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Dawn Phenomenon Diabetes Treatment

The Dawn Phenomenon And Diabetes Control In Treated Niddm And Iddm Patients

The Dawn Phenomenon And Diabetes Control In Treated Niddm And Iddm Patients

Abstract The effect of glycaemic control on the early moring plasma glucose rise, ‘the dawn phenomenon’, was assessed in two matching diabetic patient groups each comprising five NIDDM and two IDDM patients per group, who were otherwise considered to be in poor (HbA1 = 11.2 ± 0.6%) or good (HbA1 = 7.6 ± 0.2%) glycaemic control. Hourly plasma concentrations of glucose, insulin, glucagon, cortisol, and growth hormone were measured between 03.00 and 09.00 h. In all the poorly controlled diabetic patients the mean rise in plasma glucose between 06.00–08.00 and 03.00 h was ≥ 1.0 mmol/l. In contrast, the plasma glucose increment was < 1.0 mmol/l in the well controlled diabetics. The overnight mean insulin levels in the poor and well controlled patient groups were 19.3 ± 0.5 and 25.0 ± 0.6 mU/l (P < 0.001) respectively. Glucagon, cortisol, and growth hormone levels in the early morning showed no significant differences between the two groups. The decline in plasma insulin from 03.00 to 08.00 h and mean cortisol level between 03.00 and 06.00 h were both significantly correlated with the increase in plasma glucose between 03.00 and 08.00 h. We concluded that an increase of 1.0 mmol/l or more in plasma glucose during the early morning is of clinical importance. Continue reading >>

Dawn Phenomenon And High Blood Glucose Levels Explained

Dawn Phenomenon And High Blood Glucose Levels Explained

Understanding Liver Dump or Dawn Phenomenon in Diabetes Liver dump, dawn phenomenon and dawn effect are all common terms that describe the same condition. It is an abnormally high early-morning fasting increase in blood glucose. It usually occurs between 4:00 AM and 8:00 AM. It occurs in everyone's body, but it has more impact on diabetics than normal bodies. It is more common in people with type I diabetes than in people with type II diabetes. Understanding the phenomenon can go a long way towards helping diabetics manage it. The liver is responsible for the increase in glucose levels in the bloodstream. The brain, vital organs, the creation of red blood cells, and muscle tissue are constantly consuming glucose to function (24 hours per day). When the glucose levels in the bloodstream drop, the brain sends a message, via hormones, to release more glucose. At the same time, these same hormones signal the pancreas to reduce the amount of insulin that is produced and released into the bloodstream. In a normal body, the balance of glucose and insulin levels will be regulated. However, diabetics have an impaired control over this balance. Type I diabetics and insulin-dependent type II diabetics do not produce, either enough or, any insulin. The insulin in their system is dependent upon periodic injections. When the hormone insulin is out of balance with the other hormones (cotisol, glucagon and epinephrine), the liver will release too much glucose. Also, as the result of normal hormonal changes. The body's internal clock recognizes that it is morning, and the wake-up process begins. The hormones cause the increase in blood glucose levels. No one actually knows what the exact cause of the phenomenon is, but many believe that it is increases in the hormones cortisol, glucagon 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 >>

How To Control Your Blood Sugar

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 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 >>

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 >>

Dawn Phenomenon

Dawn Phenomenon

Dawn Phenomenon is a topic covered in the Johns Hopkins Diabetes Guide. Official website of the Johns Hopkins Antibiotic (ABX), HIV, Diabetes, and Psychiatry Guides, powered by Unbound Medicine. Johns Hopkins Guide App for iOS, iPhone, iPad, and Android included. Explore these free sample topics: -- The first section of this topic is shown below -- -- To view the remaining sections of this topic, please sign in or purchase a subscription -- Continue reading >>

Managing The “dawn Phenomenon”

Managing The “dawn Phenomenon”

