diabetestalk.net

Fasting Blood Sugar Dawn Phenomenon

The Dawn Phenomenon: What Can You Do?

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 >>

How To Fix High Morning Blood Sugars (dawn Phenomenon)

How To Fix High Morning Blood Sugars (dawn Phenomenon)

There are various possible causes of a high blood sugar level in the morning: The Dawn Phenomenon which is a natural rise in blood sugar due to a surge of hormones secreted at night which trigger your liver to dump sugar into your blood to help prepare you for the day. Having high blood sugar from the night before which continue through the night into the morning. Reactive hyperglycemia which is also called the Somogyi Effect. This is when a low blood sugar in the middle of the night triggers your liver to dump sugar into your blood in an attempt to stabilize your blood sugar. Why Are My Blood Sugars High in the Morning? There is a simple strategy for diagnosing the source of high blood sugars in the morning. Test your blood sugar before bed. Test your blood sugar in the middle of the night. Test your blood sugar in the morning. It takes a little bit of effort, but you only need to do it a few times to diagnose the issue. TheSomogyi Effect is less common than the Dawn Phenomenon, according to an article published by The Polish Journal of Endocrinology. To diagnose either of these phenomena, scientists recommend checking blood sugar levels for several nights specifically between 3 a.m and 5 a.m. or using a continuous glucose monitoring system (CGM). Many healthcare practitioners are now offering the use of a loan CGM for a few days which can be helpful to observe nighttime blood sugar activity. How to Fix High Blood Sugars in the Morning The Dawn Phenomenon refers to a surge of hormones excreted by your body in the early morning hours. These hormones rise each night around the same time to prepare your body to wake. Basically, your body is starting the engine, releasing some fuel, and prepping to go for the day. The Dawn Phenomenon occurs in all humans regardless of whet Continue reading >>

The Dawn Phenomenon, An Early Morning Glucose Rise: Implications For Diabeticintraday Blood Glucose Variation.

The Dawn Phenomenon, An Early Morning Glucose Rise: Implications For Diabeticintraday Blood Glucose Variation.

1. Diabetes Care. 1981 Nov-Dec;4(6):579-85. The dawn phenomenon, an early morning glucose rise: implications for diabeticintraday blood glucose variation. Schmidt MI, Hadji-Georgopoulos A, Rendell M, Margolis S, Kowarski A. Eleven insulin-dependent (type I) diabetic subjects were studied during a 24-hperiod to assess intraday blood glucose (BG) variation and related free insulin(FI) levels. Ten patients exhibited the dawn phenomenon, a rise in early morning fasting blood glucose (123 +/- 81.1 m/dl; mean +/- SD). This increase waspositively and significantly correlated with the morning postprandial BG peak (r = 0.723; P = 0.012). FI/BG ratios were highest during the night (0.717 and 0.666 at 2200 and 0400 h, respectively) and lowest during the early morning (0.294 at0800 h) (P less than 0.01). Three of the four observed hypoglycemic episodesoccurred during the period when free insulin levels were high relative to BG. We conclude that the dawn phenomenon contributed directly and significantly to theBG maximum and indirectly, in some cases, to nocturnal hypoglycemia. It thusplayed an important role in the intraday blood glucose variation of suchpatients. Continue reading >>

What You Should Know About Diabetes And The Dawn Phenomenon

What You Should Know About Diabetes And The Dawn Phenomenon

What IS the “Dawn Phenomenon” in diabetes. The Dawn Phenomenon (also known as the Dawn Effect) was defined over 30 years ago in T1D as the elevation of blood sugars during the night and early morning hours and an even greater rise in blood sugar after breakfast. Soon after, the Dawn Phenomenon was observed in T2D as well. [1] The current definition of the Dawn Phenomenon is the need for insulin to prevent the rise of blood sugar levels in the early morning hours of predawn and dawn. So, after 30 years of research, what do we know about the Dawn Phenomenon—and what do we know about how to deal with this phenomenon? The Biology of the Dawn Phenomenon In normal, non-diabetic people, blood sugar and insulin secretion remain very constant overnight. Just before dawn, insulin can rise a small amount. In this sense, the Dawn Phenomenon exists in non-diabetic people as well—the phenomenon isn’t as large and because non-diabetics are not insulin resistant, their body secretes insulin and the cells respond by taking up the sugar from the blood, causing only a slight, mostly unnoticed rise in blood sugar. However, in diabetic individuals, the Dawn Phenomenon is much more significant. Anywhere from 10-50% of people with T2D and T1D experience the dawn phenomenon. It is believed that the rise in blood sugar during the early morning hours is due to the release of glucose from the liver—this can be referred to as a liver dump. This is due to the rise in growth hormone, cortisol, glucagon and adrenaline (epinephrine), all of which can function to stimulate the release of sugar and the synthesis of new sugar (glucose) from the liver. Why the rise in these hormones? Because during the night, the blood sugars will drop—and when they drop below a certain level, the body reads Continue reading >>

