Type 2 Dawn Syndrome ?

[What is in a name]

Hello you fine people
My bloods sugar rises during the night when it should be falling !!!
A bit of Web digging turns up "a little understood" phenomenon called Dawn Syndrome.
The advice is the "speak to your healthcare professional"
BUT! When I spoke to my doctor, she dismissed it as "normal" When asked why it does not always happen, she avoided answering and moved on!
I understand that the liver does give us a squirt of glucose as we are waking up to get us going in the mornings, but why not all the time?
And why so much at times? My sugar can spike from a nice 5.5 before bed to 7.5 when I wake!
Having such a high fasting reading must be skewing my three monthly hba1c results too, so why is my doctor not concerned about it?
Honestly, when I lived in Japan, the Japanese healthcare system was far, far superior to the "care" received on the NHS.
In Japan they have a once a week oral pill for type 2 which works very well. Of course we can't get that on the NHS, the closest thing to it is Alogliptin which I was put on after my return from Japan.

 

[Melgar]

Actually DP is normal @What is in a name it's just that as diabetics our pancreas' cannot cope with the rise in blood glucose. Our circadian rhythm system governs many metabolic processes including the release of cortisol and growth hormones in the early hours , 3am ish. These hormones 'tell the liver' to release glucose, as you rightly point out in preparation for activity. It is a perfectly natural phenomenon. We can help to reduce this early morning rise by not eating late. I don't eat beyond 5pm and by reducing carb intake, especially dinners.

Ed spelling

 

[KennyA]

Hello you fine people
My bloods sugar rises during the night when it should be falling !!!
A bit of Web digging turns up "a little understood" phenomenon called Dawn Syndrome.
The advice is the "speak to your healthcare professional"
BUT! When I spoke to my doctor, she dismissed it as "normal" When asked why it does not always happen, she avoided answering and moved on!
I understand that the liver does give us a squirt of glucose as we are waking up to get us going in the mornings, but why not all the time?
And why so much at times? My sugar can spike from a nice 5.5 before bed to 7.5 when I wake!
Having such a high fasting reading must be skewing my three monthly hba1c results too, so why is my doctor not concerned about it?
Honestly, when I lived in Japan, the Japanese healthcare system was far, far superior to the "care" received on the NHS.
In Japan they have a once a week oral pill for type 2 which works very well. Of course we can't get that on the NHS, the closest thing to it is Alogliptin which I was put on after my return from Japan.

Dawn Phenom is perfectly normal and happens to diabetics and non-diabetics alike - it's not a "diabetic symptom". Some people (I'm one) also get a sharp BG fall immediately before the DP kicks in. That can mean nightmare, heavy sweating, and waking. That's the worst bit about it. Nightmares etc are usually only identified as associated with a BG fall by CGM users.

I reckon that apart from the immediate couple of hours after I eat, my liver is usually the main influence on my blood glucose, most of the time. It takes time to train a liver, and you don't want them trained to think high BGs are actually "normal".

I don't think a rise from 5.5 to 7.5 is a spike - it looks fairly low to me. Given the standard 15% inaccuracy in fingerprick testing both results could, just about, have been generated by a true BG value of 6.5. I'd guess your doctor isn't concerned about it "skewing" your Hba1c as it's a standard natural item, and therefore not a skew at all, just something we all live with. There's a host of things that will affect your BG apart from food - stress, illness, ambient temperature etc. and the chance of controlling everything that might possibly influence BG is zero. Focus on the big players, mainly food.

 

[What is in a name]

Dawn Phenom is perfectly normal and happens to diabetics and non-diabetics alike - it's not a "diabetic symptom". Some people (I'm one) also get a sharp BG fall immediately before the DP kicks in. That can mean nightmare, heavy sweating, and waking. That's the worst bit about it. Nightmares etc are usually only identified as associated with a BG fall by CGM users.

I reckon that apart from the immediate couple of hours after I eat, my liver is usually the main influence on my blood glucose, most of the time. It takes time to train a liver, and you don't want them trained to think high BGs are actually "normal".

I don't think a rise from 5.5 to 7.5 is a spike - it looks fairly low to me. Given the standard 15% inaccuracy in fingerprick testing both results could, just about, have been generated by a true BG value of 6.5. I'd guess your doctor isn't concerned about it "skewing" your Hba1c as it's a standard natural item, and therefore not a skew at all, just something we all live with. There's a host of things that will affect your BG apart from food - stress, illness, ambient temperature etc. and the chance of controlling everything that might possibly influence BG is zero. Focus on the big players, mainly food.

I see, well thanks for the information. It would have been nice for my GP to have explained it like that. Having gone from between 11 and 13.5's down to between 5.5 and 7.5 I was concerned about what seemed to me to be a high spike with zero food input.

 

[What is in a name]

Actually DP is normal @What is in a name it's just that as diabetics our pancreas' cannot cope with the rise in blood glucose. Our circadian rhythm system governs many metabolic processes including the release of cortisol and growth hormones in the early hours , 3am ish. These hormones 'tell the liver' to release glucose, as you rightly point out in preparation for activity. It is a perfectly natural phenomenon. We can help to reduce this early morning rise by not eating late. I don't eat beyond 5pm and by reducing carb intake, especially dinners.

