Waking Up With High Glucose Levels
Waking up with high glucose or blood sugar levels, or “Dawn Phenomenon,” occurs in more than 80 percent of adults with type 1 diabetes.1 Personal continuous glucose monitoring (CGM) and your insulin pump provide tools that can help you control Dawn Phenomenon. After wearing your personal Continuous Glucose Management (CGM) system for at least 24 hours, you can upload the data into CareLink® Personal Software. The software provides a “Sensor Daily Overview” report. This report can place up to seven days of data on one 24-hour time plot. This really helps you see glucose spikes during a particular time period. For example, look at the early morning hours. Is there a consistent upward spike around 5:00 AM? If not 5:00 AM, is there one earlier or later in the morning? If you see a spike, you can work with your healthcare team to change your basal rate prior to the spike so that you can smooth out your overnight glucose control. If you don’t use a personal CGM system, you can still follow your overnight glucose levels using your blood glucose (BG) meter and an alarm clock. You will have to wake yourself up a couple times during the night to check your BG using your meter. Ask your healthcare team for some guidance, but generally you will have to check a fingerstick BG at bedtime where it should be greater than 100 mg/dL, again during mid-sleep, and then when you wake up to see if your overnight basal rates are correct. Rather than writing down all of your readings, you can upload data from your blood glucose meter 2 into CareLink® Personal Software, along with your insulin pump so that you have all your information in one place. Review your findings with your healthcare provider to pinpoint when you are experiencing dawn phenomenon. Your insulin pump can handle m Continue reading >>
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How To Avoid High Morning Blood Sugars
We’ve all been there before. You wake up. Lay in bed for a few before getting your booty up to go kill the workday and accomplish big things. Check your blood sugar. 115 (6.3 mmol/l) stares back at you. You smile to yourself: life is good. Forty minutes later, when you sit down to eat, your CGM gives you a “high” notification, and you’re 180. You have eaten NOTHING. All you’ve done is prepare for the day and prepare food. Now you face the grim potential of chasing your sugars all day long. What the… This isn’t Dawn Phenomenon Many people would blame this rise in blood sugar on dawn phenomenon (DP), which has a similar endpoint, but a different mechanism. Dawn phenomenon is the result of hormones releasing in the body in the early morning – predominantly growth hormone, cortisol, epinephrine, and glucagon – which in turn increase insulin resistance. The current basal insulin from the pump or long-acting injections is no longer enough, and blood sugars rise. That hormonal surge happens around 2am-6am, with most of it occurring in the middle of the night. Let’s say you woke up at 8:30am and aren’t in the “DP zone.” It’s not DP. Then what? Feet on the floor The moment your feet touch the floor as you roll out of bed, you signal to your body, “Hey, I need energy for all the stuff I’m about to do!” Your body recognizes you haven’t eaten in lord knows how many hours. Your body is also lazy smart and wants the most easily accessible source of energy: the liver. The liver is the Wal-Mart for stored energy, since it’s got everything you need. It stores glycogen that can be easily broken down when fasted or needed for activity, AND is the home of gluconeogenesis, a process where protein is broken down to glucose for energy. Guess what? You’r Continue reading >>
High Blood Sugar In The Morning? Understand Why
Diabetes has a mind of its own. Its been notorious for acting in a strange way and let you keep thinking what wrong has been happened. There are times when you come across high fasting blood sugar in the morning. Those high numbers may give you a shock and make you wonder what exactly you did wrong yesterday to get punished by those high numbers. you may try figuring out by asking questions like: whether you took insulin properly? or whether you have taken carbohydrate-rich food? Those numbers may keep you puzzled and spoil your whole day Well, there many reasons which may shoot up your blood sugar: a. Not taken right insulin dosage or have completely forgotten it b. Have eaten carb-rich food c. Went to the part and had late dinner d. Illness e. Poor sleep f. Stress But if you have done all the things right and still had high morning numbers than you must have suffered from a mechanism named “Dawn Phenomenon”. So, what is Dawn Phenomenon? It’s a concept in which your liver dumps extra glucose in your body late at night. It occurs usually at around 4 AM and may peak at 10 AM. So if you check your blood sugar in the early morning and found it exceptionally high, then understand that it may be happening due to glucose dumping by the liver. Why does it happen? Because at night your body glucose level may drop below the required limit. In order to counter that your body release hormones (cortisol, glucagon, epinephrine) that give the signal to the liver to produce extra glucose. So when there is a long time between meals, your brain may give the signal to the liver to produce extra glucose to keep your body running. Is Dawn Phenomenon Normal? Yes, it’s completely normal. This mechanism takes place in every human body and yes, even to non-diabetics. Its a natural way Continue reading >>
