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Type 1: High morning blood sugar/ Dawn Phenomenon

Discussion in 'Type 1 Diabetes' started by paulpapa, Oct 29, 2016.

  1. paulpapa

    paulpapa Type 1 · Well-Known Member

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    Hi all,

    I've been struggling with high waking blood sugars which I've attributed to a Dawn Phenomenon (although a consult I saw was sceptical despite a months of Libre data showing it) that I see start to rise my sugars at around 3-4am. I was just wondering how other people deal with them?

    I also find that the number climbs a bit more once I'm up and out of bed. It's disheartening to wake up at 19.2, hungry and be unable to eat anything for a 3-4 hours until the number is a bit better.

    In terms of correction doses, the 1u to 2-3 mmol drop doesn't seem to work for me and I'm taking pretty large correction does of 9-10u most mornings. I know that people can be more insulin resistant in the morning and because of high blood sugar but it does seem like a lot of insulin.

    I've had my metformin prolonged release upped to 1mg twice a day - breakfast and dinner - and it seems to be helping my sugars in the day, but not so much in the morning. I've been having hypos after lunch so I'm trying to tweak that ratio - it was 2u for every 10g CHO but I'm now trying 1.5 per 10g CHO.

    I'm hopefully going on a pump either end of the year or early next year so I was also wondering how a pump can help control the Dawn Phenomenon if anyone is using one.

    Thanks,

    P
     
  2. GrantGam

    GrantGam Type 1 · Well-Known Member

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    I'd need roughly 6u bolus to correct that 19.2mmol/L and an extra 2u bolus to compensate for my rise in BG when I start moving around. So your bolus injections in the morning are actually about right.

    DP is extremely difficult to deal with and there is no easy answer. What basal insulin do you use and (if applicable) have you split the dose to take half the amount at 12 hours instead of the whole lot at 24 hours?

    With pumps, you can set different basal profiles, so for instance you could have your insulin increased between the hours of 3am and 10am as an example. I don't use a pump (although I hope to soon). There are many pump users on the forum who use the technology to offset their DP.
     
    #2 GrantGam, Oct 29, 2016 at 12:36 PM
    Last edited: Oct 29, 2016
  3. catapillar

    catapillar Type 1 · Well-Known Member

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    If you are waking up at 19, what are you going to bed at?

    A pump can help with DP because you set the basal rates by the half hour, so you can bespoke the basal rate so that at 3am (or whenever appropriate for you) it goes right up to fight the rise from DP and, hopefully, keep you flat like a basal rate should.
     
  4. paulpapa

    paulpapa Type 1 · Well-Known Member

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    @GrantGam1337 I split the Levermir twelve hours apart 35u and 35u at 8am and pm. It's just such a high jump when all I'm doing is sleeping.

    @catapillar I usually go to bed about 5-9, it just depends really. Trying to get the control tighter in the day as I know just how much it will unravel as I sleep. Wonderful news, I hope that they can work out the right rate for me once I'm on it. It's really driving me crazy.
     
  5. azure

    azure Type 1 · Expert

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    A pump should help a lot. I have both DP and a waking rise, and the pump,controls the DP perfectly. I have my basal set to increase over about 4 hours and I then wake with very good sugars. The waking rise I control best by not delaying breakfast or bolusing a tiny correction in anticipation of the rise.

    I don't know if this is appropriate for you, but have you tried correcting a little in the night?
     
  6. GrantGam

    GrantGam Type 1 · Well-Known Member

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    Although not practical in many senses, this night-time correction may be your only option until pump therapy
    @paulpapa.

    It may be worth changing your basal dosing times to 10pm and 10am. Levemir starts working about 5hrs post injection and although they claim it doesn't peak, it definitely does for me at around 8 hours after the injection. By taking your basal at 10pm, it may help put a wee dent in your BG in the early hours when it's hardest to control.
     
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  7. paulpapa

    paulpapa Type 1 · Well-Known Member

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    @azure I did try doing a 6u correction one morning at 3am and I woke up at the same value at 8am. Frustrating times.

    @GrantGam1337 I think that's a good idea. I was always sure that there was a peak to the basal so it might just help. At this stage, I'll try anything.

    @catapillar Sure is frustrating! yes, I know that a lot of the work is going to happen my end, and I've been doing a great deal already. I just want the extra support that I think they'll give me when I'm connected to something all day. I have that book on my iPad already. I'll give it another read so I'm ready for the pump.

    Thanks everyone!
     
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  8. Kristin251

    Kristin251 LADA · Expert

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    Paul, @azure and I both have found dosing in the morning and NOT eating I said worse than eating.
    I inadvertently fasted one morning trying to see when my insulin started dropping me so I could time my bolus right. Well after an entire days worth of injections between 8 am and 11 there was no drop and a slight rise. Then I ate and started dropping. Strange I know.
    It does sound a bit high for DP. What is your evening meal like? High in protein or fat? This can require split dosing. You could still be rising when you go to bed. How late do you eat? If I eat later than 6:30 I wake up with a higher fasting.

    I also agree to try taking your basal a little later. I moved mine from dinner to 10:15 and it made a big difference
     
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  9. paulpapa

    paulpapa Type 1 · Well-Known Member

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    Thank you. I usually eat between 6pm and 7pm, never terribly late if I can help it as I like to know where I am before bed. That's interesting.

    I had some curry last night - a ready meal - but the carbs in it were relatively low compared to what I know others eat at meals. I was then hungry and had some cereal three hours or so after but I bolused for. I'm pretty sure the cereal was that which screwed me over!

    I'm now having lows from my injection for lunch for today's 10u for 5CP. I think the ratio really needs tweaking. I'm pretty sure the bolus is out of my body by about 4 or 4 and half hours so I shouldn't have had any stacking from the morning's correction. I did the DAFNE course recently and ate breakfast every day on there and it was much lower. Maybe I'll try breakfast tomorrow regardless of the sugars and see if it helps me at all.

    @Kristin251, I"ll move my basal tonight to 10pm but I'm out and likely drinking so it's not going to be a fair test. Will try it anyway!

    Thank you all!
     
  10. Kristin251

    Kristin251 LADA · Expert

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    Actually, sometimes when I'm a tad higher than I like at bed I'll have a glass of wine or a bit if chilled vodka after I bolus my basal and all is well by morning so it might really help tonight!!!

    I seriously don't understand how not eating is worse but it is. I would stick to something lower carb for BF and have your carbs for lunch and dinner.
    Careful of hypos though
     
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  11. Kristin251

    Kristin251 LADA · Expert

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    I should have been more clear. When I say eat something I don't mean a full BF but just something to stop a dump like a hard boiled egg with or without mayo or half an avocado. Maybe a piece of deli meat and cheese but nothing to raise bs. I don't tolerate any carbs at BF and need to keep protein low and fat higher.
    It'll be interesting to see if moving your basal until 10 and having alcohol does anything miraculous!!! Enjoy your evening
     
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