5 ways to manage the dawn phenomenon if you live with type 1 diabetes

Beth Edwards Nutrition | Dawn phenomenon | type 1 diabetes | breakfast | blood sugar balance

How to manage the dawn phenomenon

Virtual show of hands: who feels mornings can be the trickiest time of day to get a handle on blood glucose levels? Who also feels the morning rush of doing all the real life things that gotta be done, and wishing blood glucose just played ball so you can get on more easily?

If this is you, you're not alone. Managing mornings (the dreaded dawn phenomenon) comes up in the Beth Edwards Nutrition clinic a lot. I near enough discuss it with every 1:1 client who walks through my Zoom meeting room.

It's a tricky time of day with our normal circadian rhythms giving us a dose of stress hormones to get us up and out, but this indirectly raising glucose levels can be unhelpful for the t1ds among us.

Adopting a holistic, 360 approach is the way I play it. This covers all bases. But it can feel relentless work, and I get that. So let’s break it down into easier chunks - here are 5 nutritionist-approved tips you can adopt today!

1) Pre-bolus

Ensure you pre-bolus your insulin before eating breakfast. We know that ‘quick-acting’ insulin isn’t all that quick, and it needs at least 15 minutes to activate. You may find you need to try different lengths of time to establish the best pre-bolus for you (+ this may be different for each meal, too!). For further specific guidance, please see a detailed post I wrote on Instagram.

2) Movement

Do some gentle movement in the morning. We know that movement is a great way to shuffle glucose into the cell (to be used for energy) and that this can happen in the absence of insulin! Try some gentle stretching, a morning stroll, some yoga or reiki. It doesn’t need to be a full on sweat. The key is consistency, so find something you enjoy!

3) Sleep

Where possible, aim to get between 7-9 hours of quality sleep each night. The benefits of sleep on health are endless and when it comes to type 1 diabetes, getting decent shut eye will lower morning cortisol levels (the stress hormone that drives up blood sugars) and improve glucose tolerance. Both are important to prevent those post-breakfast spikes - winning!

4) Balance your breakfast

And I don’t mean on one finger… eating a breakfast full of complex, low glycaemic load carbohydrates (whole grains, whole fruits, oats), good quality protein (eggs, clean protein powders, chia seeds) and healthy fats (nuts, seeds, flax, avocado) will ensure your plate is nice and balanced. Most typical Western breakfasts - cereals, toast and jam - are just carbohydrates. If you pair carbs with protein and fats, this will slow down the absorption of the carbs, reducing the post-meal spikes in blood glucose levels.

5) Eat dinner earlier

And consider avoiding late night snacks. This will increase the fasting window between meals, allowing your body to reset, your digestion to do its importance maintenance work and your insulin sensitivity to increase. It also means you won’t be going to bed with insulin on board, which makes blood sugar management a whole lot easier overnight - fewer CGM beeps and more chance of good-quality sleep (see point 3!).

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So there we go, some top tips you can easily implement today to help you better manage and get on top of the dawn phenomenon. Let me know below - do you have any other T1D tried and tested tips?

{Interview} Pete Lomas, Founder of NJaP

T1D Inspiring Interviews Series

Hey guys [waves]. Welcome back to another interview!

I had a little chat with Pete Lomas, person with type 1 diabetes and founder of patch company Not Just a Patch.

Not Just a Patch is designed to give maximum protection for your Freestyle Libre, Dexcom, MiaoMiao or Medtronic devices. The patch design is completely unique and original, designed by Pete after he found himself preoccupied with just how loose his Libre was getting - before the 14 days of wear was up.

If you’re familiar with the patches, you’ll know how colour they are . They’re designed to make a statement, so you can own your T1D tech and wear your diabetes on your sleeve (as a badge of honour).

Pete kindly sent me a sample of patches earlier this year and I haven’t looked back. I am always 100% confident that my Dexcom is going to stay in place if I use NJaP. I also wrote a guest blog post for them which you can read here: it’s ALLL about CGMs.

So if you’re a device wearer and you’re in need of some patches - check out NJaP!

Without further ado, on to the reason why you’re all here - the interview with Pete!

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Hey Pete! Welcome. Please tell us your type 1 journey! What age were you when you were diagnosed / what symptoms did you have? 

