Dawn Phenomenon

[Piccyman]

Has anyone worked out how to lower the blood glucose levels during the dawn phenomenon?
I have a CGM and have tried loads of things to try and lower this effect, no luck so far other than to stop taking the 1 metformine per day before bed, this lowered it from a peak of 8.5 to about 7.5.

 

[KennyA]

Has anyone worked out how to lower the blood glucose levels during the dawn phenomenon?
I have a CGM and have tried loads of things to try and lower this effect, no luck so far other than to stop taking the 1 metformine per day before bed, this lowered it from a peak of 8.5 to about 7.5.

Hi - I have a "sort of" answer.

My morning BG readings were the very last to be affected and the very last to come down. They did eventually reduce, but as they are caused by your liver (helpfully) making glucose and dumping it in your blood to get you going (rather than anything you've eaten or done) you have to persuade your liver to slow down or at least recalibrate. It will eventually get the message, but I think only when it realises that the level it's trying to get you to is a lot lower than it used to be. Livers seem to be slow learners.

I don't bother with morning readings at all now but once a year I'll do a week or so just as a check.

Metformin should interfere with your liver's ability to make glucose - this is essentially what it does but medical science doesn't yet know how it does it - I think the phrase is "the exact mechanism is unclear". So stopping metformin should logically have seen a rise in your BG, not a fall. Have you noticed any other changes?

 

[In Response]

Things maybe slightly different for me as I have Type 1.
However, I will share my experience on things that help with DP
- I find that my BG will keep rising when I get up until I eat something. I think it is something about my body thinking I am starving myself. Therefore, I try to eat something small as soon as I get up. This will halt the continuous rise.
- I find that my body is too busy refilling its glucose stores the day after intensive exercise so my liver has less glucose to drip. "Intensive exercise" does not have to be running a marathon - but enough to raise my heart rate for 30 minutes or so.

 

[ianf0ster]

As I have mentioned before, I still get some Dawn Phenomenon, but nowhere near as much as before remission. However I learned to just ignore it.
Before I learned to ignore it I found I could halt or reverse the BG rise by eating a (close to) zero carb snack e.g. a boiled egg, some cold meat or a chunk of cheese.

 

[Piccyman]

I have tried eating scrambled egg, bacon, bacon and egg, nuts, coffee, celery, carrot, apple cider vinegar, cheese, orange segment and nothing changes the upward trend until about 11:30am and then it starts to drop, pretty quickly, so its about 7.5 ish to 6 ish in about 10 mins.
Looks like I will have to be patient and carry on.

 

[aris]

Does strict keto make any difference for Type 2's? I'm thinking if your glycogen stores are depleted, then there is nothing for the liver to dump out. Being a human body, i'm expecting it not to be so simple, but has anyone tried?

 

[Outlier]

Every day! I normally don't eat until the afternoon, though if hungry earlier (like today) I'll eat earlier. I always have DP which can last until early afternoon, so now I test just before I eat because otherwise I am getting DP readings. I have been strict keto for two and a half years, BG in normal range (even with DP taking me into prediabetic levels sometimes) otherwise. We are all different - this is how it is for me.

 

[KennyA]

Does strict keto make any difference for Type 2's? I'm thinking if your glycogen stores are depleted, then there is nothing for the liver to dump out. Being a human body, i'm expecting it not to be so simple, but has anyone tried?

I'm in my fifth year of ~20g/day. I've been in ketosis - that is, producing and running on ketones for most of my needs - almost all that time. My liver is still manufacturing glucose, and I learnt recently that kidneys also produce a small amount.

As I understand it from reading Bilous and Donnelly, our livers can cunningly make glucose from a number of sources - and need to because we need around 130g glucose/day for brain processes. This is referred to as gluconeogenesis, which is not the same as glycogenolysis. Strictly speaking, gluconeogenesis is, as I understand it, creating new glucose rather than using stored glycogen.

B&D point out that at rest in the fasting state our brains use about 80% of the glucose utilised by the whole body. Brain glucose uptake is not regulated by insulin. The attached diagram showing carbohydrate metabolism is from Bilous and Donnelly and is less complicated than it first appears - NIMGU is non-insulin mediated glucose uptake; GLUT is Glucose transport; cats is catecholamines; cort is cortisol. Glcg is glucagon, and ins is insulin. Glucose comes in from either the gut or the liver: and goes to skeletal muscle, adipose tissue, and the central nervous system.

The liver section in the lower left shows the two processes of gluconeogenesis and glycogenolysis.

 

[TheSecretCarbAddict]

I discovered I had Dawn Phenomenon when I first tried CGM. My blood glucose levels shoot up as soon as I open my eyes in the morning. The attached pattern is based on me eating two meals a day at 1pm and 6-7pm, the morning increase is DP. The only way I can 'smooth' it out is to follow a low-carb diet, have my last meal of the day early, my evening meds just before bed and morning meds as soon as I open my eyes in the morning. My GP has recommended I try some resistance training first thing in the morning to get my muscles burning any excess glucose. This is next on my to-do when I have stabilised my diet.

