Dawn phenomenon

[Robin]

The algorithm drives me mad, @rebrascora . My current sensor seems even more prone to overegging my trend than usual.
I agree with Rebrascora, @MichelleF78 , his looks like something that could be managed with increased basal, or going to bed a bit (cautiously) lower, because the rise seems steady throughout the night. True Dawn phenomenon only gets going from around 4am, the graph having been downward sloping or level before then.

 

[MichelleF78]

Thanks guys. I am going to try one more unit tonight, I did try the 12 hour split with Levemir but it was too early around 6/7 pm to last me to morning.

 

[MichelleF78]

Yes, that happens due to the algorithm using previous readings to extrapolate to get the current reading but as you get towards the top of the peak, the rate of rise slows down and then changes direction but it takes 15 mins or so for the Libre to recognize that levels are peaking, so it is predicting that your levels are still rising when they may have levelled out and be starting to drop back down. If you scan when levels are changing you get that inflated extrapolated prediction like your 12.2, but as the levels start to come back down, the algorithm realizes that that prediction was incorrect and adjusts the graph so that it doesn't go through that point. I always think about it as cheating. It tells you one thing and then when it realizes it got it wrong it tries to cover it's mistake. 🙄 It is just part of the limitations or quirks of Libre and to a certain extent CGM in general, due to the difference between blood and interstitial fluid. Personally I wonder if we might not be better off without the algorithm and just learning to manage our interstitial fluid levels instead of blood glucose levels, rather than trying to bridge the gap poorly.

Thanks. You are a wealth of knowledge 🙂

 

[rebrascora]

Thanks guys. I am going to try one more unit tonight, I did try the 12 hour split with Levemir but it was too early around 6/7 pm to last me to morning.

I find taking my evening dose of Levemir as late as possible at night means that it is slowly building up from nothing when I least need it to having the most "oomph" when dawn and FOTF is kicking in.

Let us know how you get on with another unit but make sure to go to bed at maybe 8mmols just to be safe, the first night. If you then wake up about 8 and you have a relatively horizontal line, it has been a success and you can work on lowering your bedtime level a little to bring the line down a mmol or 2, as long as you aren't getting a saggy washing line graph, that starts at 8 dips down to 4mmols at 2-3am and then back up to 8. Those are the tough ones to crack!

 

[Inka]

Thanks guys. I am going to try one more unit tonight, I did try the 12 hour split with Levemir but it was too early around 6/7 pm to last me to morning.

As I’ve said, I use a pump, but I have had a number of quite long pump breaks and during those I always find I need to take my evening basal around 9/10pm. If I took it at 6 or 7pm, it would definitely run out overnight.

@rebrascora is absolutely right to say that we’re all different. Try some of the suggestions and see how they work for you. You might, for example, need a combination of two or three things tweaked to suit you as an individual.

It’s the prolonged spikes you need to watch really, not a quick rise up to 12 and then dropping back in range fairly swiftly.

 

[MichelleF78]

I find taking my evening dose of Levemir as late as possible at night means that it is slowly building up from nothing when I least need it to having the most "oomph" when dawn and FOTF is kicking in.

Let us know how you get on with another unit but make sure to go to bed at maybe 8mmols just to be safe, the first night. If you then wake up about 8 and you have a relatively horizontal line, it has been a success and you can work on lowering your bedtime level a little to bring the line down a mmol or 2, as long as you aren't getting a saggy washing line graph, that starts at 8 dips down to 4mmols at 2-3am and then back up to 8. Those are the tough ones to crack!

Will update you tomorrow x

 

[MichelleF78]

As I’ve said, I use a pump, but I have had a number of quite long pump breaks and during those I always find I need to take my evening basal around 9/10pm. If I took it at 6 or 7pm, it would definitely run out overnight.

@rebrascora is absolutely right to say that we’re all different. Try some of the suggestions and see how they work for you. You might, for example, need a combination of two or three things tweaked to suit you as an individual.