I was 30 and living in London. I was training for the London Marathon and looking forward to spending Christmas in an Italian farmhouse with friends. I started peeing like crazy, was thirsty as hell and then my eyesight got blurry. I was telling my mate my symptoms and he suggested a Boots test kit. This led to a GP visit then a hospital trip. Woke up non-diabetic, went to bed diabetic. The twists and turns of life huh ;-)

What do you wish you'd known when you were newly diagnosed?

Nothing really…but if you want an answer, I wish I'd known what the catalyst was for the autoimmune response that killed the beta cells in my pancreas.

What is the worst thing about type 1 diabetes?

General inconvenience.

(Curveball) What is the best thing about type 1 diabetes?

I have a richer understanding of my body and its relationship to the things I put in it. And it's led me to create a business which has become a fulfilling passion and given my life a purpose that it previously lacked.

What are the main challenges of living with type 1?

1) It makes people around me worry and I don't want them to.

2) It impacts my health and my mood.

How do you deal with these challenges?

I try to reassure the people that it’s all OK and I take a balanced approach to life - enjoying as much as I can, not held back by diabetes.

Where do you find support/how do you access support?

I've just found a nurse educator, but until now I'd been pretty solo.

Can you recommend any great podcasts or blogs?

1) Beth's nutrition blog is practical and digestible (excuse the pun).

2) I like Dr. Rhonda Patrick's advice on nutrition.

3) Joe Rogan's podcast for entertainment and new perspectives.

4) Sam Harris's podcast for cultural, philosophical, political and social perspectives. 

Have you ever 'hidden' your type 1 diabetes?

Hmmmm…no.

How do you think type 1 diabetes has affected your relationship with your body?

As above, much richer appreciation for the effects of food, exercise, stress and all internal and external stimuli.

How do you think type 1 diabetes has changed your approach to life and living? 

Very little actually. I have found a community and feel part of that, as well the Not Just a Patch business has given me purpose and passion. I love helping T1Ds.

Type 1 diabetes is classified as a physical condition, but we all know there is an emotional burden too. Could you describe your experiences?

When I have hypos I tend to want to be left alone and can become frustrated. I don't like it when my partner thinks that I can manage my T1D better. I don't like my friends and loved ones worrying about me.

When did you launch NJaP and what was the reason behind that?

I had the idea in January 2019 and our first sale in July 2019. The reason was that I had been wearing the Libre for a year and found that by the end of the two weeks it was always getting loose and I was constantly thinking about it. I was also swimming more and had started doing hot yoga. With swimming 40 laps there was no way that the Libre stayed in place so I was making my own makeshift patches. I had been thinking about starting a business for a while and after listening to a podcast on entrepreneurship, this galvanised the idea to launch a CGM patch business. The design is unique and original and I am very proud of it.

What is your favourite patch / colour from the online shop?

Haha, well it was black at the start but now I tend to rotate with yellow being my current fave :-) 

BONUS quick-fire round:

Pump or pens?

Pens

Finger pricks or CGM?

Finger pricks

Orange juice or jelly babies?

Jelly babies or dates or Haribo

Balmy summer nights or crisp wintry mornings?

Damn! Got to be a tie tbh - love them both

Yoga or swimming? 

Haha probably yoga now, my body is falling apart and yoga is a little more gentle

Beach or mountains? 

Damn again…tie

Porridge or pancakes? 

Neither, I don't eat much breakfast these days as I do intermittent fasting as often as I can. If I do have breaky, it will be a bacon egg and cheese everything bagel or bacon, eggs, avocado, mushrooms and sourdough toasted

Diet Coke or Kombucha?

DC

Novorapid or Fiasp?

Novo

Vegemite or Marmite?   

Haha got to be Vegemite but I do also like Marmite

Morning bird or night owl? 

I've been both. Currently night owl due to business demands

Melbourne or Sydney?

I live in Sydney and it's the most naturally beautiful city in the world. I have many friends in Melbourne and have spent much time there and think that its culture and people are second to none

Thank you so much, Pete, for your wisdom and light in this T1D community of ours!

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{Interview} Dan Newman, Type 1 Diabetes Blogger + Podcast Host

The T1D Inspiring Interviews Series is back!

Well, hey - hasn’t it been a hot minute since I did an interview with someone marv from the type 1 community?