Decoding The Dawn Phenomenon (high Morning Blood Sugar)

Decoding The Dawn Phenomenon (high Morning Blood Sugar)

Are your fasting blood sugar levels often higher than when you went to bed? Is high fasting blood sugar with normal PP figures something to worry about? If you are worried about your glucose numbers swinging during sleep or pre-dawn hours, you could be experiencing the Dawn Phenomena. What Is The Dawn Phenomena? When we are asleep, our bodies are tasked with repair, maintenance and growth jobs. Since we are not eating anything during sleep, the body uses glucose from the liver to maintain metabolic functions. In addition to that, there is a surge in growth hormones in the early hours of the dawn between 4 am to 5 am, which makes the liver produce more glucose. Fact is; this is a natural occurrence and happens to all of us. In simpler words, everyone has the dawn phenomenon. The body produces hormones, including cortisol, glucagon, and epinephrine, to help maintain and restore cells within our bodies, and also give us the energy we need to start our day and make it until breakfast. In people who don’t have diabetes, the insulin produced by the body keeps these higher glucose levels in check. However, in diabetics who suffer from insulin resistance or have impaired insulin function, this leads to higher fasting blood sugar levels which normalize only post breakfast. For pregnant women, the dawn phenomenon is even more exaggerated due to additional hormones released in the night. The body has mechanisms to maintain normal basal glucose levels during sleep, so we don’t get hypoglycemia or low blood sugar at night. In patients displaying impaired glucose tolerance, their body is unable to handle the glucose surge at night combined with the insulin suppression. People who do strenuous exercise early in the morning (e.g. weight training) are also more likely to experience Continue reading >>

Controlling The Dawn Phenomenon

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 >>

Why Is My Blood Sugar High In The Morning?

Why Is My Blood Sugar High In The Morning?

That early morning jump in your blood sugar? It's called the dawn phenomenon or the dawn effect. It usually happens between 2 and 8 a.m. But why? Generally, the normal hormonal changes your body makes in the morning will boost your blood sugar, whether you have diabetes or not. If you don't, your body just makes more insulin to balance everything out. You don't even notice that it's happening. But if you have diabetes, it's different. Since your body doesn't respond to insulin the same as most, your fasting blood sugar reading can go up, even if you follow a strict diet. The boost in sugar is your body's way of making sure you have enough energy to get up and start the day. If you have diabetes, your body may not have enough insulin to counteract these hormones. That disrupts the delicate balance that you work so hard to keep, and your sugar readings can be too high by morning. The effects of the dawn phenomenon can vary from person to person, even from day to day. Some researchers believe the natural overnight release of what are called counter-regulatory hormones -- like growth hormones, cortisol, glucagon and epinephrine -- makes your insulin resistance stronger. This will make your blood sugar go up. You may also have high blood sugar in the morning because: You didn't have enough insulin the night before. You took too much or too little medicine. You ate the wrong snack before bedtime. If the dawn phenomenon affects you, try to: Eat dinner earlier in the evening. Do something active after dinner, like going for a walk. Check with your health care provider about the medicine you’re taking. Eat breakfast. It helps bring your blood sugar back to normal, which tells your body that it's time to rein in the anti-insulin hormones. Eat a snack with some carbohydrates and Continue reading >>

