be a straight 50:50 switch that is required and in the short term any change in medication is going to cause instabilities. It may be worth the short term pain if you can help yourselves in the long run.

 

[DiabeticDadUK]

As others have suggested, it sounds like his Lantus isn't lasting for long enough. I know if I took one Lantus in the morning it would absolutely be gone well before I wake the next day and I would wake up with a high. I would suggest he speaks to his specialist about it and they may reduce the morning Lantus and introduce an early evening Lantus, so two per day, one every 10-12 hours, to combat the night time increases. I use Lantus this way and it usually works out well for me but speak to the doc before changing anything

 

[donnellysdogs]

Theres lots of different variables with splitting basals. Like mentioned above it may be that he needs less at night and more in morning or vice versa...

If it is DP he may need to have a correction dose of bolus (without food) but until you (he) gets accurate timings for when rises occur then you havent got the basics to start making any changes or more importantly eatablishing what is happening.

This weekend has been a trial for me on my cgm to find out what injections / changes I need. From this it has been established that I need an insulatard injection as well as my tresiba insulin. I couldnt manage control with split levemir or lantus and even extra morning bolus arent good either.

Is partnerwitha hospital consultant? Any chance he coukd ask them to trial a Libre sensor? This then would give overnight patterns without waking to test?

 

[DaftThoughts]

It could be that Lantus is not the right insulin for him!

I'm on Toujeo (which, like Lantus is a glargine insulin), but it is designed to last 36 hours or so. You inject once every 24 hours to maintain good levels. It keeps me extremely stable, I don't really have night time hypos or wake up high on it, and it helps me curb dawn phenomenon in the mornings by making me start at the proper level. During the day I can go without food for 6+ hours and still remain at an almost fixed level now that I found my dosage, and I never need to split it.

A lot of people have made the switch from Lantus to Toujeo because it works better for them as they struggled with similar issues your partner does. It might be worth checking in with his healthcare team to see if Toujeo is an option for him. If it doesn't work out after a week or two, he can switch back to Lantus any time.

 

[AGUINALDO PARUSSOLO]

I have used 10 units of NPH insulin (here in Brazil we call like that) before going to bed; hyper's have decreased.

 

[jones_48]

If you think it's because his basal isnt lasting 24 hours, I found Tresiba to work well because it lasts over 24 hours - could be that he just needs to change insulin. I struggled with the dawn effect for a while, my blood would be 7 before bed and 20+ in the morning - so frustrating! My bloods would be steady until about 4am then shoot up. I used to inject at around 10pm and tried out 3 different basal insulins separately within a few months (Levemir, Insulatard, Tresiba) and continued to have the problem. I even tried splitting it half in the morning and half in the evening but it didn't help.

I have since started on an insulin pump and it's been the best decision as you can alter the basal rate given during the night. I finally wake up with a normal reading! I'm 25, diagnosed at 11 and based on my experiences can only suggest changing insulin or getting a pump. Does he see a consultant regarding his control?

 

[lucymain21]

Hi all!

Brand new to the forum, my partner has T1 and I try help and support wherever possible, he has a hard time accepting he has it still. He's 24, had it since he was 16.

He struggles with high readings in the morning, he'll go to bed on around 6 but can wake up with high readings. This morning it was 22. The night time reading is settled (well over 2 hours since last meal etc), there are no carb heavy evening meals and no mid night snacking. I have a feeling it's the Dawn effect - has anyone here experienced this? Were your readings as high as 22? He takes his basal (lantus) of a morning, when does everyone take theirs?

Any help in resolving this would be much appreciated, it's incredibly distressing for him and I'd love to be able to help him out.

Thanks!
Andy

Hey,

I, like your partner, have been suffering from the dawn effect for about five years now. I am 22 y/o and have had T1 for 18 years and the dawn effect seemed to come out of nowhere! I don't know if a lack of exercise is the reason (during my A-Levels I stopped being as active as I used to be, which was about 5 years ago, so it seems to correlate) but I've tried everything I can think of (within reason) to combat it. Mine happens after I eat breakfast, however, which makes me think your partner's problem may be something else, which I will explain now. Going to bed with a reading of 6 is great, but I know that some people go low in the night without waking up. If you go low in the night and do not wake up and, ergo, do not treat the hypo, this is when the liver kicks into action by releasing reserve glucose in order to combat that low and, consequently, you end up higher in the morning. All of this happens without you waking up and if you are tired a low may not necessarily wake you up. If your partner is also going low during the day, it is a sign that this is what's happening. So, this, along with your partner's natural dawn effect, could be the reason for his extreme morning highs. I suppose what I would suggest for your partner (from my own experience) is trying to test during the night (3am is usually a good time) or try eating a small amount of carbs before bed that will stop him from going low in the night.

I hope this helps and remember that this is just my interpretation from what I know and have experienced myself! Even if this doesn't help, I really hope you and your partner get to the bottom of this.

Lucy

 

[ec_bostock]

Hey marr_mite. I was also diagnosed at 16 and I'm 26 now! Maybe he should ask his Diabetes specialist about possibly changing his background insulin from lantus to levemir? It's two injections a day (pain I know!) but it gives you a bit more freedom. You take levemir once in a morning and once before bed. You can adjust the doses to suit you personally. Maybe he should check this out as it may help with his highs in a morning!