Dawn Phenomenon

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JimDeejay

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Type 1
A very good afternoon to all,
Thanks for letting me join up to the forum. Just reaching out to see if i can get some help/advice with my diabetes control. I am type 1 insulin dependent and my control seems to have been fine, until the last couple of years. I seem to be suffering from the dawn phenomenon. My sugar levels spike at around 3am, whilst i am asleep and spike up into the hight teens/ early twenties, until around 10am.
I have tried to combat this by moving on to an insulin pump and increasing my overnight insulin uptake. I feel my body is becoming resistant to insulin uptake in the early morning hours. I am assuming this is due to a huge release in cortisol/ growth hormone.
Has/ does any one else suffer with this issue? What have you done/ are you doing to combat this issue?

Thanks
 
Hi and welcome to the forum.
I'm T2 and not on insulin so can only be marginally useful to this thread but I think a lot of us get visits from the Diabetes Fairy overnight and find she's left us with a gift of inexplicable BG levels.

I'm sure that some of the T1's who are on insulin pumps will be along shortly and will be able to offer more relevant support.
 
Hi @JimDeejay
Sorry to read about your high DP issues.
You say you have changed your overnight basal but it sounds as if you need to increase them further starting just before your start to see your levels rising. How long "just before" depends upon the speed of your insulin. You do not want to increase your basal all night as this could cause hypos.

Out of interest, what is your evening meal? I find that high carb high fat meals can cause a rise in my levels 5 or 6 hours after eating so I need to use an extended bolus for these meals. In the past, these meals have been the cause of a rise at about 2 or 3 o'clock in the morning.

Are you comfortable making basal changes? If not, I suggest reaching out to your DSN for support.
 
helli said:
Hi @JimDeejay
Sorry to read about your high DP issues.
You say you have changed your overnight basal but it sounds as if you need to increase them further starting just before your start to see your levels rising. How long "just before" depends upon the speed of your insulin. You do not want to increase your basal all night as this could cause hypos.

Out of interest, what is your evening meal? I find that high carb high fat meals can cause a rise in my levels 5 or 6 hours after eating so I need to use an extended bolus for these meals. In the past, these meals have been the cause of a rise at about 2 or 3 o'clock in the morning.

Are you comfortable making basal changes? If not, I suggest reaching out to your DSN for support.
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Thanks. This is a super helpful reply. I am happy to make basal changes. I will have a look to raise it a bit further in advance and increase the level.

My normal evening meal is usually post gym and is around 40g-50g carb. They are usually fairly high protein though. I am wondering if there is a relation between high protein slowing down the body uptaking carbohydrate.
 
Protein shouldn't slow it down but there again if we don't feed our body enough normal carb to fully cover our cells need for glucose, said body can always make extra glucose out of both protein and fat. It's just that doing it with carbs is dead easy but the other two are harder for it to convert. In comparison to carb, it can only make about 40% as much glucose from protein and only 10% from fat. Therefore if we eat very little straightforward carb (in comparison to what our body needs) we need to account for the protein and fat with insulin! Unsurprisingly if our ratio is 1u to 10g carb, it's 0.4u to 10g protein and 0.1u to 10g fat.

The standard thing with adjusting pump basal rates is to make the change TWO hours before you want the effect. I use Novorapid in mine and that timing certainly works.
 
I'm pretty much experiencing the same thing at the same time and same numbers for the last 3 months, I was taking heavy pain killers after breaking my leg badly and spent 6 months weaning them off and when I stopped them completely my DP went completely mad, I dont want to up night time Basal and was hoping to ride it out, I spoke to my Doc and he looked at my Libre results and immediately said he wants me on a pump again ASAP. I'm normally pretty good at keeping control but this has been a nightmare to try and get this sorted
 
JimDeejay said:
Thanks. This is a super helpful reply. I am happy to make basal changes. I will have a look to raise it a bit further in advance and increase the level.

My normal evening meal is usually post gym and is around 40g-50g carb. They are usually fairly high protein though. I am wondering if there is a relation between high protein slowing down the body uptaking carbohydrate.
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If that protein also has high % of fat then it could, but guess is its just protein breaking down slowly as you sleep & raising bg, with normal size protein I don't get this with higher portions do.

Worst culprit is cheese, eat plenty of it on evening & quaranteed to see higher bg levels during night & on waking without taking preventative action, on injections it would mean corrections on pump do tbr.

Tbh own basal rate goes up from 2am, example basal rate before is 0.55 but increases to 0.80u for 2 hours then 0.85 until 7am, so yeah your not alone.
 
