high and lows

Hi,

Not much I can add but RE: Dawn Phenomenon I have terrible bother with it and have been through the motions with MDI, went from Lantus, to Levemir and then Humulin I and despite changing timings injections sites etc it can't combat it.

My biggest frustration is that no matter what my waking BM is it will always rise differently each day. No matter that my routine is the same Monday to Friday it will rise anywhere between 6 to 12 mmol so I can't predict how much QA to correct by each time, one day could bring me down to target but the same dose for the same reading the next day could send my hypo or hardly bring it down. I can only keep on correcting at lunchtime when the rise has apparantly stopped and I know my ratio well enough to properly bring myself back down to target.

The slight upside is that since MDI has failed I have been approved for an insulin pump when time and availabilty comes along. Until then it's think happy thoughts and carry-on correcting (sounds like a diabetic Sid James film )

While thinking about D.P, does anyone else who experiences it find they never seem to have energy in the mornings and only 'come round' about lunchtime? I would like to think that if my D.P was tamed I would start the day with energy and enthusiasm before the whole office thinks I'm naturally grumpy in the mornings

i increased my lantus to 10 had a hypo at 3am on the 2nd night so decreased it to 9 but my diabetes is still rising when i wake up due to dawn phenomenon it plays by its own rules it dont rise by the same each morning also having problems in the afternoon when iam at work with hypos did a carb free lunch still had a hypo so decreased my am lantus to 8 leave it at that for a couple of days while the old dose washes out of my system any tips

Did you miss a correction dose on Thursday at 1150? Your BGs went from 20.1 to 2.8 in less than 3 hours without any QA which is pretty amazing. If you are marathon training though, then perfectly possible :-)

DP is really difficult to deal with as you have seen. The problem is that overnight, you are at your lowest insulin resistance so your BGs tend to drop easily. But when the rush of hormones kick in any time after 2 am, then suddenly your insulin resistance becomes really high and the active BI doesn't do such an effective job of keeping them in check.

I can think of three options to try:

1) The easiest. Increase your night time BI. At bedtime, take QA to correct any high, but have a 2 CP snack without taking any QA for it. This might stop the hypo at 2-3 am, and the increased BI might take care of the DP.

E.g. If you are 11.2 at bedtime, take 1 QA to bring it down to about 8, and have a 2CP snack without any extra QA. Have your BI + 20%.

2) A bit harder as it involves seeing your endocrinologist. In Think Like a Pancreas by Gary Scheiner, he suggests a possible strategy for DP is to use Lantus or Levemir for the morning BI and NPH insulin for the bedtime BI dose. NPH has a peak around 4-6 hours after taking it. I think it may still be likely that you would need a couple of CPs prior to bed to avoid the overnight hypo, but it may be better than a "peakless" BI like Lantus at dealing with the DP.

3) If you have been considering a pump, then it may be worth going for that option. Pumps do a pretty good job of handling DP because they can be programmed to deliver less insulin in the hours after midnight, but more around 3-4 am when the hormones get released.

Hope this helps.

thursday time was a typo 1130 not 1150 only 2 hours after b/fast didnt feel like eating didnt do a correction workmay of been a factor i work in a bakery was working close to the ovens on a active job
i will try the 1st suggestion and see how that goes