Dawn phenomena revisited

July 30, 2005

There were interesting posts on this recently which turned my

inquiring mind on. (I can ask questions like an inquisitive kid.)

We did not discuss what constitutes the phenomena. I think it

involves numbers that would show a difference than readings at other

times of day. How much of a rise would you consider necessary to

qualify? Do you think the reading would have to be outside your

normal target and/or a reading above what a non-diabetic would have?

Meters are variable. I think the body's preparation for morning

would begin sometime before you would actually rise.

When someone tells me they have a dawn rise I think of it as being

significant enough to be noticeably different from other times of

day. That is my thought when I said I am not effected by it. At 3

AM I can be 80 and 7AM perhaps 70 and a little later higher or lower.

I have gone to bed at 90, 3AM 70 and at 7 when I am up again 90. I

think it is a fluke when my bed and morning check are the same.If at

3 AM or 6 AM you are 80 and a half-hour later 120 would that be a

dawn problem? Or is it identified by what it takes to counter it?

Is there anyone else that would be interested in establishing a

definition or necessary criteria to be a dawn problem?

BVan (Betty)

July 31, 2005

If I were 80 at 6am & then 120 at 8am I not only would consider that the

DE I would have a stroke about it! I would never allow that to continue

without making some kind of adjustments to meds or other routine. YMMV.

cappie

Greater Boston Area

T-2 10/02 5/05 A1c: 5.3 = 111 mean glu

50-100 carb diet, walking, Metformin

ALA/EPO, ALC, Vit C, Calc/mag,

low dose Biotin, full spectrum E,

Policosanol, fish oil cap,

fresh flax seed, multi vitamin,

Lovastatin 40 mg/coQ10 100mg, Enalapril 10 mg

5/05:140 lbs (highest weight 309)

5' tall /age 67,

cappie@...

July 31, 2005

As I said, for me, I WOULD consider that rise DE whether hypothectical

or not.

I think that what different people consider a de is going to depend on

that person & how their control is & how their numbers usually run. I

don't believe that certain arbitrary number amounts can be used to draw

a line to determine " true " de -- as in everything else it is ymmv here

too.

cappie

Greater Boston Area

T-2 10/02 5/05 A1c: 5.3 = 111 mean glu

50-100 carb diet, walking, Metformin

ALA/EPO, ALC, Vit C, Calc/mag,

low dose Biotin, full spectrum E,

Policosanol, fish oil cap,

fresh flax seed, multi vitamin,

Lovastatin 40 mg/coQ10 100mg, Enalapril 10 mg

5/05:140 lbs (highest weight 309)

5' tall /age 67,

cappie@...

July 31, 2005

As I said, for me, I WOULD consider that rise DE whether hypothectical

or not.

I think that what different people consider a de is going to depend on

that person & how their control is & how their numbers usually run. I

don't believe that certain arbitrary number amounts can be used to draw

a line to determine " true " de -- as in everything else it is ymmv here

too.

cappie

Greater Boston Area

T-2 10/02 5/05 A1c: 5.3 = 111 mean glu

50-100 carb diet, walking, Metformin

ALA/EPO, ALC, Vit C, Calc/mag,

low dose Biotin, full spectrum E,

Policosanol, fish oil cap,

fresh flax seed, multi vitamin,

Lovastatin 40 mg/coQ10 100mg, Enalapril 10 mg

5/05:140 lbs (highest weight 309)

5' tall /age 67,

cappie@...

July 31, 2005

Cappie,

I agree with you there. Also previously someone said they thought

everybody has DE and at that time I disagree because I don't think I

do. However I think that is correct that everyone is effected by

it. It is just a matter of degree. I was wondering what people mean

when they say they do have it.

Betty

> I think that what different people consider a de is going to depend

on

> that person & how their control is & how their numbers usually

run. I

> don't believe that certain arbitrary number amounts can be used to

draw

> a line to determine " true " de -- as in everything else it is ymmv

here

> too.