Graph.jpg
I have attached an image of my libre graph. It definitely looks like the dawn phenomenen rather than the symogi effect. It really spikes high from around 3 am to 12pm. Is the same sort of thing other people are experiencing. I can up my insulin to try and combat this, but before I do that, i want to understand why it is happening.
 
Without having increased basal rates from 2am would see same results, make adjustments rather than trying to find out why.
 
Because your body needs more insulin at those times. It needs what it needs - that's a fact so accept it.
 
trophywench said:
Because your body needs more insulin at those times. It needs what it needs - that's a fact so accept it.
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That's a bit close minded. Surely the idea would be to find the cause and see if there is more of a natural way of curing the issue, rather than putting in more insulin.
Thank you for the advice though.
 
JimDeejay said:
That's a bit close minded. Surely the idea would be to find the cause and see if there is more of a natural way of curing the issue, rather than putting in more insulin.
Thank you for the advice though.
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I sit in the middle - it is useful to understand what is causing the rises and, sometimes, we can make adjustments. But it may just be that your body (and lifestyle) need more insulin than you are giving it.
I chose a lifestyle that does not restrict my insulin requirements.
 
JimDeejay said:
That's a bit close minded. Surely the idea would be to find the cause and see if there is more of a natural way of curing the issue, rather than putting in more insulin.
Thank you for the
Click to expand...

You can't always do anything about factors that effect bg levels, accepted that long time ago, but DP isn't one & you can easily deal with it by increasing basal rates, that is simplest answer to problem.
 
I remember an Endo - approx 40ish years ago - saying to me that the problem is because nobody ever bothers to test anyone's body to find out what is normal for them in terms of level of hormones, enzymes or anything else when they're fit and healthy and don't bother to find out until summat or other starts to go wrong, it's always 'a best guess', which no matter how many years you study or what you now know, will more than likely never change in our two's lifetime!

I daresay Steve (can't recall his surname) is now retired same as me, cos we were roughly the same age.

I don't feel it is 'close minded' at all. However I fully accept nobody can make me under 22 again to test everything. I also accept the suicide hour happens (ie lowest BG and the time when more people already that way inclined commit suicide) in the early hours of the morning which I first heard about when meeting a couple of junior hospital doctors on holiday - hence am never surprised when people say their own BG dips at that time.
 
That rise might just be happening because your basal insulin is not covering your needs at that time of day. It may be down to when you take your basal, or the profile of the basal you are using or that your body just needs more then.... at the moment.... but that may change is a week month or year. Adjusting your basal insulin to match what your individual body needs is a bit of a dark art (made easier by Libre) but is key to good diabetes management.
I used to get a 4-6mmol rise on a morning after I got up for the first couple of years after diagnosis and had to inject a couple of units of quick acting insulin to deal with it. That has changed and since Dec/Jan I now need more on an evening but waking readings are pretty steady. I also have to adjust my basal to take into consideration my activity and my evening basal dose of Levemir in particular needs regular adjustment both up and down.

Is that rise consistent every night? Do you eat normally or follow a low carb way of eating. If you are low carb, protein release could cause that initial upward drift and then the DP spike on the top or could it be the "pizza effect" . It could perhaps be your basal running out depending upon which basal you use and when you take it.
If it really is DP have you tried an eye cover to see if that helps prevent/reduce it.

It looks like your levels were already very high when you went to bed. Would you consider a correction at that time to bring them down, especially if this is a regular issue? I usually wake up hot and agitated during the night when my levels hit about 10, so I keep my insulin pens under my pillow and inject a couple of units of Fiasp to bring it down if that happens. Dread to imagine what I would feel like if I spiked up to 20... although we all know Libre exaggerates these things a bit. 🙄

Not sure how long you have been diagnosed but if it is fairly recently then this may indicate that you are coming to the end of your honeymoon period and your remaining beta cells are being killed off.

Anyway, those would be my thoughts. With insulin it is important to learn to accept that you need as much insulin as you need and that is highly individual and it changes throughout your life. I used to resist increasing my basal particularly but once you accept that you need to increase it and get the balance right it makes such a huge difference to how you manage your diabetes and how you feel about it. I now know that if I am getting frustrated with my levels it is almost always because my basal insulin isn't right and I need to adjust the doses or the timing or it to suit my body better.

Diabetes doesn't play fair.... just when you get the hang of it and think you are winning, it changes the rules and the goal posts move and you have to start to learn a new strategy to get back to winning. You can spend a lot of time on trying to figure out "why" but that effort is probably better spent on figuring out how best to tackle it.
 
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