Morning readings always higher than the evening ones

High morning Bg levels can be down to something called the Dawn Phenomenon.........here is a link to an explanation of the process :
viewtopic.php?f=15&t=7885&hilit=+dawn+phenomenon#p73438

Here is the information we regularly hand out to newly diagnosed Type 2's. Have a read, there may be things there which can help you.

Here is the advice we usually give to newly diagnosed type 2 diabetics.This forum doesn't always follow the recommended dietary advice, you have to work out what works for you as we are all different .

It's not just 'sugars' you need to avoid, diabetes is an inability to process glucose properly. Carbohydrate converts, in the body, to glucose. So it makes sense to reduce the amount of carbohydrate that you eat which includes sugars.

The main carbs to avoid or reduce are the complex or starchy carbohydrates such a bread, potatoes, pasta and rice also any flour based products. The starchy carbs all convert 100% to glucose in the body and raise the blood sugar levels significantly.

The way to find out how different foods affect you is to do regular daily testing and keep a food diary for a couple of weeks. If you test just before eating then two hours after eating you will see the effect of certain foods on your blood glucose levels.

Buy yourself a carb counter book (you can get these on-line) and you will be able to work out how much carbs you are eating, when you test, the reading two hours after should be roughly the same as the before eating reading, if it is then that meal was fine, if it isn’t then you need to check what you have eaten and think about reducing the portion size of carbs.

When you are buying products check the total carbohydrate content, this includes the sugar content. Do not just go by the amount of sugar on the packaging as this is misleading to a diabetic.

As for a tester, try asking the nurse/doctor and explain that you want to be proactive in managing your own diabetes and therefore need to test so that you can see just how foods affect your blood sugar levels. Hopefully this will work ! Sometimes they are not keen to give Type 2’s the strips on prescription, (in the UK) but you can but try !!

As a Type 2 the latest 2010 NICE guidelines for Bg levels are as follows:
Fasting (waking).......between 4 - 7 mmol/l.
2 hrs after meals......no more than 8.5 mmol/l.
If you are able to keep the post meal numbers lower, so much the better.

It also helps if you can do 30 minutes moderate exercise a day. It doesn't have to be strenuous.

Click to expand...

Ken ( and Sue..... )

Hiya,

I'm really struggling with high readings in the morning just now too. I've been seeing the dietician at my local clinic and we were talking about the dawn phenomenon yesterday. I've been keeping a food diary - surprising how much more attention you pay to what you're eating when you're writing it down - but I'm also increasing my night time insulin - not relevant to you I know with being T2.

Jenni

Hi Jenni

I have only recently moved on to an insulin pump having been a Type 1 on injections for the previous 22 years. In the last 2 to 3 years I had been suffering from the Dawn Phenomenon and would wake up almost every morning with BGs of 15 plus. Nothing (and I mean nothing) I did managed to alter this pattern - no matter what level i was at night, I would always be high in the morning. With the pump, however, which provides the ability to modify basal (ie background) rates, I feel I have almost overcome the problem - I usually have normal readings in the morning (ie BG 4 - 7) and anything over 10 is a definitie rarity. I have found that being on the pump has made me much more careful about what I eat too.

Richard

I've been having the same problem for 2-3 months now. It doesn't matter what I do or what my BG is before bedtime, when I wake up in the morning my BG is between 11 and 16, obviously not a good start to the day.

I went to see my GP about this, explained that it is causing me a problem because I am having to correct my BG every day by taking a larger dose of insulin in the morning, not eat until my BG has started to drop, test at least 4 or 5 times day and manage hypos accordingly.

My GP basically said that everything was ok because my last HbA1C test had been 6.9 and told me I was testing too much and that I should test once per day maximum :evil: ! I tried to explain that the reason the HbA1c was ok was because it probably only captured 2 or 3 weeks of the high morning readings and also because I was testing alot and correcting my BG.

The upshot being I had to literally plead for some more test strips and received no advice about the high morning readings! Basically the GP said, nothing we can do, we'll just check your HbA1C again in 6 months. I walked out the GPs scratching my head.

I guess I'm suffering from "the dawn phenomenom" but would appreciate some advice about how to get it sorted?

I'm T1 ( 26 years) by the way, on Humulin S, 3 or 4 jabs in the day and 1 jab of Insulatard before bed.

