I experience a liver dump (dawn phenomenon) beginning at around 5:30 or 6 am. I have tried increasing the dosage of Lantus the previous evening but have not seen a change at all. I have adverse reactions to Metformin and all other medications normally prescribed for diabetes, so those are out. I have tried wine (nice) and vinegar (yuck), and neither has helped. So right now I’m considering whether dosing Humalog prior to the beginning of the liver dump would help. Has anyone tried this?
Bernstein recommends waking at like 4am and injecting rapid as a way of suppressing Darn Phenomenon (DP). But that isn’t very satisfying. I suffer from disturbed sleep anyway, so waking to do an injection is often worse than just letting DP happen. If I have a sleep disturbance in the early morning hours it actually makes my DP worse. So I just take my basal and if I need a correction for my DP I do it upon first awakening.
Thanks, Brian. Does he say how much? I’ve tried 1 unit, then 2 units, but no result. I don’t want to have a hypo so I’m going slow with this.
Bernstein’s recommendations are always based on what I consider an extremely insulin sensitive person. So while he does recommend just a few units, that may not work for you. Being type 2 you are most likely insulin resistant and in the morning you are even more insulin resistant (most with diabetes are, this is part of the DP). I am not surprised that 1 or 2 units does nothing. You should try increasing your dose until you see some effect. However, be careful. If you only take 10 units of basal and have a sensitivity factor of 50 you should go slowly and carefully.
ps. My total daily dose is about 80 units and I routinely take 10 units upon waking just to battle the DP monster.
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My total daily dose is much more than 80 units. I use Novolog, rather than Humalog. I tend to naturally wake up around 3-5 am to use the restroom anyway so in the past few months I have started to take a bolus shot at that time. I take between 5-10U, depending on where in my rise I catch it and when I plan on waking up in the morning, and then take a little bit less at breakfast if I still have insulin on board from the earlier bolus.
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I am ridiculously insulin resistant – takes 8 units of Humalog for me to process 16 g of non-starch carbohydrate. I will experiment adding one unit per day and see what works.
Do you find that Novolog addresses the DP better?
Fast acting insulin is pretty much the only way to counteract a DP. My DP is erratic; some days it’s evident and some days it’s AWOL. My standard response for years now has been a small bolus upon awakening, when the meter reading indicates something is happening. I do have the advantage—such as it is—of being very insulin-sensitive, so it doesn’t take much.
I never tried it with Humalog. I used Humalog products about 10 years ago. I bruise about 3/4ths of the time with humalog pens, for some reason, and switched to Novolog, so really can’t compare.
I still haven’t had success with the bolus – 4 units today, and BG went UP. Very frustrating.
A couple things have helped me as I was in the same boat as you. Don’t believe that only fast acting will help DP, not true.
Lantus sucks first of all. 
When I was on it I never could get my morning sugars where I wanted. The more you take of fast acting or lantus made me go higher. It makes sense if you understand what DP is.
Things that worked for me:
Try Toujeo. I had to start taking in the am since it was too strong at night. Much flatter profile than Lantus. Did I mention I hate Lantus? I love Toujeo.
Take milk thistle extract before bed. But beware this can cause lows at night! It helps to squash the adrenaline output that causes DP.
Take 1500 iu natural vitamin E to help with insulin sensitivity. This works wonderful for me.
These work for me and I have no issues whatsoever anymore with DP unless I eat junk food then go to sleep after the wonderful sugar coma kicks in.
I hope some of these ideas will help you.
Peace
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Allen, these are fantastic ideas. I’ll talk to the endo about Toujeo and will also look at taking milk thistle extract and vitamin E.
I went ahead and bought Bernstein’s book, and I find it very helpful (except for all the meat). Thanks for mentioning the book; I hadn’t considered it before but now I’m glad I have it. I plan to try a 3 or 4 am shot over the weekend and see what happens (I’m a bit concerned about hypos, so I want to remain awake while I test this). If it works, I’ll have to get up at 4 am for a shot. Basal currently doesn’t do it for me.
Any luck so far? Do you take your Lantus at night? Lantus peaks and when I took it at night I used to fight going low then that would rebound into high mornings sugars. Going lower on the Lantus dose is the only thing that helped me and also switching to a morning shot instead. This was back when i took Lantus, I’m on Tresiba now. I will never go back. Hope you are getting some relief.
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I take Lantus at night, and continue to have higher BG in the morning. My endo said it’s OK to use Humalog to lower it - I still haven’t figured out what the problem is; I think part of it is how high my post dinner BG is. If I’m a little higher, say 160, then sometimes my BG is lower in the morning. If I’m lower, say 85 to 120, my BG is higher in the morning. But not always. It’s very frustrating! I also found out I actually am insulin deficient, not insulin resistant. My endo is paving the way for a pump. Are you happy with Tresiba?
So if you have lower bg after dinner your morning sugars are higher? Then you have too much insulin at night and are rebounding I bet. Exact same issue I had with Lantus. My advice is to ditch Lantus and try Tresiba. Just understand that if you were using the extra Lanus basal (since it does have a pronounced peak) to control some of your food you’ll have to adjust to having a flatter basal insulin. It is working very well for me I never have issues with dawn phenomenon anymore. There are many people who take it on here and all have great things to say about it.
Sounds good. I’ll talk to my endo about it. She thinks my problem is the liver dump in the AM.
What I meant by too much insulin at night is the Lantus spike since you take it at night. I would get a couple sample pens of Tresiba and give it a try. Same dose, just switch over. You can always switch back. And you can change what time you take your basal shot also. If you take at night you’ll get a higher peak (small curve with Tresiba 8-12 hours) so if you need less basal at night you could switch to morning shots. The curve is shown in your package insert and helps greatly to know the behaviour of the insulin.
Good luck.
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As you know you are very insulin resistant. Most T2 need less insulin not more, Have you thought about a change of diet, to enable this?
watch the last 15 minutes of this video about T2s getting off insulin.
This is the initial diet from the video
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I need to take insulin because I don’t make enough, unfortunately. My endo is getting all our duckies in a row to get me qualified for a pump in the future. My LC diet did reduce blood sugars considerably, as well as cholesterol and trigs, but the problem continues to be the dawn phenomenon.