Any way of controlling DP?

[Cinnabon]

I have tried all possible ways of trying to have better FBS levels and nothing seems to work consistently, or does that even exist in the blood sugar level world? (LOL)
I take an N shot at about 9 pm but nothing seems to work on a consistent level, I can wake at 92, 110, but 4 to 5 out of the 7 days, its 160. Please lend a hand......

What can I possible do to improve my FBS level? (Darn DP!)

[dixiepixie64]

Cinnabon,
I understand completely your frustration - I hate starting the day out high. I am not much help...I never got DP under control either until I started pumping. My basal rate is 67% higher from 5 a.m. until 10 a.m. and that solved the problem.
Maybe some of the others will have some ideas for you...

[duck]

I have tried all possible ways of trying to have better FBS levels and nothing seems to work consistently, or does that even exist in the blood sugar level world? (LOL)
I take an N shot at about 9 pm but nothing seems to work on a consistent level, I can wake at 92, 110, but 4 to 5 out of the 7 days, its 160. Please lend a hand......

What can I possible do to improve my FBS level? (Darn DP!)

That's N for ya--Inconsistent. The best therapy for DP is a pump, from what I read here...

[Cinnabon]

Darn...
I had a feeling about that, but unfortunately I do not know if My new insurance will cover a pump. That would really put me in the dumps to know I would have NO control over DP.

[DeusXM]

Try splitting your basal dose - you might find that will help. If you're taking isophane as well you'll find that taking it first thing in the morning will counteract pretty quickly any DP initiated rise.

Alternatively, maybe take your evening basal dose a few hours later, say at 11pm.

You may also find a change from isophane to Lantus or Levemir helpful. However, you may also find that such a change is far from helpful for a variety of reasons, as I did. Still, wouldn't hurt to try. I find isophane more than appropriate for my personal needs, but obviously we're all different.

I wouldn't be too concerned about acquirring a pump. Whilst indeed they are much easier, it is perfectly possible to get just as good results with MDI - it will require more thought and planning, yes, but whilst the pump is indeed probably the best solution yet in terms of convenience it can be equalled in performance by other means. My last HbA1c was 5.5 and I'm on MDI and not on any special diet, so it can be done.

[HeatherP]

I have found that I am consistently having to raise my dose of before-bed NPH. I started out on about 2 units and am currently up to 5.5. I think I'm going to have to raise it again based on my readings for the last several days. (I take mine between 10-11 p.m. most days)

If you're sure you're not going low overnight then I'm not sure what to tell you. :(

[duck]

I have found that I am consistently having to raise my dose of before-bed NPH. I started out on about 2 units and am currently up to 5.5. I think I'm going to have to raise it again based on my readings for the last several days. (I take mine between 10-11 p.m. most days)

If you're sure you're not going low overnight then I'm not sure what to tell you. :(

That's the problem with NPH--I know I sound like a broken record, but my fear is that you are increasing your dosages because your early morning readings are high...but what if they are high because NPH "decided" not to work as hard recently? What is NPH is only working at about 40% So you increase again, to about 7 units, and THEN it kicks in at 80-90% one morning...That's sort of what happened to me, but I didn't understand the action of NPH.

PLEASE be careful, or get on Lantus. I hate sounding preachy, but the only thing that ever came close to outright killing me with this disease was NPH two, maybe three times.

okay, back to DP...(sorry)

[HeatherP]

Ah, but I AM on Lantus: 2x a day. Doesn't cover my fastings though, so I started adding some NPH.

I had a few near brushes with death myself the last year I was on N, (I became ultra-sensitive suddenly) and I was a little worried adding it back in at first. So far it's working, and I'm just not ready for a pump at this point.

[duck]

Ah, but I AM on Lantus: 2x a day. Doesn't cover my fastings though, so I started adding some NPH.

I had a few near brushes with death myself the last year I was on N, (I became ultra-sensitive suddenly) and I was a little worried adding it back in at first. So far it's working, and I'm just not ready for a pump at this point.


