I used to suffer badly from dawn phenomenon with my glucose rising 55 mg/dl or more, but recently found some things that help me against it.
One is to eat many times to reduce the release of glucagon and to eat a lot of fiber to stimulate release of incretins like GLP1’s, which surpress glucagon. I have to say I have LADA and not type 1, so I still produce insulin.
Working out late also has a beneficial effect for me, may be in part because it makes me go to the bathroom less often.
And what I really hated to find out is I can’t have steak or cheese or stuff like that or my fasting glucose will go much higher. Since I found out about that my glucose rises no more than 35 mg/dl tops.
If you regularly go very high 3 hours after dinner, it sounds like you’re not taking enough meal time insulin. If you are carb counting, you might try reducing your carb to insulin ratio. For example, if you are now dosing 1 unit of insulin for every 10 carbs, you might try 1 unit for every 9 carbs. Try the new ratio for a few days to see whether it makes things better or worse.
Bubble; I have LADA (older Type 1) also and welcome to community. I have gotten more help here than 3 years of medical people. My latest endo flatly stated “You produce no insulin!!!” which I found insulting as I would like to know if I DO make any insulin. Interesting about the steak as I regard anything non-carbs as “safe” to eat but I have read on this forum that protein and esp. fat can contribute to glucose rise. Do you have an endo that helps you and that you trust??
Thanks Chris, that’s neat. Plasma insulin responds, slowly, to BG, plasma glucose can only be increased by the liver (so far as I know).
The 2pm trough/peak in the two shifts my (very limited) understanding. The cycle there is diurnal (since we don’t all go to bed at the same time, unless the guys doing the research strapped everyone into their bed at the same hour).
The research was performed at a single longitude based on prior experience of scientific research performed across the globe (none), so the diurnal cycle means that the trough/peak happens a couple of hours after the middle of the night.
In the non-Ds (the open equilateral triangle line, the Illuminati one, to be clear) there’s a second event, a peak this time, at sunrise. For the Ds that event is maybe masked by the response from the liver; the plasma glucose line.
Note the prescribed D treatments; our beta cells, were they present, would react to the temporarily elevated liver ejaculation of glucose slowly but surely (read the flatline comments in the article All the prescribed D treatments were unreactive to any changes.
Do not, ever, try to take my AIDD away; one of us will die.
Technically, it is not DP . I too have been experiencing the same phenomena at bed time. It started 3 years ago, and I cannot figure out what is triggering such a rapid increase in BG. I sometimes do experience a low an hour before. I have had to increase my basal from 0.25 to 1.4 units for 2.5 hrs to keep my readings from going above 200-300. In my 62 yrs of T1D/35 yrs pumping I have not experienced anything like this. The timing shifts when I change time zones, although > 3 hrs difference it takes a day or so to catch up; and so I think it is a circadian in nature. My endo is also stumped (and he is really a great endo). And it does not matter what time I eat, and I am eating low carb.
I do still have DP, but it is only a small bump, for which I easily compensate with a basal rate increase.
So rest assured, you are not crazy, or alone in this phenomena.
I envy you a great endo. I have had 3 disappointing ones over 3 years. You are on a pump??? What pump? That’s what they say I need…Have you been satisfied with your pump? I am deciding…still MDI for now. Mostly correction doses.
I have been told on this forum that I am not taking enough bolus before meals but that doesn’t seem to jive.
Last night I took 8 units bolus at 11:30 ( I know risky) but still woke up with 233. That doesn’t always happen but it is often high at 11:00 pm. Even when I took 8 units at 6:30 before dinner. My TIR is 45%.
Why isn’t your pump regulating this shift? That’s why I am not so keen on pumps although TCOYD advises all type 1s to be on pump.
This has been going on for 3 years with you? What about your eating during the evening…that is sometimes the cause for me.
As a person who recommended increasing your basal before dinner if you’re going high at 11PM, I am sorry that the suggestion hasn’t been helpful.
Back in 2008 when I moved from MDI to a pump, the Joslin had a formal pre-pump training program for all patients that included a couple of classes plus a couple of one on one meetings to make sure that the transition went smoothly. Since it doesn’t sound like you are getting that from your endo’s office, you might want to explore other resources.
