Dawn phenomenon and breakfast

A

Abner55

Well-Known Member
Relationship to Diabetes
Carer/Partner
Morning all
My wife was diagnosed with Type 1 nine months ago
Over the last couple of weeks her levels have stayed ok during the night but go high after waking ( up to 12 or 13)
She is reluctant to have breakfast at those levels, as she doesn’t want her sugars to rise any further
Currently she is on 1 unit of Novorapid before meals, and 5 units of Abasaglar in the evening
If there are any suggestions as to stop, or lower, the spike would be gratefully received
Thank you
 
There are a few things that come to mind (although it is important to remember we are all different)
- more insulin. It depends when the rise happens but if it is a continuous rise during the night, then her basal dose is too low. If it is a rise in the morning she needs a correction bolus dose when she wakes. However, you suggest she is on fixed doses which often means she is unlikely to know how to carb count or calculate correction doses. I recommend she talks to her DSN and ask about this. At the same time, I recommend a half unit reusable insulin pen to give her more flexibility.
- eat breakfast. The may sound like an odd thing to do but some of us find our liver continues to dump glucose (causing BG to rise) until we have eaten. It’s as if our body thinks we are starving ourselves and need a tip that this is not the case. This does not need to be a full breakfast. It could be a handle of nuts.
- exercise. I find when I do intensive exercise the day before, my Dawn Phenomenon is much less. It is as of the exercise has used up my glucose reserves in my liver so there is less to dump in the morning.
 
Has she been taught about doing corrections? So a correction is where you inject an additional amount of insulin to bring your levels back into range plus the amount for the food you are going to eat. Usually you are told (or work out) a correction factor, for instance they generally suggest that 1 unit of NovoRapid will drop your levels by about 3mmols, but if you are very sensitive to insulin, as it sounds like she is with such small doses, then perhaps consider using a factor of 6, so 1unit to perhaps reduce her levels by 6mmols. So if she wakes up on say 12mmols but ideally she would want to be at a nice lower in range level like 6mmols, then using that suggested 1:6 correction factor, she would inject 1unit of NovoRapid to bring her down to 6mmols (12-6=6) and then another unit to cover her breakfast, so effectively inject 2 units instead of just 1. It often takes longer for insulin to work when levels are above 10, so she might want to wait a little longer for that insulin to start working before she eats breakfast and I generally keep a close eye on my Libre watching for my levels to start coming down and then I eat.

Generally I inject my breakfast bolus plus any correction before I get out of bed because as soon as I get up my levels start to rise quite fast, so I need to get that insulin in, more or less as soon as I wake up, to give it a fighting chance to stay abreast of my glucose surge from the liver. ie DawnPhenomenon/Foot on the Floor syndrome. I would not do this if I didn't have have a sensor like Libre or Dexcom as that allows me to keep a close eye on my levels and enables me to keep myself safe.

If you haven't been given any advice about using "corrections" then speak to your wife's nurse to get some guidance.
 
Inka said:
Hi @Abner55 Is the rise happening prior to her waking (ie during the early hours of the morning)? Or does it happen once she gets out of bed? Does she have a Libre?
Click to expand...
Hi #Inka
Thank you for your reply
It’s usually when she gets out of bed, and yes, she does have a libre
I have had a couple of other replies suggesting correction doses, but it hasn’t been mentioned to us by her DSN yet
Abner55
 
helli said:
There are a few things that come to mind (although it is important to remember we are all different)
- more insulin. It depends when the rise happens but if it is a continuous rise during the night, then her basal dose is too low. If it is a rise in the morning she needs a correction bolus dose when she wakes. However, you suggest she is on fixed doses which often means she is unlikely to know how to carb count or calculate correction doses. I recommend she talks to her DSN and ask about this. At the same time, I recommend a half unit reusable insulin pen to give her more flexibility.
- eat breakfast. The may sound like an odd thing to do but some of us find our liver continues to dump glucose (causing BG to rise) until we have eaten. It’s as if our body thinks we are starving ourselves and need a tip that this is not the case. This does not need to be a full breakfast. It could be a handle of nuts.
- exercise. I find when I do intensive exercise the day before, my Dawn Phenomenon is much less. It is as of the exercise has used up my glucose reserves in my liver so there is less to dump in the morning.
Click to expand...
Hi #Helli
Thank you
We will talk to her DSN about correction doses, and a half unit pen (again!)
As yet the team at the hospital seem to prefer her to keep to her existing regime
Lots of helpful information from yourself, though
Thanks again
Abner55
 
rebrascora said:
Has she been taught about doing corrections? So a correction is where you inject an additional amount of insulin to bring your levels back into range plus the amount for the food you are going to eat. Usually you are told (or work out) a correction factor, for instance they generally suggest that 1 unit of NovoRapid will drop your levels by about 3mmols, but if you are very sensitive to insulin, as it sounds like she is with such small doses, then perhaps consider using a factor of 6, so 1unit to perhaps reduce her levels by 6mmols. So if she wakes up on say 12mmols but ideally she would want to be at a nice lower in range level like 6mmols, then using that suggested 1:6 correction factor, she would inject 1unit of NovoRapid to bring her down to 6mmols (12-6=6) and then another unit to cover her breakfast, so effectively inject 2 units instead of just 1. It often takes longer for insulin to work when levels are above 10, so she might want to wait a little longer for that insulin to start working before she eats breakfast and I generally keep a close eye on my Libre watching for my levels to start coming down and then I eat.

