T1 higher than usual dawn BG

[Jennyninja]

Morning ! After a couple of weeks of near perfect dawn BGs of 5-6 I find it's creeping up to 6-7+. Other levels during the day seem to be getting under better control but this is an anomaly. I take Lantus at night and Novorapid for bolus. I take my Specialist nurse advice and get up to just a spot higher than 8 before bedtime and sometimes supplement with half an apple or a bit of milk or maybe even a 'boring biscuit' (you know the type ). I haven't been sleeping as well as I usually do this last week or so and been going to bed a bit later. Could this be it? Could I be getting a false reading of under 8mmol after dinner because dinner has been a bit later too and the effect of some carbs haven't shown? Or could it be that I am actually ending up going to bed with less than 8 and my liver compensates by dumping more glucose through the night? I hope it's a blip that I'll figure out but would be interested to hear if others experience the same or have any views. Thanks.

 

[Robin]

Loads of us get Dawn phenomenon. I’ve yet to find a solution, and in the end, it’s only firefighting what your body does naturally. People say, oh it must be a rebound from a nighttime low, but my Libre trace shows otherwise, I just have a gentle downward curve towards 4am, followed by an upward one til dawn. Your liver releases more glucose as it gears up for the day, just in case it has to go and hunt a woolly mammoth for breakfast. If I incease my basal, I hypo in the night, if I decrease it so I don’t dip downwards after I go to sleep, I shoot upwards in the morning. I do find mine is worse when I'm not sleeping well though, so that may be part of it for you.
Having said all that, there are little tweaks you can do to smooth it down. I found Lantus had a peak after about 5 hours, so taking it at bedtime exacerbates the downwards curve, and I shove my breakfast bolus in as soon as I wake up, with an extra unit so the insulin can get working on the liver dump straight way, then have breakfast after 45mins to an hour.
The ultimate solution is to have a pump, when you can vary the amount of basal to match what your liver is doing, but I've always felt that I cope with mine within the bounds of decent control, so haven’t pushed for one.

 

[Inka]

I find a disturbed night’s sleep usually means I wake higher. It could be that @Jennyninja Even my pump can’t deal with that because it’s not psychic and I don’t ‘loop’ with it. Personally, I don’t stress about occasional wakings at 7+ and I definitely don’t mind waking at 6mmol.

I’ve probably mentioned this a million times before, but one of the hardest things I found about Type 1 was that it’s not a case of ‘getting insulin right’ and then there we are, all sorted. Things change, things change and then change back again just as you’ve adjusted your insulin to sort it 🙄 Numerous things affect our blood sugar - and not always consistently either.

 

[Jennyninja]

Thanks both. Really helpful and supportive. It's good to know I'm not alone here. There have been a few out of ordinary things happened in the last week that changed my routine a bit do I'll see what happens. I half considered increasing my Lantus but think that would be a bit drastic right now. As we all say, every day is a learning day

 

[helli]

I half considered increasing my Lantus but think that would be a bit drastic right now.

I am now on a pump but I used to use Lantus.
I found I could be flexible and adjust my basal daily . If I was feeling unwell, I would increase it. If I was exercising I would decreasing it the next day. IN fact, basal adjustment became part of my exercise regime and it would help me avoid hypos the day after a workout.

So, if you feel comfortable tweaking your Lantus up and down, I would not shy away from it - it is easy to notch it down once things return to normal.
The idea of Tresiba which takes 3 or 4 days for changes to take effect blows my mind but then I am not a habitual type of person - each day is different so needs different basal levels.

 

[Jennyninja]

Thank @helli . I've noted the exercise point. I plan to do a half marathon at the beginning of September so will keep basal tweeking in mind for this