Well I’ve had T1 for25 years and am using R and N insulin. I never was bothered by the dawn efffect. But in the last couple of years ever since I’ve been using a CGM my BG ramps up in the morning after getting up over 100 points consistently. Plus my formerly A1c numbers that were around 6.6 have shot up to 8.0 My endo is more concerned with lows and Kaiser keeps jacking up the upper A1c limit. So previously at Kaiser it was recommended to be at or below 7 then it was 7.4 and now it is 7.9 My endo may not be concerned about a high A1c but I sure am. Any ideas how to control the dawn effect as it is really bothering me.
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Are you on R and N by choice, i.e. those tools have worked well for you in the past and you haven’t had a reason to change. The reason I ask is that some of the newer insulin’s may make it easier to achieve what you are looking for. Has your endo mentioned those at all?
I am sure @Eric and some other will by by shortly with more options for you.
That’s a silly recommendation. The goal should NOT be to target a higher A1C, the goal should be to keep your BG in range as much as possible.
Reduce highs, reduce bad lows. Shorten the time you are either high or low. That should be the goal.
I would first try to figure out it if is result of waking up, or if it is a circadian thing, related only to the time-of-day.
It could be that your BG spikes as a result of the time. Like mine spikes at 4am.
Or it could be that it’s a result of waking up. When you wake up and start moving around, your liver releases stored fuel because you have not eaten all night.
First, identify which of those is more likely the cause.
Then, depending on the cause, either address it with more insulin at the correct time, like perhaps some extra NPH when you go to bed, or adding a different basal, like adding Levemir or Lantus (if it is a spike based on time).
Or just taking a morning shot of your R (if it is a result of waking up and getting out of bed, liver).
Are you able to use anything beside R and NPH? If you spike just when you wake up and move around (liver), a fast acting insulin like NovoLog or Humalog or Fiasp might help with the morning spike better.
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Hi I too have trouble with higher sugars in the morning. About the only thing you can do is go on
an insulin pump and up the basal rates higher in the morning and program lower basal rates for the rest of the day. I’ve been using omnipod the tubeless pump for such a reason.
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Some people can make do with levemir, taking a higher basal dose for overnight and a lower basal dose for the daytime (or whatever arrangement their body needs). But yes, the basal schedule in a pump is good for solving this, and it is the reason I started pumping after 7 years of MDI.
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