This is a very common phenomenon I believe and certainly happens to me, although not every day. (glad you can get your phone to work with the sensor, the new iPhone I bought specifically to work with it does not want to know despite I don't know how many reinstallation's of the app!). Only 10.4? Mine can shoot up to almost double that before breakfast! Actually I think what happens is that the body produces a shot of adrenalin specifically for the purpose of waking you up. Being Primates, we would needed to have been active after waking and the body requires increased blood sugar to enable that. My solution is threefold. 1. This does not happen to me if I get up slightly earlier than normal, i.e. before it has begun to rise. 2. I take some Fiasp quick acting insulin when I come down and make my morning cup of tea (4-6 units depending on my reading) with a further dose once I have calculated the carb content of my breakfast up to one hour later. 3. I practice intermittent fasting having a main meal around 14:00 each day with just a small snack (and I mean small, no more than 30g of carb) in the evening. I also try to avoid having a hi-carb breakfast and have almost cut out eating cereal because of the spikes it caused. Interestingly, the same cereal does not appear to have that effect if eaten much later in the day. My regime might not suit others, but it works for me and I maintain a better than 80% time in range (unless I am not well).
Dawn phenomenon
- Thread starter Besty W
- Start Date
I have a very similar result each morning.
There are of course many natural occurrences within the body which contribute to this, but my application of logic, based on my personal circumstances and insulin patterns are that I see one of my main reasons being:
•eating frequently throughout the day (between 20-80g carbs each meal, requiring between 0.5-5 units if novorapid), means that I am dosing roughly each 3 hours with smaller doses of novorapid.
Of course, when it comes to nighttime/bedtime, I am no longer getting those micro doses/multi layered doses of insulin, and so come the morning when blood start to rise in preparation for the day, I’ve been without those micro/multi layered doses for let’s say 7-8hrs. Whereas, through the day it’s every 3ish hours.
•so there’s not the same level of acting insulin and also not the same level of fast acting insulin to cope.
•my regime does of course have long acting (levemir) twice a day (3u morning, 5u night). If I up my nighttime levemir further, I end up having nighttime hypos and glucose spikes as my liver shunts glycogen out to combat the low. So does my control no better.
What I do is take my morning dose for my planned breakfast, along with corrective units in consideration of/for the rise , allowing it to take action and then eat. As if I eat immediately upon waking , even with the same doses, my bloods would rise further and stay elevated rather than come down and remain levelled.
What does have a positive impact on this for me is the amount of carbohydrates I consume in my last two servings of food, usually around 8pm and 11pm. The higher the carbs, the more exaggerated the “dawning effect” for me personally.
And even more influential is if my bodyweight is slightly lower, I’m slightly leaner, with a combination of resistance and cardiovascular exercise, the control is much much better. This really is the best means, besides all of the other benefits it carrys.
*been type 1 diabetic 20 years, last HbA1C was 34.
There are of course many natural occurrences within the body which contribute to this, but my application of logic, based on my personal circumstances and insulin patterns are that I see one of my main reasons being:
•eating frequently throughout the day (between 20-80g carbs each meal, requiring between 0.5-5 units if novorapid), means that I am dosing roughly each 3 hours with smaller doses of novorapid.
Of course, when it comes to nighttime/bedtime, I am no longer getting those micro doses/multi layered doses of insulin, and so come the morning when blood start to rise in preparation for the day, I’ve been without those micro/multi layered doses for let’s say 7-8hrs. Whereas, through the day it’s every 3ish hours.
•so there’s not the same level of acting insulin and also not the same level of fast acting insulin to cope.
•my regime does of course have long acting (levemir) twice a day (3u morning, 5u night). If I up my nighttime levemir further, I end up having nighttime hypos and glucose spikes as my liver shunts glycogen out to combat the low. So does my control no better.
What I do is take my morning dose for my planned breakfast, along with corrective units in consideration of/for the rise , allowing it to take action and then eat. As if I eat immediately upon waking , even with the same doses, my bloods would rise further and stay elevated rather than come down and remain levelled.
What does have a positive impact on this for me is the amount of carbohydrates I consume in my last two servings of food, usually around 8pm and 11pm. The higher the carbs, the more exaggerated the “dawning effect” for me personally.
And even more influential is if my bodyweight is slightly lower, I’m slightly leaner, with a combination of resistance and cardiovascular exercise, the control is much much better. This really is the best means, besides all of the other benefits it carrys.
*been type 1 diabetic 20 years, last HbA1C was 34.
