Dawn phenomenon

[Deleted member 13600]

What do you do to reduce, or better still prevent this if you suffer from it?
I'm on multi injections, no pump for me.

I have changed my timing of Lantus to almost every time of day and night and still this happens, but not every day.
And I am definitely not going hypo in my sleep.

 

[everydayupsanddowns]

Some people find a small low carb snack before bed keeps the liver happy overnight.

Certainly some people struggle more with DP than others.

The only other thing you can do really is one of a variety of insulin workarounds. Bolus immediately on waking... alarm set overnight... prop up basal with bolus (or vice versa) depending on your specific situation.

It’s frustrating, that’s for sure.

 

[Kaylz]

@Robin suffers this and she is on MDI so maybe she would be able to give some advice?
xx

 

[Deleted member 13600]

"Bolus immediately on waking"
Yes, that's what I do normally, then wait for that to start working before I have my breakfast.
My DSN told me that's not a good idea but didn't really have an alternative method.

Frustrating, it is indeed.

 

[Robin]

I’ve not solved the problem of my Dawn Phenomenon, just learned to manage it as best I can. I found. was dipping low (too low) in the middle of the night, then climbing from 4am. A change to a Levemir, so I could split the dose and take less overnight, sorted out the dipping too low, but it didn’t stop the general dip and rise. My overnight trace on a Libre looks like a washing line, I start and end up on the same level, but curve down towards the centre and back up again)
Also, the amount of rise I get in the morning depends on various things. It’s less pronounced if I have a protein snack (piece of cheese, or something) before bed, or if I've had a proteiny meal. It disappears altogether if I've had a couple of glasses of wine with my evening meal. And if I’m stressed, it starts rising from 4am, if I'm relaxed, it may not happen til I wake up.
As you say, the best solution is to inject bolus as soon as I wake up. I always do my breakfast bolus based on the number of carbs I’m about to eat, plus another 2 for the dawn rise, then wait an hour before I eat. That’s the only thing that keeps it from going on rising, but it would probably shock my nurse ( I don’t think I’ve ever told her)

 

[Schrodinger]

Tricky one, for me it is intermittent but these days I tend to get woken during the night for pee o'clock swipe my arm and depending on what that says inject a correction does. Now this could be anything from 2:00am to 5:30am, not sure if it is the right way but least it keeps it a bit more in check.

 

[Bruce Stephens]

"Bolus immediately on waking"
Yes, that's what I do normally, then wait for that to start working before I have my breakfast.
My DSN told me that's not a good idea but didn't really have an alternative method.

Really? That's pretty much what was suggested by the local team. Not the full bolus for breakfast, that is, but just a small part of it to cover the dawn phenomenon (I take 2 or 3 units, with a further 7 or 8 later for breakfast).

 

[Deleted member 13600]

Thanks Robin,
I'm glad to hear it works for you too.
It gives me confidence I am doing the right thing.

Bruce Stephens,
Yes really, I do wonder about our local team sometimes🙄. Luckily we have this website.

 

[Bruce Stephens]

Yes really, I do wonder about our local team sometimes

Now I come to think about it, they didn't recommend it, exactly. They were more neutral than that, commenting that they knew some people did this. (But they certainly didn't think it was a bad idea. It probably would be a bit risky to give the full breakfast bolus then, though that would also depend: some people need to bolus an hour before eating at breakfast. One thing the local DSNs are clear about is that everyone's different, so it's necessary for them to be flexible.)

 

[mikeyB]

I get it it too. Like Robin, I've tried adjusting Levemir, but I too get that washing line trace. I rarely eat breakfast, to be honest. I just use corrections of a few units of rapid insulin assisted by the morning Levemir. That usually does the trick for the morning. It's gotten worse since my mobility issues make getting out of bed an adventure, and my liver responds accordingly. My liver hasn't learned that my next activity is sitting on my arse, drinking a double espresso and reading the paper,

It's so reliable, I never correct a morning level of more than 3.5, so it's not all bad.

 

[Deleted member 13600]

Thanks mikeyB, it seems I have been doing the same as everyone else all along.

It's just when the hospital staff tell you , "you shouldn't really do that, you might go hypo later on" I'm thinking, well what else can I do?

 

[TheClockworkDodo]

I'm another one who pre-boluses for breakfast and then tries to time my breakfast for when my blood sugar finally decides to go down but before it gets too low (usually about half an hour). I don't always get it right, which means sometimes I hypo in the middle of breakfast (and ignore the hypo - which really would shock my diabetes team - because I know my blood sugar will very soon be on its way back up again). But mostly I manage to control the spike, if not to prevent it - I'm happy if I keep it within single figures. If I didn't eat breakfast, I'd still need a couple of units of bolus to stop the DP - I've done a bit of experimenting and I spike in the morning whatever I do. Like @mikeyB getting up in the morning is quite an effort for me and my liver hasn't worked out that all I'm going to do once I'm up is have breakfast and then go back to bed 🙄

 

[rebrascora]

Like Robin I bolus when I get up and give myself an extra 2 units of NR more than the carbs I am going to eat.... so 20g carbs and I would give myself 4 units, if I am having a mushroom omelette with no appreciable carbs then I just have 2 units. Then I wait at least an hour before I have breakfast, but will have my morning coffee with cream during that time.