Experts Please Guide : Dawn Phenomenon


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.


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.

The diabetes stash, market realities force us

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.


I just looked around and Tresiba cartridges don’t seem to be available in the US (bummer).


I’ve been studying my morning BG levels for a while now. Superficially, I do not have a dawn phenomenon, but a feet-on-floor one. At a deeper level though these seem to be connected. The common cause is the higher secretion of cortisol and friends in the morning. In my case, this is offset by the decreased insulin needs when I’m asleep. After waking up, I can see a small bump. After standing up, the insulin needs increase, and suddenly the stress hormones aren’t offset anymore.

I solve this by bolusing 2 units in addition to whatever I may need for breakfast. It isn’t and exact science, and sometimes these 2 units may be too much, sometimes too little. Impossible to tell, since there’s nothing I can measure - I can just empirically determine. When I slept long and well, it tends to be too much. When I didn’t sleep much, it tends to be too little.

Either way, my morning bolus could most likely be taken care of by an increased basal with a pump. That’s because the morning bolus effectively is a basal. A pump could be set up to slowly increase the insulin dosage. That way, I don’t get a hypo during sleep, and yet the morning BG increase would be treated properly. But until I have a pump, a morning bolus and good sleep hygiene are my two go-to methods.


I checked around as well and it appears all cartridges currently coming out of the UK. UK price is $93 for a box of 5 which means Tresiba is almost twice the price of Lantus. Lantus cartridges in Canada run me about $50 for box of 5. I see the Canada websites are starting to show the Tresiba cartridges but also show them currently on backorder and at a very high price. You may want to call a few of the online Canada pharmacies and ask them when they expect to start having availability, if they ship to US and what is the expected price. Since this is a fairly newly approved product in Canada, it may take a few more months for the dust to settle.


Good news on smaller dosing future possibilities.
So last night I was 115 at 1:30 am.
Higher than normal for me however I have a small eye irritation that probably is causing that.
So at 5:45 am I was at 145 and took a bolus.
At 7:15 I am at 89.
It feels good not to have that 145 sitting there for those extra hours.
Last night the snow trucks worked all night long with their loud engines and the beep beep of those back up sounds they make…we had loads of snow then -22 for two days and today it is 30 degrees…heading up to 40+ for the new two days. The village I live in would be so flooded and too fast with those warmer temperatures.
Anyways my higher number was probably part of being woken up about every half hour to those little beep beeps.
A little window in my life for you.
Thank you for all this great information and delving into the web for more for this post.
Thank goodness for places like this, helpful wise people and all!


I like your approach.


I also want to note that my thyroid runs on the sluggish side, when my thyroid decides it’s too low. I try to remember to take iodine regularly but once I am feeling fine I tend to forget.

When that happens my dawn phenomenon is always a lot worse. Or stress, or infection, or lack of good sleep or…


Nature - if you want the easy approach take the afrezza when you wake and it will knock you down the 40 pts and will be gone within 2 hrs so you can get on with your day.

It seems you are insulin sensitive. You can buy a box of the big cartridges for $120. They are marked 12u but don’t equate that to any current insulin you are taking. You can open and split them into 3 doses or even 6 doses if you are that sensitive.

Assuming you split them into 3’s, “4u” it will cost you less than 50cents a day if you pay cash.


@ Jim_in_Calgary That’s really interesting to know!


It would appear the MannKind/Afrezza offer has expired for new signups.

The last day of January was three days ago.

This offer is only available during the month of January for the first 1,000 registrants. See below for complete terms and conditions.


Tim - did you try to sign up?

My understanding which may be incorrect was their CEO was on a radio show last week and said the program was extended and he removed the 1,000 patient limit. He said he would be happy to take 10,000. Maybe going direct they removed the PBM costs and can still make a profit at 1/3 the retail price.

I tried the website and it still lets you register At $4 a day or in this case of using once in the morning at less than 50cents if you split the cartridges yourself it seems like a great deal. I am pretty sure it would also provide the best approach to knocking down the morning spike. which Nature has


There is no reason to believe that MannKind can make a profit with a price this low and every reason to believe (if one also believes in Generally Accepted Accounting Principles) this offer will only further deteriorate the dire financial straits of the company. This is a public company so the financials are a matter of public record.

I only mention this as you brought up the concept of profit. Otherwise, I had no intention of even going there.

Whether or not a CEO may or may not have mentioned something on a radio show is also nothing that I have any idea about.

I merely cut-n-paste from the actual company website. If the company currently and publicly states that the offer expired at the end of last month (ie - January) then all things considered, I tend to believe that their offer expired.

Timestamp of website: Now. Link as provided in previous post.


Tim - yes the original program was the first 1000 patients and was to end in January. I did confirm their CEO said this past week they now plan on expanding the program.

In Europe and Mexico you can get insulin a lot cheaper than Mannkind’s $120 a box and I suspect they are all still making a profit. I don’t know but I suspect the cost in the U.S. is driven by the middlemen. Here is one such story.

What Mannkind’s exact long term plans with this direct purchase program are I have no idea. We would have to ask Mannkind. What I can tell you is this website goes to Eagle Pharmacy which provides fulfillment. I am not sure who provides website updates. What we do know is it is still active and is still taking orders. Did you try? Maybe they will turn it off tomorrow, if so get your orders in now.

What I think is great news is that this was offered in the first place and provides a reasonable price for cash PWDs. We are getting to a point between the Libre at $2.80 a day and afrezza at $4 a day where great time in range can be a reality for most PWDs.


That is great. Be sure to post back when this is no longer rumor and is official per a company website or company news release.

Solid information is usually appreciated.

Really no point in going further down the Rabbit Hole of the MannKind finances. This is all public information easily obtainable for anybody who is interested.


DP is a big problem for many. And to just throw a chink into the thread, it is not predictable for everyone. I am on of those types. That DP happens but not often enough to make changes to basal rates. Last three days, no problems, this morning took a shower went downstairs and the blood sugar went up 40 points. So, I just have to do a correction on those days it shows its ugly face! But all I can say is thank goodness for my CGM, if I was testing, I probably wouldn’t catch that rise until it got way up there a few hours later.