Dawn Phenomenon

I read quite a bit about diabetes and diets and medicines. I was diagnosed October 2016 with Type 2 and my A1C was 31.1, sugar level was 393. I was pit on Toujeo right away then they added Invokana. I ended up having my insides literally explode last March and didn’t know it until May. 4 months late I have a 3-day long heart attack. I will 58 in a little over a week. I was taken off of those meds and put on Metformin. First 500mg twice a day and now 1000mg twice a day. But my fast numbers in the morning have been rather high since I began taking Metformin and getting higher. For 4 months after my surgery I had normal numbers and no meds. Then the numbers began to increase slowly. Most mornings my levels are around 180-230. I do not have insurance and can’t find a diabetic doctor who will let me make payments for that stupid “New Patient Fee”. Everything that I’ve read points to Dawn Phenomenon. How do I get this under control? I’m taking ALL of my meds as prescribed and even added the Apple Cider Vinegar tabs. I would appreciate an help and advice that I can get.

Thank you so much,

I’d highly recommend finding an endocrinologist. Those levels are quite high, and the endocrinologist would likely help you curtail high levels at other times of the day as well.

It sounds like insulin is needed.

Thank you so much for your response. I do need to find a diabetic doctor but with only a part time job, no insurance and medicaid says I need a bunch of kids to qualify and Medicare says I’m not old enough, YET! And most of them where I live have a $400.00-$600.00 new patient fee. I just don’t have that. Health Department didn’t help and neither did two clinics. They just wanna give you meds and not discuss anything. When I was first diagnosed they put me on Toujeo and Invokana right away. LOVED how Toujeo worked! And got on their patient assistance program but the doctors told me that Toujeo is what made my insides explode due to a softball size Abscess that attached to my appendix and colon. Had the abscess, appendix and almost half of my colon removed. So I’m afraid on any injections now. Any other advice that you can offer? I am listening to any and all that I can get. My family doctor told me last week, now to worry about since my A1C is so good. and that having only half of a colon will now cause my daily numbers to be all over the place.


I agree with Katers87, it sounds like you could benefit from insulin, which doesn’t have the same side effects as a lot of those medications. Could you talk to your family doc about that, and at least see what he thinks about it compared to other medications?

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I haven’t heard of Toujeo doing that before. Were you always injecting in the same spot? Are you sure that the insulin caused that? That’s very, very unusual.

I suppose I have heard of infected spots where injections were done, but they’re not super common. I don’t think they’re usually that bad though. I understand being scared of injections after an experience like that, but maybe by doing a bunch of research on how to ensure the injection spots are super clean, you may be able to increase your comfort level.

Your A1c is being reported in a strange way. Typically I see A1cs that range from 5.0%-14.0%. Where <5.7% is in the non-diabetes range and >5.7% indicates some form of diabetes (prediabetes, Type 1, or Type 2), though some people with diabetes can lower their A1c down past 5.7% through strict management.

An A1c of 31.1 is pretty far off the chart, so I think we may be using different metrics. An average blood sugar of 212 mg/dl should put your A1c in the 9% range (though this varies a bit from person to person). An A1c in this range puts you at a higher risk for complications. I’m surprised your doctor is comfortable with it. [Edit]: This was just a general estimate based on the glucose levels you provided.

I’d like to just recommend diet and exercise, but your fasting glucose levels are too high for that. There may be some other people with Type 2 on this site that have some suggestions.

I wish I had more helpful suggestions. I’m sorry you’re having trouble getting access to a doctor that can help.


It’s probably the UK system, they stopped using percentages in 2011. It’s equivalent to an A1C of ~5.

That still doesn’t really make sense though because a Type 2 diagnosis wouldn’t occur at 5%, right?

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Sounds like a typo, maybe it was 13.1? That would line up with 393, as initially mentioned, and also based on the person’s medical access problems, clearly not in the UK.


Also, I agree that seems like a very strange thing to attribute to insulin, and even if you had a reaction to one insulin, there are many types of them, but sounds like you may well need some kind of it.

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It was indeed a typo. I meant 13.1 Sorry folks.

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It was a typo. It was actually 13.1. Sorry

It was a typo. It was 13.1 not 31.1. Sorry.

Thank you!!!

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@CatMann did your doctor rule out Type 1 diabetes? You’re sure that you have Type 2?

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He “SAID” Type 2. But I cannot afford a diabetic doctor’s new patient fee so I’m stuck right now with going to him. During the day, most of the time, it isn’t like that but this all came about after the surgery I mentioned before. 4 months with no meds at all and normal numbers everyday. Then it gradually went back up and since my heart attack it has gotten even higher. I’m wondering about that Dawn Phenomenon. And my family doctor said last week that as long as my A1C is as low as it is for me not to worry. Well, FLIP! I check my numbers before every meal. For me that tells what what and how much of things that I can eat. Then I check 2 hours later. He told me to check once a day after my largest meal. Heck fire. I never know when that will be. …

But with only half of my colon left, I am afraid to try another one. I don’t have too much left to work with.

Did they explain why they thought the Toujeo had anything to do with that? Was it an infection at an injection site that somehow traveled…? Otherwise I’m just not getting the connection at all, and wondering if it could have been a miscommunication?

For me, the more carbs I eat during the day the more prominent dawn phenomenon is the next morning and vice versa. Speaking of insulin injections, it is not necessary to inject into a belly (if this is the case of your worries), buttocks and thighs a often used too, upper parts of arms will work as well.


As for a doctor, look for large healthcare chains in your area. They usually have medical assistance programs that help people like you to get appointment with a specialist within their system.

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It may not be possible for you, but a c-peptide or Gad test would tell if you have type 1 or 2 for sure. C-peptide is produce with insulin so its kinda says how much your pancreas is making insulin and Gad test is to see if you have “diabetic antibodies” if im correct…