Dawn Phenomenon

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    • #5943


      Hope you are all well, first post, and its insulin related – has anyone ever heard of the Dawn Phenomenon? (great name isnt it?)


      Only discovered it is a known condition recently but its something i think I have suffered from on and of over the last year or so. I’m on MDI of Humalog and Lantus and though I usually go to bed with pretty much perfect glucose levels (around 7) I will sometimes wake up with them really high (this morning it was 17.something, yesterday 24!, though not usually quite that high). Then I will do a slightly larger humalog (only a couple of units extra) and have a normal breakfast and it will suddenly all sort itself out, I may even go hypo mid morning. I’m pretty sure I’m not going hypo in the night (i know this can make levels rise in the morning). Also some days it will not happen (3 days ago i woke up with bg of 6 so all fine). And it will only happen for a few weeks then not at all for a while.

      Its almost as if the Lantus is not doing anything until breakfast makes it kick in, i’ve read stuff about Lantus loosing its effects after using it for a while (i’ve been on it > 5 years now i think). The stuff ive read about the Dawn Phenomenon just says there is no real way to treat it. As it seems to be pretty much on and off I cant think of a way to sort it without waking up every 3 hours and testing my bg (too lazy for that!). Or probably going onto a pump???

      So was just wondering if anyone else has heard of it / suffered from it? and if so any advice.



    • #6964

      Anyone with fully functional adrenals have the pleasure of sweetening up at dawn – it’s just a problem if your pancreas/basal insulin isn’t capable of raising its head along with it (cast envious look at pumpers). I’ve never really had problems because of that early morning cortisol surge; it’s the late night cortisol slump and waking up sub-3 that have harried me more…lately I’ve started to do Lantus at 00:00, so that its supposed peak is closer to that of cortisol’s, and until 2 there’s as little insulin present as is possible (without tweakable pump). You didn’t mention when you usually inject your Lantus?

    • #6965

      I know it’s a pain, but why don’t you start with the night time BGs to see what is really happening :)

    • #6966

      I’ve just started having problems with this. Sort of annoyingly the first time a doctor is taking proper notice of the specifics, I am struggling to control it all! the first two years of type 1 I had HbA1c’s of 7-9, my last was 11 :(

      @Stephen: when you say night time bgs, do you mean before bed? Or waking up specially for them? Waking up isn’t gonna happen for me, I’m only just getting the hang of going to bed before nine thirty and still feeling tired (c’mon, 07:30 start at work isn’t right when you’re a night person!), so I guess I’ll keep winging it with steadily increased morning break snacks – hopefully!

      Good luck with it Andy – if you find something that works, let me know! :)

    • #6967

      I’ve had similar problems over the last couple of years. If you’re sure you haven’t gone hypo overnight (it really is worth testing tho…) it could be that your lantus is too low- that’s assuming you inject it in the evening. You could try adding 1 or 2 units for a few days and seeing if that has any effect on morning BGs. Obviously you would have to test more than usual and be more careful with the humalog (that’s the disclaimer as I’m not a doctor!) I was very surprised at the different 2 units made.

    • #6968

      @neobrainless – I mean waking up. I’m not suggesting @andyg doesn’t have DP, but if you’re getting erratic or strange behaviour in the morning then testing in the middle of the night (aim for the middle of going to sleep and waking up,) can at least give you a pointer as to what’s happening in the wee small hours.

      When I have to do it I set an alarm, put all the kit on the nightstand and can almost do it without opening my eyes now. It’s rough I know, but any information is good information!

      I’ve been through these symptoms in the last month, and in my case it turned out I was having big hypos in the night and not waking up (which is scary as they started happening for no reason!) Reducing my evening lantus from 18 to 12 sorted it out. (I do 2x lantus a day as one dose wasn’t balancing right.)

      Again, I couldn’t of made that distinction without testing :)

      I’m hoping to move to a pump soon, but it isn’t a solution to DP or any erratic night time behaviour (though it surely can help.) More night bloods are probably going to be required to get the basal dose right.

      Just my 2p, as @hils said … I am not a doctor!

    • #6969

      Thanks for the replies, its interesting to hear other diabolics (my mums name for it!) experiences.

      I usually do my Lantus about 11 pm, and wake about 7.30, so it should have kicked in by then. Maybe I am going hypo in the night though it used to wake me up or i’d know the next day as i’d feel pretty rough but maybe i have lost those warning signs? I’ll try the wake up and test thing soon i promise (have just over a week away on holidays coming up from this weekend so I have a feeling the lifestyle change will make any investigations pointless at the moment). Need to rule it out though i suppose.

      @Hilary – I have upped my Lantus by 2 units this week (used to be 18, now 20) and it hasnt made much difference, may try another 2 units tonight, in fact now, its 11pm! I have previously tried stuff like changing the vial of lantus thinking it was defective, and altering my injection site (in case of a fatty build up) but neither seemed to solve the mystery, it just seems to rectify itself of its own accord after a while.

      I was just pretty amazed that such a thing as DP existed and i knew nothing about it, i’ve been diabletic for 20 years, and think of myself as pretty clued up, and have a very good health care team but had never heard of it til this week when i found it from some googling. But then again you do have to take some stuff you read on the net with a massive pinch of salt!!!

      @Stephen – Do you mind me asking when and why exactly you changed to 2 Lantus injections? and do you find it helps?

      Thanks for the replies again!

    • #6972

      @andyg I moved onto Lantus / Novorapid about 8-10 years ago. Could be longer, I really don’t remember :) Back then I was on something like 26U of Lantus at tea time and that worked perfectly for me for about 5 years.

