Dawn Phenomenom

New Topic Post Reply Printable Version
[ << Previous Thread | Next Thread >> ]

Tabithghtw27
New Member


Date Joined Mar 2009
Total Posts : 5
   Posted 3/12/2009 10:44 AM (GMT -7)   
  I was wondering if anyone has any advice on how to prevent Dawn Phenomenom?  For about the past month, my BG has been around 230 at bedtime, and at about 3 AM my glucose is bottoming out (to the point my husband has to give me Glucagon so I will come around enough to treat my low glucose).  Every night before I go to bed, I am eating yogurt and drinking milk, but it doesn't seem to be helping. 
  I am currently taking Levimeir 2x a day, and Novolog with every meal, and am wearing a CGMS to try and figure out what my body is doing to me, but beyond that, my endocrinologist and I are both at a loss!
  If anyone has any suggestions or ideas, I would really appreciate it!

Phishbowl
Veteran Member


Date Joined May 2006
Total Posts : 547
   Posted 3/12/2009 1:02 PM (GMT -7)   
Hiya Tab... Welcome to the group! (Though, as Jennie always says, "sorry for the reason" ) :-)

Are you new to (what sounds like) Type 1 Diabetes? If so, you could be going through what's called, the "honeymoon period". Your body might still be producing insulin and causing some of the roller coaster ride for you.

How've your HBA1Cs been? Are you following any kind of eating plan (Dietician/Nutritionist recommended?)?

When it comes to insulin injections to compensate for food ingestion (Novolog), maintaining control can come down to: timing and area of injection, carb to insulin ratios (C:I) being different at different times of day, splitting your Levemir to suit your body's natural circadian rhythm instead of a 24-hour clock (i.e. 7:30AM & 10:30PM), how much & when you exercise, how balanced your meals are (protein/fat/carb ratios), and how often & when you eat. Oh yes, we can't forget to factor in whether Jupiter's moons are in alignment or not, too! Just kidding - it just can seem like that sometimes :-)

The CGMS results should help you figure out your body's rhythm and I:C ratio for each of your meals and snacks, as well as identifying nightime lows and DP. I was "tested" on a CGMS for a week and it was neat to see the results. I'm kind of a keener about metrics and stuff ("what's not measured is not managed") so the numbers provided me with some valuable info.

To help with some of your questions... bottoming-out at 3:00 is usually a sign that your evening Levemir shot may be too much or timed improperly. Do you take them 12 hours apart? What's the dose for each? Do you take any Novolog with an evening snack? BTW, your snack is high in quick-acting carbs and not high enough in the fat & protein department (meaning: spike & crash and probably why you see 230's at bed time and have lows in the middle of the night). Cheese, peanut butter, nuts, meat, eggs, (along with some carbs), would help with both the crashing and the DP. At night you're looking more to maintain a good glucose level than to have it spike & dip.

A good book to read is, Gary Scheiner's: Think Like a Pancreas - A Practical Guide to Managing Diabetes With Insulin. Another option to think about is an insulin pump. Some folks found their management (much) improved by it.

I'm currently at that point. Going next month to actually pick out the pump and might be on it as soon as June. I'm one of those "brittle" diabetics (although an outdated term), whose BGLs are highly unpredictable and vary widely at any given moment. Just passed my 4-year anniversary and my Diabetes Team still look at me as a case study :-)

I also found out that it was in my best interest to learn all I could about how to manage this thing myself. I learned about food, metabolism, the endocrine system, tools, research, history, basically anything I could get my hands on - still do. It took a while for some things to sink in but when they did, so many other things became clearer. Lots of testing and daily recording of everything have helped me tweak my regimen as best as possible. The understanding that I am the one who controls the quality of my life, from one hour to the next, was also a compelling argument for me to start learning how to be an artificial pancreas from now on. Learning about diabetes is like learning about quantum physics, you can't learn it overnight and you can't start anywhere but the beginning; it's a process. One that can also lead to enlightenment about so many other things :-)
Cheers,
- Phishbowl (Type 1 since Jan'05 - Levemir, NovoRapid)
"What's Not Measured Is Not Managed"

