Dawn Syndrome?

[gettingby]

I don't think I've ever experienced this before but I believe I am now. :eek:
I need the advice of my forums family.
Over the past week, I have went to bed with my bgs within the normal ranges set by my CDE and myself. No snack or bolus. I have awoken with my bg at/almost double what it was before bed. My old CDE had me taking my Lantus in the morning because of 2-3 AM lows. Worked for a while but now this happens. Should I wait it out until my visit on 4/6 or should I call my new CDE today?
If you can help me, thanks in advance.

[Cyborg]

Deja Vu...

Sounds like what I went thru. I had to start taking my Lantus (when I was on MDI) in the morning because of nighttime lows. When I switched to the pump I discovered I had the dawn phenomena. With me, my sugars skyrocket after I wake, not before like most people. The pump is a great way to handle the dawn phenomena. Some people have found other ways to deal with it. Search the forum for some of the other recent threads for some suggestions.

[JediSkipdogg]

I would think maybe splitting your lantus dose might help. Like Cyborg said, the pump would be the ultimate solution. And for some reason, the Dawn Phenomenon can develop and get worse over time. When I first started pumping I never had a problem, now, 3.5 years down the road, my carb ratio is 3 times greater in the morning than in the evening.

Being April 6 is only 2 weeks away, the decision is up to you if you want to wait. It depends on how waking up like that is making you feel.

[David]

I don't think I'd wait 2 more weeks, I'd call my CDE today if its been occurring for more than a couple of days.

How are you feeling? How are your BGLs the rest of the day? I'm asking because you might be coming down with a bug/infection and want to eliminate that as a possibility.

You mentioned having 2-3AM lows before. Make sure that's still not happening and you're simply rebounding (Somogyi Effect) by testing around that time. If so, a snack before bed would help this.

Two injections per day of Lantus works better for some people, using different dosages, morning and evening. That would allow both a full 24 hour coverage and two different basal profiles.

David

[gettingby]

Cyborg, dude you rock !! I found the thread you started on Dawn Phenomenon and it seems to help me understand it a little more.
Jedi, I think I will call her:call: and see about splitting the dose. That way, I can tell in the 2 weeks until my appointment if this is gonna work or if we need to try something different.
Thanks guys !!!!!!!!!
PS I think it's time to reopen the pump discussions.

[jeggeman31]

I had to split my dose due to that. I was going low in the middle of the night, so I changed the time of my dose and then spiking in the A.M. I split my dose (I can't remember off the top of my head) 70/30 or 60/40 and that helped out. However I did not do that to long before moving to the pump. As for your CDE I would call her first think in the morning and not wait.

[Cyborg]

I would think maybe splitting your lantus dose might help. Like Cyborg said, the pump would be the ultimate solution. And for some reason, the Dawn Phenomenon can develop and get worse over time. When I first started pumping I never had a problem, now, 3.5 years down the road, my carb ratio is 3 times greater in the morning than in the evening.

Being April 6 is only 2 weeks away, the decision is up to you if you want to wait. It depends on how waking up like that is making you feel.

Jedi, how are you handling your DP? Are you dealing with it strictly through your increased carb ratios? Or do you have modified basals also?

My endo's suggestion, and what works for me, was to have a huge spike in basal about 1 1/2 hours before a wake. The spike lasts for approx 5 hours and is just enough so that the numbers stay nice and even. There's a small fluctuation in the very numbers so it's not perfect, but I can pass a morning basal test.

[Doetsch]

When I had this happen to me I split my Lantus. I took 50% at bedtime and 50% when I awoke. This seemed to work. However, I too have found that the best solution for this is Pump Therapy.

[JediSkipdogg]

Jedi, how are you handling your DP? Are you dealing with it strictly through your increased carb ratios? Or do you have modified basals also?

My endo's suggestion, and what works for me, was to have a huge spike in basal about 1 1/2 hours before a wake. The spike lasts for approx 5 hours and is just enough so that the numbers stay nice and even. There's a small fluctuation in the very numbers so it's not perfect, but I can pass a morning basal test.

Mine is solely related to carb intake. If I eat no carbs, it doesn't change. So I handle my through my carb ratio. The reason I don't do basal is because I work a 4 on, 2 off work week. And my 4 on I awake at 5 am and my 2 off I awake at 9 am. So where do you put a huge spike in a basal rate so that it doesn't make me go high or low? You can't.

[gettingby]

I don't think I'd wait 2 more weeks, I'd call my CDE today if its been occurring for more than a couple of days.

How are you feeling? How are your BGLs the rest of the day? I'm asking because you might be coming down with a bug/infection and want to eliminate that as a possibility.

You mentioned having 2-3AM lows before. Make sure that's still not happening and you're simply rebounding (Somogyi Effect) by testing around that time. If so, a snack before bed would help this.

