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Dawn Phenomenon In Non Diabetic People

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 >>

Morning Highs? What Is The Somogyi Effect?

Morning Highs? What Is The Somogyi Effect?

Ok, so what’s up with this term that people keep throwing around called the dawn phenomenon? As type 1 diabetics we’ve all been there, up at 1:30 in the morning testing our blood sugars and come back with a perfect reading of 100 mg/dl only to wake up a couple of hours later with a glucose level of 400 mg/dl! Why is this? What’s happening to our bodies during that 2 1/2 hour period that sends sends our blood sugars into the stratosphere! Welcome to what is called, the dawn phenomenon. Lets take a closer look at what this is all about and what we can do to try and stabilize our blood sugars. What Causes The Dawn Phenomenon: The body prepares for waking up by secreting several different hormones. First, between 4:00 and 6:30 a.m. it secretes cortisol, epinephrine, and norepinephrin. You may recognize these as they are the hormones involved in the “fight or flight response.” In this case, their job is more benign, to give you the energy to get up and moving. Besides giving you a burst of energy, these hormones raise blood sugar. You aren’t going to be able to make any kind of energetic response if you don’t have fuel, and after a long night’s sleep, the fuel your body turns to in order to get you going is the glucose stored in the liver. So once these hormones are secreted, typically around 5:30 am, plasma glucose and insulin can start to rise. Though a non diabetic will automatically get a rise in insulin to help cells use this morning glucose, as type 1’s, we know that’s not always the case and instead of giving our cells a dose of morning energy, all we get is a rise in our blood sugars. Dawn Phenomenon vs Somogyi Effect? The somogyi effect (first discovered my Dr. Michael Somogyi) is caused by nighttime hypoglycemia, which leads to a rebound hypergl Continue reading >>

Dawn Phenomenon

Dawn Phenomenon

The dawn phenomenon (DP) is a term which describes an unexplained rise in blood sugar levels between 5-9 am, usually due to a previous night time rise of growth hormone which stimulates the liver to break down glycogen and release glucose into the blood stream. The term was coined in a 1981 paper by Schmidt et al. In a paper published in Endocrine Practice, the authors defined this increase in blood sugar in the early morning hours by writing: "To be clinically relevant, the magnitude of the dawn increase in blood glucose level should be more than 10 mg/dL or the increase in insulin requirement should be at least 20% from the overnight nadir...Approximately 54% of patients with type 1 diabetes and 55% of patients with type 2 diabetes experience the phenomenon when the foregoing quantitative definition is used." In more simple terms, fasting blood sugars in the morning are more elevated than would be expected given food and activity levels. Normally, elevated blood sugar is the result of eating carbohydrates or too much protein. However, the overnight blood sugar increase in DP is not associated with food consumption. For example, a person with diabetes might have average blood sugars around 110 at bedtime, but upon awakening, fasting blood sugar may be 120 -130, even though they didn't eat all through the night and sleep was normal. It starts with a process called gluconeogenesis in the liver. Some researchers believe that a release of other hormones such as cortisol during the night may be involved. DP may also involve a weakening of the action of insulin between 2 AM and 8 AM, and it can result in very high blood sugars after breakfast, especially if carbohydrates are consumed at this meal. (See this paper.) The actual mechanism involved is not well understood. In som 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 >>

