Question about dawning

I posted here a while back about my daughter Conner, who is 6 and was
diagnosed with T1 in July. Her numbers seem to be doing quite well, but
she's having a problem with a dawning effect. My question is can this
happen at any time of the day, or only in the am? For example, at
2:45(post-lunch), she was 119. When checked again at 5:30(pre-dinner), she
was at 234. She had nothing to eat and only water to drink in between, so
I'm wondering if she's having a "afternooning" effect, similar to the
dawning effect. Any thoughts or help would be appreciated. I still have so
much to learn, and I've already learned so much from you all. TIA!

Tasha

silers <silers@earthlink.net> wrote:
: I posted here a while back about my daughter Conner, who is 6 and was
: diagnosed with T1 in July. Her numbers seem to be doing quite well, but
: she's having a problem with a dawning effect. My question is can this
: happen at any time of the day, or only in the am? For example, at
: 2:45(post-lunch), she was 119. When checked again at 5:30(pre-dinner), she
: was at 234. She had nothing to eat and only water to drink in between, so
: I'm wondering if she's having a "afternooning" effect, similar to the
: dawning effect. Any thoughts or help would be appreciated. I still have so
: much to learn, and I've already learned so much from you all. TIA!

: Tasha

Tasha,

Are you the lady who was having so many problems with yoru daughter's
school? If so, how is tht working out? I have been wondering and
worrying aobut that for a while.

As I am a non-insulin dependant tpe 2 I cannot help you with your
daughter's "afternnon effect" There will be others who have dealt with
these roblems along son to offer suggestions. I have some gesses, but
don't thik it appropriate fo rme to even try with Conner's problem. Is
she enjoying 1st grade?

Wendy

"silers" <silers@earthlink.net> wrote in message
news:NFc2h.795$L6.207@newsread3.news.pas.earthlink .net...
>I posted here a while back about my daughter Conner, who is 6 and was
>diagnosed with T1 in July. Her numbers seem to be doing quite well, but
>she's having a problem with a dawning effect. My question is can this
>happen at any time of the day, or only in the am? For example, at
>2:45(post-lunch), she was 119. When checked again at 5:30(pre-dinner), she
>was at 234. She had nothing to eat and only water to drink in between, so
>I'm wondering if she's having a "afternooning" effect, similar to the
>dawning effect. Any thoughts or help would be appreciated. I still have
>so much to learn, and I've already learned so much from you all. TIA!
>
> Tasha

Suggest you contact your doctor ASAP and ask his/her advice.

Also, please describe the insulins your daughter is taking so that the T1's
here can better understand what's going on with her. Also, you should
describe what she is eating and how active she is.
Thanks

She is on 5u Lantus at bedtime, and her Novolog dosage is different at every
meal. Breakfast is 1/2u:15g, Lunch is 1/2:25g, and Dinner is 1u:25g.
Average carb intakes are Breakfast-40, Lunch 60, and dinner-50. Her most
active times are during the afternoons at school, when she has recesses and
phys ed classes. She's usually pretty pooped when she gets home, so she
takes it easy here. Sometimes they'll go outside to play, but even then
it's not what I would call vigorous exercise. Can the activity at school
make BG go up instead of down?

Tasha




"Uncle Enrico" <Uncle@nospam.com> wrote in message
news:ewd2h.20196$TV3.2557@newssvr21.news.prodigy.c om...
>
> "silers" <silers@earthlink.net> wrote in message
> news:NFc2h.795$L6.207@newsread3.news.pas.earthlink .net...
>>I posted here a while back about my daughter Conner, who is 6 and was
>>diagnosed with T1 in July. Her numbers seem to be doing quite well, but
>>she's having a problem with a dawning effect. My question is can this
>>happen at any time of the day, or only in the am? For example, at
>>2:45(post-lunch), she was 119. When checked again at 5:30(pre-dinner),
>>she was at 234. She had nothing to eat and only water to drink in
>>between, so I'm wondering if she's having a "afternooning" effect, similar
>>to the dawning effect. Any thoughts or help would be appreciated. I
>>still have so much to learn, and I've already learned so much from you
>>all. TIA!
>>
>> Tasha
>
> Suggest you contact your doctor ASAP and ask his/her advice.
>
> Also, please describe the insulins your daughter is taking so that the
> T1's here can better understand what's going on with her. Also, you
> should describe what she is eating and how active she is.
> Thanks
>

She is doing SO much better now. The school finally realized this isn't
like a cold and is going to go away soon. They hired a nurse specifically
for my daughter's care, and have had 6 different people go to training on
her care. She is loving 1st grade. They just had their Halloween party on
Tuesday, and she had a blast. She has only had a few BG problems at school,
but as of yet(knock on wood!), we have not had anything that required
emergency treatment. I hope we never do! Thanks for asking Wendy!

