'Early Hours' effect

[Gary_W]

We've all heard of Dawn effect / DP whatever you want to call it. Many of us have it to some extent or another.

Whilst most people need less insulin during the first part of the night, I'm just wondering how profound the difference is because mine is shocking and explains why Lantus was giving me so much grief.

Most of the day, my basal rate hunts around 0.400 - 0.450 per hour. For DP, I need to up this to 0.500 though I suspect more would help (I haven't done a morning fasting test yet as I'm still perfecting the night one...). So all of these are subject to a bit of change, but they're not far out; I'm not getting unexpected drops or rises which I cannot attribute to bolus insulin or food. My night time one is more or less right I think as my 3.30am and waking BG were identical to my night time one :)

At 10am at night, I turn it down to 0.275 which gives me a faint rise before bed (which is nice).

From midnight to 4am, it is down ot 0.075 per hour! This is the only way I can do a blood test at 3.30am and have the same number I went to bed as.... Does anyone else have a night time basal that dips to 16% of their 'typical' daily needs? It really does explain an awful lot about my night-time lows on Lantus...

Gary

[xMenace]

Whilst most people need less insulin during the first part of the night, I'm just wondering how profound the difference is because mine is shocking and explains why Lantus was giving me so much grief.


A new believer! Welcome to the club brutha Gary!


Most of the day, my basal rate hunts around 0.400 - 0.450 per hour. For DP, I need to up this to 0.500 though I suspect more would help (I haven't done a morning fasting test yet as I'm still perfecting the night one...). So all of these are subject to a bit of change, but they're not far out; I'm not getting unexpected drops or rises which I cannot attribute to bolus insulin or food. My night time one is more or less right I think as my 3.30am and waking BG were identical to my night time one :)


It sounds rather typical to me.


At 10am at night, I turn it down to 0.275 which gives me a faint rise before bed (which is nice).


You shouldn't need to do this. My objective is to "know" what my sugars are going to do so I don't have to go to bed high; however if there's any doubbt, I don't hesitate to adjust like this. I went to bed at 1am this morning with a 7.0 mmol and cut my basals 50% for four hours. I tested 5.6 when I woke at 7am. Ya still gotta do what ya gotta do.


From midnight to 4am, it is down ot 0.075 per hour! This is the only way I can do a blood test at 3.30am and have the same number I went to bed as.... Does anyone else have a night time basal that dips to 16% of their 'typical' daily needs? It really does explain an awful lot about my night-time lows on Lantus...


Sounds like it can drop a tad more. Mine were a smidgen high for awhile too, and I was having some lows. I stayed up all night one night and tested often to find the right rates.

Here's mine for comparison

12am .70
1 .70
2 .70
3 .70
4 .70
5 1.30
6 1.85
7 1.85
8 1.85
9 1.15
10 0.60
11 0.45
12 noon 0.45
1 0.45
2 0.45
3 0.45
4 0.90
5 1.30
6 1.40
7 1.40
8 1.30
9 1.15
10 .85
11 .75

[Chappo]

Gary, just a random question (as you know i'm stalking your threads ahead of my move to pumping).

At what time(s) of day were you taking your Lantus and how much? I used to get an awful Dawn Effect until i delayed my daily Lantus injection from 8pm and instead injected at midnight.

[xMenace]

Gary, just a random question (as you know i'm stalking your threads ahead of my move to pumping).

At what time(s) of day were you taking your Lantus and how much? I used to get an awful Dawn Effect until i delayed my daily Lantus injection from 8pm and instead injected at midnight.


Interesting. I'm thinking more Symogi effect than DP. The delayed start kept you higher in the night.

Did you also experience nighttime hypos? If so, did you see any difference?

The Dawn Phenominon & The Symogi Effect, By Mr. Metabolism - Diabetes Health (http://www.diabeteshealth.com/read/1993/02/01/77.html)

[Chappo]

Well the Symogi effect is exactly why I started to experiment moving around with my Lantus injections.

I wouldn't experience nighttime hypos often with the 8pm injection, however much more often than with the midnight.

I also noticed that now, when i am injecting at 8am, i have no lows whatsoever and the dawn phenomenon is completely counterracted.

It's fairly interesting - especially the effect that high-carb beers can have on the release of Lantus. I experience extremely bad lows after having more than 5 or 6 beers, however with Spirits or Wine i am as stable as a rock.

[Subby]

Gary, I need to go through basal testing again as my needs seem to have shifted (and I want to aim for lower numbers in general).

But, based on reasonable basals from fasting tests I have a variation of 60% through the day. Strangely I peak in the afternoon, eg at about 3pm then I dip sharply at about 6pm and my low point is at 2 - 4am.

So I suppose I have an "arvo syndrome"! Frustratingly I have days this does not occur and my quest to find out why has not yet born fruit.

Just to let you know you are not alone in discovering some rather significant trends in background requirements through the day/night.

One thing is has done, is explain why I had such a **** of a time trying to make MDI work all those years.

[Gary_W]

One thing is has done, is explain why I had such a **** of a time trying to make MDI work all those years.

That about sums it up.... When you see what your body is actually requiring, it's amazing that it works at all... Don't get me wrong, when MDI worked for me, it did so very well indeed. I'm just shocked that it did when you look at the pump history / basal settings and see what ACTUALLY keeps you level.

X-Menace - thanks for the welcome to the believers club :) Regarding my slight rise before bed... Both my nurse and my pump rep wanted me to run much higher all day than I like to, so there were quite a few compramise agreements in place. My aim is to go to bed as a 5.5 and wake up the same. They didn't like that number and insisted that, until I'm used to pumping at the very least, I should go to bed 8+. As my evening basal is seeming to be about right and my evening meal bolus is mostly doing what it should, my BG is between 4 and 5.5 all evening which is great. I don't want to snack before bed, so the little basal drop late evening is my way of a slight rise to show I'm complying with their wishes (and I think their wishes are well intentioned and sensible on this occasion). The drop in basal last night meant I went to bed at 6.7 and woke up this morning 6.0. A few more nights of similar performance and I will do without the basal drop before bed so I can go to bed as a 5.x and be confident I won't hit trouble.

Chappo - With the 14u of Lantus, I always took it around midnight. In theory, the previous days dose will be at its lowest ebb or indeed gone and the new dose is supposed to take a few hours to ramp up. As my 'low time' in terms of basal needs is between midnight and 4am, I was already catering for my low time with the timing of the Lantus (although I didn't have such an understanding of what was going on until getting the pump).

I did experiment with other timings and splitting the dose, but I only managed to make things worse. For quite a long time, Lantus worked very well for me and I could wake up the same number as I went to bed at. As I reduced the dose (intentional weight loss) the control with Lantus became more fiddly. When I was whacking in a reasonable amount of the stuff, it was nowhere near as picky about things. Once I got down to 14u per day, a single unit would make a huge difference. And then my body decided that it needs next to nothing in basal terms for a few hours a day.

Gary