[ebster]

Hello,

Am a newbie here. I am posting on behalf of my girlfriend. She is 50, a type 1 diabetic, and more or less a creature of habit as to her diet and glucose management regimen. The past few weeks she has inexplicably been waking up mornings with glucose levels 200 to 300, when she had been accustomed to waking up with 50 to 80 levels. Her basic habits evenings before she retires is unchanged. She has recently taken to setting her alarm to wake up 2 am to do a check, and typically her level at that time is 80-110 - only slightly higher as compared to when she retires. She is otherwise apparently as healthy as ever.

Any ideas as to what the cause of this change might be? or strategies for managing this new situation? Any links or previous posts you can direct me to that may shed light on this vexing situation? I will supply additional info if needed.

Thanks in advance for any help!

'Ebster"

[Brian J]

Ebster,

Get her to check her blood at 4am, 5am and so on until she finds when it starts to rise. It could be dawn phenomonen. The liver assumes there is not enough glucose in the system because her insulin level is too low, so it releases extra glucose into her. Usually, what is needed is a slight extra amount of insulin at the time just before it starts. I started getting this happening to me at about 48 years old. One or two units of novorapid at 6am prevents the rapid rise for me.

[Subby]

Yes, I'd echo that sentiment. Considering that she has now narrowed the rising trend down to between 2am and wake up (which is usually what time?), as Brian says focus in on that period and try to catch more specifically where things start to go wrong. Then she can start looking at solutions such as Brian's early morning adjustment dose. Depending on the factors other solutions are probably possible. Even, if desired and affordable, going on an insulin pump which can be programmed with many changes in basal rates to cope with such "behind the scenes" fluctuations.

Out of interest, it's great you are seeking answers, is she aware you are doing this research? I hope she is privy to the conversation if possible (and might even join in).

[ebster]

Thank you very much Brian and Subby. Your responses are certainly helpful.

For the first time last nite she took a small amt of insulin at 2 am and it helped. She was 64 this morning (she normally rises at 5:30 for work), which is certainly better. We'll zero in on this issue with your suggestions in mind.

Question: Can we expect this "dawn phenomenon" continue indefinitely, even 'permanently'?

Will my gal participate herself here? She likes the way I'm handling this and reads before I post.

Many thanks again, good people!

Ebster

[Simons70]

Hi Ebster-
Maybe your girl friend is like me. For many years, probably 45 my insulin stayed very steady and was easy to maintain. But as I got older I find I have times when it will go high and even with every meal adjustment will stay back for a couple of days or up to ten days and than go back to normal for a month or so and than a repeat.
It drives me crazy but I am finally just saying "that's just the way it is".
Simons

[Brian J]

I fought with it for a couple of years, usually started at 4 am, but somedays not at all , other days at 5 am, it was very inconsistent. A few years back, I talked a doctor into putting me on metformin ( 500mg in the morning and 500mg at 5 pm) and it reduced the variability of it so now it usually only happens 30 minutes after I get up. Just be careful of going low in the night if you take too much insulin and try and find out exactly when it starts if possible.

[Subby]

Originally Posted by ebster

Thank you very much Brian and Subby. Your responses are certainly helpful.

Anytime.

Question: Can we expect this "dawn phenomenon" continue indefinitely, even 'permanently'?

It does seem to usually be a long term trend, from what I've come to understand. Could be weeks, months, or years.

Mind you, remember there is another phenomenon that may come across as similar but is caused by going to low overnight in sleep, resulting in a "bounce back" too high in the morning. That conversely can often be fixed by less basal insulin/insulin in the evening/snack before bed. Something to keep in mind if you suspect hypos during the night. If you want to know more about that scenario, feel free to ask.

Will my gal participate herself here? She likes the way I'm handling this and reads before I post.

And you've done a good job, and it's great to see partners being so proactive and supportive in taking on these problems. I just wanted to double check you weren't doing the behind-the-back thing, which is understandable but often backfires

[soso]

I wondered if it was slightly high basal.. if she was waking up at 80 all well and good, but 50 seems a bit low and it's not too much of a stretch to imagine the liver going into overdrive if it was dropping lower than that. That 2am 80-110 could be it just getting cranked up and into gear..

If it was me, I would probably try lowering the basel first and see if there is any improvement, as in the long run, providing it works, that's going to be a lot easier than waking up for a shot every night..

[Subby]

Originally Posted by soso

I wondered if it was slightly high basal.. if she was waking up at 80 all well and good, but 50 seems a bit low and it's not too much of a stretch to imagine the liver going into overdrive if it was dropping lower than that. That 2am 80-110 could be it just getting cranked up and into gear..

This is a really good point. I didn't pick up quite how low the figures mentioned are, as I work in mmol/l not mg/dl and didn't use the converter this time.

People know this, but for my own benefit: 50 is really quite low, for the vast majority of human beings . 80 is also technically low, taking standard guidelines. As you say soso, any slip downwards earlier in the morning, and the liver could well be kicking out glucogen, causing the spike.

ebster, I'm sorry I didn't quite realise how low your GF was "walking the line" so to speak. Thing is, don't rule this second scenario out because the early morning correction shot seems to work: it would work in either scenario:

scenario 1: dawn effect (internal hormone/energy release) -> effectively not enough basal insulin (for that small period) -> high

scenario 2: too much basal insulin/less need for basal (many possible causes) -> low during small hours of morning -> liver releases glucogen to prevent coma (good, normal reaction) -> high

Not trying to repeat things or be too obvious, it's just good to come at non-intuitive things like this a few different ways.