Overcoming Dawn Effect Frustrations on Pump Therapy

#1

Using the 670g has certainly presented challenges overcoming the dawn effect. I’ve found an effective solution and would love to read other suggestions since so many struggle with this bothersome issue.

2 Likes
#2

I’d love to hear about it. This was the issue that finally caused me to throw in the 670 towel. It was more an issue of the G3 sensors consistently undershooting my a.m. BG and thus failing to account for my DP than anything with the pump itself, though the slow correction rate was part of it. I tried various things, including getting up in the early hours to do calibrations, but nothing worked. Eager to hear your fix!

#3

I’ve observed two different phenomena related to morning glucose rises. The first is the traditional dawn phenomenon caused by the natural circadian rhythm. I address this by adjusting my basal rates two hours in advance of any expected BG peaks.

The second phenomenon is what I would call “feet-on-the-floor syndrome” because it seems connected to when I actually get out of bed to start my day. If I get up earlier than usual then my BG rise is earlier; if I sleep-in then this happens later.

To counteract this feet on the floor effect, I take a pump delivered pre-emptive dose. Yesterday I noted that it took two 0.5 insulin boluses to stop and then pull down a trending feet on the floor glucose rise. Today I just delivered a 1 unit dose and that seems to be working well. Instead of my BG rising to 120 mg/dL like yesterday, my BG rise has stopped at < 100 mg/dL and is shelfing in that range.

If I’m not as attentive to my morning BG trends and I find myself climbing higher than I’d like, I use a 4-unit dose of Afrezza to stop it cold. I usually use Afrezza (inhaled insulin) for corrections only and am sensitive to its action.

Morning blood sugar rises, whether dawn phenomenon or feet on the floor syndrome, I find are best solved using personal experimentation. I’m curious what solution you use, @Elyssia_Reedy.

3 Likes
#4

@Elyssia_Reedy

Dawn phenomenon (DP) has haunted me for as long as I remember, but it wasn’t until I began pumping (with Animas) plus a CGM that I could monitor and control it.

My BG rises between 3-4AM; my solution is to crank basal dose from 0.40 to 0.90 units/hr. Like Terry, I also have “feet on floor” phenomenon, so as get up I give myself a 2.50 - 3.0 unit bolus.

I maintain a higher basal rate until 8am. My BG rarely goes above 110mg/dl in the morning following this time-tested process.

I should add that I’ve been trying FiASP for the past 10 days and I’ve had even better results as the onset time is far quicker than Humalog has been for me. Past 2 days I’m testing a 50/50 FiASP + Humalog mix. Stay tuned for updates.

#5

I have a similar pattern at 3:30-4am and have the pump programmed for a higher basal rate between 4am-8am which takes the edge off of it. I also have feet on the floor phenomenon but I tend to deal with that by having 10-12g carbs with a bolus + correction dose rather than just a bolus otherwise I tank later in the morning.

1 Like
#6

I don’t get it. (I use a 530G). Why can’t you 670 users just set higher basal rates for the early morning hours?

1 Like
#7

I don’t think you can set basal rates in auto mode. You just have to hope the pump is smart enough to realize DP is a real thing, which it sounds like it isn’t!

#8

IMO, that BLOWS! No way would I give up the ability to set various basal rates–especially to a pump that has demonstrated how utterly unreliable it is in regards to both it’s algorithms, and it’s sensor issues.

#9

The thing is, it’s constantly adjusting basal rates, that’s kind of the whole point of a looping system. Instead of a couple of big square waves, it’s a continuously adjusting stream of larger and smaller microboluses. The problem with the Medt version of this approach is that they’ve locked a key parameter, the target, to a value that doesn’t work for everyone. The open-source, DIY looping systems aren’t as restrictive, which I think is a much better model, but the principle is the same. Ultimately the point is to have a basal delivery that behaves dynamically based on biofeedback, like a real pancreas, in place of the big square steps for different segments of the day that you set manually with a standard pump. Think of it as a much higher-resolution system for doing the same thing a manual pump does in a lo-res way.

#10

Meanwhile, @Elyssia_Reedy–still waiting for you to return and tell us what the “effective solution” was that you found for DP with the 670! Dying of curiosity here :slight_smile:

1 Like
#11

I think of it as a sadly underwhelming system.

#12

Yes I agree, but I was referring to how all looping systems work, not just the 670. The whole point is to better model how the biological system works, which necessarily means using dynamic feedback rather than setting your own basal rates manually.

