New to the Group! Anyone have Dawn Phenomenon?

By lara72 Latest Reply 2014-07-09 17:09:29 -0500
Started 2014-07-01 19:31:00 -0500

Hi everyone, I just joined and I am looking forward to "meeting" new diabuddies. I have been a Type 1 diabetic for 38 years. I am currently on mdi. I also have hypothyroidism, peripheral neuropathy of feet and hands, neuropathy of the bladder, I am hypo unaware and have insulin resistance. Anyway enough about complications.

My question is about the dawn phenomenon. For the last two months I have been going to bed with a good range of blood sugars in the 100-120 range. I wake up in the morning with 400-500 blood sugars. I have tried increasing my levemir by 2 units everyday and am now up to 52 units. This is causing a problem with me falling low during the day. I have also tried switching from taking my levemir at night to in the morning. This hasn't helped. I have also tried splitting my dose taking half in the morning and half at night. This hasn't helped either. I finally get to see my endo tomorrow. Has anyone else had this happen and what is the treatment? I am thinking I am going to have to be put on the pump and get a cgm but Im not sure.

20 replies

22eva 2014-07-03 19:19:27 -0500 Report

I believe you should be taking a fast acting insulin also… I take Levimer and also Humalog . Ask your doctor why you are not taking a short acting insulin. I'm guessing your sugar levels are peaking in the night because of the lack of fast acting insulin. Also be sure to eat a snack before you go to sleep… Not eating can cause your levels to peak also make sure there is some protein in your snack, it helps to keep your sugar levels down

lara72 2014-07-08 17:05:48 -0500 Report

Hi, I am taking humalog as my short acting insulin. I guess I should have mentioned that in my original post. I have started eating 15 g of protein before I go to sleep and have noticed a slight decrease in my sugars in the morning. They have gone down to the lower 400's. Its still a mystery though.

haoleboy 2014-07-08 17:39:42 -0500 Report

just curious … have you set your alarm for about 3 am and tested your blood to see what's happening over night?
I would guess your endo suggested this, no?


lara72 2014-07-09 17:09:29 -0500 Report

Yes, I have in fact. I will wake up at 200, take a correction dose then right back up to 400 or 500. I have tried the apple with peanut butter and that isn't helping either. I have no clue what is going on because most of the people I have talked to dont have their numbers jump that high with dawn phenomemon. I know its not the symoji effect. I guess the only thing I can do at this point is wait for the pump and adjust my basal to cover those early morning highs.

Chopstix 2014-07-03 11:09:48 -0500 Report

Hello and welcome to the family, lara72. Have you tried a small snack with some type of protein before bed? How about cinnamon, turmeric, ginger being incorporated in your diet? Apple cider vinegar with the 'mother' in it might help also. I'm just saying. Sometimes natural works better than pharmaceutical…

MoeGig 2014-07-03 08:17:04 -0500 Report

You don't mention taking Humalog, a short acting insulin. Levemir and Lantus are similar long, slow acting insulins. I have to take a shot of Humalog before most meals to supplement the Lantus. It seems that you should be doing the same. When I try to avoid Humalog (like when I'm on a diet to lose weight), I have to eat zero carbs to maintain a reasonable blood sugar. Your evening meal must be causing the spike after you go to bed. Check with your doctor…I can't believe you shouldn't be taking some Humalog in addition to the Levemir. I could be wrong, but after dealing with Type 1 for 49 years, I don't think so.

Type1Lou 2014-07-03 15:10:39 -0500 Report

I hadn't picked up that no fast-acting insulin was mentioned in the post. It does seem inconceivable that a Type 1 would not take fast-acting bolus injections for meals, although, the PCP I had seen after first moving to Florida in the early 2000's tried to get me to eliminate my Novolog shots while increasing my Lantus, which led to poorer control and serious low BG's. Needless to say, I never eliminated the Novolog (it just didn't sound right) and his advice prompted me to find an endo even though he was over an hour away. I'm convinced that move saved my life.

