Dawn Phenomenon

Pardon the resurrection of an old thread, but I was wondering if any of you have tried splitting your before bed/evening BI dose so you get two peak working times to cover the dawn time? I'm thinking about trying this myself but it'd be good to know if anyone has tried it already.

I currently take 16 BI in the morning and 11 BI at night, Levemir. The BG rise happens between 3am and 7am for me and I find that when I took my evening BI at 10pm, I would tend to wake on 7BG but I would suffer highs before bed because of my day BI running out (I would go to bed on 15BG, something like that).

I'm looking at splitting my evening BI dose something like 80% at my usual time of 8pm then the rest at 10pm to try and assist for the rise.

Thoughts?

I havent tried it personally, I only experimented with the timing of the dose, so basically taking the PM dose as late as possible........obviously compensating for extinguishing AM BI after dinner.....

Its definitely worth a go............


I wouldn't of expected a double peak though......

What kind of peaks do you experience on your BI?

11BI for my evening dose stops 3am hypos.

If I took my evening BI at 10pm, I would be high before bed (11-12BG) but great in the morning.

If I took my evening BI at 8pm, I would go to bed on a good level but wake up high (11-13BG).

Saying all that, since my period started calming down with the hormones, my levels went all green so I'm not planning to test this split idea yet, however I'm now wondering if I get DP on a temporary basics while my hormones are wacky at period time. Will see how it goes next period.


Edit - stupid phone won't let me edit the word "basics" to basis. T_T

So does your BI dose not hold you steady then?

My understanding is that it should hold you steady....[between 1-2mmol/l], playing about with the timing just changes the duration of the dose.

Your are on an analogue BI aren't you?

Levemir for BI, yup. Currently 16 morning, 11 evening. 7am then 8pm.

Shall I post some diary entries too?

Edit: On my personal help thread I reference a Levemir peak working times graph. Thread is "Need help please", should be somewhere between page 8 and page 11 if I remember right (will look now to confirm).

http://dafneonline.co.uk/forums/4/topics/2026?page=4

Remembered wrong... It was page 4. XD What cha think?

Edit: quote! (Won't cut it down because phone gets confused when I ask it to delete text)

JWo said:
Yes, it would be nice but it wouldn't surprise me if they're either covering their backs or it doesn't matter that much where it is injected.

The fact they say about "it will vary according to dose, blood flow, temp and level of physical activity" suggests to me that where I inject it does not matter exactly but it is wise to keep those factors in mind. They also have a disclaimer on the same page which in turn makes me skeptical of what they say.

The fact that on the Levemir information site http://www.levemir.com/levemir/usinglevemir.aspx states "Levemir® insulin therapy can be injected in the thigh, abdomen, or upper arm." -- use of CAN instead of SHOULD -- encourages the idea that they are additional options to the common idea of using the thighs/buttocks for slow steady release.

I dedicate the use of my buttocks for my BI. I try to swap butt cheek for each injection as well as vary the exact site on the buttock. I know I put "other" for my morning dose, but that's because I usually inject my QA in my leg as well as injecting my BI into my buttocks.

I am not willing to start injecting my stomach or upper arm with my BI. This is mainly because:

For my stomach, I have at least first signs of the common problem, lipohypertrophy. I have had this checked and confirmed, though that several years ago. The lumps - though barely noticeable in appearance and feel - are in the middle area of the area starting from the sides of my belly button to my sides. Since being told this, I have been trying to avoid using that area too much and being even more select about where I inject in my stomach. If I am at work, I tend to inject in my stomach while I'm at the table/desk to save myself time at a limited lunch break but any other time, I try to do my thigh(s) instead.

For my upper arms, I was advised on the DAFNE course, and possibly before that, that it was not a good idea to inject in your upper arms. I do tend to find that when I inject a dose larger than say, 3 units, then I get a nice lump on my arm. I am usually very fussy about my arms because of this, and if it is true that it can cause a peak insulin reaction, I tend to try and only use my arms for corrections, if I use those sites at all.

I currently mainly use my thighs for meals or if I'm not happy to use the other sites - so if I was to change my BI site, it would be my thighs. They are problem free from what I can tell but in the past I did use to inject on top of the thigh pre-DAFNE, rather than the side like I do now so this may be the reason why.

Since we're posting links to things, Ruuk (my partner username on here) came across this Levemir information, sent it to me by email and this was his thoughts on it applicable to me - it may be of interest to you too:

Ruuk said:
http://www.diabetesdaily.com/wiki/Levemir_Speed_Versus_Dose

I think your morning is about 0.15 un/kg and your evening 0.26 un/kg.

Diabetes Daily: Levemir Speed Versus Dose Article said:
Levemir Speed Versus Dose

Levimir had a speed of action that depends on dose size much more so than older insulin varieties. Novo Nordisk technical papers were used to extract data points and then a 3d curve fitting program was used to generate the surface graph. You can use this information to decide if Levimir is suited to a purpose and to see how to optimize dose timing for that purpose.

Depending on dose size and BG behavior patterns of the person, it can be a basal control and it can be a dawn effect control.

Sod's law, I do not have the diary entries from the date this was emailed to me (25/11/2011) on here. *goes looking for paper diary* I have found it... I will attach this day's entries to this post. I did two carb free meals!

I am not sure if his opinion will be different based on the dose differences.

Edit: For a laugh at my crude drawing - this is also how I used to see my Levemir working times sometime after seeing that Levemir chart - dated 22/01/2012 - haha (BI inject times are 7am/7pm) - I forget what the blue notes to the side are:

I have seen this graph on the diabetes support forum, however it overwhelmed me and I never really took it in.........

Would the jist of it be that the more units you take the more sever the spike and the longer it will last?

If it is I would agree there will be spikes, but even when I was on MDI and 70 units of Levemir and being 18stone I didn't observe any spikes from the BG results and the graph would have me on the 1.5units/kg.....

So you, if I remember would be right at the front......


P.S. Love the drawing.......
Have your BG results shown similar BI behavior to that of the graph.....?

The overnight patterns alone do suggest that I do get a peak depending on when I took it. I'm still a 5'5" 10 st person with enough insulin sensitivity that 1QA drops me by 6BG so I'd imagine being effected by the peaks quite a bit.

Or in other words, it is all still bloody hard to work out. Made some great progress recently with counting bit differently after reading that book we're talking about more recently on my thread. So much still to learn on top of DAFNE...

I'm glad you don't suffer the peaks btw. That must be helpful.