Ok here’s my dilemma. Been pumping for a year now and was placed on the pump due to DP. Pump therapy alleviated DP. Started Bernsteins Method, and over nite and early morning Basal rates lowered due to hypo unawareness. Now DP is re-occuring BADLY!!! will goto bed with BG at 80 to 95 and wake up with BG at 130 to 170…CGM shows I go low, (50 or lower), around 3:00am and then shows me going starting to go higher around 4:30am, with continuous rise til I get up around 8:30am…I don’t treat the lows because my pump isn’t loud enough and doesn’t vibrate strongly enough to wake me…I’v tried setting my alarm clock to wake me at 3:00am to do a fingerstick but CGM would show me WNL and fingerstick would be WNL. So I stopped doing that after about a week. I do wake up drenched in sweat, and confused at least once a week and when I look at the CGM it shows I’ve gone low and Fingerstick confirms…Should I raise mt Basal rates back to what they were before or wait til my next Endo appointment on the 13th of Nov…My endo doesn’t want patients calling the office as he “won’t treat over the phone”. His practice prefers patients to goto the ER then follow up at a later date in the office…Thoughts??
Is it possible that your lows are causing you to counterregulate? If that is the case the solution might be to to actually drop you basal to avoid the lows.
I thought that too Brian…But with having 7 different basal rates to deal with I was actually just thinking about raising my 12:00midnight one and 6:30AM on back to what they were before and test if that corrects the problem…My other alternative is to stop or regulate Bernsteins method, that I have been following to a T to having a before bed Moderate Carb. (maybe 2gram of carb) snack and not bolusing for it to see if that might help…1 gram of Carbs raises my BG by 4 md/dl…BTW
I’d recommend a sample of tresiba to see if it smooths out the overnight ups and downs better than variable rates of pumped insulin do. Can always go right back to the pump if it doesn’t help.
I understand, but from what you had said you lowered your basal rates after starting Bernstein. I would be worried that you would have even worse overnight lows.
Maybe you can consider setting your CGM with custom night settings so that it can help you catch the lows.
Never thought of that Brian…I will see How to do that and give it a try before I do anything else…Maybe if I show my Endo whats going on he can figure out a plan of action with me. Thanks.
I find that I sleep through my Dexcom vibration or normal mode but wake with attentive mode. You might also be able to set the hypo threshold a bit higher (like 80-90) and see if preemptively treating an impending low avoids the later DP.
I haven’t been doing Bernstein’s approach, but have lowered my carb intake significantly - sort low-carb-moderate-protein-moderate-fat. Like you @weaver3, my basal rates needed to be dramatically cut - My total basal for a day is now just a bit more than half of what it was before. And like you, my problems with DP have re-awakened! I’ve noticed other changes, however. For example, unlike before, if I go somewhat low without a lot of insulin on board, I can count on my BG to rise (due to a liver dump…). I’ve also noticed that, also unlike before, I can “correct” more serious lows by setting a 1-2-hour temp basal of 0%. Of course, the caveat is that if I have an occlusion, my BG rises much sooner and steeper than it did in the past.
I’m thinking that the changes in my diet have improved my liver function – so, now, it “detects” low BG better and sooner than it has in the recent past. The downside of that, apparently, seems to be that DP is back and needs control.
A couple things that seem to work somewhat. One is increasing my carb intake at dinner time by 15-20g carbs (or so). When I do that, my BG us usually more stable in the morning. Another is having a glass of wine or a shot of spirits in the evening 8-9 hours before I plan to get up in the morning. Sometimes I do both. Finally, it seems that if I have a breakfast that requires approximately 4u (for me) taken before the morning rise begins, it seems to short-circuit the DP response, so my BG stays flatter.
Get a new endo. I never have problems with Dawn Phenomenon. I wake up and don’t know where I am. I believe the technical term is Tony Orlando Phenomenon. 