Generally I inject my breakfast bolus plus any correction before I get out of bed because as soon as I get up my levels start to rise quite fast, so I need to get that insulin in, more or less as soon as I wake up, to give it a fighting chance to stay abreast of my glucose surge from the liver. ie DawnPhenomenon/Foot on the Floor syndrome. I would not do this if I didn't have have a sensor like Libre or Dexcom as that allows me to keep a close eye on my levels and enables me to keep myself safe.

If you haven't been given any advice about using "corrections" then speak to your wife's nurse to get some guidance.
Click to expand...
Hi #Rebrascora
Thanks for your vey detailed reply
We haven’t learnt about correction doses/carb counting yet from her DSN, mainly, I think, because of the low doses she is on at the moment. Also, they suggested it may be too overwhelming.
She is definitely going to try injecting before she gets up, to see what happens
Thanks again
Abner55
 
Just a thought Abner..... if your wife doesn't eat because her levels are high her DSN will not perceive a problem and assume she doesn't need corrections and doesn't realise that your wife is going hungry to try to manage her levels, so in some respects it may be counter productive for your wife to avoid food because her levels are high. I appreciate learning to manage your diabetes wit insulin is very complex and that they don't want to overwhelm your wife with info they perceive she doesn't need, but it is better that she learns to manage her diabetes with insulin than restrict her diet to try to manage it whilst still having to juggle insulin anyway.
Good luck to her with injecting before getting out of bed (it has made a huge difference to my morning levels) but do make sure your wife keeps a close eye on things and has her low alarm set at a safe level (maybe about 5mmols) and has jelly babies to hand wherever she is including the bathroom. A hot shower can sometimes drop your levels quite quickly and there has been the odd occasion when I have been caught on the loo for a while (a bit constipated 🙄.... Sorry if TMI but these are real life situations that can happen) and levels started dropping fast, so keep hypo treatment in all areas of the house for easy access.
 
rebrascora said:
Just a thought Abner..... if your wife doesn't eat because her levels are high her DSN will not perceive a problem and assume she doesn't need corrections and doesn't realise that your wife is going hungry to try to manage her levels, so in some respects it may be counter productive for your wife to avoid food because her levels are high. I appreciate learning to manage your diabetes wit insulin is very complex and that they don't want to overwhelm your wife with info they perceive she doesn't need, but it is better that she learns to manage her diabetes with insulin than restrict her diet to try to manage it whilst still having to juggle insulin anyway.
Good luck to her with injecting before getting out of bed (it has made a huge difference to my morning levels) but do make sure your wife keeps a close eye on things and has her low alarm set at a safe level (maybe about 5mmols) and has jelly babies to hand wherever she is including the bathroom. A hot shower can sometimes drop your levels quite quickly and there has been the odd occasion when I have been caught on the loo for a while (a bit constipated 🙄.... Sorry if TMI but these are real life situations that can happen) and levels started dropping fast, so keep hypo treatment in all areas of the house for easy access.
Click to expand...
Thanks Rebrascora
My wife’s low alarm is set at 5mmols all the time, so we have time to react, if required
Also, there are jelly babies etc all round the house! Lol
Thought not in the bathroom until 5 minutes ago!
Here’s hoping your loo situation resolves itself soon
Regards
Abner55
 
It has been a very rare occurrence and usually because I have lapsed on my fibre intake so very easily resolved but it can happen to any of us both with constipation or diarrhoea at times (Norovirus is going the rounds at the moment) and not wanting to leave the loo but levels dropping or as I said a hot bath or shower can do it and you don't want to have to traipse through the house naked and dripping wet to find hypo treatment, so really pleased you now have treatment options in the bathroom too for any eventuality!
 
Abner55 said:
Hi #Inka
Thank you for your reply
It’s usually when she gets out of bed, and yes, she does have a libre
I have had a couple of other replies suggesting correction doses, but it hasn’t been mentioned to us by her DSN yet
Abner55
Click to expand...

That sounds like Foot on the Floor then. I get that too. On work days my blood sugar can shoot up 5mmol for no reason. I have some insulin as soon as I see it rising and that helps stop the rise.
 
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