Overcoming Dawn Effect Frustrations on Pump Therapy

#21

Not a believer in low carb. If you want a low carb diet that is a choice. But I don’t believe it’s better for the brain or the heart, And in fact a recent study has said low carb puts you at higher risk of afib and increases risk of strokes and heart failure. Increased fat lowers microbiome in the gut and increases risk of chronic diseases. Ketones are a back up fuel for the brain, when glucose is not available, not the fuel of choice, the brain loves whole grains, veggies and fruits carbohydrates, but definitely not refined sugars carbs . So we will strongly disagree on the health of a low carb diet.

#22

Yikes, I couldn’t even imagine or want to run at those levels. Would a non-diabetic in ketosis run at those low BG numbers?

#23

@Jim26

Jim - any number of (non diabetics) run numbers in the 1.6-1.8 mmol/L (29-32 mg/dl) range while doing extended fasts (Ketones after 3-5 days rise from barely 1.0 to 5.0 mmol/L or more).

Ketones at those levels are still nowhere near danger Will Robinson (DKA) levels, especially if you’re producing (pumping insulin). While I’m still cognizant below BG = 2.0 (36mg/dl) when ever I get down near this level I bail out with a gram or 2 of carbs.

While I know medical textbooks claim brain death and other nasty things start to occur at BG’s less than 2.6mmol/L (47mg/dl), there’s a doctor who claims several of his Non diabetic keto patients call to let him know just how high their ketones are and how low their BG’s are (see Glucose Ketone Index).

Merck and other medical texts really should do an update with respect to BG thresholds and just. how much ketones change the norm applied to carb based diets

#24

Interesting, but seems very dangerous. Anyway, sounds like you’ve done your research. Good luck.

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#25

I, too, went off of the 670G auto-mode because it couldn’t keep up with dawn phenomenon, and other times my BG rose higher than its meager micro-boluses could contend with. Keep in mind that Medtronic had to get this pump to be super conservative in its micro-bolusing to bring down highs in order to pass muster with the FDA. I now use my 670G in manual mode with a Dexcom G6 - which sends data to my Apple watch every five minutes (actually to my phone, but all of this being bluetooth, i see it on my watch.) I’m pretty happy with this setup, though I look forward to future/better iterations of the auto-mode idea.

Second, I wanted to see if anyone has switched to a lower carb diet (not super low - average of 55 g per day) and cut out bread, pasta, rice, etc. and then had an abnormally high creatinine level. Mine is at 1.4 and GFR of 43 (blood). My endo has had me repeat the lab work and it’s still high. No dehydration or other obvious issues. I don’t have protein in my urine. I can’t think of any changes in the last year besides my diet. My A1c is steady at 6.9. I’ll be seeing a nephrologist to get to the bottom of it, but wonder if anyone has had this issue.

#26

Higher protein can be hard on the kidneys. A girlfriend that had bad kidneys was put on a very controlled low protein diet, unless you are on dialysis, then I think it’s different. I also had a dog years ago that went into kidney failure from an antibiotic and we had to extremely lower his protein intake.

#27

I will say that that is your choice and you can absolutely hold on to it! Keep in mind however that a lot of those “studies” focus on low carb diets that are more Adkins style. Obviously if you turn into a bacon machine you’re gonna kill over pretty quick.

#28

Hi @DrBB so glad that my methods have peaked your interest! I know since you were a 670g user you know the premise of this pump is to calculate based on a set target. With that being said, I drastically increased the amount of insulin I take per carbs in the morning. So much that the Carb Ratio screen displays, “A Carb Ratio of … is valid but outside the typical range of 5-50g/U.Continue?” Of course when initially setting this I ignored the warning and saved. I give a heavy amount for breakfast which covers my carbs and the dawn effect. This was great at first but problems started to arise when I slept in, had no carbs for breakfast or just didn’t eat breakfast. To counter this I give a 1.0 to 2.0 bolus for NO carbs at all depending on my bg reading.If I wake up with a low blood sugar by rare chance I eat and only bolus for the food I ate 15-40 minutes after a meal. Another tip is to wait 15 minutes before eating but trust your instincts and if you feel like you need to eat at that very moment then EAT. I think the most important premise to take away from this idea is to treat insulin as your tool and if food raises your blood sugar, adjust accordingly. If the dawn effect raises your blood sugar, adjust accordingly. Just remember as the old timers say, “just a dab’ll do ya”!

#29

@Terry4 this is a well executed explanation for those who might not fully understand the dawn effect.

#30

I would also like to note that every body will take to the dawn effect differently and your rates could drastically vary from mine so tread with caution! Trust your instincts.

#31

But you can’t do that in automode IIRC—no manual mode bolus; you have to have the wizard calculate for you so you have to enter carbs to get anything. Hence the “phantom carbs” tactic a lot of people use to get around this restriction. Is that what you do, or do you just pop out into manual?

The trick of setting a way different I:C ratio to force larger bolus in the a.m. is a good tactic though—hadn’t thought of that, though again it depends on having carbs to declare if you’re staying in auto. I usually only have coffee for breakfast, light cream and Splenda, but I’ve always had to bolus as if it was 32g of carbs, so that might have been a good thing for me to try. My main problem was that DP wasn’t getting picked up by the G3 sensors, so my pump would be showing an FBG of like 110 or something but fingerstick would be 160. Didn’t seem to be any way to address that, but the I:C trick might have been a good way to get the equivalent of a bigger correction after calibrating with the correct number.

BTW, the debate over whether the I:C setting only affects meal boluses or has some effect on microbolusing is still a hot topic on the 670 FB group. My MedT trainer told me absolutely that it’s only used in the bolus wizard and not in the microbolus algorithm, but others insist that’s wrong. MedT is so close-mouthed it’s hard to be sure of anything.

Thanks for getting back!

#32

@DrBB my trick is faking out carbs in the morning. I’ve memorized what carb calculations I need and just pretend like I just had a baby snickers. I do feel a lot better at night without waking up for lows which is what I love about the 670g but it certainly has it’s pitfalls. I just have to tell it little white lies and go about my business. :stuck_out_tongue_winking_eye:

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