Two injections per day of Lantus works better for some people, using different dosages, morning and evening. That would allow both a full 24 hour coverage and two different basal profiles.

David
I'm feeling ok. My bg's have been a little elevated in the late evenings but I take a correction for that and have decent levels before bed.
Take last night for example:
11:00PM -147
7:05AM- 301.
I was like wtf?
3/18
11:41pm- 118
7:00AM- 220
I want to run out the door screaming !!!!!!!!!!!

[Cyborg]

Mine is solely related to carb intake. If I eat no carbs, it doesn't change. So I handle my through my carb ratio. The reason I don't do basal is because I work a 4 on, 2 off work week. And my 4 on I awake at 5 am and my 2 off I awake at 9 am. So where do you put a huge spike in a basal rate so that it doesn't make me go high or low? You can't.

If your pump supports multiple basal programs, seems like you could switch back and forth. Does your DP happen before or after you wake? If after, I'd say stick with what is working. If before, maybe consider 2 different basal programs?

[Cyborg]

I'm feeling ok. My bg's have been a little elevated in the late evenings but I take a correction for that and have decent levels before bed.
Take last night for example:
11:00PM -147
7:05AM- 301.
I was like wtf?
3/18
11:41pm- 118
7:00AM- 220
I want to run out the door screaming !!!!!!!!!!!

lol... sorry.

I know the feeling. It's common, don't sweat it.

[David]

I'm feeling ok. My bg's have been a little elevated in the late evenings but I take a correction for that and have decent levels before bed.
Take last night for example:
11:00PM -147
7:05AM- 301.
I was like wtf?
3/18
11:41pm- 118
7:00AM- 220
I want to run out the door screaming !!!!!!!!!!!

Might be Dawn, but I'd still want to make sure it's not actually Somogyi before making any changes in my Lantus.

[gettingby]

I am definitely calling my CDE today. She has always been quick to return my calls and offer advisement. I know it's stupid but this has got me really worried. I am not a whiner (as Dew and others can attest to) but I feel so lost today.

[Cyborg]

When I told my endo about it and I asked him what caused it, his answer was, "we don't know". I'm not sure if there is a test or not. Maybe someone else on the forums has heard of one. Lots of us have found different ways to deal with this issue. Get some tips, talk to your endo and try to find one that works for you. Trial and error (and hopefully learning from your errors) is part of building your customized diabetes managment plan and getting your disease under control.

[JediSkipdogg]

If your pump supports multiple basal programs, seems like you could switch back and forth. Does your DP happen before or after you wake? If after, I'd say stick with what is working. If before, maybe consider 2 different basal programs?

The problem is then remembering to switch. If I'm on the one that gives a huge basal change at 4 am (1 hour before waking) and I have the day off, then I'll wake up at 6 am with a huge low. Also, say I want to have 0 carbs for breakfast that day, then I'd have a huge spike in insulin for nothing. So that's why when the DP is solely carb related, one should counteract that with carb ratios and not touch the basal rate.

[Cyborg]

The problem is then remembering to switch. If I'm on the one that gives a huge basal change at 4 am (1 hour before waking) and I have the day off, then I'll wake up at 6 am with a huge low. Also, say I want to have 0 carbs for breakfast that day, then I'd have a huge spike in insulin for nothing. So that's why when the DP is solely carb related, one should counteract that with carb ratios and not touch the basal rate.

I see your point. My pump doesn't even automatically switch to the weekend basal program and back, little lone switch to pre-programmed ones on queue. They could really do some cool stuff with these pumps if they got smart.

[JediSkipdogg]

I see your point. My pump doesn't even automatically switch to the weekend basal program and back, little lone switch to pre-programmed ones on queue. They could really do some cool stuff with these pumps if they got smart.

That's true on alot of our medical equipment. If they paid a few computer programmers some money, heck, 2 kids right out of college at $35,000 a year would do, they could make pump software, meter software, etc. so much better. My grandma's A/C thermostat on the wall is the size of my pump and is 400 times smarter.

[gettingby]

That's true on alot of our medical equipment. If they paid a few computer programmers some money, heck, 2 kids right out of college at $35,000 a year would do, they could make pump software, meter software, etc. so much better. My grandma's A/C thermostat on the wall is the size of my pump and is 400 times smarter.
Sad but true. :frown:
LOL on grandma's thermostat. I needed a good laugh. Thanks !!! :rofl:

[JediSkipdogg]

Sad but true. :frown:
LOL on grandma's thermostat. I needed a good laugh. Thanks !!! :rofl:

Is it not true though? Think about it. A thermostat maintains a steady temperature throughout the day (basal rate) but can be changed by the hour if needed to adjust for people in the house or not. Then if you need to lower or up the temperature, you can give it a temporary change (temp basal) or in the case of 2 stage heat pumps, activate the emergency heat button (just like a bolus) to give that extra fast heat.