>

> cappie

> Greater Boston Area

> T-2 10/02 5/05 A1c: 5.3 = 111 mean glu

> 50-100 carb diet, walking, Metformin

>

> ALA/EPO, ALC, Vit C, Calc/mag,

> low dose Biotin, full spectrum E,

> Policosanol, fish oil cap,

> fresh flax seed, multi vitamin,

> Lovastatin 40 mg/coQ10 100mg, Enalapril 10 mg

>

> 5/05:140 lbs (highest weight 309)

> 5' tall /age 67,

> cappie@w...

July 31, 2005

Cappie,

I agree with you there. Also previously someone said they thought

everybody has DE and at that time I disagree because I don't think I

do. However I think that is correct that everyone is effected by

it. It is just a matter of degree. I was wondering what people mean

when they say they do have it.

Betty

> I think that what different people consider a de is going to depend

on

> that person & how their control is & how their numbers usually

run. I

> don't believe that certain arbitrary number amounts can be used to

draw

> a line to determine " true " de -- as in everything else it is ymmv

here

> too.

>

> cappie

> Greater Boston Area

> T-2 10/02 5/05 A1c: 5.3 = 111 mean glu

> 50-100 carb diet, walking, Metformin

>

> ALA/EPO, ALC, Vit C, Calc/mag,

> low dose Biotin, full spectrum E,

> Policosanol, fish oil cap,

> fresh flax seed, multi vitamin,

> Lovastatin 40 mg/coQ10 100mg, Enalapril 10 mg

>

> 5/05:140 lbs (highest weight 309)

> 5' tall /age 67,

> cappie@w...

July 31, 2005

Cappie,

I agree with you there. Also previously someone said they thought

everybody has DE and at that time I disagree because I don't think I

do. However I think that is correct that everyone is effected by

it. It is just a matter of degree. I was wondering what people mean

when they say they do have it.

Betty

> I think that what different people consider a de is going to depend

on

> that person & how their control is & how their numbers usually

run. I

> don't believe that certain arbitrary number amounts can be used to

draw

> a line to determine " true " de -- as in everything else it is ymmv

here

> too.

>

> cappie

> Greater Boston Area

> T-2 10/02 5/05 A1c: 5.3 = 111 mean glu

> 50-100 carb diet, walking, Metformin

>

> ALA/EPO, ALC, Vit C, Calc/mag,

> low dose Biotin, full spectrum E,

> Policosanol, fish oil cap,

> fresh flax seed, multi vitamin,

> Lovastatin 40 mg/coQ10 100mg, Enalapril 10 mg

>

> 5/05:140 lbs (highest weight 309)

> 5' tall /age 67,

> cappie@w...

July 31, 2005

Well it has been so long since I aklloweed any kind of rise in the

morning that I've forgotten what it useed to be.

I take my meds at 6am & that usually holds my fbg steady till I get up &

going a few hrs later. Then I eat immediately! I usually eat to keep

no more than a 20 point rise in the morning assuming I am my usual 80-85

fbg. I try to stay under 100 pp. Sometimes I may go a 2 - 5 points

over.

So no, I don't actually " see " a de anymore but I know there WOULD be one

if I didn't take the steps I do to control it.

cappie

Greater Boston Area

T-2 10/02 5/05 A1c: 5.3 = 111 mean glu

50-100 carb diet, walking, Metformin

ALA/EPO, ALC, Vit C, Calc/mag,

low dose Biotin, full spectrum E,

Policosanol, fish oil cap,

fresh flax seed, multi vitamin,

Lovastatin 40 mg/coQ10 100mg, Enalapril 10 mg

5/05:140 lbs (highest weight 309)

5' tall /age 67,

cappie@...

July 31, 2005

In a message dated 7/31/2005 1:51:40 PM Eastern Standard Time,

whimsy2@... writes:

> My FBG tends to be extremely variable, despite the fact that my basal dose

> is the right

> one. I keep very good records, and I've learned that can go to bed with

> the same BG four times but my FBG the nex morning can vary widely.

Nice report, Vicki. So that's the DE. Perfidious to say the least.

Interesting that it varies with position, horizontal or vertical.

PMR (polymyalgia rheumatica), an autoimmune disease, can be like that.

Horizontal it can be very painful, vertical the pain reduces. Nobody knows

anything

about the disease, only how to treat it . . . with prednisone.

