Dawn Phenomenon

I was telling my endo I’ll eat the same thing for breakfast as for lunch, but for breakfast I’ll hit 190 and for lunch I’ll hit 120 as my peaks. He said many people have a bit of insulin resistance in the morning to so bolus more. I had never heard of that. Does that happen to anyone else?

Absolutely happens to me too. I manage by eating negligible amounts of carbohydrate in the morning (~15 - 20g) and take almost uncomfortable amounts of bolus insulin to cover it, which works pretty well… Frankly, I believe the “resistance” is really a function of the facts that your stomach is empy and not distracted (glucose hits the bloodstream much faster) and that our circulation isn’t quite at full speed given we were recently asleep and dormant (insulin doesn’t get distributed quickly). Sadly, most of the conventional breakfast foods in existence are loaded with carbohydrate…I dream of the day I can say goodbye to EggBeaters for ever and ever.

Good luck!

Yes, I don’t consider that DP though, DP is more when you wake up very high and keep going higher till you eat. But yes, most of us use lower I:C ratios for breakfast than other times of day. Mine are 1:7, 1:8 and 1:18 for the three meals.

Actually all forms of eggs are pretty much carb free; so you can eat scrambled or omelettes with vegies or meats, cheese, etc. Lots of choices, as long as you like eggs…lol. Other people have specific choices they eat, but I pretty much stick to eggs. I usually eat 23 carbs during the week (15 grams used for 1/2 cup of homemade refried beans) and 32-35 on the weekend at it works fine for me if I bolus 1:7. Why EggB eaters, Thomas? Are you trying to lose weight?

No, for me I’ve tested when I get up at 7am and before I eat at 8:30am and my numbers are like 85 when I get up and like 95 or so when I am ready to eat. Then I have 28g of carbs and bolus my normal 1:8 ratio and I hit 190. I had the same exact meal for lunch 5 hours later and hit 120 as a peak.

So is this Dawn Phonomenon a result or effect of the insulin that you guys put into your system? The reason that I’m asking is that when I check my BG levels before breakfast in the mornings, the levels are always higher than they are the rest of the day. I don’t take insulin shots, I’m just on metformin. So I would like to know if you guys have any suggestions as far as lowering those morning numbers?

Dawn Phenomenom is something that happens to everyone, even non diabetics. It is basically from the production of stress hormones like cortisol and adrenaline and growth hormone. When these hormones are produced early in the morning they send a messge to the liver to convert stored glycogen into glucose. If you have a stong pacreatic response your body will produce enough insulin to push the glucose into the cells to be used as energy. But many diabetics have few insulin producing beta cells, so our response is shakey. Some find using an insulin pump where they can regulate insulin levels early in the morning works. Other type 2’s have found other ways to combat DP.

Thanks Jeannie, that clears up a lot and it makes a lot of sense. So now that I’m clear on that, I guess I can try to start seeing about getting those morning numbers down.

Yes, happens to me also. For breakfast my insulin/carb ratio is 1:10, then for lunch & dinner its 1:12.

If you don’t have it already, I highly recommend the book Pumping Insulin by John Walsh. You can pick it up from amazon for around $5 used or $12 new. A lot of great info on using insulin and easy to understand, good book to have to reference back to also.

I find that if I get up during the night anytime from midnight to 3am and eat anything my morning BG will be 30 points lower. I usually have a whole wheat ritz and peanut butter

You say you bolus your “normal 1:8 ratio” and hit 190. If this happens regularly than obviously the 1:8 ratio is not good enough for that time of day. Many of us have different ratios for different times of day. The only other choice would be not to eat carbs at all for breakfast. Just have eggs, cheese, vegie, meat, etc and fill up on that and skip the bread or whatever is in your 28 carbs.

My son nearly always has high BSs school mornings. Endo reduced his ratio but I don’t think its enough, though when breakfast can be delayed like on the weekends his pre and post checks are fine, so I hesitate to make permanent changes. It sounds true that his circulation isn’t at full speed yet when he eats at 6:45am. He has DP with high numbers only some of the mornings, (this morning 205) but always above 13O 2-hrs after breakfast (school days) other factors could include; stress(rushed morning, 1st and 2nd period math and english honors classes), growth hormone(15 years old), morning basal needs to be increased. I dread doing basal/bolus testing, he hates missing meals and I hate serving same meals. Oh yah, his breakfast is usually the lowest carb meal at around 36; eggs, ww eng. muffin, cheese, cand. bacon small fruit and low carb choco. milk. thanks in advance for any insight. Diagnosed Dec. 09, so I am still educating myself. Going to order Pumping Insulin and Think like a Pancreas.

I am also wondering if pre-bolusing would help, but we are not on a CGM yet so it all the changes would hard to see.

Pumps are great: you can program your pump for the dawn phenomenon and never think about it again. On MDI, I adjust every morning: If low, I eat and if high, I correct. If I wake up in the normal range (really most of the time), I know my BG will steadily go up, so I take 1/2 unit each of Apidra and Regular (mixed) and take my thyroid pill. One hour later, I’ll still be normal and have my breakfast (not really, I have my mocha latte). I think this is a normal reaction/need because of the DP. Dr. Bernstein says he takes a unit of rapid acting insulin to start his day. The rate of rising BGs seems to stay consistent, so once you find what works for you, you have a plan.

I gotta try that, approx. how many carbs do you eat during the midnight snack?

We have about 40mins from wake up to getting pick up for school. Small bolus sounds interesting but I would hate to have him check twice in that short amount of time. Replied to a pre-bolusing discussion but it stop being active. Have you tried this, some go as early as 45mins.(w/ rapid insulin)! Right now we just overcorrect and hope for the best.

I have heard the explanation for Dawn Phenomenom or DP goes back to cave men times. When our ancestors woike up there was no food in the cave , so their bodies dumped glucose so they would have energy to go hunt food. Lots of people have found things that work for awhile. Some will eat a very late night snack of protein or fat, peanut butter and cheese seems to be favorites. Some wake up very early and eat something. I found increasing my metformin helped me control it. The other thing I find that works is to limit the carbs you eat, that way you don’t have lots of extra glycogen in your liver. I have also eliminated all processed food and chemicals and preservatives from my diet. My system seems to work a lot better and I rarely get those spikes in the morning.