Side question (I might have to split this 
): how did you find a way to deal with dawn phenomenon on MDI?
I used to set an alarm at 5:00am for that when we were on MDI (for an early treating bolus). I never liked it because I had a hard time going back to sleep afterwards when it was summer and the sky was already light 
For me it is about timing. I split my Levemir into two injections a day, and take an equal amount for the two injections. I take my morning shot when I wake up (about 8am). I tried taking my evening shot 12 hours offset at around 8pm, but that was too early, and I would wake up with dawn phenomenon (high blood sugar) pretty much every day. So instead I tried taking it later and later and finally settled on taking it at 11:30 PM (I set my cell alarm to go off every night - it warns me to take my insulin and turn on Steven Colbert). I imagine some of my dinner insulin is covering the morning Levemir that is wearing off, but that is easy since I’m taking a bolus then anyway and doesn’t lead to any lack of coverage.
If I wake up really late for my morning shot then my BG will have gone up, and even with the alarm I will occasionally forget my evening insulin, so it isn’t foolproof. Which is why I’m very curious to try Tresiba. My first endo appt in several years will be next week now, and I have a pretty long list of things to get (CGM, Tresiba, Fiasp, Afrezza, … anything else I should add)
This is what I did, except I bolused two or three units of Humalog at 3:00 AM every morning and then went back to sleep. I was already splitting my Lantus dose, with a larger dose in the evening than in the morning, but still needed the bolus or I’d wake up at over 10 mmol/L (180+ mg/dl) every single day.
My suggestions only work for adults, but a little evening alcohol and/or Metformin ER. Alcohol honestly is the most effective for me, completely wiping it out, but to the point where I actually need a lower overnight basal, so it’s not really a good fit for Tresiba (but worked ok with Lantus, since I could tweak that more easily, and imagine would have been great with Levemir if I could have used that). These days on Tresiba, I also rarely drink, but drinking means overnight lows unless I go to bed a bit high.
Similar to what Jag said about split Levemir dose:. Mine are 6 am and around 930 pm. The evening dose being so late takes care of my DP very well, but if I sleep in on the weekend, I have 130ish BG instead of approx 90 BG.
As weird as this sounds, my most effective technique is to make sure I head into the night time hours in my target zone of 100-120, and have a bit of carb and protein as a bedtime snack.
And of course, it also helps to have a correct basal dose. Like many others, I split my Lantus/Basaglar dose into an AM and PM schedule. Originally I was doing equal amounts, but my endo switched me to 1 dose in the AM, then quickly reversed the opinion that one big dose would be more effective than split dosing after she saw the glucose results of that idea. This resulted in a 70/30 split directive, which I subsequently changed myself to 60/40.
Ironically, I initially made the switch to accommodate pen dosage constraints, and subsequently discovered that this particular ratio was more effective for controlling my overnight levels.
I also used to split my Lantus dose, taking my evening dose, which was 1 or 2U lower, with my dinnertime Humalog around 8pm. I had a hunch, à la @cardamom, that a little alcohol always helped, but handling the DP was still hit-and-miss. (And there was no way in Hades I was going to set my alarm for 2 in the morning.)
As well, I plunge mid/late afternoon every day (just naturally – it happens regardless what I do with food/insulin/fasting for the previous 8 to 12 hours, and believe me, I tried every configuration), and Lantus was useless at coping with that. If there hadn’t been a tubeless pump option, I might have experimented with another long-acting, but with a pump I can adjust with a small increase for DP and, in the afternoon, drop from 0.55 to 0.15 for several hours before going to 0.95 for the evening. Not sure any long-acting insulin could do that for me.
In Gary Scheiner’s book, he talked about adding a small before bed dose of NPH that for some people gives a slight mini-bump of action around the time dawn phenomenon kicks in approx 8 hours later.
Thanks Stearner! I am very glad Gary has said that in his book. I have told a lot of people that, but if Gary says it, maybe more people will do it. So many people freak out when I tell them to try NPH!
@Michel, do you remember me telling you that exact same thing 2 years ago?!? It’s almost like Gary and I are the same person…
You did!
The bump is earlier for us though, more like 5 hours.
Hmmm… the math on that is pretty easy… maybe take the NpH a little earlier then;)
You mean later?
Yeah, just adjust
Big difference, though. One makes you wake up and the other does not. With 5 hours for NPH, if you have to wake up anyway you might as well use fast acting whose action is much more repeatable.
I thought you meant he gets spikes 5 hours after he goes to bed, and the NpH peaks in 8 hours, so he’d take it about 3 hours before going to bed