Fear not, we’re back with a bang!

Dan Newman developed type 1 diabetes at the age of 10. He went on to experience diabetes distress in his teenage years and then developed chronic kidney disease in 2013. He places emphasis on being open in discussing his complications in a bid to reduce stigma and shame that can engulf these challenges. I for one (& I know there are many others) am extremely grateful for his honesty.

I first came across Dan on Jen Grieves’ podcast Type 1 on 1 - a pod where she interviews people doing wonderful things in the type 1 space. Dan’s episode is here. His wisdom and perspective shines through and his calming voice is a total tonic for the soul - you’ll be pleased to know you can hear more of his wisdom (& soothing voice) on his own fantastic podcast, The Talking Type 1 Podcast. Give it a listen (after you’re done with this blog post, of course!)

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Without further ado, on to the reason why you’re all here - the interview with Dan!

Hey Dan! Welcome. Please tell us your type 1 journey! What age were you when you were diagnosed / what symptoms did you have? 

I was diagnosed when I was 10 years old during the summer holidays. I remember that I was drinking a lot but because it was hot outside my family didn’t think anything of it. My aunt took myself and my cousins to the cinema (movies) and I was unwell and that continued during the rest of the evening. My mum called the emergency doctor and he said you need to take him to accident and emergency (emergency room) now. What seemed like many hours the doctor told me that I had diabetes. I think I was in the hospital for a week or two but I can’t remember because it was so long ago!

What do you wish you'd known when you were newly diagnosed?

That there would be difficult times particularly the mental aspect that comes with living with type 1 diabetes. I think just seeing type 1 diabetes as a physical condition didn’t help me because it’s a physical, mental, and emotional condition all wrapped into one.

What is the worst thing about type 1 diabetes?

The, at times, unpredictable nature of type 1. The fact you can do the same activities, eat the same foods two days in a row and have two different results can be frustrating at times.

(Curveball) What is the best thing about type 1 diabetes?

The best thing for me is the skills and qualities it has taught me as a person. These qualities include me being more resilient, understanding of others and determined to succeed in whatever I do in life.  

What are the main challenges of living with type 1?

The challenge is that it’s an unpaid full-time job which you didn’t ask for, with no annual leave and you are the only employee. Type 1 is always there in the background no matter how much you tell yourself it isn’t. One challenge for me was to overcome trying to be the perfect diabetic who was always in range no matter when I tested my levels. I would think as the numbers as either good or bad and not just what they are - which is numbers.

How do you deal with these challenges?

I learnt to realise that trying to always have perfect levels whilst living with type 1 diabetes just isn’t possible. I learnt that the data from my blood glucose monitor was giving me information on what I needed to do next and that I was attaching emotion to the numbers.

Where do you find support/how do you access support?

The diabetes online community, in particular Instagram. I enjoy speaking to other type 1s from all over the world and speaking about the ups and downs of living with type 1. It’s nice to speak to people who just ‘get it’.

Can you recommend any great podcasts or blogs (as well as your own)?

One of my favourites is Type 1 on 1 | Diabetes Stories by Jen Grives. Jen is a great host and interviewer and I had the pleasure of being interviewed for her podcast. There’s also Emily and Miriam at Pancreas Pals and Brandon and Matt at Bolus Maximus both great podcasts. Finally, I have a podcast called The Talking Type 1 Podcast.

Have you ever 'hidden' your type 1 diabetes?

Definitely. I found type 1 particularly during my teenage years, so I would not tell many people at school. I’d inject under the table in class or go to the toilets to do my injection just so that I could appear normal to everyone else. I’ve hidden it in the workplace so in some jobs I only told one or two people who I felt needed to know just in case but I never actively spoke about my type 1.

How do you think type 1 diabetes has affected your relationship with your body?

I think being diagnosed at 10 I went through many life stages with type 1 so it was always part of my body. It has had a positive impact because I’m more aware if something isn’t quite right for example my levels usually go out of sync a week or so before I come down with a cold.

How do you think type 1 diabetes has changed your approach to life and living? 

It’s taken a long time to get here but I now aim to do my best every day when it comes to managing type 1 which I use in my everyday life. Type 1 has also shown me that I can get through the worst situations, it’s not easy or pleasant at times but there is an end and I also use this in my approach to life and living.