Tasha
"W. Baker" <wbaker@panix.com> wrote in message
news:eiblot$ra7$1@reader2.panix.com...
> silers <silers@earthlink.net> wrote:
> : I posted here a while back about my daughter Conner, who is 6 and was
> : diagnosed with T1 in July. Her numbers seem to be doing quite well, but
> : she's having a problem with a dawning effect. My question is can this
> : happen at any time of the day, or only in the am? For example, at
> : 2:45(post-lunch), she was 119. When checked again at 5:30(pre-dinner),
> she
> : was at 234. She had nothing to eat and only water to drink in between,
> so
> : I'm wondering if she's having a "afternooning" effect, similar to the
> : dawning effect. Any thoughts or help would be appreciated. I still
> have so
> : much to learn, and I've already learned so much from you all. TIA!
>
> : Tasha
>
> Tasha,
>
> Are you the lady who was having so many problems with yoru daughter's
> school? If so, how is tht working out? I have been wondering and
> worrying aobut that for a while.
>
> As I am a non-insulin dependant tpe 2 I cannot help you with your
> daughter's "afternnon effect" There will be others who have dealt with
> these roblems along son to offer suggestions. I have some gesses, but
> don't thik it appropriate fo rme to even try with Conner's problem. Is
> she enjoying 1st grade?
>
> Wendy

silers wrote in message ...
>I posted here a while back about my daughter Conner, who is 6 and was
>diagnosed with T1 in July. Her numbers seem to be doing quite well, but
>she's having a problem with a dawning effect. My question is can this
>happen at any time of the day, or only in the am? For example, at
>2:45(post-lunch), she was 119. When checked again at 5:30(pre-dinner), she
>was at 234. She had nothing to eat and only water to drink in between, so
>I'm wondering if she's having a "afternooning" effect, similar to the
>dawning effect. Any thoughts or help would be appreciated. I still have
so
>much to learn, and I've already learned so much from you all. TIA!
>
>Tasha
>
>

Dawning, or the Dawn Effect is caused by a hormone release. The
hormones "order" the liver to release glucose into the blood.

There are other reasons why the liver will release glucose into the blood.

Stress and illness are the most common. A cold or mild infection can trigger
a liver release which could require you to double her daily insulin dose to
keep her in control. On the other hand, a low blood sugar can be defined
as "stress" and the liver will react by releasing glucose (Somogyi effect,
Rebound effect). If she went low between 2:45 and 5:00 from her exercise +
pre-lunch bolus combo, that 245 could be a reaction to the low

Vigorous exercise can also be considered as "stress" and can cause a liver
release. I bring my meter and insulin to exercise sessions and test after
the 1st hour. I cannot predict beforehand whether I will need to inject a
Corrective Bolus or eat some Smarties in order to handle the rest of the
session.

Note that a liver release trigger which often concerns T1 is called "basal
fade"

The liver does not monitor blood sugar. It does respond to circulating
insulin levels. Whenever it detects a level below about 8-12
microUnits/Liter, it "assumes" that the pancreas has stopped producing
insulin because the person has a low blood sugar. So it "saves" the person
by releasing glucose into the blood.

Of course, T1 don't all have a pancreas which can keep the level of insulin
above the 8-12 microUnit/Liter level. So we have to keep it there
artificially by injecting a slow insulin into our fat layer. The dribble
of insulin from the slow-insulin injection keeps us above the 8-12 level and
thus prevents the liver release. . . .if we figure everything out correctly.

Lantus is one of the most popular basal insulins around because one shot a
day can be sized to keep many** folks above the 8-12 microUnit level.
However, if the one shot is too small, or the T1 happens to be a fast
absorbing** T1, the T1 will run into a condition called "basal fade".
In a figurative sense, our basal insulin seems to fade.

