My Pump Gave Me DP?

So I’ve never had Dawn Phenomenon. Even right before I started on insulin (LADA being treated as type 2) when my post prandials were soaring up into the 300s and even 400s, my fasting had just slowly climbed up into the 120s or 130s. These days my fasting is usually under 100. But then in the last week I’ve had high numbers either when I first get up, before breakfast or after my usual breakfast and bolus like say 160-180 which is crazy high for me in the morning.

I don’t see any reason why I would all of a sudden develop DP when it hasn’t been a part of my diabetes since diagnosis 3 1/2 years ago. Is DP related to insulin resistance? Again I don’t see why I would develop that all of a sudden. I haven’t gained weight at all and my insulin use has actually decreased since I started my pump on 1/8.

Maybe that is it. I reduced my basal by 20% when I first started and now have reduced it another 10% to not have daily lows. Maybe this level is fine for the rest of the day but not the early morning? Could I have different basal needs in the morning even though I don’t have DP? So I am going to try raising it back up 10% or more for 6AM to 10AM. I usually get up around 8AM and eat breakfast an hour later. Any other suggestions?

Yeah, most people don’t have the same basal rates throughout the day.

When I was on Lantus, I didn’t have DP because I took my Lantus dose at night and, apparently, that was enough to cover my DP. As soon as I switched over to a pump and programmed in an initial basal, DP showed up. I went back and adjusted my basal for the early AM hours where I was showing DP and that took care of that.

First of all, 160-180 isn’t all that crazy high :-). My morning numbers when dawn phenomonen is roaring can reach 300 or 400 real easy.

Not sure how long you were on shots but the basal insulins used for shots, are not truly flat. It’s likely that over the time you had been on shots, that you had adjusted the doses and timing and your schedule, such that the peak in your basal activity came before dawn and helped fight dawn phenomenon. You might not have known that it was optimized in that way but it was :-). And at the same time, because there was a bump before dawn, the rest of the day was a “valley” in terms of basal activity.

Now that you have a pump and a truly flat basal adjusted for days, you are missing what you didn’t know the shots were giving you, in terms of that bump in insulin activity before dawn. Yes, programming the pump for additional basal in the pre-dawn hours will really help. My feeling is that you need the bump-up in the pre-dawn hours to stop DP from setting in, not in the after-waking hours when you are responding to the high bg numbers from the DP.

Thanks, guys, your answers sound on the money. I was taking Levemir twice a day so I probably had the morning rise that I didn’t even know I had covered. I thought DP was a function of insulin resistance, but maybe that is wrong.

Ok, it sounds like maybe I should program the higher rate for more like 5-8AM if I usually get up around 8AM?

i would do overnight basal testing…you might actually need to up your overnight basal.

my dp shoots me up past 300…but a low basal rate (certain time of the month) will get me near 200.

Yikes, maybe I don’t have DP, just higher needs at certain times! Yeah, I’ve never done the testing thing, but I’ll try upping the 5AM-8AM basal by 10% and see if that helps first.

I set a higher basal starting around 2 to 3 hours before my DP kicks in, and let run for an hour or so after the DP peak.


Ah, I see, John. That is what I thought DP was, when I’ve heard people describe their blood sugar climbing from the time they get up. Since I never had this experience, maybe I just have the first phase issue that I didn’t see before because my nightime dose of Levemir was covering it. Previously I woke up under 100 then had my capp and got online for about an hour and when I tested before breakfast I was either the same, down a little or up a little which I assumed was from the milk, but never over 120. I’ll try the 5-8AM basal increase first and see how that works.

I didn’t develop DP until I was 16. I’ve been diabetic since I was 6. I don’t think it has to do with insulin resistance. Your liver just decides it wants to dump glucose then.

It’s not uncommon to have different basal needs. Most people on pumps have varying basal levels throughout the day (and mine changes based on whether it’s a weekend or a workday). Also, my basal rates need to be readjusted every month or so. It just happens. You will be constantly adjusting these things - there’s no escaping it.

Thanks, Kari. I’m still not sure I technically have DP, due to the way people describe it, but just, like you say “varying basal needs during the day”.

I was kind of hoping to get away from constant adjustments when I went on the pump! (Seems I was always going up and down because I could only adjust in whole numbers). I’m hoping once I get past the adjustment to the pump period things will be stable for a while? Don’t tell me if I’m being naive…lol

I don’t think it matters if this is DP or not, what matters is that you need to have variable basal rates throughout the day. They always start you on a pump with a flat rate all day, but as others have said a long acting insulin dose is not flat. You should try testing at 2am & 4am to discover when your rise starts, then up the basal rate starting 1 to 2 hours earlier, I need 2 hours others find 1 hour works. Nighttime testing is a pain in the …, but it has to be done if you want to really use your pump properly.

That’s the beauty of the pump. You can increase those basals and get your fasting numbers back where you want them!

My endo has a strict philosophy to follow the numbers. Sometimes my numbers have told us to adjust my pump settings in ways that surprised us both, but when we follow the numbers, the results are better!

Sorry, but we’re doomed to spend our lives tweaking & adjusting. Warning–don’t ever say out loud that you’ve figured out rates. The diabetes gods live to hear those statements to throw big ole curve balls:)

Agree with you totally here. Since switching to the pump the ability to have multiple basal rates for different times throughout the day has most certainly helped me keep better control over my blood sugars.

Now if only there was a way to prevent the spike after eating a good meal! hah.

Have you tried bolusing a little earlier (10-20 minutes)? That works wonders for me!

Yeah, most of the time I try to bolus 10-15 minutes before I eat. However lately I’ve been eating out a lot which has made that hard because you never know exactly when the food is going to arrive, and how much is going to be on the plate.

Don’t want to hijack the post but that would be interesting to see how often people have to change. When I went on my pump, after I had everything set, I did not have to change anything for 5 years. Then all of the sudden EVERYTHING changed. It really throws you for a loop when you have been stable, with good control (A1c never over 7%), and all of the sudden everything changes.

I cannot express clearly enough, in words, pictures, or interpretive dance, how invaluable my CGM was in helping me establish my basals, especially overnight.

Yes, good point. I never bolus early when I eat out. If possible I try to start eating the meat/veggies/salad and give myself about 10 minutes before I dig into the carbs.

I also didn’t change often when one the pump, but I was struggling to get my A1c under 7%. So I think that I may have needed more frequent adjustments and just didn’t log enough to see the patterns.

Now that I log more we make adjustments at every endo visit, which is every 6 weeks. These are more tweaks than huge changes, but still there is always some pattern that we can identify that gives a reason to adjust things.

I’m currently four months pregnant and now my settings are changing at least once a week, but that is another story!