Type 1 diabetes is classified as a physical condition, but we all know there is an emotional burden too. Could you describe your experiences?

I’ve had diabetes distress and diabetes burnout particularly in my teenage years and early 20s. I never knew that there was a reason for how I was feeling at the time it was just how I felt. I had two changes in my life which put me on the right path to coming out of diabetes burnout and I’m thankful that they happened when they did. I also set myself small goals of testing my levels once a day and build on it. If I missed a test that day I wouldn’t be hard on myself and start again the next day and build-up momentum. A big challenge related to this is that I had to overcome (still occasionally do) is not attaching emotion to my blood sugar levels. I’ve learnt that the numbers aren’t judging me they are just giving me information on what I need to do next. I do think it’s important to celebrate when your hard work being a pancreas has paid off, for example, if you lower your HbA1c, you hit your target time in range.

When did you launch your podcast, The Talking Type 1 Podcast, and what was the reason behind that?

I launched my podcast in March 2020. My reason was to help others living with type 1 by interviewing different people about their lives with type 1 and sharing their experiences with others who live with type 1 diabetes. I like learning about people and believe that everyone’s story of living with type 1 is unique and can help another person.

I remember how I felt alone at different times when living with type 1 and I don’t want anyone else to experience that feeling. Overall, It has been a rewarding experience to speak to each guest.

Do you have a favourite episode, or one that you're particularly proud of?

Good question! An episode that I’m proud of is episode 10 called Black, Diabetic and Proud. I speak to other black people living with type 1 diabetes about their experiences living with type 1. We cover a number of topics including diabetes and health discussions within the black community, representation within the diabetes community and more. I like this episode because it was an opportunity to amplify the voices of other black people living with type 1. I have other episodes which I like; I’ve spoken to someone who had a pancreas only transplant, someone who has recovered from diabulimia, someone who has lived with type 1 diabetes for over 47 years and a mum who wrote a letter to her son on his first diaversary which spoke about their experiences as a family during that first year. I’ve spoken to some great people.

BONUS quick-fire round:

Pump or pens?

Pump

Finger pricks or CGM?

Finger pricks

Juice box or jelly babies?

Both, but if pushed, juice box

Balmy summer nights or crisp wintry mornings?

Balmy summer nights

Diet Coke or Kombucha?

Diet Coke

Morning bird or night owl?

Night owl

Porridge or pancakes?

Porridge

Breakfast, lunch or dinner?

Dinner

The smell of insulin, love or hate?

Love

Thank you so much, Dan, for your wisdom and light in this T1D community of ours!

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{Interview} Jen Grieves, Type 1 Diabetes Writer + Podcaster

The T1D Inspiring Interviews Series with Jen Grieves

Hey all, I’m super thrilled to welcome Jen Grieves, type 1 diabetes writer and podcaster, onto the blog.

I. Am. Excited.

Jen was one of the first people I found in the diabetes online community. I’d pore over her blog, gathering strength from every insight, experience or feeling she’d bravely share about living with a compromised pancreas.

Jen then began creating videos about a host of important topics (mental health and type 1, navigating hypos, travelling with type 1, lockdown + type 1).

I eagerly await for her newsletter notifying me of a new video!

In 2019, Jen launched her podcast Type 1 on 1 where she interviews people doing wonderful things in the type 1 diabetes space. I recently listened to the episode with Claire from Organising Chaos. It’s raw, open and a tonic for any weary type 1 soul.

[I interviewed Claire back in May - you can read that great blog post here]

Jen’s a true superstar in the diabetes community. If you want to follow her online [you should], check out her Instagram here, her website here.

Without further ado, on to the reason why you’re all here - the interview with Jen! [FYI I had a little cry at some of Jen’s answers. I felt so heard + seen. Have your tissues at the ready.]

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Let’s dive into the diabetes questions

Hey Jen! Welcome. Please tell us your type 1 diabetes journey! What age were you when you were diagnosed / what symptoms did you have? 

My diabetes journey is currently 24 years long, and it’s an ever-evolving process of learning, understanding and tuning into my body. I was diagnosed in 1996 at the age of 8 and embarked on a life laden with injections, finger picks and glucose tablets, but apart from this extra physical baggage I carried on doing all the things I was already doing - sports, school clubs, sleepovers - and I think that shaped my outlook around diabetes from the get go. I’m grateful to my parents for not being afraid to let me live my life.

