T2 Dawn Phenomenon?

Newb here, diagnosed 5/1/20 with BGL over 300 during a non STEMI heart attack. Turns out I have a bad heart valve. I won’t see an endo until next Friday, 3 month after diagnosis. I have been working with my PCP who recommended increasing basal (Lantus) by 1 unit every 3 days until I was in range. I started at 20 units daily and I’m up to 45 units now. I have also been increasing bolus (Humalog) a little at a time, based on meals/carbs. I’m monitoring BGL with a Freestyle Libre but making decisions based on a One Touch Ultra 2. Everything has been trending in the right direction (I’m keeping an .xls chart to track progress and variability between the two measurements). Avg. BGL is 125 with 50/50 time in target (120 - 80).

Every morning I get 3 -4 hour spike of about 35 points which bumps me from about 110- 120 to around 150 - 160. I have started compensating by adding a little more bolus every day, but not seeing any real improvement. This morning, fasting BGL was 120 and shot to 202 by finger stick two hours later. I had consumed a Boost Glucose Control shake - 16 carbs, 190 calories. I did add some bolus (10 units, which is a good bit for me) and BGL is slowly coming down. I seem to be extremely carb sensitive anyway, but this seemed unusual. Could all the heart meds be an issue?

I have only really seen DP or FOTF issues in the T1 forums here. Am I missing something? Thanks in advance.

Welcome to the group. Wow, you have a lot going on . I am surprised they did not give you metformin as this is how type 2 ‘s are usually treated, very interesting.
Dawn phenomenon is waking up of your body dumping glucose . Timed 2-8 am.some people eat a little snack with protein in it in the evening . Again welcome to the group. Nancy50

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Dawn Phenomenon can be a problem for T2s also. It is natural for your liver to dump sugar in the morning as your body is preparing for the day. If you are insulin challenged that’s when the trouble starts, without enough insulin or the ability to efficiently use the insulin you may have your blood glucose levels will rise.

Sometimes the timing of when you take your basal insulin can help with DP. Trying to time your bolus so that it is at peak action in the morning can help.

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Silly question, but are you sure they gave you Type 2 as a diagnosis? I’ve never heard of a doctor jumping straight to insulin without trying other more typical type 2 treatments first. It’s REALLY unusual. There’s a lot of (invalid) stigma attached to a Type 2 starting insulin, like they somehow failed at diabetes-ing, and it’s typically used as a last resort. Or are there complications with the heart attack that prevent using any of the plethora of diabetes oral meds?

I guess I’m wondering if they did a test to confirm a late-onset Type 1 diagnosis, hence the insulin, but the staffers just mistakenly say “type 2” because it’s more common.

Unfortunately there are MANY contributing factor to BG variations. Even the most experienced of us can’t always justify why things took a crazy swing. Personally, it sounds like you got thrown into the deep end of the pool with a scary treatment option and little support, but you’ve still managed to do amazing. Those are good numbers after a meal.

If you see a consistent pattern I where you’re trending high or low, it’s always a good idea to make small adjustments in your insulin regime. There’s no need to justify it with any particular med or diagnosis. Just beware of two things first: Are you pre-bolusing 15-30 minutes before your meal? If not, that would explain your spike if you absorbed the carbs before your insulin started working. 2. Make sure you’re watching for lows after a bolus. Lows can cause a rebound high later, because your body releases a flood of glycogen to fix itself. If you miss the low and just catch the later high, it’s easy to assume you need more insulin… When you actually need the exact opposite. It can cause a vicious cycle of too much insulin and bad hypos!

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Thanks for the warm welcome. Yes, I have been and continue to make a lot of lifestyle adjustments, but so far so good. My DP seems to start the moment my eyes open, peaks about 10am and slowly works it’s way back down. I’m usually in the 130 range by noon and 120ish by dinner - regardless of what I eat or if I eat nothing at all. Today was a little scary, as I haven’t topped 200 in well over a month.

@Stemwinder_Gary, I have been trying to catch it on the way up with bolus when I first wake up. I will try waiting a bit and see how that works. Thanks for the input!

@Robyn_H I was in hospital for 4 days and they ran a full blood panel every day and finger sticks 4 - 6 times a day. I was on an IV drip of blood thinner and loads of heart meds. The insulin could be because of a potential interaction. Great question for my cardiologist tomorrow and endo next week. I have been making a lot of small adjustments to doses and timing based on info gathered on this forum and recommendations from my PCP. Overall, I feel as if there has been some improvement. I’m also a little worried about going OCD on control.

Thanks for the great feedback, and sorry, I just read the tip in the sidebar not to make multiple replies. I guess I’m new to forums as well. Thanks for being patient with me.

Welcome. It’s hard to accommodate DP with basal because of the timing. I’m T1 doing MDI, so a little different situation, but have good results doing early am bolus for DP.

Thanks again for all the great feedback!

Update: I met with an endo for the first time after being diagnosed 3 months ago. Seems like a good dude. He took plenty of time answering loads of questions, was extremely supportive and was wide open to my input in putting together a plan going forward. Still waiting to hear back on the blood and urine analysis, but estimated A1C to be in the 7ish range, down from 11.6 three months ago.

We are going to fiddle with basal and early morning bolus to address FOTF (semantics? My morning spikes start when I wake up, not really before). I have decided to try getting more of a regular morning routine - get up at the same time, bolus at the same time, walk the dog at the same time and see if that helps some too.

I appreciate y’all helping me not only better understand what the doc was saying, but also be able to ask some informed questions!