Dawn effect or symogi?

Type 1 and LADA
1

So, with the awareness that I have the most defective case of T1 diabetes known to man, and that what I consider “high” is actually perfectly acceptable according to the ADA, and I probably shouldn’t even be worrying . . .

Over the last few weeks, between getting married and fighting off a cold, my fasting sugars have been creeping up. I tried increasing my very large Lantus load from 2U to 3U, and the fastings seemed to get a bit higher (moved into the 120-130 range.) Decreased it to 1U, was in the 90s. Started my new Lantus pen last night, 2U, (generally, I find that pens go bad after 3 weeks or so, and this one was almost the full 4 weeks old) and had the highest fasting sugar I’ve had since honeymoon kicked in, around 138.

2 hour posts, by and large, are all <140, and usually <110. Bedtime sticks are usually also approximately 2 hours post dinner, and are in the 85-105 range. I’m maintaining postprandial euglycemia without exogenous insulin.

On weekends, when I’m up at ridiculously late hours, my sugar is below 100 at 2-3 AM. Since it would seriously screw up my ability to function at work (I have a heck of a time falling back asleep once I wake up), I haven’t set an alarm to check my sugar at 2 AM on a regular night, but that’s usually only about an hour or so after I go to bed, anyway.

One last piece of data to throw into the mix. Just over a month ago, my endo and I wanted to try moving that huge insulin dose to the AM for some reason which I can no longer recall. After 1 day, I moved it back to nighttime, because I had my first hypo in ages about 2.5 hours after breakfast. (Yes, on 2U Lantus. Like I said, defective T1.)

So the question is, does this sound like dawn effect or symogi (body correcting for low sugar by dumping large quantities of glucose)?

Thanks,

– Dov

2

Throw into the mix that I’ve started taking a fish oil supplement to try to raise my HDL, which can apparently have a minor effect on FBS.

3

Dov,

Are you sure you are a Type 1? Your doses and you reactions sound almost identical to what I use–and what I go through. Including the “going up with a teensy bit extra Lantus” experience. And also the way that, for me, pens seem to “go bad” fast while no one else seems to have this problem. I assume it is because I’m using those 2-3 unit doses though I can’t figure out the exact mechanism.

Doctors don’t care since like you, I keep my numbers very good through immense work. But I really wish I knew what was going on. I am currently eating less than 10 g of carbs a day for a few week and my fbg is the best I’ve ever seen. If I eat even at Bernstein carb intake levels, it goes right back up.

I am reinforced in the belief that my beta still put out normal basal secretion but nothing else, though I’m coming to believe that my glucogon-producing Alpha cells may be involved The only oral drug that really helped me was Januvia, which I had to stop taking because it inhibits a gene known to suppress a kind of cancer I have already had.

But the one thing that Januvia does that none of the other drugs do, including Byetta is to increase a hormone GIP which impacts glucagon production. So perhaps I have a alpha cell glucagon disorder causing these huge in appropriate surges in blood sugar.

Sure would be nice if doctors had the slightest curiosity here and a willlingness to do some testing. They don’t. One look at the A1c (5.9%) and they are done.

4

I am type 2 and am on 500mg of Metformin twice daily. My fasting numbers are always above 140, and I thought that was normal. My one hour is usually in the 180’s to 200’s, and my two hour is always above 140, usually in the 150’s. I see my doctor on the 20th for a follow-up, and have kept a log. Should I be that high with Metformin and regular exercise and a low carb, high fiber diet?

5

At my last endo visit, my endo - who’s one of the few doctors my parents (MDs both) both say they trust - provisionally reclassified me as T2, pending results of the antibody tests. When he got those back, he was at a loss to understand why I had ANY pancreatic function at all. Insulin and ICA-512 antibodies (I think - whichever of the islet cell antibody tests is the most current) 3-4x reference range, and GAD65 antibodies appx 100x reference range. He didn’t bother doing any c-peptide testing, since, in his words, it’s obvious that I’m still producing insulin.

