Monday, March 1, 2010

The Dawn Phenomenon

Dun Dun Dun!! That is my foreboding music. Imagine it in your mind.

Definition of Dawn Phenomenon: High blood sugars in the morning hours due to the release of certain hormones during the night (glucagon, epinephrine, cortisol, and other growth hormones). We know kids do most of their growing during the night. It makes sense these growth hormones would be released in the nighttime which proves to be counter effective with their insulin--they aren't recieving enough from either their basal rates w/ the pump or from their Lantus. In people without diabetes there is a compensation with insulin from the pancreas so blood sugar levels remain stable. In people with diabetes, however, we can't predict whats going on so the result is high blood sugars and, in my house, a very frustrated, sleep deprived mamma.

We really struggle with this with Syd. The morning time seems to always have high numbers. BUT, I'm happy to say that I THINK we have figured out a solution to our problem...even if it's only temporary. One of the biggest hurdles we face is the spike in numbers after breakfast. Soooo I have tweaked her basal numbers during the night so she is running a little higher. She will then wake up a little higher (150s-200ish). BUT this allows us to give her insulin about 30-45 minutes BEFORE she eats w/out worrying about a low. By this time the insulin has a head start (it works slower than food in getting through the body) and helps to offset the spike in sugars.

We have our bad days still but, overall, we have seen a great improvement in her numbers during the morning time. Not perfect, but better. Of course, as with anything T1 related, it will not last forever. But, for now, we are going to enjoy it!! We have also found that increasing her fat intake and fiber in her breakfast helps to offset the post breakfast spikes. So a couple links of turkey sausage and a slice of double fiber whole wheat bread = much improvement.

Do any of you guys struggle w/ the dawn phenomenon? What tricks have you used to conquer it?

8 comments:

Casey said...

I see it, but I just have my basals higher from 2am - 8am so that effect is seen from 4am - 10am in my numbers. My I:C ratio is higher in the morning too.

Reyna said...

Well...I have always had to whack Joe a good one with his breakfast bolus...the ratio would be like a 1:12...to hold off the post breakfast spike, but then I would have to apply the brakes so his morning snack ratio was really low...like a 1:60 (at one time it was even a 1:100) with a really low basal rate going into lunch (literally a .025u/hr). This helped stave off the lows from the huge morning bolus. Lunch and dinner ratios were a 1:26 (just to give you an example).

As he has aged, it still seems he needs a strong breakfast bolus, but doesn't need the drastically reduced insulin for his morning snack and he doesn't need the decreased basal going into lunch. I hope you find this helpful Shamae! XOXO

Amy said...

Jada has a HUGE dawn phenomonen it seems!!! Her insulin to carb ration in the morning is 1:10 compared to lunch and dinner, which is 1:35. We usually need to give it to her at minimum 15 minutes before she eats. It works pretty well...I'm wondering how/if it will change when she starts pumping...

Heidi / Jack's Pack said...

Good thinking, Shamae! D sure keeps us on our toes, doesn't it?!

Jessica said...

We totally have the same issues, but no solution. In fact, I just realized that I was allowed to delay him eating. Our CDE's always stressed even giving him insulin after he ate since he's 3 and unpredictable. It only took one look at a post breakfast spike (GAH!) to make me mess around with things.

Wendy said...

We always pre-bolus for everything...that post breakfast spike is THE WORST!!!!!! Like you, I try to get her insulin going first thing and then she gets dressed, etc...man, those numbers are stubborn in the morning!!!!!

6.8 :) Obviously you're doing something right!!!!!

Mike LeBlanc said...

We also do a higher basal rate from 4:30 am to 8:30 am. This head start before breakfast at 7 seems to help.

The only drawback is that she'll likely go low if she sleeps in or has a late breakfast. On the weekends I usually push everything back 1 hour to let her sleep in a bit more. Sometimes we can get it dead on, other times it doesn't work so well. Keep at it and you'll eventually get it... Until everything changes again... What a fun game !

Diabetes Super MOM said...

We do struggle with that as well. I feel the older Mattie has gotten the harder it is to control.

I just test her at 3:00 and give her a correction if needed. The body is way too mysterious.