diabetestalk.net

What Is Dawn Phenomenon In Diabetes?

The Dawn Phenomenon

The Dawn Phenomenon

The dawn phenomenon can lead to an elevated blood glucose (sugar) level in the morning. The dawn phenomenon is a natural process that occurs at the end of a night’s sleep when your body releases hormones, such as cortisol, adrenalin and growth hormone, to prepare the body for awakening, among other tasks. These hormones have a counter-regulatory action on insulin, and they encourage the liver to secrete glucose, both of which can increase the level of blood glucose (sugar). Thus, it is possible to wake up in the morning with an elevated blood glucose (sugar) level even though it was within target values when you went to bed on an empty stomach. Your medication might need to be adjusted to correct this problem. If so, discuss this with your doctor. Research and text: Diabetes Québec Team of Health Care Professionals August 2014 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 >>

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: What Can You Do?

The Dawn Phenomenon: What Can You Do?

What is the dawn phenomenon that some people with diabetes experience? Can anything be done about it? Answers from M. Regina Castro, M.D. The dawn phenomenon, also called the dawn effect, is the term used to describe an abnormal early-morning increase in blood sugar (glucose) — usually between 2 a.m. and 8 a.m. — in people with diabetes. Some researchers believe the natural overnight release of the so-called counter-regulatory hormones — including growth hormone, cortisol, glucagon and epinephrine — increases insulin resistance, causing blood sugar to rise. High morning blood sugar may also be caused by insufficient insulin the night before, insufficient anti-diabetic medication dosages or carbohydrate snack consumption at bedtime. If you have persistently elevated blood sugar in the morning, checking your blood sugar once during the night — around 2 a.m. or 3 a.m. — for several nights in a row will help you and your doctor determine if you have the dawn phenomenon or if there's another reason for an elevated morning blood sugar reading. What you can do Your doctor may recommend a number of options to help you prevent or correct high blood sugar levels in the morning: Avoid carbohydrates at bedtime. Adjust your dose of medication or insulin. Switch to a different medication. Change the time when you take your medication or insulin from dinnertime to bedtime. Use an insulin pump to administer extra insulin during early-morning hours. Continue reading >>

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 >>

Taming The Dawn Phenomenon

Taming The Dawn Phenomenon

Just like diabetes itself, we don’t have a cure yet for the dawn phenomenon. But unlike diabetes, you can’t completely control it. The best you can do is tame the dawn phenomenon. There are a lot of definitions for what the dawn phenomenon is, but the simplest is the government’s one, "the early-morning (4 a.m. to 8 a.m.) rise in blood glucose level." The best way to see if you have it is to test your blood at bedtime and then when you get up, and if it’s higher then you probably have the dawn phenomenon. But if you take insulin, maybe the effect of the insulin you took the night before is wearing off. There is even a third possibility, although it is much less likely. It is a rebound from a low blood glucose level in the middle of the night. You can see if this is happening by checking if your blood glucose is low at 2 or 3 a.m. It’s important to know what causes your high morning blood glucose. If you have night-time lows, you might need to reduce the dose of insulin you taken in the afternoon or add a bedtime snack. On the other hand, if you aren’t running low at night but are high in the morning, you might need to take more insulin. A lot of people who aren’t taking insulin also experience the dawn phenomenon. It varies from person to person. And sometimes you might have it and other times you won’t. We know what causes the dawn phenomenon. Some of our hormones tell our liver to release glucose to give us the fuel we need when we wake up. But when these hormones are out of balance with the hormone insulin, the liver releases too much glucose. We don’t know a way for everyone to control the dawn phenomenon. It would be great, but we can’t just put a lid on our liver. The only report in the professional literature of a treatment for the dawn phenom 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 >>

Dawn Phenomenon: What Is It, What Causes It, And How Do You Fix It?

Dawn Phenomenon: What Is It, What Causes It, And How Do You Fix It?

Are you noticing that your blood glucose is highest in the morning when you wake up and you haven’t even had anything to eat yet? Don’t worry! This is a very common effect known as the dawn phenomenon. Let’s take a look at the science behind this phenomenon and explore strategies to help you reduce your fasting glucose. What causes the dawn phenomenon? The dawn phenomenon, sometimes referred to as the “dawn effect,” has earned its name from the recurrence of elevated blood glucose (a.k.a. sugar) around the hours of waking, roughly between 4-8 AM. Although the exact underlying causes of the dawn phenomenon are still unclear, it is known that hormones, including adrenaline, cortisol, glucagon, and growth hormone, play a large part. These hormones follow a circadian rhythm, or a daily cycle, and tend to be found in higher concentrations in the blood in the morning to help prepare us for the day ahead. The hormones that promote glucose release into the blood include: Adrenaline: Known as the “fight or flight” hormone, adrenaline increases blood flow to the muscles and promotes the release of glucose into the blood. Cortisol: Known as the “stress hormone”, cortisol also plays a role in increasing blood glucose. Glucagon: Signals the liver to release glucose into the blood. Growth Hormone: Important for repair and regeneration and promotes the release of glucose into the blood. Two key processes occur in the liver overnight that result in the release of glucose into the bloodstream and contribute to increased morning blood glucose: 1) Glycogenolysis, the breakdown and release of stored glucose (a.k.a. glycogen) 2) Gluconeogenesis, the creation of glucose from components of protein (i.e. certain amino acids) or fat (i.e. glycerol) One more hormone that plays 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 >>

