This is something that started happening to me earlier this year after a lengthy period of having my blood sugars under control. From having good 7, 14 and 30 day averages of sub 8 mmol/l (145.45 mg/dl) and rarely spiking above 10 mmol/l (181.82 mg/dl) during the day in one of my 4-5 daily blood tests and getting up in the morning with good sub 8 mmol/l levels I started waking with 10+ levels.

As a T2 diabetic I have been controlling my sugars with two injections of Byetta 10ug a day (before breakfast and before dinner) and was also injecting 12 units of Lantus Solostar insulin in the morning - all of this under the supervision of the diabetes unit at our local hospital where I attend a clinic every six months. This combination, together with some other meds I am on, once worked out, kept my sugars in check.

Then a month or so ago I started noticing that my morning levels were elevated, over 10 mmol/l. In consultation with the diabetes clinic it was decided I should start taking my Lantus in the evening before going to bed and increase the dose to 18 units and now my morning levels more often than not are sub 8 mmol/l.

My last HbA1c check in February was 7.8 which both my cardiologist and the diabetes clinic are happy with.

I note the above in relation to the following article:

The Diabetes Dawn Phenomenon: Why It Happens, What To Do

By Jacqueline Marshall, Apr 14, 2014

How frustrating to wake up in the morning with elevated blood sugar when all you did was dream about eating a piece of cheesecake.

A seemingly spontaneous rise in blood glucose during the early morning hours – experienced by many people with type 1 and type 2 diabetes – is called the dawn phenomenon, or dawn effect.

The dawn phenomenon is actually the body’s response to an aspect of its own natural rhythms.

Why It Happens

The human body, with its wired-in wisdom, releases hormones such as cortisol, catecholamines, and growth hormone during the early morning hours. These hormones help maintain and restore the body’s cells, and they trigger the liver to release glucose. The rising glucose is meant to be regulated by circulating insulin.

Many people with diabetes do not have enough circulating insulin during predawn hours to regulate this end-of-night surge in blood sugar, so they are greeted on waking by the rising sun and an elevated morning glucose reading.

What to Do About It

A recent research study suggests that taking basal insulin in the evening is the only effective solution to the dawn phenomenon. However, if you are not currently taking insulin, consult with your doctor, and consider trying one of these possible dawn effect solutions:

• Exercise late in the day. Being active closer to bedtime may lower your blood sugar while you sleep.
• Adjust your medication(s). Talk to your physician about tweaking your medication(s) to counter the higher morning readings.
• Eat breakfast. When you eat breakfast, your body will tell the predawn glucose-stimulating hormones to give it a rest.
• Limit late-night carbs. In the evening, snack on items that have high protein and fat content such as peanut butter, meat, cheese, or nuts. These foods digest more slowly than carbohydrates, keeping glucose levels steadier.

Evidence for Evening Insulin?

The result of one research study does not prove anything, but it suggests something that may prove true.

Researchers at the Université Montpellier in France studied the dawn phenomenon in people with type 2 diabetes being treated with diet alone or with non-insulin medications.

The 248 study participants were examined for 48 hours using continuous glucose monitoring; 50 percent of them experienced the dawn phenomenon. The investigators defined the dawn phenomenon as a greater than 20 mg/dL rise in blood sugar.

The researchers concluded that:

1. The dawn phenomenon is already active in some individuals being treated for diabetes solely by diet; and diet does not regulate the phenomenon.
2. The dawn effect is not effectively blunted with oral hypoglycemic agents such as metformin or sulfonylureas, even in combination.

“We are unable to control the dawn phenomenon with our current armamentarium of oral hypoglycemic agents, even though metformin is probably the one that has the highest potency for reducing [it],” said researcher Dr. Louis Monnier. “My position is that insulin should be considered for the treatment of type 2 diabetes as soon as the A1C becomes greater than 7 percent when patients are already treated with maximal tolerated doses of oral agents.”

Keep Calm and Carry On

Keep calm, consult your doctor, and carry on. Stay informed and continue tweaking your diabetes management regimen to get results you and your professional team are satisfied with.

Link to original article:  http://www.informationaboutdiabetes.com/lifestyle/lifestyle/the-diabetes-dawn-phenomenon-why-it-happens-what-to-do

Still feeling my way around with this blog thingy - My Angina attack in May, 2014

So still trying to work out how this blog thingy works. Do I construct an historical timeline of what happened to me, before, during and after the heart attack in July, 2007? Or do I post about my heart event and intersperse this with things as they happen now on a day to day basis?

Thought about this yesterday whilst doing some exercise and have decided on the latter. Will post about issues as I recall them taking place and ongoing issues as they occur. I think this is the way to go and more REAL in the sense that it will help illustrate that when you have more than one health issue going on at the same time, 'fixing' one does not necessarily mean that all is hunky-dory.

For example: This morning I get up not feeling 100% - just one of those things that happens with my diabetes and can be the way I start a day once, twice or more times a week. Check my sugars as I do first thing each morning and they are 9 mmol/l (163.64 mg/dl) which is not fantastic but not all that bad given I don't sleep all that well which I now know impacts on my sugars.

