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How To Treat Dawn Phenomenon In Diabetes

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

Dawn Phenomenon

Dawn phenomenon is the term given to an early-morning increase in blood sugar levels, usually occurring between 2:00am and 8:00am. This is caused by the body releasing certain hormones and it is relatively common among people with diabetes who do not have a normal insulin response to adjust for this. The rise in glucose during dawn phenomenon is largely due to more glucagon being produced by the liver than your body requires. Glucagon raises blood glucose levels, and less insulin is made as a result which prevents blood sugars from stabilising. Dawn phenomenon affects people with type 1 diabetes who inject insulin – and cannot produce insulin during the night – as well as people with type 2 diabetes, in which high fasting glucose levels can be common. Dawn phenomenon is often confused with Chronic Somogyi rebound, in which a high blood glucose level responds to low blood glucose. However, dawn phenomenon is different as it is not brought on by nocturnal hypoglycemia. Causes of dawn phenomenon Dawn phenomenon occurs when hormones are released by the body, such as cortisol, glucagon and epinephrine, which cause the liver to release glucose. This dawn effect describes the early morning reads that are abnormally high due to increased glucose, which normally occur between eight and 10 hours after people with diabetes go to sleep. Researchers have previously investigated whether a period of insulin resistance occurs after the release of hormones, which would also explain how blood glucose levels rise. Do I have dawn phenomenon? There are a number of reasons why high blood sugars can occur in the morning. These can include insufficient insulin or other medication doses, and not accounting for carbohydrate eaten before bed. If you believe that you may be experiencing dawn p 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 >>

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 >>

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 >>

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

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 >>

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 >>

Will Lantus Help With Dawn Phenomenon?

Will Lantus Help With Dawn Phenomenon?

A fellow caregiver asked... Will a long-acting insulin help a parent with type 2 diabetes deal with "dawn phenomenon?" Expert Answers Probably not because Lantus (generic name: insulin glargine), a peakless, long-acting insulin, is a very flat insulin, meaning it provides a constant level of the hormone over a 24-hour period. So it's unlikely to have much impact on what's commonly called the dawn phenomenon. The phenomenon, named after the time of day it occurs, is the result of the body's response to hormones typically released between 4 a.m. and 8 a.m., which cause glucose levels to rise. This process occurs in everyone, but people with diabetes may not have sufficient insulin in their system to keep this added glucose under control. So the end result can be hyperglycemia, a blood sugar level that is unhealthily high, occurring upon waking and before a person eats. If the dawn phenomenon is a recurring problem, then adjusting medications may help. Switching to an intermediate-acting insulin such as NPH (generic name: insulin isophane, common brand names: Novolin, Humulin), which begins to work in four to six hours, peaks around eight hours, and ends by around 12 hours, may do the job, as it helps with increased insulin needs in the early a.m. But NPH must be taken at bedtime -- not at dinner -- to achieve this outcome. Modifications in diet may also help some people address this concern. Eating dinner earlier does the trick for some, as long as it’s followed by a small snack prior to bedtime. For others, a protein-and-fat snack such as nuts or cheese (and limiting carbohydrates) before bedtime can help. And, as counterintuitive as it sounds, eating breakfast can also limit the dawn phenomenon’s effect by signaling to the body its time to turn off the hormones that 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 >>

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 >>

Dawn Phenomenon

Dawn Phenomenon

Go to: Introduction The “dawn phenomenon” refers to periodic episodes of hyperglycemia occurring in the early morning hours before, and to some extent after, breakfast. Originally described in the early 1980’s by Schmidt, et al., the dawn phenomenon differs from the Somogyi effect in that it is not preceded by an episode of hypoglycemia. Understanding and differentiating between these two clinical entities become critical in the optimal management of diabetes. Go to: Etiology Diurnal variation in hepatic glucose metabolism has been well documented. The transient increase in both glycogenolysis and gluconeogenesis in the early morning hours can be responsible for hyperglycemia if unopposed by insulin. Go to: Epidemiology The dawn phenomenon, and more recently the extended dawn phenomenon (persistence of hyperglycemia into the later morning hours), have been studied extensively with numerous articles published on the subject. Both entities are responsible for morning glucose elevations which are difficult to control. The dawn phenomenon has been documented in both type 1 and type 2 diabetes and has been demonstrated in all age groups, even type 2 diabetics over 70 years of age. For both type 1 and type 2 diabetes mellitus, prevalence is estimated to exceed 50 percent. This obviously affects a large patient population over a wide age range, and the dawn phenomenon will be an important consideration for any clinician who manages diabetic patients. Go to: Pathophysiology Studies in nondiabetic populations have shown that blood glucose, and plasma insulin levels remain steady through the night, with only a small increase in insulin secretion before dawn, which serves to depress hepatic glucose production. Hyperglycemia is prevented by this physiologic surge of insulin. 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 >>

