All,

I'm getting to the point where I'm not sure what to do, and I am very frustrated.

For the last 6 months or so, it seems I cannot get my morning number under 220, and it feels as though I am becomming a lot less sensitive to insulin. My basals have gone from 24 units per day to 34. My carb ratio has gone from 1:9 to 1:5, and my correction is about 1:30. I'm running 16 units of Levemir at 8 am, and 18 units at 11pm. My basal feels right, as it runs even though out the day. And if I go to bed at at 120, around 3am, I'll still be in that range, but by 7am I'm in the mid 200s.

I've started checking everynight in the middle of the night, but it doesn't seem to help. Its like my body is pumping out sugar to match my insulin intake. I've checked at 5am, it will be 220, 100 points higher than my bed-time number, I'll take 3 units, and at 8am, I'll be 205, as if the 3 units did nothing.

I'm out of ideas. I thought about maybe when I wake in the middle of the night, taking 2 units, and a tablespoon of peanut butter to try and curb the starving aspect.

Anyways, any thoughts?

Much appreciated.

Jason

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Sorry to hear of the troubles sir. Have you tried either putting your Levemir dose more at night? In other words split it so that you are taking 25 at night (or the entire dose)? Also, maybe ask your endo about switching to lantus and see if it helps?

No, I've never considered that. I think that is a good idea. I orginially split it because I was getting morning highs, where I was taking it all in the the morning. Plus I had heard that splitting it made it more level. I have read about people that do 75% at night, 25% in the morning.

Give it a shot (hah!). Just remember to watch your evening levels. I take my Lantus dose all at night, and tend to have to use a little more Novo towards the end of the day to compensate (not much, just an extra unit or so with dinner). Breakfast tends to be my largest meal, so I take my 40 of L @ 9/10pm so it "soaks in", as I like to call it, overnight and my levels come breakfast time are usually great.

Also, I recently started on a cgms which has really helped get my numbers in even better control.

Black Llama, Thanks for this post. I tried this and it seems to be working. Instead of doing the Levemir 16am/18pm, I'm doing 12am/23pm. Last few nights, I've been much more level. Monday night I went to bed at 102, woke at 3am and it was 107. Decided to leave it alone, woke at 7, and it was 107. I'm not getting as big of swings either. I have my fingers crossed that this will continue.

Take Care, Jason

I thought about asking the endo about taking metformin, but I've wondered if it can makes things even less predictable. I've thought about the NPH too, but I don't have any experience with that either. ANy idea what the dosing schedule looks like?

Is it possible for you to get a pump? A pump is a really effective tool for dealing with dawn phenomenon and uneven basal requirements.

I have a decent idea of what you are going through. For most of my life I have been battling a large dawn phenomena in the early hours of the mourning. I was unable to wake up with a BG less than 180 most of the time untill I started pump therapy. I have 6 differnt basal rates for the approximate 7 hours of sleep I get a night. They start off low and then spike from 2 - 3 am and then dip down to the lowest levels around 4 am. (Keep in mind that I use humalog so the peak activity of the insulin is 2 hours later, therefore my basal rates spike to their highest from 4 -5 am).

Furthermore, my DP is constantly changing and it seems that every few weeks I need to make an adjustment. I have read that some T1s can effectively fight their DP with 2 varried doses of levimir/lantus a day, but it is something I just could not achieve. I would highly recomend that you speak with your endo about starting pump therapy.

As for your changing I:C ratios, correction factors, etc. I would say that you are acting correctly by adjusting as you notice the problem. Maintaining (near) normal BGs should be your goal. I believe that modern medicine does not have the tools to accurately predict insulin needs/changes sometimes. You will drive yourself crazy if you try to figure out some of these changes as we just don't know why yet. I try my best to react to changing insulin needs quickly as needed and sometimes just accept that this is how it is in the T1 world.

Yes, I looked in to getting a pump, it was very expensive, and at the time I could not justify the cost. I have a very low limit on my non-essential durable medical. Maybe with the new year coming around, I should do that.

Also, I have noticed that my DP is changing all the itme as well. Somedays at 6am, I'm 140, others I'm 260 with no apparent change in anything.

As much as it is a horrible thought, there are people who set an alarm during the night in order to give an injection to ward off dawn phenomenon. Obviously a pump would help solve this problem for you. But if you can't afford it, you may have to resort to an alarm. I would probably try the NPH at bedtime before the alarm clock.

What does the NPH schedule like that look like? Is that 2-3 units at bedtime? And Do those units replace the basal units?

Jason-Because I use a pump I have never added NPH to an MDI regimen. I used to be on NPH before I used Lantus.

I frankly think you will need to experiment and probably start by replacing some of your basal with the NPH. Since you take some of your Levemir at 11:00PM, I would replace some of that with NPH. Be conservative and see what happens.

Hopefully someone who has done this will chime in with some suggestions.

First of all, I LOVE your avator, Jason!

Pump is a great idea, as always. One of the best pieces of advice I ever got on TU is to consider when you take insulin to counteract a high. If I am waking up at 220 every morning at 7am, I would up my basals starting around 3:00 am, as it acts over a 4 hour time span. But with Levemir, I am not familiar.

Even with a pump, I set an alarm every night for 1 am, test and go from there. If I were you, I would set one 4 hours back from wake up and start to ascertain when the glucose levels begin to rise. You may need to bolus overnight to counteract this.

Dawn phenom? Good luck and let us know how it goes.

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