Applenerd81
Well-Known Member
My sugars climb before I’d get the chance to even start! Even morning “bedroom” cardio has a tendency to cause
Sorry I said cardio, I meant to say exercise, something that gets your muscles going like weighted squats for example.
So you tried fasted cardio and it raises your blood sugar?
My sugars climb before I’d get the chance to even start! Even morning “bedroom” cardio has a tendency to causeblood sugar to climb!
What are you eating at what time between 8 hour prior to bed leading up to bed? This sounds more like it could be the culprit
My levels start to soar around 4-5am no matter what I’ve had to eat the day before. Insulin is the only way to deal with it.Nope, this is normal for a lot of type 1s. It is part of the dawn phenomenon, has nothing to do with what was eaten the night before. Your body dumps its glycogen stores at an accelerated rate to fuel you for physical activity, requiring more insulin.
Have only just started splitting doses this weekend (yesterday), so I am perhaps a little keen! Tresiba is stated to last up to 36 hrs however, that number is based on dosing of 0.4-0.6iu per KG bodyweight - which for me equates to around 32iu - 48iu per day, my basal needs are around 18-24 per day - so I'd doubt it would ever last thta long, plus im not keen on injecting so much insulin in one site.
For what it's worth, my opinion is to get a pump. I have had type 1 for 40 years and had dawn phenomenon from before it was given a name.
You can't treat Dawn phenomenon with long acting insulin. You can only treat it with short acting - that means waking up at 5 am (ish - depending on when your BG starts to rise) and throw in some fast acting. Or use a pump to automatically adjust your basal rate for you - my preference.
Long acting is intended to give a flat basal. Some people have a flat basal requirement and it works well for them - many don't and it doesn't.
If you increase your long acting (basal insulin) to the point where it is covering your peak insulin requirement (ie the dawn phenomenon) then for the rest of the 24 hr period your BGs are going to be falling as your basal insulin is in excess of requirements and you will either go hypo or have to take on carbs to cover it.
Get a pump. I speak from experience and not an insignificant amount of medical knowledge.
I have significant experience on and off a pump. I agree for many it is the most practical and, perhaps, only option to slay DP. However, there are ways to do it on MDI too, even using basal insulin. What you said applies to Tresiba - if working correctly, it provides a constant 24-hr dose and thus shouldn't in theory tackle DP. However, Levemir can be split to take a higher dose at night and less during the day, solving the problem of having to take basal at a higher dose and be stuck with it for 24 hours. It also has a slight peak which can be timed to coincide with when DP kicks in.
Yeh. I've not used the newer long acting and I guess they never give a perfectly flat basal but it's going to be pot luck to try and get the long acting peak to coincide with your dawn phenomenon at the correct dose. I guess if you're dead against pumping it's worth a try but it's not a logical or neat solution.
I find a pump gives a very clear insight into diurnal insulin requirements that can be very closely matched with CSII via a pymp throughout the day. Once correctly set up it gives infinitely more leeway and freedom with all other activities and meals vs injections. Alongside much better control, generally. I appreciate it might not be for everyone but if there is also a strong clinical indication for it (ie with Dawn phenomenon) then it is certainly worth considering. Not many change back to injections after trying a pump.
Yeh. I've not used the newer long acting and I guess they never give a perfectly flat basal but it's going to be pot luck to try and get the long acting peak to coincide with your dawn phenomenon at the correct dose. I guess if you're dead against pumping it's worth a try but it's not a logical or neat solution.
I find a pump gives a very clear insight into diurnal insulin requirements that can be very closely matched with CSII via a pymp throughout the day. Once correctly set up it gives infinitely more leeway and freedom with all other activities and meals vs injections. Alongside much better control, generally. I appreciate it might not be for everyone but if there is also a strong clinical indication for it (ie with Dawn phenomenon) then it is certainly worth considering. Not many change back to injections after trying a pump.
Well, I’ve shifted my Tresiba dose from morning to evening. I didn’t have DP this morning, or my usual late afternoon slump. I’ve had just the reverse... literally a 12 hour shift.
Woke up with a 6.3 at 8am, which rose to 7.1 in half an hour, so took my usual DP correction dose, and I’m back in the 6s again. Be interesting to see what happens this afternoon and whether I get the slump I’ve had until the other day, or the rise I had yesterday!That's really interesting, because I take my Tresiba in the evening, and yet I had my usual DP this morning to the tune of 15.6.