It seems that I’ve found the only endo in the world who actually is concerned about what concerns the patient, and wants to work with the patient. I’m not listening to his dietician - am low carbing, high protein and fatting, etc. - but since my A1C was 5.2, he said, just keep doing whatever you’re doing, because it’s working. At the same time, he suggested the antibody tests about the same time I was going to ask about them.

So, in that regard, I’m a T1 with more or less euglycemia. I think (in my admittedly non-expert opinion) what probably happened is that I had a weight/stress related flareup of T2-type insulin resistance with the bar exam, lack of sleep, wedding planning stress, etc, and that led to the discovery of T1 that has yet to really take hold. Of course, I could be like Halle Berry and have cured my diabetes :-p.

I’m going to go down to 1U Lantus tonight, discontinue the fish oil, and try to get home and eat early and take the insulin early so that I can get a 3-4 hour post and have an idea where things are going.

6

Being a T1 with defective diabetes, I know just about nothing about T2, but those numbers sound like they’re in the ADA range. Depending on your meter, 150s can really be in the 140 range. I suspect, based on my expert knowledge (in other words, I’m talking out of my . . . ahem) that your doc may increase your Metformin. Also, as you start to get into better shape, you’ll possibly find your sugars dropping. It certainly happened with me. Losing 50 pounds certainly helped a great deal, even for my screwy pancreas.

You’re also still in the early stages, where you’re figuring stuff out. Your doc should help you get things on track, and there are people here who put a lot of MDs to shame when it comes to knowledge.

Keep us posted!

7

Sounds to me like your numbers are just starting to increase, at the end of which you will come out of your honeymoon. Coming out of the honeymoon you may start to see higher numbers in the evening and overnight. End of honeymoon, you will see much higher numbers than you mention, in the high 200s. You still must have a lot of beta cell function left though.

8

I’d think that, except for the dose-dependence of it and the fact that my post-prandials are staying the same/improving, except for perhaps breakfast. Higher dose of insulin=higher FBS; newer insulin=higher FBS.

I suppose I should wait to see what happens after this cold breaks, however.

9

Dear readers.

Well with Dov HA1c being so good as 5.2 % you my not be entitled to see a Diabetic doctor here (Calgary, alberta, Canada). My lousy 6.2% was deemed to be spectacular by my Endo. I asked my wife who is part British what that meant was it good or bad? She said very good.

Today I went to see a new GP, He said 7.2 i.e. 130 , 7 day average of fasting and postpradial was not great. Also He did not say that I was a lunatic to be trying a low carb diet. He said the A1c should be measured every 3 months not once a year. Sounds like we are going to get along.

10

Dear Dov.

Is this 2 to 3 units of Lantus per day and is that all you are taking? This is way less than a type 1 who has been for years, who takes about 55 IU about half and half Lantus and rapid, and probably not much insulin resistance that I met. Some type 1’s on this site use about 0.4 IU/Kg-day.

More insulin and higher blood sugars is strange. Stress and cold could be factors.

Type 1 seems a lot more fun than type 2 if I am don’t really know nobody bothered to test. I think somewhere in between because even with extreme weight loss and super exercise the fasting was never below 130. Metformin and Avadia did not work. Insulin works can go hypo if I try hard enough.

11

Anthony –

Sounds like your new GP has a clue!

– Dov

12

Right now, the 2U is all I take. I can go into the high 70s 2 hours PP with no exogenous insulin on board, and I find that when I’m really bad (see: wedding - rice, cake, and other carby goodies) I’ll still have numbers in the 110 range. Well, except for breakfast, and that’s meal dependent.

13

Yes Dov. I think old one learnt the business with urine test strips with which I never measured any blood sugar with readings below 200. Maybe at 300 you get sugar in the urine or does it depend on the individual kidneys?

14

According to wikipedia, the renal threshold for glucose is between 160-180, depending on the person. http://en.wikipedia.org/wiki/Glycosuria. Your mileage may vary, obviously.

15

This is great Dov.

So far it is a friendly diabetes, may God allow it to stay that way for ever. Mine is also behaved as nothing below 75 and nothing above 150 but takes a lot of work and being achieved with excessive weight gain in the past. Garbbie goodies bye bye, a must or soon death.