Hi Nugget

I'm sorry to hear you are now experiencing the same DP I had (although it does sound like you have very poor service from your GP). Don't listen to hogwash like you "should only test once a day" - maybe this could be applicable for a Type 2 but not for a Type 1.

If you haven't already, I would highly recommend you get the book "Using Insulin" by John Walsh (published 2003) which discusses things in detail and ways to counter the DP. The link to this book on Amazon is here:

amazon.co.uk/Using-Insulin-Everything-Need-Success/dp/1884804853/ref=sr_1_1?ie=UTF8&s=books&qid=1272458215&sr=8-1

I must say since coming on to the pump, I have subsequently realised how basically uncontrolled my diabetes was before the pump. I now count my carbs religiously and consequently am eating much smaller meals. I think this, in addition to the pump, has helped me control my BGs better.

Incidentally, I always had a good HbA1C too (6.0 at the last test) but this in no way reflected the highs and lows I was suffering.

Good luck!

Richard

RichardFromHampshire said:

Don't listen to hogwash like you "should only test once a day" - maybe this could be applicable for a Type 2 but not for a Type 1.

Click to expand...

I agree with the first half of this sentence and I am shocked that you should have been told not to test so much. :shock:

However, whilst I think it is 'critical' for T1s to be able to test freely I also think that it is very important for T2s who want to gain and maintain good control to be able to test freely.

Hi all,

Dawn Phenomenon is taking over my life at the moment. The latest advice I have been given is to not go to bed on a reading below 8.0 because of this.

I have been desperately trying to adhere to the new rules and have also increased my bedtime lantus to 25 from 23 on advice from clinic as lantus is stopping working too early. This did seem to be working -readings of 15/16 in the morning coming down to 8. Last night I went to sleep on 6.7 and woke up with 17.1! Although the night before last I went to sleep on 10.7 and woke up with 14.3...no rhyme nor reason. Last month I could go to sleep on 7.0 and wake up with 7.0.

Having read the bad press lantus gets on here and recognising some of the side effects people have reported I am keen to change, but I'm so frustrated with the high readings in the morning.

I don't know what the answer is for me - I know I am being considered to test a continuous glucose monitor for my clinic, but other than that I'm a bit stumped. I've been seeing a dietician to try and work things better with food and to look at control from that angle, but I'm just a bit all over the place just now!

Richard reading your comments is cementing my whole change of attitude towards the pump! I will be persevering though - what's the alternative?!

Jenni

If you go to bed on a bg below 7 when you go low in the night your liver will chuck out glucose as a response to this but doesent know when to stop hence the high morning bgs. I am a type 2 on insulin only so I too have to grovel to increase the script for strips but at the end of the day its my life my kidneys and my eyes etc so I just keep on pointing out that I really do need to test loads

RichardFromHampshire said:

Hi Nugget

I'm sorry to hear you are now experiencing the same DP I had (although it does sound like you have very poor service from your GP). Don't listen to hogwash like you "should only test once a day" - maybe this could be applicable for a Type 2 but not for a Type 1.

If you haven't already, I would highly recommend you get the book "Using Insulin" by John Walsh (published 2003) which discusses things in detail and ways to counter the DP. The link to this book on Amazon is here:

amazon.co.uk/Using-Insulin-Everything-Need-Success/dp/1884804853/ref=sr_1_1?ie=UTF8&s=books&qid=1272458215&sr=8-1

I must say since coming on to the pump, I have subsequently realised how basically uncontrolled my diabetes was before the pump. I now count my carbs religiously and consequently am eating much smaller meals. I think this, in addition to the pump, has helped me control my BGs better.

Incidentally, I always had a good HbA1C too (6.0 at the last test) but this in no way reflected the highs and lows I was suffering.

Good luck!

Richard

Click to expand...

Thanks for the reply. Bizarrely my morning blood sugars have returned to normal for over a week now.

I'm not complaining but sometimes I really don't understand whats going on with this diabetes lark even after nearly 27 years as T1! :?

davidwoods said:

Hi,

I have found that my morning readings on my Glucomen device are always higher in the morning than they are in the evening. For example this mornings reading was round about the fifteen mark, whereas this evening was 6.8. Now this lower reading is probably because I had very little to eat today.

