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#1
papa369

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I have been having a issue with the Dawn effect, has anyone had a problem with it? Does anyone have any suggestion on how to deal with it?

#2
meontheweb

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Dealing with it for 1-2 years now, and the doctor finally said "ENOUGH" and put me onto insulin therapy (humulin). My fasting is slowly coming down, and hopefully as I put in more regular exercise it will get within target.

#3
papa369

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That's what I'm afraid is next. My Doctor has me taking 3 5mg Glipizide 10 minutes before dinner. and she want me to start eating dinner at 7 pm now instead of 6pm. My sugars are fine the rest of the time with diet & exercise.

#4
princesslinda

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Since diagnosis, my morning #'s are always higher than they should be, usually in the 115-125 range, regardless of what I eat the night before or what time I eat. I assume that's my normal, and as long as the rest of my #'s throughout the day are in-line, I just don't stress over it. In the 7 years since diagnosis, i've probably not had a dozen readings in the double digits for my fasting reading.

T2, diagnosed 8/31/06.
Meds: Metformin-ER 500 mg twice daily, HCTZ 12.5 mg every other day for BP Enalapril 20 mg 1 daily (ace-inhibitor)
Diet: I eat to my meter, generally eating 75-100 carbs/day with the occasional splurge.


#5
Hammer

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papa369, have you tried eating something before you go to bed?...like maybe a slice of cheese or a handful of nuts? Maybe try drinking a glass of wine before going to bed. A lot of people have success with their Dawn Phenomenon when they do these things.

Presently taking: Hyzaar for blood pressure:
Novolog and Lantus for diabetes.
Welchol for cholesterol and diabetes
Mega-Red Omega-3 Krill Oil (300 mg)
Mega-Red D3 (5000 IU)
I was diagnosed in 2003...

(The human body is so resilient that no matter how badly you abuse it, it will still last you a lifetime.)


#6
pat593

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Yes. Went to bed 118 last night woke up at 169. When you figure out what to do - tell me!

My endo and primary tell me not to worry about it but I've been struggling with it too long so I hope to try another med when I get my next A1C. They do not think I should try insulin yet and even think I should consider going off the Met. ???

This should be an interesting thread since I'm sure a lot of people have had this issue. I'm hoping some of the experts come out and explain Type 1.5 diabetes which I believe many of us Type 2 might be, especially those of us who cannot control our fasting sugar levels no matter how good we are with lifestyle.

Oh, and by the way, I found my fasting numbers to be even higher on ER Met. I tried that for 6 weeks taking my last 2 before bedtime and I still had higher fasting numbers than on regular Met. Endo said there should not be any difference.

Keep posting what you find and what you try.

Pat
Age 56
Diagnosed 8/12 - A1C 9.1 Fasting 200, weight 183

2/13 -  A1C 6.9
5/13 -  A1C 7.1
8/13 -  A1C 6.5         weight 118

10/13 - A1C 7.4%  
2/14 -  A1C 7.0%      diagnosed as Type 1.5

3/14 -  A1C 6.3%

6/14 -  A1C 6.3%      weight 128

9/14 - A1C 6.3%    started Dexcom CGM - Yeah!  

Lantus, Humalog, Metformin
low carb, regular, gentle exercise every day
 


#7
jwags

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I have been plagued with it for almost 7 years. Trying to figure it out takes trial and error. This is what has helped me

1. Low carb diet, especially dinner, no more than 10-15 carbs
2. Full dose of regular metformin. I take one 850 before bed, one around 4-5 am and the last one at 9 am.
3. Eating a high fat snack around 8-9 pm
4. Never exercise in the evening but at a different time of day.
5. You might want to do some basal testing. Wake up several times during the night to see when you spike.

As far as Type 1.5, you need to get a GAD Antibody test. If you test positive you are a Type 1. Most of us even the thinner ones tend to be insulin resistant not insukin deficient.

metformin 2550 mg
Moderate carb diet 40-75 carbs a day
3 T of Coconut Oil daily

Vit D, CoQ10, Melatonin, Multi vitamin, zinc, B 12
Chia Seeds , Flaxseeds, fish oil, biotin, occuvite and zinc

Exercise- Tennis - 2 hours/week, Power Walking- 2-4 miles most days, Hiking in the summer on trails and in the mountains

diagnosed Feb 2007
Age 64

#8
jims_forum

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I have been plagued with it for almost 7 years. Trying to figure it out takes trial and error. This is what has helped me

1. Low carb diet, especially dinner, no more than 10-15 carbs
2. Full dose of regular metformin. I take one 850 before bed, one around 4-5 am and the last one at 9 am.
3. Eating a high fat snack around 8-9 pm
4. Never exercise in the evening but at a different time of day.
5. You might want to do some basal testing. Wake up several times during the night to see when you spike.

