Dawn Phenomenon

Hi All!

For the past few nights, I’ve been waking up with higher bg levels. I go to bed with a 100, check
between 2 and 4 am, and bg is 120, then wake up around 6 am and have a reading of 150. Do you
think it may be DP. I take 19 units of Lantus am. only. Maybe I should split the dose. I’m up for
any advice. Thanks!
Linda

It sounds to me that your body might not be getting enough insulin through the night, but you’re pretty darned close. In all honesty for a Type 1 diabetic, the numbers really don’t sound that bad at all. I see that your new to the world of diabetes. For most people some variability in blood sugar is just a fact of life. Before making any changes I would definitely check with your Endo.

Thank you for your reply Kevin. I was just dxd January this year so I take it one baby step at a time.

My Endo has me on a correction scale so I’m not counting carbs to insulin as yet. I go back in February

and she said we’ll discuss all further options,including pump therapy. I am 58 years old and my recent

diagnosis is frightening to me since no one in my immediate family has never been a diabetic. My bg levels

during the mid-morning and later hours are quite good, so I still am leaning toward the DP. I just try and not allow

my numbers to stress me. I agree with you that all of us at one time or another have to deal with rollercoaster

readings.

LINDA

Hey Linda,
I agree with Kevin that 150 isnt too bad but your situation should definately be monitored. Dawn phenomenon is a weird thing because it just ‘appears.’ I’ve had diabetes for over 15 years and JUST had this start happening to me for the first time last month. I’d go to bed with a good reading. I’d check it at 7am and it would be decent but by 9am it would be in the 200’s. The insulin pump has been excellent to help prevent these highs from occuring. Diabetes is a scary thing, especially in the begining, but it will get easier with time.

Hi Linda,

I have DP & can relate. I also was diagnosed recently (late May), am in your age group & no one in my family has diabetes either.

I was put on carb counting right away. Don’t understand why your doctor is waiting a year!

150 is high. Sure, it could always be worse, but it could be a lot better.

You should be taking an evening dose of Lantus. It’s not necessarily a matter of just splitting it. If your daytime readings are good, you may need the full dose of 12u for your waking needs. Basal taken at night is used up within 8 hours, so two separate doses are usually prescribed.

I was on Lantus & it never lasted for 14-18 hours in my body. Other people have had the same experience.

What has helped me, if you want to discuss this with your doctor:

*I was switched from Lantus to Levemir. My endo feels that Levemir is more stable. It’s also less expensive & lasts longer than 28 days. My fasting numbers are much better now on Levemir.

*Two doses of basal–one immediately upon arising. The other immediately before going to bed. Again, it only lasts 8 hours, so you have to take it at the right time.

*Taking a bolus rapid acting immediately upon waking up & eating right away. With DP, numbers continue to rise for several hours after getting up for most people.

*Eat dinner 4-5 hours before going to bed. Don’t eat a dinner heavy in fats.

Hope this helps!

Good fasting reading should be less than 100.

Linda,
You are still learning if you were just diagnosed this year. Try not to be too hard on yourself. Have you tried checking in the middle of the night, like around 2 am or something? This usually helps determine if it is DP or not. My endo and I are trying to figure out if I have DP. However, he said that sometimes, if we go low in the middle of the night, then our liver starts trying to keep us from going “too low” and starts producing more and more glucose to keep this from happening. As Kevin said, though, definitely check with your endo before making any changes to your insulin regimen. Good luck.

HI HOLLY

YES I DO SET AN ALARM AND CHECK BG AROUND 230 OR 3 AM. IT IS USUALLY ONLY A 5-7 POINT

DIFFERENCE. WHEN I GET UP AROUND 6AM,IT THEN JUMPS ANOTHER 5 … THAT’S WHY MY ENDO

FEELS ITS DP. I’M RELUCTANT TO MAKE A CHANGE IN MY BASAL LANTUS INSULIN. I TAKE 19 UNITS

UPON WAKING AND IT DOES SEEM TO KEEP MY DAY READINGS AT A SAFE LEVEL. AND YES I AM

LEARNING. I HAVE ALWAYS KEPT JOURNALS SINCE DXS, AND LOOKING BACK I ALSO WENT THROUGH

A LONG HONEYMOON PHASE AS WELL. MY ENDO ASSURES ME WE WILL DISCUSS OTHER TREATMENT AVAILABILITIES WHEN I SEE HER IN FEBRUARY.