You may have heard the term “the dawn phenomenon.” Our bodies produce a surge of hormones around 4 to 5 a.m. that increases our fasting (pre-meal) glucose levels. Because you lack the insulin needed to regulate the increase, your fasting glucose levels in the early morning (or dawn) are high. Managing these early morning highs can help you gain better control of your diabetes. Here are three strategies to help you do this: Eat earlier dinner, with fewer carbohydrates. Both when you eat and what you eat can affect your early morning blood glucose levels. By eating earlier, you can better match the “blood glucose raising” effect of carbs to your insulin dose. If you are hungry for a night snack, opt for ones that do not increase your blood glucose, such as a handful of nuts, a chunk of cheese, or a boiled egg. Tip: Try substituting grilled vegetables or a salad in place of rice or potatoes, or cut your usual portion of carbs in half. Do something active after dinner. A little exercise can help to lower blood glucose levels during the night and into the early morning hours. Tip: Go for a walk, practice yoga or spend 15 or 20 minutes on a stationary bike after dinner. Track your morning blood glucose levels. For a week or two, test your blood glucose every morning. Look for patterns that relate to your activities or what you ate the previous night. If your morning blood glucose levels are consistently high, 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 what you’re experiencing is the dawn phenomenon or if there's another reason behind it. Check with your healthcare provider to learn more or if you have any questions. References: Continue reading >>

Natural Remedies For The Dawn Phenomenon

Natural Remedies For The Dawn Phenomenon

If you check your blood sugar first thing in the morning after fasting all night and it is significantly higher than when you went to bed, you are probably experiencing what is known as the “dawn phenomenon.” This is also known as the “dawn effect” and it is one of the most difficult challenges diabetics face. At night when we sleep, it is natural for our bodies to release cortisol, glucagon, and epinephrine. These regulatory hormones stimulate the liver to produce extra glucose. In this way, the body builds up a little extra glucose in the bloodstream just before we get up so we’ll have the energy needed to start the day. However, in diabetics, blood sugar often goes up too much during this process. Some diabetics try to control the dawn phenomenon by adjusting their oral medication or insulin. Unfortunately, this often doesn’t work and it is a constant struggle. There are several natural methods that seem to work well for many diabetics. Here is a list: Eat a Small Snack Just Before Bedtime Most diabetics that have experimented with different bedtime snacks have found that eating something high in protein and healthy fat works best. Many people swear by a small handful of nuts or a spoonful of all natural nut butter. Of course raw almonds or almond butter would be our first choice on the Health-e-Solutions lifestyle. Our Fudge in a Flash recipe in our Ultimate Recipe e-Book would be great as a bedtime snack since it contains almond butter and cinnamon (also known for its blood sugar-reducing attributes). Be sure not to get any nut butter with sugar added. Nuts are slow to digest and contain just enough carbs to prevent the liver from being triggered to release more glucose. Take Milk Thistle Just Before Bedtime Milk thistle has been shown to significantly Continue reading >>

Dawn Phenomenon

Dawn Phenomenon

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 >>

Frequency Of The Dawn Phenomenon In Type 2 Diabetes: Implications For Diabetes Therapy

Frequency Of The Dawn Phenomenon In Type 2 Diabetes: Implications For Diabetes Therapy

Abstract This study was designed to assess the frequency of the dawn phenomenon in patients with type 2 diabetes. A secondary aim was to examine the influence of varying treatment regimens on the frequency of the dawn phenomenon. The dawn phenomenon was defined as a rise in plasma glucose levels of > or = 0.5 mmol/L (10 mg/dL) between 0500 and 0900 h occurring after a growth hormone surge of > or = 5 microg/L. Sixteen subjects (six men, 10 women) with type 2 diabetes were studied overnight on their current mode of therapy in the General Clinical Research Center. Additionally, six of these subjects were restudied in random order after each of the following three therapeutic regimens: (1) 6 weeks of glipizide, (2) 6 weeks of bedtime NPH insulin, and (3) 3 days of intensive insulin therapy with multiple injections of regular insulin followed by assessment during overnight intravenous infusion of insulin. Thus, a total of 34 overnight studies were performed under various treatment conditions to provide an approximate frequency of the dawn phenomenon in type 2 diabetes. Blood was drawn every 30 min between midnight and 0800 h for measurement of glucose, insulin, C-peptide, and growth hormone levels. Additional counterregulatory hormone levels were determined during 24 of the studies, and the integrity of growth hormone secretion in response to insulin-induced hypoglycemia was assessed in 12 of the 16 patients. The subjects were aged 51 +/- 15 years with a body mass index of 31 +/- 5 kg/m(2) and a mean glycosylated hemoglobin of 8.1 +/- 1.2%. The dawn phenomenon occurred in only one of 34 (3%) studies. Moreover, the four different treatment regimens did not affect the frequency of occurrence of the dawn phenomenon. Ten of the 12 patients tested failed to secrete growth hormon Continue reading >>

