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Splitting Lantus to stop dawn phenomenon

Discussion in 'Type 1 Diabetes' started by AlanaPerrin, Dec 8, 2019.

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  1. AlanaPerrin

    AlanaPerrin · Active Member

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    Hello!
    I’m quite newly diagnosed and have been on insulin since August. I take Lantus twice a day and Fiasp for meals ... and am getting frustrated at the dawn phenomenon.
    I take Lantus before bed (not at an exact time) and when I wake up. On my Libre graph I can see I stay steady until I wake up, when it rises. I need an extra half or full unit with breakfast to avoid going out of range (8mmol). This morning I haven’t eaten breakfast at my usual time and I’ve gone up to 8.4 (with a steady rise arrow).
    Does anyone know if it would help to change the times I split my lantus, or if there’s anything else I can do?
    Thanks!
     
    #1 AlanaPerrin, Dec 8, 2019 at 7:26 AM
    Last edited: Dec 8, 2019
  2. kaylz91

    kaylz91 Type 1 · Well-Known Member

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    I'd talk to your team personally, it may just need a small dose adjustment
    xx
     
  3. AlanaPerrin

    AlanaPerrin · Active Member

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    Thanks. I’m seeing them this week but was just wondering if anyone else experienced this. I’m worried if I up my night dose I’ll be low overnight.
     
  4. EllieM

    EllieM Type 1 · Well-Known Member

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    I'd be very interested to hear what your team suggest. A couple of things that might work are

    1) long term, go on an insulin pump, then you can set it to increase your dose in time to correct the effect
    2) not a serious suggestion because you're probably better off with dawn phenomena - alcohol in the evening suppresses your liver's glucogen production in the morning (too busy processing the alcohol). Of course that also means that your liver isn't able to help you out of any dangerous night hypos.
    3) Just take a bit of extra insulin on waking.
     
  5. AlanaPerrin

    AlanaPerrin · Active Member

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    Thank you for replying
    I am hoping to discuss a pump with them, but not sure what the criteria are for the NHS to consider it as an option. I don’t drink, so number 2 isn’t likely to happen! And would you suggest a bit of extra fast acting or extra Lantus in the morning? My glucose starts rising as soon as I wake (probably fight or flight reaction from my young sons waking me every morning ) so I’m guessing fast acting? It’s all so new to me still!
     
  6. therower

    therower Type 1 · Well-Known Member

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    @AlanaPerrin . Welcome to the forum.
    Dawn phenomenon in most instances happens whilst asleep, usually around 2 to 4 a.m.
    You’re post as I read it is saying that your BS rises once you get out of bed. Is this correct?
    If it is then what you are actually having is what we call “ feet on the floor “.
    Basically once we get out of bed and start the day our body wants fuel. If we don’t provide this fuel via breakfast for instance then our liver decides to provide the fuel for us. Obviously we can’t control what our liver decides what to do and when, annoyingly.
    If your problem is feet on the floor then altering your lantus will have next to no affect. What you need to do is
    1. Provide bolus insulin ( Fiasp ) to counteract your liver dump if you are not eating breakfast. This is obviously difficult because you’ll have no idea how much insulin you’ll need to counteract the glucose release from the liver. Personally it’s only a small amount of insulin but everyone is different. Trial and error along with intensive monitoring is the only way.
    2. Probably slightly easier is to have breakfast on rising. Obviously this will require your bolus injection to match what you eat, like all other meals. By eating even a small breakfast you will stop your liver from becoming active and releasing glucose for you.
    As you are newly diagnosed it’s imperative at the moment that you talk to your diabetics team prior to making dosage changes.
    Good luck.
     
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  7. barrym

    barrym LADA · Well-Known Member

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    Good luck with this. I find it totally unpredictable. I can have a great waking BG, have a 10g carb breakfast, take accordingly and my BG rise to 10 over the next hour or two. Other times the same scenario works perfectly. So taking an anticipation dose is a high risk strategy. Sometimes it'll work others I have to catch a plummeting low.

    Makes me as angry as hell. I curse myself for not keeping bloods in range even though I know it's the phenomenon that is the cause.

    I have tried split dosing, a midnight snack, alcohol (still trying this one), all sorts. The only thing you can guarantee is the fact of will beat you ☹️.

    Maybe you'll have more luck.
     
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  8. AlanaPerrin

    AlanaPerrin · Active Member

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    Yes, that’s it. I didn’t realise there were two different names ... it’s definitely feet to the floor that I’m experiencing, and makes sense as the longer I leave it to have breakfast, the higher it rises and then comes back down. I tend to have breakfast about an hour after waking (have to sort my children out first), but I’ll try injecting for breakfast as soon as I wake and eating before them to see if it helps. There are so many adjustments to make since being diagnosed, and it’s not easy having a young family!
     