However, after about 3 years, when the pain intensity of my PMR had reduced,

l found that the pain could be eliminated by using a hormone cream. Makes me

wonder how much DE is affected by hormones.

BTW, I had negligible dawn effect when I tested a few years ago. It may be

time to retest, but my FBG is usually between 75 and 85

July 31, 2005

In a message dated 7/31/2005 1:51:40 PM Eastern Standard Time,

whimsy2@... writes:

> My FBG tends to be extremely variable, despite the fact that my basal dose

> is the right

> one. I keep very good records, and I've learned that can go to bed with

> the same BG four times but my FBG the nex morning can vary widely.

Nice report, Vicki. So that's the DE. Perfidious to say the least.

Interesting that it varies with position, horizontal or vertical.

PMR (polymyalgia rheumatica), an autoimmune disease, can be like that.

Horizontal it can be very painful, vertical the pain reduces. Nobody knows

anything

about the disease, only how to treat it . . . with prednisone.

However, after about 3 years, when the pain intensity of my PMR had reduced,

l found that the pain could be eliminated by using a hormone cream. Makes me

wonder how much DE is affected by hormones.

BTW, I had negligible dawn effect when I tested a few years ago. It may be

time to retest, but my FBG is usually between 75 and 85

July 31, 2005

Then you must have had many strokes from me posting that my morning

rise goes up to 140 without me eating anything.

I think I could fix it with Lantus, but that would put weight on me.

It is always a balance of priorities, ain't it.

> If I were 80 at 6am & then 120 at 8am I not only would consider that

the

> DE I would have a stroke about it! I would never allow that to

continue

> without making some kind of adjustments to meds or other routine.

YMMV.

>

> cappie

July 31, 2005

Then you must have had many strokes from me posting that my morning

rise goes up to 140 without me eating anything.

I think I could fix it with Lantus, but that would put weight on me.

It is always a balance of priorities, ain't it.

> If I were 80 at 6am & then 120 at 8am I not only would consider that

the

> DE I would have a stroke about it! I would never allow that to

continue

> without making some kind of adjustments to meds or other routine.

YMMV.

>

> cappie

July 31, 2005

Cappie,

This morning, at 3AM I was on the computer as you could see instead of

sleeping. That was because I was having a lot of sciatic pain. I

finally gave up and took some pain medication. At that time I was 89

and when I checked again 7:30 I was 98. 79 normally would have been 79

to 89. I take Starlix as a bolus and I usually take 250mg sometime

none, but took 500 because of that. Normally I take 250 in the AM and

500 with the other meals if I am as much as 100 before meals. I do not

think a set medicine routine would be any different for the AM than any

other time. I adjust my dossages to cover as necessary. But since my

AM usually requires less meds than the rest of the time I think I

would say the DA is minimal. But overall I would not call it a dawn

syndrome just because of the way I figure my dossages. If I didn't take

my meds I would always be high and in the AM yesterday's is toward the

end of it's life. I guess I have always thought of a rise that leaves

me higher in spite of the meds. Perhaps the dawn is the group of

metabolic mechanism with any numbers. Now I seem to be having a problem

completing a good sentence because of the pain med. I really try to

avoid that. I am hoping others will chime in on this.

BVan (Betty)

> Well it has been so long since I aklloweed any kind of rise in the

> morning that I've forgotten what it useed to be.

>

> I take my meds at 6am & that usually holds my fbg steady till I get

up &

> going a few hrs later. Then I eat immediately! I usually eat to keep

July 31, 2005

Carol: & that is exactly what I would do if I could not control the way

I am. To me it does not matter HOW one gets those numbers under

complete control--including the de--but just that one does it, whether

that means taking more meds or insulin or newer drugs or whatever. You

do whatever you gotta do IMO.

cappie

Greater Boston Area

T-2 10/02 5/05 A1c: 5.3 = 111 mean glu

50-100 carb diet, walking, Metformin

ALA/EPO, ALC, Vit C, Calc/mag,

low dose Biotin, full spectrum E,

Policosanol, fish oil cap,

fresh flax seed, multi vitamin,

Lovastatin 40 mg/coQ10 100mg, Enalapril 10 mg

5/05:140 lbs (highest weight 309)

5' tall /age 67,

cappie@...