"It is impossible for a man to learn what he thinks he already knows"-Epictetus


Tabithghtw27
New Member


Date Joined Mar 2009
Total Posts : 5
   Posted 3/12/2009 7:35 PM (GMT -7)   
Thanks for answering! No, I'm not a new diabetic, I was diagnosed when I was 9, and I'll be 26 in March. I am, unhappily, new to bad A1c (my last was an 8.6) and early morning lows (which my endocrinologist is calling DP). With my third pregnancy I started having issues with my glucose levels. Well, my youngest is now 15 months old, and I am still having problems. My bedtime snack is actually what my endocrinologist and dietician recommended. I am carb counting, and keeping my carbohydrates as close to birdseed as possible (Iactually make my own bread made from wheat I grind myself) and avoid potatoes and corn and stuff like the plague).
Ok, so my insulin routine is this: Levimeir 26u every morning (about 9) and 6 units at bedtime (about 9P). I take Novolog on a sliding scale and for a 1:4 ratio at breakfast, 1:5 at lunch, and 1:6 at dinner. I don't take any at bedtime unless my BG is over 300 (thankfully that doesn't happen often). I also take 10/40 of Vytorin before bed as well.
Part of my problem with the DP issue is the fact that I am combative when my husband tries to wake me up. A few nights ago, I when I came around, I looked like a domestic abuse victim (literally) and David had a bloody lip and I had bitten him. The thing that scares me is, what if one of my children needs something, comes to wake me up, and I wind up hitting them bc I can't control what I am doing.
Ok, so would a better snack be like a half of a PB sandwich? You are the first one that has indicated that my snack might be an issue. I'm willing to try anything, so any kind of creative snack idea would be great.
DX:  Diabetes Mellitus Type I, hx of pyelonephritis, high cholesterol
 
The Drugs!:  Levimeir every AM and HS, Novolog Q meal for correction and carbohydrates and HS as needed.  Vytorin QHS


Tabithghtw27
New Member


Date Joined Mar 2009
Total Posts : 5
   Posted 3/12/2009 7:42 PM (GMT -7)   
Oh, I did forget to add, I am checking my BG anywhere from 5-9 times a day. I am actually getting a pump sometime this month. I'm pretty active (my youngest brother is torturing me along with himself because he is trying to get into shape for Marine boot camp). I am also in school to become a nurse, so in my opinion, if I can't get better control of this problem, how can I teach others to do the same?
DX:  Diabetes Mellitus Type I, hx of pyelonephritis, high cholesterol
 
The Drugs!:  Levimeir every AM and HS, Novolog Q meal for correction and carbohydrates and HS as needed.  Vytorin QHS


ceebee
Regular Member


Date Joined Dec 2006
Total Posts : 401
   Posted 3/13/2009 12:05 AM (GMT -7)   
Hi:)

I have tried many bedtime snacks and the one half pb sandwich is the one that keeps me stable all night. Recently, I need a whole sandwich to do the trick. Good luck:)

Tabithghtw27
New Member


Date Joined Mar 2009
Total Posts : 5
   Posted 3/13/2009 6:16 AM (GMT -7)   
Thanks ceebee. I tried the half sandwich last night, and still dropped, so I'm going to do the whole one tonight.
The CGMS that I'm wearing is kind of driving me crazy. My endocrinologist has is set so that if it senses my BG is below 80, it will vibrate. Well, it started doing that every 5 minutes yesterday, and I was repeatedly getting meter readings of mid 90s to 105. Gotta call about that today. :')
DX:  Diabetes Mellitus Type I, hx of pyelonephritis, high cholesterol
 
The Drugs!:  Levimeir every AM and HS, Novolog Q meal for correction and carbohydrates and HS as needed.  Vytorin QHS


Phishbowl
Veteran Member


Date Joined May 2006
Total Posts : 547
   Posted 3/13/2009 12:00 PM (GMT -7)   
Wow! Almost 17 years as a diabetic! Going through the teen years must've been a challenge, not to mention 3 pregnancies?! I was diagnosed a Type 1 at 37 (after almost 1.5 years of them thinking I was Type 2). For the difficult time I've had, I'm glad I got it later in life.

Sounds to me like you may need to have your basal insulin adjusted? - like you're "feeding the insulin" just to keep you from going low. A good way to tell if that's what you're doing is to skip breaky and lunch and see what your levels are like (if you start going low, you'll know that's where to reduce the dose). Essentially, your basal doses should keep you humming along at an acceptable BGL. 26 units in the morning and 6 at night seems like an odd split. Maybe a more even split would work better? (that's more like a "dose with a top-off at night" kind of regimen more than an actual split). Has your dose been the same since giving birth? Hormones/pregnancy can play with your control big time! It's possible they still are.

