Dawn Phenomenon

First Shot of Fiasp

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This morning, I woke up to a blood sugar of 8.4. It had come down a little from a 12.7 earlier in the morning, largely thanks to a late dinner of chicken and chips the night before and an inability to keep my eyes open for much longer after that.

Normally, starting my day even slightly out of range would be a recipe for disaster. The high combined with dawn phenomenon and my non negotiable morning coffee would be sure to send me even higher.

However, today I had a new tool at my disposal.

If you haven’t heard of Fiasp, it’s a brand new and faster acting insulin from Novo Nordisk. It begins working within around 5 minutes of injecting, compared to the 15 that I’m used to with my Novorapid. It’s approved for use in people over the age of 18 and was listed on the PBS here in Australia on the 1st of June, meaning that people with diabetes can access it at a similar subsidised cost to other insulins.

Although I’m not visiting my endo until tomorrow, I was lucky enough to be hooked up early with a spare pen from a friend of mine until I receive a script of my own. In return I promised her that I wouldn’t come back and hold her liable for any consequences of my mischief. Which brings me back to this morning.

I got up out of bed, switched on the lights and reached for the spare box of needles in my wardrobe. I screwed the needle onto my Fiasp pen, and injected two units. Half an hour later once coffee was in my system, I was 8.3.

Another 40 minutes later, and my blood sugars were back in range.

But this story still isn’t over.

I was also running a little late out the door this morning. Not having time for breakfast, I decided to wrap up three Weet-bix to take to work. Fun fact: Weet-bix also spikes my blood sugar without a decent pre-bolus. Weet-bix is one of those foods that I instantly think ‘high’ and not worth the effort. I don’t think I’ve ever eaten Weet-bix and not gone high.

So when I arrived at work with around 10 minutes to spare, I injected another 2 units of Fiasp to cover me for the Weet-bix. The highest blood sugar I registered was 7.3 around an hour and a half later, before eventually drifting back down into range.

It was like magic.

Fiasp, I love you already.

Dawn Phenomenon, Spring Style.

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My levels have been a bit of a mess over the past couple of weeks.

A few weeks ago, I began to notice my blood sugar levels slowly but steadily rising through the night. I found myself waking up to blood sugars of 8 or 9 at around 2am and giving a correction, only to find it had little effect by the time morning rolled around.

After I had ruled out any after effects of afternoon snacking or evening meals, I began increasing my overnight basal rates until I had curbed that steady rise.

But I still hadn’t quite managed to clean up the spill.

To add to my woes, the FreeStyle Libre sensor I’m wearing at the moment to fine tune those rates has been producing long flat red lines through the night – the kind of ‘LO’ readings that make me a walking talking miracle. Thankfully, multiple finger prick readings quickly confirmed that Libre is at fault, and not me.

I’m usually quite tuned into carb counting, protein and how I bolus for my meals when I’m on my feet at work. Yet morning after morning, I would bolus for my breakfast and find my blood sugar spiking into the teens. Those highs would carry through into my morning tea and lunch.

Eating is something that I can’t really afford to be skipping at the moment. I’m working on packing more into my meals to fuel my active days so that I don’t feel so dreadfully exhausted and limping into bed at night. I’m a better person for it.

As I was setting up the basal profiles on my brand new tslim over the weekend, a mental lightbulb flicked on in my head.

If I had increased my basal rates through the night to cover my dawn phenomenon, why hadn’t I increased them to cover my insulin resistance the moment I wake up?

I have been tinkering my overnight basal rates back and forth since I began pumping insulin two and a half years ago.

I have a theory that the lighter mornings during Spring and Summer enhance that insulin resistance in the wee hours of the morning, compared to the darker days of autumn and winter.

After upping my waking basal rates by 25%, in line with what I had done through the night, I’m hoping I have a better week in store for me.

Basal Rate Intuition.

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This morning, I woke up to a relatively flat line and a number in range.

I shuffled into the kitchen, knowing full well what I should do. I stared longingly at the coffee machine, knowing full well what I should do.

