dawn phenomenon... how to stop the rise?

I have recently finished the DAFNE course (which of course was very helpful) but I have been struggling for a few weeks with having extremely high blood glucose levels when I wake up. Literally every day they are above 20 when I wake. For instance; yesterday, I went to bed with a level of 6.5 after having a hypo an hour earlier and treating it exactly as told. I woke myself at 2am and my sugars were 6.4... but this morning, when I woke, it was 24.3 !? I am pretty sure I am suffering from dawn phenomenon as it was mentioned by the trainers when we were discussing my glucose levels in morning sessions, but I wasnt told if/how it can be stopped? obviously waking up with blood glucose levels of +20mmol is causing problems- i feel rubbish!
Any advice on how to / if i can prevent it other then correcting with my breakfast pleeeease reply!

thankyou!

stacy x

Hi there stacy.....welcome to the forum......

I too suffer from dawn phenomonon and always wake up with double figures apart from once in a blue moon when I am on target with no apparent reason......

As you may have been told already 'dawn' is simply just a natural hormonal response which triggers the releas of glucose from our livers in the morning to assist in getting us up and ready.

All I have simply done is experimented with different background insulins, as well as time of dose to try and get the numbers down......

Sometimes a dose of Quick Acting insulin to cover a pre bed snack together with your background can help as its dual action, I find that if its toast or something similar then I will wake higher than normal as its released too slowly for the quick acting to catch, so something released fairly quickly or with a low GI is good.......thats just me though..

I am now on Humilin I as my background as it has a peak in it, unlike Lantus and Levemir...

I couldnt confidently say it has had an effect but it seems to keep me down to about 11 and 12 in the mornings.......

Its really all about experimenting with your doses and trying to trick your body in some ways to minimise the glucose dump......I have had no real success.......

I can assume your backgound is correct at this point?

For me its not having an effect on my HbA1c at the moment, and as long as it keeps getting better I can live with it.....

But as you say rising with high readings does make you feel rubbish and tired........

My conclusions are to initially try upping your BI dose if you havnt already and consider consulting with your team about different insulins to take advantage of the different onset, peaks and durations, as well as having a snack before bed so you have some quick acting working as well.........

In the end you may never come down, and if it is effecting your daily activity and pushing your HbA1c up then the only thing left to try is a pump..........they have been proven quite effevtive in tackling 'dawn' due to the ability to increase the dose of BI automatically whilst you sleep.........

Sorry for going on for so long..........

Keep us all posted

I have also experienced the 'dawn' phenomenon, but sometimes I wake with a high headache around 2am and correct with Novorapid, but it seems to have little effect, and I end up correcting again before the night is out. Has anyone else had this problem?
Martina

Thats quite strange to get a high at 2am, and even stranger to be woken by it, must of been really high....

I think you should up your evening dose of background, assuming your on a split dose......if not on split I would consider it so your getting the most out of the background when you need it in the small hours...

This morning I woke up with a 9.2 which is good for me......I was 13.2 before bed, so I took 2 units of novo and actually dropped by background 4 units (i had previously increased it to try and tackle dawn).......

I am hoping I can achieve a smiliar result again.....I feel so much better this morning.........

Thank you novo...
Pre DAFNE I was on Lantus, and the exact opposite was happening... I would be waking up with lows of around 1.5, its so odd!

I've been trying everything you suggested... a pre bedtime snack with quick acting didnt make any difference, but I did do a 2 day fast and the high morning glucose levels didn't happen. So I'm wondering if it is something to do with my fast acting not being right. I am going to try eating a carb free dinner for a few days and see if that makes any difference. Im also gonna have to try and stop sleeping through my alarm at 2am and check my bg to see if it is rising or not then. They had said on the DAFNE course that I was a prime candidate for a pump as I exercise a lot and cant manage my insulin around it very well, so maybe that is an option. Anyways. Thank you so much for the advice, your a star!

Martina... I haven't ever been woken with a high, but that sounds awful! I would reccomend you taking the advice novo gave me and play around a bit with seeing what the cause is. The 2 day fast I had was hard, but it has cleared a lot up for me so i would deffo reccomend that. xx

and well done novo!!! I just read your morning bg... awesome!!!

2 day fast, how does that work?

id been told on here to do it, apparently you dont eat for 2 days, and therefore dont do any of your fast acting insulin... just your BI. then you can see whether the bi is working, cause if it is you shouldnt see a rise or fall in your bg all day. they say do it for 2 days cause obviously on the first day things can still be influencing your bg's from the previous day, but by the second it should all be down to the bi. Then you can see that it definately isn't your background insulin being too low causing the rise from bed time bg levels to morning bg levels. x

I dont know if i could do that...........if you take your single dose at night or if your split you can see if it works if you rise the same as you went to bed with................have you tried that............I suppose it might be hard to establish if it works if your suffering from dawn phenomonon...........oh its a hard life..................

stacy, 'told on here to do it' ? when and by whom, it doesnt sound like very sound advice to me and I would never try it without checking with my DAFNE Educator/Diabetes Team first. I don't agree that carbs you eat can have an effect in excess of 24 hours, thats a very strange idea. I can see the benefit of a carb free meal to check BI but not 2 days of it.
I'm not sure that you can prove your its your BI or dawn apart from maybe testing at 3am, at this time your BG is usually at its lowest and
should not go lower if your BI is correct, however as always there are always exceptions. Generally dawn would kick in around 5am but again not guaranteed. This would normally push up your BG, due to hormones bouncing around getting you read to get up and start the day.
Still if you have already done the 2 day fast then at least it would give you an fairly good idea how your BI is working and as novoboi says
not sure we would have the dedication to do that ! Hopefully it was worth it.
Its also strange that you didn't get it with Lantus, since its apparently not something that comes and goes but rather something that happens consistently all the time. However Lantus is supposed to have a longer profile than levimir, so that 'might' explain. Are you on a split dose of levemir ? Since in many people including me it doesn't last 24 hours and needs splitting into 2 doses to make it 'last' the full 24 hours.