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 >>

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 >>

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 >>

High Morning Blood Sugars Could Be The Dawn Phenomenon

High Morning Blood Sugars Could Be The Dawn Phenomenon

Have you ever woken up with an unexplainable high blood sugar and wondered how it could be higher in the morning than it was at bedtime when you didn’t eat anything all night? We may have an explanation and some dietary things you can do to help. Potential Causes of High Morning Blood Glucose There are several reasons your morning reading could be high. Did you eat a high carb snack before bed? Does your insulin dosage need to be adjusted? Did you forget to take your medication? These are simple things can explain a high morning reading. Another possibility is that your blood sugar went too low during the night. Known as the Somogyi Effect, the low sugar triggers the liver to pump out glucose to compensate. To determine if this is happening, set an alarm to do a few glucose checks throughout the night. If your level is normal all night, but then suddenly spikes in the wee hours of the morning, you can rule Somogyi out. If nothing else explains a morning blood glucose being at least 10 to 20 points higher than it was at bedtime, you may be experiencing the Dawn Phenomenon (or Dawn Effect). Between 4 am and 8 am, everyone’s body shoots off epinephrine, glucagon, cortisol, and growth hormones to stimulate the liver to produce glucose. This process gives the body an energy boost to start the day. Unfortunately, people with diabetes don’t produce the insulin required to compensate for this sudden sugar rush, which can lead to an early morning surprise. Treatment If morning highs occur on a regular basis, make sure you work with your doctor to determine what’s causing them. They can significantly impact your A1C and your overall health. Your doctor may suggest the following treatments: Changing your medication dosage. For example, you may need additional insulin. Chan 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 >>

The Dawn Phenomenon In Type 1 (insulin-dependent) Diabetes Mellitus: Magnitude, Frequency, Variability, And Dependency On Glucose Counterregulation And Insulin Sensitivity

The Dawn Phenomenon In Type 1 (insulin-dependent) Diabetes Mellitus: Magnitude, Frequency, Variability, And Dependency On Glucose Counterregulation And Insulin Sensitivity

Summary In 114 subjects with Type 1 (insulin-dependent) diabetes mellitus the nocturnal insulin requirements to maintain euglycaemia were assessed by means of i. v. insulin infusion by a Harvard pump. The insulin requirements decreased after midnight to a nadir of 0.102±0.03 mU·kg−1·min−1 at 02.40 hours. Thereafter, the insulin requirements increased to a peak of 0.135±0.06mU·kg−1·min−1 at 06.40 hours (p<0.05). The dawn phenomenon (increase in insulin requirements by more than 20% after 02.40 hours lasting for at least 90 min) was present in 101 out of the 114 diabetic subjects, and its magnitude (% increase in insulin requirements between 05.00–07.00 hours vs that between 01.00–03.00 hours) was 19.4±0.54% and correlated inversely with the duration of diabetes (r = −0.72, p<0.001), but not with age. The nocturnal insulin requirements and the dawn phenomenon were highly reproducible on three separate nights. In addition, glycaemic control, state of counterregulation to hypoglycaemia and insulin sensitivity all influenced the magnitude of the dawn phenomenon as follows. In a subgroup of 84 subjects with Type 1 diabetes, the multiple correlation analysis showed that not only duration of diabetes (t = −9.76, p<0.0001), but also % HbA1 significantly influenced the magnitude of the dawn phenomenon (t = 2.03, p<0.05). After 5–9 months of intensive therapy, the magnitude of the dawn phenomenon decreased from 24+-2% to 18±2% (p<0.05) in seven Type 1 diabetic subjects with initially poor glycaemic control, whereas it increased from 17±2% to 24±3% (p<0.05) in five Type 1 diabetic subjects in whom glycaemic control had deteriorated for 2 weeks. In 18 Type 1 diabetic subjects the magnitude of the dawn phenomenon correlated with the indices of adequate glu Continue reading >>

More in diabetes