Dawn Phenomenon. How much is too much?

I have been having issues with elevated morning reads. If I go to bed with a decent number I will wake up higher, 40 to 60 points higher. I have been testing at around 3am for the last few weeks, I am lite sleeper so this is no problem. I find that I will drop a very sight amount from bedtime but its always the same 40 to 60 points higher in the morning,

I know that some DP is inevitable but how much is too much?

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I just had a discussion with my endo on this topic. She is convinced that I am going extremely low overnight and counterregulating in the morning. I called ■■■■■■■■, but in order to prove her wrong I have to get up in the middle of the night (repeatedly) and test. I did this last night and I didn’t go low (surprise). We ended up coming up with a compromise, I will wear a clinical CGM and we will record my overnight blood sugars. I basically already know what it will say, I don’t go low overnight. Unfortunately I will likely have to admit that I probably need a pump if I have any hope of controlling my Darn Phenomenon.

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Love it! The Dawn Phenomenon is exactly why I went on the pump and oh, how I love my pump! I’ve got my basal rates dialled in to the point where I stay flat within 10 points all day if I fast (I work at a desk job).

As far as how much is too much, well that’s up to the individual, I guess. I had 50-60 points of rise and it worried me to the point that I asked to get a pump. My endo was wishy-washy because that was literally the only real spike in my BG, but in the end, I sweet talked him into it :smile:
–buck

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Before I got the pump, I was combating DP by taking a small mixed-nutrient snack (low-carb ice cream) at around midnight every night. This helped me keep my mornings no higher than 110. Problem was that despite that, I was also going low twice a day – at around 4am and at 5pm. Changes in my basal insulin helped, but only for 2-3 days, after which I was back to the same pattern. My endo also thought that my high BGs was a counter-regulation (Smogyi effect). I DO wear a CGM and saw that even on those nights when I did not have a low, I still had high numbers in the morning (when I skip that midnight snack); however, my endo wouldn’t accept my explanation.

Maybe it’s for the better, though - to avoid those lows, he got me on a pump. The pump has been wonderful - within 2 weeks, I all-but eliminated those daily lows by adjusting basal rates. It has also added a lot of convenience, though that was not part of the reason to get it. Are there issues? Sure, but I think it’s been a good trade off, so far.

When I do a formal basal rate test my goal os to limit an BG excursion to within 30 mg/dl of the starting BG. So I would say, if you rise (or drop) more than 30 points overnight then I would define that as “too much.”

The reason that Darn Phenomenon (DP) is a curse on those of us with Type 2 is that we usually lack the tools needed to deal with it. Diet, exercise and oral medications are useless. Few of us are able to get pumps and many of us can’t even get access to insulin to manage things. And the terrible thing is that for many of us, if you wake with really bad DP it will be harder to control your blood sugars for the entire day.

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Before I went on the pump in 2007, it was rare for me to wake up below 10 mmol/L (180 mg/dl) even going to bed with a blood sugar of 5.5 mmol/L (100 mg/dl). The only way to not wake up high (and usually I woke up much higher than 10 mmol/L) was to wake up at 3:00 AM and take a couple units of rapid acting insulin. I wasn’t willing to do that forever, which is one of the primary reasons I switched to a pump.

Recently my dawn phenomenon seems to have disappeared, which would go along with my blood sugars in general going completely out of whack lately. I used to have my basal rate increase drastically at around 2:00-3:00 AM, which was my highest basal rate of the day. Now my basal rate is highest during the day and lowest overnight.

@Brian is right, dawn phenomenon is very difficult for most T2s to deal with because without insulin there is not much that can be done.

Having an insulin pump is the best for tackling DP because you can set a higher morning basal rate to counter act it. I am luckier than most T2’s because I do have a pump.

I see some adjustments to my morning basal rate in the very near future.

Thanks Everyone.

My dawn phenonomen numbers (fasting numbers at waking up) were over 200. Type 2 here also. This alone got me qualified for a pump. I’m so glad I got the pump, never could achieve a good a1c with injections.

My insurance wanted to see numbers over 500 to qualify me for a pump (despite my regular hypos)! I only got it thru the “back door” because while they wouldn’t pay for a pump, they will pay for pump supplies. The Asante Snap sold completely as “supplies” vi pharmacy, so I got it. I am glad I did! Now, with Asante gone :frowning: I have the Vibe which I got via trade-in.