(**many, fast absorbing: Lantus exhibits absorbences ranging from 16 to 34
hours+ in various people)

We solve that problem by increasing the Lantus dose or splitting the dose
between two shots spaced about 12 hours apart.

A common starting point for a Lantus dose is about 0.2 units/day-kg body
weight. A 5-unit daily dose implies a 55-lb child which sounds about right
if I judge your post correctly. That suggests that if she has basal fade
symptoms on a regular basis, splitting the Lantus might help.

I am leaning more towards the "illness" and/or "exercise+pre-lunch bolus
low" explanations though. One of the cruel facts of life which plague
T1 is the variation in day-to-day response to insulin, food and carb.
You can do what seems to be exactly the same thing two days in a row and get
very different results.

Some stuff about T1 girls growing up that you might find interesting:

http://www.medscape.com/viewarticle/436291

". . .Insulin Analogs and Approaches to Therapy
Lois Jovanovic, MD, FACE, Sansum Medical Research Institute, Santa Barbara,
California, discussed the use of insulin analogs and approaches to intensive
insulin therapy. She suggested that, in addition to diet and exercise,
psychological, physical, and hormonal stresses must be taken into account
when determining insulin requirements. The insulin requirements of growing
children increase from approximately 0.5 to 2.0 U/kg/day during puberty;
girls show peak insulin requirements at around age 12 and boys at around age
14. During pregnancy, insulin requirements increase from 0.5 to 1.0
U/kg/day. . . . ."

Regards
Old Al

Thanks for all the info Al! I really appreciate all the help I can get!

Tasha


"oldal4865" <oldal4865@yahoo.com> wrote in message
news:4quaaiFoihl3U1@individual.net...
>
> silers wrote in message ...
>>I posted here a while back about my daughter Conner, who is 6 and was
>>diagnosed with T1 in July. Her numbers seem to be doing quite well, but
>>she's having a problem with a dawning effect. My question is can this
>>happen at any time of the day, or only in the am? For example, at
>>2:45(post-lunch), she was 119. When checked again at 5:30(pre-dinner),
>>she
>>was at 234. She had nothing to eat and only water to drink in between, so
>>I'm wondering if she's having a "afternooning" effect, similar to the
>>dawning effect. Any thoughts or help would be appreciated. I still have
> so
>>much to learn, and I've already learned so much from you all. TIA!
>>
>>Tasha
>>
>>
>
> Dawning, or the Dawn Effect is caused by a hormone release. The
> hormones "order" the liver to release glucose into the blood.
>
> There are other reasons why the liver will release glucose into the blood.
>
> Stress and illness are the most common. A cold or mild infection can
> trigger
> a liver release which could require you to double her daily insulin dose
> to
> keep her in control. On the other hand, a low blood sugar can be
> defined
> as "stress" and the liver will react by releasing glucose (Somogyi
> effect,
> Rebound effect). If she went low between 2:45 and 5:00 from her exercise
> +
> pre-lunch bolus combo, that 245 could be a reaction to the low
>
> Vigorous exercise can also be considered as "stress" and can cause a liver
> release. I bring my meter and insulin to exercise sessions and test
> after
> the 1st hour. I cannot predict beforehand whether I will need to inject
> a
> Corrective Bolus or eat some Smarties in order to handle the rest of the
> session.
>
> Note that a liver release trigger which often concerns T1 is called "basal
> fade"
>
> The liver does not monitor blood sugar. It does respond to circulating
> insulin levels. Whenever it detects a level below about 8-12
> microUnits/Liter, it "assumes" that the pancreas has stopped producing
> insulin because the person has a low blood sugar. So it "saves" the
> person
> by releasing glucose into the blood.
>
> Of course, T1 don't all have a pancreas which can keep the level of
> insulin
> above the 8-12 microUnit/Liter level. So we have to keep it there
> artificially by injecting a slow insulin into our fat layer. The
> dribble
> of insulin from the slow-insulin injection keeps us above the 8-12 level
> and
> thus prevents the liver release. . . .if we figure everything out
> correctly.
>
> Lantus is one of the most popular basal insulins around because one shot a
> day can be sized to keep many** folks above the 8-12 microUnit level.
> However, if the one shot is too small, or the T1 happens to be a fast
> absorbing** T1, the T1 will run into a condition called "basal fade".
> In a figurative sense, our basal insulin seems to fade.
>
> (**many, fast absorbing: Lantus exhibits absorbences ranging from 16 to
> 34
> hours+ in various people)
>
> We solve that problem by increasing the Lantus dose or splitting the dose
> between two shots spaced about 12 hours apart.
>
> A common starting point for a Lantus dose is about 0.2 units/day-kg body
> weight. A 5-unit daily dose implies a 55-lb child which sounds about
> right
> if I judge your post correctly. That suggests that if she has basal
> fade
> symptoms on a regular basis, splitting the Lantus might help.
>
> I am leaning more towards the "illness" and/or "exercise+pre-lunch bolus
> low" explanations though. One of the cruel facts of life which
> plague
> T1 is the variation in day-to-day response to insulin, food and carb.
> You can do what seems to be exactly the same thing two days in a row and
> get
> very different results.
>
> Some stuff about T1 girls growing up that you might find interesting:
>
> http://www.medscape.com/viewarticle/436291
>
> ". . .Insulin Analogs and Approaches to Therapy
> Lois Jovanovic, MD, FACE, Sansum Medical Research Institute, Santa
> Barbara,
> California, discussed the use of insulin analogs and approaches to
> intensive
> insulin therapy. She suggested that, in addition to diet and exercise,
> psychological, physical, and hormonal stresses must be taken into account
> when determining insulin requirements. The insulin requirements of growing
> children increase from approximately 0.5 to 2.0 U/kg/day during puberty;
> girls show peak insulin requirements at around age 12 and boys at around
> age
> 14. During pregnancy, insulin requirements increase from 0.5 to 1.0
> U/kg/day. . . . ."
>
> Regards
> Old Al
>
>
>
>
>
>