Then she also has the ability to change all 7 days of the week to different settings, or do different programs depending on which day of the week it is. It also has a built in calendar and tells you what day today is (Monday for instance.) Show me a pump with a calendar option.

And the sad part, we bought it for her for Christmas at the unbelievable cost of $100. In medical prices that would be around $10,000.

[gettingby]

Is it not true though? Think about it. A thermostat maintains a steady temperature throughout the day (basal rate) but can be changed by the hour if needed to adjust for people in the house or not. Then if you need to lower or up the temperature, you can give it a temporary change (temp basal) or in the case of 2 stage heat pumps, activate the emergency heat button (just like a bolus) to give that extra fast heat.

Then she also has the ability to change all 7 days of the week to different settings, or do different programs depending on which day of the week it is. It also has a built in calendar and tells you what day today is (Monday for instance.) Show me a pump with a calendar option.

And the sad part, we bought it for her for Christmas at the unbelievable cost of $100. In medical prices that would be around $10,000.
I totally agree with you. Right now, we are at the mercy of the pump companies until someone finds a better design for a pump and that's just :mad:

[JediSkipdogg]

I totally agree with you. Right now, we are at the mercy of the pump companies until someone finds a better design for a pump and that's just :mad:

Sorry to hi-jack this thread. But we veered off to a good topic. I was watching something the other day on TV about a couple that owns their own business and has one of the highest health insurance plans possible, they pay about $1500 a month for their plan for just them.

The interesting part of the show was that the wife had some sort of cancer (I can't remember which.) She was on some sort of miracle drug that actually put the cancer in a recessive state, however, it costs her over $8000 a month for it. It was so expensive, the insurance refused to pay for it.

The show then continued on with other couples in the same situation. One drug they showed had a price of $300,000 annualy to take and a person needed to be on it for 2 years. It was like the miracle drug for some disease.

They then went on to say that there is no federal government guidelines for drug companies to follow when making a drug. They even used insulin as an example and added tht if Lilly wanted to change overnight the cost of a bottle of insulin to $1000 each, they could and nothing is illegal about that. Price gouging doesn't even qualify.

[gettingby]

It's all infuriating, isn't it?

[gettingby]

Ok. At the moment, I am running at 199. This is after my Lantus injection and my before breakfast injection(2 hours ago). Just got a call back from the nurse. She is gonna explain all of this to the doctor (CDE is out today) and call me back. Will update after work tonight. Thanks for all of the advice. All of you rock !!!!!!!! Have a great day.

[gettingby]

Sorry I didn't update last night but I was tired. :sleep:
They upped my dose a little and are having me to split it 50/50. I don't mind another injection if it's gonna help. We are gonna see what happens between now and the 2 weeks until my appt.
Thanks for all of the advice yesterday. You guys :rock:

[Cyborg]

Good luck and let us know how it goes. :)

[stella117]

I don't think I've ever experienced this before but I believe I am now. :eek:
I need the advice of my forums family.
Over the past week, I have went to bed with my bgs within the normal ranges set by my CDE and myself. No snack or bolus. I have awoken with my bg at/almost double what it was before bed. My old CDE had me taking my Lantus in the morning because of 2-3 AM lows. Worked for a while but now this happens. Should I wait it out until my visit on 4/6 or should I call my new CDE today?
If you can help me, thanks in advance.
Two ideas:

You could split your Lantus dose into an AM and PM and get better coverage that way.

You could try drinking a little red wine in the evening. It's tricky, but when the liver processes alcohol, it's too busy to release glucose.

Option 3: Just accept that for a couple of hours, you'll be a little high. If you move your AM tests up, you'll probably find that you're just fine for most of the night. So if you're a little high until your breakfast bolus or AM Lantus dose kicks in, it's not that bad. Probably a lot better that consistently going low all the time.

[gettingby]

Ok. Looks like the split dose may be working. I'm not waking up with high numbers (been on split dose since Tuesday). I think my morning dose may be a little too much but that's a horse of a different color. LOL.:)

[seacomp]

Ok. Looks like the split dose may be working. I'm not waking up with high numbers (been on split dose since Tuesday). I think my morning dose may be a little too much but that's a horse of a different color. LOL.:)
Good that you are getting positive results. When I switched to a split dose, I found that I needed about 10% less. Others have also reported reductions in the amount of long-term insulin required although the amounts differ.

[gettingby]

Good that you are getting positive results. When I switched to a split dose, I found that I needed about 10% less. Others have also reported reductions in the amount of long-term insulin required although the amounts differ.
Thanks seacomp. I've been doing a little experiment and for the last 2 days I have skipped lunch. decent numbers before, no insulin, no extra activity, but I've been going hypo at the 2 hour mark. Oh well, gotta keep working on it. LOL