Does this make sense

i had to call my dr about having highs above 200 a couple weeks ago. I got a call today from the dr herself telling me that i need to check my blood sugar at 3am and if need be take a dose of insulin to bring this down.

does this make sense? Like i understand the dawn effect but will this counteract this?

It works but it may also turn you into a zombie? With a pump, you can program in a "basl bump" at that time of day to smooth out the BG curve. Another option might be adjusting your basal timing or splitting shots to match any slight basal peaks that are there with your body's need for a "booster shot" at that inconvenient time of day?

Metformin taken at 10:00 pm and 12:00am midnight - 500 to 725 mg doses can stop the dawn affect as well. Do not combine in one large dose - that does NOT work.

Typically on my body before fix; I would see following BG numbers:

at 12:00 midnight 100
1:00 am - 110
3 am - 150
6:30 am - 238

It seems the major increase of liver glucose release really gets rolling around 3:00am and that is why Doctor had you check then.

Insulin dosing as indicated usually works and improvement of basil insulin can help.

For me metformin was far more effective. See salk institue and john hopkins childrens on latest meformin research, work and operation.

At all times work with your Doctor to identify best cure/doses for you.

I wake up at least once a night around 3 AM and test when I do. Correcting at 3AM helps me get back on track and start the day with reasonable numbers but I pump and can easily correct with tiny hit of insulin. Unless your correction ratio is very low - say 1:15 - correcting with a syringe or pen gets tricky.

digestion time is usually 2 hours for easy digest stuff and 6 hours on the tough stuff - proteins. Assuming no late night snack -midrats, the bump you see would be dawn effect -liver glucose release that starts its major release consistently and every night at 3:00 am unless liver unloaded its buffer early on a liver dump.

If dinner at 6:00 pm and no late night snack any major glucose output should be done by 12:00 midnight unless you fell asleep early and meal stalled in intestines.

If you are going high in the AM because of dawn effect, a very good way to "nip it in the bud" is a small boost in insulin at or before the dawn effect kicks in.

This is because the body's internally generated AM glucagon can be suppressed with just a tiny little uptick in bloodstream insulin.

So in the end 1 unit at 3 AM stopping the rise, can be a whole lot more efficacious than letting bg spike above 200 (or 300 for me!) and then taking a whole bunch of units to bring it down.

Darn Phenomenon is also caused by a natural process that clears your body of insulin in the early morning hours (as well as the glucagon/cortisol effect Tim mentioned). For those of us who are insulin challenged this is a problem. If you can create a way of having higher insulin levels overnight, you can counteract this process. But if you only take Lantus or Levemir, you may be stuck. Bernstein recommends two basic options. One is to set your alarm for 3am, test and inject rapid insulin (or R) starting with a modest dose and adjusting until you wake with a perfect blood sugar. Myself, I already have sleep problems, so that is a no go. The other option to consider is to take an injection of NPH at night before bed. The action of NPH peaking 4-9 hours after injection is a good match for the insulin boost you need. You need to be careful with NPH tho, some people find it highly variable in its effect.

I am on Levemir and am struggling with this issue. I use a split dose of Levemir, 35 units at night and 12 in the morning to try to get higher overnight levels. But it is not working as well as NPH did for me, my morning numbers are still 20-40 mg/dl higher than I want. I am actually considering going back to NPH.

my metformin has proven reliable day after day and stops dawn effect.

Yes liver works on reverse insulin status - ie low insulin, liver assumes you do not have enough glucose and you get the french foreign legion survival march glucose load.

For me met stops excess glucose release by liver in other times as well and in fact stops excess glucose release at source rather than having to have muscles absorb excess and then have to work off to prevent saturation.

I can see I am sending some folks nuts into the deep end of the used nuclear fuel rod swimming pool.

What keeps getting missed in their argument is this:

For type ones who have deficit of insulin and I believe rarely have glucose saturation of the skeletal muscles and as a result little insulin resistance in effect, adding insulin usually/always works.

For type 2's suffering glucose saturation most of time, adding insulin can be a frustrating no action result leaving excess insulin rotating around a type 2 body till some of the saturation of the skeletal muscle cells drops down and insulin receptors of muscle cells go back to accepting insulin.

Using met to slow down liver glucose release works irregardless of insulin resistance and stops excess liver glucose at source.

