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Is there anyway to deal with intermittent dawn phenomenom?

Rokaab

Well-Known Member
Messages
2,257
Location
Reading
Type of diabetes
Type 1
Treatment type
Pump
So I seem to suffer from intermittent DP and am unsure how best to deal with it.
So the facts so far: about 75-80% of the time my sugar level suddenly starts rising at about 3am in the morning, by the time my alarm has gone off for work (about 6:25) my sugar levels will have gone up by anywhere between 5 and 12 - this morning I was 5-6 at 3am (according to the libre - and it had been level since midnight) when it started going up and by 6:25am ish when I got up it was 16ish - thanks Mr Liver!
Looking at the libre the amount it goes up doesn't seem to correlate with the number as it was at 3am - it can go up a lot whether it starts at 4 or whether it starts at 8-9.
However the other 20-25% of the time it seems to stay pretty level all night until I have breakfast.
Doesn't seem to make a difference whether its a weekday or weekend.

So yeah, anyone any clues as to how to deal with this without having to get up at 4am to check - on the grounds that I'm tired enough already when I get up (I don't think I sleep particularly well), if I get up at 4am I'll likely be a complete menace on the road at 7.10am due to tiredness (and the M4 is already bad enough without me being half asleep!)
 
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When you find out let me know. Have exactly the same problem. On bad days it will continue to rise all morning. Then other days it doesn’t rise at all.
I started to inject about 4am but had to stop because of hypo risk on the days it stays stubbornly the same. Right pain in the neck!
 
I know as a type2 on insulin that insulin can only do so much. Food is the key. Nibble on a fatty protein before bed. The fat will slow the digestion so by 3am the protein raise you just enough to stop the liver dump.
Ive done it hundred of times and my liver enzymes have reduced too. Win win situation. Now you just have to play around to get the right amount of fatty protein for you.
Test test test. Not in middle of the night thou. View your fbg as the result. Test on rising not after ablusions. Then test before food./breakfast.

Let me know how you get on.
You both may benefit from it. Hba1c loves it too!
 
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ickihun said:
Nibble on a fatty protein before bed. The fat will slow the digestion so by 3am the protein raise you just enough to stop the liver dump.
Click to expand...
Ok, and the stupid question for today: what counts as fatty proteins?
 
Rokaab said:
Ok, and the stupid question for today: what counts as fatty proteins?
Click to expand...
Nuts, cheese, bacon not naked, cream or mackerel. Not a meal worth just a small palm size for me but im obese with a big tum so maybe less for you types?
Far less tum since applying 'liver block'.
 
ickihun said:
Nuts, cheese, bacon not naked, cream or mackerel. Not a meal worth just a small palm size for me but im obese with a big tum so maybe less for you types?
Far less tum since applying 'liver block'.
Click to expand...
Thanks, I'll give it a try, I have a feeling I was snacking on peanuts last night anyways, but I seem to have the memory of a below average goldfish at times so I might be wrong
 
ickihun said:
Nuts, cheese, bacon not naked, cream or mackerel. Not a meal worth just a small palm size for me but im obese with a big tum so maybe less for you types?
Far less tum since applying 'liver block'.
Click to expand...
Well after trying this for a week or so, unfortunately it doesn't seem to make a blind bit of difference whether I have fatty proteins before I go to bed or not, my DP still often kicks in
 
Is there any link to type of evening meal the night before?
 
slip said:
Is there any link to type of evening meal the night before?
Click to expand...
I have found this is mostly the case for me.
IF
- I eat later (after 8:30pm)
- do very little exercise during the day (for me this is less than 3000 steps)
AND
- eat a carby meal such as large bowl of pasta with more than 100g carbs
THEN
- I wake we a high BG
I have also realised the correction dose for this high BG is less than when it is lower or at other times of the day. I worked this out after a few mid-morning hypos which only occur when correcting high morning BG.

If I exercise, eat earlier or eat less carbs, I am fine.

(*apologies for the format - I'm a software engineer so couldn't help it)
 
slip said:
Is there any link to type of evening meal the night before?
Click to expand...
Not that' I've noticed, I'll try and actually keep a record

helensaramay said:
If I exercise, eat earlier or eat less carbs, I am fine.
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I tend to stay pretty structured, dinner is normally at about 6pm, occasionally a bit later (like if I'm delayed by a docs appt or a quick drink after work) - only on very rare occasions do I ever eat my main meal after 8 (and that's normally a meal out with friends who can't get there early - but this is only a couple of times a year). I also tends to have roughly the same amount of carbs each time for dinner (60-70) with the occasional 80 (maybe once every 2 or 3 weeks).

helensaramay said:
(*apologies for the format - I'm a software engineer so couldn't help it)
Click to expand...
ELSE
- All good
You forgot the ELSE statement - yes I work in software dev too, If-Elses are useful
 
Have you done an overnight basal rate test with fasting from midday the day before?

(I am thinking that maybe you need a bit more basal overnight and a bit less insulin with the evening meal.)

I assume that your liver function test results are normal (don't trust your GP, look them up yourself).

Do you exercise a lot in the evening?
 
I think we need a DO LOOP in there somewhere .

What insulin regime are you on? what when and where + bolus ratios please.
 
ringi said:
Have you done an overnight basal rate test with fasting from midday the day before?

