A rant on the joys of the dawn effect:

I've always had to deal with the dawn effect -- BG climbing shortly after I wake up in the morning, regardless of food. For example, this morning (a fairly typical one), I woke, around 6:30, with BG at 97. A good start to the day. By the time I got to work and was ready for breakfast around 9, I was 237. I had not eaten anything. I had not exercised, but I had been puttering around the apartment. Of course, I corrected with breakfast and was down to the 180s by noon, and then better in the early afternoon.

Still, it is so frustrating to watch the BG go up, and so quickly. I've increased my morning basal rates now -- twice in the last 3 months, but the morning climb is still there. Some days, it is an extreme and rapid climb, like today, some days slower, but it is always there. And, of course, it takes a long time to bring my numbers back down, which really pushes the a1c up.

There was a discussion recently about things I resent about diabetes, and this is certainly one of them. If I am trying to get an average BG reading of 125 and I am at 237, I'm going to have to be under 100 for a long time to achieve that average goal, particularly when it takes several hours to get that 237 down. No wonder it is so miserably tough to maintain a good a1c. Frustrating beyond words.

And yes, that is one of the many things that I resent about diabetes. But, I am thankful that it is a condition that I can manage -- everyone, at some point in their lives, has some medical issue to deal with or some major family or personal stress. At least mine is something I can live with and work to control. I have a job, a home, my daughter is healthy. I have love in my life. Can't ask for much more.

Views: 1

Comment by Kelly Rawlings on December 23, 2008 at 1:10pm
I hear you! I don't mind going from a lovely 97 to a not-so-great 237 when I've eatern something to cause the climb. But it's NOT fair when it happens sans calories!

Have you experienced big variations in how long it takes a correction dose to work on dawn phenom numbers? Sometimes it takes HOURS to get back on target. Urgh.

I've been trying to be good about getting 30 minutes of exercise in the mornings. That does help quite a bit (and allows me to eat a carb serving or two at breakfast).
Comment by Jonathan on December 23, 2008 at 1:21pm
It takes me a long time to come back down. I tend to have a 90 minute lag before a correction bolus starts to work, and then it works slowly, so for the first 75 minutes, I keep climbing before I stabilize and then start coming down. Fasting, it can take 5 hours for the correction to get me back in range. At my next endo appointment, we're going to talk about switching to Apidra.

I usually exercise mid-day, just before lunch, and that helps the afternoon numbers. Wish I had the time to work-out in the morning.
Comment by Preta on December 23, 2008 at 1:24pm
I understand your frustration. I didn't have this issue before, but now that I'm on the pump I experience this everyday....but only the work days. My CDE thinks it's the stress due to going to work...lol. It takes 4-3 hours to come down for me.

How will Apidra help? This peeks my interest.
Comment by Jonathan on December 23, 2008 at 1:37pm
I used to have two different basal rate patterns -- one for work days, when I am mostly sitting at my desk and exercising mid-day, and one for the weekends, when I am a bit more active and exercise late in the day. The two patterns eventually merged into each other (I also kept forgetting to switch to the weekend pattern). You may want to focus more on your activities during week days and on weekends.

I've read, here and elsewhere, that Apidra works more quickly than Novolog and Humalog. The question for me is whether it works a lot more quickly.
Comment by Laura on December 23, 2008 at 1:41pm
Jonathan I have the same exact problem. I am stable until I open my eyes and start moving. Then up and away. Now this is how I found to help but it is YMMV. I keep string cheese in the fridge. When I wake I eat one drink a glass of water for hydration and this has seemed to help keep that morning from going high. The only thing I can think of is the liver will release sugar to get us going and eating a small something helps to stop that. I do have a basal increase when I wake but not as much anymore. and any adjustment insulin I might have to take seems to work faster then with nothing at all in the morning

Hope it helps be loved
Comment by Kelly Rawlings on December 23, 2008 at 2:29pm
I switched to Apidra after years on Humalog. It does seem to start working a bit more quickly for me (for example, I can bolus 15 minutes before meals rather than the 20-25 I needed with Humalog), but not sure it's really the insulin itself or simply the change after being on one type of fast-acting insulin for so long.

Brilliant suggestion on the protein, Laura!
Comment by Laura on December 23, 2008 at 6:31pm
Thank you Kelly I found out by accident when I woke up really hungry one morning but did not have time to make breakfast. I grabbed a piece of cheese and expected my usual morning rise an hour later when I had time to make a good breakfast I was surprised my BG had hardly moved. So decided ot test it and found it really helped. Don't know if it will help others though.
Be loved
Comment by Jonathan on December 24, 2008 at 3:42am
Laura: Do you get a BG rise later in the day from the cheese? I find that if I have an all protein snack without bolusing, I will go up a couple of hours later (more than I do without doing anything). I'm still trying to find the right amount to bolus for non-carb meals.
This morning is off to a good start after raising basal by 20%. BG at 87 when I woke. We'll see in a couple of hours.
Being loved makes all the difference in the world!
Happy Holidays to every one!!

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