Ed spelling

No food after 17:00 eh? That's a tough one for me because due to one thing or another I usually end up eating at 19:00. I'll see if I can pull that back to 18:00.
Cheers

 

[KennyA]

I see, well thanks for the information. It would have been nice for my GP to have explained it like that. Having gone from between 11 and 13.5's down to between 5.5 and 7.5 I was concerned about what seemed to me to be a high spike with zero food input.

It is probably your liver being used to higher BGs and doing its best to get you back to where it thinks you should be, based on your recent levels. It took mine around six months or so to accept the new normal.

I don't test in the mornings these days - I do a week once a year just out of interest. It always tends to be low to mid fives which is definitely not what was happening five years ago.

As far as time of eating goes, I tend to eat late in the evenings, usually around 7-9 pm. For me there seems to be no impact on what happens to my BG that night or the following morning. To find out what happens to you, you need to be varying the routine and testing.

 

[What is in a name]

It is probably your liver being used to higher BGs and doing its best to get you back to where it thinks you should be, based on your recent levels. It took mine around six months or so to accept the new normal.

I don't test in the mornings these days - I do a week once a year just out of interest. It always tends to be low to mid fives which is definitely not what was happening five years ago.

As far as time of eating goes, I tend to eat late in the evenings, usually around 7-9 pm. For me there seems to be no impact on what happens to my BG that night or the following morning. To find out what happens to you, you need to be varying the routine and testing.

Liver training eh? I don't suppose alcohol can be used for that
I did take some consecutive early readings to confirm the Dawn Syndrome, mine seems fine at 4am, but starts to rise after 5am.
I keep a fairly detailed "food diary" of morning and evening readings, food consumed, sleep quality (poor more often than not) exercise done, tea/coffee/water consumed, pain, severity and location, pain killers taken, and occasionally Ketone which just nudges the 0.6 lower level even with a BSR of 7.1.
I am trying to build a picture of cause and effect but as yet there is no clear indication of what works for me after two months of monitoring following the introduction of Gliclazide.

As Toyah Wilcox once sang - It's a mystery to me !

 

[lovinglife]

It’s worth noting that although it’s called dawn phenomenon it can happen at any time of day, mine tends to be between my breakfast at 5 am & my lunch at 12pm -usually around the high 6s or very low 7s, I don’t usually do anything about it unless my lunch is going to be significantly later, then I’ll have a no carb snack like a bit of cheese or cooked meat or a few nuts. It doesn’t happen between my lunch & evening meal which has the similar amount of time in between (about 7hrs) if anything my BG can be in the high 3s very low 4s before dinner

We can only do what we can only do

 

[KennyA]

Liver training eh? I don't suppose alcohol can be used for that
I did take some consecutive early readings to confirm the Dawn Syndrome, mine seems fine at 4am, but starts to rise after 5am.
I keep a fairly detailed "food diary" of morning and evening readings, food consumed, sleep quality (poor more often than not) exercise done, tea/coffee/water consumed, pain, severity and location, pain killers taken, and occasionally Ketone which just nudges the 0.6 lower level even with a BSR of 7.1.
I am trying to build a picture of cause and effect but as yet there is no clear indication of what works for me after two months of monitoring following the introduction of Gliclazide.

As Toyah Wilcox once sang - It's a mystery to me !

Well, alcohol does have an impact on liver function - it basically stops it adjusting your glucose levels for a time. This can result (I was running with low BGs, in ketosis and not eating a lot of carb) in very low BGs. I've had one experience with that and I do not want a repeat.

If you're on gliclazide that alcohol warning needs to be underlined a few times.

I don't see much point in trying to stop DS - it happens to non-diabetic folks as well so it looks to me like a normal bodily function.

 

[What is in a name]

Well, alcohol does have an impact on liver function - it basically stops it adjusting your glucose levels for a time. This can result (I was running with low BGs, in ketosis and not eating a lot of carb) in very low BGs. I've had one experience with that and I do not want a repeat.

If you're on gliclazide that alcohol warning needs to be underlined a few times.

I don't see much point in trying to stop DS - it happens to non-diabetic folks as well so it looks to me like a normal bodily function.

The comment was tongue in cheek, but thanks for recounting your personal experience with that.

 

[What is in a name]

The comment was tongue in cheek, but thanks for recounting your personal experience with that.

It’s worth noting that although it’s called dawn phenomenon it can happen at any time of day, mine tends to be between my breakfast at 5 am & my lunch at 12pm -usually around the high 6s or very low 7s, I don’t usually do anything about it unless my lunch is going to be significantly later, then I’ll have a no carb snack like a bit of cheese or cooked meat or a few nuts. It doesn’t happen between my lunch & evening meal which has the similar amount of time in between (about 7hrs) if anything my BG can be in the high 3s very low 4s before dinner

We can only do what we can only do

Information is power! Understanding leads to empowerment, so thanks for relating your experience, it helps me build a picture of "normal"