Morning Highs (Dawn Syndrome)

[kid_fears99]

Does anyone know any solution to Dawn Syndrome? It has been hitting me really hard the past few weeks. Last night I tested before bed and I was at 200. I took 2u of Humalog, and went to sleep around 11:30. I woke up at 6:30 this morning at 370!!!! It seems like no matter what my BGLs are when I go to bed, I wake up near 400 every morning. I e-mailed my doc about it and his suggestion was to increase my Lantus dose, but I fasted a couple of times this weekend, and my basal is leveling me out around 100 - so I'm not sure I actually need to increase the Lantus. I've been waking up and immediately testing my BGLs and taking humalog, but inherently after waking up that high I feel awful the rest of the day. Any ideas?

[Stumpkins]

HI, I had the same thing forever! My sugar could be 70 at bedtime, and 350 when I woke up. Going on the pump has definately helped. I've been on it since Feb.6, 2006, and I wake up and check @ midnight and at 3am, and get up for work at 6am. My sugars are still sometimes high, but 80% of the time, they are between 100-140!!!! I know what you mean about feeling bad the whole day....and my experience was that if it starts out high, it's very tought to get it back to normal anytime soon!!

[Cinnabon]

this dawn thing is really frustrating. I had DP before my pump and I was miserable. It is kinda tough to beat on MDI. I would go to bed w/ 105 and wake up at 300.
Have u ever considered a pump?

[Fred&CharlesFan]

Does anyone know any solution to Dawn Syndrome? It has been hitting me really hard the past few weeks.

kid_fears99,

It is a natural response, the DawnSyndrome. Your body is waking up, so your system is naturally raising your BG, whether you ate pre-bed or not. You are spiking though!
Consider the pump routine of checking BGs at midnite, 3 am, 4:30am, 6am. Your DawnPhenominom of a high at waking up at 7am, is already starting much earlier in the morning (3 am). Follow the BG test procedure for at least 3 days to understand what YOUR individual pattern is. It is the only way to be able to adjust at bedtime (i.e. 11pm), what your body is starting at 3:30 am, and have the result you want at 7am.
Yes, it is a drag getting up at those times to check your BG, but it is only sleep you're loosing and you and your improved control are worth getting the right data.
Hang in there!

[DeusXM]

There are a couple of solutions to DP that you might find helpful. Firstly, are you eating breakfast regularly in the morning? If you're not, then your liver has trained itself to think that you will always need lots of glucose first thing because you're out of food for a few hours in the morning. If you start regularly eating breakfast, you will retrain your liver to start behaving itself and not go into a mad flap first thing in the morning.

If you are eating breakfast regularly, then it gets a bit trickier. When do you take your Lantus dose. Is it first thing in the morning? If it is, then what is probably happening is that your Lantus is burning out a couple of hours before you wake up and so you're running on empty. If this is the case then you might want to think about either moving your Lantus dose time to another time of day or perhaps splitting your dose.

Another slightly left-field option is to tackle the problem at the source. The BG rise is caused by the liver doing its own thing. So keep your liver busy. A glass of wine or a pint of beer or a glass of whisky just before bed doesn't have that much booze but it might be enough to divert your liver's attention away from pumping out glucose the next morning.

Finally, you might also want to check that you're not actually experiencing the Somogyi Effect. Check your BG around 2-3am and see if you're going low. It may be that your increased BG in the morning is caused by you having sleep hypos, in which case you'll need to reconsider your insulin routine and evening snack.

[Pitzi]

I speak under correction here, but perhaps your insulin is too short-acting?

I have never ever had problems with dawn syndrome using intermediate acting insulin. But when I got changed over to fast acting it became a nightmare.

[Cyborg]

Finally, you might also want to check that you're not actually experiencing the Somogyi Effect. Check your BG around 2-3am and see if you're going low. It may be that your increased BG in the morning is caused by you having sleep hypos, in which case you'll need to reconsider your insulin routine and evening snack.

This is a good thing to check for, especially if you took insulin right before going to bed.

The only way I could get my DP problem under control (if that's what it was) was through pumping.

[DeusXM]

I speak under correction here, but perhaps your insulin is too short-acting?

