The Dawn Phenomenon

Type 1 and LADA
1

I’d like to get a little more info on this.

Over the last 2 weeks I have been waking with much higher number than I went to sleep with. On average I go to bed with a BG of 85-110. I check myself at about 2:45-3:00am just about every night. This number tends to be about 115-120. Then upon waking at about 6:00 my number is around 190-210. Now to add some more mystery to this; my normal correction factor at this time almost never works correctly. I find myself battling for 4 hours to get back down to the 80-120 range. taking double and sometimes triple the normal correction.

So the more research I have done I am getting people saying it is the dawn phenomenon. What is this and how can I fix this???

Thank you!

2

One more thing. I also tried raising my basal rate from 3am-7am by .10. No success with that.

3

my rate from 3am-7am is acctually 1.65…

4

12:00a – 3:00a 0.75
3:00a - 7:00a 1.65
7:00a – 10:00a 1.55
10:00a – 11:00a 1.10
11:00a – 2:00p 0.95
2:00p – 7:00p 0.35
7:00p – 10:00p 1.40
10:00p – 11:00p 1.05
11:00p – 12:00a .55

5

up until 2 weeks ago I did an overnight fasting from 6pm-10am and they didnt go above 160 or below 80. I have been on the pump for 10 years. I also fasted between 10am-4pm and only dropped below 80 at around 3pm and my endo adjusted it and it was fine since. All my basals have been set by my endocronologist and were set by doing these fasting tests.

My last A1C was 5.9 . So I am very well under control and these basals are correct. I don’t usually change my basals w/out consulting with my endo. I use apidra in the pump.

6

So if my bg are great and my cgm line stays pretty straight, i’d imagine they are right. The only issue I have is the morning highs.

7

" I suggest you read Pumping Insulin and consider making your basal changes less abrupt. It’s like trying to swat a fly blindfolded the way they go up and down."

sorry, one more thing. They weren’t made abruptly, that was over a 4 week span of going down my .10 until I was stable.

I also test about 16 times a day.

8

this was done from doing series of fasting tests and dropping very low between 3-4pm (and this is from fasting since 9am and no exercise of any sort). We gradulay lowered it by .10. Which eventually got it to .35 . The fasting test finally stabled my BG and that basal rate. Same goes the the big jump before bedtime.

Like I said before, this was and still is all being done by my doctor. And while I value your opinion and help, I trust my doctor. He has kept me healthy for 11 years with no complications and an no A1c over 6.1 in the entire 11 year span.

No if you mean as being unstable as in the 3 hour period overnight, then yes, i suppose I am unstable.

The real question in my original post, what was dawn phenomenon???

9

I’m not on a pump & have dawn phenomenon.

Yep, normal correction ratios don’t work well for dawn phenomenon.

What it is: In preparation for waking, the liver dumps glucose, a normal process. Lowest BG tends to be between 2-4 AM. Without a functioning pancreas to regulate, BG spikes in the morning. Some PWD have this to a greater extent than others. DP is more common in Type 1s, but Type 2s can have this as well.

What has helped me: Won’t go into basal rates, because Dave covered that well & I don’t know squat about basal rates on a pump. I slowly increased my evening basal dose until my fasting numbers came down. I take a basal injection immediately before bed.

I test, inject & eat as soon as I wake up. Eating immediately made a world of difference by preventing further spikes. Seems against logic to eat when already high, but this appears to stop the liver from further glucose production.

My insulin:carb ratio is different for breakfast. I take a lot more insulin in the morning because of DP. I also eat all protein breakfasts to keep BG in a more normal range. When I’ve added carbs for breakfast, I go sky high.

Not that I get to do this often, but when I sleep in my DP is worse. Appears my basal is gone over 8 hours. On a pump this shouldn’t be a problem for you.

Eating dinner close to sleeping can send fasting BG high. I don’t eat at least 5 hours before bed. I also avoid dinners that are high fat/high protein because they’re slow to digest & play havoc overnight.

You’ll need to experiment for yourself about a small, protein snack before bed. Something like cheese or nuts helps some people with DP. I haven’t found it makes a difference for me.

I can’t exercise in the morning because of DP. Sends me even higher. Moderate exercise is fine, but anything strenuous ruins the whole day.

10

For me, even moderate exercise in the morning will send me over the wall for the rest of the day. On weekends I plan most of my activities, even shopping, for the afternoon and evening.

11

Thank you for this insight on The Dawn Phenomenon Gerri, a lot of good info here…

12

Hope it helps!

Know that feeling of dread seeing fasting numbers. I hold my breath every morning. Realize it’s after the fact of already having high fasting BG, but eating & dosing right away has helped me. I don’t even wait for the correction to take effect. Eating a not heavy dinner made a big difference, too. Took me months to find the right evening basal dose.

13

So after a lengthy discussion w/Dave I am going to try to revamp my basal rates…

So I am going to be starting a basal rate check test. I have instructions from my doctor on how to do this. But I do have a question.

Here is the directions she gave me.

This is for the evening test:

Eat a low fat lunch (with a kown carbohydrate amount). Take usual insulin for food and blood sugar. No food, no bolus after lunch.

Start test 3 hours after your meal and insulin, then test every 2 hours. No food or insulin until the test is done.

Continue test until a late dinner.

Stop test if BG goes under 70 and treat low

Stop test if BG Goes over 250 treat the high.

Now the test is the same for other times of the day just starting at different times.

Now my question is, when I eat my first meal (lunch) if I am like say 160, do I give a correction bolus along with the meal bolus? or just the meal bolus?

Thanks in advance for the help!!!