So sorry I hope you are feeling better. I would def think about a pump- you can just shut off the insulin, no long acting basal hanging around and if you have too much on board and are are crashing I find shutting off helps me tremendously. And the new glucagon is a must too. A friend who has bad lows a lot told me the ems give her iv glucose which is very fast and no side effects. Too bad we can’t do that. I get migraines / headaches as well after and before lows sometimes.
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The low was from rapid-acting insulin, not long-acting. I fail to see how a pump would’ve helped in this situation. You can over correct with a pump just as well as with a pen/syringe, which is what happened in this scenario
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Absolutely correct!
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Which is why I think perhaps a CGM with properly set alarms is the right answer, not a pump. Marilyn, I believe is currently waiting for delivery of a CGM.
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I agree with that, but I wouldn’t exclude a pump. If I had to choose between a CGM and a pump however, I think I’d go with an ACCURATE CGM system. The only thing about what I just wrote is that someone with big time DP will have an issue with their overnight numbers which can start each day off on the wrong foot, bg-wise, if they aren’t pumping.
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I fixed my big time DP by going lunch OMAD and skipping nighttime basal. May not work for others but for me the nighttime Lantus/Levemir basal was causing me hypoglycemic events nightly between midnight and 4 AM and my dinners were producing my wild morning DP. If I have to eat for whatever reason at dinnertime, I stick to as close to 0 carbs as possible for dinner but then still get mild DP from any protein in the dinner.
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I’ve made the same adjustment, and now try to eat my only meal of the day prior to 2pm.
My DP is much better, but I have significant feet-to-floor BG spikes 30 minutes after I get up in morning.
The trouble is 30 out of 31 mornings this occurs, but there’s always that one day it doesn’t (like Marilyn I bolus quick acting every morning before 5am, even when my waking BG is 70 mg/dl.
This occasionally causes lows, and even with a CGM it can be deleterious, as I discovered first hand 5 months ago.
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I don’t understand the reasoning for doing this. Wouldn’t a BG of ~100mg/dL be better than risking hypoglycemia?
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My BG would be over 200 and take 6 hours to bring down if I didn’t bolus. My IR increase 4x’s between 5am - 9am
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Understood. I had misread thinking you wrote that your BG rises 30 mg/dL , instead of 30 minute after rising
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I didn’t eat anything after 6:00 pm. Dinner consisted of a small bowl of Indian spiced chickpea and kale stew with a green salad, and 2 garbanzo bean cookies. I actually slept from 10:00pm until 7:00 which is very unusual for me. When I woke up my blood sugar was 130. I suppose that wasn’t bad. I was down to 73 an hr later. I prefer not to run that high when I wake up but I will take it over yesterday morning.
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Even after my DP went away, I was still getting a morning rise, but now instead of a 4 AM rise only starts at 7:30 AM until 11:00 AM. I look at my CGM at 7:30 and then bolus based on the rate of climb over 3 subsequent 5 minute readings between 7:30 - 7:45 which keeps my morning rise within 25 points of BG
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Using a pump with basal rates calibrated to counteract a dawn phenomena rise is a reasonable tactic for a case like what Marilyn experienced. A CGM is likely a better tactic to use since the timely warning it can raise gives the user the ability to take an effective counter-measure.
When I took a several month pump vacation a few years back, I used Tresiba as my basal and it gave me relatively good control. I found, however, that when I adjusted my Tresiba dose for good early morning glucose levels I then had to fight off late afternoon hypos. If I dosed for the afternoon hypos then the morning rise was higher than I prefer.
I returned to my pump for this express reason. Now that I use Loop with its dynamic insulin dosing, I enjoy the ability to control both competing situations.
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I believe only a pump with a closed loop dosing system (which I Believe you have @Terry4) would be effective in combating dawn effect. I’d imagine for most people the dawn effect varies each morning as do many physiological processes. Therefore pre-programmed basal rates that are constant each morning wouldn’t work well, most of the time either providing too much or too little insulin
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I’ve been successful in configuring a morning basal profile that counteracts dawn phenomena long before I used Loop. While needs do vary from day to day, my patterns were stable enough to use a pump to resolve. I don’t think my experience is atypical, but your experience may vary.
I did learn to adjust my basal profile when my needs changed. These changes were slower than day to day variations and my basal adjustments were often made a few times per month.
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Exactly. After several months I backed way off my pump basal doses (cut them in half) for this very reason. Now the solution is to awaken prior to 3am and increase temp basal by 0-50% depending on CGM reading.
And then of course deal with completely separate feet-to-floor spikes 
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I do often deliver a feet on the floor bolus of Afrezza to keep things in line but I do wait to see the rise before I take the Afrezza dose.
@Terry4, if or when the Afrezza option becomes available in Canada I’ll be the first one lining up to get some
Apologies for the Hijack @Marilyn6
I used to have my DP basal settings much higher and would start them at 5:30 with a huge increase at 6:30. This worked well for a long time and my DP got slowly better so I started decreasing the settings.
The basal settings on my pump have worked well for me to control it if I just accept that sometimes it won’t and I don’t want to get woken up with alarms of too high. Or get alarms of too low because it’s too aggressive of dosing. As an example my BG hit 188 at 6:30 in the morning because it decided to take off. I have my high alarm at night set at 200 so I only just catch it if something really really obnoxious is going on. (140 alarm during the day) I am more aggravated it ruined my streak of 5 days at 100% in range lol. (My range is 65-160 day, 65-180 sleeping)
But a pump has been wonderful for controlling DP for the most part.
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