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Type 1 and Dawn phenomenon

A

Andy Moore

Newbie
Hi, I’ve been struggling with high blood readings in the mornings when i wake and my consultant says I have dawn phenomenon, and I’m finding it really very difficult to handle as readings using the LibreLink sensor can be anything up to 26 and having to take a huge injection when I wake in order to get the readings back to a normal range by lunchtime.

Has anyone got any advice or suggestions please?
 
I know I've been approved to get a pump to help deal with my DP - was however approved in November and I still haven't got it :( - with mine the libre def shows its level (or slightly dropping) til 3am at which point it starts to rise steeply. Mine really does take all morning to return to something normal - ie about 5-6 hours later
Maybe you could consider a pump and see if you can get approved for one to deal with it - 26 is very high - higher than mine goes.

I did at some point see suggestions about having low carbs snacks before bed to try and stop it but it didn't make a blind bit of difference for me.
 
Andy Moore said:
as readings using the LibreLink sensor can be anything up to 26
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Have you checked with a blood testing meter, I would be very skeptical about those figures from a libre…..?
Maybe incorrectly, I associate DP with T2 tendencies (aka insulin resistance). If this is the case for you you could try going on a lower carb diet....
 
i have suffered from dp since diagnosis 3 years ago ,i notice that my bloods start rising from about 3am what i do is wake at 3am and give a couple of units of insulin which seems to work for me and i wake on decent numbers .i went on a pump for this reason but unfortunately the pump wasnt for me and i went back to injections, i hope you find a solution .
 
Andy Moore said:
Hi, I’ve been struggling with high blood readings in the mornings when i wake and my consultant says I have dawn phenomenon, and I’m finding it really very difficult to handle as readings using the LibreLink sensor can be anything up to 26 and having to take a huge injection when I wake in order to get the readings back to a normal range by lunchtime.

Has anyone got any advice or suggestions please?
Click to expand...

Hi Andy,

Welcome to the forum.

What insulin/s are you prescribed?

& do you double check these high numbers using a BG meter too?
 
Hi @Andy Moore

My personal advice is to eat something upon rising try low carb though so an egg, plain yoghurt and do your bolus with food, the body is releasing glucose to get you on your feet so digesting food is sending the message to the liver that there is some incoming to help.
 
I give my insulin a head start in the morning: I usually wake at 6.30am, take 4.5 units of short-acting (Humalog) and 7 units of long-acting (Tresiba – I take 14 units total but I split dose, taking the other 7 at 10 pm). Important! I'm not recommending these doses for you or anyone else, this is just what I need. As you're a different human being with a different weight, height and metabolism, your insulin requirements are different to mine :).

I then shower, get dressed, put the radio on and empty the dishwasher, before putting breakfast on (an omelette – 2 eggs, 15g cheddar, 25g bell pepper. I also have a coffee with a tsp of 100% cocoa so very low carbohydrate). That means that I'm having breakfast just after 7 usually. Sometimes I still get a bit of dawn phenomenon but not always. These are my Libre readings for the past couple of weeks to give you an idea of what my levels run at with this method. Hope that helps!

Screen Shot 2020-06-12 at 11.21.59.png
 
Wayward Blood said:
I give my insulin a head start in the morning: I usually wake at 6.30am, take 4.5 units of short-acting (Humalog) and 7 units of long-acting (Tresiba – I take 14 units total but I split dose, taking the other 7 at 10 pm). Important! I'm not recommending these doses for you or anyone else, this is just what I need. As you're a different human being with a different weight, height and metabolism, your insulin requirements are different to mine :).

I then shower, get dressed, put the radio on and empty the dishwasher, before putting breakfast on (an omelette – 2 eggs, 15g cheddar, 25g bell pepper. I also have a coffee with a tsp of 100% cocoa so very low carbohydrate). That means that I'm having breakfast just after 7 usually. Sometimes I still get a bit of dawn phenomenon but not always. These are my Libre readings for the past couple of weeks to give you an idea of what my levels run at with this method. Hope that helps!

View attachment 42011
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Almost a straight line, wow!! x
 
It seems some people don't have an issue with DP, and they are very lucky. DP makes achieving and maintaining satisfactory control much more difficult.

Try using different insulins and timing shots so you get the required insulin action when you need it. One solution is to use bedtime injected basal insulin that peaks a few hours before you wake up, like NPH. When I had a similar problem I had NPH before bed and Lantus in the morning to cover basal needs. Worked well for many years.

I now find that any basal at night makes me go low. The DP effect seems to have disappeared. I inject both Lantus and Actrapid in the morning for basal. The Actrapid fills a basal insulin action gap before lunchtime. We all have different metabolisms and theprocess needs to start with basal testing. Having a Libre makes that easy. Where you can see there is not enough basal action to keep blood glucose in the target range, you need more basal action.
 
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MarkMunday said:
It seems some people don't have an issue with DP, and they are very lucky. DP makes achieving and maintaining satisfactory control much more difficult.

Try using different insulins and timing shots so you get the required insulin action when you need it. One solution is to use bedtime injected basal insulin that peaks a few hours before you wake up, like NPH. When I had a similar problem I had NPH before bed and Lantus in the morning to cover basal needs. Worked well for many years.

I now find that any basal at night makes me go low. The DP effect seems to have disappeared. I inject both Lantus and Actrapid in the morning for basal. The Actrapid fills a basal insulin action gap before lunchtime. We all have different metabolisms and theprocess needs to start with basal testing. Having a Libre makes that easy. Where you can see there is not enough basal action to keep blood glucose in the target range, you need more basal action.
Click to expand...
Have you tried using a different Basal insulin? I was on Lantus aged 14–28; for the last couple of years of it I noticed that its profile was anything but steady. Like you, I found it would drop me low at night, only to give me a big rebound when its effectiveness dipped a few hours later. I changed to Tresiba about five years ago, and it's been so much steadier.
 
I always inject 2 units of novorapid upon waking. I then monitor it through the morning and take some food if it looks like going low or skip breakfast if it doesn’t.
 
Hi @Andy Moore,
I have a similar problem, and have for a number of years. I am told the best thing to do is get put on a CGM and pump as this can then automatically administer insulin if necessary. I went through a stage of waking up every morning at 4am and injecting and then going back to sleep, which was not great! I have heard similar things about changing from Lantus (which I am currently on) to something like Tresiba which acts over longer periods of time. I am waiting for an appointment with my doctor to sort something out. Strangely enough, I find if I do exercise just before bed (like a quick 10min walk around the block) my numbers are better in the morning, even if when I go to bed they are the same as if I don't do exercise! Let me know if you do change your regime and how it affects DP... I would be interested to know!
 
Wayward Blood said:
Have you tried using a different Basal insulin? ....
Click to expand...
Tresiba in the morning, with action overlap from the previous day's dose in the morning, could work for me. But it is not funded here (New Zealand). Lantus and NPH are the only basal insulin options. Filling the gap with Actrapid, which is funded, works well enough. But I suspect there are a lot of long-time T1s with weak DP who are not able to get the control they want. :bored:
 
Well had the old DP this morn8ng blood sugars fine before bed woke at 2 for a pee( the joys of old age), bloods 5.2 , back to sleep woke at 6 bs 12.4 took 3 units by 9 o’clock bs back to 6.1 time for brekky. It’s a pain in the bum but time and a little bit of experiment on my part does seem to help. As I’ve said in other posts I tend to keep my bs between 5 and 9 gives me a little more breathing space instead of chasing bloods and over shooting so to speak, as we all know what works for one doesn’t for another ,
Take care stay safe
 
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