I HEARD LEVEMIR HAS ITS PLUSSES OVER LANTUS. I HAVE HEARD GOOD FEEDBACK ABOUT APIDRA
AS WELL. I LIKE THE FACT THAT APIDRA ALLOWS YOU TO TAKE IT AFTER THE START OF A MEAL VERSUS NOVALOG WHICH I HAVE ALWAYS TAKEN PRE MEAL. MY ENDO DOESN’T WANT TO CHANGE
MY LANTUS TO A SPLIT DOSE. SHE SAYS OTHER PATIENTS THAT TAKE LANTUS AT BED HAVE EXPERIENCED LOWS IN THE MIDDLE OF THE NIGHT. I WOULDE BE A BETTER CANDIDATE TO TAKE
LANTUS AT 6AM AND 6PM, BUT THAT’S SOMETHING THAT WILL BE DISCUSSED ON MY NEXT APPOINTMENT.

I may not be converting this right, but 150 calculates to 8.3, not 5.5. Divide by 18, right?

5.5 is 99, which is ideal:)

I’m not sure. All I can tell you was my last appt. 3 months ago was 7. At dxs I was a 14
then 10 then 7 so I’m hoping for the 6’s. Next appt. in February.

I was replying to Rainbowgoddess:)

She’s in Canda. The Candian way of measuring BG is different from that in the US. Not talking about A1c, but BG reading. She was saying that a BG reading of 150 is their reading of 5.5, but it’s not. You take ours & divide by 18 to get their equivalent, Or, take their scale & multiply by 18 to get ours.

Sorry, confusing:)

Sorry, I was responding to what you said about 150 being ok. 150 calculates to over 8, yes. 5.5/ 99–ideal, yes. Every time I’ve had fasting numbers over 100 consistently, my endo, CDE & internist said this was too high & told me under 100 is what I should aim for. My basal doses were changed, then the brand of basal, what I could eat for dinner & when. Under 140 post meals was the goal, but they were very concerned when my morning numbers were what they considered high.

Hi Linda,

A 50 pt overnight rise sure seems like DP but I’ve read that for some people Lantus does not last a full 24 hours. So, it could be one of two issues or a combo of both. You are not catching any lows when you test during the night, so I’m guessing you are not getting the rebound highs that Holly mentioned.

I had a similar situation where my bg was rising about 30 pts overnight, so I started taking my 15 units of Lantus at night instead of at morning which was a perfect match to the DP because my Lantus peak drops me about 30 pts. (I am just now shifting back to taking it in the morning because I appear to not be getting this 30 pt DP anymore (if indeed it really was DP). Maybe I was getting rebound highs?

In your shoes (keep in mind, I’m very independent of my doctor), I would first try taking the full dose of Lantus at night. The peak effect of the Lantus should eliminate most of the 50 pt rise. If you still go too high overnight (keep confirming this over several nights, if not more), then you know it is DP in which case I’d split the dose and slightly increase the nighttime dose to cover the DP leftover after the Lantus peak. On the other hand, if you notice your bg creeping up in the hours before taking the bedtime Lantus, then you know the Lantus is conking out before the 24 hr mark and you should split the dose to get full 24 hour coverage. Personally, Lantus has worked extremely well and I’ve never had to split the dose.

A 150 blood sugar isn’t going to hurt anyone. People without diabetes have 150 blood sugars on certain occasions. If my blood sugar was 150 (it is slightly high) every morning. I could live with it.

Hi Don,

Just a few details from yesterday. 7pm last nite bg was 124. Had a big snack (my bad) so by bedtime I

was at 175. I am on a correction scale of a minus 1 Novalog if bg is between 150-199. so there was no

Novalog given. Now this is whats strange… I set my alarm for 2am and my reading was only 118. Now keep

in mind there was no novalog at bedtime with my 175 reading. I got up at 6am and my fasting reading jumped

to 159. Maybe it is the Lantus wearing off, but I don’t feel its the culprit.

Kevin,

I just replied to Don and told him my evening bgs last nite. I had a 124 at 7pm, had a snack ( too much). I went to

bed with a reading of 175. Woke up 2am and that reading was 118. Got up at 6am and my fasting bg was 159.

I really don’t think its the Lantus, but DP. My day readings yesterday were quite good.