I have never ever had problems with dawn syndrome using intermediate acting insulin. But when I got changed over to fast acting it became a nightmare

I'm fairly sure that there's a member on this board who solved their DP on their Humalog/Lantus regime by taking a few u of Insulatard just before going to bed.

[vrocco1]

I'm fairly sure that there's a member on this board who solved their DP on their Humalog/Lantus regime by taking a few u of Insulatard just before going to bed.

I read a post where someone was taking type N before bed.

Actually, drinking red wine before bed worked out very well for me. It sort of retrained my liver as DeusXM suggested.

[drewgolden]

Does anyone know any solution to Dawn Syndrome? It has been hitting me really hard the past few weeks. Last night I tested before bed and I was at 200. I took 2u of Humalog, and went to sleep around 11:30. I woke up at 6:30 this morning at 370!!!! It seems like no matter what my BGLs are when I go to bed, I wake up near 400 every morning. I e-mailed my doc about it and his suggestion was to increase my Lantus dose, but I fasted a couple of times this weekend, and my basal is leveling me out around 100 - so I'm not sure I actually need to increase the Lantus. I've been waking up and immediately testing my BGLs and taking humalog, but inherently after waking up that high I feel awful the rest of the day. Any ideas?

When are you eating and how much?

Three squares, and avoid FAT at dinner.

Make sure you dose accordingly at dinner.

At bedtime, I try to be around 90-110 and take Lantus (or L) at bedtime.

If you snack between dinner and bed, then all bets are off. If you test at 200 at bedtime, then you need to determine which direction it is going. And FAT and alchohol at dinner can throw a monkey wrench into the mix as well.

Try avoiding snacking between dinner and bed. And avoid fats at night.

A painful exercise (but it may be worth it) would be to wake up every 2 hrs at night and record where you are.

Pick a day and test more intensly so you know what is happening. If I am 200 and it's bed time, and I am unsure what direction it's moving, I will dose and stay up an hour to make sure things are moving the right direction.

Perhaps your basal coverage is askew.

Personally, my sugar raises when I rise at 6.30 - it will go from 80-90 to 140 in an hour or two. Having a small breakfast (and approprite dose) heads the rise off at the pass. :-)

HTH

drew

[kid_fears99]

Wow - You guys are amazing. Thank you so much for all of the great ideas. It's funny - I've been trying to get ideas from my doctor for a week now, and he won't even return e-mails or messages, but you guys have given me tons of different things to try within the span of hours!

Tonight, I ate a very low fat meal for dinner - so I'm going to see if that makes a difference (crosses fingers) because I do generally eat high-fat at dinner. One night this weekend, I'm going to try to wake up every 2 hours and see exactly what my BGLs are doing - whether they're going low and then back up, or gradually getting higher throughout the night. I'll keep you posted!

Ugh what a day though - I started off at 370, by 11:00 a.m. I had fallen to 60, then I freaked out, overcorrected, and was back up to 300 by noon. So haven't been feeling well to say the least, but I'm hoping your suggestions will help with Dawn Phenomenon (sorry, called it Syndrome before :) ) so I can get my levels back on track. Thanks again everyone!

[Cyborg]

DP is a hard one to solve. Sometimes you can find a solution, sometimes you just have to deal with it first thing in the morning by eating and dosing with a specific insulin to carb ratio.

With regards to the over-correcting, make sure you follow the 15/15 rule. Take 15g of carbs (glucose tabs preferrably) and wait 15 minutes, then recheck and repeat if necessary. Most of the time you won't have to repeat. For years I would over-correct. The roller-coaster effect isn't very fun.

Good luck!

[Lilly164]

My AM sugars are higher when I have eaten nuts or other high fat foods the previous day. It seems to take a day for the extra to percolate through. And I love nuts! Extra food without corresponding exercise also seems to show up the next day. Go figure.

[Tokyo Cate]

If you snack between dinner and bed, then all bets are off. If you test at 200 at bedtime, then you need to determine which direction it is going. And FAT and alchohol at dinner can throw a monkey wrench into the mix as well.

But, I bet there is somebody here who successfully snacks between dinner and bedtime and adds a bit of fat and alcohol to the mix. I would like to here from that person as I finish work at 9:00 p.m. and frequently have a snack (though usually low fat and low protein) between 10:00 p.m. and 1:00 a.m. (sometimes even with alcohol) and I would love to know how others have coped.

