Suggestion for Dawn effect phenomenon

[Antonyponraj]

I have my elevated blood sugar which raises after 5am. It raises from 90 to 120 @ 7 am, 140 @ 9 am .
Metformin 500mg+actos7.5mg+glimepride 1mg is taken along with dinner at 9pm.
Request help how to control this dawn effect pl.
Antony

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[pavlosn]

Try having a small snack before going to bed such as a hot cup of milk. By keeping your 5.00 am level slightly higher you may be able to avoid the dawn phenomenon. Worth a try.


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[sconnelly1]

Hi could you explain please how this might work.I also have a huge problem with this. Think I may be missing the point. Thanks


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[pavlosn]

Dawn phenomenon occurs because of hormones being released in our body in anticipation of us waking up so that we can be ready to face the day. Experimentation with what time to wake up, have nighttime and morning meals and medication may help to avoid this. This is a matter to discuss with your healthcare provider before making major changes.

Another reason for the increase in morning blood levels may be a liver dump of glucose when the body is running low. 90 mg/dl (5 mmol/l) is not really low but what if the level was lower earlier in the morning( plus our meters are not very accurate so true level could be lower anyway). By suggesting a small cup of milk, I am suggesting that if blood glucose stays slightly higher in the night perhaps the liver will not be triggered to dump glucose in the morning.

What I am really suggesting is that only by experimenting, making small changes in our routine, and measuring the results on our glucose levels can we fine tune our glycemic control. This is one of the reasons I consider self testing so important!

Pavlos


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[Antonyponraj]

Thank yo.will try definitely tonight

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[carty]

Dont be too disapointed if this doesnt work I have tried many ways to lower my morning levels and non have worked so far I think my liver wants a good talking to
CAROL

 

[Yorksman]

Request help how to control this dawn effect pl.

Why would you want to influence the result of this test? It is one of the best indicators of how you are controlling your diabetes that you are able to do for yourself. It is entirely natural.

When you sleep you are fasting. Your body still requires glucose and when your level drops to around 4.0, your body releases some more. In a non diabetic person, the insulin response is swift and it starts to act to bring the BG level within the normal range. In a diabetic, the response might be slow, the amount of insulin may not be enough and its effectiveness may be impaired. That's why you get high readings. What you hope to do as a diabetic is to make improvements to your insulin response, the amount of insulin you produce and to the sensitivity of that insulin, through lifestyle changes. The only way you can measure how well you are doing it to measure that over a period of time, and it does take time. You can't hurry it along by getting up at 3am and having a quick snack to make sure this perfectly natural homeostatic process doesn't kick in. It is the equivalent of hiding unpaid bills and ignoring them. Learn what needs to be done, not how to manipulate the figures.

 

[novorapidboi26]

I'm type 1 and had/still do have issues with this, even on a pump.

You should try getting something in your stomach, nothing too carby, something low GI, this will let your brain know that the 'fast' is over and you don't need the extra assistance from your liver.

 

[pavlosn]

What you hope to do as a diabetic is to make improvements to your insulin response, the amount of insulin you produce and to the sensitivity of that insulin, through lifestyle changes. ......... Learn what needs to be done, not how to manipulate the figures.[/quote]

While I agree that trying to improve insulin response etc are valid long term aims I disagree that trying to take action to restrict sugar levels rising is manipulating the figures.

After all there is only so much weight loss you can have and only so much extra exercise you can do. So improvements in insulin response are limited. If they were not we would be able to cure ourselves.

What do you do if you can not improve further. Also improvements in insulin response are so slow that at any point in time as a diabetic you are effectively faced with a fixed level of impaired insulin response. Making the right choices such as the type, quantity and timing of your meals, the level of exercise to perform, and the medication to take are vital parts of the valid short term aim of keeping your sugar levels down within a healthy envelope in order to avoid long term complications.

Is avoiding meals which are carb heavy also manipulating the figures?


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[pavlosn]

What you hope to do as a diabetic is to make improvements to your insulin response, the amount of insulin you produce and to the sensitivity of that insulin, through lifestyle changes. ......... Learn what needs to be done, not how to manipulate the figures.