Hacking Diabetes

Hacking Diabetes

NOTE: The top part of this post is background and basics. If you are a diabetic who wants the advanced techniques, they are further down a bit. Being a Type 1 diabetic sucks. But, if you know anyone who is diabetic then you likely already know that. Over the last twenty years I've tried many different drugs, diets, techniques, and hacks all meant to keep me alive as long as possible. Diabetes is the leading cause of blindness, liver failure, kidney failure and a bunch of other stuff that also sucks. It would be really awesome to die of regular old age rather than some complication of diabetes. Every few months a diabetic should get a blood test call an hA1c that is a measure of long term blood sugar control. A normal person's A1C is between 4% and 6% which roughly corresponds to a 3 month average blood sugar of between 70 and 120mg/dl, which is great. My A1c has been around 6.0 to 6.7 which is under the American Diabetes Association's recommendation for Type 1 diabetics of 7.0, but not as low as I'd like it. Related Reading I recently redoubled my efforts and lost about 30lbs, started working out more and removed more carbohydrates by implementing a relaxed paleo diet. This, combined with some medical equipment changes that I discuss below have resulted in my latest A1c - just in last week - of 5.7%. That means for the first time in nearly 20 years I have maintained near-normal blood sugar for at least 3 months. Basics A Type 1 diabetic doesn't produce any insulin, and insulin is required to process sugar and deliver it to the cells. Without insulin, you'd die rather quickly. There's no diet, no amount of yoga, green tea or black, herbs or spices that will keep a Type 1 diabetic alive and healthy. Type 1 diabetes is NOT Type 2 diabetes, so I'm not interested in your jui Continue reading >>

How To Course For All Diabetics: Blood Sugar Basics- Insulin Resistance – Blood Sugar Targets – Eating In Hospital – Different Carb Counting Methods – Foot Care – What Diabetics Need To Know

How To Course For All Diabetics: Blood Sugar Basics- Insulin Resistance – Blood Sugar Targets – Eating In Hospital – Different Carb Counting Methods – Foot Care – What Diabetics Need To Know

Blood sugar basics Often you may notice that the blood sugar in the morning is higher than when you went to bed at night even when you have not had any bedtime snack. This can be due to a variety of causes including gluconeogenesis, the dawn phenomenon and delayed stomach emptying which is also known as gastroparesis. There are many other variables that affect blood sugar besides just the macro nutrients of the food you eat. Gluconeogenesis Gluconeogenesis (Latin for “the making of new sugar”) is the process where the liver converts protein to glucose. This goes on all the time to some extent but is suppressed in the presence of adequate amounts of insulin and drinking alcohol. In type one patients who are no longer able to make enough of their own insulin this process accelerates and is what causes their sugars to rise so high and for them to lose so much weight. Dawn Phenomenon The Dawn phenomenon is called this because the liver clears away insulin more efficiently first thing in the morning compared to other times of the day. At the same time growth hormones and sex hormones are manufactured during the night and these make cells less sensitive to the action of insulin which normally moves sugar from the blood into the cells. These two mechanisms result in higher blood sugars in the morning for most people after puberty gets underway. Various dietary and insulin techniques can be used to minimise the effects of this phenomenon. Delayed Stomach Emptying / Gastroparesis Delayed Stomach Emptying is due to the effects of long term nerve damage on the way the stomach works. The rate of stomach emptying is reduced and the bottom end of the stomach called the pylorus can go into spasm. It can be difficult to know how your stomach will respond from one meal to the next. Continue reading >>

Diabetes: Dawn Phenomenon And Somogyi Effect

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 >>

How To Control The Dawn Phenomenon

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 >>

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 >>

Blood Sugar And Sleep Problems: How Blood Sugar Levels Impact Sleep

Blood Sugar And Sleep Problems: How Blood Sugar Levels Impact Sleep

November is National Diabetes Month and Alaska Sleep Clinic is dedicating this month’s blog posts to raising awareness for diabetic complications and how they correlate with sleep disorders and overall tiredness. SLEEP PROBLEMS AND SNORING MAY PREDICT DIABETES Studies have shown that individuals who consistently have a bad night's sleep are more likely to develop conditions linked to diabetes and heart disease. Loud snoring sleepers (many of whom may have sleep apnea), compared to quiet sleepers, double (2x) their risks of developing certain types of metabolic syndrome(s); including diabetes, obesity, and high blood pressure. This likelihood also increased dramatically to 80% in those who found it difficult to fall asleep and to 70% for those who woke up feeling not as refreshed. Blood Sugar and Sleep Problems Sleep can affect your blood sugar levels, and your blood glucose control can also affect your sleep. It’s a vicious cycle. As the amount of sleep decreases, blood sugar increases, escalating the issue. Lack of sleep has been shown to increase blood sugar levels and the risk of diabetic issues. Higher blood sugar means less long-lasting fat metabolism in the night and even less sleep. Researchers at Boston University School of Medicine found that people who slept less than 6 hours a night had more blood sugar complications compared to those who received 8 hours of sleep. HIGH BLOOD SUGAR - HYPERGLYCEMIA Sleepless and restless nights hurt more than your mood and energy; it is a form of chronic stress on the body. When there is added stress on your body this results in having higher blood sugar levels. When researchers restricted people with type-1 diabetes to just 4 hours of sleep, their sensitivity to insulin was reduced by 20% compared to that after a full nig 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 >>

