Experts Please Guide : Dawn Phenomenon

Thanks Dave44! Hoping so!

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https://www.sciencedirect.com/topics/medicine-and-dentistry/dawn-phenomenon

A pump is also not an option for me and I basal on Lantus and have been able to cure dawn phenomenon with careful analysis of CGM curves. My dawn phenomenon always started at 4 AM so for a while I got up at 4 AM every day and took bolus humalog to counteract but that was not the answer. I then realized that the phenomenon always happened and extent was due to the long acting carbohydrates I had eaten at my 6PM meal. I gave up my supper carbs and now only do carbs at lunch or very minimal at dinner. That gave me a straight line all through the night, however, I found that taking 8 units of lantus, my glucose level dropped ever so slightly every 15 minutes or so throughout the night. Then cut back to 7 units of Lantus and my glucose would rise ever so slightly every 15 minutes throughout the night. I am fortunate to have a digital pen that delivers insulin in 0.1 units and found that at 7.4 units, and little to no dinner carbs flatline my readings throughout the night. PS - my morning comfort level is also 80-100. Hope this helps.

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Whew deep reading here will delve more deeply as I just scanned a bit. Loads of info and considerations.

Oh goodness, lots to figure out and you did it.
I will work with fewer carbs at dinner time fingers crossed that helps.
I am also going to check in at 4 and 5am just to see what those numbers are.
Thank you.

@NatureOrbs - Carbs (or glycogen released by your liver at around 4am) are not the predominant cause of early morning rise in blood glucose.

Your body has an adrenal release (it secretes higher levels of growth hormone, cortisol, glucagon and adrenalin). These effectively increase your short-term insulin resistance, after which even normal low levels of glucose in bloodstream cannot be neutralized.

My dawn phenomenon (aka DP) is now at the point where at 3:30am, my basal pump dose increases from 0.3U per hour to 1.5U / hr. Even though I pump, I now need to awaken at 4am to check BG and decide if I’ll give myself an additional 1.5Unit or 2.5Unit bolus of Humalog.

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Thank you so much to learn truely missing the honeymoon days.
I so appreciate all this insight here! Very helpful!

Maybe I can’t justify the science but works for me.

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Me too. But here’s a thing I just learned. If you’re on Medicare and doing MDI, your insulin is treated like any other pharmaceutical and is subject to the Part B donut hole, so you end up having to pay for it out of pocket for a month every year. That just happened to a T1 friend of mine who recently started Medicare, and she was shocked. Fortunately I was able to help her out by giving her three vials of Novolog from my Diabetic Zombie Apocalypse Emergency Stash. It was an eye-opener for me too—I’m not far off from Medicare. But it turns out that it’s not a problem if you have a pump: the insulin is treated as a component of the prosthetic device and covered under the durable medical equipment benefit.

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Have you ever split your basal? (I didn’t read everything posted here).

I would call 90 to 100 a pretty small (kinda unrealistic) target. Your target makes me nervous. I feel like your trying to throw a machete at a grain of sand. There is simply not much room for natural system variability. I would throw a word of warning about monkey-ing around with something that’s not broken.

Your blood sugar machine cannot even likely read within the precision of the target that you are trying to hit. Does that make any sense?

Like, your expectations might be setting you up to feel very uncomfortable. Does that make sense? More than you ought to.

Can you tell us where you get this pen and does it come in Tresiba?

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30 to 40 over your comfort level honestly isn’t that bad for dawn phenomenon. I would go up much higher without my pump. It would be nicer to wake up in a more perfect range, but as a type 1 you’ll find all sorts of things will play with your blood sugar. A pump , sorry I’ve know it’s been said, but a pump is one of the best helps with it.

My basal rate is .50 from 11-5:30 am and 2.20 from 5:30-9:00 am to cope with it.
And that doesn’t always work completely!

I feel you Jim in Calgary, i don’t wake up early to catch it, but a lot of the times I am giving myself .50 to 1.50 extra units upon awakening. You can’t automatically set it for extra because you don’t always need it! But if I wake up in the early morning hours the first thing I do is reach for my CGM to check what I’m at and to see if I need an extra dose!

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The pen is only a delivery system and does not contain any insulin. The pen is Compatible with the current 3 ml insulin cartridges from the manufacturers:
Lilly® Sanofi-Aventis®
Berlin-Chemie® Novo Nordisk®
I have one of these pens for Humalog and 1 for Lantus and have been using Pendiq pens for about a decade. Please note that they are not FDA approved and therefore not available in the US but I do import mine from Germany and Germany will send them to the US. My opinion is that we are a 3rd world country when it comes to diabetes and better treatment options are available outside US. The pens are wonderful but would not consider them highly robust as they tend to wear out in about 18 months (at average 5-6 shots per day) and a real pain to get warranty service from Europe. They are manufactured in Korea.

Humalog cartridges for these pens are available in the US, however, Lantus cartridges are not. I therefore buy my Lantus cartridges in Canada or anywhere else in the world. I don’t use Tresiba so not sure if and where Tresiba may be available in cartridges.

Pendiq 2.0 Insulin Pen delivers 0.1u Increments

Love the Zombie reference and yikes I should have a stash.
Your story confirms my fears about Medicare.
Big Sigh.

I get that part of numbers. I had that woth my honeymoon.
The 80-100 target is for when I have no bolus or food…target only. I typically sit at low teens.
And my basal is 1.2 units so splitting isn’t an option.

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Thing is, no matter what regimen you’re on, there isn’t one single, fixed dose-per-day. What a lot of us do is just have our endo prescribe based on the max you might need. For instance, my Fiasp prescription is for 100u/day, which is (shh, don’t tell CVS Caremark) a ridiculous amount. But y’know, it could happen. But since mostly doesn’t, I build up a surplus, and when it gets to a certain point (e.g., my wife complains there’s no room left for actual veggies in the crisper drawer) I just hold off refilling the scrip for a bit, thus maintaining a couple months’ worth for the day the zombies attack (and trust me, they will).

I think you can do the same thing with pens, at least for your fast-acting insulin. Basal dosing is more predictable, but if you’re on good terms with your prescriber they may be willing to work with you. It’s not like you’re trying to cheat anyone, it’s that you’re trying to stay alive, and a certain safety margin is a reasonable part of doing that. Not to mention that if we weren’t targets for massive, blatant price-gouging (let alone zombies and medication-stealing robots!) none of this would be an issue at all. If someone’s cheating in this deal, it sure as hell isn’t us.

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Good ideas here. I use very little insulin so my stash doesn’t last because once I open a bottle it loses vitality after about 25 days and I only get thru one quarter of a bottle! Crazy… I will talk to my endo about this and see if they can get more for me.

Tresiba 100 units/ML Cartridge (Penfill)

I have checked and see that Tresiba is made in cartridges that will fit the Pendiq pen as it is a Novo Nordisk A/S product. This would allow you to dose in 0.1 units allowing for very fine tuning.

The bigger challenge now will be to see if the cartridges are available in the US. My guess is that they will not be available in the US at this time but ask your doctor to check it out. Otherwise you would need to import it.

Thank you!

I was on MDI for 3 years and had dawn effect the whole time.

When I took Tresiba + Humalog, I took the higher weekly dose of Trulicity which seemed to keep it mostly at bay.

When I had to switch to Toujeo + Humalog this past summer (due to formulary changes) the Trulicity wore off by the 3rd day. I switched to the high dose of daily Victoza taken at 8pm as its peak effect is 8-12 hours which corresponded with my most challenging hours 4am-8am. It was effective.

I started the pump with Humalog only this past weekend and have had no dawn effect for the past 6 days. I am not taking Victoza at this time.