Pesky dawn phenomenon

Applenerd81

Well-Known Member
Messages
205
Type of diabetes
Type 1
Treatment type
Insulin
Dislikes
Carbs
Hi All,

I am tired of this dratted morning rise in blood glucose(BG). Every evening I go to bed with my BG in the low fives, but it has risen to the 6s by the time I wake up. Then it rises steadily until I eat brekkie, sometimes as high as 8.5 (I often forget to eat til quite late, because my BG is so high that I don't feel hungry)!

Well, I've had enough.
It's mucking up my HbA1c more than anything I eat during the day.
So I am planning a systematic campaign to sort the thing out.

Each week, for 7 days, I'm going to try one thing (suggestions welcome!) and keep track using my monitor. If whatever technique I am trying seems to be having an effect, I can extend it for another 7 days.

Feel free to join me, add suggestions, throw peanuts (although I may eat them!), or tell me how YOU beat the Dread Dawn Phen....

Week 1:
I'm going to use an old Montignac suggestion to eat something low carb before getting out of bed
- in my case it will be a 1oz cheese string, or babybel, since they can sit on my bedside
(I never have carby snacks before bed, so I don't need to cut those out)

Hi, not sure if you've finished your experiment but a couple of things to counter dp that worked for me on injections - glass of red wine before bed, bolus 1-2iu upon waking (no food required), increasing glargine from 24iu per night to 28-30iu (these solutions work individually not together!)
 
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Debmcgee

Well-Known Member
Messages
1,939
Type of diabetes
Prediabetes
Treatment type
Diet only
@brun
Is a week long enough to take an effect? When I go back to low carb, it can take up to 3 weeks for me to see it in my bg so I'm just wondering whether you could extend a bit longer? X
 

Mafat

Well-Known Member
Messages
45
https://intensivedietarymanagement.com/dawn-phenomenon-t2d-8/


According to Dr.Jason Fung :



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 to start pushing out some glucose. Adrenalin gives our bodies some energy. Growth hormone is involved in repair and new synthesis of protein. Cortisol, the stress hormone increases as a general activator. After all, we are never quite so relaxed as deep sleep. So these hormones gently get us ready to wake up. A good ol’ fashioned hormonal kick in the ass, so to speak. Hormones are secreted in a pulsatile manner peaking in the early morning hours then falling to low levels during the day.

Since these hormones all tend to raise blood sugars, we might expect that our sugars would go through the roof in the early morning. This does not actually happen.

Why? Insulin secretion also increases in the early morning to counteract the counter regulatory hormones. In other words, insulin is there to make sure blood sugars do not go too high. However, if you look closely at the blood sugar readings, there is a slight increase in the morning time.

So, in the normal, non-diabetic situation, blood sugars are not stable throughout 24 hours. The Dawn Effect happens in normal people. This is easily missed because the magnitude of the rise is very small – from 89 to 92 mg/dl. However, this effect was found in every patient studied. So, unless you are specifically looking for the DP, you are likely to miss it.

Think about it this way. Your body has the ability to store food energy as sugar (glycogen) and fat. When you eat, you store food energy. As you sleep (fasting), your body needs to release this stored energy. Around 4am or so, knowing that you will soon be waking up, your body prepares you for the upcoming day. It does this by increasing counter-regulatory hormones to release sugar into the blood. You can see that glucose production falls overnight and starts to ramp up around 4 am. In order to prevent the sugars from rising too much, insulin increases to act as a ‘brake’ on the system.

Now, what happens in the situation where you have T2D, or high insulin resistance? First, the technical explanation. Around 4 am, counter regulatory hormones surge and insulin is also released to counter this. However, in T2D, the body has high insulin resistance, meaning that the insulin has minimal effect at lowering the blood sugars. Since the counter regulatory hormones (mostly growth hormone) still are working, blood sugars rise unopposed, and therefore much higher than the normal non diabetic situation.

Some people have normal blood sugars except for the Dawn Phenomenon. This still indicates that there is too much sugar stuffed into their liver. They need to keep burning down that sugar. It means there is much more work to be done before they are cleared of their diabetes.

Think about it this way. The Dawn Phenomenon is simply moving sugar from body stores (liver) into the blood. That’s it. If your body stores are filled to bursting, then you will expel as much of that sugar as possible. By itself it is neither good nor bad. It is simply a marker that your body has too much sugar. Solution? Simple. Either don’t put any sugar in (LCHF) or burn it off (Fasting). Even better? LCHF + I
F.
 
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AloeSvea

Well-Known Member
Messages
2,051
Type of diabetes
Type 2
Treatment type
Other
Well - me too massively interested in the DP, and the liver dumping stored sugar because of signalling system gone bung.