You're a smart (low-carb) cookie, but just be careful, please. I am less concerned with diabetics who eat cheesecake than I am for diabetics who use NPH...

(okay, I think I am done hijacking this topic--back to DP)

[Harold]

Based on personal experience or observation you might try sleeping a different amount of hours. Try keeping a log of how many hours you sleep and what your morning readings are. I know this has an affect on my readings and you may be one of the lucky ones that can control the amount of or nearly the same amount of sleep most nights. Then you might be like me and you sleep whatever, if it's 2 or 12 hours you never know until you do it.

[DeusXM]

I am less concerned with diabetics who eat cheesecake than I am for diabetics who use NPH...

Hehe...I do both and have never had any problems. In fact the only time I've ever had problems was when I was on Lantus - that was a year of my life I lost to that **** insulin, probably one of the most important as well, and because of Lantus I wasted it.

[kemist]

I have tried all possible ways of trying to have better FBS levels and nothing seems to work consistently, or does that even exist in the blood sugar level world? (LOL)
I take an N shot at about 9 pm but nothing seems to work on a consistent level, I can wake at 92, 110, but 4 to 5 out of the 7 days, its 160. Please lend a hand......

What can I possible do to improve my FBS level? (Darn DP!)

I am having the same problem with Lantus. I recently split up my lantus does, and although things improved for 2 days, its uncontrollable now. The fine line between going to low (causing a liver secretion of WAAAY to much glucose) and not having enough night time insulin is so hard to stay in...

Also finding that I have to give double the amount (or more) of Novorapid to cover my breakfast... I don't know what causes these SWINGS in dosage requirements for the same breakfast.... sometimes i feel like I am injecting water, and it's doing nothing.... where is all this sugar coming from?!?! Is it my darn liver messing me up? :confused: :confused:

kemist

[KickStart101]

Hi Cinnabon: Well, it is possible, but you can't slack on the job or it'll bite you in the butt. ;) Firstly, you have to be consistant with your regime of meds, diet, exercise, etc. as you know. Secondly, you MUST be using Insulin
that works for you. I've been on Lente and Humalog for 9 yrs. now and still works good for me. You and your Dr. are really the only ones that can make it work for you since you are there, we are not. Also weight-loss is very important,(no I do not remember your size, just stating a fact, I feel so anyway)(you use less Insulin and it is absorbed much better). It is trial and error for everyone. This is me:
1. On Insulin that works for me
2. I am 124 lbs., 5' 2 and a proud half.
3. I eat 4 - 5 small meals a day and other snacks. By small I mean 1 bowl
of home-made soup and a glass of milk or a tuna sandwich and a glass of
water or a mixed salad or caesar salad)with a juce or a small potato with
a porkchop and green beans, etc. I eat normal food, nothing fake(except
for gum sometimes). I drink lots of liquids. I am not hungry or mal-
nourished or dehydrated.
4. I do my hour of exercise 5 days a week.
5. My FBS's are usually between 4.0 and 5.8. I usually take 32 units TDD.
-I take 9 units of Lente when I get up and 9 units Humalog.
-Eight hours later I take 7 units of Lente and 2 units of Humalog(if needed)
-Seven hours later I take 6 units of Lente...and have something to eat
6. I use the longer needles 12.7 mm(so I know the Insulin is where it is
supposed to be, not leaking out when I take the needle out...makes me
feel better). I use the short needles for 6 units or less.
7. Oh my snacks would be like: a yogurt or an apple, a couple crackers with
cheese, a half grapefruit, a handful of nuts, etc.
Sorry, so long. This is my regime. If yours doesn't work
then there's the pump. Good luck either way. :)

[DeusXM]

As a thought, I've just had an idea. DP is when the liver releases glucose prior to/on waking, and we're trying to find a way of getting the insulin to work to counteract that.

How about an alternative way of dealing with this - what about helping prevent the liver from releasing glucose in the first place?