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You have a completely different approach than I have - I eat late, usually between 8 and 10 PM and have a substantial midnight snack (low carb though, like almost all my meals) before bed as well. And I like my drinks.
I usually stay fairly flat throughout the night and only start to rise after I wake up so it's no trouble to inject for it right after waking.
Both our approaches seem to work well for us, good to know there are more ways to skin a rabbit.
jddukes
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Thanks for starting this topic. I was always under the naive and erroneous assumption that "dawn phenomenon" (DP) was a gluconeogenesis in the liver phenomenon, purely. I didn't feel I really suffered from it.
Then more recently, I have switched to a carnivore diet (on top of intermittent fasting where I don't eat before 13:00 every day), so have 0 carbs, essentially (certainly <10g in a day), and no food in the morning. I previously have done keto diets (not carnivore), and not observed DP then, but realise I was on Lantus then. I am now on Levemir.
The DP I see, where I wake up and my levels might be at 8-9mmol/l, and as soon as I get up they shoot up to 11-12mmol/l. This is happening without carbs in the evening (although I wonder if too much protein is contributing here), and instantly on getting out of bed it starts to go up. Work has been quite intense personally and I've put this down to increased cortisol on waking - cortisol is known to increase BS levels. However, I would hope (expect?) that longer term carnivore/very low carb diets would deplete glycogen store availability to reduce the effect of cortisol (I struggle with the idea of gluconeogenesis occurring so rapidly on waking, but perhaps there is the sleeping pattern regularity that my body is operating under and so as I wake up the same time each day pretty much, this is happening earlier and snowballs?).
So I'm guessing the best solution for this in the near term sounds from the advice here to just instantly take some novorapid on waking (this can be a challenge, as I don't eat, and then often cycle to work which means novorapid + fasted state + exercise = large effect of reducing BS levels risking hypos following the exercise), but perhaps pursuing the pump may be a good way to manage this?
Then more recently, I have switched to a carnivore diet (on top of intermittent fasting where I don't eat before 13:00 every day), so have 0 carbs, essentially (certainly <10g in a day), and no food in the morning. I previously have done keto diets (not carnivore), and not observed DP then, but realise I was on Lantus then. I am now on Levemir.
The DP I see, where I wake up and my levels might be at 8-9mmol/l, and as soon as I get up they shoot up to 11-12mmol/l. This is happening without carbs in the evening (although I wonder if too much protein is contributing here), and instantly on getting out of bed it starts to go up. Work has been quite intense personally and I've put this down to increased cortisol on waking - cortisol is known to increase BS levels. However, I would hope (expect?) that longer term carnivore/very low carb diets would deplete glycogen store availability to reduce the effect of cortisol (I struggle with the idea of gluconeogenesis occurring so rapidly on waking, but perhaps there is the sleeping pattern regularity that my body is operating under and so as I wake up the same time each day pretty much, this is happening earlier and snowballs?).
So I'm guessing the best solution for this in the near term sounds from the advice here to just instantly take some novorapid on waking (this can be a challenge, as I don't eat, and then often cycle to work which means novorapid + fasted state + exercise = large effect of reducing BS levels risking hypos following the exercise), but perhaps pursuing the pump may be a good way to manage this?
I also have the dawn effect. I take 2/3 units of fast acting insulin in the morning before getting up. I also take the basal insulin at the same time. If im able (timewise) to snooze one or two times after that, the insulin will be working when i get up and go into the shower.
In the shower I also get a high alarm most of the times, but sometimes it goes back down afterwards without taking extra insulin.
I have tried eating almost no carbs yesterday evening (conjac noodles), but still got the dawn effect this morning. But of course it always helps to eat less carbs and do more sports and work out to limit fluctuations. Going for a walk in the morning shortly further raises my dawn effect, but afterwards (back in rest) my bg will drop.
By the way, i completely skip breakfast too as otherwise i wont be able to keep my bg down in the morning.
Good luck and if anyone has better ideas, always welcome
In the shower I also get a high alarm most of the times, but sometimes it goes back down afterwards without taking extra insulin.
I have tried eating almost no carbs yesterday evening (conjac noodles), but still got the dawn effect this morning. But of course it always helps to eat less carbs and do more sports and work out to limit fluctuations. Going for a walk in the morning shortly further raises my dawn effect, but afterwards (back in rest) my bg will drop.
By the way, i completely skip breakfast too as otherwise i wont be able to keep my bg down in the morning.
