Beating dawn phenomenon

[Naty]

Hi everyone,

I don't know if anyone will remember me - when I joined the forum four years ago I lived and worked in London and was type 2...

...now I live and work in Kent and am type 1.5!

I did the DAFNE course in May which I found really useful. I currently have a LIBRE sensor on (not on prescription unfortunately) which is also really useful - but of course you can also see spikes

The dawn phenomenon is well documented, but is there any way to inject to cover it? I use a ratio of 1 unit of Novorapid to 10g carbs at breakfast time. Would increasing the ratio help?

Thanks in advance 🙂

 

[Sprogladite]

I used to get up at 3am to bolus to beat it but could only keep it up for a few months. Now I wake in low teens and immediately bolus before I've even got out of bed. Just means I have to be very careful in terms of stacking insulin with breakfast, but the libre has helped immensely with this. As far as I know the only "proper" way to get around it is to use an insulin pump.

 

[Robin]

If anyone finds the answer, let me know!
This is something I struggle with. The best way I've found to manage it is to inject my breakfast bolus early, as in, up to an hour before I eat. I take my insulin pen up to bed with me, and do it first thing when I wake. Then I use the Libre to monitor, ( if I'm wearing one, otherwise I just go by experience) and as soon as I see the line taking a downwards turn, I eat.
If I'm having a very low carb brekkie, like scrambled egg, or avocado, I still inject a couple of units, as this is what I need to mop up the excess glucose my liver has so thoughtfully provided.
Whether you need extra breakfast Bolus will depend on what your pre lunch number comes out at. If you're in range, then no, and it's just a timing issue, if you're higher than you'd like, then try extra Bolus ( and also tweak the timing)

 

[mikeyB]

It doesn’t always need a pump. I’ve abolished my DP almost completely by being switched from Lantus to Levemir split dose, with the second dose at bedtime. The other day I maintained 6ish from 7.00 in the evening, before food, till 11.00 the next morning. Even then, the creep was only up to 7.5, so it can be done without tinkering with a pump, although that is the perfect way to do it.

 

[Sprogladite]

If anyone finds the answer, let me know!
This is something I struggle with. The best way I've found to manage it is to inject my breakfast bolus early, as in, up to an hour before I eat. I take my insulin pen up to bed with me, and do it first thing when I wake. Then I use the Libre to monitor, ( if I'm wearing one, otherwise I just go by experience) and as soon as I see the line taking a downwards turn, I eat.
If I'm having a very low carb brekkie, like scrambled egg, or avocado, I still inject a couple of units, as this is what I need to mop up the excess glucose my liver has so thoughtfully provided.
Whether you need extra breakfast Bolus will depend on what your pre lunch number comes out at. If you're in range, then no, and it's just a timing issue, if you're higher than you'd like, then try extra Bolus ( and also tweak the timing)

Oh yes, I usually do carb free breakfast and a couple of extra units to mop up excess too! I've been experimenting with trying carbs with breakfast lately but I just spike far too much if I do

 

[Robin]

It doesn’t always need a pump. I’ve abolished my DP almost completely by being switched from Lantus to Levemir split dose, with the second dose at bedtime. The other day I maintained 6ish from 7.00 in the evening, before food, till 11.00 the next morning. Even then, the creep was only up to 7.5, so it can be done without tinkering with a pump, although that is the perfect way to do it.

I've also switched to Levemir, and while it's helped enormously, it hasn't eradicated what I call my 'washing line' Libre trace, and I still need a boost from a couple of units of Novorapid. But yes, basically, I've found I can tweak it sufficiently without a pump.

 

[Naty]

Thanks for all your replies so far!

What often happens to me is that I wake up with a respectable number and then it really takes off. This morning's a good example. Woke at 7.25 with a reading of 6.9. By 8.35, having consumed one coffee, I was 10.9. Had porridge for breakfast, had 3 units for that plus a correction of two more units - and then by eleven o'clock was up to 15 - though I fell down to 12.7 by midday.

 

[Robin]

Thanks for all your replies so far!

What often happens to me is that I wake up with a respectable number and then it really takes off. This morning's a good example. Woke at 7.25 with a reading of 6.9. By 8.35, having consumed one coffee, I was 10.9. Had porridge for breakfast, had 3 units for that plus a correction of two more units - and then by eleven o'clock was up to 15 - though I fell down to 12.7 by midday.

I find caffeine gives me a spike, so that may be contributing too. Not that I'm suggesting you give it up! Just something else to factor in. It looks like you need to play around with doses and timing til you find the 'best fit' Oh, and I rarely have porridge, I find it the worst thing to tame. If I'm having a carby breakfast, I find Burgen toast, or muesli and full fat Greek yogurt with extra seeds sprinkled over, do better for me. Though some people swear by porridge, just goes to show how different we all are.

 

[Naty]

Thanks Robin 🙂