As we all know, alcohol inhibits your liver's ability to release glucose. Therefore how's this for a suggestion? Before you go to bed, have a drink - nothing heavy, maybe a glass of red wine (wards off heart disease too, folks!). The small amount of alcohol in your system may help inhibit the release of glucose in the morning, thus solving your problem.

This is just a theoretical suggestion, I'm just looking at the science and making a judgement based on that.

[kemist]

DeusXM, yeah I might just have to try that.. This is some real 'out of the box' thinking. :thumbsup:

it might even be good to do this once or twice during times when you have lost control of Fasting B.S to get things back into control, and maybe they will get better? who knows, guess we need a guinny pig... that might be me.. lol.

ONE THING I am confused about... You seem to point out that DP is the rise in Glucose levels PRIOR to waking, and everyone is talking about their morning lantus shot covering DP.. how is this possible if it occurs 2 hours PRIOR to waking?? Something is needed to 'hit' the peak while sleeping.

We should clear that up for others as well, cuz caused some confusion..

you really got me thinking about the wine thing. how much would u need? over the course of time, would this be bad for you to have a small amount each night?

kemist

[kemist]

Here is a neat study done to examine the effects of alcohol on morning B.S's.... its actually quite comprehensive - have a read:

http://care.diabetesjournals.org/cgi/content/full/24/11/1888


kemist

[kemist]

Here is an informative graph that shows the potential difference between consumption of water at bedtime and wine (on sugar levels):

http://care.diabetesjournals.org/content/vol24/issue11/images/large/dc1114432001.jpeg

[DeusXM]

DP affects people at different times - some prior to waking, some just after. Again, this is an individual thing and so everyone has to find their own solution.

As for alcohol - again, I'm not sure how much you'd need, but I'm erring on the side of caution - maybe just one or two glasses a night. I don't see how this would necessarily be bad for you. Problems with the liver caused by alcohol only happen when the liver is overloaded regularly - one glass a night will not do this. Red wine has also been identified as helping prevent heart problems, so it wouldn't hurt for that either. The net daily calorie increase as a result of a glass of wine a day is also neglible and would hardly result in weight gain.

And finally, the most clinching argument of all - check your local paper whenever it reports on someone who's made it to 100. Bet you £10 that they say they have a glass of whisky most nights.

Seriously. There's definitely something in it, since around 80% of the reports of centenarians I've read have mentioned that person drinks some kind of alcohol every night.

[Funnygrl]

Am I the only one who has NO CLUE what DP means?

[rzrbks]

Funnygrl

Am I the only one who has NO CLUE what DP means?

Dawn Phenomenon

http://www.fromallangles.com/glossary/diabetes/terms/dawn-phenomenon.htm


Dawn Phenomenon
A sudden rise in blood glucose levels in the early morning hours. This condition sometimes occurs in people with insulin-dependent diabetes and (rarely) in people with noninsulin-dependent diabetes. Unlike the Somogyi effect, it is not a result of an insulin reaction. People who have high levels of blood glucose in the mornings before eating may need to monitor their blood glucose during the night. If blood glucose levels are rising, adjustments in evening snacks or insulin dosages may be recommended. See also: Somogyi effect.

[Funnygrl]

Okay. Yes, I have heard of the dawn phenomenon, but couldn't figure out what DP stood for.

[Cinnabon]

check blood sugar levels around 2 a.m. to 3 a.m. for several nights.

If the blood sugar level is low at 2 a.m. to 3 a.m., suspect the Somogyi effect.

If the blood sugar level is normal or high at 2 a.m. to 3 a.m., it's likely the dawn phenomenon.


Already sleepy fom reading this.. LOL

[archimeech]

Cinna,
the only thing that helped me to overcome the Dawn Phenomenon was going on the pump. I have my basal adjusted to a sign curve that climbs higher as it goes through the night, untill aobut 8am. In my regimen, I go from an 8pm of 1.4/hr to 2/hour at 3-8am then back to my normal 1.4/hr at 9am. it works rather well, as long as I stay away from pizza or anything else with high carbs, high fat for dinner time.