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  9. hyponilla

    hyponilla Type 1 · Well-Known Member

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    I have "feet on the floor" as well, and while it's annoying I feel lucky that the blood sugar rises after I get up rather than before because it's easier to work around. Here's what I do to fix it. I inject insulin as soon as I wake up and go to make breakfast. Every day I eat the same thing (eggs and cheese) and take the same insulin dose. I'm more insulin resistant in the morning, so I take twice as much as I do for other meals. On top of that I take an extra unit if I'm going to work that day. All that moving around drives my blood sugar up. This I figured out by trial and error, and your insulin needs would be different than mine. I mention it because the morning is such an extreme case for many people.

    Apart from the cream in my coffee, I don't have any carbs in the morning. It's way too unpredictable.

    I've taken three different types of basal insulin (one was split-dose lantus), and it's made no difference to the morning rise. My blood sugar will climb until I feed the liver. If I sleep in and miss the 7am feeding I usually wake up high, so I'm always up before 8am cooking omelette like a zombie. For me, breakfast is definitely the most important meal of the day.
     
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  10. AlanaPerrin

    AlanaPerrin · Active Member

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    That does sound frustrating. I’ve been having the same breakfast every day and have worked out the extra insulin I need to add to my ratio to stay in range. The problem has been if I don’t eat within a certain amount of time, I go out out range before I have a chance to counteract it. It’s mind-boggling!
     
  11. DunePlodder

    DunePlodder Type 1 · Well-Known Member

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    Hi. I'd second what others have said. You said you'd gone up to 8.4. Does it continue up?
     
  12. therower

    therower Type 1 · Well-Known Member

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    @AlanaPerrin . It’s a 24/7 condition add children who are 24/7 and it becomes very very challenging.
    It does and will get easier, certain things will become almost second nature in time.
    This forum can be a great source of information for you going forward. Things will change and evolve with your diabetes, usually there is someone here who has experience of these changes and can offer advice.
    Sometimes a little forward planning can be a godsend. You don’t want to be trying to eat a sit down breakfast whilst sorting the kids out in the morning. Something that you can hold in one hand and walk around with maybe. Have you considered making a smoothie the night before for instance. One of my fave breakfasts is a smoothie. Banana, peanut butter, avocado and milk all blended together and left overnight. No need to buy an expensive blender, a little hand blender does the job.
    In the morning just drink or spoon it from a cup or glass.
    Just a suggestion.:)
     
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  13. barrym

    barrym LADA · Well-Known Member

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    Kids? You have my total administration. I'm late onset so kids had flown before I got dealt these cards. So I've got all the time in the world to manage it and that's exactly what it takes.

    What will I be eating? What is my BG now? Should I do this, or not? Etc. It's full time and I'm still **** at it.

    A friend of one of my kids had been T1 since 17. She's 35ish now with 3 kids and is always getting told off by her DSN for poor management. The DSN is of course not a diabetic. She copes, sort of. What else can she do?

    Ah well, nearly time for Sunday roast, with very few potatoes, or carrots.

    Next post will be positive, honest.
     
  14. AlanaPerrin

    AlanaPerrin · Active Member

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    I’ve only once completely missed breakfast and it went up to about 9 then came back down. Like a little hill on my graph!
     
  15. AlanaPerrin

    AlanaPerrin · Active Member

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    Yup, I feel like I have SO MUCH going on right now. A three year old, five year old and I also work full time on top, with a week in five on call 24 hours. I know loads of people must do all this and manage fine, but there’s no warning of what’s to come!
     
  16. AlanaPerrin

    AlanaPerrin · Active Member

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    That’s a good plan. I’ve made some low carb granola which I’m hoping will be a quick breakfast ... but I’m still at the stage of weighing what I eat, so nothing is as quick as it could be! I like the sound of a smoothie though!
     
  17. AlanaPerrin

    AlanaPerrin · Active Member

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    Would you inject for eggs and cheese if you ate it for lunch? Or is the insulin because you know you rise in the morning? I’ve been sticking with exactly the same breakfast and the same dose, but this morning I tested my glucose a bit later than usual and noticed how much higher it had gone. I’ll have to start injecting as soon as I wake and eating earlier I think.
     
  18. therower

    therower Type 1 · Well-Known Member

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    Something else you will have to consider is that you may currently be in a honeymoon period with your diabetes. This in itself makes things very unpredictable and is something that needs to be considered when things don’t always follow a day to day pattern.
     
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  19. DunePlodder

    DunePlodder Type 1 · Well-Known Member

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    In that case I'd say don't worry too much especially as you are fairly newly diagnosed. You are obviously working hard at your control, which is great. It's easy to obsess about these things. Many people have mountains not hills on their graphs!
     
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  20. AlanaPerrin

    AlanaPerrin · Active Member

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    Oh yes I’ve had some mountains! Sometimes my ratio seems completely off, and other times it works. Such a frustrating condition. I admire people who have coped with it for years.
     
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