Dawn Phenomenon Timing


#1

I’ve been trying to split my dose and use bolus corrections upon waking up to try and better handle the dawn phenomenon but i have some questions:

  1. When does the liver dumb actually begin ?

  2. How far should i split my lantus dose ?

  3. Will using another type of insulin help ? like Levemir or even complementing with short/intermediate insulins ?

  4. does R-ALA help with the DP ? i’ve already ordered some to try after reading Dr Bernstein’s Diabetes Solution.

right now i’m doing it at bedtime and as soon as i am up for convenience which usually leads to higher BGs in the morning but today i tried one dose at bedtime and second at 4 am instead of the usual 6:40 dose plus 1 unit bolus correction and it did help as i woke up 6:30 with a nice 5.5 but after taking the morning shower and getting dressed it climbed to 6.4 and by the time i arrived at work it was 7.1


#2

With me there is no exact time that the DP starts. It is usually around 4-5am. My endo has my pump to start adjusting at 2am.


#3

I see two phenomena at play. The ‘Dawn Phenomenon’ that tends to happen (for me) around 4:30am and the “foot on floor” phenomenon that happens, well, when I get up. I’m on a pump, so I program my basal increase around 3am to try and stop DP - I suppose it should be at 2:30am to give the insulin the opportunity to fully work, but that sends me too low around 4am, before the liver kicks in.

I take a bolus correction after getting up and getting dressed to handle the “foot on floor” spike. I wait for that, because the FoF spike seems much more unpredictable, so I have to see what happens before correcting.

Note, I’m using a pump, so only use rapid insulin. With basal insulins, the timing might be different. I know Dr. Bernstein says that he takes his second dose of Lantus at 3am to cover his DP.


#4

Depending on your dose, the duration of Levemir can last anywhere from 5-23 hours. so you could take it at night and use it to help your BG early in the morning. You could also take NPH which, if timed correctly, could help. I take it at night when I am using injections.


#5

If it’s dawn phenomenon, then the liver dump probably begins around 3-4 AM. There’s also “feet on the floor” phenomenon that can occur as soon as you wake up. There’s also just general insulin resistance in the morning for some people. There are lots of different things that can factor into higher morning basal needs.

You could try adding more to your evening dose/less to your morning dose. Your morning dose is tapering off/starting up in the morning, so adding more there will likely not help. You can split your daily doses as far as will work for different times of the day. If you end up running high in the late afternoon/evening (when your night dose is tapering off/starting up) then you’ve allocated too much to the evening dose and not enough to the morning dose.

I think it’s worth trying to adjust the amount you dose at different times of the day. Depending on your bg level during the night, you could try adding a unit to your night time dose. There are a few different approaches you could try. Eventually, through trial and error, you’ll likely come across one that resolves the problem.


#6

Since I began splitting my dose and measuring more frequently i’m becoming aware of these two being at play in the morning DP and foot on the floor. if i covered correctly for DP during the night and woke up with a nice low BG i’d still have to use perhaps a unit or two of Novorapid to cover the slight increase that occurs as i wake up, shower and head to work.
I still find that I have to increase the bedtime Lantus dose to cover the DP, i’m thinking maybe i should switch to NPH for the bedtime dose to make use of the “peak” which doesn’t come with Lantus. I’m thinking so because it would be useful that it might also rid me of the need for the little bolus dose when I wake up.


#7

I’ve actually found a study that confirms that NPH is more useful than Lantus in controlling DP, I guess i just need to get a prescription for it.


#8

You can get a prescription for the name-brand NPH versions to make it cheaper with insurance.

But you can also get the Walmart version of it with no prescription necessary. And it is only $25 with no insurance needed.

It is called ReliOn Humulin N, and you can get it from any Walmart pharmacy over-the-counter.


