Dawn Phenomenom

  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!

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.

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:)

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

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

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?