How To Control The Dawn Phenomenon
If you had asked me a year ago how to control the dawn phenomenon in Type 2 diabetes you’d have stumped me. Why? Well because even though I was helping folks online through health forums, I wasn’t coaching anyone “live” because it really makes a huge difference between what you know versus what actually works for the client. Once I started coaching folks live – getting on the phone with them, talking with them through Skype, emailing them and texting them via WhatsApp, looking through and scrutinizing their food journals and daily blood glucose readings week after week, I began to realize that many of them have what is known as the dawn phenomenon i.e. high fasting blood glucose in the mornings with lower blood glucose readings the rest of the day. What is the Dawn Phenomenon? Many folks with both Type 1 and Type 2 diabetes find that their fasting blood glucose spikes in the morning and are much harder to control than their post-grandial (post meal) blood glucose. And sometimes they find that when they eat the same foods during breakfast, lunch and dinner, they find their post grandial readings after breakfast higher than before. This isn’t limited to just folks with Type 1 and Type 2 diabetes. It seems that some healthy people also get it but their blood sugar spikes are much less pronounced and stay within the normal range so it doesn’t get picked up by the blood glucose monitor. What Causes the Dawn Phenomenon? According to WebMD, the dawn phenomenon or dawn effect is the result of several natural body changes that happen while you’re asleep. Between 3 am and 8 am, your body starts to ramp up the amounts of certain hormones that work against insulin’s action to drop blood sugar levels. These hormones are the growth hormone, cortisol, glucagon and ad Continue reading >>
The dawn effect, or dawn phenomenon is an early-morning increase in blood sugar, that befalls both Type-1 and Type-2 diabetics. In so much that the fasting blood glucose is the highest of the day, even though careful attention is paid to keeping post-meal readings normal. Why Does This Occur? At about an hour before waking, the body gets ready for the energy needed to get up and moving, by releasing different hormones, like norepinephrine, cortisol and epinephrine. They stimulate the increase of blood sugar, resulting in the increase of insulin production. In a non-diabetic, this is the necessary energy boost to get going. A diabetic, however, do not have this normal relationship with insulin and the result is an abnormally high fasting blood glucose, instead of an injection of morning energy. According to some researchers, the released hormones could cause insulin resistance in diabetics, this would explain the rise of blood sugar, resulting in the dawn phenomenon. Overnight the liver mops up unused/excess insulin, so there is limited available insulin by the time the hormones stimulate the increase of blood sugar. The hormones also trigger the secreting of insulin to cater for the expected raised blood sugar. This works great for a normal person, but a diabetic ends up with high blood glucose in the morning. Restricting carbohydrates produce a natural decline in insulin needs and levels, which in turn activates hormone sensitive lipase. Fat tissue is then broken down, and free fatty acids are released into the bloodstream, which are taken up by the muscles, to use as fuel. And since the muscle’s needs for fuel were met, it decreases sensitivity to insulin. Taking insulin stimulating drugs or insulin injections could result in an abnormally low blood sugar while slee Continue reading >>
This is basically a process which happens to every person every day: the body prepares itself to go into "wake mode" and releases cortisol to ready itself for wake up. In non-diabetics, it happens virtually unnoticed, as the properly working pancreas produces more insulin to handle the cortisol release. Persons without diabetes are unlikely to be checking their blood glucose values on a regular basis, so any temporary increases would not be measured. As with almost everything else, not all diabetics are affected by dawn phenomenon, just as not all have post-prandial blood glucose spikes. If a person with diabetes believes he/she is having a control problem due to dawn phenomenon, the way to check is to take one's bg's at about 3AM for a few days and compare readings. A high or higher reading at about this time is likely due to dawn phenomenon and this can be managed by evening/night insulin increases. Some current information regarding dogs and dawn phenomenon is that canines are said not to have an organized cortisol release. This means that they supposedly have no set pattern for them as humans do. Personal experience with a canine message board dog says otherwise. The dog in question was suspected of having dawn phenomenon and was tested at 3AM for a few days, results being noted and compared. The 3AM readings all showed high/higher blood glucose values. He had received no food or insulin since dinner time (evening); breakfast (morning) food/insulin pattern results were as expected. We have 3 studies confirming a cortisol pattern similar to humans, 3 which found no evidence of similarity and one which confirmed it in adult non-senior dogs only. This 2003 study which refers to them found that some dogs do have a pattern similar to that of people and suggests the si Continue reading >>
Demonstration Of A Dawn Phenomenon In Normal Human Volunteers.