silers wrote in message ...
>Thanks for all the info Al! I really appreciate all the help I can get!
>
>Tasha
>

Some land mines in your future

1. I once decided to try to exactly measure the effect of a bad cold on my
insulin needs. Between 7 a.m. and 11 p.m, I had to shoot enough extra
insulin to handle ~1 lb of sugar. Consider the mental image of a lb of
sugar sitting in a bowl and your daughter running through the room all day,
stopping to eat a teaspoon of sugar every few minutes till the lb was gone.

2. I once experienced a bleeding ulcer and some serious blood loss. As a
result, my body went into stress-mode for a week or so, with the primary
symptoms being an elevated pulse, elevated blood pressure, and sky-high
needs for insulin.

I exactly doubled both my basal and bolus insulin doses. It was an eerie
experience, i.e.;

a. Wake up, shoot enough Insulin R to put me on the floor
b. Shoot enough basal UL to put me on the floor that afternoon
c Wait an hour, shoot enough Humalog to put me on the floor
d. Wait an hour, eat breakfast
e. Wait two hours, shoot more Humalog if needed! !

etc, etc,.

Regards
Old Al

"silers" <silers@earthlink.net> wrote in message
news:NFc2h.795$L6.207@newsread3.news.pas.earthlink .net...
:I posted here a while back about my daughter Conner, who is 6 and was
: diagnosed with T1 in July. Her numbers seem to be doing quite well, but
: she's having a problem with a dawning effect. My question is can this
: happen at any time of the day, or only in the am? For example, at
: 2:45(post-lunch), she was 119. When checked again at 5:30(pre-dinner),
she
: was at 234. She had nothing to eat and only water to drink in between, so
: I'm wondering if she's having a "afternooning" effect, similar to the
: dawning effect. Any thoughts or help would be appreciated. I still have
so
: much to learn, and I've already learned so much from you all. TIA!
:
: Tasha
:

Hi Tasha,

Glad your daughter is doing much better. I can relate to your issue, I had
a simular
one myself. While I wasn't a child diabetic, things for us T1's are often
very close.
First off, PLEASE, PLEASE PLEASE.. consult your doctor above ALL things
anyone including
myself might have to say here. There are more T2's that are very low
carbers and think
ALL diabetics including children should be as well to control their glucose
and they have ZERO
understanding of how T1's actually work.

With that said, your daughter is taking the best amount of carbs for her
STILL growing young
body, NEVER change that without first consulting with your childs Endo or
dietician.

