Dawn Phenomenon

[Bunnybar86]

Hi I am type 2 on Humulin m3. 16 units bd . My last Hba1c 2 months ago was 44. For the past week my FB G has been somewhere between 9 & 10 . It is usually between 5 & 6 Before bed last night 6.8 3am 6..5 Then up to 9.4 at 7 am what can I do

 

[rebrascora]

When did you do the 9.4 test relative to waking up, getting out of bed getting washed and dressed etc rather than the actual time of 7am. It could be that your levels are rising as soon as you get out of bed (Foot on the Floor syndrome) rather than from 3am onwards. If it is FOTF rather than DP tehn you could inject your insulin as soon as you wake up and before you get out of bed to deal with it. The sooner that insulin gets into your system, the sooner it starts working and bringing those levels down. I always inject muy insulin whilst I am still in bed because the moment my feet touch the floor and I stand up, my levels start rising and they can rise by as much as 6mols in that first 3/4 of an hour before I have breakfast if I don't test and inject before I get out of bed.

 

[rebrascora]

Obviously, don't inject before you get up and then take the dog out for a walk or something as you will be at risk of a hypo but if you are just pottering on in the house getting washed and dressed and making breakfast, then that should work a lot better for you.

You might also want to take up the free 14 day Libre 2 CGM trial....basically one sensor, which works with an app on your phone and samples your levels every minute so you can see when levels start to rise and time your insulin better to counteract the rises. I can post a link if you are interested. There is no obligation, you just need to be diabetic and have a suitable smart phone to use to access the readings.

 

[Jasmin2000]

Regarding the 3 am DP spike I've not found a satisfactory solution except to wake up and inject 2-3 units of fast-acting - but I needed many attempts to understand when and how much to inject. I've tried increasing basal and shifting it to earlier/later but it results in hypos at other times. I'm don't qualify for the obvious solution of a closed-loop.

@rebrascora makes a good point about Foot on the Floor syndrome being different and mine is nice enough to wait for a half hour after I get up before spiking so I have time to address it.

 

[Bunnybar86]

When did you do the 9.4 test relative to waking up, getting out of bed getting washed and dressed etc rather than the actual time of 7am. It could be that your levels are rising as soon as you get out of bed (Foot on the Floor syndrome) rather than from 3am onwards. If it is FOTF rather than DP tehn you could inject your insulin as soon as you wake up and before you get out of bed to deal with it. The sooner that insulin gets into your system, the sooner it starts working and bringing those levels down. I always inject muy insulin whilst I am still in bed because the moment my feet touch the floor and I stand up, my levels start rising and they can rise by as much as 6mols in that first 3/4 of an hour before I have breakfast if I don't test and inject before I get out of bed.

Regarding the 3 am DP spike I've not found a satisfactory solution except to wake up and inject 2-3 units of fast-acting - but I needed many attempts to understand when and how much to inject. I've tried increasing basal and shifting it to earlier/later but it results in hypos at other times. I'm don't qualify for the obvious solution of a closed-loop.

@rebrascora makes a good point about Foot on the Floor syndrome being different and mine is nice enough to wait for a half hour after I get up before spiking so I have time to address it.

Thankyou for your advice. I always test before I get up and as I said the levels have been fine until this last week, so I have always got up and washed and dressed before Insulin. If I am still high tomorrow morning I will do as you suggest and have my Insulin before getting up

 

[everydayupsanddowns]

Welcome to the forum @Bunnybar86

Sorry to hear your levels have been playing silly games recently

Do you think you might be coming down with a cold or other infection? Or are you feeling stressed about something going on in your life? Have you recently started another medication (eg a low dose of steroids?)

Hope it settles down for you, and your levels return back to where you are used to.

Mixed insulin seemed to suit you really well, but one of the downsides of its simplicity is that it isn’t very easily tweakable.

I guess you’ll have to see if things settle down, or whether some sort of adjustment ends up feeling worthwhile?

 

[Bunnybar86]

Welcome to the forum @Bunnybar86

Sorry to hear your levels have been playing silly games recently

Do you think you might be coming down with a cold or other infection? Or are you feeling stressed about something going on in your life? Have you recently started another medication (eg a low dose of steroids?)

Hope it settles down for you, and your levels return back to where you are used to.

Mixed insulin seemed to suit you really well, but one of the downsides of its simplicity is that it isn’t very easily tweakable.

I guess you’ll have to see if things settle down, or whether some sort of adjustment ends up feeling worthwhile?

I cannot think of any reason why this is happening. I am really at a loss, hope this is just a blip. Adjusted Insulin dosage and Carb intake,Cut out bedtime snack, this resulted in 3.2 @ 3.00a. Will just see what tonight brings.

 

[Leadinglights]

I cannot think of any reason why this is happening. I am really at a loss, hope this is just a blip. Adjusted Insulin dosage and Carb intake,Cut out bedtime snack, this resulted in 3.2 @ 3.00a. Will just see what tonight brings.

I think people can imagine that things stay the same and there are many things that can affect blood glucose levels sometimes unexpectedly and inexplicably. Things that come to mind are dehydration, is there a possibility you have a urinary tract infection, changeable weather are things that can affect blood glucose. Could your insulin have gone off, so using a new pen might be something to try.
Perhaps given you mature years you are being too strict about your glucose level. Are you able to speak to your Diabetic nurse for reassurance.

 

[Bunnybar86]

I think people can imagine that things stay the same and there are many things that can affect blood glucose levels sometimes unexpectedly and inexplicably. Things that come to mind are dehydration, is there a possibility you have a urinary tract infection, changeable weather are things that can affect blood glucose. Could your insulin have gone off, so using a new pen might be something to try.
Perhaps given you mature years you are being too strict about your glucose level. Are you able to speak to your Diabetic nurse for reassurance.

No signs of any infection. Very conscious of staying hydrated . Insulin definitely not gone off

 

[Bunnybar86]

I cannot think of any reason why this is happening. I am really at a loss, hope this is just a blip. Adjusted Insulin dosage and Carb intake,Cut out bedtime snack, this resulted in 3.2 @ 3.00a. Will just see what tonight brings.

I cannot think of any reason why this is happening. I am really at a loss, hope this is just a blip. Adjusted Insulin dosage and Carb intake,Cut out bedtime snack, this resulted in 3.2 @ 3.00a. Will just see what tonight brings.

No signs of any infection. Very conscious of staying hydrated . Insulin definitely not gone off

4.5 this morning