Good luck and if anyone has better ideas, always welcome
I am told by my Diabetic team that this morning high is common to all, not just Diabetics. The body draws sugars from all major organs when morning activity starts, I was told not to worry about it & I don't. Been living with it for many years now.
Eat a zero carb snack or meal if you feel it's getting too high.
Eating something tells the body there is no need for extra glucose, since you have just 'hunted/gathered' your first meal of the day and can now source your energy requirements from your food.
If that food was zero carb or next to no carb then it won't raise your BG level, so at the 2hrs postprandial mark your BG will be lower or at worst no higher !
I’m curious too. I’m only on one metformin at night before bed and diet too of course. High fasting and drops consistently over the morning. I don’t usually eat until late morning (just coffee with half&half and monk fruit on rising). I feel fine. And it seems to be a stable pattern. About 170 fasting.
LindiePops
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Marie 2
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DP, or Dawn Phenomenon is a release of hormones pre waking usually around 4-6 am. Those hormones release glucose before you wake to supply your body energy and get it ready for the day. It's just in "normal" people they make insulin to use that glucose and Type 1's don't. Those hormones also cause insulin resistance for a few hour after too. Type 2's can also be effected by it because they are insulin resistant, so it happens to them too. All sorts of things have been tried to help it, but it really varies per person what or if anything works. There is also FOTF, or Foot On The Floor, very similar to DP, it's a release of hormones/glucose after you wake. That can be right when you wake, or after you first put your feet on the floor, or after an hour or two and you have been awake and start moving around more. It also causes insulin resistance for a few hours after. You can have one or both.
Besides higher settings in my pump basal rate I also have a higher I/C ratio for the mornings.
But as a type 1, you soon understand your body just decides to do things at any time............ and we like to blame it on what color socks we wear for the day.
@LindeePops My BG level spikes when I take a warmer/hot shower too. It can be really significant if I take one in the mornings. My solve has been learning to take a lukewarm shower at night and then it hardly bothers me. On a very very small study of type 1's it turns out it's a 50/50 split on showers. 50% have a BG rise and 50% have a BG decrease.
@Alan-58 It sounds to me like you might need a bolus adjustment, your I/C or insulin carb ratio might be off. If you get your bolus right, you might need less basal too. The best way though is to usually start with a basal test. You fast for periods of time to see if your basal amount is right. Once you get your basal right, then it's easier to work on your bolus ratio amounts.
www.mysugr.com
www.mysugr.com
Besides higher settings in my pump basal rate I also have a higher I/C ratio for the mornings.
But as a type 1, you soon understand your body just decides to do things at any time............ and we like to blame it on what color socks we wear for the day.
@LindeePops My BG level spikes when I take a warmer/hot shower too. It can be really significant if I take one in the mornings. My solve has been learning to take a lukewarm shower at night and then it hardly bothers me. On a very very small study of type 1's it turns out it's a 50/50 split on showers. 50% have a BG rise and 50% have a BG decrease.
@Alan-58 It sounds to me like you might need a bolus adjustment, your I/C or insulin carb ratio might be off. If you get your bolus right, you might need less basal too. The best way though is to usually start with a basal test. You fast for periods of time to see if your basal amount is right. Once you get your basal right, then it's easier to work on your bolus ratio amounts.
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LittleGreyCat
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Diet drinks - the artificial sweeteners taste vile.
Having to forswear foods I have loved all my life.
Trying to find low carb meals when eating out.
Tricky one.
I tend to get DP if I stray from the keto way and have spare glucose stored in my liver (well, that is my theory).
I also get DP if I exercise strenuously in the morning.
Either way it goes down again quite rapidly around noon.
Generally my BG is normal to low overnight so any drug which could cause a hypo would require a very fine balancing act.
Memo to self - eat fewer carbohydrates.
Hobs
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I too am a T2 and have 'suffered' this DP for several years despite a change in meds etc. My DSN told me there is not much that can be done and as it's only a temporary rise and soon under control, not to worry about it.
I treat with Glucophage SR + Victoza injections with a HbA1c of 6.3 for the past 5+yrs.
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T2 response: The Phemenon itself seems to be an entirely natural thing and (thanks to CGMs for the info) it happens with non-diabetics as well. IMO t's not the mechanism that's the issue, it's a resulting high level that's unwelcome.
DP doesn't concern me at all these days. I did a week of first thing readings a while back just to check, and while I'm still getting the rise, it's starting from a lower point and never goes anywhere near a level I would be worried about. The low starting level is a result of 20g/day for four years in December. I can stop any rise with eg four almonds, or a single slice of salami.