Abstract To ascertain whether the dawn phenomenon occurs in nondiabetic individuals and, if so, whether it is due to an increase in glucose production or a decrease in glucose utilization, we determined plasma concentrations of glucose, insulin, C-peptide, and counterregulatory hormones, as well as rates of glucose production, glucose utilization, and insulin secretion at one-half-hourly intervals between 1:00 and 9:00 a.m. in eight normal volunteers. After 5:30 a.m., plasma glucose, insulin, and C-peptide concentrations all increased significantly; rates of glucose production, glucose utilization, and insulin secretion also increased (all P less than 0.05). Plasma cortisol, epinephrine, and norepinephrine increased significantly from nocturnal nadirs between 4:00 and 6:30 a.m. Plasma growth hormone, which had increased episodically between 1:00 and 4:30 a.m., decreased thereafter nearly 50% (P less than 0.05). Plasma glucagon did not change significantly throughout the period of observation. These results indicate that a dawn-like phenomenon, initiated by an increase in glucose production, occurs in nondiabetic individuals. Thus, early morning increases in plasma glucose concentrations and insulin requirements observed in IDDM and NIDDM may be an exaggeration of a physiologic circadian variation in hepatic insulin sensitivity induced by antecedent changes in catecholamine and/or growth hormone secretion. Continue reading >>
Diabetes The Basics: Blood Sugars: The Nondiabetic Versus The Diabetic
BLOOD SUGARS: THE NONDIABETIC VERSUS THE DIABETIC Since high blood sugar is the hallmark of diabetes, and the cause of every long-term complication of the disease, it makes sense to discuss where blood sugar comes from and how it is used and not used. Our dietary sources of blood sugar are carbohydrates and proteins. One reason the taste of sugar—a simple form of carbohydrate—delights us is that it fosters production of neurotransmitters in the brain that relieve anxiety and can create a sense of well-being or even euphoria. This makes carbohydrate quite addictive to certain people whose brains may have inadequate levels of or sensitivity to these neurotransmitters, the chemical messengers with which the brain communicates with itself and the rest of the body. When blood sugar levels are low, the liver, kidneys, and intestines can, through a process we will discuss shortly, convert proteins into glucose, but very slowly and inefficiently. The body cannot convert glucose back into protein, nor can it convert fat into sugar. Fat cells, however, with the help of insulin, do transform glucose into fat. The taste of protein doesn’t excite us as much as that of carbohydrate— it would be the very unusual child who’d jump up and down in the grocery store and beg his mother for steak or fish instead of cookies. Dietary protein gives us a much slower and smaller blood sugar effect, which, as you will see, we diabetics can use to our advantage in normalizing blood sugars. The Nondiabetic In the fasting nondiabetic, and even in most type 2 diabetics, the pancreas constantly releases a steady, low level of insulin. This baseline, or basal, insulin level prevents the liver, kidneys, and intestines from inappropriately converting bodily proteins (muscle, vital organs) into g 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 >>
The Dawn Phenomenon – T2d 8
The occurrence of high blood sugars after a period of fasting is often puzzling to those not familiar with the Dawn Phenomenon. Why are blood sugars elevated if you haven’t eaten overnight? This effect is also seen during fasting, even during prolonged fasting. There are two main effects – the Somogyi Effect and the Dawn Phenomenon. Somogyi Effect The Somogyi effect is also called reactive hyperglycaemia and happens in type 2 diabetic patients. The blood sugar sometimes drops in reaction to the night time dose of medication. This low blood sugar is dangerous, and in response, the body tries to raise it. Since the patient is asleep, he/she does not feel the hypoglycaemic symptoms of shakiness or tremors or confusion. By the time the patient awakens, the sugar is elevated without a good explanation. The high blood sugar occurs in reaction to the preceding low. This can be diagnosed by checking the blood sugar at 2am or 3am. If it is very low, then this is diagnostic of the Somogy Effect. Dawn Phenomenon The Dawn Effect, sometimes also called the Dawn