Dawn Phenomenon possibility?

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JayBee DAFNE Graduate
James Paget University Hospitals NHS Foundation Trust
587 posts

Hi all,

I have been having a lot of trouble getting my doses right. My biggest problems seem to be over night... and I'm beginning to wonder (after so long of being stubborn) that I have the dawn phenomenon thing on top of it all.

I have posted up my last week of results and as you can see, if I have 1:1 ratio on most meals (particularly note the after lunch and evening stuff in this case), I tend to hypo... sometimes quite badly. At the moment my "set up" is:

All meals: 0.5:1 QA/CP
Morning BI: 9
Evening BI: 18

A correctional 1 QA seems to take me down by roughly 4 points, not the usual 2-3. Took a lot of hypoing to work that out.
My insulins are (QA) Humalog and (BI) Levemir. I manually inject using pens.

So, can anyone see a pattern?

I will be trying to do a during the night test to rule out during the night hypos, but considering morning highs have been quite common for me, I haven't been too worried that I'm hypoing considering my results have tended to be 8.5 or something when I've tested before. Since then, after speaking to my DAFNE team, I have been advised to concentrate on before bed stuff... make sure that my meal hasn't been leaving me high all night... but I dunno, I seem to rise.

Doesn't help either that I've also been trying to rule out that massive shifts are also being caused by "time of the month" - this has not been as successful a workout as I hoped because there's too many other factors to consider. I feel so sad when I've yet again hit a 17-21 BG again due to reasons I cannot see. Sad

My DAFNE nurse thinks it's odd that I'm all 0.5:1 across the board but I'm reaching a point where I'm wondering if that's really how's it's got to be considering if I adjust my BI over the day, I either go really stupidly high or I start hypoing at different points during the day depending. It has been an endless battle. -_-

Thanks in advance for any helpful replies - especially from those with experience of DP.

novorapidboi26 DAFNE Graduate
NHS Lanarkshire
1,800 posts

Most of the rises overnight that you hae recorded are not that large, so it would definitely be worth getting some eearly morning readings to confirm whats going on...

you seem to be quite sensitive to insulin, being on a 0:5:1/1:1 ratio, and a reasonably low BI dose..................i would try and get some basal testing done overnight and during the day.........you may find that you just need really small amounts, which would be perfect qualifications for a pump..........especially if you end up needing less than 0.5:1 for your carbs........

i seen a 21 after exercise, this may be down to having little to no insulin on board, i need to have carbs before exercise, not immediateky before, but with my dinner at 17:30, then exercise at 19:30, I need insulin in my system to ensure my BG doesnt rise.........coz if theres no insulin, how does your muscles get the energy in?

DP occurs in everyone, its just diabetics cant control it, and for me personally the effects are large, however I dont think this is the case for you, as your body seems to use the insulin really well..........i think with the basal test, this will be confirmed.......

you may want to consider taking youe PM BI dose later if you find the DP is effecting you, this would allow you to have more units working at the time the DP starts, roughly 2 hours before you ususally get up, this may help if you think an increase in dose would drop you overnight.............

all speculation at the moment though, you need to get some overnight results, basically confirm your BI doses are right, if so , decide if you are seeing the DP effect, find a strategy to combat it, like moving PM dose later, and ultimately, decide whether a pump is needed to cope with your tiny doses......

nice hearing from you again............ Very Happy

JayBee DAFNE Graduate
James Paget University Hospitals NHS Foundation Trust
587 posts

Hey NB, thanks for replying.

I certainly agree with you about doing the overnight and carbs free during day. I keep meaning to but some nights I'm just outright exhausted. I'm not convinced I sleep well right now. I will aim for a evening 5hr test and a 3am tonight.

That 21 you've noticed is at least a couple of hours after exercise. Apologies for the confusion.

I will have to have a good think about my doses if I have to look at pushing my evening BI back to 9 or 10pm. Shall cross that bridge when I get to it...

Thanks.

JayBee DAFNE Graduate
James Paget University Hospitals NHS Foundation Trust
587 posts

Here is the next day... as it unfolds....

novorapidboi26 DAFNE Graduate
NHS Lanarkshire
1,800 posts

so it would seem that you arent really getting the dawn rise, but a few more nights would confirm it.................

do you have any thoughs as to why you were high at 1:10am.....?

I personally would of thougght 1.5 units would not be enough, but everyone is different I suppose, and you use insulin really well, so I dont think you would need the amounts I take for correction, you could of maybe went to 2 units, but you know more than me about how you react.......

you might want to get a BG reading at breakfast, as its perfectly possible you could have went up further..........

JayBee DAFNE Graduate
James Paget University Hospitals NHS Foundation Trust
587 posts

Yeah, my dinner was a bit of guesswork yesterday.. I have started using the Android DAFNE app and I sometimes add information a bit late. Sorry. Sad At the time I was rushing to get to the table and had other things on my mind as the evening went on.

I will be doing two overnight checks again tonight and tomorrow, well, if I carb free and don't have to correct, it might be just one (I've made evening carb free plans with the boyfriend right now to do so so it's looking likely!).

For a while now, 1.5 QA correction for 14 BG has been a mostly precautionary dose. If it happens again tonight, I will brave 2 units (if 1 QA really does take me down by 4 BG, 6 would be lovely).

Thank goodness it's Easter so I can mess around with sleep... will aim for a more usual wake up time tomorrow. Today wasn't great but I did go to bed late and got up twice.

Hope things are working out well for you NB. Smile

(Edit: Wheyhey, my 300th post lol.)

JayBee DAFNE Graduate
James Paget University Hospitals NHS Foundation Trust
587 posts

Here we go...

After chatting to my partner, I'm planning to put my evening BI up tonight from 18 to 20. The whole waking up at 12-14 pattern is too frequent to ignore especially now this has been seen (a repeat of the last time I looked but concentrated on before bed first).

Let's do this.

novorapidboi26 DAFNE Graduate
NHS Lanarkshire
1,800 posts

i agree............... Wink

JayBee DAFNE Graduate
James Paget University Hospitals NHS Foundation Trust
587 posts

How interesting... and frustrating... looks like it's been made worse! XD
Do I really need more than 20 BI in the evening? Let's see what happens tomorrow I guess.

novorapidboi26 DAFNE Graduate
NHS Lanarkshire
1,800 posts

It would be hard to answer your question as there is still too many variables on the page......you took 4 correction instead of your normal 5, this is an additional change to your BI change, so it could have contributed to your blood sugar level.............on the Saturday it seems you had some more carbs after dinner, desert maybe, this is an additional dose with its own profile, this too could have contributed to blood sugar levels.......by 00:33 you are still really high, is this BI or QA? It would seem QA as your BG then dropped by 3am [you had correction] and it still went up by morning.........

So lots of variables as I say, you need to eliminate as many as possible to get accurate results that can be used.......

When basal testing overnight, try to be strict, try and refrain from supper, and try and decide on what your dinner will be, including desserts/snacks after the main meal, before your eat.........

I would get a few nights like the one described above, just to be sure if you need more.......my strategy would be to increase the PM BI dose until you go low before or at the 3am mark, then you know your maximum dose for overnight.

If still high by morning, the DP is beginning after 3am and you may need to bring your time forward to later on, before bed even........this will give your BI dose more of a kick and longer duration while still holding your levels steady......