DP doesn't concern me at all these days. I did a week of first thing readings a while back just to check, and while I'm still getting the rise, it's starting from a lower point and never goes anywhere near a level I would be worried about. The low starting level is a result of 20g/day for four years in December. I can stop any rise with eg four almonds, or a single slice of salami.
I'm interested in this also have type 2 diabetes. Borderline prediabetes and diabetes right now. And I'm just trying to control with diet no medication. And I also struggle with the first test of the day when I get up and haven't even eaten yet that is always the highest one and then it goes down throughout the day. I'm still kind of new at this and was also wondering about the same thing
Interestingly I never used to suffer from it before this year. I've not changed insulin, nor activity level, nor anything else I can think of.
It is interesting to read the comments above about reducing/eliminating DP by changing eating habits. My understanding is/was also that DP is related to glycogen -> glucose conversion from the liver (i.e. glucogenesis) due to the effects of hormones (as mentioned above by @Marie 2 and others.
I've not tried different eating habits, but if I do lots of exercise the preceding day I don't get or get very diminished DP the following day (and actually the one after that too.) It appears that it can take a quite significant time to replenish both liver and muscle glycogen stores (much longer than I'd thought) - on the order of 12h to 24h depending on what you eat - I need to do some deeper diving into the numbers that are quoted to turn these into hours consuming something normal, vs lab tests with very high concentrations of glucose/sucrose.
This paper is quite interesting: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6019055/#:~:text=Liver glycogen is rapidly restored,conversion of lactate to glucose. especially the comment and links to papers (in the section entitled "TIME COURSE OF GLYCOGEN REPLENISHMENT") re replenishment (repletion is apparently the preferred term) especially the comment that those on low carb diets might "replete" 13% of their stores over 24h vs 93% for those on a high carb diet.
One assumes that the liver attempts to replenish (I can't deal with replete any more, sorry) itself to 100% if possible, so I'm guessing that the amount and timing of exercise those on low carb/intermittent diets are also doing also feeds into this.
My final assumption is that the liver is less inclined to release glucose due to cortisol/adrenaline (requires higher concentration for example) when it's in a depleted state, though this is purely an assumption, there are doubtless papers out there, if anyone finds anything relevant please post a linky.
There are a couple more papers that are linked from the first one that look interesting, I've not read them yet, only skimmed:
Do you find that the cycling first thing has any effect on BG at all re DP? If I leave first thing for a long ride, I (now) need to take bolus for my DP, and it's a fine line trying to judge how much to take to account for DP but not so much that I then go low. I do eat breakfast though, so I have safety in terms of that supplying glucose while I ride. I currently take about the same bolus to cover DP + breakfast as I would just to cover DP on day when I'm not riding.
Before the advent of DP for me, I'd leave in the morning (for long rides) without any bolus cover for my breakfast (though I would probably run a little high to start with, but it's hard to tease that effect apart from stress as I can ride without bolus cover if I leave at lunchtime). I therefore assume that my dosing requirement to cover DP is constant whether I ride or not, because I also eat breakfast which covers the insulin tail. I'm pretty sure (never tested mind you) that the DP effect is much shorter than the carbs coming from the digestion of my breakfast, it would be interesting to know if anyone has tested/noticed though.
That was very round-about and not directly relevant to you (sorry!) Are you willing/able to eat carbs in the morning in an emergency, so that you can try taking some very small bolus doses to see what effect they have but be able to avoid hypos? If so, I'd be tempted to try that starting at 0.5U and working up. I'd be very interested to hear what you find.
P.S. Yes, sort of, a pump would partly solve this problem. Some people suffer from a slowly increasing BG in the morning due to I'm guessing growth hormone (et al), for something like this a pump is ideal as you can increase the basal rate and remove the rise. For "foot on the floor" DP caused by adrenaline (afaiu) I can't see that a pump would help - you could perhaps try to taper your BG downward before you plan to get up so that you're heading low to offset the high, but you'll still end up needing to take insulin which has a long tail which will affect your fasted riding. I'm not on a pump though, so am more than willing to accept I'm wrong about this.
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Marie 2
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@pauldogs_0 This is the explanation I gave earlier. You know you have it when you wake up in the morning with higher numbers for no apparent reason. A CGM is a great way to know, you'll see steady numbers until somewhere around 4-6 am a spike in your BG level.
