Dawn Rise

[Red6]

Hi everyone!
I need help…for around 3 months now I’ve been on tresiba long acting (changed from levemir) and every morning I’ve woken up with sugars of late twenties. I’ve tried to speak to my nurses several times and all they do is keep increasing the dose which isn’t helping. I’m considering self funding a pump at this point because my symptoms of high sugars are getting worse by the day. Has anyone self funded the pump?

 

[Inka]

@Red6 Did Levemir work better for you? If so, have you asked to change back? Not all insulins suit every person.

Have you looked to see if you’d be entitled to a pump on the NHS? Although you could fund one, I believe you’d still need the approval of a specialist.

 

[barrym]

I think a little more detail about you, your lifestyle, diet etc might help. There are plenty of anecdotal posts here about mitigating the dawn phenomenon and I'm sure you'll get good advice.

 

[Pumper_Sue]

Hi everyone!
I need help…for around 3 months now I’ve been on tresiba long acting (changed from levemir) and every morning I’ve woken up with sugars of late twenties. I’ve tried to speak to my nurses several times and all they do is keep increasing the dose which isn’t helping. I’m considering self funding a pump at this point because my symptoms of high sugars are getting worse by the day. Has anyone self funded the pump?

If you were better off on Levemir, go back to it.

You wont be able to self fund a pump unless you have the support of a consultant as they are prescription items.
Then I would have to ask if a consultant is willing to support you with a privately funded fund why is s/he not supporting you with a NHS funded pump?

 

[rebrascora]

Hi and welcome back.

From your post a few months ago, you seemed to be possibly having some issues with insulin resistance. Did you try any of the suggestions or discuss them with your DSN. ie increased exercise, Metformin, perhaps reducing your carbs?

I know you also felt like you were struggling with burn out which may have made everything so much more difficult. How are you doing with that? Are you managing to inject insulin when you need to. Have you talked to your health care professionals about it. They should be able to help you with some strategies to cope better. I appreciate access and services at diabetes clinics are pretty stretched still, but since you said you had needed hospitalizing twice a few months ago, it is in their interests to help you keep yourself safe and out of hospital. Don't feel embarrassed about needing help because burn out is a very real problem at various times for many diabetics.

You also mentioned then that you were having problems with injecting 40 units Tresiba in one go and felt it was bruising and causing lumps. I was a bit anxious about injecting larger doses of basal insulin when my needs increased, so I split the dose into 2 and inject half into each buttock. No idea if it makes any difference (probably not), but I feel better about distributing it rather than having it all in one place and I suppose if one does get trapped in some lumpy or scar tissue or whatever, at least it limits the impact. If you are still getting lumpy injection sites ask about changing your needles as some can cause an allergic reaction and that may reduce the efficacy of the insulin you are injecting into it.

Are you still using 40 units or has that been increased? I appreciate that you might not want to inject more insulin but getting your basal dose right makes all the difference in the world and you need whatever you need.

As regards your Dawn Phenomenon, I believe you have Libre, so you should be able to see when DP is kicking in. What sort of levels are you going to bed on for it to be getting into upper 20s in the morning? Could you attach a photo of a typical day's Libre graph so we can see what is happening.
I scan and inject Fiasp to cover Dawn rise (or Foot on the Floor in my case) as soon as I wake up, before I get out of bed, to deal with it. For me is usually takes 1-3 units.
I find that I have to wait a long time on a morning from pre-bolusing to eating breakfast otherwise I spike badly, so I usually inject my bolus with those extra units for FOTF, before I get out of bed, then I potter on with my morning routine waiting for my levels to start coming down before I eat. It is usually 45 mins for me with Fiasp and I try not to eat until my levels are at least below 8 otherwise they just go shooting back up again.

If you can give us more information about your routine, when you inject and your levels/Libre graph, we should be able to pinpoint the problem and suggest ways to improve it.
From your previous post, it seemed like this issue started whilst you were on Levemir and they changed you to Tresiba to see if that would help, but clearly it hasn't.

 

[Ivostas66]

I tend to see a rise of one or two mmol around the same time each morning. If you are seeing levels of 20+ I would suggest contacting your consultant asap. Have you been checking for keytones? When do you inject basal? Some on here, like me, inject basal when they wake, others prior to bed, but many have found splitting basal so that they inject half in the morning and the remainder prior to bed really helpful. Again, these are things that I think you should check with a specialist asap.