Dawn Phenomenon, Site Change, and Breakfast Spike, Oh My ???

Wow, talking about a trifecta of ugliness that causes a bad blood sugar day…..this particular morning, it was a combination of:

  1. Dawn Phenomenon – no matter what the linked Wikipedia article says, I *do* have to change my insulin intake to manage the spike in sugars that happens in early morning. Over the years, my endo and I have tweaked my morning basal rates to account for it in some part.  And I *do* eat a small snack before bed that has about 10g-15g of carbs and some protein and fiber in it so that my stomach isn’t so absolutely empty by the morning that the dawn phenomenon cranks up my sugar to exponential heights. For me, if I don’t eat breakfast by around 8am, my sugar just starts climbing and climbing no matter what I’m doing or how much insulin I take. Thank you, Mr. Liver for that input of yours. Sigh. This particular morning, I was so busy doing other things, it was close to 9am before I could eat.

    An infusion set, showing the insertion needle.

    An infusion set, showing the insertion needle. (Photo credit: Wikipedia)

  2. Infusion set site change – My pump ran out of insulin at 7am, so I had to put more liquid life into my pump (in the form of Novolog) and change out the infusion set. It never fails – no matter if it’s a new or old bottle of insulin,
    no matter if I’m putting the site on my stomach, my hip, etc, it seems to take a few hours for the insulin from a new site to really start absorbing and working. I sometimes supplement with shots, but that brings on it’s own level of danger since who knows when the pump insulin will start absorbing.
  3. Post-Breakfast blood sugar spike – I have fought this battle for many years, and Metformin has helped immensely with this, but with the dawn phenomenon and infusion set change already hard at work at wrecking my sugar, it was inevitable that breakfast would send me over the edge. (I took the picture of my Dexcom at 9:17am right after breakfast, and then it got all confused at the rapid rise and gave me the ???, but trust me, it stayed up in the 200s for several hours of the morning.)

Ugh.

The good news? By lunch time, the new infusion site had settled in and started working, and my sugars only mildly tanked because I had so much insulin on board from taking a couple of shots in an attempt to avoid the 300s. The rest of the day was thankfully uneventful, sugar-wise. Note to self: in the future, try to think ahead and change out the infusion set at ANY other time than the morning. Of course, we always have the best intentions that don’t always pan out…thinking of and remembering to do every-single-thing-every-day-to-counter-bad-blood-sugars? Good luck!

11 thoughts on “Dawn Phenomenon, Site Change, and Breakfast Spike, Oh My ???

  1. Just as a tip – try bolusing a bit with the old site before changing out. A lot of times, our body doesn’t absorb from the new site due to inflammation from the “trauma”. And as far as Dawn Phenom, I used to just straight-up bolus a half unit as soon as my feet hit the floor. Worked for me…. but it’s not in anyway shape or form medical advice…sooooo….. you know… ask your doc first.

    • I like the way you think 🙂 I do try both of those things, depending on how long I’ve stretched what insulin I have left at “low reservoir” time. I always try to squeeze every unit of insulin out of a set that I can. Sometimes, it helps, but sometimes….this kind of day happens. And as we all well know…something that works for my body may not work for yours, and vice versa. Gotta love the similarities and differences between all our variations of the “same” diabetes!!!

  2. could you try and chnage your catheter when your insulin needs are low say before bed? then the high might be less dramatic? do you rotate your sites regularly?

    • That’s what I try to do….but things just don’t always work out that I’m running low on insulin in my pump before bed 🙂 This post just highlights a poor conflagration of events on my part 🙂 And yes – I’ve gone from belly sites to hip sites to butt sites in plenty of variations of rotations.

  3. I can absolutely identify with #2 above. After a site change, it seems to take anywhere from 2 to 6 hours for my BG to get back to normal again. And at that point, everything seems to work great until the reservoir is gone. Go figure.

    • When I was in my 3rd trimester of pregnancy, my insulin requirements were so high I was changing out my pump every 1.5 days. Rather than deal with the “site change highs” so often, I left the port in for at least 3-4 days, regardless of switching out the insulin cartridge. It helped *immensely* and even now, if I have a site that is working well, sometimes I will keep it in for 5-6 days.

  4. I wonder if (& if we had the ability to think ahead enough to do this, obvsly) we kachunked the new site into place while the current/old site was still working, and then changed the insulin cartridge/plugged into the new site a few hours later…I wonder if that would help? We have the same settling-in-period issue you describe most times.

    • It might be worth a shot! (pun intended 🙂 ) If the problem is due to the new site “trauma,” then I could see it helping for sure. If it’s due to the cells around the site taking some time to get used to absorbing the insulin they are suddenly hammered with…it may not help as much. Sounds good in theory, though!

  5. Dawn Phenomenon and Post-Breakfast spike kill me every time (I don’t know if those are two isolated problems or two different views of the same thing). It’s interesting that you find a snack before bed helps. I tend to find that whatever food I eat or whatever insulin I take just sits there – sleeping while I am – and when I wake up in the morning, BAM! it hits me all at once.

    As for site changes, I find just the opposite. It works really well with a new site change – almost too well! I’ve always been suspicious of the amount of insulin they say to use to fill the cannula — when I was using Silhouette infusion sets, and I switched from the longer to the shorter cannula, the “prime” amount was still the same: 0.7 units. That cannula, by the way, is terrifyingly larger than the QuickSet, but takes less to prime. Someone’s not being perfectly honest, if you ask me. (Of course, using the steel-cannula Sure-T’s, there is no ‘fill cannula’ step. You prime the tubing til drops come out of the needle, then stick the needle in and leave it there).

    But Sarah’s explanation makes a lot of sense too.

  6. I have the same problems when I change my infusion site! Skyrockets for a while, then it seems like it all catches up. It’s very frustrating!

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