I get on with it, have a yogurt and coffee after having earlier taken a shot of both Byetta and Lantus insulin for my diabetes which I do every morning before starting my day. I feel better, check what's happening on the internet and then get to preparing the food for our birds a daily routine which I have been doing on my own while Evelyn has been away this past week.

 Byetta

Lantus Solostar Insulin

I take out Gilly (a long bill corella we adopted in 2008) from his room in our house where he spends nights and put him on the patio with the food I have prepared for all of our birds (and even wild birds like this king parrot who wasn't about to wait to be fed!).

This is a photo I took a few days ago. Gilly will sit in his cage watching me feed our other adopted birds and wildlife visitors before I put him into his aviary for the day.

Whilst feeding and watering our birds I start to feel unwell again - headache, bit of nausea, light chest pain and tingling down the left side of my arm/hand. Not uncommon for me, usually happens for no apparent reason like not exerting myself or exercising and been told a while ago I have unstable angina. More often than not, this can happen when I am sitting at my desk at my computer, however, this morning started soon after I got up from bed, improved then got worse as I was outside doing the birds.

Now when this all started a number of years ago I used to get all anxious and even would panic and would pick up the phone, make an appointment to see my cardiologist which a number of times resulted in my having various tests. Over the years since my heart attack I have had numerous stress tests and will talk more about these in a separate post. Even did a CT angiogram a couple of years ago which showed my stents were all okay.

Upshot of all this was being diagnosed with angina and being put on Duride (Isosorbide Mononitrate) to help manage it. I was also given a GTN Nitro spray to be used when an angina event occurred and I guess it would be fair to say that over the past few years I have managed my angina with these two meds.

Nitrolingual (GTN) Spray

So when I felt unwell again this morning, I took a shot of my GTN spray, sat down for a bit to let it take effect and then went back to finishing up with the birds after feeling better.

I guess if there is a message I wish to share about the above it is one about the need for diabetics to recognize the interrelationship between poor sleep affecting sugar levels which in turn can affect the heart and bring on an angina attack.

Throw in additional issues that can arise for someone who has an endocrinological issue such as a thyroid condition, life can become that much more interesting with the continual battle to balance sugar and thyroid levels whilst managing a heart condition. Did I mention I have (had) Graves Disease? And if you have carotid artery blockages we are really getting into interesting territory.

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In May this year (2014) I had what turned out to be a pretty bad angina attack which landed me in hospital for two days and I learnt a lot from this incident about the relationship between sleep, diabetes and angina. I wrote the following about what happened on my Facebook page:

"On Tuesday, May 13 shortly after lunch I sat down at my desk and began feeling clammy and sweating profusely. I also had a touch of nausea, a queasy feeling and felt light headed but these lasted only a minute or two. In addition I had very slight pressure/ache down both sides of my neck going up to the lower jaw on both sides. I took my GTN spray as I thought this was just another angina attack but the sweating and pressure in my neck did not go away - usually within a few minutes of taking the spray any symptoms I have go away. The week before I had two angina attacks two days in a row, both of which were the worst to date, and my GP said the next time I have an attack to call an ambulance to get it checked out.

Because the sweating and neck ache persisted and given that  I have blocked carotids - up to 69% on the right side and up to 54% on the left - I decided that this time I would get this episode checked out and my wife phoned 000 to get an ambulance. On arrival the paramedics checked my blood sugars which came up with 3.8 and they said I may be having a Hypo/low. Now this was strange as just before I had lunch I had checked my blood sugar at 12.30pm and the reading was 5.2 so to be told I was having a Hypo less than two hours after eating a toasted chese and tuna sandwich and not feeling the Hypo symptoms I usually get had me confused.

The paramedics confirmed that I should be taken to hospital to be checked out, especially given the neck issues. They gave a tube of glucose to suck on which I couldn't tolerate so I opted to eat a bunch of my glucose laden jelly beans. En route to the hospital my sugar levels climbed to 6.2 and from memory, by the time I arrived at the hospital it was around 10.

In addition, they gave me four additional shots of GTN en route and by the time we arrived at emergency the ache on the left side had all but gone - the right side ache disappeared earlier after a couple of GTN shots."

From this episode I was reminded about having "silent" hypos at night while sleeping, something I had not thought about a lot.

I wrote more about this in a NOTE on my Facebook page and also highlighted the need for me (others) to be more vigilant in taking control of our own health, specifically when it comes to CHECKING OUR NUMBERS including sugar levels/HbA1C, blood pressure, thyroid/TSH levels, iron levels, etc. especially if you are someone like me with a number of issues going on at the same time. From this incident I also learnt about the need for me to address my poor sleep patterns and breathing issues both of which I was told during my hospital visit would  be impacting on my heart and affecting my angina.

Read the full NOTE here: https://www.facebook.com/notes/784466408244717/

My final comment in this note was: In summary, this week's events were a more than subtle reminder that I need to be more diligent and attuned to what is going on with my various issues and that to fail to do so could have dire consequences.

Here I am after being brought into hospital in May, 2014.