Source
r/diabetes•
linernotes

NPH + Lantus for Dawn phenomenon

Type 1

Has anyone combined NPH with their basal to treat Dawn phenomenon?

I recently went off my pump to MDI for a few reasons. But I seem to always forget when planning a pump break how bad my Dawn Phenomenon is. We’re talking a 3am spike from 7.5mmol to 18.6 over 3 hours. In the past I’ve just woken up at 3am to take a fast acting injection but this time around I’m exploring other options. I’m currently on Tresiba but will probably be switching back to Lantus so I can split doses more effectively.

I saw this article talking about the profiles of basals and when they peak: https://diabetesstrong.com/managing-dawn-phenomenon-basal-insulin/

And I’m curious if anyone has tried NPH and a basal together. Also wondering about getting endo support for it.

Posted Aug 7, 2021, 11:37 AM UTC

513
Rockitnonstop•

I would worry about ”stacking“ your long acting, especially if you give it in the evening.

You may also want to watch out for your dinner. Lantus lasts 20-22 hours. I give mine at 6 am, which means if it is typically out of my system by 2-3 am. If I have a late, fatty, or protien heavy dinner, sometime bolus and basal will run out before the dinner is worked through, leaving me with a nice spike a 3-4 am.

I would also look into R with your endo. It has a more gradual peak over a longer duration than something like Humalog, and might be another option.

2
linernotesOPType 1•

Oh yeah I’ll definitely work with my endo. But I’m a researcher by trade so I like to gather as much context before those convos.

I’ve been on MDI before, this isn’t new to me. But I’ve always struggled with the early morning spike so I would love to find another solution.

Historically I’ve split my lantus. I’m not splitting the Tresiba but am definitely feeling that it’s not working well for me hence my explorations :)

Hadn’t thought about R, I’ll check on that too. Thank you!

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TheGrumpyBear04•

I too would like to know. I tend to spike up to 160 in the mornings, even if I went to bed at 80. It's aggrivating.

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linernotesOPType 1•

Right?! Like fine if I screw up my blousing that’s on me. But when I’m just sleeping and it spikes it drives me nuts.

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AnotherGoutSuffererT2D in the family•

Do we know that the Dawn Phenomenon warrants treatment? Or should we just let it run its course?

1
[deleted]•

[deleted]

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linernotesOPType 1•

I’ve had type 1 diabetes for years and have always had Dawn phenomenon. It causes difficult highs that take all day to correct so yeah, it warrants treatment.

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slimpickins2002Type 1•

Tresiba is quite good in the respect that it lasts for near 46 hours I think , it's classed as an ultra long acting insulin ,I take my same dose at the the same time every night and my sugars only go up that dramatically if I've been eating something high in carbs Before going to sleep/ taking my tresiba as I do both round the same time

That being said you may need a higher dose of your tresiba and change the time when you inject it ,but don't do this without consulting with an endo or a DSN/GP

Hope this helps

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[deleted]•

for me, tresiba is too.. flat?! it is too stable, i hope you know what i mean bc in the mornings it does absolutely nothing for my foot on the floor syndrome and i spike when i eat 2g of carbs.. it is very annoying. however, i also cant take more units bc at night, i tend to go down ca. 3 mmol/l.

just another experience/review of tresiba :)

oh, and injecting it in the mornings instead of at night helped a bit with my blood sugar going down. before, i would go down up to 5 mmol/l.

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linernotesOPType 1•

This is my problem. The flatness is great except for 3am-7am where the spike is so aggressive and Tresiba doesn’t help.

3
friendless2•

I have been doing the NPH + Lantus for 6 or 8 months now for the dawn phenomenon.

It is working well. I had to move my Lantus to the morning to avoid stacking at night. I figure the Lantus is on a downward trend at the end of it's time, so this seems to work.

My morning numbers were in the 200's (11+) a lot of mornings. Rarely over 300 (16.7). Rarely under 180 (10).

Now my numbers are usually between 90 (5) -120 (6.7). So it seems to work.

Finding the amount of NPH to take was a guess. Managed some lows at night at first (especially when Lantus was used at the same time).

I get my NPH from Walmart without a prescription. Cheap and easy. 1 vial lasts 42 days unrefrigerated.

You could always try it and quit later if you want to. I just had to get the prescription for syringes doubled to try it out. I am liking the results.

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linernotesOPType 1•

Thanks for sharing!! What kind of doses of Lantus and NPH are you on, only if you don’t mind me asking.

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friendless2•

12 Lantus, 9 NPH

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linernotesOPType 1•

Cheers, thank you!

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