How To Control Your Blood Sugar
Author's Perspective: When I was diabetic, I learned very quickly that there were hundreds of ways to lower my blood sugar. I also met a lot of marketing/sales people, MLMers and charlatans selling supplements and other products that they claim would lower my blood sugar. But, during my research, I discovered that there was more to diabetes than just lowering my blood sugar. Unfortunately, most people with diabetes are not aware of this. As a result, they go looking for the "quick fix" and after wasting their time and money, they eventually learn that a "quick fix" is not the answer to their diabetes. If someone approaches you with a product that promises to lower your blood sugar, do your home work first. Talk to a real diabetes expert who understands diabetes -- don't rely on their marketing people to bamboozle you. Also, before you spend your money, read our web page about the 8 warning signs of a diabetes scam. When I was diabetic, I realized that there were 4 key factors that affected me being able to control my blood sugar and keep it in the normal range: nutrition, lifestyle, blood glucose testing, and medications (temporarily). And, because I had help from my mother and daughter, I was able to control my blood sugar by addressing these 4 key areas. For example, my mother and daughter took care of the house and preparing my meals. In addition, I was on paid disability leave from work. So I had a lot of free time to test my blood sugar and make adjustments to (lower) my insulin dosages. I also had time to modify my lifestyle by exercising two times a day. In addition, because I didn't have to worry about preparing meals or going to work, I was under a lot less stress. As a result, I was able to make significant progress in a short period of time. Author Sidebar: D Continue reading >>
The Dawn Effect: Tips For Fixing High Morning Blood Sugars
An early morning spike in the blood sugar can be a sign of poorly-controlled diabetes or something called the Dawn Effect. Here's what you can do. The dawn phenomenon sometimes called the dawn effect, is the term given to an early morning spike in the fasting blood sugar in an individual with diabetes. Typically occurring between 2 and 8 AM, it can be frustrating for those who are making every effort to control their blood sugar. Fortunately, the dawn phenomenon can be effectively managed. Why it Happens Everyone—those with or without diabetes—experiences a rise in blood sugar in the early morning. “There is a surge in growth hormone secretion in the early morning and this appears to be the hormone that may be the most responsible for the dawn phenomenon, at least in people with type 1 diabetes,” says Robert Courgi, MD, a hospitalist and endocrinologist at Southside Hospital in Bay Shore, New York. “The dawn phenomenon is apparently not only responsible for a rise in fasting glucose, but it can also account for an exaggerated rise in post-breakfast blood glucose.” Growth hormone, as well as hormones like cortisol, are “get-up hormones that work to get us started on our day,” explains Yan Yan Sally Xie, MD, an endocrinologist at Long Island Jewish Medical Center in New Hyde Park, New York and North Shore University Hospital in Manhasset, New York. “But all these hormones cause glucose levels to rise.” In a person who doesn’t have diabetes, there is sufficient insulin to cope with the blood glucose, or sugar, when it rises, Dr. Courgi says. “But in someone with diabetes, there’s just not enough insulin to control the sugar,” he adds. The pancreas isn’t able to produce insulin as needed, so the blood glucose rises. The Consequences of High Blo Continue reading >>
By Theresa Garnero, APRN, BC-ADM, MSN, CDE Have you ever gone to bed with a relatively normal glucose reading, only to wake up with a much higher value? Do you wonder why glucose numbers can swing during sleep or pre-dawn hours? This slideshow will address readers’ questions about the difference between two possibilities: the Somogyi effect and the dawn phenomenon. Continue reading >>
The Dawn Phenomenon