Don't you just love the human body.
That said, really glad it's working for you
I had a pump for 2 years, and whilst I agree it provides the best option for DP, it was also great to learn my basal pattern. However, I quit the pump for a number of reasons - I didn't like the constant reminder of my diabetes and the feeling of wearing a pump (had Cellnovo). I hated the set change/IC change process and inconvenience in the event of any kind of error. Felt surprisingly liberated when I switched back to MDI!For what it's worth, my opinion is to get a pump. I have had type 1 for 40 years and had dawn phenomenon from before it was given a name.
You can't treat Dawn phenomenon with long acting insulin. You can only treat it with short acting - that means waking up at 5 am (ish - depending on when your BG starts to rise) and throw in some fast acting. Or use a pump to automatically adjust your basal rate for you - my preference.
Long acting is intended to give a flat basal. Some people have a flat basal requirement and it works well for them - many don't and it doesn't.
If you increase your long acting (basal insulin) to the point where it is covering your peak insulin requirement (ie the dawn phenomenon) then for the rest of the 24 hr period your BGs are going to be falling as your basal insulin is in excess of requirements and you will either go hypo or have to take on carbs to cover it.
Get a pump. I speak from experience and not an insignificant amount of medical knowledge.
Some of us have to change back... and I have known at least 2 children to do so as well as 2 adults. This isnt via virtual forums, its real life people I have around me. Its not that rare...
There are definite ways to get over DP on mdi, its just having the courage to do something different to what the standard text book says that the consultants cannot advise you to do because its outside of their NICE guidelines and the instructions from manufacturers.
Its balancing when your peak needs for insulin are, when they wear off and knowing the timings for how the basal insulins peak (or not).
Yes, it takes faffing around... but I've been off Pump for 3 years and I had 5 great years before it all went wrong with my body and pump.
Do I miss it, 100% no. Would I go back to it? No, the CGM is a far better tool for me to manage my bloods by.
Yeh there's always the exception that proves the rule.Some of us have to change back... and I have known at least 2 children to do so as well as 2 adults. This isnt via virtual forums, its real life people I have around me. Its not that rare...
There are definite ways to get over DP on mdi, its just having the courage to do something different to what the standard text book says that the consultants cannot advise you to do because its outside of their NICE guidelines and the instructions from manufacturers.
Its balancing when your peak needs for insulin are, when they wear off and knowing the timings for how the basal insulins peak (or not).
Yes, it takes faffing around... but I've been off Pump for 3 years and I had 5 great years before it all went wrong with my body and pump.
Do I miss it, 100% no. Would I go back to it? No, the CGM is a far better tool for me to manage my bloods by.
Yeh there's always the exception that proves the rule.
I've never met anyone who's changed back except on these forums and I worked as a GP with special interest In diabetes and knew the lead consultant for Diabetes pump therapy in Liverpool that at the time was one of the few centres that offered the service and covered the West Midlands, Wales and most of the North Western HA's and he told me NOBODY had changed back from pump therapy.
Admittedly that was 5 years or so ago and I've been retired for the last 10, so I'm sure these mythical beasts exist but pretty rarely. Incidentally, I did say "not many' change back. I didn't say no one does.
From my experience with the dawn phenomenon, the only thing that resolved it was the pump. I've tried monotard, leo mixtard, ultratard, glargine in single bolus and split bolus. None of which coveted it and most of the time I ended up having to time my meals to coincide with the lows I got as a result.
Guess it depends how bad the DP is. Not sure why you're so against pumps - especially if it hasn't been tried
Yeh there's always the exception that proves the rule.
I've never met anyone who's changed back except on these forums and I worked as a GP with special interest In diabetes and knew the lead consultant for Diabetes pump therapy in Liverpool that at the time was one of the few centres that offered the service and covered the West Midlands, Wales and most of the North Western HA's and he told me NOBODY had changed back from pump therapy.
Admittedly that was 5 years or so ago and I've been retired for the last 10, so I'm sure these mythical beasts exist but pretty rarely. Incidentally, I did say "not many' change back. I didn't say no one does.
From my experience with the dawn phenomenon, the only thing that resolved it was the pump. I've tried monotard, leo mixtard, ultratard, glargine in single bolus and split bolus. None of which coveted it and most of the time I ended up having to time my meals to coincide with the lows I got as a result.
Guess it depends how bad the DP is. Not sure why you're so against pumps - especially if it hasn't been tried
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