Diabetes? Don’t Let ‘dawn Phenomenon’ Raise Your Blood Sugar

Diabetes? Don’t Let ‘dawn Phenomenon’ Raise Your Blood Sugar

As morning approaches, your sleeping body begins preparing to rise. Your body releases a surge of hormones, and they can work against insulin to cause blood sugar to rise slightly. When this happens, it is known as dawn phenomenon. In most people, dawn phenomenon is typically harmless; the body creates a small amount of insulin to correct the problem. However, for those with diabetes, it can become a bigger challenge, says endocrinologist Sana Hasan, DO. If you have diabetes, here’s what you need to know about regulating your blood sugar at night so you don’t have to worry about managing it first thing in the morning. How does dawn phenomenon work? For people with diabetes, dawn phenomenon is problematic because your body isn’t able to naturally correct for insulin changes during the night. This often creates consistently high blood glucose levels in the morning. Estimates show that dawn phenomenon occurs in about 50 percent of people who have type 2 diabetes. How you can help pinpoint the problem If you find that your blood sugar is consistently high when you wake up, you can help diagnose the issue by checking your blood sugar levels during the night. Dr. Hasan suggests that you set your alarm for 2 or 3 a.m. for a few nights in a row to see what the levels are like during that time. If they’re high then, that’s probably a sign of dawn phenomenon, she says. Low blood sugar at night — a different problem But if you find low blood sugar levels during the night, that is another issue altogether. If this is the case, you likely have what is known as the Somogyi effect, or rebound hyperglycemia. This happens when blood sugar drops during the night and your body releases hormones (including cortisol) to counteract this drop, causing a higher-than-normal blood su Continue reading >>

Mary Ann Liebert, Inc. - Home

Mary Ann Liebert, Inc. - Home

Mary F. Carroll, MDMark R. Burge, MDDavid S. Schade, MD This study was designed to assess the frequency of the dawn phenomenon in patients with type 2 diabetes. A secondary aim was to examine the influence of varying treatment regimens on the frequency of the dawn phenomenon. The dawn phenomenon was defined as a rise in plasma glucose levels of ≥0.5 mmol/L (10 mg/dL) between 0500 and 0900 h occurring after a growth hormone surge of ≥5 μg/L. Sixteen subjects (six men, 10 women) with type 2 diabetes were studied overnight on their current mode of therapy in the General Clinical Research Center. Additionally, six of these subjects were restudied in random order after each of the following three therapeutic regimens: (1) 6 weeks of glipizide, (2) 6 weeks of bedtime NPH insulin, and (3) 3 days of intensive insulin therapy with multiple injections of regular insulin followed by assessment during overnight intravenous infusion of insulin. Thus, a total of 34 overnight studies were performed under various treatment conditions to provide an approximate frequency of the dawn phenomenon in type 2 diabetes. Blood was drawn every 30 min between midnight and 0800 h for measurement of glucose, insulin, C-peptide, and growth hormone levels. Additional counterregulatory hormone levels were determined during 24 of the studies, and the integrity of growth hormone secretion in response to insulin-induced hypoglycemia was assessed in 12 of the 16 patients. The subjects were aged 51 ± 15 years with a body mass index of 31 ± 5 kg/m2 and a mean glycosylated hemoglobin of 8.1 ± 1.2%. The dawn phenomenon occurred in only one of 34 (3%) studies. Moreover, the four different treatment regimens did not affect the frequency of occurrence of the dawn phenomenon. Ten of the 12 patients tested Continue reading >>

Diabetes Support Information Exchange

Diabetes Support Information Exchange

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 Everyone, diabetic or not, exhibits some Dawn Phenomenon. It is a natural part of our bodies’ circadian rhythms. Some have said it is the way our ancestors had the strength to rise and slay a woolly behemoth for breakfast. Since most of us fast while sleeping, with teenagers a possible exception, 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 is stored in the liver and muscles. Since it is basically nothing more than a complex matrix of glucose, it is easy for the body to store and use, something the body does all day long. The technical term for the act of creating and storing glycogen is glycogenesis. When the body calls for the conversion of glycogen back to glucose it is called glycogenolysis. Another macro-nutrient that is available to be converted to glucose is protein. Most of us think of our protein as being stored in muscle, but the body has protective mechanisms to make muscle wasting its last choice. One of the most useful and readily available sources of protein storage is in blood components, i.e., albumin (plasma). The body uses a process performed in the liver to convert amino acids, the building blocks of proteins, into glucose. The name for this process is gluconeogenesis, literally “the creation 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 >>

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