Many people with diabetes observe that their numbers first thing in the morning are often higher than their target. This condition is called “dawn phenomenon” and it can occur in people with type 2 diabetes. It’s best described as a high fasting blood sugar (FBS) number after waking in the morning. This puzzles and even alarms many people, especially when their blood sugar number the night before was in the right range for them, they have been following the meal and exercise plan set out by their doctor or diabetes educator and are taking their medications as prescribed. What’s your A1c? Before we delve into the dawn phenomenon though, it’s really important to emphasize that if your A1c is at or below your target, individual glucose numbers that are higher than your target aren’t a big deal. Your diabetes is still doing fine. If your A1c is above your target though, that’s when you really need to work with your doctor to figure out when your blood glucose is high and what to do about it. Figuring out how to address high morning numbers can be an important part of this process. Why does this happen? The science behind a high fasting blood sugar number has to do with a group of hormones that are released by the body during the night. All people, with or without diabetes, experience this as a part of the natural body cycle, or circadian rhythm. The hormones (including growth hormones, cortisol, glucagon and epinephrine) that are released sometime between 2 a.m. and 8 a.m. increase insulin resistance and cause blood sugar to rise. As you near waking time, the liver begins to release stored glycogen to give you the energy you need to get up and start the day. For a person without diabetes, the pancreas then reacts to this glycogen by appropriately releasing the Continue reading >>
Thirty Years Of Research On The Dawn Phenomenon: Lessons To Optimize Blood Glucose Control In Diabetes
More than 30 years ago in Diabetes Care, Schmidt et al. (1) defined “dawn phenomenon,” the night-to-morning elevation of blood glucose (BG) before and, to a larger extent, after breakfast in subjects with type 1 diabetes (T1D). Shortly after, a similar observation was made in type 2 diabetes (T2D) (2), and the physiology of glucose homeostasis at night was studied in normal, nondiabetic subjects (3–5). Ever since the first description, the dawn phenomenon has been studied extensively with at least 187 articles published as of today (6). In this issue, Monnier et al. (7) report an additional observation on the dawn phenomenon in a large group of T2D subjects and quantify its role on overall BG control. Given this information and the extensive data to date, an assessment of our knowledge in this area should be determined. Specifically, what have we learned from the last 30 years of research on the dawn phenomenon? What is the appropriate definition, the identified mechanism(s), the importance (if any), and the treatment of the dawn phenomenon in T1D and T2D? Physiology of glucose homeostasis in normal, nondiabetic subjects indicates that BG and plasma insulin concentrations remain remarkably flat and constant overnight, with a modest, transient increase in insulin secretion just before dawn (3,4) to restrain hepatic glucose production (4) and prevent hyperglycemia. Thus, normal subjects do not exhibit the dawn phenomenon sensu strictiori because they secrete insulin to prevent it. In T1D, the magnitude of BG elevation at dawn first reported was impressive and largely secondary to the decrease of plasma insulin concentration overnight (1), commonly observed with evening administration of NPH or lente insulins (8) (Fig. 1). Even in early studies with intravenous insul Continue reading >>
Blood Sugar: What Causes High Blood Sugar Levels In The Morning
There are two reasons why your blood sugar levels may be high in the morning – the dawn phenomenon and the Somogyi effect. The dawn phenomenon is the end result of a combination of natural body changes that occur during the sleep cycle and can be explained as follows: Your body has little need for insulin between about midnight and about 3:00 a.m. (a time when your body is sleeping most soundly). Any insulin taken in the evening causes blood sugar levels to drop sharply during this time. Then, between 3:00 a.m. and 8:00 a.m., your body starts churning out stored glucose (sugar) to prepare for the upcoming day as well as releases hormones that reduce the body's sensitivity to insulin. All of these events happen as your bedtime insulin dose is also wearing off. These events, taken together, cause your body's blood sugar levels to rise in the morning (at "dawn"). A second cause of high blood sugar levels in the morning might be due to the Somogyi effect (named after the doctor who first wrote about it). This condition is also called "rebound hyperglycemia." Although the cascade of events and end result – high blood sugar levels in the morning – is the same as in the dawn phenomenon, the cause is more "man-made" (a result of poor diabetes management) in the Somogyi effect. There are two potential causes. In one scenario, your blood sugar may drop too low in the middle of the night and then your body releases hormones to raise the sugar levels. This could happen if you took too much insulin earlier or if you did not have enough of a bedtime snack. The other scenario is when your dose of long-acting insulin at bedtime is not enough and you wake up with a high morning blood sugar. How is it determined if the dawn phenomenon or Somogyi effect is causing the high blood sug Continue reading >>
Dawn Phenomenon: A Good Thing For Running With Type 1 Diabetes?