Type1Lou 2014-07-03 08:07:04 -0500 Report

Hi Lara! I too have had diabetes for 38 years. I started pumping in 2011 after experiencing more frequent and severe hypoglycemias. I hope I never have to go back to MDI. Pumping has given me greater flexibility and control with no really serious hypos. I do still struggle with Dawn Phenomenon, but it doesn't occur every morning and my fasting BG's have never gone into the range yours see. Prior to pumping, my endo had changed my long-acting insulin from a bedtime shot to a morning shot and that helped a bit. I also have a high sensitivity to insulin which is different from you. I had been on a low-carb diet prior to pumping and still follow it, limiting myself to 120 grams of carb per day. I do not have a CGM but wish I did (too costly and not covered by Medicare). The pump has so many neat features that allow you to better manage. I would also recommend reading Gary Scheiner's book "Think Like a Pancreas" which has much useful info. It will take time to get your pump settings tweaked to your metabolism and you'll need to be serious about counting carbs and bolusing for the food you eat for it to work well. But the patience and effort will get you good results. Wishing you well. If you have any pump-specific questions, please don't hesitate to ask…I'm a pump-believer!

lara72 2014-07-02 17:04:49 -0500 Report

Thanks for the advice everyone. I saw my endo today and Im completely lost and confused. He said my blood sugars were NOT due to the dawn phenomenon and he didn't have an answer for me. He said the dawn phenomenon doesn't cause a rise in blood sugars that high, it only causes a 20 to 50 point rise. Now I have to wait for a month until Medtronic comes back to his office to get the cgm and start the pump process. I really dont know if I can wait a month feeling like poo all the time. Very frustrating. Ive been seeing my endo for 12 years and its a 3 hour drive to another endo so finding someone else is not really an option for me.

22eva 2014-07-03 19:26:28 -0500 Report

I would take the three hour drive just for a second opinion. I could not survive on Levimer alone. I am also T1D and this has me concerned for you. Too many high readings could cause damage to your organs. Please get a second opinion

Just Joyce
Just Joyce 2014-07-02 10:04:06 -0500 Report

I use to have liver dumps until I started eating a protein before bed. However before taking our non medical experience advice, talk to your doctor about it. Each person is different when it comes to diabetes.

Rose67 2014-07-04 08:32:51 -0500 Report

What is a liver dump

haoleboy 2014-07-04 09:38:19 -0500 Report

"Dawn phenomenon. The dawn phenomenon or "liver dump" is the end result of a combination of natural body changes that occur during the sleep cycle and can be explained as follows. Between 3 and 8 a.m., your body starts to increase the amounts of counter-regulatory hormones (growth hormone, cortisol, and catecholamines). These hormones work against insulin's action to drop blood sugars. The increased release of these hormones, at a time when bedtime insulin is wearing out, results in an increase in blood sugars. These combined events cause your body's blood sugar levels to rise in the morning.
Somogyi effect. This condition is named after the doctor who first wrote about it. It is also called "rebound hyperglycemia." Although the cascade of events and end result — high blood sugar levels in the morning — is the same as in the dawn phenomenon, the cause is more "man-made" in the Somogyi effect (a result of poor diabetes management). The term refers to pattern of high morning sugars preceded by an episode of hypoglycemia (usually with no symptoms, but night sweats can be a sign). Your blood sugar may drop too low in the middle of the night, so your body counters by releasing hormones to raise the sugar levels. This could happen if you took too much insulin earlier or if you did not have enough of a bedtime snack." - from WebMD

Just Joyce
Just Joyce 2014-07-04 09:08:22 -0500 Report

At night 2 hike sleeping, your blood sugar can go low. The liver acts as the bodies doctor and will dump stored carbs to combat the low. This can cause a morning high. This is why you should eat a snack before bed. The snack should contain a protein. This prevents morning highs. I no longer have liver dumps.

jayabee52 2014-07-02 02:18:15 -0500 Report

Howdy Lara
WELCOME to DC. Sorry you qualify for this shindig, but since you do I'm glad you found us

I had liver dumps for a while too. I asked my PCP about it and he told me to take my BG levels and if they were below 130 mg/dl that I was to eat a snack much like Neverlow said. I followed his advice and had never had a liver dump again.

God's best to you and yours
James Baker

neverlowbg 2014-07-01 20:27:18 -0500 Report

I think it happens to everyone the best trick I've learned from everyone here is peanut butter covered apple slices at bed time and it controls it pretty good I haven't woken up high since try it out also talk to your dr about it

Type1Lou 2014-07-03 08:09:52 -0500 Report

An apple with peanut butter (all-natural PB) is my lunch nearly every day…sweet, crunchy and satisfying. I have a scale that, based on the weight and a food code that you enter for apples, tells me how many carbs in any given apple since they can vary quite a bit based on weight.

22eva 2014-07-03 19:28:22 -0500 Report

Where did you get the scale? I would love to have one

Type1Lou 2014-07-04 10:35:02 -0500 Report

A friend gave me hers a number of years back. It was sold under the name Chefmate Digital Nutritional Scale and was distributed by Target. It was made in China and had a 2006 copyright under Target Brands. I use mine every day.

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