#13

I like to drop before I have my dawn phenomenon, but not always. This I combat by not going to bed lower than 120. If I set my basal level lower to compensate for the probable drop I stay too high most of the night. And since the time can vary I can’t be more exact about adjustments. I usually start shooting up right before 6, I always go up some, but once in a while not much but then I will really shoot up after I get out of bed.

Right now my BG rise isn’t quite as bad as it was, but I have my basals at

12am-5:30am .70
5:30am -8:00am 2.00
8:00am-12:00pm 1.40
12pm-12am 1.00

It by far isn’t 100% solve, sometimes I don’t need as much, that’s only 10-20% of the time, but then it’s an excuse to eat a cookie or drink some OJ. Mostly if I wake up at 7 am and I’m at 150 or more I go ahead and give myself some extra. But then because I have my basal set higher and I still need it half the time I can end up dropping a little low at 9 in the morning. But since that is usually not the case I prefer to be a little more aggressive in trying to not go too high for too long.

It is very irritating to find out you’ve been at 180-200 a good part of the night and that has happened because for some reason my BG’s shot up at 2 in the morning instead of waiting until 6! But I also refuse to be woken up by alarms that say I’m too high and have my sleep disrupted!

1 Like
#14

This is my experience as well @Marie20. There was a time that I thought sleep was more important than BG, but times change and now I have 2 (or 3) late night / early morning alarms set to check BG’s and bolus accordingly. I fall back asleep in less than 10 minutes, and this is critical for me to maintain a non-diabetic A1C.

2 Likes
#15

Sleep is still more important to me as I don’t always go back to sleep easily. I’ll be awake for hours or if I’ve had 4 or 5 hours already, I won’t be able to go back to sleep at all. So sleeping through the night is a treasure! My A1C is 6.4 and has stayed at that level for a while, so I’m happy with that.

Jim! I envy you that you can wake up and do adjustments and go back to sleep! I do have a Dexcom that would give me an alarm, I think I have it really high at 250?? So it doesn’t wake me up unless I’m really really bad. I’ve been known to go over 300 if it starts before my pump settings start kicking out extra insulin.

1 Like
#16

Ugh, I can’t stand those high bg’s! Mine is set to alarm at 150. yes, it can disturb sleep when it alarms, but if I don’t get on it before it hits 200 I’m going to be feeling a lot worse than missing some sleep.

1 Like
#17

@Dave44 I’d be woken up every single night if it was set at 150, generally I go to 150-160 before it starts dropping from my settings. I just can’t start my higher amounts earlier because it can vary when it starts. 200 doesn’t bother me, I think I have to go over 300’s for it to wake me and then it was just a vague feeling of why am I awake?

#18

The only time I have high nighttime BG’s is when a site goes bad (high for me is > 130mg/dl)

I’m not comfortable running BG’s higher than 100 mg/dl any longer, and my aim is to keep them below 90 at all times

#19

I like to keep mine between 95-120. I have always felt really bad if I dip below 80 and I can’t even go to sleep if I am under 100. I gather you might get used to lower numbers. Before insulin I once went to urgent care with a 450 reading and didn’t feel bad at all. They asked if I felt okay, I told them I felt great , they didn’t even test me for ketones, gave me a shot and made sure I started to drop and sent me home. I was hitting a lot of 300/ 400’s before insulin. the 300’s started again before I went on a fast acting insulin.

I had gotten a meter to test my sugars before diabetes because I had had an uncle that had type 1 and I thought it would be a good idea. I never tested below 100. I was always in the not eating or fasting range of 100-102. Always, and I never went above 140 after meals, whatever the meal was or when I tested. So I have always thought my body prefers the 100 level.

In fact I ended up testing at 115 one morning and went into the doctor right away telling them something was wrong, my sugar level was 115 yesterday and today it was 114. They did do an A1C test which was normal and said I was just having a fluctuation, don’t worry about it. But that was the start of my type 1 diabetes.

#20

I’ve been running on ketones rather than carbs for the past 9 months, and in fact prefer to run a bit lower than I ever did before going on a low-carb diet (under 15 grams of carbs a day).

BG levels that would have incapacitated me a year ago are now “normal” for me (running at 2.5-3.0 mmol/L (45-54 mg/dl). Hard as it is to believe, ketones are a far better fuel for your brain (and heart), with a cleaner exhaust (credit to @Terry4 for that description).

I certainly would not recommend this to anyone not in ketosis.

1 Like