Here's my take on what might be going on. I was on Lantus prior to pumping
and after 7 months
of careful study on my own body I found that Lantus simply no matter if I
took a single dose or
split my dose that I didn't get more then 19hrs out of my Lantus dose a day
and ended up having
to suppliment with NPH around the 17th hour to make sure I had enough
coverage otherwise I was
seeing a great increase in my numbers later in the day if I took my dose in
the morning. If I took
it at night before bed, I was seeing that around 7-8pm at night I was going
high and thought it was
from what I was eating for dinner, having too many carbs, so I reduced my
carbs to around 20gm
therefore I would only need 1u, but still found myself high. (300+) --- So
this might be something
to check out, if she's getting the full 24hrs of Lantus, otherwise she might
need some form of
supplimenting to cover her during that lost time.

Dawn Phenomenon can happen really anytime one sleeps, being at night or a
nap. It's just the body
spitting out glucose to help us wake up. Through more careful testing I
found mine was from 4:30am
until 9:00am, if I can have perfect coverage during that time, then I no
longer see highs. Prior to pumping
the bad part, is Lantus only covers x % over 24hrs. I was taking 18u, which
was .755u per hour for me,
which during my DP time simply isn't enough, I've now found that I need
1.25u per hour and now I no longer
see any highs during my DP time. Pumping might be an option for her. At
6yrs old, she's old enough and
I would think she could very much benefit from pumping being a growing
child.

Children's glucose and insulin needs change SO SO much. Hormone changes,
growth spurts, sleeping and
any form of activity will cause a change in her glucose good or bad. I have
a friend who had GD, her 1yr old
daughter was teething and she started showing signs of diabetes.. I
suggested she use her meter and test
the child. The child started running high after all meals and her fasting
glucose was consistantly in the hypo
area. She took her to the doctor and the doctor didn't wanna hear it. Well
she carefully watched her daughter
and soon learned she was cutting 6 teeth at the same time!!! and soon as she
cut those teeth her glucose
went right back to normal. So, this was a great learning curve for us
both... Who'd ever thought teething
would cause a non-diabetic's glucose to rise to 200+....

In diabetics, when we exercise, especially I've found for T1's more then
T2's (again, type specific) that our
glucose will rise more often then it will decrease, depending on the type of
exericse. Another wonderful
advantage of pumping over injections. That you can suspend insulin doses
while pumping and exercise and
you cannot do that when take injections. This can help a child avoid hypos.
Same with you can take an extra
bolus when pumping when you're a wee bit too high with a simple push of a
button and not have to carry
extra insulin with you, whip out a syringe and inject. Hint; there is a
child lock on all pumps, so children that
don't quite understand, cannot just press buttons and give more insulin to
harm them.

What other trends have you been noticing? Is she teething by chance? Could
she be coming down with a cold?
Have you gotten her a flu shot yet? Yes!! Even children that are diabetic
should have a flu shot each year.

Sorry this is so long, just wanted to put it all in and maybe offer some
suggestions.

Best of Luck, we're here to help and support when we can.

--
Reisa, T1, Animas IR1250 Pumper
DX-5/00 ASD-7/00
A1C: 6.2% (8/24/06)
Daily CHO: 150-200gm
TDD: 34-38u

"rk" <p_haha_medium@gmail.com> wrote in message
news:WTq2h.1218$ig4.754@newsread2.news.pas.earthli nk.net...
> First off, PLEASE, PLEASE PLEASE.. consult your doctor above ALL things
> anyone including myself might have to say here. There are more T2's that
> are very low carbers and think ALL diabetics including children should be
> as well to control their glucose and they have ZERO understanding of how
> T1's actually work.
>

I don't think anyone here has told her to either ignore her (child's) doctor
or to put the child on a low-carb regime.

>In diabetics, when we exercise, especially I've found for T1's more then
T2's (again, type specific) that our glucose will rise more often then it
will decrease, depending on the type of exericse.
>

I sometimes -- and almost always after particularly vigorous exercise or a
race -- find my bg rising, sometimes considerably, after exercise.

You insist on painting T2's with a broad brush dripping in black paint! And
consider them (us, really, since I'm T2) sort of inferior-type diabetics.
bj
T2

I've never seen a type 2 say that ALL diabetics should low carb, never.
You give really good information rk, as the rest of your post is, and I
know you have a really big heart, but I wish you would quit with the pot
shots at the type 2 posters every chance you get. It's getting really
tiresome, and it takes a lot to make me tired.
--
Cheri

rk wrote in message ...