I’ve been waking up with high blood sugar levels (130-180) most mornings for as long as I can remember (at least as long as I’ve had diabetes). Known as the Dawn Phenomenon, these early morning elevated blood sugar levels are the result of nighttime release of hormones, including growth hormones, cortisol, glucagon and epinephrine – which cause insulin resistance and blood sugar levels to rise. A few days ago, or nights ago, I found myself waking up every few hours from the noise of the wind. At 3:50 a.m. I woke up and got out of bed again. The noise of the wind blowing through the trees and against our windows and shudders was so loud that I, in my half-asleep state, was sure it was raining. I quickly got up to close the living room window. As I began to close it, I realized the street was totally dry and that it wasn’t raining at all. It was just the strong wind. Being up, I decided to check my blood sugar (I find myself doing this when ever I’m awake at unusual hours). I had gone to sleep 94 and wasn’t sure in which direction I was going. I was very happy to see that I was 102. I went back to sleep for a couple hours and when I got up a little before 6:00 a.m. to go running, I checked my blood sugar again. This time it was 146. Now that’s the dawn phenomenon for you, I thought to myself. About to go running, I didn’t mind being 146, but it did piss me off that even after adjusting the basal rate on my pump to combat this phenomenon, I still seem to wake up over 120 most mornings. And the evidence from my pre-dawn test proved I did everything right the night before. One of the reasons I went on the pump was to combat this problem. I thought the ability to have a different basal rate at different times of the day would definitely solve this issue once a Continue reading >>
The Dawn Phenomenon: What Can You Do?
What is the dawn phenomenon that some people with diabetes experience? Can anything be done about it? Answers from M. Regina Castro, M.D. The dawn phenomenon, also called the dawn effect, is the term used to describe an abnormal early-morning increase in blood sugar (glucose) — usually between 2 a.m. and 8 a.m. — in people with diabetes. Some researchers believe the natural overnight release of the so-called counter-regulatory hormones — including growth hormone, cortisol, glucagon and epinephrine — increases insulin resistance, causing blood sugar to rise. High morning blood sugar may also be caused by insufficient insulin the night before, insufficient anti-diabetic medication dosages or carbohydrate snack consumption at bedtime. If you have persistently elevated blood sugar in the morning, checking your blood sugar once during the night — around 2 a.m. or 3 a.m. — for several nights in a row will help you and your doctor determine if you have the dawn phenomenon or if there's another reason for an elevated morning blood sugar reading. What you can do Your doctor may recommend a number of options to help you prevent or correct high blood sugar levels in the morning: Avoid carbohydrates at bedtime. Adjust your dose of medication or insulin. Switch to a different medication. Change the time when you take your medication or insulin from dinnertime to bedtime. Use an insulin pump to administer extra insulin during early-morning hours. Continue reading >>
High Fasting Levels
High fasting levels are a huge problem for many ladies. Fasting blood sugar levels, levels taken first thing in the morning when you wake up, are the hardest thing to control with gestational diabetes. But why is that? When we're sleeping we are not eating and drinking and we are not active and so the body is left to it's own devices with regards to controlling blood sugar levels. Impacts on fasting blood sugar levels Many things can impact fasting levels: what you've eaten earlier in the evening when you last ate hydration levels how well you've slept the dawn phenomenon the Somogyi effect What you ate earlier in the evening Bearing in mind how much of each food group converts to glucose in the bloodstream and the time taken, your fasting levels may be impacted by this. Too much carbohydrate in your evening meal or as a snack before bed can contribute to high fasting levels, as your body can only produce or use so much insulin, so if you raise your blood sugars too high by eating too much carbohydrate, your body can spend the night battling to try to lower your blood sugar levels. A high fat meal such as takeaway food can also cause higher blood sugar levels and so eating a well paired evening meal is important. When you last ate The key to stabilising blood sugar levels is to eat small amounts, often. We obviously cannot do this throughout the night, but if you eat your evening meal early and do not eat again until breakfast the following day, it can be an extremely long time to go without eating. Likewise, if you eat a large meal just before going to bed, this too can have a detrimental effect on your fasting levels. Hydration levels Dehydration will cause higher blood sugar levels. Water helps to flush excess sugar from the body and so it is important to stay well h Continue reading >>
Dawn Phenomenon And The Somogyi Effect
The dawn phenomenon and the Somogyi effect cause high blood sugar levels, especially in the morning before breakfast, in people who have diabetes. The dawn phenomenon is a normal rise in blood sugar as a person's body prepares to wake up. In the early morning hours, hormones (growth hormone, cortisol , and catecholamines) cause the liver to release large amounts of sugar into the bloodstream. For most people, the body produces insulin to control the rise in blood sugar. If the body doesn't produce enough insulin, blood sugar levels can rise. This may cause high blood sugar in the morning (before eating). If the blood sugar level drops too low in the early morning hours, hormones (such as growth hormone, cortisol, and catecholamines) are released. These help reverse the low blood sugar level but may lead to blood sugar levels that are higher than normal in the morning. An example of the Somogyi effect is: A person who takes insulin doesn't eat a regular bedtime snack, and the person's blood sugar level drops during the night. The person's body responds to the low blood sugar by releasing hormones that raise the blood sugar level. This may cause a high blood sugar level in the early morning. The Somogyi effect can occur any time you or your child has extra insulin in the body. To sort out whether an early morning high blood sugar level is caused by the dawn phenomenon or Somogyi effect, check blood sugar levels at bedtime, around 2 a.m. to 3 a.m., and at your normal wake-up time for several nights. A continuous glucose monitor could also be used throughout the night. If the blood sugar level is low at 2 a.m. to 3 a.m., suspect the Somogyi effect. If the blood sugar level is normal or high at 2 a.m. to 3 a.m., it's likely the dawn phenomenon. Continue reading >>
Morning Highs? What Is The Somogyi Effect?
