Dawn phenomenon.

[Patties1508]

My blood sugar readings have been going up in the morning for the last eight months. They start increasing before I get up and go as high as 19.1. I rang my Diabetes Resource Centre at my local hospital and the Diabetic nurse asked me if I snacked before I went to bed to which I replied no I do not eat after 6pm. She also asked me had anything changed in my life and I also said no. She said I could have Dawn Phenomenon where the blood sugar reading increase in the morning.
I was told to measure my blood sugar as soon as I get up in the morning and if it measures high which it is, to take 6 units of Novorapid and to take my long lasting insulin Levemir as well which is 12 units in the morning and to drop my night time amount from 12 to 9 units.
I have noticed that the Novorapid insulin used to start working after 10 minutes but now seems to take up to an hour and a half before it starts to lower my blood sugar readings. Has anyone else had trouble with their Novorapid.

 

[Jon-Manchester]

From what others have said here is it quite common to be more insulin resistant in the morning. Personally I need to take 4 units of Novorapid to combat the dawn phenomenon when I first wake up and it can take up to an hour or even longer for even it to have an effect
So the mornings when I have a carb breakfast I need to do my prebolus at least 45 - 60 minutes before hand. At dinner I can’t take my novorapid much more than a few minutes before hand or I hypo

 

[Toucan]

Hello @Patties1508
There is some more information on Dawn phenomenon on this link: https://www.diabetes-support.org.uk/info/?page_id=143

 

[SB2015]

Hi @Patties1508 , I am also more resistant to insulin in the mornings, so I use a different ratio then compared to the rest of the day. I also find I need to deliver my Bolus as soon as I wake up which is a good half hour before breakfast. We are all different and have to find what works for us.

Another thing you could try is to eat a non carb snack such as nuts as soon as you wake up. This might con your liver into thinking it doesn’t need to dump the glucose to get you going.

 

[Lanny]

I found that insulin alone without anything to eat didn’t work & I HAVE to eat something: actually rose higher for longer than without any insulin at all; I just let it rise without insulin if getting fasting blood tests & add a correction on top of my usual dose when I eat after. I found half an oatcake & half my usual breakfast dose of bolus Novorapid works for me if I’m not hungry & don’t want to eat breakfast: never been a breakfast person; STILL don’t eat breakfast about 75% of the time! It took me a while to find the right amount of food & insulin I needed to stop the rise: a whole oatcake was too much food & there was a bit of a rise; you may need to experiment a bit to find what works for YOU!

 

[trophywench]

@Patties1508 - very concerned about you changing Levemir doses without a proper basal test and frankly before I want you to even think about your Novorapid doses - you need to get your Levemir doses as near as humanly possibly it is to be ideal for you.

Hence - please do a basal test properly - unless you wish to just base doses on pure guesswork.

Basal insulins « Diabetes Support Information Exchange

www.diabetes-support.org.uk

 

[rebrascora]

I need 2 units for Dawn Phenomenon, so even if I have no breakfast I need 2 units of Quick Acting insulin straight away along with my morning Levemir. It takes NovoRapid just over an hour to get working on a morning or Fiasp takes about 45 mins for me but everyone is different and the higher fasting reading I have the longer it seems to take to get going.
For the rest of the day ie lunchtime and dinner, I only need to prebolus 15-20mins before food.

 

[rebrascora]

I agree with @trophywench that getting your basal insulin doses correct is key with anything like this and whilst dawn phenomenon will usually raise your BG by 3 or 4 mmols, it may be that your basal insulin dose being incorrect is adding to the problem. With Levemir, I find it peaks about 8 hours after injecting it for me, so it may help to adjust the time that you take your evening Levemir so that you get that peak of Levemir action at the point that DP is kicking in..... so if it kicks in at 6am, then injecting the Levemir at 10 or 11pm may help. I find it surprising that the DSN would suggest reducing your evening Levemir when you are struggling with DP as it is the evening dose which would have most impact on it in my experience.

 

[trophywench]

Goodness that's a slow peak to have with Levemir! - However of course to tell when you'd normally get it depends on the dose/weight ratio, as per the graph.

 

[rebrascora]

Interesting. I have always seen a dip in BG late afternoon/early evening which I could only attribute to the Levemir since I either don't bother with lunch or have low carb and little or no bolus and DP never seems to kick in until after I get up on a morning (which is not early) whereas some people see it several hours before they get up so I assumed the Levemir was peaking at that point.

 

[everydayupsanddowns]

I’m another who needs a different ratio and/or a little extra insulin around breakfast time.

Checking overnight around 2-3am may give you some useful information too - to see whether your levels are dipping then rising, or rising gradually through the night.

I‘d also agree that a fasting ‘basal test’ as suggested by @trophywench would be a great first step. It’s a standard part of starting or updating insulin pump therapy - but for inexplicable reasons rarely gets suggested to people on MDI.

 

[trophywench]

@rebrascora - My honest opinion? That's the point at which your body naturally takes a dip in BG.