It’s the prolonged spikes you need to watch really, not a quick rise up to 12 and then dropping back in range fairly swiftly.

Thanks @Inka x

 

[nonethewiser]

Hi @nonethewiser only since December. Can it only be controlled by a pump and not injections?

Can't answer that as we are all individuals & respond to insulin differently, just from own experience my bg levels are more stable through night then they were on injections, but expect some users on mdi will have equally good bg levels through night & upon waking, that's how it goes sometimes.

 

[MichelleF78]

I find taking my evening dose of Levemir as late as possible at night means that it is slowly building up from nothing when I least need it to having the most "oomph" when dawn and FOTF is kicking in.

Let us know how you get on with another unit but make sure to go to bed at maybe 8mmols just to be safe, the first night. If you then wake up about 8 and you have a relatively horizontal line, it has been a success and you can work on lowering your bedtime level a little to bring the line down a mmol or 2, as long as you aren't getting a saggy washing line graph, that starts at 8 dips down to 4mmols at 2-3am and then back up to 8. Those are the tough ones to crack!

 

[MichelleF78]

Morning guys,
Took 1 extra unit. Still a wee rise. What you think? @rebrascora @Inka @Robin

 

[helli]

@MichelleF78 you mention that you can not take half units.
Are you using single use or reusable pens?
If the former, I highly recommend requesting the reusable ones. As well as allowing you to take half units, they are more robust, cause less waste and the cartridges take up less space in your fridge (and holiday luggage) than pens.

The extra unit may have helped this time but it is always helpful to have that half unit flexibility.

 

[MichelleF78]

Hi @helli just single use pens. So do I contact diabetes team to request or my GP practice? Thanks

 

[Robin]

It’s always tempting to look at one nights results and think, oh that’s sorted it, or oh, that’s still not quite enough. The trouble is, there are so many other confounding factors that affect our levels, I think you need to be patient and see what happens for a couple more nights before making any more changes.

 

[helli]

Hi @helli just single use pens. So do I contact diabetes team to request or my GP practice? Thanks

Unfortunately, I think that question is one of those things that varies. I got my pens (many years ago) from my diabetes team; others get them from their GP.
In your position, I would contact whichever is easiest and ask them

 

[MichelleF78]

Unfortunately, I think that question is one of those things that varies. I got my pens (many years ago) from my diabetes team; others get them from their GP.
In your position, I would contact whichever is easiest and ask them

Thanks I will email the diabetes team and ask.

 

[Lucyr]

What basal are you on, the maximum dose on the half unit pen for lantus is 30u. If you’re already on 29 bear in mind that switching to half unit pen might mean needing to split into two injections. If you’re on levemir, I’m not familiar with the max dose on half unit pen for that.

 

[MichelleF78]

What basal are you on, the maximum dose on the half unit pen for lantus is 30u. If you’re already on 29 bear in mind that switching to half unit pen might mean needing to split into two injections. If you’re on levemir, I’m not familiar with the max dose on half unit pen for that.

Hi Lucy I am on Levemir twice daily.

 

[rebrascora]

Yes, 30 is the maximum single dose on the Levemir half unit pen (the Novo Pen Echo Plus), but personally I feel that splitting any dose over 10 may be beneficial, so my dose of 22 gets split into 2 11s, one into each buttock. I suppose it depends how you feel about an extra jab for the perhaps very minimal benefit of improved absorption.

 

[rebrascora]

I would give it another day before deciding whether to increase it again. It looks like it is coming down just before you wake up at 6am, so perhaps you had something slow release for tea last night which was working against it in the earlier part of the night.

 

[MichelleF78]

Is it the basal injections that are making me gain weight you think? I have gained over a stone since starting insulin in December. I eat way less than I did before. I did lose a lot of weight before diagnosis but I can’t go on gaining weight at this rate.