Ok, so what’s up with this term that people keep throwing around called the dawn phenomenon? As type 1 diabetics we’ve all been there, up at 1:30 in the morning testing our blood sugars and come back with a perfect reading of 100 mg/dl only to wake up a couple of hours later with a glucose level of 400 mg/dl! Why is this? What’s happening to our bodies during that 2 1/2 hour period that sends sends our blood sugars into the stratosphere! Welcome to what is called, the dawn phenomenon. Lets take a closer look at what this is all about and what we can do to try and stabilize our blood sugars. What Causes The Dawn Phenomenon: The body prepares for waking up by secreting several different hormones. First, between 4:00 and 6:30 a.m. it secretes cortisol, epinephrine, and norepinephrin. You may recognize these as they are the hormones involved in the “fight or flight response.” In this case, their job is more benign, to give you the energy to get up and moving. Besides giving you a burst of energy, these hormones raise blood sugar. You aren’t going to be able to make any kind of energetic response if you don’t have fuel, and after a long night’s sleep, the fuel your body turns to in order to get you going is the glucose stored in the liver. So once these hormones are secreted, typically around 5:30 am, plasma glucose and insulin can start to rise. Though a non diabetic will automatically get a rise in insulin to help cells use this morning glucose, as type 1’s, we know that’s not always the case and instead of giving our cells a dose of morning energy, all we get is a rise in our blood sugars. Dawn Phenomenon vs Somogyi Effect? The somogyi effect (first discovered my Dr. Michael Somogyi) is caused by nighttime hypoglycemia, which leads to a rebound hypergl Continue reading >>
Dawn Phenomenon: How To Control High Morning Blood Sugars
The dawn phenomenon is a normal, natural rise in blood sugar that occurs in the early morning hours, between roughly 4 and 8 a.m. The shift in blood sugar levels happens as a result of hormonal changes in the body. All people experience the dawn phenomenon to one level or another, which can vary day by day. People without diabetes may never notice it happening, as a normal body's insulin response adjusts for the rise without intervention. A person with diabetes is more likely to experience symptoms from the rise in blood sugar levels, however. How does it affect people with diabetes? Dawn phenomenon is a normal rise in blood sugar released by the liver. The release happens as the person's body is preparing to wake for the day. The rise in blood sugar is normally handled with insulin. For people with diabetes, insulin is not produced in high enough quantities, or the body is unable to use the insulin properly. As a result, a person with diabetes will feel the effects of having high sugar levels in the blood. These effects can include: faintness nausea vomiting weakness disorientation feeling tired extreme thirst Managing the dawn phenomenon Managing blood sugar levels is nothing new to most people with diabetes. A combination of diet, exercise, and medication often help keep the symptoms and problems under control. In the case of dawn phenomenon, there are some additional changes that may help prevent issues caused by the spike in blood sugar. Some steps people with diabetes can take to manage the dawn phenomenon include: changing medication entirely or making adjustments with a doctor on existing medication avoiding skipping meals or medication doses taking medication closer to bedtime and not at dinner time Other steps include eating dinner earlier in the evening. Afte Continue reading >>