Phenomenon (DP) was first described about 30 years ago. It is estimated to occur in up to 75% of T2D patients although severity varies widely. It occurs both in those treated with insulin and those that are not. The circadian rhythm creates this DP. Just before awakening (around 4am), the body secretes higher levels of Growth Hormone, cortisol, glucagon and adrenalin. Together, these are called the counter-regulatory hormones. That is, they counter the blood sugar lowering effects of insulin, meaning that they raise blood sugars. The nocturnal surge of growth hormone is considered the primary cause of the DP. These normal circadian hormonal increases prepare our bodies for the day ahead. That is, glucagon tells the liver Continue reading >>
Dealing With Unexplained Blood Sugar Spikes
You can do everything right to keep your diabetes under control — eat a smart diet, exercise, take medications as prescribed, and follow your doctor’s instructions for blood sugar monitoring — and still wake up in the morning with unexplained blood sugar spikes. Even in people who don’t have diabetes, blood sugars fluctuate constantly, says Linda M. Siminerio, RD, PhD, director of the University of Pittsburgh's Diabetes Institute. But when you have diabetes and wake up with an increase in blood sugar levels, you shouldn’t ignore it. If high blood sugar happens once in a while and you're able to get it under control quickly with insulin or exercise, it may be nothing serious. “Maybe you have high blood sugar in the morning because you went to a party last night and had a bigger piece of birthday cake,” Dr. Siminerio says. “Or it snowed, and you couldn’t go for your morning run the day before.” But if you consistently wake up with blood sugar spikes and don’t know why, you need to investigate the cause. You may need to adjust your diabetes treatment plan, possibly changing your medication. You won’t feel right if you have high blood sugar, a condition known as hyperglycemia, says Anuj Bhargava, MD, president of the Iowa Diabetes and Endocrinology Research Center in Des Moines and founder of My Diabetes Home, an online platform that helps users track their blood sugar and manage their medication. When your blood sugar is too high for a few days or weeks, it can cause more frequent urination, increased thirst, weight loss, blurry vision, fatigue, and nausea. It also can make you more susceptible to infections. When you have high blood sugar for a long time, it can damage the vessels that supply blood to your heart, kidneys, nerves, and eyes, and caus Continue reading >>
You know, how bad dawn phenomenon is? Now you can learn, how much it impacts your A1C levels? How to prevent it? What is dawn phenomenon? Dawn phenomenon is a normal physiological process at dawn (early morning around 4 a.m.) during which certain hormones in your body work to raise your blood glucose level to prepare you to wake up. The hormones involved in the dawn phenomenon are cortisol, glucagon, epinephrine, and growth hormone. These hormones are called counter-regulatory hormone because they work against the action of insulin. It causes the liver to release glucose to a healthy individual and the liver dump glucose in people with diabetes. Results in an increase in blood glucose levels, which is normalized in nondiabetic and not in case of diabetic called as dawn phenomenon. The circadian rhythm creates this phenomenon. In healthy, nondiabetic individuals the blood glucose and plasma insulin level remains constant overnight. However, with modest raise in insulin secretion just before dawn to control hepatic glucose production and to prevent hyperglycemia. That is why, healthy individuals do not exhibit the dawn phenomenon, because of proper insulin secretion to prevent it. Dawn Phenomenon (DP) was first described 30 years ago. Prevalence is estimated to be over 15 % in both type 1 & type 2 diabetes, although severity varies widely from person to person. The circadian rhythm is behind this phenomenon. Around 4 am, you will soon go to wake up; your body prepares you for the upcoming day by releasing certain hormones such as cortisol, glucagon, epinephrine, and growth hormone. These hormones are called counter-regulatory hormones because it raises your blood glucose level. Your body raises insulin secretion, to prevent the sugars from rising too much. The dawn phenom Continue reading >>
Will Blood Sugars Rise Later In Morning Without Eating?