I know I am probably answering my own question here, but could it be what I am eating for my evening meal that is so set to schew things in the morning. I thought that by eating around the six oclock mark would mean that in the morning things should have balanced out. I am thinking of keeping a food diary.

Dave W

Click to expand...

my readings are low in the morning and high at night, it will depend what you eat how much, you will find keeping a food diary is a good idea then you know what you are eating jean

I am a T1. Here is what works for me - do not eat after 8pm, ensure you take a morning dose of insulin 15 minutes before eating breakfast, after breakfast I do 15 min of exercises to stop getting a spike, and get a private GP and your own consultant.

Nugget said:

I've been having the same problem for 2-3 months now. It doesn't matter what I do or what my BG is before bedtime, when I wake up in the morning my BG is between 11 and 16, obviously not a good start to the day.

I went to see my GP about this, explained that it is causing me a problem because I am having to correct my BG every day by taking a larger dose of insulin in the morning, not eat until my BG has started to drop, test at least 4 or 5 times day and manage hypos accordingly.

My GP basically said that everything was ok because my last HbA1C test had been 6.9 and told me I was testing too much and that I should test once per day maximum :evil: ! I tried to explain that the reason the HbA1c was ok was because it probably only captured 2 or 3 weeks of the high morning readings and also because I was testing alot and correcting my BG.

The upshot being I had to literally plead for some more test strips and received no advice about the high morning readings! Basically the GP said, nothing we can do, we'll just check your HbA1C again in 6 months. I walked out the GPs scratching my head.

I guess I'm suffering from "the dawn phenomenom" but would appreciate some advice about how to get it sorted?

I'm T1 ( 26 years) by the way, on Humulin S, 3 or 4 jabs in the day and 1 jab of Insulatard before bed.

Click to expand...

It always shocks me when I hear how poor GP's understanding of Type 1 diabetes is. When I was diagnosed 35 years ago I was lucky that my GP sent me to the local hospital where I spent a week (I was very ill). My consultant (the wonderful Dr Mike Baxter) was a forward thinker and a great believer in patient self-management. I remained under his care until I moved from the area (when I made sure to transfer to the local hospital diabetic team) and have been lucky enough to remain under hospital care for my diabetes ever since. My current GP (supposed to be the practice diabetes "specialist") has a limited knowledge so my entire support is from my hospital diabetes team. My consultants have always, held the view that patients know their own condition far better than a doctor and have always been open to discussion about the best way forward. I was shocked when, after complaining about being treated as if I didn't know anything about my condition by Registrars, my consultant said that most patients apparently don't want to know and want to rely entirely on the doctor. That's just lazy and not helping yourself at all.

Because of my experience with my first consultant, I have always taken an active role in my consultations and questioned when I didn't understand something. I saw how poor my aunt's experience of GP diabetic care was and I would encourage any T1 diabetic with unanswered concerns to request referral to a hospital diabetic department. You may have to fight for it but you have every right if you have concerns that are not being met by your GP, particularly as they are NOT specialists in the condition. They may do some additional training but they are not up-to-date with current research, advice and trends. In this day & age of GPs with randomised appointments and reliance on telephone consultations, actually getting to see your diabetic specialist GP is hit or miss.

I experience the same 'dawn rise' phenomenon and my consultant and the specialist nurses have been brilliant with looking at how to deal with it. Ihave never been told "there's nothing more they can do" or that I'm testing too much. In fact, I've been encouraged to test regularly and that's what helped me bring my HbA1c down to a much better level (from 72 to 46 for the last 5 or 6 years). I'm currently on a new insulin after being on Levemir for years (which apparently is being discontinued next year). It's only once a day instead of twice but it seems to be helping, although I'm not there yet and the nurses continue to monitor my Libre2 readings (which I can't see a GP doing). Don't just accept what a GP can or can't tell you. Continue to question and request to see an actual diabetic specialist if your GP can't help you and you'll likely get a specialist Type 1 clinic. With far fewer T1s than T2s, you can guess where a GP's focus is going to be. If you do get referred you might end up with a registrar. They're not always as knowledgeable as the consultants so you can always express a desire to see the consultant. If you check before you're appointment and find they won't be there that day then change your appointment to when he or she is there. The only time I've seen a diabetic registrar was last summer after my consultant retired and he almost completely messed things up for me. Saw my consultant in Feb & he was able to put things right. Don't settle.!