Dawn Phenomenon

[IainB]

Hi all,
I was diagnosed as type 1 at the age of 5 and now at the grand old age of 71 I think I maybe suffering with the dreaded dawn phenomenon or foot on the floor thing.
When I wake my sensor reading is about 5 get up and move around and it shoots up to 10+
I have increased my Novorapid from 10 to 15 but by the time I have had breakfast my readings are up to 14-15 and a pain to get down. I am allowing 30 minutes between my insulin and breakfas.
Spoke to DNS briefly and she more or less told me to ignore it, have my normal insulin and don’t bolus until it’s above 17. The speed Novorapid works my readings would be 20+ by the time the insulin takes effec.
Any advice would be gratefully received
Iain

 

[SB2015]

Hi all,
I was diagnosed as type 1 at the age of 5 and now at the grand old age of 71 I think I maybe suffering with the dreaded dawn phenomenon or foot on the floor thing.
When I wake my sensor reading is about 5 get up and move around and it shoots up to 10+
I have increased my Novorapid from 10 to 15 but by the time I have had breakfast my readings are up to 14-15 and a pain to get down. I am allowing 30 minutes between my insulin and breakfas.
Spoke to DNS briefly and she more or less told me to ignore it, have my normal insulin and don’t bolus until it’s above 17. The speed Novorapid works my readings would be 20+ by the time the insulin takes effec.
Any advice would be gratefully received
Iain

Good morning Iain.
Have you considered a pump at all? I found that this helped where I was sticking to a routine, as I could set my basal to address the inevitable rise in the morning. This was fine when I was getting up at the same time each day, but I am now ‘of an age’ where life is a lot more variable, and if I fancy a lie in that is what I do. I am now using a closed loop and this, along with the pre bolus for breakfast, deals with the rise very effectively.
Another things that might be worth trying is to increase your pre-bolus time. I know that some need over 45 minutes. As always this needs to be done cautiously, but might be worth considering. Some others bolus for the DP and then wait for levels come below a specific level before eating their breakfast.
I hope that you find something that works for you.

 

[Inka]

@IainB I found that injecting a small amount of bolus (Novorapid) insulin as soon as I got up helped. I agree with @SB2015 that you might need a little longer time in advance of eating, eg injecting 40 mins before breakfast or whatever, but getting the right amount and timing of that initial waking up Novorapid should help a lot.

As you’ve had Type 1 so long, you might also want to look at your injection sites. They get ‘thickened’ even if you can’t see it and this can affect absorption.

 

[IainB]

Good morning Iain.
Have you considered a pump at all? I found that this helped where I was sticking to a routine, as I could set my basal to address the inevitable rise in the morning. This was fine when I was getting up at the same time each day, but I am now ‘of an age’ where life is a lot more variable, and if I fancy a lie in that is what I do. I am now using a closed loop and this, along with the pre bolus for breakfast, deals with the rise very effectively.
Another things that might be worth trying is to increase your pre-bolus time. I know that some need over 45 minutes. As always this needs to be done cautiously, but might be worth considering. Some others bolus for the DP and then wait for levels come below a specific level before eating their breakfast.
I hope that you find something that works for you.

I have considered a pump, mentioned it to DSN but no chance. Looked at paying for pump myself but you need support and unfortunately here in Wigan I don’t think that would be forthcoming ☹️
This morning I increased my Novorapid and waited until my readings started to come down then had breakfast, this seemed to work,
Thanks for your reply
Iain

 

[IainB]

@IainB I found that injecting a small amount of bolus (Novorapid) insulin as soon as I got up helped. I agree with @SB2015 that you might need a little longer time in advance of eating, eg injecting 40 mins before breakfast or whatever, but getting the right amount and timing of that initial waking up Novorapid should help a lot.

As you’ve had Type 1 so long, you might also want to look at your injection sites. They get ‘thickened’ even if you can’t see it and this can affect absorption.

Tried similar this morning, increased my Novorapid slightly and waited until readings started to drop then had breakfast. Seems to have worked, just need to monitor for possible hypo now. Makes me realise why an American consultant calls it “not so rapid” I waited 45 mins

 

[Inka]

Did you have a small amount of NR when you got up? I find that’s the key to smoothing the spike and avoiding later hypos. That small bit of NR can start working on the DP/FOTF and then your normal breakfast bolus is more effective.

 

[helli]

As always, great advice above.
I have one other thought : what basal insulin do you take and when do you take it?
This maybe a longshot but, if your basal is Lantus and you take it in the morning, it maybe running out at the same time as DP kicks in. I found Lantus only lasted about 22 hours for me so I took it in the evening and used Novo(not so)Rapid to fill the gap. Others split their Lantus.
This doesn't stop DP but it does reduce the combined affect causing the rise.

