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Re: [IP] RE:Dawn phenomenon? Is it really?



 The dawn effect can be coped with by setting the basal rate to deliver enough
insulin to prevent it.
 To do so it is necessary to test your fasting blood sugar throughout the night.
The tests will indicate when you have the dawn effect and basal insulin can be
increased to cover it. If you have an endocrinologist, they can best explain
what has to be done. They might be able to provide a loaner CGM that would make
the test simpler to do. One of the main things about the test is to have no
bolus insulin remaining when you start.

 Like you said, not much has been said about the actual ABSORPTION of insulin
being a factor,
 I agree in fact I believe that it is the major flaw with insulin pumps. Since
going on the pump, the insulin delivering infusion sets have not been reliable.
I took shots for 44 years and never had the problems that l have had with
infusion sets. Steel needle SureTs have worked best for me because the delivery
is as good as a shot yet the problem of pooling takes over a portion of my body
and I must relocate. It takes about a year before I can use the area again. That
makes me wonder if the insulin delivery isn't too slow because as compared to
shots where the insulin delivery is really fast.

 I agree that pumps are only a partial solution to the problem and unless they
can come up with a better delivery system, the future closed loop system can
expect the same problems as the current pumps., namely unreliable absorption.

 The CGM is an excellent tool for tracking blood sugar readings plus it is
fantastic for setting both bolus and basal rates.

Richard 


Sent from my iPad

 > On Apr 20, 2015, at 10:55 AM, Tom at-Hotmail
<email @ redacted> wrote:
> 
> From: Greg Fark
> Sent: Tuesday, April 14, 2015 4:16 AM
> To: IP Group-Main
> Subject: Re: [IP] Insulin Pump Programming: Preventing Dawn Phenomenon in
> T1D
> 
> The problem is that the extent, intensity and duration of dawn phenomena
> are NOT consistent....influenced by many factors as well as "random roll of
> the dice".Inconsistency of SOMETHING... yes, but is it really the dawn
 > phenomenon? Tweaking the boluses in the early AM seems to be the solution? No
> one has solved this riddle yet. We change insulin types. We change amounts.
> But we are all guessing. Controlled experimentation is what is needed. We are
> all GUESSING.
> Frankly, I don't hear much talk about the actual ABSORPTION of the insulin
 > being a factor. The issue of hypertrophy is different for everyone but I
think
> for me personally, hypertrophy is something that is more of a factor for me.
> Absorption of insulin after many years of diabetes happens not only at night
> but at any time of day. I notice that after 3 days of insulin absorption in
> the same spot produces some irregularity. I believe it is INCONSISTENT
 > ABSORPTION that is a factor in the measuring of blood sugars. Also, the
uptake
> of insulin by the muscles during bedtime is another factor. I have been
> hospitalized with low blood sugars at 2AM after intense activity during the
> day. So, it is not just HIGH blood sugars during the early morning hours but
> LOW blood sugars as well. Again, another factor which has nothing to do with
> the DAWN PHENOMENON.
> Isolating the particular factor or factors affecting the blood sugars is only
> relevant because we use insulin as the primary tool to make the final
> adjustment for blood sugar level normalcy. The coming advent of the bionic
> pump where the administration of glucagon to adjust the blood sugar level
 > UPWARDS IN case of low blood sugars is much more important. Our insulin pumps
> are only a partial solution of our total problem with maintaining our blood
 > sugar levels. The dawn phenomenon is an old concept that diverts our
attention
> from the real problem.
> Best Regards, Tom
> .
> Follow us at https://www.twitter.com/insulinpumpers
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