So since it looks like you all might be right and I now have DP (making me feel guilty for whenever you spoke about it and I was relieved it wasn't me!)...I need to sit down and focus on "Using Insulin" and "Pumping Insulin" but so far don't see any specifics: Can people tell me during what time zone(s) they increase their basal and by how much? Muchas gracias. Sorry if I was sounding a tad irritated; it's how I'm feeling at the moment...sigh.
I would start with a 120% temporary rate about one hour before going to bed for as long as you normally sleep (e.g. 7 hours). But I would make sure that I woke up in the middle of the night and tested. If your blood sugar is low 2-3 hours after going to bed, you can cancel the temporary and see what happens in the morning. If your blood sugar is normal or high at 2-3 hours then what you are dealing with isn't (only) DP.
If you are still high at 120%, I'd bump it up another 10-20% and try again. Using temporaries is much simpler than changing zones.
While DP is a likely culprit, you don't yet have hard evidence since you haven't narrowed the time of your spike.
Maurie
Thanks, Holger; glad your numbers are starting to stabilize, albeit at a higher dosage. I do resist taking more insulin since I'm so susceptible to weight gain, but if I need it I need it. Yes, California has a mild change of season, but more so where I live which is in the mountains in the north. It can be 20s and snow during winter and over 100 during summer. That beta cell thing is still a possibility as well. I'm going to do a c-peptide when I go to Guatemala in July.
Thanks for your wisdom; you are a very logical person which I am only about 1/2 the time...lol
Let me make sure I understand correctly, Maurie. The Ping Temporary Basal works by "Change %". So when you say 120% temporary rate I'm assuming you mean a "change %" (increase) of 20%? So a rate of .600 becomes .720? Correct?
I'm also confused by why you say if my blood sugar is normal or high at 2-3 hours then what you are dealing with isn't (only) DP? If I go to bed at say midnight then wake up and test at 2 or 3AM and I am normal, doesn't that mean that the increase effectively countered the DP? (Since Walsh says the rise starts generally around 2AM)?
DP is just when your blood sugar rises in the early morning (after about 3:00 AM), not necessarily after waking up. If I have a flat basal rate I can go to bed at 5.5, be 5.5 at 3:00 AM, and then be 13.5 at 7:00 AM, without eating anything. On MDI there was no real way of controlling this other than waking up at 3:00 every morning to take a shot. On the pump, my overnight basal rate goes from 0.95 u/h to 1.45 u/h at 3:00 AM and stays higher over the next six hours to cover the rise.
Even with the basal rates adjusted, if I wake up and don't eat I will often (but not always) rise. This morning I was 7.7 (139 mg/dl) when I woke up at 7:30, but I was running late so didn't correct and didn't have breakfast until I got to work. By the time I had breakfast at 8:45, I had risen to 12.4 (223 mg/dl) without eating anything. I think this is part of the dawn phenomenon, but not exactly the same, because if I slept in late until 9:00 I wouldn't wake up high; it's only when I wake up and don't bolus or eat.
That's correct .60 becomes .72. I've never used the Ping so I don't know what the screen's look like but the goal is to increase your basal from 100% to 120% of the amounts you've set as your basal per your schedule.
I didn't realize that Walsh says that the rise starts around 2AM. That's barely after my bedtime :-). I was assuming that DP hits a little before dawn - let's say 4AM or a couple hours before waking which for me is closer to 6AM. If I'm high at 3AM, I think of it as needing more overnight basal and not only additional basal to cover DP. The bigger idea is that you want to up your basal a couple of hours before you start seeing a spike to give the insulin a chance of countering it.
oh, okay. Well if John Walsh says so. It is just a fact ALL living creatures have some level of DP, as diabetics we just have to counter the affect of it. I have my increase at 5 am as I said earlier, and it covers my DP, and allows me to have a nice cup of coffee before I hit the trail in the morning. Yay for pumps!!
Thanks, Jen. Wow, that's a 50% increase! I'm going to have to work my way up slowly, because living alone it would scare me to increase by that much at once. But at least I know when to target the increase now.
I give up.
Yes - I would definitely increase slowly! I was already having major problems with the dawn phenomenon when I started on the pump, so my endocrinologist was comfortable making a pretty big "bump" in my basal rates around that time, and it's made a big difference in my morning readings!
Zoe - Have you checked your blood sugars at 2-4 AM? It sounds to me more like somogyi effect than anything else. The more you raise your basals, the lower you might go at some point in the night; then your liver pumps out glycogen, thus raising your blood glucose astronomically.