      After that it just packed it working and my sugars started soaring in the afternoons. I was getting home from work to a BG of 25+

      A week of intensive blood sugars later and it looked like the Lantus was just flat running out after 18 hours or so, dose-age was irrelevant as increasing it didn’t help at all. I started hypoing all over the place.

      Increasing my Novorapid wasn’t really an option at lunch time as I was already taking 20U+ (depending on the meal of course) and I was advised not to push it over 25 as it wouldn’t really have much more effect.

      Had a lengthy conversation with my diabetes nurse at the time and she suggested I try splitting the dose and taking it mid morning and before bed. The principal being to spread it out over the day.

      With the exception of the recent issue making me lower the evening dose, this system has worked well for me since then.

    • #6973

      Hi there all. Sorry to say been there done it got the t shirt now got a pump – much easier! I think after a while the Lantus just doesn’t want to work because your body is so used to it. Doing extra blood tests every 2hrs is great fun but it does indicate were the problem is. Getting the basal rate on the pump is interesting fasting( never knew diabs could do that!) and testing ev 2hrs but it pays off.

      Based on using a pump my basal rates are
      1 unit of Novorapid every hour from 8pm until 1am.
      0.9 units from1am-2am
      0.4 units from 2am -4am DP clearly shown here and I never believed it happened!
      0.6 units from 4am till 5pm
      0.7 units from 5pm-8pm
      This gives me a basal rate of 16.6 which can be modified to accommodate exercise etc.

      I found having two lots of Lantus really confusing and annoying as I’d been told it was a 24hr insulin.

      I think as we all get older every thing changes and we have to adapt sometimes the insulin doesn’t allow this to happen. That’s my view right or wrong. Its just another problem for us pancreatically challenged.

      Good luck anyway and keep us posted on the outcome @AndyG

    • #6974

      Before the pump I used to split my Lantus dose between morning and evening too. I found taking it all at once made me low overnight and then high in the early evening as it seemed to run out. Middle of the night testing was the only way I figured it out, it’s a pain but does give you the info you need.

    • #6978
      Annette A

      I always had a 3am dip all my life (tended to go hypo at that point). When I went onto Lantus, I started with giving it in the mornings only, to try and correct that, which worked to an extent (many fewer nighttime hypos) but left me with a major DP – my feeling was that the Lantus was disappearing by about 5am, so by 8am I was going high. Normally I got up early enough to be able to counter it with extra Novorapid, but that meant I could never have a lie in.
      Then I got a pump. I did all the fasting things – did every 2 hours bg tests overnight for several days. Only to discover that I dont actually have either a 3am dip or a DP. My basal insulin levels are totally steady from 5pm to 8am the following day, I dont need to adjust them for anything overnight. Which makes me wonder what was happening for all those (33) years?

    • #6980

      @Annette – that’s really interesting about your basal levels being flat overnight. One of the best things for me about the pump was being able to reduce my basal rate massively from 0230 until 0530 when I ramp it back up. Then I usually take about 0.5u when I wake up as I start rising as soon as I get out of bed (no matter what time I get up so it seems to be adrenalin/starting the day related rather than a specific background issue).

    • #6988

      @andyg – here’s another idea, why don’t you see if your clinic can lend you a CGM for a week, so you can have your BG checked for you every five minutes (or whatever frequency they check at) all through the night. You can then see if there are any patterns to what’s happening.

      I used to split my lantus, but don’t anymore – just 39 units in at about 7.30pm. I find that lantus tends to peak after an hour or so and then, for me, tail off at about 22 hours or so.

    • #7007

      Been away for the weekend but an update…..

      on thursday night I did a couple of tests through the night, at 2.30am it was around 12 and at 6am it was 15, so creeping up through the night. Only one night of a couple of checks so the results are not conclusive by any means! Then over the weekend was visting family and had no problems at all, bg stayed normal all weekend. makes no sense really as the week days are when my life is more stable. Kind of agree with katherine above, the lantus may stop being as effective over time, which could be why lots of folk move to pumps over time???

      Good idea on the cgm @tim, i may ask next time i have an appointment. I’m finding my lantus is acting very differently to yours, seems to take much longer to kick in.

    • #7013

      @AndyG sorry to say this Andy but are you stressed? Being stressed and being diabetic are a nightmare the thought occurred to me because you said about with family/relaxing/enjoying life? My b/s have and are dreadful at times just through to stress.

    • #7014

      @mustard I suppose i am at the moment, not due to family though. There has been a big change in my life recently and am having to sort stuff out from that which is proving stressful. Cheers, food for thought anyway….

    • #7092

      I’m just starting to struggle with my DP. Consistently high in the morning (ever the after breakfast reading, which is AFTER my cycle in to work!) then I have hypoed (mild mostly) EVERY day at lunch time for the last week or two. Getting REALLY fed up with it. But is really hard to crack, have started having snacks at break time, currently have an apple and a nutri-grain, but I don’t think there has been ANY difference, so they are obviously two of the worst things I could try?!

      Doctor has referred me to a proper diabetes nurse (I thought he was meant to be a specialist, but apparently not, just better than the main doc), so hopefully that’ll help, but it’s been two weeks already since he said that, and when I checked about it today he said I should have had a letter already.

      Not been my day, as my bad knee has been playing up, and my ‘good’ one has been joining in! And it rained on me on my way home. I should be all happy at getting out of work 3 hours early, but no. Not today. *sigh* I’ll feel better in a day or two, might lower control a little to have a break from the hypos, even if I do run high.

      /bitching session :P

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