Does Dawn Phenomenon hit you the same way each day?

[LorraineP]

Hello, I’m going through the basal testing stage at the moment with my new pump. I thought we had the morning stage sorted out because on the first morning after adjustment my reading was 6.2. However that was a one off and my results are still erratic in the morning (in fact they are higher) which affects the afternoon basal testing. Over the past week I’ve only had 2 days where the afternoon results aren’t distorted by food or insulin corrections. Food eaten and meal times don't vary.

I feel I really need to get the morning basal sorted out correctly before rushing onto the afternoon testing. The problem is that some days I wake with increased BG and other days I don’t. So I feel there’s no single dosage pattern that will suit.

So my question is:

Does the dawn phenomenon affect you every day to the same degree and during the same set of hours? If not and it only affects you on some days, sometimes slightly sometimes severely, how on earth do you treat it?

When I was doing my morning basal testing my BG rose mid-morning to 15 after eating bacon and eggs and after waking up with morning readings within range. My DSN told me that the rise was caused by dawn syndrome but I’m wondering if it was caused by the protein. I was told I could eat during basal testing as long as the meal was carb free.

So I think I’ll start the morning basal testing again but this time I’ll follow the guidelines in Basal Testing Made Easy rather than the scant instructions given by my hospital!

I’ll also test without drinking coffee as I’ve just read that caffeine can increase BG. I've been a T1 diabetic for 40 years and I’m still clueless!

 

[trophywench]

Well how long after doing the waking up reading did you eat the breakfast? and what was your BG before you ate it?

And - have you been told it's OK to eat a protein only meal whilst you are basal testing cos despite what DSNs tell us - you like me and no end of other people - find that it isn't. You might get away with 25g weight of cheese or half an egg or something - but not a meal! - if you're hungry have a drink and do a crossword/read a good book .....

Give yourself a manicure? Knit a jumper?

You get the picture, LOL

 

[LorraineP]

Yes I was told it was OK to eat protein but the results suggest otherwise. That's why I'm going to start from scratch again this time eating no food and no coffee. It's not a problem for me going without food for several hours because I rarely feel hunger. Suspected gastroparesis, yet to be confirmed....

On the 3 days of morning basal testing my pre and post (protein only) breakfast readings were:

Pre 7.6 Post 11.8
Pre 6.8 Post 10.9
Pre 8.2 Post 15.8

I normally eat 60 - 90 minutes after I get up and on these days my readings on waking were 1 - 3 points lower than the pre breakfast readings so dawn syndrome is a factor but I need to test again without eating any food to rule out any effects of eating protein. But I don't always wake with readings in range. I can wake up with readings from 5 - 15. It's not the same every day and I can't predict it. I just wondered if this was unique to me or if dawn syndrome affects other people this way too?

I ordered a Freestyle Libre this morning and I can't wait until it arrives. I never thought I would get excited about a glucose monitoring kit!

 

[SB2015]

I have found that it is a lot simpler simply not to eat when doing the basal rate tests. It means that there Re no other issues to deal with apart from the basal rate dealing with glucose my body is making. So I test when I wake up and then hourly, as I want to know when to change my basal rate. If I see a rise or fall I track back to two hours before and adjust the basal rate at that time accordingly. The best recording for doing all of this I have found is the Roche basal rate testing sheets, although I don't use them as they intend you to. But on them are all the dos and don'ts of basal rate testing.

The advice from Pumping Insulin is to sort out your overnight rates first. The Libre will be brilliant for that. You will just need scan before you go to sleep, and then do one scan during the night (for me that is no problem as I always have the 'opportunity' to do this when nature calls) and again in the morning. Just check that you have not eaten or corrected within four hours of going to bed. Once up just delay your breakfast for as long as you can and swipe again before you eat. Job done. Download and look for patterns.

During the day if doing fasting I do it in chunks of 6 hours and then cover the full day over a week (since life often gets in the way of doing the planned fasts.

 

[LorraineP]

Thank you for your suggestions as it really helps me to get my head round this.

 

[Radders]

I find that Dawn phenomenon does not affect me the same every day. I think it might possibly be related to how much carbohydrate I ate and exercise I did the day before, but I haven't systematically proved this yet.
I also find that protein affects my blood sugar too.

 

[Robin]

I fond I tend to get less of a dawn phenomenon when I've had a couple of glasses of wine the previous evening. Must be something to do with the fact that when the liver processes the alcohol, it can't churn out as much glucose. ( Livers must be male, they can't multitask!)

 

[LorraineP]

Thank you Radders and Robin as you've both confirmed that dawn phenomenon can't be accurately predicted nor will it reach the same highs each day. Some days I wake with my BG in range and as my basal rate has been set to deal with dawn phenomenon I'm worried that it will put me too low on the mornings my liver decides to behave and have a day off from torturing me.

How do you deal with this unpredictability? Have you managed to find the right settings on your pump? Did you get there eventually? I suppose I'm keen to know if you managed to find a "one size fits all" basal rate to solve the problem?

Robin, there's something in what you say about wine. I find one glass the night before seems to help the morning BG but not if I've had more. I suppose it's nature's way of telling us dawn phenomenors not to overindulge!

 

[SB2015]

I have learnt to reduce my basal insulin by 10% for each glass of wine that I have had in an evening. That deals with the inability of the liver to process alcohol, alongside prodrug in some glucose. Seems to work so far.

 

[Robin]

I'm on MDI, and Lantus at that, so changing basal is a slow palaver. I tend to go to bed a bit higher when I've had wine, or had a strenuous day, which is something else that has me waking to low numbers the next morning, otherwise, with the help of the Libre looking at overnight patterns, I've just tried to find the 'best fit'. My waking numbers have tended to be between 4.2 and 6.9 recently, looking at my meter. But I know if I wake on the high side, it'll tend to carry on rising, and I'll be 8 or 9 soon if I don't leap out of bed and have breakfast and do some short acting.

 

[Radders]

I think the answer is for me that whatever I do is better than MDI, and sometimes I put up with having to correct before breakfast.

 

[SB2015]

Have you looked at the timing of your insulin delivery before meals. I was amazed at the difference that made in reducing my spikes after meals. I aim to inject about 30 min before my meals, but reduce this time interval if my BG is low, and or split the injection if I am uncertain about how many carbs I will eat or the timing of its arrival, for example when out for a meal. I then estimate sensibly and top up as necessary, once the food is in front of me

 

[everydayupsanddowns]

Nope. Mine varies quite a bit. Chops and changes and then settles back again. All part of the fun 🙄