Diet and hearty exercise as well help get glucose burned off skeletal muscles temp storage sites ( reduce insulin resistance) so they (skeletal muscle temp glucose storage) can go back to storing more glucose and regulating blood glucose. Controlling blood glucose is always a storage function that insulin drives.

In a distributed muscle/glucose storage site - some muscles will have room for more glucose, others will not. Those muscles with no room turn on insulin resistance - downgrade cell insulin receptor sites to prevent a muscle cell glucose storage site getting overloaded with glucose and poisoning the cell.

Type 1 and type 2 are not same disease even if they share some similarities in possible treatment options.

This also explains why actos can always force more glucose into muscle cells when added insulin appears dead or useless.

Phil yes it does. I've been doing the bs check for maNY YEARS AT 3 AM WHEN i TEND TO RUN HIGH OR LOW IN THE MORNINGS. yES IT WILL HELP IT BUT PLEASE KEEP A WATCH ON UR BS'S IN THE MORNING U DON'T WANT TO GO TO LOW EITHER stupid caps now I'm doing what Linda does in chart. Sorry!

I am not a metformin user myself (I am T1) but I look at all the wonderful things it does to suppress gluconeogenesis and wonder why it's not more commonly prescribed for T1's who are having trouble with dawn phenomonon etc.

Metformin + low carb seems to be incredibly effective for so many T2's, maybe it would help me have better success than my previous attempts at low carb (which sometimes resulted in me taking more total units of insulin!!!)

low carb diets while having good benefits in reducing glucose generation make assumption liver and its glucose add functions when BG sub 70 is working correctly - ie only add sufficient glucose to move blood bg up to 20 % above the nominal level of nominal

in case of diabetes and reduced insulin levels, liver over adds glucose ( as in my case and see BG shoot from 120 to 311. not helpful.

sometimes it may be better is start with low carb diet but keep sufficient carbs to enable keeping blood glucose above 100 and keep liver out of picture.

your comment about treatments on t1 and t2 and how we seem to get some restricive thinking that somehow there are treatments for T1 and some for T2 and never the twain shall meet.

jims, I downloaded and read your book a month or so ago. I only take 500 mg of metformin twice a day, but just changing the timing of when I took it, following your recommendation, brought my a.m. BS from the high 90s where it was drifting, back down to the low 80s. I always wake up precisely at 3 a.m. anyway (??) so it's no problem to take a met then. (I'm T2)

Thank you for reading my book.

The dosage that works as indicated by John Hopkins Childrens varies from person to person and apparently they claimed they had simple test to determine min dose that works.

At time of book writing, I was finding that on one generic met on my body , this would occur at 500 mg. On another did not work on standard 500mg - Teva.

Later ajusting dose up a little to 725 mg seemed to correct on the teva.

Generally my experience says that one wants the met up to strength by 3:00 am meaning 2 and 1/2 hours ingestion prior - 12:00 am through 12:30 am for best effect.

In any event be sure you work with your Doctor on this and not rely on my comments and data.

Thank you for your comments.

As a type 2, no amount of metformin was ever able to bring my fasting numbers down or address my Darn Phenomenon. I also tried stacking all the metformin (up to 2500 mg) at night and it still wasn't effective. While it is worth trying, someone who is already on 2000 mg of metformin and has progressed to MDI probably won't see much difference. Certainly worth a try, but.

Interesting comments.

Single large doses - 1000 mg up at night never worked on my body.

What in fact did was the 500mg dose at 10:00 pm and the dose at 12:00 am that worked. Otherwise dawn phenominum just kept cranking.

so far the two doses i take hold off liver glucose from 12:30 midnight clear through 5:30 am. The key being keeping the met dose up to strength over the stated time priod.

John hopkins childrens also stated that this met feature works on some and not others and simple test they have can tell who will be successful.

If the dose take is slightly smaller than that needed; liver will not cut off. Also residuals from large dose do not affect liver cutoff -only met up to sufficient strength in blood system does and for the run time. Typically standard met has a 2.5 hour up to strength time and a lasting time at strength of 1 to 3 hours. For me it was always 2 hours.

I'm sorry, Philmore, but I don't remember what you said in your other post about this. The one thing I would suggest it to make absolutely sure this is Dawn Phenom, and not a rebound high (somogyi effect). The way to do that is also to wake up at 3AM and test...if your blood sugar is low at that time, then your morning highs are a result of rebound, not Dawn Phenom. In that case, the answer is to have a snack containg some protein before bed.