When I was in the Joslin, my roommate had come from the west coast to stay at the Joslin to figure out why she was so high in the mornings, even though she kept raising her nighttime dosage. Sure enough, she was going LOW in the middle of the night, prompting the somogyi effect. As soon as they LOWERED her nighttime dosage, her morning bg's came back to normal.
Ruth
"And I know for sure that I have not had it for the last 6 years"
I only started experiencing it myself about 5-6 years ago after 20+ years Type 1. My original endo thought it was creeping insulin resistance which is neither here nor there with this effect--I only heard the term "dawn effect" about 6 months ago when I first started investigating switching to a pump from lantus/novolog. I was taking metformin at night but found I was still having to inject novolog according to a rule-of-thumb method of my own devising to keep my morning BGs within my target zone. Which was crazy--sometimes it worked, sometimes it didn't, sometimes I'd be getting severe lows in the wee hours (fortunately I sense 'em and wake up). My new endo said that was crazy and I should look into pumping so I could set appropriate rates for what my metabolism was doing.
So the lesson for me anyway is don't think things won't change. Your body goes through lots of changes as the years go by and you have to be prepared to alter your regime to account for it.
Manual control of your own endocrine system is not simple.
Thank you, DrBB. Very good advice. I keep getting hung up in trying to understand things instead of just dealing with them. A very smart man, Fritz Perls once said, "Understanding is the booby prize". I like your last sentence.
Thanks, Ruth; at everyone's suggestion I'm going to be checking my blood sugar during the night. I honestly don't think this is the case, (It's an Occam's Razor/ intuition thing) but it will show up on the checks if it is.
Zoe - I've had dawn phenomena for a long time. As long as I've had a pump, since the late '80s, I've programmed a DP basal profile. Since you asked, here are my current settings:
12:00 a.m. 0.5
4:00 a.m. 1.1
7:00 a.m. 0.7
As you can see, my DP bump is very pronounced. Gary Scheiner said it was larger than most. Another thing Gary advised me is that it's better to adjust basal rates in appropriate sized steps. For me, he advised 0.1 increments. During a recent video interview here I asked if that increment applies to everyone. He said no. If a child was only taking 0.2 units basal, an appropriate increment for them might be 0.025.
My total daily basal insulin = 16.4 units and my rates for the rest of the day run from 0.5 to 0.7.
Very good at catching this right away. I've had things like this in the past go on for weeks. I'm getting better at responding now. I'm tweaking basal rates several times each month. I use a spreadsheet to track the changes now. It gives me some perspective.
You will fix this.
I've definitely had that happen, too. I can wake up at 110 and have the least little bit of carbs, say 5 grams, and my BG will shoot up to 200. When I see that, I know I'm on a rebound and that I not only had a low but that it probably went on for more than a 1/2 hour. Now that I have the CGM I can actually measure the time I went low but usually the Dex or the dog wakes me up before I stay low for too long.
Thanks Terry; very encouraging! Ironically, right before I read this I programmed in my tentative bump from .600 to .700 which is exactly the .100 increment you mentioned! But, reading Walsh, I started mine earlier, from 1AM to 7AM. We'll see how it goes. And yes, though I HATE it, I will check around 3. I may just stay up which is less painful to me..lol. Yes, I keep track of my changes too though I do it old school. Never a dull moment with this crap. And some people actually need to do puzzles to keep their brain active as they age!
Well, I got the timing pretty clear of my jump in numbers. At 1:00AM I was 135 and at 3:00AM I was 238! Which puts it right in the middle of the time period John Walsh describes for the DP rise (1-3AM)! I tried increasing my basal from 1AM to 7AM to .700 which felt like a scary leap to me but was only a 12-15% increase from my previous rates. I woke up in the high 200s again (I didn't correct during the night). So I will do another .100 increment tonight. This is stressful!
Maurie, you never said, how much is your actual increase in rate for DP? I feel pretty comfortable in knowing the timing between my experience and John Walsh's recommendation and I know I'll keep increasing it slowly. But having a reasonable target in mind would help. Terry gave me his which is a 100% increase and said that he was told that was a high one. How much do other people increase their basals by for DP (whatever time you do it)? Thanks.
Stubborn, ain't it? I've been inching mine up to deal with this over the last week+. Right now I'm at midnight-3pm: .85, 3am - 7am 1.95 and that finally seems to be reining it in. It's definitely wise to be incremental but the effect can be surprisingly tenacious. I'm terribly impatient about this stuff myself--I want that number down goddamit--but it's helpful to see what other peoples' experience is.
Interesting to hear that Jen. For me on a pump and CGM with DP, even if I sleep-in, I start to rise same as if I woke and didn't eat.