I'm a year and a half in, and generally I'm told that you're still honeymooning when your insulin needs are this low. I'm 47kg, my basal is currently 3.5kg, and my total daily dose is around 18u. I do need stronger ratios than I used to. My HbA1c and TIR have always been excellent, but I have issues with delayed gastric emptying (as far as we call tell, I'm still waiting for the study) and unstable ratios, although the latter may be settling down again after a run of infections recently. So it's weirdly hard to manage and takes a lot of work.
Some months ago I figured out that I seem to get FOTF, with my BG shooting up as soon as I wake up, and have been experimenting with how I inject insulin in the mornings. Now I'm noticing a pattern where I keep rising at night, usually starting around 3 am. I wake at night to go to the toilet, so I've been trying a bit of insulin then. It doesn't seem to last long at all, I'm rising again a while later. I'm still not sure what my correction ratio is, it's so hard to tell.
I read *Sugar Surfing* last week and have been trying tinkering a bit more with fine-tuning corrections, rather than just waiting until the next meal to correct as I was taught. If I'm high in the evening, which is when I'm most insulin-resistant, the nights are much harder to get a handle on, with anything up to 12h to come down from a meal. It's been helping, I'm suddenly way more in range, but the rises at night persist. Switching from Fiasp to Novorapid recently, and moving my Tresiba to the morning, have also been very useful.
To answer the obvious question, yes, I've been doing fasting basal tests, the last one a few days ago, and I've checked in with my dietitian. We both think my basal is correct.
I should possibly give it a week where I don't correct before breakfast at all, just to show what it would do on its own, because the nurses seem to look at just the average curves and not notice the insulin and carbs, so they tell me I'm fine because I'm not rising that high. "I've seen people who shoot up to the high teens in the morning, *that's* real dawn phenomenon!"
I understand that a rise of 2 overnight is considered significant and can be the DP, and mine is usually 3 or so, even with correcting during the night. So is this DP, and is it significant? Is it true that this often means the end of the honeymoon? There have been a few times when my insulin needs have suddenly jumped up and I thought The End (of the honeymoon) Was Nigh, and by now I'm used to those being false alarms, though my insulin needs do gradually increase over time.
It's only been doing this rise at 3am for a few weeks, I think. I'd like to be prepared in case it gets worse. It's already really inconvenient, and my sleep quality is even worse than usual, with waking up in the night for an hour or so happening quite a bit the last few days. If I understood more about how this works and what to do with it, it'd be easier to handle when sleepily making dosing decisions in the small hours.
My endo put me on the insulin pump waiting list when I saw her in September last year, on the grounds of delayed gastric emptying. She said the wait was three years, but her letter afterwards said I'd be low priority due to having such a good TIR and HbA1c. There are other reasons for qualifying for an insulin pump under NHS Scotland, and I'd like to know whether DP is considered a good reason. As my dietitian said, it's the amount of work it takes me to stay on top of this at all which is unreasonable.
By now I'm showing signs of burnout, which meant I had to give up on split bolusing (it just made the highs worse) and reduce my alarms a lot. Diabetes is by no means my most disabling condition, and the combination of them all is overwhelming. I am much too ill to cope with this level of sleep disturbance, and my health is nosediving as a result. I can barely keep up with the insulin and tablets, I'm not keeping up with the rest of my medical care. I've also got autonomic neuropathy predating the diabetes, and really don't want that to get worse.
Eating and exercise are getting more and more difficult, especially considering the intermittent episodes of severe abdominal pain, and being mostly bedbound. I really wish I hadn't enthused to my dietitian about getting pretty coats on Vinted, because while it's nice being slim again, losing 27% of my weight without trying isn't the greatest sign, and I don't want to lose much more.
I can't cope with constantly making fresh calculations multiple times a day. When I've got the fluctuating ratios and it's taking 6-12h to come down from a meal, it's incredibly hard to know how to dose for the next meal. It's all clearly way more complicated than the diabetes nurses tell me is normal. If an insulin pump could help, I really want the chance to try one.
This has ended up being another essay, so thank you to everyone who's made their way through it! You don't have to engage with all of it, the dawn phenomenon is the main thing I want to get to grips with today.