While I agree that trying to improve insulin response etc are valid long term aims I disagree that trying to take action to restrict sugar levels rising is manipulating the figures.

After all there is only so much weight loss you can have and only so much extra exercise you can do. So improvements in insulin response are limited. If they were not we would be able to cure ourselves.

What do you do if you can not improve further. Also improvements in insulin response are so slow that at any point in time as a diabetic you are effectively faced with a fixed level of impaired insulin response. Making the right choices such as the type, quantity and timing of your meals, the level of exercise to perform, and the medication to take are vital parts of the valid short term aim of keeping your sugar levels down within a healthy envelope in order to avoid long term complications.

Is avoiding meals which are carb heavy also manipulating the figures?


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Ouo


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[Antonyponraj]

Hi. Now this works for me. I get up @ 6 am and bs is 110 and I eat small breakfast say an egg with small carb of 4g with mayanoss and took 500mg metformin. Bs @ 8.30 is 85. And I take my regular breakfast.

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[Yorksman]

While I agree that trying to improve insulin response etc are valid long term aims I disagree that trying to take action to restrict sugar levels rising is manipulating the figures.

But eating a late meal specifically to delay a liver dump is manipulating the figures. OK, by eating late you avoid homeostatic gluconeogenesis and your reading looks normal, but that has been artificially achieved and you are deluding yourself if you think you are controlling your FPG levels via this method. The entire basis for diabetes diagnosis and diabetes monitoring is done via Fasting Plasma Glucose readings.

Readings which are not fasting readings only show the effects of those foods on your plasma levels. They provide no indication of how well you are controlling your diabetes. By not taking fasting readings you are never going to know on a daily basis how you are doing and you will have to wait until your next hba1c. For some people that might be a year, only to be told, your A1c is still too high.

 

[pavlosn]

Fully agree that fasting glucose levels should and are used (amongst other tests) to diagnose diabetes.

I am not as convinced that fasting counts in isolation are the best indicator of how well controlled you are as a diabetic or for that matter the best predictor of HbA1c scores. Could it not be the case that if you suffer ffrom a strong dawn pheniomenon rise in your blood sugars then your early morning fasting level wil be less than your average glucose level leading to an overestimation of your eventual HbA1c score ( which is a reflection of your average levels). In fact HbA1c score itself is an imperfect indicator of glycemic control as it is an average score and so could be disguising periods of unhealthily high and unhealthily low glucose levels within a healthy overall average.

As far as I am concerned a well controlled diabetic is one who manages to keep his levels as constant and as close to non diabetic levels as possible.
By levels I mean all glucose levels, fasting , before meals and after meals.

The dawn nphenomenon is just another maniifestation of our diabetes. Non diabetics do not suffer from this. Their pancreas compensates for any increased hormones and they do not suffer from glucose level rises at dawn. So if we can take also take action to limit it then, in my opinion, we should.

 

[David147]

It can be serious. According to the American Diabetes Association, “Some people with dawn phenomenon find that their glucose continues to rise until they eat in the morning. For others, levels will settle down a few hours after waking, regardless of whether or not they eat.”

Either way, that can be a long time to spend with elevated blood glucose levels. For some people, like Mishelle, the highs aren’t that dangerous. Others go much higher.

According to columnist Wil Dubois, the higher your A1C, the more likely you are to have a significant dawn phenomenon. It could be that spending a number of hours each morning out of control is having a significant effect on your overall control.

So it’s worth trying to get dawn phenomenon under control. How can you do that? You have to figure out what is triggering it and then try some possible solutions.

Some people have high glucose levels in the morning because their medicines wear off overnight. This could be true of medicines like insulin, sulfonylureas, and metformin. If you are taking any long-acting medicine, consider asking your doctor about changing meds, doses, or times. Our reader Mishelle might benefit from taking her metformin later in the evening, for example. Metformin is good at keeping a lid on the liver.

 

[Bebo321]

How effective is eating say a small piece of cheese, or a handful of nuts (so something zero or very low carb) the minute you wake up? I know it works for some, but I would be interested to hear for those of you who suffer from rising BGs in the morning if it is actually helps some or most. (If you fancy being a guinea pig perhaps you would be good enough to give it a go and report back whether the results are good, bad or indifferent)