As far as Type 1.5, you need to get a GAD Antibody test. If you test positive you are a Type 1. Most of us even the thinner ones tend to be insulin resistant not insukin deficient.


Jwags:

Blessings and thanks for your feedback.

I too have to follow similar approach and metformin use.

Great data. Bets wishes with your health and sharing with the rest of us. Cheers!
James (Jim) W. Snell
30+ years as type 2 diabetic
40 years as Digital Microprocessor System designer
Stroke in 2007 and retired.
Metformin, Humalog Lispro, 1200 calorie Diet and 1.5 to 2 miles walking exercise A1C = 6.4
http://db2jimcaresta.com

#9
jims_forum

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Yes. Went to bed 118 last night woke up at 169. When you figure out what to do - tell me!

My endo and primary tell me not to worry about it but I've been struggling with it too long so I hope to try another med when I get my next A1C. They do not think I should try insulin yet and even think I should consider going off the Met. ???

This should be an interesting thread since I'm sure a lot of people have had this issue. I'm hoping some of the experts come out and explain Type 1.5 diabetes which I believe many of us Type 2 might be, especially those of us who cannot control our fasting sugar levels no matter how good we are with lifestyle.

Oh, and by the way, I found my fasting numbers to be even higher on ER Met. I tried that for 6 weeks taking my last 2 before bedtime and I still had higher fasting numbers than on regular Met. Endo said there should not be any difference.

Keep posting what you find and what you try.


As one who has been fortunate using a cgms. The glucose digestive process shows two bumps in the BG. The main one is at 2.5 hours after eating in general or earlier but there is also one at 5 to 6 hours when the intestines crank off the hard to crack stuff causing a second peak. I use fast acting insulin - humalog lispro at 7:30 pm and recheck bg at
midnight and add another shot then to bang down this latest bump back in control rest of night.

The science shared with us all is disgracefully incomplete and simplified by the non diabetics.

Best wishes and cheers.
James (Jim) W. Snell
30+ years as type 2 diabetic
40 years as Digital Microprocessor System designer
Stroke in 2007 and retired.
Metformin, Humalog Lispro, 1200 calorie Diet and 1.5 to 2 miles walking exercise A1C = 6.4
http://db2jimcaresta.com

#10
Scotty13

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Dawn phenomenon has proven to be my Achilles heel. I was put on insulin from day one. I was determined to get off the insulin with diet and exercise. Twice tried to wean myself off..each time my blood sugar levels started a slow but steady climb. Within 3 days my morning fasting number hit 140 or more and I had to go back on it...both times. Last night I took only 10 units of Lantus insulin....not much. But without that tiny bit of back ground insulin in my system..I cannot control my dawn phenomenon. Plus it helps keep my numbers in check all day...even after meal spikes. Since I am starting at a normal number ...it gives me a little room before I go into the red zone. Insulin is really no big deal...so much less painful than a finger stick. The needle is so tiny I often do not feel it at all. I know people tend to dread going on insulin...but really there is nothing to it. Everyone is different..but for me it is a hard cold fact without insulin I would not be able to control my dawn phenomenon. I have held every A1C for the last two years at 5.5 Insulin is my friend.
Metformin 2000mg, Lantius insulin 15 units
A1C May 2011 13.2 A1C 5.5 for a year and a half
Walk a hour and a half most days...at Basset hound speed, ellipitical machine at times.

#11
ramon

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Sometimes even with insulin we can have DP. A shot of alcohol or glass of wine with a protein snack like jerky seems to work for me. I take a drink right before my head hits the pillow and it helps with a sound sleep too. Some have suggested peanut butter for the protein snack but jerky works best for me. The alcohol and jerky keeps the liver busy and helps prevent the glucose dump. Lately I wake to a bg in the 80's to 90's range, that's good enough for me.

#12
pat593

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If insulin is the next step, why stay on the Met as well? Can you go off Met if you start insulin?