What do you wish you'd known when you were newly diagnosed?

It’s hard to say as I’m sure if I’d been told much more when I was diagnosed it would have been overwhelming. I definitely shouldn’t have been told I could never eat sweets again - that was not fun for an 8-year-old to hear, nor was it true.

I wish I’d been told at some point how much type 1 diabetes is an emotional condition as much (If not more) than a physical one. I didn’t find that out for over a decade and I was very much scrambling in the dark with the toll my condition had taken on me at that point and had no idea why I was struggling so much.

What is the worst thing about type 1 diabetes?

For me I struggle with how it can’t be defined because each day is so different. Some days I feel like it’s absolutely fine, and others I just want to throw it out of the window. There’s a duality between how ‘manageable’ it can be and how huge and permanent it also is. I find that a difficult line to walk and figure out each day, and that’s also quite hard to articulate to others.

(Curveball) What is the best thing about type 1 diabetes?

I honestly believe it’s made me a better, kinder, more compassionate human being and I’m really thankful for that. Type 1 has given me an acute awareness of what other people might be going through without you realising. I am aware that I have a lot of amazing things in my life and I think the struggles of living with a chronic illness have also conversely made me much more positive and hopeful in general. I also can’t not mention the connections I’ve made with amazing people all over the world that I wouldn’t have otherwise had!

What are the main challenges of living with type 1?

‘Doing’ type 1 diabetes day in and day out really can get boring! The mundanity of waking up, checking your sugar, starting from scratch again each day, dosing, correcting, the admin of diabetes and most of all the space it takes up in my brain. It’s always in the back of my head and often it’s right at the front when I’d rather not have to think about it.

How do you deal with these challenges?

I focus on the fact that I’m doing the best I can and I don’t berate myself when my blood sugars go awry. One ‘bad’ day in a lifetime of trying to replicate a pancreas is not a big deal, even though it can make you feel rubbish. Making room for my diabetes has allowed me to live a much happier, healthier life and that means I can do more things that make me feel good and have nothing to do with type 1, which then makes the frustrations of type 1 seem less significant.

Where do you find support/how do you access support?

The type 1 online community has been an incredible source of support and knowledge over the past 10 or so years. We’re all dealing with this wild condition in our little packets of the Earth so it’s nice to connect and know that other people get it. My friends and family are also amazing; they’ve absorbed so much just by virtue of being in my life. I rely on my friends when I want to think about things that aren’t diabetes - chatting about life, going on adventures, just having fun. That’s a huge source of support in itself.

Can you recommend any great podcasts or blogs (as well as your own)?

The Talking Type 1 Podcast is great, by @t1d_dan. He is such a considered, calm interviewer and he’s had some really interesting guests.

Have you ever 'hidden' your type 1 diabetes?

There was definitely a period in my final year of university where I wasn’t engaged with my type 1, but it wasn’t necessarily a conscious thing; I wasn’t in a great place in general and I was struggling with various hormonal imbalances and so ability to manage my type 1 diabetes suffered.

I’ve never hidden it as such, but some days I feel more willing to open up a conversation about it than others. Dating is where I feel like I have to repeatedly ‘reveal’ it but it often comes up fairly quickly, either because I’m talking about my podcast or we’re eating/drinking and I need to check my blood sugars or take insulin. There was one date, years ago now, where I remember heading to the toilet to fix a hypo because it hadn’t come up in conversation yet and I was scoffing sweets in the cubicle - gross!

How do you think type 1 diabetes has affected your relationship with your body?

Oooofff that’s a big question! It’s been a long road for me - my diagnosis is definitely the reason I started to properly notice my body for the first time. I put on a fair bit of weight after diagnosis and my puberty seemed to be affected in the years after (I was 8 years old) so it definitely set the stall for a more complicated relationship with my body. Now I think my body is bloody incredible - it hasn’t failed me, it’s working so hard to keep me alive and we work together so that I can live my life and think and feel and love, which is such an amazing thing when you think about it. I’m so much more in tune with my body because of type 1.

How do you think type 1 diabetes has changed your approach to life and living? 

