Dawn Phenomenon?

[plinstedt]

I am new to this so here goes....I was diagnosed with Type 2 about 8 years ago. Things had been going well until about a year ago. I had some stress in my life and my numbers started to rise. I upped the metformin xr to 1000/day and things were OK until about 3 months ago. My fasting morning readings began to range from the 150s to the 190s. The dr. added januvia but nothing improved. I then added 1 mg. glimepiride, nothing changed. The glimepiride was doubled to 2 mg- no improvement. What's the next step? I am very frustrated as my readings throughout the day are normal. :( Can someone give me some advice? Thanks!

[xMenace]

Understand this is a prgressive disease and some of these meds can help the progression. Doc will likely up you to 2000mg of met, the max they usually give. Some may go higher. The next step after that is insulin. Often they start type 2's on Lantus, a basal insulin. Others like to run with a mixed insulin. Many of us hate the mix as it fixes you to a static routine: activity and meals with no ability to adjust for highs or lows. We prefer an MDI regimine made up of a basal like Lantus and a fast acting like Humaog or Novarapid.

Oops. Welcome to the forum! :D

[plinstedt]

Ooops! I should have said I am on 2000/mg metformin xr. Sorry!

[morrisma]

As menace said, the next probable step is insulin. You seem to have nearly run out of "pill" options.

Insulin is not a bad thing though. You should talk to your endo about multiple daily injections (mdi) where you take a long acting insulin once or twice a day which mimics the pancreas' background function and then take a fast acting shot to counter the amount of carbs you eat at each meal or correct for highs.

It takes practice and a little planning but it gets to be second nature and I felt like I was taking control of the disease rather than the other way around. Very empowering actually.
Good luck,
Mike

[SpringRam]

As an old time Type II who has repeatedly done things I should not have done over the years regarding my diabetes, I agree that in addition to the metfomin, using Lantus as a basal to establish good morning numbers (as well as helping the rest of the day) is an excellent strategy to consider. However, one must also recognize that as a diabetic, diet also plays a large roll in maintaining good blood sugar control. For me, that is maintaining a relativley low carborhydrate diet (50+/- net carbs per day) along with the metformin, Lantusand exercise. I just can't eat all the things I want like I used to such a hamburgers, pizza, and pasta dishes and maintain good control. Having Novolog around to correct mistakes is good but using it so that one can eat whatever they want all the time is more than likely to cause weight gain - not what a Type II needs to be doing. Sorry to ramble on, but Type II's must make lifestyle changes in addtion to merely taking the meds if they want to have good control.

John

[Ginette]

Hi Plinstedt,

I am having the same problem with the dawn phenomenon so I have been reading up on it. On my last 75g GTT, my fasting BG was 8.5 (153) and 6.9 (124) 2hours post. And since I have been monitoring, I have never had a value above 8 during the day, even after meals. Unlike you though, I am not taking any meds...I asked my doctor to let me see how I can control things with diet and exercise alone before considering meds...

What I read about DP though, from T1's and T2's, is that food intake and exercise have been better at helping them tame the dawn phenomenon than changing their meds. Tips I read about that have apparently helped some include eating a green apple (granny smith type) before bedtime as it is slow to digest and helps avoid a low BG around that crucial 2am-4am time span. Another thing that seems to work for some is taking a glass of wine with a snack, cheese and low carb crackers. The wine apparently keeps the liver busy enough so that it won't start producing as much glucose in the morning hours before you wake. Some say that a simple snack of nuts at bedtime also helps lower that morning BG. But that all seems to depend also on how much carb people have had for dinner that night...

So I have been doing my own bit of experimenting with what I eat in the evening and my exercise regiment. Wine seems to help, but it has to be a dry wine. But that can become an expensive habit! Also eating a handful of raw almonds at bedtime has given me better morning BGs, 6.7 (120) this morning. I also try to avoid having my largest carb intake of the day at dinner time. I have noticed that my morning BGs will be higher if I have had BGs up in the 7s during the evening, even if they drop below 7 before bedtime.

