Dawn Phenomena - Page 3

Cyborg · #31 (**permalink**) 02-21-2006, 11:57 AM

Quote:

Originally Posted by duck

Dude...I don't see where there's a "problem"?

I tend to like by bg below 100...

duck · #32 (**permalink**) 02-21-2006, 01:58 PM

Quote:

Originally Posted by Cyborg

I tend to like by bg below 100...

A whole hour after eating?

MarkMunday · #33 (**permalink**) 02-21-2006, 02:13 PM

Quote:

Originally Posted by Cyborg

Woke up this morning at 7:20 am with a 95 bg. Immediately ate a small can of lite peaches (13 g carbs) and bolused. Thought I'd try to nip the DP in the bud.

No such luck... I was 143 at 8:41 and 165 at 9:35. I'll try eating something different tomorrow to see if that helps, perhaps something with a lower glycemic index.

I thought a major advantage of a pump was that you can program the basal rate to deal with the dawn phenomenon. I can see how eating can help avoid the rebound effect. But I don't see how it can stop the DP. The DP starts to kick in at like 3 am!

The flat action profile of Lantus is a double edged sword. It doesn't cause lows like NPH. But it doesn't cope with the DP either. I inject NPH the night before to compensate for the DP. And it works very well.

Cheers,

Mark

Cinnabon · #34 (**permalink**) 02-21-2006, 02:29 PM

Thats the only way I beat it, adjusting my basals from 4:30am-7 am.

Cyborg · #35 (**permalink**) 02-21-2006, 03:16 PM

No, I don't expect to keep the bg below 100 immediately after eating. But the experiment was an attempt to stop the DP. And eating only 13 grams of carbs did not do it. My bg rises the same due to the DP with or without the food in the two experiments (one eating immediately upon waking and one eating something high in fat and protein, peanut butter, before bedtime).

I'm trying the early morning change in basal tomorrow as seems to work for Cinnabon... My trainer wanted the basal change to occur at 7 am, I wanted 5 am, so we compromised on 6 am, but I think it will end up closer to 5 in the end... Will report tomorrow.

duck · #36 (**permalink**) 02-21-2006, 04:31 PM

Can you repost your basal rates as they are now? I'm not arguing with you (you'd know better than I would if you were having DP) but your numbers look too good to be DP. Typically, the afflicted here end up much higher than what you are showing. You may indeed have something of a waking liver dump that some of us suffer from, but it's milder than DP...

MarkMunday · #37 (**permalink**) 02-21-2006, 05:13 PM

Quote:

Originally Posted by Cyborg

No, I don't expect to keep the bg below 100 immediately after eating. But the experiment was an attempt to stop the DP. And eating only 13 grams of carbs did not do it. My bg rises the same due to the DP with or without the food in the two experiments (one eating immediately upon waking and one eating something high in fat and protein, peanut butter, before bedtime).

I'm trying the early morning change in basal tomorrow as seems to work for Cinnabon... My trainer wanted the basal change to occur at 7 am, I wanted 5 am, so we compromised on 6 am, but I think it will end up closer to 5 in the end... Will report tomorrow.

When I used the CGMS, we could see that the DP started increasing the blood sugar at about 3am. But then we are all a bit different. It may be worth your while getting hooked up to a CGMS for a few days to find exactly how you work ...

Mark

Cyborg · #38 (**permalink**) 02-21-2006, 05:58 PM

Quote:

Originally Posted by MarkMunday

When I used the CGMS, we could see that the DP started increasing the blood sugar at about 3am. But then we are all a bit different. It may be worth your while getting hooked up to a CGMS for a few days to find exactly how you work ...

Mark

I was reluctantly thinking about asking the endo next week about it. Wasn't too excited reading about some of the other posts. It doesn't sound like it's very comfortable, but if it provides useful data, I suppose it's worth it.

Cyborg · #39 (**permalink**) 02-21-2006, 05:59 PM

Quote:

Originally Posted by duck

Can you repost your basal rates as they are now? I'm not arguing with you (you'd know better than I would if you were having DP) but your numbers look too good to be DP. Typically, the afflicted here end up much higher than what you are showing. You may indeed have something of a waking liver dump that some of us suffer from, but it's milder than DP...