#9

I’m afraid i’m in Australia, there is no over the counter insulins here but the upside is all insulins are subsidised :slight_smile: the hard bit will educating my own GP or Endo in why I need several insulin types :sweat_smile:


#10

Basal testing might help determine when. You can learn more about it here:


#11

When I need changes to my diabetes control régimen, I do some research and make some print-out to show my GP to help convince her of my needs. I try not to tell my endo because they have some attitude, "I am the expert so shut up… then I counter with… Doc, it´s me who´s going to die with poor control, not you so shut up and give me the script.

The medical system is sometimes “anti-diabetics”


#12

I mentioned this recently on another tread. Unless your endo is a diabetic, you have more experience taking insulin and doing BG tests then they have.


#13

man i just had this conversation with my GP last night , i asked her to prescribe me Humulin N (NPH) to use it to control DP as well as Humalog and Humuin R as Dr Bernstein recommended and she was like " we do not prescribe Humalog or Humulin anymore in Australia and you cannot have Humulin N i can give you novomix which is like 30/70 or 50/50 rapid acting and NPH".

she told me that HBA1C of 6.2 which is my latest is great and i should just chill and increase my lantus bedtime dose.
i was so angry when i left her office i literally felt the blood rushing to my brain :angry:
I’m seeing an endo in 2 month, I guess i’ll find a way to make him write a prescription for me.


#14

Take a trip to America, and stock up. Like I said, no prescription needed, and only $25. :grinning:


#15

I am fortunate with my Endocrinologist - he is receptive to any suggestions I make and has ordered different types of blood work to explore other aspects of diabetic management at my request. He has told me several times he wishes all of his patients with diabetes were as actively involved in their management as I am. I have had other specialists, however, who go with the ‘holier than thou’ attitude so I am grateful my endocrinologist
doesn’t do that.


#16

Just to add a little story to this problem. I also had some wicked DP problems for awhile and we were trying so hard to get the blood sugars perfect so I could get the ok to try and get pregnant. I was up to five shots a day. We split the long acting, we changed the timing of the long acting. We tried everything. That was when my endo said, the only thing that is going to help this problem is a pump. Man, I didn’t want a pump. Diabetes is tough enough, I didn’t want to add more to it. But we wanted a child, so I went for it. It wasn’t smooth sailing at first but it did fix my DP. And have now been pumping for over 27 years.
The only other suggestion if pumping is not an option or something you would like to try, I have talked with many who have the “feet hit the floor “ type. They just automatically take an injection or short acting as soon as they wake up. Good luck with this one. Iguana tough one and as we all know, when you start the day off with a good number, the day just seems to go better!


#17

cost is a big issue for me at the moment, i’d have to get insurance to get a pump a year later, and i’m still not sure if they would cover all expenses like infusion sets and so on. I can certainly live with multiple daily injections, maybe i’m saying this because I cannot imagine yet how good the pump will be but i might end up getting that insurance just for the sake of a pump and i might find one that covers CGM as well. i just cannot imagine having something tied to my body at all times yet :face_with_raised_eyebrow:


#18

I’m not a big fan of pumps. I currently use Tresiba as my basal insulin. I’ve heard Levemir is great as well (though it’s very different). Lantus is an older basal insulin, and I’ve used it many times before. It’s ok, but I think Tresiba is a lot better. Does Australia cover Tresiba? Or Levemir?


#19

we don’t have Tresiba in Australia but we do have Levemir, I might switch to Levemir from Lantus if i decide to go with NPH for Bedtime insulin to control DP but i’m afraid at the low dosage i’ll be taking (5 or less during the day) Lantus has a better chance of lasting closer to 24 hours than Levemir otherwise i’d have to split Basal into 3 doses


#20

My reference is to Regular but same was true about NPH. Walmart’s contract changes every so often for which Regular is only $25. It might be Novolin today and Humulin next month so I always say “I need a vial of Regular insulin, Novolin or Humulin, whichever is priced near $25”. I do not notice any difference in the 2 brands.