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Dawn Phenomenon Diabetes

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 >>

Morning Highs

Morning Highs

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 >>

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 >>

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 >>

Diabetes And The Dawn Phenomenon

Diabetes And The Dawn Phenomenon

What does the movie Dumb and Dumber (pictured above) have to do with blood sugar? Let me explain. Do you ever wonder why blood sugar goes up in the morning – when you haven’t eaten for a long time? This happens to everyone, but it’s often very apparent in people with type 2 diabetes. On a low-carb diet, when the blood sugar does not go up much after eating, morning blood sugar levels can be the highest of the entire day. This is called “The Dawn Phenomenon”. How it works The reason is that the hormonal levels in the morning tell the body to get ready for the new day. This makes the liver release stored sugar. And if the liver is totally stuffed with sugar – common in type 2 diabetes – the release can be massive. This is especially true if the brake for the blood sugar rise is not working well. If there is insulin resistance – also common in type 2 diabetes. Then there is a huge release, and not much holding it back. The result? Well, something like the picture above, metaphorically. Only in this case it’s about the liver dumping sugar into the blood. This new post by Dr. Fung explains it well: Dr. Jason Fung: The Dawn Phenomenon So what can you do to avoid the Dawn Phenomenon? Get the excess sugar out of the liver, and reduce the insulin resistance. How do you do that? An LCHF diet or intermittent fasting… or preferably both. More Earlier How to Cure Diabetes New Diabetes Cases, at Long Last, Begin to Fall in the United States! Get the Effect of Bariatric Surgery Without the Side Effects, Without the Surgeon, For Free Doctor in the House – Watch Diabetes Reversed Using Low Carb on BBC, While Old-School Dietitians Freak Out Dr. Rangan Chatterjee Shakes Up Type 2 Diabetes Treatment On Breakfast TV Continue reading >>

The Dawn Phenomenon: A Diabetes Puzzle Solved

The Dawn Phenomenon: A Diabetes Puzzle Solved

The dawn phenomenon is one of the most disturbing challenges for those of us who have diabetes. Many of us wonder about the puzzle of why our blood sugar level spontaneously rises during the last hours of sleep each night. This has also mystified our doctors and medical researchers, so much that they have published at least 187 articles in the professional literature during the past three decades since the first study of the subject appeared. But four new studies by European researchers just published in American professional journals have shown a bright light that clarifies the major questions we have had about the dawn phenomenon. We now know who gets it, how bad it is, how much it impacts our A1C levels, and how to prevent it. Whether you have type 1 or type 2 diabetes you are likely to have the dawn phenomenon. However, dawn levels among people who don’t have diabetes rise only slightly, if at all, "because they secrete insulin to prevent it," according Francesca Porcellati, MD, and her associates at Italy’s University of Perugia. Their study, "Thirty Years of Research on the Dawn Phenomenon: Lessons to Optimize Blood Glucose Control in Diabetes," appears in the December 2013 issue of Diabetes Care, a professional journal of the American Diabetes Association. The full-text of this study is free online. Whether you are managing your diabetes with diet alone, an insulin sensitizer alone (like metformin or Avandia or Actos), or an insulin secretagogue (like the sulfonylureas or Prandin or Starlix or Januvia) combined with an insulin sensitizer also doesn’t make a difference. This is one result of research led by Louis Monnier, M.D., of France’s University Montpellier and his associates. Dr. Monnier is one of the world’s most respected diabetes researcher, and Continue reading >>

Dawn Phenomenon

Dawn Phenomenon

The dawn phenomenon, sometimes called the dawn effect, is an early-morning (usually between 2 a.m. and 8 a.m.) increase in blood sugar (glucose) relevant to people with diabetes.[1] It is different from chronic Somogyi rebound in that dawn phenomenon is not associated with nocturnal hypoglycemia. The dawn phenomenon can be managed in many patients by avoiding carbohydrate intake at bedtime, adjusting the dosage of medication or insulin, switching to a different medication, or by using an insulin pump to administer extra insulin during early-morning hours. In most of the cases, there is no need to change insulin dosing of patients who encounter the dawn phenomenon.[2] See also[edit] Cortisol awakening response [edit] External links[edit] Mayo Clinic - The 'dawn phenomenon': What causes it? Diabetes Self Management - Dawn Phenomenon Dawn Phenomenon (Liver Dump) 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 >>

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 >>

Thirty Years Of Research On The Dawn Phenomenon: Lessons To Optimize Blood Glucose Control In Diabetes

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 Health Type 2: How To Manage The Dawn Phenomenon

Diabetes Health Type 2: How To Manage The Dawn Phenomenon

Dawn phenomenon is the situation where the liver removes insulin from the blood in the morning hours, which causes morning blood sugars to go up, even if breakfast is skipped. Non-diabetics make insulin in little squirts about a minute apart. They make it whenever they need it and they make less of it if their blood sugar drops. What would happen if the insulin that they’d been making remains in the bloodstream when they don’t need it? Their blood sugars would drop eventually to zero, and they’d be dead. Humanity would no longer exist. Humanity is still here so something else is happening. The liver clears insulin out of the bloodstream very rapidly. In fact, thanks to the liver, the half-life of insulin in the bloodstream is only about 6 minutes. The dawn phenomenon happens during the first few hours when you get up in the morning. It starts at about nine hours after you go to bed. The liver is working extra hard at clearing away insulin. This doesn’t make any difference to non-diabetics. They’re capable of tripling their insulin production, whereas a diabetic doesn’t have this capacity and he’s likely to experience an elevated blood sugar shortly after rising in the morning. On top of that, if he exercises during those first three hours when the dawn phenomenon is acting, his blood sugar might go up instead of down when he exercises. For this reason, we give diabetics half as much carbohydrate at breakfast as at other meals. That’s number one, so they won’t have to take excessive amounts of insulin. Also, many of these diabetics should be given a tiny amount of a rapid-acting insulin on arising just to prevent the dawn phenomenon. I have to take a half unit of Humalog insulin on arising, or I’ll go up by about 40 or 50 in the next hour. Many of my Continue reading >>

Dawn Phenomenon And The Somogyi Effect - Overview

Dawn Phenomenon And The Somogyi Effect - Overview

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 >>

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 >>

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 >>

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 >>

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