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Dawn Phenomenon

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NM76

New Member
Relationship to Diabetes
Parent of person with diabetes
Hi
I’m hoping someone can give me some advice. My daughter has Type 1, diagnosed over 3 years ago, I have trawled this site ever since for tips and reassurance, however, I feel lately we’re fighting a losing battle with high numbers in the morning.

I check through the night every night and her levels are normally around 6-8 at 2.30am. I used to then leave the next check until breakfast at 7.30am but she could be around 14 so I decided I have to try and catch this early morning rise. I’m now checking at 5.30am but still her numbers are high. An example is last night her bloods were 6 at 2.30am, 13.8 at 5.30am (4 units novorapid given)10.8 at 7.30 am. I also feel she is taking a lot of insulin at present but I know every individual is different, she’s currently on MDI, Levemir and Novo, does not want the pump or libre as is a bit embarrassed at school about the condition, she is 15 years old. Any advice appreciated
 
It was the DP as well as the desire for more flexibility that drive me to want a pump, but I understand that she doesn’t want one. Has she seen the recent ones. They are small. I tuck mine away at the start of the day and then I do not need to touch it again all day as it is controlled by Bluetooth. I just use the test kit when I need to, so no one needs to see it at all.

With the DP some have tried just having a quick snack as soon as they wake so that the liver gets the message not to dump the glucose to get you going. I know that seems a bit counter intuitive.

Is she on a split Levemir. I found it useful splitting mine as I was then able to make adjustments without affecting the other dose.

With regard to her being embarrassed about her diabetes, it may be helpful to talk to her team at the hospital about this. In some areas there are psychologists attached to the team.

Keep in touch and let us know how you get on.
 
@NM76 Ah, I was just going to suggest a pump as mine sorted out my Dawn Phenomenon perfectly. As @SB2015 says, they’re so small now and not at all obvious. My pump is controlled by my phone so at mealtimes it just looks like I’m checking my phone rather than bolusing for my meal.

My pump is a DANA RS and when I was researching it, I saw a young person reviewing it on YouTube who made it look cool and something appealing rather than medical. I can search for the video if you like.

Apart from that, all you/she can do is set an alarm to correct 4/5am as you’ve done above.

It’s sad that she’s embarrassed. She shouldn’t be. It’s not her fault at all. I do understand how hard it is to be ‘different’ when you’re her age though.
 
Thanks for the replies, for now a pump is out of the question for her, I would love her to have this but can’t force it upon her, I hope in time she’ll come round to it for her long term health. I just wondered if there was anything else anyone would do, I can’t really give her a snack between 2.30 and 5.30... might try changing my time to 5am. She’s on split doses of levemir at 8am and 8pm, requiring more throughout the day than night as her levels are fine at 2.30am. She’s due her first transition appointment on January but I’m sure the only solution is a pump. I agree she shouldn’t be embarrassed but I think it’s an age thing, hoping that also changes in time, thanks again
 
Libre (or CGM) would be my suggestion, just so you can all see what's really happening.

At one point my GP offered to get me admitted to hospital for a night where they could take a blood test every hour or two, so that kind of thing might be possible. But I thought at the time that's not necessarily going to be useful since that's not a normal night.
 
Absolutely you can’t force a pump on her. She’s not alone in her reluctance to have one. I resisted a pump for years because I thought it would be like a massive great ball and chain. In fact, it’s given me my freedom back and made me feel ‘normal’ again - ie not diabetic. I totally underestimated the benefit of having a basal that exactly matched my needs. The change in how I felt physically was surprising - and lovely.

Perhaps listening to why she doesn’t want a pump and letting her work through it with you and her team without any pressure from any of you would help her. It might be that her team knows people of a similar age to her with a pump.

Wishing her all the best. Type 1 isn’t an easy thing to deal with at any age, but I do think the teens are especially hard.
 
I assume if you are testing and giving her insulin in the middle of the night whether this is exaggerating her DP.
I know this sounds counter intuitive but if DP occurs when (or before) we wake, and her body is getting used to being woken at those times, it is preparing by doing a liver dump.

If she cannot get a Libre funded, it may be worthwhile self-funding one so you can see what happens "naturally" without hte external interruptions.
 
I very rarely give insulin the middle of the night as she is within range and she rarely wakes. She occasionally hypos but not that often so I understand the highs in the morning following treatment of a hypo but not this every day occurrence. Do you think my check at 2.30am could be waking her slightly and her body preparing a liver dump?

I would gladly have the libre but she doesn’t want it for now.

I’m considering a snack tonight at bed which may result in a slightly higher 2.30am check, skipping the 5.30am check and see what the morning brings.

Thanks for the replies
 
Inka said:
Absolutely you can’t force a pump on her. She’s not alone in her reluctance to have one. I resisted a pump for years because I thought it would be like a massive great ball and chain. In fact, it’s given me my freedom back and made me feel ‘normal’ again - ie not diabetic. I totally underestimated the benefit of having a basal that exactly matched my needs. The change in how I felt physically was surprising - and lovely.
Click to expand...

Absolutely agree @Inka, and that was my experience of a pump too. very resistant for years, but now a firm convert and when I briefly returned to MDI recently it felt very clunky and generally ‘difficult’ which really surprised me as I’d happily jabbed, not wanting a pump, for decades!

It sounds like a really difficult balancing act for you on Levemir @NM76 especially as her levels are so good at 2am and then rise so rapidly :(

One slightly sideways thought which you *could* consider is to borrow a technique from older (more variable) basal insulins... I wonder if it might be possible to snack before bed which would give some extra BG ‘coverage’ and allow you to raise the evening basal injection to offset the 5.30 rise in BG?

It‘s a bit backwards and no one these days should be ’feeding their insulin’ but while her hormones and liver dumps are playing sully games I wondered if this might give you more flexibility with basal dose?

Maybe something to discuss with her paed team / DSN?
 
NM76 said:
I’m considering a snack tonight at bed which may result in a slightly higher 2.30am check, skipping the 5.30am check and see what the morning brings.
Click to expand...

Haha! obviously wasn’t reading carefully enough - you are already considering the snack option
 
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This thread is now closed. Please contact Anna DUK, Ieva DUK or everydayupsanddowns if you would like it re-opened.
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