Impact Of The Dawn Phenomenon On Type 2 Diabetes Patients

Impact Of The Dawn Phenomenon On Type 2 Diabetes Patients

About 50% of patients experience the dawn phenomenon…. This study included 248 patients with noninsulin-treated type 2 diabetes. Each of the patients were divided into three groups based on their current treatment. Those groups included diet alone (n = 53), insulin sensitizers (metformin or thiazolidinediones) alone (n = 82), and insulin secretagogues (sulfonylureas, glinides, DPP-4 inhibitors) alone or in combination with insulin sensitizers (n = 113). According to the study, the dawn phenomenon was quantified by its absolute increment from nocturnal nadir to prebreakfast value. Although when the treatment groups were compared there was no significant difference, the overall median magnitude of increase in the dawn glucose was 16 mg/dL. Then patients were divided into two paired subsets after they had been separated by the presence or absence of a dawn phenomenon based on a threshold of 20 mg/dL and matched for glucose nadir. When analyzed, both the HbA1c and 24-h mean glucose values were significantly higher in those who exhibited the dawn phenomenon in comparison to those who did not (P= 0.007 and P= 0.0009, respectively). Overall, the mean impact on HbA1c was 0.39% and 24-h mean glucose was 12.4 mg/dL. There was no significant difference seen between those on diet alone or those treated with oral hypoglycemic agents. Based on the findings of this study, the researchers showed that the dawn phenomenon occurs in about 50% of patients and is present in those who are not taking any oral hypoglycemic agents. Additionally, the results indicate that the dawn phenomenon has a remnant impact on patients who are treated with current oral agents. Practice Pearls: Dawn phenomenon has an impact on patients with type 2 diabetes treated with diet alone or oral agents. A rise in Continue reading >>

Dealing With Unexplained Blood Sugar Spikes

Dealing With Unexplained Blood Sugar Spikes

You can do everything right to keep your diabetes under control — eat a smart diet, exercise, take medications as prescribed, and follow your doctor’s instructions for blood sugar monitoring — and still wake up in the morning with unexplained blood sugar spikes. Even in people who don’t have diabetes, blood sugars fluctuate constantly, says Linda M. Siminerio, RD, PhD, director of the University of Pittsburgh's Diabetes Institute. But when you have diabetes and wake up with an increase in blood sugar levels, you shouldn’t ignore it. If high blood sugar happens once in a while and you're able to get it under control quickly with insulin or exercise, it may be nothing serious. “Maybe you have high blood sugar in the morning because you went to a party last night and had a bigger piece of birthday cake,” Dr. Siminerio says. “Or it snowed, and you couldn’t go for your morning run the day before.” But if you consistently wake up with blood sugar spikes and don’t know why, you need to investigate the cause. You may need to adjust your diabetes treatment plan, possibly changing your medication. You won’t feel right if you have high blood sugar, a condition known as hyperglycemia, says Anuj Bhargava, MD, president of the Iowa Diabetes and Endocrinology Research Center in Des Moines and founder of My Diabetes Home, an online platform that helps users track their blood sugar and manage their medication. When your blood sugar is too high for a few days or weeks, it can cause more frequent urination, increased thirst, weight loss, blurry vision, fatigue, and nausea. It also can make you more susceptible to infections. When you have high blood sugar for a long time, it can damage the vessels that supply blood to your heart, kidneys, nerves, and eyes, and caus Continue reading >>

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