July 31, 2005

Carol: & that is exactly what I would do if I could not control the way

I am. To me it does not matter HOW one gets those numbers under

complete control--including the de--but just that one does it, whether

that means taking more meds or insulin or newer drugs or whatever. You

do whatever you gotta do IMO.

cappie

Greater Boston Area

T-2 10/02 5/05 A1c: 5.3 = 111 mean glu

50-100 carb diet, walking, Metformin

ALA/EPO, ALC, Vit C, Calc/mag,

low dose Biotin, full spectrum E,

Policosanol, fish oil cap,

fresh flax seed, multi vitamin,

Lovastatin 40 mg/coQ10 100mg, Enalapril 10 mg

5/05:140 lbs (highest weight 309)

5' tall /age 67,

cappie@...

July 31, 2005

Yeah, we do what we gotta do, except that I don't have strokes or heart

attacks when I see a number higher than I think it should be - I just

take whatever pill or injection I think I need to handle it. We're all

different and, as said, we have different priorities. As long as

my averages are staying in the 90s to low hundreds (without lows) I'm

not obsessing on the bg numbers. And there are lows now and then, so I

grab a couple gtabs and get on with my life. I'm not terribly concerned

with the labels we put on some of these things, like " dawn effect " .

What difference does it make what we call it - if your bg is too high

you bring it down, doesn't matter what time of day it is.

CarolR

cappie@... wrote:

You

> do whatever you gotta do IMO.

>

July 31, 2005

I've written about this before but since I experienced it this morning,

it's at the top of my mind so might as well add my 2 cents.

I'm an early bird, usually up at 5:30 with alarm at home. Well, I went

to visit my daughter this weekend - she lives 2 hours away, in the

mountains And she's NOT an early riser. So I was prepared to be up but

not have breakfast until later than usual.

We compromised and agreed on breakfast together at 7:15.

Even without the alarm, I woke up at 6;15 (late for me, smile)...so I

checked my BG, which was 120. Got up, took Fosamax, peed, got dressed

then sat up and read until she got up and we had breakfast about an

hour later. Checked my BG at that time to see how much rise there'd been

and how much insulin to take for the meal. It had risen to 155.

As I've mentioned before, my dawn effect seems to be based on me being

vertical as opposed to the time of day. So as long as I was in bed,

lying down, it would've stayed at approximately 120 (I know this because

of multiple tests over a period of years)...but since I was up and

about, within an hour and without eating anything, it went to 155.

That's the DE in action, smile.

This number isn't written in stone, either. My FBG tends to be

extremely variable, despite the fact that my basal dose is the right

one. I keep very good records, and I've learned that can go to bed with

the same BG four times but my FBG the nex morning can vary widely. (And

wildly) - sometimes there's as much as a 50-point variable. Oh well..I

just deal with it, smile.

Vicki

Re: Dawn phenomena revisited

I don't recall seeing any particular percentage of rise that would

definitively constitute the dawn phenom, or any defining time for the

start value - is it just whenever you wake up, or do you set the alarm

for a certain time and count from there? For those who use a basal

insulin a rise greater than the meter variance percentage would probably

be a dawn phenom because properly dosed basal, as I understand it, is

supposed to keep the fasting bg at a steady rate around the clock. When

I go from a 6am bg of 88 to an 8 am bg of 120 I figure there's some dawn

phenom plus coffee going on. Before I started insulin the 6am numbers

were way higher. Even now, without some intervention, those numbers

(for Me) will just continue to rise until about 10am. Whether everybody

has a dawn phenom or not, it IS bothersome enough that a whole lot of us

are trying to find ways to deal with it on a daily basis. I never could

deal with when I was on just the oral meds - had to go to insulin to get

a handle on it.

CarolR

Betty wrote:

> There were interesting posts on this recently which turned my

> inquiring mind on. (I can ask questions like an inquisitive kid.)

> We did not discuss what constitutes the phenomena. I think it

> involves numbers that would show a difference than readings at other

> times of day. How much of a rise would you consider necessary to

> qualify?

July 31, 2005