 

[rebrascora]

For me the key is injecting before I get out of bed because as soon as my feet hit the floor my levels are rising and Novo(not so)Rapid used to be struggling to get off the starting line whilst my glucose levels were racing ahead of it. I also inject 1.5-2 units to cover my Foot on the Floor syndrome (same as Dawn Phenomenon but waits until I get out of bed). I swapped to a faster insulin Fiasp although I typically still need 30-45 mins prebolus time even with that.... I needed about 75 mins prebolus timing with NR.
Like you I now inject and then watch my Libre and eat breakfast when I can see my insulin is working. If my levels are quite low like this morning when I woke on 4.3, I need less time but still about 30mins for my 5.5units of Fiasp to work. If my levels are 8 or above I need much longer and more insulin. Yesterday I woke on 8.3 and injected 9 units and I needed to wait 1hr 35mins before eating the same breakfast! I find it best to just keep a close eye on my Libre and eat when I get down into the 5s, however long that takes! I get a coffee and make my breakfast (yoghurt berries and seeds) as soon as I get up so that it is ready to eat when my Libre hits the 5s be that 20mins or an hour. I might be onto my second coffee by then though.
I do not advocate other people wait so long or let their levels get down into the 5s before eating because they might have a slower digestion than me, but this is what works for me and as you can see from those 2 examples, it can be VERY variable. I am lucky in that I am retired so have the time to delay my breakfast.

 

[IainB]

As always, great advice above.
I have one other thought : what basal insulin do you take and when do you take it?
This maybe a longshot but, if your basal is Lantus and you take it in the morning, it maybe running out at the same time as DP kicks in. I found Lantus only lasted about 22 hours for me so I took it in the evening and used Novo(not so)Rapid to fill the gap. Others split their Lantus.
This doesn't stop DP but it does reduce the combined affect causing the rise.

I take Lantus and inject in the evenings but I think it is quite well known now that it only lasts 20-22 hours

 

[IainB]

For me the key is injecting before I get out of bed because as soon as my feet hit the floor my levels are rising and Novo(not so)Rapid used to be racing ahead of it. I also inject 1.5-2 units to cover my Foot on the Floor syndrome (same as Dawn Phenomenon but waits until I get out of bed). I swapped to a faster insulin Fiasp although I typically still need 30-45 mins prebolus time even with that.... I needed about 75 mins prebolus timing with NR.
Like you I now inject and then watch my Libre and eat breakfast when I can see my insulin is working. If my levels are quite low like this morning when I woke on 4.3, I need less time but still about 30mins for my 5.5units of Fiasp to work. If my levels are 8 or above I need much longer and more insulin. Yesterday I woke on 8.3 and injected 9 units and I needed to wait 1hr 35mins before eating the same breakfast! I find it best to just keep a close eye on my Libre and eat when I get down into the 5s, however long that takes! I get a coffee and make my breakfast (yoghurt berries and seeds) as soon as I get up so that it is ready to eat when my Libre hits the 5s be that 20mins or an hour. I might be onto my second coffee by then though.
I do not advocate other people wait so long or let their levels get down into the 5s before eating because they might have a slower digestion than me, but this is what works for me and as you can see from those 2 examples, it can be VERY variable. I am lucky in that I am retired so have the time to delay my breakfast.

This morning I increased my not-so- rapid to 18, waited until my readings were down to 7ish then had breakfast. It seems to have worked ok as I have been in range all morning and no hypos.
One thing I have noticed lately is I have had to increase my not-so-rapid quite a bit and my carb to insulin ratio from 1:6 to 1:5. Not sure why maybe due to insulin resistance after using it for 64 years

 

[SB2015]

This morning I increased my not-so- rapid to 18, waited until my readings were down to 7ish then had breakfast. It seems to have worked ok as I have been in range all morning and no hypos.
One thing I have noticed lately is I have had to increase my not-so-rapid quite a bit and my carb to insulin ratio from 1:6 to 1:5. Not sure why maybe due to insulin resistance after using it for 64 years

Just another thought - Have you also changed your sensitivity factor for corrections? If there is increased insulin resistance it will apply to the corrections as well as the bolus.

 

[helli]

Just another thought - Have you also changed your sensitivity factor for corrections? If there is increased insulin resistance it will apply to the corrections as well as the bolus.

And basal 🙂

 

[eggyg]

This morning I increased my not-so- rapid to 18, waited until my readings were down to 7ish then had breakfast. It seems to have worked ok as I have been in range all morning and no hypos.
One thing I have noticed lately is I have had to increase my not-so-rapid quite a bit and my carb to insulin ratio from 1:6 to 1:5. Not sure why maybe due to insulin resistance after using it for 64 years

I am very insulin resistant on a morning and my morning ratio is 1:5ish, some days I take 6.5 units of NovoNotSoRapid for one slice of bread, as opposed to 1:10 even 1:15 the rest of the day. I sometimes have to wait an hour or even more for it to get to a number I like ( under 6 if possible) before eating. It is what it is but a blooming nuisance when I’m starving!