Duck, do you want to see basal rates, or morning bg values?

duck · #40 (**permalink**) 02-21-2006, 06:00 PM

Quote:

Originally Posted by Cyborg

Duck, do you want to see basal rates, or morning bg values?

How about both?

Cyborg · #41 (**permalink**) 02-21-2006, 06:43 PM

Ok, for those that are interested, as of today my basals are set at:

12:00 am - 1.1 u/hr
06:00 am - 1.4 u/hr
01:00 pm - 1.1 u/hr

Before today the basals were set at:

12:00 am - 1.1 u/hr
09:00 am - 1.2 u/hr
01:00 pm - 1.1 u/hr

Last 3 morning bg readings

I've listed when I've eaten and when I've bolused...

02/21/06 (I fasted as I had to do blood work)

01:00 am - bg = 65 (16 grams peanut butter taken)
04:09 am - bg = 73
07:22 am - bg = 87
10:13 am - bg = 116
10:15 - Bolus Taken

02/20/06

07:20 am - bg = 95 (ate 13 grams lite peaches and bolused)
08:41 am - bg = 143
09:35 am - bg = 165 (bolus taken)

02/19/06

01:52 am - bg = 92
07:17 am - bg = 96
08:20 am - bg = 126
09:18 am - bg = 145 (bolus taken)

duck · #42 (**permalink**) 02-21-2006, 07:13 PM

Personally (and this is NOT a criticism but a voiced concern), I think your numbers looked VERY good before today, and I think you are trying to do too much too soon. There are members here who have been on a pump for a while who do not have blood sugar readings this good, and yet within a week of going on a pump, you're trying to get readings better than that of a non-diabetic? I think you're being too aggressive...(I'm worried about hypos down the road).

Okay, let me back up and come from a different angle: What are your goals? Specifically, what do you expect your 1, 2 and 4 hour-post meal readings to be? My goals are based on 2 and 4 hour-post meal readings, and those are (2 hours) less than 140, greater than 120, and 4 hour to be about 120 (in theory, I should have been 120 or so before I ate, but there are variables that I will accept).

duck · #43 (**permalink**) 02-21-2006, 07:15 PM

Oh, I meant to say that you may want to decrease the basal rate between 11PM and say 2AM from the two readings you were able to collect at the 1AM hour.

Cinnabon · #44 (**permalink**) 02-21-2006, 07:20 PM

I agree with Duck about wanting to tighten too fast, too soon. You will go through some time till your body gets used to all this. Its not that high of a rise you are having. The last thing you want is to go low on a pump. (I did, NO FUN!)

Cyborg · #45 (**permalink**) 02-21-2006, 07:36 PM

Quote:

Originally Posted by duck

Oh, I meant to say that you may want to decrease the basal rate between 11PM and say 2AM from the two readings you were able to collect at the 1AM hour.

I had fairly good control of my diabetes before moving to the pump. I was not running a daily 300 like alot of pre-pumpers. My problem on MDI was that I was getting too many spikes and lows. That said, right now I'm concentrating on getting the settings for the pump fine tuned. Specifically, I'm currently working on find a way to deal with the dawn phenomena.

My goal is to be able to skip breakfast if I have to and not have my bg go up to 160 or higher, but stay near or below 100. I am determined to find a way to do so. I consider the pump a powerful tool that is as close to an artificial pancreas as exists today. It is a tool that requires much interaction and requires much testing and experimentation to personalize, just as any diabetes treatment.

Yesterday my numbers were running a little low and I'm not sure why. They were running low the latter part of the day and through the evening. But since being on the pump, I've been testing very frequently. I may go ahead and ask for the CGMS when I see the endo next week.

Right now it's dawn phenomena time. I can't agree with you about my morning numbers looking good. Look at 2/19... I awoke around 7 and 2 hours later with no food at all my bg rose 50 points. Uncontrolled, it would have gone higher and I would have started dumping glucose in the urine. This is not new to me and has been occuring for a long time. This is not how I want to live my life as a diabetic. This is another reason why I moved to the pump to deal with issues like the dawn phenomena.