How do I deal with the dawn phenomenon?

This is my first post, and I mistakingly sent it as a message to all members of this group. Sorry about that.

Here it goes,- public this time:

I`ve been using a pump for 20 years, now I´m back on MDI with Lantus and Humalog. I split my Lantus dose in two, making sure my evening dose and morning dose is no more than 9 hours apart ´cause this is what I´ve read should deal with DP. Still my readings are in the 7-9 mmol/l range (should be same as 125-160 mg/dl) in the mornings. For some reason I almost alays wake up around 3 o`clock in the night and bls then is fine. So - my question is if anyone knows what do try out.

Thank you in advance.

How far in advance of sleeping do you take your evening dose? You could try taking it later & adjusting the time of the other dose. Are your daytime readings good?

Problem with Lantus is that it peaks. Your 3 AM reading could be a peak so BG is good then, but high in the morning.

I've found that not eating at least five hours before bed helped. Also, not eating high protein/fat dinners. They're slow to digest resulting in high fasting from digesting overnight.

Since changing to Levemir (still two doses), my numbers improved. It's more level.

Thanks, Gerri.

When I go to bed differs from day to day. Main goal is to never have more than nine hours apart from the evening dose to avoid th DP, but it doesn´t seem to work. I do a 50/50 split with my Lantus at 07.30 in the morning and 22.30 in the evening, and that´s pretty default to the minute.

Daytime readings are OK. I´ve always had DP, but with a pump it was easier to try to fix. I´ve never had a grip on this MDI-thing, so I think it´s really hard to understand.

I didn´t eat anything the last 5 hours last night and I drank lots of water. I read somewhere at tudiabetes that it could help the liver. And I think I read something about actually having a snack befor bedtime, but can´t get my head around if it was protein/fat or whatever and when and if you should bolus for it. Hence my posting here.

I´ve also found that eating fish instead of meat for dinner makes a huge difference for my morning readings. Fish makes wonders. Pure veggie dinners is OK too, but fish is the superior thing regarding bls readings.


Not sure how much help I will be, however, I am also on Lantus and Humalog. I have never taken my Lantus in multiple doses (I did have to take my Humalin N in two doses while I was pregnant, but that was mostly because the dose was so large). I take it every night at the same time (or at least within 30 mins of that time).

I agree with everything Gerri has said (with the exception of the change to Levemir - as I have not personally tried it - which I thought was the generic version of Lantus...?). Another thing to keep in mind is the general BG high everyone experiences at that time of the day (the predawn rise) and that (if you are in Canada) the CDA has recently advised that numbers like you are getting (btw 7-9) are not all that terrible.

I probably haven't helped at all, but I can at least sympathize :)

You are asking a great question. I am still trying to figure it out. I take shots so I wake up around 3am also. What I do is just take humalog to bring it down. I know we are supposed to rely on our long lasting to do this but I can't figure it out. I then check again at 5am and 7am and I continue using the humalog to keep bringing it down. I will eat breakfast around 7-7:30am usually two eggs with some butter and take 6 units of Lantus. Two hours after I eat I will check again and usually be around 110-130 on my meter. I won't take anything. However, if I check a couple of hurs later I will be in the 150-160 range and will take maybe 2 units of humalog. By then it is getting close to lunch. So much easier to control my sugars the rest of the day. I do check A LOT. Not because I love to but because I can't figure out the long lasting insulin.

Thanks for the reply, Bac. I´m not in Canada, I´m in Norway and not sure what the recommendations are here. Personally I would just like to be more stable over night. Does a lot to my sleep quality.

All replies are helpful in my mind. They help me redirect my thinking and gives my brain new input. I did in fact not know that absolutely everyone experience the DP.

Thanks for your reply, Yolanda. Sounds like you put in quite an effort to keep your bls stable. Hope it doesn´t cost too much regarding sleep and rest.

OK. Maybe this could be something to try? I found this in another forum, and it goes like this:

"I used to keep beef sticks by my bed so if I woke up in the night & was acting like I might go higher, I'd eat a beef stick to signal my liver that its help was neither wanted nor needed!"
And this:
"This is so far out of my range of experience . . . I wish I could wave a magic wand for you because I sure don't know any tried & true methods for defeating this. I have read where a coupla spoonfuls of cider vinegar at bedtime can sometimes help - if you're a pickle person, that might be an option. Or whole flaxseed meal. Glass of red wine . . . anything to distract your liver from noticing you're sleeping - not eating!

But do try the beef sticks thing for the times you DO wake up in the night & get a decent reading."

Have anyone tried something like this?

Fish is faster & easier to digest than red meat or chicken. Some DP problems I think are the result of food disgesting overnight.

Risky to bolus for a snack before bed & defeats the purpose. Some people eat a small amount of protein to help keep BG from going too low overnight.

Hi Bec,

Levemir & Lantus are different in action. Levemir isn't a generic form of Lantus. Lantus is acidic & why it stings. I had bad lows on Lantus because of the peaks & find Levemir to be smoother. Contrary to what they say, Lantus doesn't last 24 hours, so split doses help if people are having problems with highs or lows that can't be chalked up to bolus insulin.

Sad the CDA & ADA both push readings that are too high for our health.

Hiya Gerri,

According to my endo the CDA/ADA are pushing not for unhealthy high numbers, but to curb the negative effects of chronic significant lows (and most of what was stated dealt with post-meal BGs).

I agree, Lantus does not last the 24 hours it claims (my endo says it generally lasts about 20-22 hours), so I can see how that may be altered by splitting the doses.

I read somewhere on TuD that Levemir and Lantus are the same thing, I will have to look into it more (I have never had a problem with my Lantus stinging).

Cheers for the info :)

Rather than guide patients on how to avoid lows with proper dosing, they advocate for higher BG. Doctors don't have the time to go over logs to help patients tweak doses. The larger the insulin dose, the greater the chance for lows. One reason I eat low carb is to avoid lows.

Lantus & Levemir are quite different. There's no generic basal. Sorry someone gave wrong info.

I have to speak up on behalf of my endo -who is wonderful- because she does sit with me and pours over my logs/charts and works with me to find appropriate ratios and doses; I am thankful for her.

I too eat very low carb, but still have trouble on occasion with lows (possibly the hazards of a busy life running after a toddler).

From what I have read (in the last few minutes!) Levemir and Lantus are similar in their effects and very different in their creation. I also found that those who use Levemir have nothing nice to say about Lantus and those who use Lantus have nothing nice to say about Levemir, so it is really hard to sort it all out when the two camps do not actually provide the needed and necessary information. Also problematic is that with the internet and (medical) forums everyone thinks they are a doctor.

I do appreciate the clear-up regarding no generic basal ;)

You're so fortunate to have a great endo!

I've used Lantus & Levemir. Yep, people have loyalty to certain brands:) Had to do battle to get changed to Levemir because my doctor insisted I shouldn't be having problems with Lantus lows. Splitting doses, changing timing, taking smaller doses didn't make a difference. When Lantus peaked, I had lows.

Thanks again, Gerri. Having a proetin snack is a thin I will try out. Did you try that out?

For the moment I try the light meals and going to bed on an empty stomach approach first. Have to give it some time.

Going to bed on an empty stomach is a really good thing. I have the worst fasting BG with a heavy dinner the night before. I usually have a small piece of cheese before bed, nothing carby. Seems to help.

Let us know how you're doing. Know how exasperating it is!