The Correlation Of Dawn Phenomenon With Glycemic Variability Parameters In Type 2 Diabetes Mellitus

The Correlation Of Dawn Phenomenon With Glycemic Variability Parameters In Type 2 Diabetes Mellitus

Introduction. Dawn phenomenon could have deleterious effect on overall glycemic control. Glycemic variability may be an independent risk factor for the development of diabetes chronic complications. The study aimed to evaluate any correlations between the dawn phenomenon and parameters of glycemic variability in a cohort of type 2 diabetes patients (T2DM). Material and methods. This retrospective observational study included 131 T2DM patients. Continuous glucose monitoring (CGM) has been performed. Data from the first 24h of full recording were used for analysis of glycemic variability indices: mean level of 24h interstitial glucose value and standard deviation; % coefficient of variation; J index; mean amplitude of glycemic excursion - MAGE; continuous overall net glycemic action (CONGA) at 1, 2, 4 and 6 hours; mean of daily differences (MODD) index. Results. Mean age was 56.04 ± 9.91 years, 35.9% women, 17.6% on diet, 53.4% on oral therapy and 29% on insulin. Dawn phenomenon was more frequent in patients below 60 years (70%) and in oral therapy group (72.85%). Significant correlations between the dawn phenomenon and j-index, MAGE, CONGA-4 and CONGA-6 have been found in T2DM patients on diet therapy alone. The amplitude of dawn phenomenon was 46.10 ± 24.40 mg/dl and significantly correlated (p<0.05) after adjustment for age, gender and treatment with % CV, MAGE, CONGA-1, CONGA-2, CONGA-4, CONGA-6 and MODD. Conclusions. The dawn phenomenon significantly increases the glycemic variability parameters in drug-naive T2DM patients, with no impact in T2DM on oral or insulin therapy. 1. Bright GM, Melton TW, Rogol AD, Clarke WL. Failure of cortisol blockade to inhibit early morning increases in basal insulin requirements in fasting insulin-dependent diabetics. Diabetes 1980; Continue reading >>

What Is Average Blood Sugar? When Do I Worry About Diabetes?

What Is Average Blood Sugar? When Do I Worry About Diabetes?

“Do I have average blood sugar levels?” You would think a simple question like that would have a simple answer. But, think again! The truth is that average blood sugar for each person depends on a lot of factors. It is more than worth your while to understand how your age, race, gender, family history, and overall health impact your personal average. When someone’s average blood sugar spikes out of control, the risk of developing diabetes becomes a reality. The National Stem Cell Institute (NSI) is a leading regenerative medicine clinic based in the United States. NSI reports that diabetes continues to be one of the most common conditions that bring patients through their doors. What is Normal Blood Sugar Level? Understanding what your average blood sugar level should be is crucial to your health. Particularly as we age, understanding what average blood sugar is and how to manage it can be critical to our health. Controlling diabetes blood sugar numbers, for example, can make the difference in cardiovascular health, the robustness of peripheral nerves, and even intimate relations. So let’s take a closer look at some of the primary aspects of maintaining an average blood sugar level that’s right for you. If any of this information makes you wonder if you should talk to your doctor, the answer is probably yes! Average Blood Sugar in Diabetics versus Non-Diabetics In the United States, we measure blood sugars using milligrams per deciliter (mg/dL). In someone who is not diabetic, average blood sugar levels have a tendency to float between 70 and 100 mg/dL. These levels can rise as much as 120 mg/dL after a meal is eaten, then return to normal within 2 hours after eating. These are good baselines for average blood sugar levels in non-diabetics. In someone who has 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 >>

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