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Not sure what to do! Dawn phenomenon or end of honeymoon?!

asyarlk

Well-Known Member
Messages
155
Type of diabetes
Type 1
Treatment type
Insulin
Hi

I have been diabetic for 10 months now and most of the time I have had good control, a part from going to restaurants and when I was on holiday... Still learning to carb count accurately and to trust my instincts!

In general when I wake up, I've been between 5-6.5mmol. However, recently (3-4weeks) I've been waking up 7.5/8.5/9mmol which is very unusual for me. I am taking 2.5u straight away when I wake up and wait around 30 mins before eating, this seems to keep me around 7 after eating. But I can't understand the higher readings? Any ideas?

Some background:
I take 7 u of lantus in the morning - I tried 8 but was hypo-ing all day so went back to 7.
I curb my carbs if possible when at home and finish eating dinner around 7/8pm each evening. I take novorapid for meals.

Thanks in advance! Just want to sort this out as it messes me up for the whole day!!
 
Watching with nearest. I woke with a BG of 10 this morning and I'm not sure whether to correct it as half a unit of bolus without food might take me too low. I'm thinking of doing a bit of housework instead to see if the energy will help instead!
I'm not sure if I'm coming to the end of my honeymoon as well as you, I only have 3.5 units pm & 2 units am of basal and a 1:20 ratio of bolus. Hmmm!
So sorry I can't help but I'll be interested in following.
Just to throw a spanner in the works, I went to bed high but didn't correct as I'd had wine and the high is usually short lived and BG goes back to normal when I've had a drink. So even more wary due to the fact my body will be dealing with the alcohol today. Easier not to bother!
 
Hi asyarik

You will probably need to do some basal testing over a couple of nights to see if your evening meal ratio is right/overnight basal is right or if it is DP. My OH has DP from about 4am onwards. We have a CGM and can see it clearly kicking in each day around about that time.
 
I'd try 8U of Lantus again and see if that helps ... if you only did it once the hypo-ing the following day may have been the result of something else. If it turns out 7U is correct and you are peaking in the early AM then I don't think there's much you can do other than waking up to correct or getting a pump.
 
As an update, I tried 8u and didn't see much of a change. Moved onto 9u and numbers are slightly lower in the morning. However, I've been waking up a lot in the middle of the night and subsequently testing. I noticed that my results have been okay and in line with what I went to bed on. However, I went to see my DSN and she said that the reason I'm waking up is because I've been having hypos and when I test I've already missed them, if this is the case then 9u is too high. She thought that the reason I'm getting higher readings in the morning is because of these night time hypos and my body is rebounding and by lowering my lantus my results should improve. So I put my libre on and once again I woke up in the night. Libre read 2.3!!!! But blood said 6.5... Could I have missed the hypo ago as I know the libre is 5/10 mins out? Has this happened to anyone and would you recommend going back to 7u of lantus?

My other issue is that my numbers are now erratic throughout the day, could this be linked to mysterious hypos in the night? I can eat a no carb meal and still go up by a lot and I also find the tiniest piece of chocolate/sugar free jelly now sends me up which it did not before... That's why I thought maybe my lantus was too low originally as well.
Any thoughts?
 
Easiest way to find out is to set your alarm clock earlier than you'd normally wake-up, if you find your bg has dropped from your pre-bed reading then your DSN may be right.
 
I'd personally suspect a false libre reading in those circumstances.

Like noblehead said you will probably have to set your alarm for during the night/early morning and take a few readings. A couple of nights of testing will tell you if you are rebounding or DP is kicking in. Worth doing.

If you're blood glucose levels are shooting up in the first or second hour after eating it is most likely the timing/amount of novarapid you allow. Some people need insulin for non carb meals too.
 
Thank you for the advice. I haven't taken my lantus yet, would you recommend I keep it at 9 for today and do another Basel test in the night?
 
asyarlk said:
Thank you for the advice. I haven't taken my lantus yet, would you recommend I keep it at 9 for today and do another Basel test in the night?
Click to expand...


Do what your DSN has advised and test, test your bg levels at 2 & 4am for a couple of nights and see what readings you get, they say if your basal insulin is set at the right dose your fasting bg levels shouldn't fluctuate by more than 1.6mmol/l.
 
One point on the Libre. It (and all cgms) suffer compression lows, so if you lay on the sensor it would easily read 2.3 versus a blood of 6.5. I've never seen a Libre show such a large discrepancy. Your reaction does sound like end of honeymoon though.

Also try to avoid eating carbs in the evening. I've found they induce a DP in a crazy way.
 
Just to update, I went back to my DSN. She recommended taking my lantus at night time rather than the morning and go back to 7u. I have done this for a week and my levels are far better in the morning and no more night time hypos! However my sugars do continue to rise which I think is the dawn phenomenon but at least my numbers aren't too high before this happens!!
 
Has anyone tried Glumetza-ER (Metformin -extended Release) & noticed any difference on Fasting Blood Sugar ? I have T2.
 
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