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 hyperglycemia in the early morning hours. You see, when your blood glucose drops during the night, hormones are released which trigger the liver to release stored glucose. This normally results in a high-fasting glucose reading the next morning.
The Somogyi effect is a result of having extra insulin the body before bedtime, either from not having a bedtime snack, perhaps you ate dinner late and over bolused, or from having your long-acting insulin not at the proper dose. The Somogyi effect occurs mainly with type 1 diabetics.
They Somogyi effect is similar to the dawn phenomenon in that both lead to high morning blood glucose readings. The difference is that dawn phenomenon is not caused by hypoglycemia, but by a natural release of hormones that are released during the night hours to prepare you for the days upcoming events.
How To Reverse Dawn Phenomenon?
One of the very first steps that you should take is to contact your doctors office. Once you and your doctor figure out how your blood sugar levels behave overnight, here are some suggestions that he or she may start to incorporate:
- Take long-acting insulin in the evening so its peak action happens when your blood sugars start rising.
- Change the type of insulin you take in the evening.
- Start incorporating a continuous glucose monitor (CGM) to get a better time frame of when the spikes start to take place
- Take a small amount of insulin overnight if your blood sugar goes up during the night.
- Switch to an insulin pump, which can be programmed to automatically increase your basal rates in the morning. This works perfectly for me with my omni pod pump system from Insulet.
For me, before I started on my pump and CGM, I was always constantly trying to guess when the spikes were happening but by incorporating a CGM into my management plan, that really opened up an entirely new window of what was happening.
Once I was armed with that information, I adjusted my basal rates accordingly, particularly my 2am – 4am basal rates and things really evened out. So if you have the opportunity to talk to you doctor about incorporating a CGM from Dexcom or you may just want to call up your insurance company to see what your coverage is. They are fantastic and you will really be able to pinpoint what is happening and be able to adjust your basal rates accordingly with your doctor.
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