The Dawn Effect: Tips For Fixing High Morning Blood Sugars

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 >>

Dawn Phenomenon: How To Control High Morning Blood Sugars

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 >>

Controlling The Dawn Phenomenon

Controlling The Dawn Phenomenon

Do you wake up with a blood glucose level that’s higher than when you went to bed? You might wonder how this could be. Is this “dawn phenomenon” serious, and what can you do about it? Our reader Mishelle commented here, “I don’t eat [much] during the day. [I take metformin morning and night.] My blood sugar is still too high in the morning…sometimes 125–140ish.” How can Mishelle’s glucose levels go up if she didn’t eat anything? She probably has a mild case of dawn phenomenon. Her glucose is going up from sources other than digested food. Some of it is produced by the liver from stored starch and fatty acids. Livers that produce too much glucose are one of the main ways diabetes causes high blood glucose levels. Other organs also produce small amounts of glucose. This is called “gluconeogenesis” for you science freaks out there. Organs do this to keep blood glucose from going too low at night or other times of not eating. From about 2 AM to 8 AM, most people’s bodies produce hormones, including cortisol, glucagon, and epinephrine. All these hormones increase insulin resistance and tell the liver to make more glucose. The idea is to get you enough glucose to get out of bed and start the day. The whole process is apparently started by growth hormones. Everyone has a dawn phenomenon. Otherwise they’d be too weak to get breakfast. But in people without diabetes, insulin levels also increase to handle the extra glucose. People with diabetes can’t increase insulin levels that much, so their early morning blood glucose levels can rise dramatically. Experts disagree on how many people have a dawn phenomenon. Estimates range from 3% to 50% of Type 2s and from 25% to 50% of Type 1s. Is dawn phenomenon a serious problem? It can be serious. According t Continue reading >>

The Dawn Phenomenon – T2d 8

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 >>

The Dawn Phenomenon

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 >>

Why All The Morning Highs?

Why All The Morning Highs?

Sometimes diabetes doesn’t make a lot of sense. Think of those mornings when you wake up to find your blood glucose looking as if you’ve been up all night eating cookies. What’s up with that? You’d think that not eating for those seven or eight hours would give you lower blood glucose, right? Such morning highs are common in people with diabetes, but one of the reasons has a particular name: the dawn phenomenon. The dawn phenomenon is a natural rise in blood glucose between 4 and 8 a.m., which happens because of hormonal changes in the body. All people have the “dawn phenomenon,” whether they have diabetes or not. People without diabetes would never notice it happening, as a normal body’s insulin response adjusts for this. However, because people with diabetes don’t have normal insulin responses, they may see an increase in their fasting blood glucose. This is primarily because people with diabetes produce less insulin and more glucagon than they need. The less insulin produced by the pancreas, the more glucagon the pancreas makes as a result. Glucagon, in turn, signals the liver to break down its storage supplies of glycogen into glucose. This is why high fasting blood glucose levels are commonly seen in patients with type 2 diabetes. The effects of dawn phenomenon vary in each person, and your blood glucose may be higher on some mornings than on others. But not to worry—there are steps you can take to get those numbers down and start your days more comfortably in your target blood glucose range. Treatment for dawn phenomenon depends on how you treat your diabetes. If you take insulin, you may be able to adjust your dosing so that peak action occurs closer to the morning rise in your blood glucose. If you have type 2, diabetes pills provide options as Continue reading >>

Blood Sugar: What Causes High Blood Sugar Levels In The Morning

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 >>

Rocky Morning Highs?

Rocky Morning Highs?

With a little sleuthing you can identify—and fight—the causes of those rises in waking blood glucose Sometimes diabetes doesn't make a whole lot of sense. Take those mornings when you wake up with blood glucose that's higher than it was when you went to sleep. You'd think that not eating for those seven or eight hours would give you lower blood glucose. But in fact, there are three reasons your blood glucose may be higher in the morning: the dawn phenomenon, the Somogyi effect, or waning insulin. The dawn phenomenon is a natural rise in blood glucose between the hours of 4:00 a.m. and 8:00 a.m., and it occurs because of hormonal changes in the body. "The body does several things to get ready for the day," says David S. Schade, MD, professor of medicine and chief of the Division of Endocrinology at the University of New Mexico School of Medicine in Albuquerque. "The body releases hormones like cortisol and growth hormone and the blood glucose rises. People without diabetes just secrete more insulin to handle the blood glucose, but for people with diabetes, the rise in blood glucose can be substantial." Schade notes that the effects of dawn phenomenon vary in each person, and your blood glucose may be higher on some mornings than on others. "You can do the same exercise and eat the same thing every day and have different blood glucose [levels] on different mornings because of dawn phenomenon," he says. "That makes it a little problematic." He adds that the scientific community is still figuring out the relationship between the release of these hormones and the rise in blood glucose. However, one thing scientists do know is that the liver produces glucose as part of the dawn phenomenon. Treatment for dawn phenomenon depends on how you treat your diabetes, says Stuart Continue reading >>

More in blood sugar