Having some issues with Dawn Phenomenon - any advice?

Now that I am getting tighter control, I am really starting to notice Dawn Phenomenon. For example, I woke up low this morning - 50. (This was a result of after-effects of strenuous exercise from the day before, and isn’t typical.)

I ate one smallish apple to correct, and by an hour later had jumped to 147. By the time I got to work an hour later I was 159. The only explanation I can figure out for this is dawn phenomenon.

Other days I’ve been waking up 130-170ish…never had problems with this that I know of before, but if I don’t take insulin right away my sugar can rise 20 points or more in an hour.

I take Lantus shots (split dose - one dose around 9 a.m. the other around 9 or 10 p.m.) and Novolog, and would prefer not to be on the pump - anyone have tips?

That sounds like this morning may have been a counterregulatory response more than DP. You may find that with less carbs and tighter control you may reduce your lantus and that proportionally you need more in the evening to reduce the darn phenomenon. What is your current split? For many, insulin is key to suppressing the DP.

Ah, interesting. I have always taken more Lantus daytime than nighttime. I am currently taking 16 during the day and 6 at night. Maybe I should reverse, or change it to 10 and 10?

Would it work for you to wear MM’s the Guardian Real -Time Continuous Glucose Monitoring System ? …monitor looks like a pump.
Did you also have a High after exercise and over -corrected ? …not unusual for this to happen as you probably know .
Suggest to finger poke during the night , to get a sense , what happens during the night .
I don’t eat an apple to correct my low ; do take glucose pills …I hope others can help you .

Hi Sarah,

Do you have any BG reading through the night to measure your DP? Where is your BG at when you go to sleep, and in the middle of the night?

If you didn’t bolus any insulin for the morning apple, then a jump of roughly 100 points in your BG in 1 hour wouldn’t be surprising at all.

Why do you not want to be on the pump? I’m on the pump (it will 2 years in January), but was on a similar regime to your before that. I use to have some wicked deadly middle-of-the-night lows because of my DP, which the pump has done away with. I’ve been able to find tune my basals with the pump, and overnight lows are a thing of the past. I use to wake of 3-4 nights a week with the hypo sweats, now it’s rare. Now those late-night lows happen maybe a couple times a year, and usually they are related to heavy duty exercise or work from the previous day. I had a big misconception about how the catheter worked on the pump ( I thought it was some huge, seriously invasive thing, not the little tubey thing it actually is), and that is why I resisted the pump for so long. I personally would hate to have to go back to MDI. But everyone is different.

Best of luck to you.

Cheers, Mike

Its hard to know without seeing what your glucose is overnight, but this sounds more like your lantus dose may be off more than dawn phenom. The first thing I would do (and what I did when I had a similar problem) is to wake up in the middle of the night at different times throughout the week to record my overnight BG. I would wake at 2:00, 3:00, 4:00am and check my BG, and then I adjusted my basal rates until I was level throughout the night until the morning.

Since you’re not on the pump, and considering your lantus dose, what may be happening is your lantus is not covering long enough to prevent your spike in the morning (with the exception of this morning’s low). If you’re comfortable doing so, you may want to first get those overnight readings, then adjust your lantus dose if you notice that you are trending higher as you approach the morning.

If you notice in your overnight readings that you are dropping very low, then spiking back up, it may be due to hormone response (Somogyi effect) but I would be willing to bet this is just a lantus dosing issue. In fact, with dawn phenomenon eating will sometimes actually PREVENT your glucose from spiking by telling your body that there is no reason to release glycogen, further suggesting that this is a lantus issue.

Good luck with your adjustments!

Thanks Tim! I think I will play with dosage this week as well as overnight readings.

You’re welcome, I hope everything works out! I should mention that I woke up that early on different nights, not all the same night (one night at 2:00am, the next night at 3:00am, etc). The whole process of adjusting took about 1-1.5 weeks, but now I go to bed in the low 90s and wake in the low 90s or 80s.