Dawn Phenomenon

Hi, I'm being driven crazy with Dawn Phenomenon and trying to stop it or at least ease it. I have tried reducing my night-time dose of Lantus by 1 unit to 4 but find my bloods really high in the morning, and yet when I take 5 units of Lantus I am prone to go low over night. I can spend the following morning chasing the high with my correction and it's driving me crazy! Anyone been able to crack the phenomenon???

Hello Joan,

What I have found helpful with dawn phenomenon is to add a third insulin to my QA and BI. I use Humalin NPH. Its action kind of sits between QA and BI with a peak around 6-8 hours after injection. I find if I inject it around 9 pm, then it covers the DP period of 3-5 am without inducing too many highs or lows and is largely finished by the time I wake around 7 am.

It sounds like you are on quite low amounts of insulin, so with this, you'd probably only need to inject 1 or 2 units of NPH to go with your injection of 4 units of Lantus at night.

What does the rest of your insulin regime look like?

From what you have said it sounds like you are taking a split dose of Lantus - once in the morning and once in the evening? If so, it may be that your morning basal insulin is running out (for some people, Lantus only lasts around 18 hours), in which case you could consider slowly adjusting your basal insulin injections so that you inject a little less in the morning and the equivalent amount extra in the evening.

If you are comfortable sharing your diary with this thread, then we can probably offer more tailored advice.

Thanks,
Warwick.

I’m experiencing something similar, on split dose of Levimir.
Would the same thing work for me?

Hello Muriel,

Lantus and Levemir are both basal insulins, so the same advice should apply. Their behaviour differs - I find that changes made to Lantus doses can take 2 to 3 days to show a difference in BGLs, whereas changes to doses of Levemir are much more responsive. Also Lantus can continue to work up to 18-24 hours after injection whereas Levemir almost always stops acting 18 hours after injecting which is why it is good to be on a split dose for Levemir.

I think that with Levemir, you would actually be in a better position to try decreasing your morning dose and increasing your evening dose by the same amount and see if that makes any difference. It is more responsive than Lantus, so you will see if this works sooner. Just drop one unit from the morning dose and add one, leave for a few days and see if there is an improvement. If so, then you can consider whether to repeat that.

Feel free to post your diary to this thread. It's always easier to give advice when looking at a few days worth of your readings and doses.

Thanks
I’ll give that a go. I did try increasing my nighttime BI by one but was going low around 5-6 am. I hadn’t decreased my morning dose though, so worth a try.
I’ll let you know how it goes

Never really cracked it but a must to tame it is definitely a split dose of basal insulin, preferably Levemir......this allows you to focus solely on the overnight portion of the day, which means you can really push that basal dose to its limit overnight...

I also benifted from taking my overnight basal dose right before bed, as opposed to 12 hours after my morning dose.....this allowed me to have a larger, stronger dose working by the time the liver woke up at 3/4am....I compensated any defecit in the evning with my meal time bolus....no that I noticed any significant issues....

I also broke the fast as quickly as possible as this signals the liver to stop which helps stop the rise in levels throughout the morning....

eventually ended up on the pump....

novorapidboi26 said:
Never really cracked it but a must to tame it is definitely a split dose of basal insulin, preferably Levemir......this allows you to focus solely on the overnight portion of the day, which means you can really push that basal dose to its limit overnight...

I also benefited from taking my overnight basal dose right before bed, as opposed to 12 hours after my morning dose.....this allowed me to have a larger, stronger dose working by the time the liver woke up at 3/4 am...I compensated for any deficit in the evening with my meal time bolus....no that I noticed any significant issues...

I also broke the fast as quickly as possible as this signals the liver to stop which helps stop the rise in levels throughout the morning...

eventually ended up on the pump...

Sally Mac said:
Hi, it sounds like you were disappointed to now be on a pump. I hope that's not the case.

Hi@novorapidboi26, I did I have to admit have a bit of an "I can manage on pens quite adequately thanks" when my second pump broke in 8 months of use. Of course how foolish was I? I wouldn't be without it now. As you say it is the last thing to try and for the majority, it works wonders which is all anyone would want.

Out of interest, which pump did you pick or were you given only one choice?

Sally Mac said:
Out of interest, which pump did you pick or were you given only one choice?