And the more I read up on it myself, following threads and links online to understand it more - the more complex it seems to get. It isn't a simple equation of too much sugar in the blood = the DP. If there was ever a case of confusing cause and effect - I think it is if one tries to explain the DP in diabetics this way. Well - you can! But that, in my understanding, is not really the truth. (I say this as someone who really wants to understand how it works so I can, if I can, figure out a way to orient my own treatment. As one of the fellow diabetic DPers.)

I had had a 'got it' moment when I read that the bung signalling is because we don't have enough insulin, too many dead and dying beta cells to get enough insulin out there to give the liver the right signal (the 'got it' moment was realising the liver cells read insulin levels - not the glucose levels) - care of the wonderful Jenny Ruhl in Blood Sugar 101.

http://www.phlaunt.com/diabetes/14046621.php

Then, through wanderings in this forum, I came across this link (I didn't watch it but skipped to reading it instead)


http://www.jci.org/articles/view/60016

About the role of glucagon (regulating hormone) - and realised - well - with all the peptins and alyses (and what-not!), and now apparently this hormone has a lot to do with it, and the DP - my 'got it' has gone by the wayside! :). And I think, oh dear, this is too complex for me to really understand - as far as I can go - I can't or don't want to keep these processes in my head to understand the liver dumping.

And I like the idea that all we really need to know is low-carbing seems to work a treat! Along with IFing/Fasting a la Fung etc. Or at least, can help our bodies adapt to having a bung signalling system.

Because now I know that my body seems to make a lot of insulin still (from my C peptide reading, if I have understood the science and the numbers correctly) - it's my cell receptors and insulin resistance that is still a big obstacle to lovely BG regulation. So then if I do have enough insulin, then it the other regulators that are bung in my liver - the liver cells and all those peptins and alayses and so on (I won't even bother finding out what they are exactly) - I just know they are still very very bung, due to high FBGs.

I do keep in mind, after reading Ruhl, that those things, and Prof Unger (whatever hormones and - well - other regulators etc) may be permanently damaged. (And I mean how the hell could we or do we try and suppress glucagon? Without medication? If and when there is medication for it.) And if they (a and b cell receptors) may be able to regenerate. (Hard to find out online - if anyone has info on this - do post links!) Who knows? (anyone?) This is where I end up seeing my own body and life as a 'case in point', an experiment in time low-carbing, and experimentation with levels of low carbing, to see when, if ever, the DP let's off , lowers, to allow me personally, to have near normal or normal BG levels. Over time. And I am not alone, I gather, in that. And this is the place where diabetics are most fully pooling their information, in English at any rate.

Apologies for my usual long way of saying something simple about something that seems to be way-complex. BG homeostasis/regulation is about way more than simply levels of sugar in the blood. (Did I read once that there are 40,000 genes that affect BG regulation? 40,000!) It may come from, ultimately, too much glucose from the diet that messes up that regulation system, in tandem with genetic factors (or what determines our 'fat storage pathways' - ie fat stored on the liver and pancreas, and other parts of the regulation system that can become damaged in the process Ruhl writes about) - but it isn't just about that once the system is damaged - is it? Or, what degree of damage. Otherwise my poor brain would not be screaming when faced with all those acronyms for liver/BG regulators that I cannot keep in there.

When I did a Very low- Low Calorie diet last year to see if I could knock my diabetes on the head significantly, I became very interested in the different dieter's post diet physical reactions and responses - as the variation is huge. (I didn't really understand the role of properly lowering carbs then. It took me following a fat-bomb diet group to really get my head around that.) Now I tend to think about is as degree of damage. (Ruhl's and Bernstein's work tend to point in this direction.) Degree of low-carbing. (Thank goodness for hope! Thank goodness for good control.)

But very keen to see how much we can, if that is possible, affect that liver dumping of blood glucose during the last stages of sleep before waking.
 
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Kristin251

Expert
Messages
5,334
Type of diabetes
LADA
Treatment type
Insulin
I inadvertently had a morning fasting and it was a disaster. My morning fasting bs is always good but 3 hours after I eat I pop up about 25-30 points. Steady for 2.5 hours then bam. So I decided to set the timer for 15 min and see how long it took for my bs to start lowering and then I would eat. Hoping this would prevent the jump by timing my insulin better. Well after 3 hours of testing every 15 min and bolusing 1/2 unit very 1.5 hours my bs still never came down. Finally I are my regular BF and yup, went down. My issue is more the fact I always have higher readings at 3 hours but steady until then. I can't take more insulin or I will go low first. I wish I could find a way without splitting boluses. I end up taking a half unit around 2.5-3 hours to correct. Lunch and dinner are fine.

I do find a small alcoholic nightcap with a small protein fat snack stops the DP.