Pat
Age 56
Diagnosed 8/12 - A1C 9.1 Fasting 200, weight 183

2/13 -  A1C 6.9
5/13 -  A1C 7.1
8/13 -  A1C 6.5         weight 118

10/13 - A1C 7.4%  
2/14 -  A1C 7.0%      diagnosed as Type 1.5

3/14 -  A1C 6.3%

6/14 -  A1C 6.3%      weight 128

9/14 - A1C 6.3%    started Dexcom CGM - Yeah!  

Lantus, Humalog, Metformin
low carb, regular, gentle exercise every day
 


#13
kevtn

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I was having that same issue myself....I am on glucopage 500mg bid. I used to take it when I woke up and before bed. I found if I took my second dose between 5-7pm and eat a high protein dinner (min carbs) it works better for me. Was in the 180's not anywhere from 117-125. Also found it helps throughout the day too. I am running below 100 throughout the day.

Good luck

#14
TX_Clint

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Ditto Scotty. And, I agree with all on a shot of the good stuff or/and a late night snack really helps too. As to going off met when you start a basal insulin... nope. They are two different approaches to treatment and work well together for a type 2.

<p>DX - 08/1997 - A1c 10.4

Metformin 500x4

Invokana 300

Levothroxine 137

2012 A1c 10.4/6.2/5.7

2013 A1c 5.9/5.5/5.3/5.4

2014 A1c 5.5/5.4/5.8


#15
Uff Da

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If insulin is the next step, why stay on the Met as well? Can you go off Met if you start insulin?

Staying on met is a common practice with type 2s. It can reduce the amount of insulin used and acts as a mild appetite suppressant. Met is not listed for type 1s, but is often prescribed off label for those who have some of the type 2 symptoms.

I was delighted to dump the met after I was prescribed insulin, even though my endo said I could stay on it. I don't have much of a dawn phenomenon and as best I could tell from my experiments, it would only have made one or two units of insulin difference a day. The big thing for me, though, was that I needed to gain weight. And the blunting of the appetite on met, while not great, was just enough to make it difficult to force myself to eat enough to gain. For someone trying to lose, it just might make it a little easier, but YMMV.

Dx diabetic Oct 2011, Dx type 1.5 March 2013
A1c: 10/2011 - 11.5, 3/2013 - 7.6, 7/2013 - 6.4, 10/2013 - 5.8, 2/2014 - 5.8, 5/2014 - 5.6
, 9/2014 - 5.9
Lantus 6 units, Humalog 18-27 units daily, vitamin D3, BP meds
Diet: Moderate carb diet, 120-170 carbs, 1800-1900 calories daily
Currently within my preferred weight range of 125-130


#16
jims_forum

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Staying on met is a common practice with type 2s. It can reduce the amount of insulin used and acts as a mild appetite suppressant. Met is not listed for type 1s, but is often prescribed off label for those who have some of the type 2 symptoms.

I was delighted to dump the met after I was prescribed insulin, even though my endo said I could stay on it. I don't have much of a dawn phenomenon and as best I could tell from my experiments, it would only have made one or two units of insulin difference a day. The big thing for me, though, was that I needed to gain weight. And the blunting of the appetite on met, while not great, was just enough to make it difficult to force myself to eat enough to gain. For someone trying to lose, it just might make it a little easier, but YMMV.


There is a misconception here. metformin helps stop excess liver glucose release. Insulin helps to have skeletal muscles absorb more glucose. It is not one ot the other.

If ones Liver is behaving itself and signalling on the insulin in blood stream correctly; there may be no need for metformin.

Type 1's sometimes get put on met to stop liver excess glucose release. These drugs do 2 different roles. There is some indication that the liver can improve its actions and response to insulin over time thusly reducing need for metformin.

It is also true that extra insulin can absorb smaller amounts of excess liver glucose release but fact remains one needs to exercise the excess glucose stored. When the liver glucose release gets too much, metformin is more effective dealing with that by stopping excess glucose release at source!

Edited by jims_forum, 22 October 2013 - 08:55 AM.