I'm on Levemir and I find for me... 1) it doesn't last 24 hours - more like 18, 2) it works better to split it into 2 doses, and 3) it does have peaks (though not "supposed" to) at about the 6-hour mark. If you're taking it at 9:00PM that would put you right about 3:00AM that it peaks (for me anyway).

Have you tried testing at 1:30, 2:30, and 3:30 in the morning to see what kind of "trending" might be going on? Or hopefully, the CGMS will give you that data. It sucks but, you could set your alarm for 2:00-2:30 to test and/or eat to combat DP and deal with any problems (lows) before they happen.

Peanut butter is high in fat, good for protein and carbs. I would skip the jelly/jam and have 1.5-2TBS of the PB on either: 1/3 bagel, piece of toast, 1/2 apple, 1/2 small banana as a better option. I tend to go heavier on the fats & proteins at night; keeping the carbs under 15 grams. Peanut butter was one of my "go-to's" but, I'm into the cheese these days :-)

If you're doing heavy-duty cardio training, especially if you don't ramp-up to it gradually and without lots of testing before, during, and after... you could be setting yourself up for some serious lows. For me, exercise can affect me for up to 12 hours later. I've also had 20 minutes of hard playing with my 5yr old Nephew send me dropping fast (depending on when & what I last ate and how close I am to a meal). This is an area that always throws me outta whack.

You may just be a prime candidate for the pump you'll be going on. That's often what they've told me. There are too many adjustments to be made that MDI just can't cover them properly (i.e. variable basal rates through he day, dual wave and square wave bolusing to cover trickly (slow-digesting) meals like pizza, pasta, etc., insulin sensitivity and more). Plus the lovely alarm that'll wake you so your Hubby doesn't have to :-)

Just to share: I do a morning Levemir shot (13 units) around 7:30, NovoRapid (1:8) around 8:30, Rapid (1:12) around 12:00, Rapid (1:8 or 1:10) around 5:00, Rapid (1:12) around 8:00, Levemir (14 units) around 10:00. I test 5-9 times/day, too (can't know where I'm going if I don't know where I'm at :-)

Congrats on the career pursuit! You'll make a great nurse; your first-hand experience will certainly give you an edge - experiences good and bad. Many professionals just get to learn from a book. You'll have a better understanding.

I hope the CGMS will give you some data you can use to get things straightened out. The results should also help set up your pump's basal rates. Once that's sorted out, the rest comes so much easier (so I understand and will soon find out for myself). Let us know how things work out.

Cheers,
Kris
Cheers,
- Phishbowl (Type 1 since Jan'05 - Levemir, NovoRapid)
"What's Not Measured Is Not Managed"

"It is impossible for a man to learn what he thinks he already knows"-Epictetus


Tabithghtw27
New Member


Date Joined Mar 2009
Total Posts : 5
   Posted 3/13/2009 3:24 PM (GMT -7)   
Hi Kris-
Oh, boy, the teenage years were really bad bc of my "I can do anything I want and still be fine" attitude! My first two pregnancies were hard, simply bc I was driven to do things right. With my youngest, even though I was following along with my doctor's instructions, my control went down the drain. For some reason I seemed to be more prone to pyelonephritis (a UTI that has gotten into the urine making cells in the kidney). My BG levels were so bad every time I had one of these that my GP called me "brittle". Thankfully, my little girl was only 6 lbs 9oz, and was perfectly healthy.
My meds changed a lot after my pregnancy. It's been a little more than 15 months now, so I'm not thinking hormones are an issue anymore. I was switched from Lantus to Levemier bc my insurance changed. I agree that the 26:6 split is odd, but I found out a long time ago that self adjusting my dose is not a good idea (those fun teenage years).
The college I go to had an open fitness area that we are encouraged to use, so I generally spend about a half hour in there a day, and run around and play with my kids in the evening (the amount of time varies then, just depends on who tires out first :'D). That 12 hour range would again put me at the 3 AM zone. It may also explain why I am low normal at dinner. Weight wise after Ashley was born I went from 191 lbs to 147 @ my last appt with my endocrinologist.
The CGMS so far is showing me the same stuff that I pointed out to my endo, that I'm going high before lunch and dinner, and after I take my short acting insulin, I am down about two hours later and I start climbing again. I finally figured out which pump I'm going to get, now it's just a matter of my endo signing off on it. I'll let you know how it works out. And I'll try the apple with the PB tonight and see how that does. (No worries on the jelly, I don't like it, it's waaay too sweet for my tastes).
DX:  Diabetes Mellitus Type I, hx of pyelonephritis, high cholesterol
 
