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Very high Dawn Phenomenon...

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Indy1282

Well-Known Member
Messages
60
So for the last week I have been getting really high Dawn Phenomenon. It's starting at around 2 - 3am and I'm going from around 7mmol right up to between 16 - 20mmol! I wake up at around 6ish and always correct it. I have the libre and I can see its happening like clockwork.

It's a big rise and I've never had DP before so I'm a bit puzzled and want to get it sorted. I take 12 units of Tresiba in the AM and that keeps me steady throughout the day.

Any ideas?
 
Could there be something wrong with the libre??? Seems unlikely but might be worth considering, perhaps? You could double check the results with a finger prick test.

Otherwise, no ideas I'm afraid. Your DM nurse is probably the next port of call.
 
Hi @Indy1282,
A puzzling situation indeed!
So going through a list of possibles:
Has Tresiba been out of fridge for too long, or partly deactivated for some other reason, e,g hot temperatures or partial freezing
Use of old injection sites leading to poor absorption
Leaking of some Tresiba out of your pen or via a cracked ampoule or leaking rubber plunger
Food: a large bedtime snack
Faulty cgm readings. I assume you have double checked these nocturnal readings with glucometer. as per @ sunspots
Hypo: an unnoticed hypo with resultant high bsls as measured
Stress: leading to increased release of stress hormones. But does seem a bit early for typical DP
Automonous release: of a hormone whose action opposes insulin action e.g. glucagon
Medication: prescribing and taking of a medication whose composition and timing might impact on nocturnal bsls.
Best Wishes on finding an answer and an easy solution!
 
sunspots said:
Could there be something wrong with the libre??? Seems unlikely but might be worth considering, perhaps? You could double check the results with a finger prick test.

Otherwise, no ideas I'm afraid. Your DM nurse is probably the next port of call.
Click to expand...

Have check libre with blood test and its correct. DSN is lovely but not much help - the answer is always take more insulin.
 

The Tresiba is fine. I have just changed from Abaseaglar but had DP when I was on that aswell. Not having any hypos in the night, not eating before bed and the cgm is correct as I have checked against my meter.

Not stressed and I dont take any other medication!
 
Sorry if I’m not of much help, but I was wondering if you spoke to your consultant about the limitations of Tresiba. While I think Tresiba is good, it’s one injection and no room for tweaking. If you take Levemir for example, its two injections and you can either tweak morning or night dose to help with night highs or morning highs.
 

Before Tresiba I used to split my dose and it didn't really help. I'll try eating a light low carb meal tonight and see if that helps, just incase it's a delayed food reaction.
 
@Indy1282 I am a little confused - your opening message talks about experiencing really high DP for the last week (which I think is the reason for some of the suggestions being insulin and/or Libre issues) and other comments you mention you have experienced DP on other basal insulin.

If you constantly experience extreme DP, have you thought about an insulin pump which will be able to adjust your basal to counteract the high demands in the early morning?
I have read other people suggesting they will not qualify for a pump because their Hb1AC is "too good". From personal experience, I know Hb1AC is not the only thing which is taken into consideration for pump qualification.
 

I don't constantly have DP. I have only just changed to Tresiba in the last couple of days and previously used Abaseaglar, i had DP on that also but only the past week - 10 days.

Since being diagnosed this is the only time I have experienced DP.
 
Have you done basal testing to check that your background insulin is working properly and there is a sufficient amount?
Or as you say the profile of food during the evening. I know if I eat something greasy with split dose novorapid, I still run slightly high into the night.
 
I am taking slightly less Tresiba as advised by my DSN so will tweak if needs be but as it's long lasting I need to give it at least 48hrs to settle before increasing it.

I did get it on my previous basal which was the correct dose.
 
First I'm wondering if your Tresiba is wearing off by early morning nowadays? I am a type 1. But the thing that has helped me the most is a pump. I have it set at a much higher rate starting at 5:30 am for a few hours, it's the only thing that really helped me control it. I know someone else who has a significant problem and on shots and he actually sets his alarm to wake up and give a shot of fast acting insulin so he doesn't go so high.And just a warning, the hormones that cause it also usually cause insulin resistance for a few hours following it.
 
Maybe consider a basal check for Tresiba. I too take Tresiba, and I was told by the consultant is to at least give it 3-4 days to settle. I tend to find Tresiba doesn’t quite reach 36hr mark. It didn’t help my high BG when I was running the monthly hormones. So I did corrections anyway. Maybe give your DSN a call to discuss it.
 
Must be that time of the year. I’ve been getting high DP the last 10 days too, have been pumping for 14 months and never had DP before this, except on rare occasions which I put down to overnight hypos (woke up with a bleeding headache)!!! The only thing I’ve changed is I’ve started exercising this last two weeks in the evening. Fairly strenuous workout before dinner, bgl good at dinner, good before bed, through the roof in the morning. Not hijacking your post but maybe you are burning up the carbs before bed and it’s reactive bgl. I know they say the bgl rises after exercise, thinking that’s maybe what’s happening on my end, the bgl is rising after workout and dinner then falling back into sync overnight????
 

I have just realised that I was on my period when it started going up - D'oh! It could well be related to that as my normal basal/bolus needs tend to increase around that time. Although i have never had DP when I've been on my period before... i guess wait it out and see if things settle in a few days.
 
Dawn phenomenon is often due to the blood glucose going too low before the rise starts. Have you checked for low values earlier in the night?
 
Tresiba really highlighted DP for me, I ended up setting an alarm for around 0330am and taking a couple of units to head it off at the pass - maybe try that? Now I have a pump, I have quite an increase in the basal rate at that time and it seems to have sorted it.
 
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