 

[Paul_]

I discovered I had Dawn Phenomenon when I first tried CGM. My blood glucose levels shoot up as soon as I open my eyes in the morning. The attached pattern is based on me eating two meals a day at 1pm and 6-7pm, the morning increase is DP. The only way I can 'smooth' it out is to follow a low-carb diet, have my last meal of the day early, my evening meds just before bed and morning meds as soon as I open my eyes in the morning. My GP has recommended I try some resistance training first thing in the morning to get my muscles burning any excess glucose. This is next on my to-do when I have stabilised my diet.

Eating a small, low/zero carb breakfast can also often help reduce dawn phenomenon duration, as it's generally caused by your liver dumping glucose into your system when your stomach is empty.

Mine has improved over time, but I used to have eggs of some sort (boiled or omelette generally), if my dawn phenomenon was running riot with my BG levels.

 

[In Response]

My GP has recommended I try some resistance training first thing in the morning to get my muscles burning any excess glucose.

This sound counter intuitive to me.
I appreciate we are all different but, in general, resistance training g will raise BG and cardio will reduce it during exercise. Both will reduce BG over the next 24 hours but that will not help reduce the continuous rise first thing in the morning.
As @Paul_ (and I explained ), eating something small first thing in the morning can help reduce the continuous rise. By not eating breakfast, your body is thinking it is starving so your liver will continue to dump glucose until it gets the message that it does not need to.

 

[Melgar]

This sound counter intuitive to me.
I appreciate we are all different but, in general, resistance training g will raise BG and cardio will reduce it during exercise. Both will reduce BG over the next 24 hours but that will not help reduce the continuous rise first thing in the morning.
As @Paul_ (and I explained ), eating something small first thing in the morning can help reduce the continuous rise. By not eating breakfast, your body is thinking it is starving so your liver will continue to dump glucose until it gets the message that it does not need to.

I agree. If I do resistance training my BS shoots up by as much as 9-10 mmol/ls on top of whatever is my starting point. And like you cardio reduces my BS.

 

[Melgar]

To be honest I ignore my DP rise. Most of the time it rises up to around 8mmol/ls first thing. I simply close my eyes and sip on my morning tea then I watch the birds. Ed spelling

 

[Paul_]

This sound counter intuitive to me.
I appreciate we are all different but, in general, resistance training g will raise BG and cardio will reduce it during exercise. Both will reduce BG over the next 24 hours but that will not help reduce the continuous rise first thing in the morning.
As @Paul_ (and I explained ), eating something small first thing in the morning can help reduce the continuous rise. By not eating breakfast, your body is thinking it is starving so your liver will continue to dump glucose until it gets the message that it does not need to.

Agreed. Physical activity is a mixed bag in terms of it's effect on my BG, however I've only used fingerprick testing and haven't had the benefit of a CGM. Low intensity exercise, where my heart rate doesn't enter the cardio heart rate zone or higher, has seemingly little impact on my BG levels.

However, two consistent trends I've noticed is that 1) both cardio and resistance training at higher intensities (i.e. where either activity pushes my heart rate to high level cardio or anaerobic zone ranges), or 2) exercising while I'm hungry, will cause rises in my BG. Probably also worth noting that for me personally as a T2 diabetic, my BG levels reduce back down to pre-exercise levels within 90 mins to 2 hours of finishing the exercise session (if not lower than before) providing I'm not fasting/hungry. This will depend on insulin resistance though, so testing would be advisable for T2 diabetics who don't have a CGM.

@TheSecretCarbAddict - Please don't think we're recommending you not exercise here. Exercise is beneficial in a multitude of ways, particularly to diabetics, and that goes double if you're a T2 diabetic with a fatty liver. However, any stressful activity, be that physically stressful or psychological stress, will potentially cause your liver to dump glucose into your system for an energy boost - our livers are what ultimately make the instinctual flight/fight response and "moments of super human strength" possible after all, but it also applies that same talent when you're lifting weights or running in complete safety. @In Response raised a good point here and weight training while also experiencing dawn phenomenon, without eating first, could result in pushing your morning BG numbers higher again than you currently see.

 

[MissMuffett]

I’ve been reading Dr Elizabeth Bright’s book (and her YouTube talks), she says muscle building exercises (is that resistance training?) are better than cardio but she is targeting her audience on menopausal women and those with insulin resistance. I haven’t read as far as to why she suggests this but thought I’d put my two penn’orth in.

 

[Outlier]

Similarly to Melgar - I ignore my DP and know that any exercise at all raises my BG. So I read a fasting blood test before I eat, whatever time that is, or else after my morning walk and after I have been sitting relaxing for an hour or so. Stress, pain, emergencies and annoying stuff raise my BG too. I'll never be different, and earned my living in fast-response work, so that's just how I am.

 

[TheSecretCarbAddict]

Thanks all for useful pointers. Plenty of ideas to test out and see what works best as I continue on my journey. I've been procrastinating and putting off any kind of formal exercise for as long as I can, though . Sticking to my daily brisk walks for now. I have to say that just by doubling down on LC, my morning BG spikes are a lot more reasonable. Today's one was a small blip that lasted a couple of hours... this morning's routine was to take meds as soon as I'm awake, snack on a few almonds, and 30 min brisk walk with coffee after dropping off my car at my local garage.

I think my GPs reasoning around resistance training was that muscles will use up any BG available (at some point), and having more muscle mass in the long term will help with BG control anyway.