Type 1 Is it Dawn Phenomenon?

MVSmith · Sep 18, 2019

Good morning all, I hope everyone is well? I'm new around here and this is only my second question to the forum....

I've been Type 1 for 17 years and to be honest I still haven't got this thing tied down well! So last night my BG was a nice 5.2, I was so happy thinking yes I'm in the green, but this morning's reading was not so great at 15.1!!! I can't seem to shake these high mornings and it's so frustrating! I went to the gym last night, well I do most evenings and do a mix of cardio and weights. I don't know guys, any tips or guidance as to how I can shake these morning highs off!

I take Novorapid in the day and one single injection of Lantus before bed.

Thank you all and have a great week

Muneeb · Sep 18, 2019

MVSmith said:
Good morning all, I hope everyone is well? I'm new around here and this is only my second question to the forum....

I've been Type 1 for 17 years and to be honest I still haven't got this thing tied down well! So last night my BG was a nice 5.2, I was so happy thinking yes I'm in the green, but this morning's reading was not so great at 15.1!!! I can't seem to shake these high mornings and it's so frustrating! I went to the gym last night, well I do most evenings and do a mix of cardio and weights. I don't know guys, any tips or guidance as to how I can shake these morning highs off!

I take Novorapid in the day and one single injection of Lantus before bed.

Thank you all and have a great week

To be honest without a CGM, its very difficult to pinpoint what is happening.

I tend to find dawn phenomena occurs when I have heavy meals for dinner, otherwise its relatively steady.
Other reasons may be, lantus dosage may be incorrect
Evening meal may have been high in fat/protein causing delayed absorption or release of glucose
(Its happen to me sometimes where even 3 hours after eating, its a tad low so I have a snack before bed, but it was actually on the rise, so wake up high)
Insulin could be off
The dosage for evening meal was incorrect (may need a split dosage)

What time do you have your last meal before bed? Also do you snack in-between?

himtoo · Sep 18, 2019

DP affected me for many years on MDI -- agree that checking during the night to see where the rise is taking place would be beneficial
I was never able to solve my DP on injections but my little trick was to take a small correction dose first thing in the morning

I have been on a pump for the last 4 years and I am able to avoid DP by increasing my basal rates on the pump in the hours between 3 and 5am to mitigate the rise.

EllieM · Sep 18, 2019

Look, cheese is my kryptonite. If I have more than a minute quantity in the evening I can guarantee a morning in the mid to high teens.

The obvious culprit is your basal - how confident are you that it is correct?

I am relatively insulin resistant and my dad is T2, I think I'd be prediabetic if not T1. Exercise reduces my insulin to carb ratio significantly and though dawn phenomena is still an issue (if I skip any cheese and drink alcohol it's non existent ) I don't think becoming an alcoholic is a real solution to DP.

My serious suggestions : set your night time alarm and get some night time figures, consider more exercise if you think insulin resistance might be an issue, get your clinic to at least lend you a cgm so you can check your night time readings. And yes, a pump might be the ultimate solution (I've considered it) but if you don't want to go there look at the other options first.

Good luck.

Fairygodmother · Sep 18, 2019

Hi @MVSmith, as you know there are quite a few reasons why your morning bs is high. One that hasn’t been mentioned is that it could be a liver dump after a nighttime low. Lantus has a peak about 4-6 hours after injecting so if it’s sending you low your liver will dump glucose to bing it up again. It often overdoes the dump.
Are you in the U.K.? If you are speak to your Consultant and see if you can be prescribed a libre to help you fix the problem.
Another possibility is splitting the Lantus, or moving to a different basal. I had horrid Lantus readings but Levemir’s proved much easier for my own levels to be managed.
We’re all different so the best people to help, who can look at all your records, are most probably your diabetes healthcare team.

