especially in the morning. When I have some free time this weekend, I will provide more detail. This has been going on for months now. What am I doing wrong? I've tried every trick in the book, and my endocrinologist hasn't given me any real advice...
Some folks have more problem with what is known as "the dawn effect" than others. Upon first waking, the body produces hormones that can cause morning insulin resistance, and the result is high levels during morning hours. Read more here: www.mayoclinic.com/.../AN01213
Have you tried waking up around 3 or 4 am to see what your blood sugars are at that time? I did that for about 7 years (high school through early college) when I had a similar issue. It's a pain, and not fun, but I at least woke up with normal sugars and could start my day off on a good foot.
I don't have that problem frequently any more (though it does happen on occasion). It might be my long-lasting insulin, Levemir, that gives me better control.
Susan, that sounds about right. It's weird. The dawn phenomenon never gave me nearly this much trouble in the past...
Khristine, I wake up at 4 am, and my blood sugar is almost always perfect. Then I eat breakfast and my blood sugar skyrockets to anywhere between 270 and 470. It then takes a few hours, sometimes even several hours, for my blood sugar to come down. Sometimes, my blood sugar stays in the mid 300s the entire day, which is why I hesitate to attribute this to the dawn phenomenon.
Elie,
I don't know what all you have tried but here's a couple of my experiences.
I have the Dexcom G4 sensor and noticed a slight fall (not low) around midnight and then I would slowly rise and wake up high. I increased my basal around the time it started to creep up, but that didn't help. I ended up trying decreasing my basal before the time I usually dropped and the highs stopped since my pancreas wasn't kicking out glucagon, I guess. I'm not sure why there was so much response to such a small drop in blood sugar, but it worked. If you have a sensor and can look at what happens overnight, you may be able to see if there's a pattern going on.
Also, I too have problems with the dawn effect. I don't know if yours is related to food, but I used to have highs after breakfast that took several hours to come back down no matter how much insulin I took. I started eating a protein only breakfast and skipping the carbs. I usually eat meat or eggs, sometimes with celeray and peanut butter. Now I don't spike after breakfast.
Hope some of this may help you!
Laurel
None of my doctors have ever mentioned to me the huge factor of female hormones on glucose levels. Or allergies. Both can be an issue. If pollens are high, you can go high while adrenal hormones are rising to help your body with allergens, and then drop low later. For the hormone issue, at the end of your monthly cycle, you produce high levels of hormones that can act as an insulin blocker, so for several days can run high no matter what you do. I know of some women who just cannot lower their levels on those days and have to eat low carb meals for a few days. The danger of course is that when those hormones change you can drop low, so you probably should look at your calendar and see if hormones may be part of the problem. Then, just watch carefully so after the high days, you are ready for the drop.
Hmm. So frustrating what a trial-and-error type of thing it is sometimes. In addition to what everyone else has said, it seems like your sugars are high AFTER breakfast, as opposed to before...is that correct? Maybe talk to your doctor about adjusting your insulin, or try eating something different? I don't know everything you do/have done to deal with it, but I also don't want to inundate you with questions.
As an example, for me, if I eat any type of cold cereal, my blood sugars go crazy high. So breakfast for me is a small bit of plain oatmeal, or fruit and some yogurt, or maybe toast with sugar free jelly. If I go out to eat breakfast, or if I eat a particularly big breakfast, I check my blood sugars within an hour of eating, so I can at least try to catch it on its way up.
Frustrating, especially when your day begins that way. I hope you're able to figure it out :(
Elie,
Same thing here. I can't stand it! I also haven't talked or been to my doc in a while but, at this point I don't know what I could do unless I basal test throughout the night as well as the day. That is the last of my bag o tricks!
Elie-
Can't remember how old you are, but dawn phenomenon usually gets more pronounced as you get into your 20's. It causes a basal increase but also makes you more insulin resistant when you eat.
Some people have a special carb ratio at breakfast or they avoid anything high carb in the mornings. I usually avoid cereal in the morning, but otherwise just add an extra 3 units of insulin (or an extra 7 if I'm drinking coffee since it makes my blood sugar high too) to my breakfast bolus.
Any chance that the higher blood sugars are stress related? I've noticed that my dawn phenomenon is more pronounced on work days than on the weekend.
Let us know what you figure out.
-Jenna
Elle- I hope you figured this out and have it under control now but if not, you may want to consider the absorption rate of your insulin. I found on article on things that cause absorption to slow or speed up at different times.
Thanks for all the responses! Unfortunately, I don't have time to respond to everyone. I do use Continuous Glucose Monitoring, and I can assure you my blood sugars are PERFECT throughout the night and when I wake up and only spike after breakfast. Casey, I definitely agree with you about the relevance of absorption rates. I try to rotate my sites as much as possible...but, just as with my fingers for fingerpricks, it feels like I can never rotate enough. Jenna, I'm currently 24. If what you say is true about the dawn phenomenon increasing with age, that would partly explain what's been going on...although the suddenness of the change in my glucose levels suggests to me it may have more to do with (a) reduced potency of insulin, (b) poor absorption rates, (c) stress (although this is the least stressed I've been in months...), (d) leaving infusion sites (including tubing, insulin, etc.) on too long, (e) dramatic changes in my exercise routine (I went from exercising every day to not exercising at all and THOUGHT I had increased my rates sufficiently...), (f) everything I'm forgetting..
On top of all this, my apartment mate left the refrigerator open all day yesterday by accident, and when I got back everything was room temperature... Is the insulin still okay to use? I've been so busy and haven't had enough time to thoroughly research anything...
Elie, I’m a very sensitive diabetic & have struggled w/the dawn effect as well. My endo had me on an aggressive basal rate during the hour segment I was most likely to eat breakfast at. He also told me that if I could not eat breakfast at the same time every morning, I could instead give a more aggressive bolus for the meal. A change in hormones can bring such sudden instances regardless how controlled your routine has been, especially if you tend to be a “brittle” diabetic as well. As for your insulin, opened vials are good for a month whether refrigerated or at room temperature. So, it’s ok to still use it. Unopened vials are good up to 3 months in the fridge. One day at room temperature should not effect the quality.
Ha well, that's a relief.
Like Scrappy said, your insulin is fine unrefrigerated for a while. I refrigerate insulin when possible, but have had times without a fridge for months at a time, living in college dorms or as a camp counselor. I 've never had a problem with insulin effectiveness.
Based on your response your highs are probably caused by:
d) leaving sites in too long (they just don't absorb as well on the 3rd, 4th, 5th day; it also takes your skin longer to recover when you leave it in more than 3 days, so change it out and save yourself trouble)
e) exercise change (this causes increased insulin sensitivity through the day)
You also forgot another option:
g) the weirdness of diabetes (it's ALWAYS changing; usually you can figure it out, sometimes you can't; just roll with it)