[Tokyo Cate]

Ugh what a day though - I started off at 370, by 11:00 a.m. I had fallen to 60, then I freaked out, overcorrected, and was back up to 300 by noon. So haven't been feeling well to say the least

That sounds like a terrible day. I hope you manage to sort a few things out and get back on track quickly.

Could you go back to a strict routine of eating the same thing in the same portions at the same time for a few weeks (the 1970s diabetic diet) and adjust your insulin to carb ratios, sensitivity factors, etc. based on the results of the trial and then start introducing other foods with (hopefully) similar carb values to see how you respond? [That is basically the way I started carb counting on my most recent round of carb counting experience.] Diabetes is a load of work, but my health and well-being is worth a lot to me and I am totally willing to do the work if I have the resources and the direction. If you think I am being silly, you can absolutely tell me so.

[klpants]

Be wary of what you eat at night, I stick to low fat, and carbs just from veggies or low fat cottage cheese and then monitor during the night to avoid lows, yes it's hard work but at least I don't have the highs so much!

[Cyborg]

Be wary of what you eat at night, I stick to low fat, and carbs just from veggies or low fat cottage cheese and then monitor during the night to avoid lows, yes it's hard work but at least I don't have the highs so much!

I've got a slightly different take on how to avoid the lows at night. If I feel I might go low, I will eat a small amount of fat and protein. The protein will metabolize at a slow rate into glucose at about a 50% ratio, while the fat slows down the digestion process. Since the protein metabolizes slower than carbs anyhow, the added fat provides a buffer to help extend it throughout the night.

[drewgolden]

I've got a slightly different take on how to avoid the lows at night. If I feel I might go low, I will eat a small amount of fat and protein. The protein will metabolize at a slow rate into glucose at about a 50% ratio, while the fat slows down the digestion process. Since the protein metabolizes slower than carbs anyhow, the added fat provides a buffer to help extend it throughout the night.

Once you've gained control and have a sense of your numbers; I agree with your strategy of using fat to slow metabolism.

I think the original poster seems to be a bit all over the map with their numbers; so my thoughts were to simplify the diet (no fat) and test FREQUENTLY AND OFTEN in order to stabelize their numbers.

Once you have stable numbers, you can re-introduce fun stuff, like fat.

As an example; I just switched to two new insulins at once (Novolog and Lantus.) So I am having to test frequently, and I am very carefullly watching what I eat and carefully tracking carb intake (trying to determine new ratios.)

We went out to lunch and we ended up in a mexican restraunt (mmm, cheeze, beans, tacos, chips, salsa, mmmmmm) but I resisted and had a small bowl of soup and a salad (no taco shell and little/no cheeze.) I had to because a.) I could not even begin to guess carbs on some of that yummy mexican food and b.) I am trying to figure out my numbers - the basics - like how much Novolog to take if I ingest 90g of carbs.

... I really wanted a taco and a magaharita; frozen no salt please. :-)

drew

[seacomp]

We went out to lunch and we ended up in a mexican restraunt (mmm, cheeze, beans, tacos, chips, salsa, mmmmmm) but I resisted and had a small bowl of soup and a salad (no taco shell and little/no cheeze.) I had to because ..
Mexican food is a B****, if you are trying to low carb it. (I don't consider soup and salad a meal). There is a high-class mexican place in far north Plano that's ok.
BTW, what the photo in your profile?

[kid_fears99]

So Friday night/Saturday morning, I woke up to test a few times during the night. Each time I was between 100 - 140. Then woke up at 6:30 (same time as usual), and no DP! My BGLs were 150. Every other day I have DP - go figure, the one day I lose sleep to test, the DP goes away :)

[seacomp]

the one day I lose sleep to test, the DP goes away :)
Perhaps it went away because you woke to test for it?

[psilocybin]

uhm, to avoid lows at night all you need is a proper nightly basel rate thats all. u should not have to eat a thing to avoid lows if your basels are set up properly....

[Yvonne Burns]

Dear T.C., I have read alot of your posts!! Thank you. I was curious as to why you went from the pump to injections. It is not the usual direction for a diabetic to travel. Are you glad that you did?--Yvonne