Muneeb · Sep 18, 2019

Fairygodmother said:
Hi @MVSmith, as you know there are quite a few reasons why your morning bs is high. One that hasn’t been mentioned is that it could be a liver dump after a nighttime low. Lantus has a peak about 4-6 hours after injecting so if it’s sending you low your liver will dump glucose to bing it up again. It often overdoes the dump.
Are you in the U.K.? If you are speak to your Consultant and see if you can be prescribed a libre to help you fix the problem.
Another possibility is splitting the Lantus, or moving to a different basal. I had horrid Lantus readings but Levemir’s proved much easier for my own levels to be managed.
We’re all different so the best people to help, who can look at all your records, are most probably your diabetes healthcare team.

I'm not sure if liver dumps alone would raise glucose levels to mid teens?

MVSmith · Sep 18, 2019

Muneeb said:
To be honest without a CGM, its very difficult to pinpoint what is happening.

I tend to find dawn phenomena occurs when I have heavy meals for dinner, otherwise its relatively steady.
Other reasons may be, lantus dosage may be incorrect
Evening meal may have been high in fat/protein causing delayed absorption or release of glucose
(Its happen to me sometimes where even 3 hours after eating, its a tad low so I have a snack before bed, but it was actually on the rise, so wake up high)
Insulin could be off
The dosage for evening meal was incorrect (may need a split dosage)

What time do you have your last meal before bed? Also do you snack in-between?

Last night I ate at about 5.30 pm and it was nothing heavy, just a chicken breast with salad and I injected 8 units of Lantus just before bed at 11:15pm. I don't snack really in between either so I just don't know?

MVSmith · Sep 18, 2019

helensaramay said:
Sorry to read of your high mornings @MVSmith
There are few things which may be causing them and I think some night time readings will help to pinpoint the issue
- it could be your evening meal. High fat meals can delay carb absorption until we are asleep. For me, this is things like a bowl of pasta with a creamy sauce, curry or the dreaded pizza. If this was the cause, BG is likely to rise after a few hours and then stay high during the night
- it could be DP. If this was the cause, BG would stay low through most of the night and start rising inn the early morning
- it could be you do not have enough basal. This would show as a constant rise ... unless you take your daily basal in the morning and it is running out in the night.

My recommendation would be either to fund a Libre to see what is happening through the night or set an alarm in the middle of the night and take a finger prick reading.

Once you have a better idea of your BG pattern through the night, you can get down to working out the cause.

Thank you

MVSmith · Sep 18, 2019

Fairygodmother said:
Hi @MVSmith, as you know there are quite a few reasons why your morning bs is high. One that hasn’t been mentioned is that it could be a liver dump after a nighttime low. Lantus has a peak about 4-6 hours after injecting so if it’s sending you low your liver will dump glucose to bing it up again. It often overdoes the dump.
Are you in the U.K.? If you are speak to your Consultant and see if you can be prescribed a libre to help you fix the problem.
Another possibility is splitting the Lantus, or moving to a different basal. I had horrid Lantus readings but Levemir’s proved much easier for my own levels to be managed.
We’re all different so the best people to help, who can look at all your records, are most probably your diabetes healthcare team.

Yeah I'm in good ol' blighty. Thank you so much I shall enquire

Muneeb · Sep 18, 2019

MVSmith said:
Last night I ate at about 5.30 pm and it was nothing heavy, just a chicken breast with salad and I injected 8 units of Lantus just before bed at 11:15pm. I don't snack really in between either so I just don't know? View attachment 35727

That looks delicious, making me hungry I must say. From 5:30 to 11:30 novorapid has probably stopped working, and if there was a rise from protein you would most likely see that happening before bed. From the amount of protein you had there, it seems unlikely that it would be the sole cause of the high.

I would suggest carrying out a basal fasting test, as it sounds like your lantus may be too low. It could be that you are getting ill, but if its been happening for a while probably not, however either way (illness or not) you probably need at least a temporary increase in Lantus to counteract this.

As suggested above, lantus isn't the greatest basal, but works pretty well for me. I currently use it but have asked to be switched to tresiba.

novorapidboi26 · Sep 18, 2019

To confirm DP you really need to do a 3 am reading.....with a pre bed and waking one too....

if you went to the gym thought there is a chance you may have dropped down lower overnight and then the rise you seen was the livers response to that low....

Type 1 Is it Dawn Phenomenon?

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