Keeping track of your blood sugar levels is not only important if you have diabetes, but it can also help you achieve a healthy weight, maintain good energy levels and prevent chronic diseases. You can easily obtain a blood glucose meter at your drugstore to check your blood sugar levels at different times throughout the day to see how your body reacts to the foods you eat. Your blood sugar levels can also change even when you go a few hours without eating. For example, skipping breakfast and not eating in the morning is likely to induce a rise in your blood sugar. Video of the Day Measuring your blood sugar levels occasionally before and after a meal is a good way to observe how your food choices influence your blood sugar levels. Carbohydrate is the nutrient that has the most impact over your blood sugar because both starches and sugars, which constitute the total carb content of a food, are broken down to glucose and, therefore, contribute to elevating your blood sugar after a meal. If you skip breakfast or go for a few hours without eating, you would probably expect your blood sugar levels to decrease, but it actually causes a blood sugar rise in most people. The dawn phenomenon corresponds to a normal effect that occurs in the early hours, while the secretion of many hormones occurs to prepare your body for the day ahead. Among the hormonal changes that accompany the dawn phenomenon is increased insulin resistance. If you are more insulin resistant in the morning, it means that your insulin is not as effective at keeping your blood sugar levels in check as it should be. The dawn phenomenon explains why many diabetics have higher blood sugar levels in the morning. Depending on the time you awake, you may see a rise in your blood sugar levels, even if you don't eat, 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 >>
Diabetes: Dawn Phenomenon And Somogyi Effect
One of the most frustrating things that diabetics deal with is an unexpected rise in blood glucose overnight. You go to bed with a BG of 100 mg/dL (5.6 mmol/L), and wake up with a BG of 130 (7.2)! You didn’t eat, so what happened? This results from two distinctly different processes: Dawn Phenomenon and Somogyi Effect. Here are some basics. DAWN PHENOMENON While it has rather an attractive name the Dawn Phenomenon can cause problems for diabetic’s. The Dawn Phenomenon occurs when there is an apparently unexplained morning rise in the fasting blood sugar (blood glucose) levels. That is when the fasting (pre-breakfast) level in the morning is higher than the pre bed-time level. When fasting blood sugar levels in the morning are much higher than the pre-bedtime reading, with no food eaten in between there is obviously a problem somewhere. Increased morning blood sugar levels can have two causes – The Liver dumps its reserve of glycogen (a form of glucose) when blood sugar levels get too low. Insufficient Insulin in the blood together with increased Insulin Resistance due to hormones released in the early morning. Everyone, diabetic or not, exhibits some Dawn Phenomenon. It is a natural part of our bodies’ circadian rhythms The hormonal changes are basically preparing the body for the expected exertions of the morning and occur in everyone, both diabetic and non-diabetic. In diabetics though they can raise blood sugar levels too high and cause further difficulties at breakfast time. Since most of us fast while sleeping, our bodies use stored energy during sleep. The body uses all three macro-nutrients (carbohydrates, proteins, and fats) to store energy. The most easily used is the storage medium of carbohydrates, called glycogen. Glycogen is made from glucose, and i Continue reading >>
Why Is Blood Sugar Highest In The Morning?
Many people with diabetes find that their fasting blood sugar first thing in the morning is the hardest blood sugar to control. In addition, they find that if they eat the same food for breakfast as they do for lunch or dinner they will see a much higher blood sugar number when testing after breakfast than they see at the other meals. The reason for this is a normal alteration in hormones experienced by many people not just people with diabetes. It is called "Dawn Phenomenon." What Causes 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 norepinephrine. You may recognize these as 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 so you can find the food your body needs for energy. To help you do this, these hormones also raise your blood sugar. After a long night's sleep, the fuel your body turns to to get you going is the glucose stored in the liver. So after these stress hormones are secreted, around 5:30 a.m., plasma glucose rises. In a person with normal blood sugar, insulin will also start to rise at this time but many people with diabetes won't experience the corresponding rise in insulin. So instead of giving their cells a dose of morning energy, all they get is a rise in blood sugar. Not Everyone Experiences Dawn Phenomenon Researchers who have infused different hormones into experimental subjects have found that the trigger for dawn phenomenon is a nocturnal surge in growth hormone. If they block the growth hormone, blood sugars stay flat. This may explain why some people, particularly older people, do not experience a rise in blood sugar first thing in the mor Continue reading >>
Controlling The Dawn Phenomenon
One of our most stubborn challenges is to control the dawn phenomenon. That’s when our fasting blood glucose readings in the morning are higher than when we went to bed. The dawn phenomenon is a normal physiological process where certain hormones in our body work to raise blood glucose levels before we wake up, as we wrote in The New Glucose Revolution: What Makes My Blood Glucose Go Up…And Down? Professor Jennie Brand-Miller of the University of Sydney, Kaye Foster-Powell, and I co-authored that book (Marlowe & Co., first edition 2003, second American edition 2006). These so-called counter-regulatory hormones, including glucagon, epinephrine, growth hormone, and cortisol, work against the action of insulin. They stimulate glucose release from the liver and inhibit glucose utilization throughout the body. The result is an increase in blood glucose levels, ensuring a supply of fuel in anticipation of the wakening body’s needs. If you take insulin injections, it could be that the effect of insulin you took is waning. Your blood glucose will rise if you didn’t take enough to keep your insulin level up through the night. The dawn phenomenon varies from person to person and can even vary from time to time in each of us. That much was clear when our book came out. But how to control it was a different story. A couple of years ago here I wrote about several efforts for “Taming the Dawn Phenomenon.” People have tried everything from eating a green apple at bedtime to high-maize grain to uncooked cornstarch. None of these remedies that I have been able to try ever worked for me. I always thought that the most promising remedy was one that a correspondent named Renee suggested – vinegar capsules. “I am still using vinegar tablets (usually 8) each night and have us 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 >>