James (Jim) W. Snell
30+ years as type 2 diabetic
40 years as Digital Microprocessor System designer
Stroke in 2007 and retired.
Metformin, Humalog Lispro, 1200 calorie Diet and 1.5 to 2 miles walking exercise A1C = 6.4
http://db2jimcaresta.com

#17
Uff Da

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From just one of my sources on metformin for type 1s:

Among the results: "This was associated with a decreased insulin requirement and mean daily blood glucose." From The addition of metformin in type 1 diab... [Diabetes Obes Metab. 2007] - PubMed - NCBI

Dx diabetic Oct 2011, Dx type 1.5 March 2013
A1c: 10/2011 - 11.5, 3/2013 - 7.6, 7/2013 - 6.4, 10/2013 - 5.8, 2/2014 - 5.8, 5/2014 - 5.6
, 9/2014 - 5.9
Lantus 6 units, Humalog 18-27 units daily, vitamin D3, BP meds
Diet: Moderate carb diet, 120-170 carbs, 1800-1900 calories daily
Currently within my preferred weight range of 125-130


#18
FeistyRedhead

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The more I read about DP the happier I am I wake up at 3am. I know that sounds totally insane, but I hit the gym for 2 hours before work. When I get up at 3am I do not suffer from DP. However, if for some odd reason I sleep in, which is almost never, I wake up with DP. Get up at 3am and my numbers are usually in the 80's/90's range. The very rare day I sleep in until 5am and I get DP. Hubs thinks I'm crazy for getting up at 3am even on days I don't work just to avoid DP. lol

Diagnosis of Type 2 Diabetes May 2012
May '12 A1c: 10.1
Sept '12 A1c: 5.8
March '13 A1c: 5.9
July '13 A1c: 5.5
March '14 A1c: 5.3

Weight at Dx: 219
December weight: 170!! Hit my goal weight 12/22/12
Weight June '13: 165. Happily maintaining my goal weight.
Weight March '14: 178 unhappily gained.
Medications:
Metformin 2000mg daily, 10mg Lisinopril, 3000mg Vitamin D3 daily, 1000mg B12, 1500 mg Vitamin C, 1 low dose aspirin daily & a 8 billion Bifidus probiotic twice daily.


#19
jims_forum

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The more I read about DP the happier I am I wake up at 3am. I know that sounds totally insane, but I hit the gym for 2 hours before work. When I get up at 3am I do not suffer from DP. However, if for some odd reason I sleep in, which is almost never, I wake up with DP. Get up at 3am and my numbers are usually in the 80's/90's range. The very rare day I sleep in until 5am and I get DP. Hubs thinks I'm crazy for getting up at 3am even on days I don't work just to avoid DP. lol


Having watched this nasty in detail with cgms, for me; the DP starts after 3:00am reliably and shoves numbers up by 7:00am and higher. Insane - nope ; your wake up is shutting
down the DP. Are you also eating a snack when you wake-up?

Seems to make sense to me.
James (Jim) W. Snell
30+ years as type 2 diabetic
40 years as Digital Microprocessor System designer
Stroke in 2007 and retired.
Metformin, Humalog Lispro, 1200 calorie Diet and 1.5 to 2 miles walking exercise A1C = 6.4
http://db2jimcaresta.com

#20
Uff Da

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Having watched this nasty in detail with cgms, for me; the DP starts after 3:00am reliably and shoves numbers up by 7:00am and higher. Insane - nope ; your wake up is shutting down the DP. Are you also eating a snack when you wake-up?

Seems to make sense to me.


Count me as another where I believe an early wake-up catches any DP before it gets started. It took me a long time to realize I even had it, as I'm most frequently up and down in the night, eating snacks (sometimes practically a full meal) in the night. So that, of course, would change my BG by morning. But recently I've slept through the night more often until my partner gets up at 4:00. And if I get up then, my Lantus has usually kept me level through the night. But if I wait until much later to arise, like 6:00 or 7:00, my morning reading will often be higher than my bedtime or middle-of-the-night reading. For me the rise is small, only 10 or 15 points. But I've learned to inject my breakfast bolus and eat before it happens.

My breakfast I:C ratio is 1:5, whereas the rest of the day my ratio is 1:8. Whether part of that is for DP or all due to more insulin resistance in the morning really doesn't matter. It takes care of the problem for me.

Dx diabetic Oct 2011, Dx type 1.5 March 2013
A1c: 10/2011 - 11.5, 3/2013 - 7.6, 7/2013 - 6.4, 10/2013 - 5.8, 2/2014 - 5.8, 5/2014 - 5.6
, 9/2014 - 5.9
Lantus 6 units, Humalog 18-27 units daily, vitamin D3, BP meds
Diet: Moderate carb diet, 120-170 carbs, 1800-1900 calories daily
Currently within my preferred weight range of 125-130





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