I mentioned the Joslin DOIT program in an earlier post. Another option is consulting with Integrated Diabetes Services. The company was set up by Gary Scheiner who wrote the classic “Think Like a Pancreas” and it offers online consultations and training. I don’t know how much it costs but it might be worth checking them out.
I can’t increase my basal at dinner as I take Tresiba once daily at bedtime.
Endo has not changed nor specified 2x daily. The nearest Joslin is in Syracuse, NY about 200 + miles away. I do watch the TCOYD videos that you linked me to and are informative.
I also just got a response from someone in the forum who has 65 years T1D, pump for 30 years and has same problem with high BG at bedtime…Has good endo too and neither can figure out why.
Maybe will inquire into IDS thinking like pancreas site. Glad your T1D is so well-managed.
The correction at 3:30 and 8:30 are to manage the rise the CGM showed me.
Do you have a desktop or laptop computer or access to one? Reviewing CGM data is best done on a big screen. Abbott has a website https://www.libreview.com/ that lets you see your CGM data. Use the same account you created when you installed the Libre app on your phone. Then start logging everything. when you took insulin, when you ate, what you ate, when you woke up and went to bed, what you did that day, etc so you can start seeing how different food/activity/doses work together and affect you.
Last thing, I apologize. I should have asked earlier if you were still making any insulin. If you are, that’s great but you also need to think more like a type 2 diabetic. You and I are not only in different boats, I’m on a lake and you are on a river.
Sorry to get back to you so late. Yes I am on a pump, a Medtronic 780g, but using Dex G7. So my pump cannot automatically correct for the high unless I program the basal to deliver insulin about 30 min before I go up; and then, if needed, decrease the basel if I need to. I think on MDI it is not as easy, you would have to take a series of micro boluses before you start going up. My endo knows I have become very good at analyzing my basel and making adjustments as needed.
Being on a pump has allowed me to do out door activities where I needed to cut back the basel for the activity. It has allowed me a degree of freedom I could not acheive on MDI.
I am satisfied with my pump, but all pumps are good - you just have to select one that offers the features you like, or talk to people here to see what features you like. Tandem seems committed to innovating pump technology. When I was last looking at pumps (was on Animas), I had a lot of trouble seeing the screen in sunlight. Being outdoors a lot it was a non-starter. That was before they had a phone app. Even with the Josylin being so far away it would be worth it to get a good tune-up.
BTW, what is your correction dose? It seems like you are taking a lot of insulin before bed. I do split meal boluses, and start the first dose 30 min before eating (if I can).
I think a pump would help you out a lot. I agree with TCOYD, however, it does take months for your body to adapt to getting insulin this way, so you have to be patient. And eat low(er) carbs.
Mike, Thank you for your info. I do take a lot of insulin before bed as my glucose tends to be high near bedtime. A few nights ago I was
over 300 all night long…..even though I took the correction does before bed. I tend to do correction per my current reading. I used to have have lots of lows (when taking Lantus) ..in one month…47 lows. I do worry about taking too much bolus near bed but so far no early morning lows.
I just had a low today when I took 7 units Novolog when my BS was 317 and rising. Then less than 2 hours later…….57 BS and then the eating of candy and drinking 8 oz grape juice. BS rising and now (at 4:00) up to 265…..all before dinner???
Fast acting insulin does not seem to cause a drop in glucose they was it should. I have gotten some guidance from the forum on this.
I am looking into both Bionic iLet and Sequel Twiist AID.
Thanks again. Andrea
I think you would benefit by being on a pump, and having a better basal profile. It would give you a better gauge of how much insulin you have on board and judging correction doses, and, most importantly, avoiding dose stacking.
I also recommend the book “Thinking Like a Pancreas”.
All the prescribed D treatments were unreactive to any changes.
. I too have been experiencing the same phenomena at bed time. It started 3 years ago, and I cannot figure out what is triggering such a rapid increase in BG. I sometimes do experience a low an hour before. I have had to increase my basal from 0.25 to 1.4 units for 2.5 hrs to keep my readings from going above 200-300. In my 62 yrs of T1D/35 yrs pumping I have not experienced anything like this. The timing shifts when I change time zones, although > 3 hrs difference it takes a day or so to catch up; and so I think it is a circadian in nature. My endo is also stumped (and he is really a great endo). And it does not matter what time I eat, and I am eating low carb.