The Drugs!:  Levimeir every AM and HS, Novolog Q meal for correction and carbohydrates and HS as needed.  Vytorin QHS


Phishbowl
Veteran Member


Date Joined May 2006
Total Posts : 547
   Posted 3/13/2009 4:14 PM (GMT -7)   
Ya know... it sounds like you'll have this regimen much more figured out once you're on a pump. Which one you going for? I think I like the Medtronic one?? Jury is still out (probably cause I'm still debating whether I can manage it - the being attached 24/7 part). I'd love to know how it all works out for you!

A couple of things popped out at me in your last post... did you recently move from Lantus to Levemir? I used to be on Lantus. It's profile did not match mine at all - part of my "brittle" problem - but it was certainly better than NPH. I found I needed about 20% more Levemir and splitting the dose works much better than a single shot of Lantus. In my research, I found this to be the case with a lot of folks switching. Can't say I've heard of a split as varied as yours but, I hope that won't be an issue for long; once you're on the pump and just using regular insulin. Sorry I don't know about Vytorin. What's it for/do? Could it be causing havoc with your BGLs?

Seems to me like you've got a pretty good handle on the whole carbs thing, too. I found, (for me), that eating something balanced every few hours helps with the control. If I skip breakfast or say, do the cereal & milk thing, I'll find myself high (and hungry!) before lunch no matter how I compensate with insulin. I begrudge a heavy breakfast and find it hard to eat those things I SHOULD eat rather than what I feel like at the moment. I've tried to learn to feed what my body needs rather than what I think I want but, that doesn't mean that I don't creatively work in some yum-yums on a regular basis :-)

I eat a lot more fat & protein than the "experts" would recommend and while I don't follow any particular low-carb diet, I do keep them around 90-150 grams/day. I've maintained my weight at 110lbs (give or take a few here and there), for 4 years now. My cholesterol is acceptable (to them - don't get me started on this, though), and I'm otherwise in great health. Now if I could just nail down this Diabetes thing, I'd be all set :-)

Kris

P.S. I think I know what you mean about jelly being too sweet :-)
Cheers,
- Phishbowl (Type 1 since Jan'05 - Levemir, NovoRapid)
"What's Not Measured Is Not Managed"

"It is impossible for a man to learn what he thinks he already knows"-Epictetus

Post Edited (Phishbowl) : 3/14/2009 12:36:54 PM (GMT-6)


Phishbowl
Veteran Member


Date Joined May 2006
Total Posts : 547
   Posted 3/14/2009 11:36 AM (GMT -7)   
Since I posted earlier about circadian rhythms/clocks, I found this intriguing article that came out today in Medical News Today:

http://www.medicalnewstoday.com/articles/142224.php

Some say time(ing) is everything :-)

Kris
Cheers,
- Phishbowl (Type 1 since Jan'05 - Levemir, NovoRapid)
"What's Not Measured Is Not Managed"

"It is impossible for a man to learn what he thinks he already knows"-Epictetus


ceebee
Regular Member


Date Joined Dec 2006
Total Posts : 401
   Posted 3/14/2009 3:32 PM (GMT -7)   
Congratulations on "Little" Ashley:) Although my first two babies were high normal weights, My daughter was 10 pounds and 19 and a half inches and my last son 11 pounds and 23 inches. Hope your lows are getting better. What did the doctor say?
New Topic Post Reply Printable Version
Forum Information
Currently it is Sunday, December 04, 2016 7:26 AM (GMT -7)
There are a total of 2,732,491 posts in 301,026 threads.
View Active Threads


Who's Online
This forum has 151186 registered members. Please welcome our newest member, debbixij.
266 Guest(s), 8 Registered Member(s) are currently online.  Details
John_TX, Carioke65, mtm3461, Buzzlymeyear, poohcheez, franko63, trumpet123, JesperTrottier


Follow HealingWell.com on Facebook  Follow HealingWell.com on Twitter  Follow HealingWell.com on Pinterest
Advertisement
Advertisement

©1996-2016 HealingWell.com LLC  All rights reserved.

Advertise | Privacy Policy & Disclaimer