I would love to hear from anyone who has successfully been able to control that DP through modifying diet and exercise. I used to be a long distance runner and would always run at night once the kids were in bed. I no longer run, but I have a threadmill at home and have taken up walking and jogging while watching TV. I have read that exercise at night can actually make things worse regarding the dawn phenomenon. It apparently lowers BG too much during the night and makes the liver kick in even more in the morning hours to produce glucose.

Has anyone had any experience with this?

Ginette

[xMenace]

As an old time Type II who has repeatedly done things I should not have done over the years regarding my diabetes, I agree that in addition to the metfomin, using Lantus as a basal to establish good morning numbers (as well as helping the rest of the day) is an excellent strategy to consider. However, one must also recognize that as a diabetic, diet also plays a large roll in maintaining good blood sugar control. For me, that is maintaining a relativley low carborhydrate diet (50+/- net carbs per day) along with the metformin, Lantusand exercise. I just can't eat all the things I want like I used to such a hamburgers, pizza, and pasta dishes and maintain good control. Having Novolog around to correct mistakes is good but using it so that one can eat whatever they want all the time is more than likely to cause weight gain - not what a Type II needs to be doing. Sorry to ramble on, but Type II's must make lifestyle changes in addtion to merely taking the meds if they want to have good control.

John

I agree that lifestyle changes can and do help tremendously, but they are longer term and may not even work. I adamantly advise getting the BGs down first with whatever meds are necessary, then start weening yourself off of them. There's no purpose in damaging your body while you try to lose 40lbs in six months only to find your numbers are higher or worse, you've gained weight.

[xMenace]

Has anyone had any experience with this?
32.5 ****ing years of experience! Regular exercise helps, but it is not a cure. Alcohol does little for me. That 2am drop or Symogi Effect is IMO ****. My testing shows I drop, but there is no liver dump. My DP kicks in around 6am. A Symogi dump would be around 3 or 4am. I've yet to see someone test low at 2 and high at 4. IMO that late night snack does no good; though many will contend. Metformin may help a lot, but endos don't like to give it to insulin dependants. It's on my discussion list. Pumping is the best way.

[SpringRam]

I agree that lifestyle changes can and do help tremendously, but they are longer term and may not even work. I adamantly advise getting the BGs down first with whatever meds are necessary, then start weening yourself off of them. There's no purpose in damaging your body while you try to lose 40lbs in six months only to find your numbers are higher or worse, you've gained weight.

Somehow you got the idea I was suggesting that taking meds was not important. Getting the BG's quickly under control is primary. Being diabetic since 1991, I can tell you that I cannot control my diabetes without them. What I am suggesting is that along with the meds one must also think about food intake and adequate exercise so the meds can have the proper effect. I take 2000 mg of metformin ER daily along with 30 units of Lantus. My morning numbers are almost always under 90. However, if I have pancakes and syrup for breakfast my BG's will shoot up to over 200. Yes, I can take some fasting-acting insulin to get it down but that is not a very good way for a Type II to consistantly maintain good control.
For a Type II, acheiving a 2 hour post-prandial below 140 is better done through proper carb and fiber counting over the long haul rather than just eating whatever you want and then correcting with fast-acting insulin.

John

[xMenace]

Somehow you got the idea I was suggesting that taking meds was not important. Getting the BG's quickly under control is primary. Being diabetic since 1991, I can tell you that I cannot control my diabetes without them. What I am suggesting is that along with the meds one must also think about food intake and adequate exercise so the meds can have the proper effect. I take 2000 mg of metformin ER daily along with 30 units of Lantus. My morning numbers are almost always under 90. However, if I have pancakes and syrup for breakfast my BG's will shoot up to over 200. Yes, I can take some fasting-acting insulin to get it down but that is not a very good way for a Type II to consistantly maintain good control.
For a Type II, acheiving a 2 hour post-prandial below 140 is better done through proper carb and fiber counting over the long haul rather than just eating whatever you want and then correcting with fast-acting insulin.

John


I think we agree 100% ;)