(I am thinking that maybe you need a bit more basal overnight and a bit less insulin with the evening meal.)
Click to expand...
I couldn't possibly fast from midday til the next morning, I would be eating the furniture around me - I'm one of those people that always seems to feel hungry - my stomach is currently growling me as we speak
However I did try increasing my basal at some point (on the diabetic clinics suggestion) and what this meant was that I was waking up very low (as in about the 2-3.5 mark for the whole 3-4 days I tried it) at which point I gave it up as a bad idea as I would rather not wake up in a hypo state (luckily my boss at the time was very understanding and didn't mind that I was late into work every day)

ringi said:
I assume that your liver function test results are normal (don't trust your GP, look them up yourself).
Click to expand...
If I knew which of the 5 billion results were the liver tests on my medical records web page I'm sure I could find out

ringi said:
Do you exercise a lot in the evening?
Click to expand...
Nope, I tend to play on my PC - MMO's take a lot of time
Though I have just got an exercise bike to try and do some exercise in the evening, not really started this yet though

slip said:
I think we need a DO LOOP in there somewhere .
Click to expand...
DO
-- swear at liver!
WHILE sugar level too high because of liver dump
That do

slip said:
What insulin regime are you on? what when and where + bolus ratios please.
Click to expand...
Novorapid -
Breakfast - about 15-20 mins before breakfast, carb ratio 1:5 + correction if liver dump - don't have more time than that in the morning before I have to leave for work (breakfast about 6:40am on weekdays, about 8:30-9:00am weekends) - note: gf cereal is very carb heavy and much as I'd love to have bacon and eggs I just don't have the time to cook*
Lunch - if sugar level is high then take Novorapid just before lunch, otherwise just after - cos about half the time it has this horrible tendancy to kick in before the food has taken effect, same carb ratio of about 1:5 (lunch at 12:30 mon-thurs, 1:30 on Friday (at the pub), about 1ish on sat,sun)
Dinner - see lunch (at about 6pm), slightly more carbs than breakfast and lunch
Before bed (10:30ish) - Lantus
Basal:bolus = between 30:70 and 25:75 (dependent on food intake and corrections) - I realise this is an odd ratio but as said on a previous attempt to up the basal did not go down well.

* also: due to various other issues I don't like using the cooker before I go out - I generally have to check at least 3 times that the cooker is turned off (and that's if I haven't used it) and even then I have doubts about whether it was actually off or not - and its a gas cooker.
 
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Rokaab said:
I couldn't possibly fast from midday til the next morning, I would be eating the furniture around me - I'm one of those people that always seems to feel hungry - my stomach is currently growling me as we speak
Click to expand...

I was like this until I cut out all sugar and high GI carbs (bread etc), now I can fast without a problem.
 
I have a similar intermittent dawn phenomenon as well. I usually take a unit of Novorapid before getting out of my pit in the morning, unless my BG is under five, and then I’ll take an extra unit with breakfast. Some mornings it’s a bit more - today I woke up with a 10.1 (I’m just starting Tresiba once a day after split dosing Lantus after ten plus years - my doctor said the units are usually equivalent, but to start on a couple less and build it up if needed) so injected three units. It’s coming down.

It would be so much easier if the dp was every day, wouldn’t it?
 
Going to come at this from a different angle...
It may not apply to you at all but have you ever tracked your sugars over your monthly cycle?!?
It is amazing how much the change in hormones during the month effects our sugar. I have only had my libre since September and there is a clear pattern for me that I would have never have understood pre libre. What I find personaly is the week before im due to start my period i become insulin resistant, most months this is over night as you describe and as im lucky enough to have a pump I then spend 7 days on 120% basal. This isnt always the case but mostly, i have had 1 cycle when i was resitant 24hrs and 1 when it was just during the day. I am sure this must happen to a lot of us.
Its interesting as the gradual rise during the night is exactly what I see, then when I check my diary its ' oh yes a week to go, lets up my basal! '. Day my period starts im back to normal basal and more sensitive to insulin again.
 
Oh yes! The week before it’s due, I’m a good 1.5-2mmol higher than the rest of the month. Libre showed me that too. I shove in an extra unit of basal that week, still experimenting.
 
Yep me too. I have a PMT basal regime to cope with that.
Other than that I go to bed with no active bolus on board (4 hours after eating) as the late night nibbling did make bgs unpredictable.
 
sninge said:
Going to come at this from a different angle...
It may not apply to you at all but have you ever tracked your sugars over your monthly cycle?!?.
Click to expand...

Well I don't think it is, mainly cos I've got the implant so haven't had a period in about 6 or 7 years (mine was never very regular anyways - it was somewhat unpredictable), also my DP seems to happen about 5 times a week no matter when said week is.
 
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Thanks for the comprehensive info, I too would love to have bacon and eggs for breakfast, unlike you I only have time issues and not cooker issues (theres got to be SOME story behind that!?)

You said you'd try and keep a record of food, hows that going? Did you have DP this morning? if so what was last nights 'tea'? Any lows/hypos yesterday?

Rokaab said:
DO
-- swear at liver!
WHILE sugar level too high because of liver dump
Click to expand...

Your coding is wrong, there's no meaningful action in the do statement that allows the program to drop out the loop...........
 
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