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Re: [IP] Methodology: Using pump to control Dawn Phenomenon

At 02:10 PM 6/18/98 -0400, Darrin wrote:

>Could anyone with a pronounced Dawn Phenomenon please relate their
>methodology for controling it with teh pump?
The details are going to vary among users, but your understanding is
correct. An increase in the basal rate is programmed to offset the rise in
BG during those hours. More accurately, the basal increase is programmed in
*advance* of the anticipated rise in BG. Pumpers who use Velosulin or
Regular may start the increased basal rate farther in advance of the need
than Humalog pumpers, due to "speed of onset" differences between the two

I run basals of .2 and .3 most of the day, from 10:00 a.m till 1:00 a.m.
the next morning. Starting at 1:00 a.m., my basals increase in quick
increments to .9, where they stay until 10:00 a.m.. I am at .9 from 3:00
until 8:00 a.m., drop to .7 for an hour, then down to .2 for most of the
day. I categorize this as a "pronounced Dawn Phenomenon", to coin your
phrase. I require approximately a 2 hour lead time for my basal rate
changes. In other words, the increase at 1:00 is to take care of the rise
in my BG which is noted at 3:00. This seems to work quite well, but it took
me 2 years of pumping to realize this. My health care team consistently
missed this. (I love them just the same ;-))

>I suspect you program an increased basal for XXX hour in the am.  What are
>your results with this and do you ever expereince am hypos because of over
>compensation on the basal increase?  I assume the basal program is
>permanent and not have to be re-programed each night.
Excellent question. There may be a risk of "overcompensating", then
subsequently going low, but this is minimized by checking your BG patterns
and carefully adjusting your basal rates. It takes a while to get things
just right, but the results are well worth the effort.

The basal rate does not need programming each night, since the dawn effect
tends to kick in at the same time each night. There may be some slight
variation, but as long as you leave enough "slack" and don't attempt to
keep your BGs too close to the edge, you should handle the occasional
variance quite well. I don't think there is any way with MDI to approximate
the level of fine tuning you can do with the pump. Some MDI users are
successful, but I could never work this out with my pattern. It is simply
too pronounced, with occasional variations. Those variations are what
caused me to "party with the paramedics" too many times in my pre pump career.

One of the best books dealing with problem BGs such as the Dawn Effect is
"Pumping Insulin", by Walsh & Roberts. There might be a link on the web
page to order this. I read this book cover to cover almost a year before I
started pumping. It covers common BG "problem patterns" such as the dawn
effect, and discusses great ways to deal with them. Even though it's
written for pumping, the theory behind this stuff still holds true. You're
working with a different set of tools with MDI, but you're working on the
same problem. I really suggest looking at this book if you haven't already
done so.

Bob Burnett

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