Instead, I took a seat at the table and opened up my iPhone. After I had whiled away some time, I headed back into my room and gave that dreaded swipe of the FreeStyle Libre.

I was almost expecting to see an upward trend arrow, indicating that I would need to go back to the basal rate testing drawing board and start again tomorrow. I wasn’t even too sure if I would be that disappointed, because then I would be able to validate my need for coffee.

Instead, I was pleasantly surprised to see a result that had barely moved since waking up, accompanied by a steady trend arrow.

I don’t really know what my morning basal rate is. Not since my morning routine changed a year ago. I just make small tweaks here and there, going by how my blood sugars react after my breakfast. I’ve been putting off doing a proper basal test for ages, because it’s so damn hard to wake up without coffee or breakfast. Not to mention that a basal test will only work when you wake up to levels that are steady and in range (less than 6mmol).

Since starting on the YpsoPump, I’ve been forced to make some tweaks to my morning basal rates to account for its limitation of only being able to set basal rates on the hour rather than half hour. I’ve noticed my blood sugars trending upward after breakfast recently. I’m also not as active as I once was at work, which could warrant an increase in insulin as well.

As I got ready for work, drove in and began my day, I was pleasantly surprised by the result of every single scan of the Libre.

I wasn’t expecting that diabetes would let me off this easy after just one day. Or that my basal rate intuition was this good.

With a mental ‘tick’ against my morning basal rates, my only homework for tomorrow is to drink coffee and revisit the insulin to carb ratio I’m employing to cover it.

All About That Basal, ‘Bout That Basal

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I remember those inflatable beach balls that I used to get as a kid. The kind that often came in showbags. Inflatable hammers, mascots, and giant fingers for that matter, too.

They were so much fun. I would muck around, and have such a good time with them for a while.

Then they would begin to deflate. They would get these tiny little punctures that you can’t see, and the air began to escape them. Even though I tried to blow them up again, playing with them just didn’t compare to an unpunctured one. No sooner than I had patched up one of those holes, I would discover another. And another.

At the moment, I feel like one of those inflatable beach balls. I feel like I’m trying to patch up these little flaws in my basal rates, and try to stop my blood sugar levels from spiralling out of control.

Since starting out on an insulin pump, I can quite honestly say that my basal requirements in the early hours before waking have been subject to the most fluctuation. I can recall having to make subtle changes every month, or every second month at the very least. It’s been a steady upward trend, which I usually pick up from my FreeStyle Libre, or when my levels stop responding to corrections during the night.

After steady upward adjustments in recent months, I’ve now found myself waking to a few lows in the early hours. Looking over my Diasend history, the downward trend seems to start out at the 4am mark, so I’ve made some subtle changes again.

I am still struggling to grasp the fact that a basal rate that once held me steady through the night, no longer does. One theory that has been hanging over my head in recent days, is the early morning light coming in through my window. Over the past few months, the earlier morning light could have enhanced my dawn phenomenon before waking. But with the mornings now getting darker, could my insulin needs be heading on a downward trend? Time will tell…

I’ve also noticed changes in my morning basal requirements after I wake up. I usually run a higher basal rate for the first 2-3 hours to combat dawn phenomenon, and I’ve had to jack this rate up by 0.1 units per hour. While the new rate gives me much better coverage, this basal rate still needs some more perfecting. Basal testing, particularly morning basal testing, is hard work. There are days where I deviate from my routine, days where my levels might not be ideal for a basal test, days where I can’t handle more failure, and simply days where no coffee is too hard.

Unlike my last problem, I feel like this one has been triggered by a shift in routine. Which brings me to another theory. I think basal rates are a little bit like a cog in a wheel. When you change something here, it might provoke subtle changes somewhere else in the wheel. I don’t know…I’m just thinking aloud here.

My biggest gripe about diabetes is that it is always changing.

But I truly believe that a well tuned basal, and bolus regimen, is the key to success with an insulin pump.

March on…