>First off, PLEASE, PLEASE PLEASE.. consult your doctor above ALL things
>anyone including
>myself might have to say here. There are more T2's that are very low
>carbers and think
>ALL diabetics including children should be as well to control their
glucose
>and they have ZERO
>understanding of how T1's actually work.

"silers" <silers@earthlink.net> wrote in message
news:irl2h.917$L6.801@newsread3.news.pas.earthlink .net...
> She is doing SO much better now. The school finally realized this isn't
> like a cold and is going to go away soon. They hired a nurse specifically
> for my daughter's care, and have had 6 different people go to training on
> her care. She is loving 1st grade. They just had their Halloween party
> on Tuesday, and she had a blast. She has only had a few BG problems at
> school, but as of yet(knock on wood!), we have not had anything that
> required emergency treatment. I hope we never do! Thanks for asking
> Wendy!

That's great to hear : )

Nicky.

--
A1c 10.5/5.5/<6 T2 DX 05/2004
100ug Thyroxine
95/72/72Kg

On Thu, 02 Nov 2006 18:35:34 GMT, "rk"
<p_haha_medium@gmail.com> wrote:

> There are more T2's that are very low carbers and think
> ALL diabetics including children should be as well to
> control their glucose and they have ZERO understanding of
> how T1's actually work

Enough. You have gone too far.

That is an outrageous statement. I have never seen any
regular here, of any type, give such advice for a type 1
child. Back it up with links - or shut up.

Your other type 1-related advice may, or may not, be
excellent for this child's mother. I'll leave it for the
insulin users to judge that.

But you are not helping the OP by warning against imaginary
dangers and trying to embroil her in your personal
vendettas. Your paranoia on the subject of type 2's and
reducing carbs, and on BG spikes and your total
incomprehension of the different dangers T2's face from
spikes that you consider acceptable, is way over the top.

I wish you well, and I wish the pain gone and soon. But I
can no longer excuse crap like this out of sympathy for your
problems.

Put up or shut up.

Alan, T2, Australia.

The enemy is anybody who's going to get you killed, no
matter which side he's on.
Joseph Heller (1923 - 1999), Catch 22

bj <bjones44@bellatlantic.net> wrote:
> "rk" <p_haha_medium@gmail.com> wrote in message
> news:WTq2h.1218$ig4.754@newsread2.news.pas.earthli nk.net...
>> First off, PLEASE, PLEASE PLEASE.. consult your doctor above ALL things
>> anyone including myself might have to say here. There are more T2's that
>> are very low carbers and think ALL diabetics including children should be
>> as well to control their glucose and they have ZERO understanding of how
>> T1's actually work.

> I don't think anyone here has told her to either ignore her (child's) doctor
> or to put the child on a low-carb regime.

But it's an ever present danger! Constant vigilance and frequent
warnings are essential. I know nothing like that has ever actually
happened, but it might, and think of the consequences if it did! These
low-carbing T2s are totally unscrupulous and can't be trusted for a
second.

--
Chris Malcolm cam@infirmatics.ed.ac.uk DoD #205
IPAB, Informatics, JCMB, King's Buildings, Edinburgh, EH9 3JZ, UK
[http://www.dai.ed.ac.uk/homes/cam/]

On Thu, 2 Nov 2006 22:13:41 -0000, "Nicky"
<ukc802466929@btconnect.com> wrote:

>
>"silers" <silers@earthlink.net> wrote in message
>news:irl2h.917$L6.801@newsread3.news.pas.earthlin k.net...
>> She is doing SO much better now. The school finally realized this isn't
>> like a cold and is going to go away soon. They hired a nurse specifically
>> for my daughter's care, and have had 6 different people go to training on
>> her care. She is loving 1st grade. They just had their Halloween party
>> on Tuesday, and she had a blast. She has only had a few BG problems at
>> school, but as of yet(knock on wood!), we have not had anything that
>> required emergency treatment. I hope we never do! Thanks for asking
>> Wendy!
>
>That's great to hear : )

Yes not only a result for you but for any future diabetic kids at the
same school.