I’ve touched on it a few times but it’s given me such an appreciation for the simple things, and I take nothing for granted. Getting through each day is an achievement because we work so hard to keep ourselves alive. At the other end, I definitely am an adventurous person who lives for experiences and I feel like every time I travel or do something that takes more planning because of my diabetes I’m showing myself what’s possible. Working in the TV industry is not a 9-5 and I’m proud that I’ve figured out a lot of diabetes hurdles and challenges to have some amazing work opportunities.

Type 1 diabetes is classified as a physical condition, but we all know there is an emotional burden too. Could you describe your experiences?

It’s just a constant low level consumption of my headspace and I didn’t realise this for years so I therefore didn’t understand that over time it had started to take its toll. I think the emotional side of things is often a greater load than the physical aspects like injecting or testing your blood sugar. It’s just so complex, so personal and so constant.

In the past couple of years I’ve set a lot more boundaries and stopped trying to do everything all the time - I have a tendency to spin a lot of plates and try to do too many things. I’m OK with telling people that I need a day to myself to reset, which is something I never would have done before. Exercise has also been key - I used to exercise for my body, but now I exercise for my mind. And it’s not about running marathons - I just do what makes me feel good that day.

When did you launch your blog and what was the reason behind that?

This is actually very much linked to the emotional burden of type 1 diabetes. Once I realised that my condition was having an emotional impact, it was like a lightbulb and I suddenly wanted to learn more about my condition outside of my bi-annual clinic appointments for the first time. This was about 14 years after my diagnosis and I’d just embarked on my career. I had a new life in a new city and I felt like I was coming back to life, and I didn’t want to jeopardise all of that by not taking care of my health - on reflection I maybe felt like I suddenly had something to lose.

I’ve always been a writer so I started a blog to try and make sense of all the information and as a form of catharsis after so many years of feeling quite sad and lost. It was the first time I realised there were hundreds of other people out there living through similar experiences, and here we are, 10 years later.

We love your vlogs! Do you have a favourite video?

Aw thank you! I honestly can’t believe anyone watches them, I ramble so much (as these answers are illustrating very well!). The ones that people find the most useful are the explainers around diabetes technology so it’s great to know that you’re helping people because that’s the whole point of the channel, but my favourites to make are the vlogs because they’re so creative. I really love the process of putting a story together through the filming, words, music and editing, even though it takes much longer! Hopefully it’s helpful for people to see someone living their life going through similar feelings, experiences and struggles because of type 1. Shameless plug - here’s a recent one!

You launched your podcast Type 1 on 1 last year. What have you learned from your guests along the way?

It’s something I’d wanted to do for so long because unlike on social media where there’s not much room, in a podcast you get an hour of really intimate, open conversation and I just felt like that could be really helpful to people who feel isolated with their condition, and for those that don’t interact with other people online. I feel so lucky to have spoken on that deep level to other people about their personal experiences - I’ve learned that this condition has SUCH a varied and huge impact on those living with it, and it’s not often people really get to reflect on that. I’ve also learnt that as unique as each person’s experience is, there are so many similarities in what we go through. It’s an ongoing process for each person who lives with type 1 - you can’t ‘complete’ diabetes. Ultimately, people are incredibly inspiring and resilient - at the risk of sounding cheesy there is just so much inner strength that people don’t realise they have. The podcast is definitely something special to me.

BONUS quick-fire round:

Pump or pens?

Pump now, but I was happily on pens for a long time

Finger pricks or CGM?

CGM! Gamechanger

Juice box or jelly babies?

Juice box

Balmy summer nights or crisp wintry mornings?

Ohhh, balmy summer nights

HIIT classes or running?

HIIT classes

Meditation or yoga?

Meditation (if only to get me to sleep!)

Porridge or eggs?

EGGS FOREVER

Diet Coke or Kombucha?

Neither

Novorapid or Fiasp?

I want to try Fiasp! But for now, Novorapid

Morning bird or night owl?

Night owl

Pip n Nut or Meridian?

Hahaha SO ON BRAND. Can I say Aldi own brand? It’s SO GOOD

Podcasts or vlogs?

ARGH I CAN’T CHOOSE. Podcasts because I get to chat to amazing people

Sorry, apparently I can’t even answer quick-fire questions quickly!

Thank you so much, Jen, for shining brightly in this little T1D community of ours!

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