I’ve recently started to have my diabetic reviews with a teaching hospital in Ireland, the second of such two days ago. Dismayed by the doctor’s tendency to see me as a statistic rather than a guy with specific difficulties, she changed my meds to address problems she thought I SHOULD have (but honestly don’t) and dismissed anything I said that apparently contradicted her assumptions. One of those was the Dawn Phenomenon. This, as I understand it, is the liver dump EVERYBODY experiences as they rouse themselves for the day but is problematic for diabetics because it isn’t accompanied by the insulin release to counteract it, resulting in high blood glucose levels for diabetics in the early morning. Now, from my reading, this seems to be a widely-recognised condition, with diabetes education sites saying half of the Type 2 diabetics are affected by it. But it seemed that this diabetic clinic were quite unfamiliar with the term and not interested in it. In fact, though my glucose log shows higher levels in the morning than the previous bedtime (I do know fluctuations are normal and that as long as the difference between the bedtime levels and morning levels is at most 1.6, things are alright), she latched onto only the past two weeks where I told her I had started low-GI oatmeal with pecan nuts at bedtime to investigate the possibility of rebound from hypos during the night was my problem. Conveniently dismissing the constant overnight readings for the past three months of my current log (and the evidence of the previous five years), that my levels rose overnight even though I habitually stopped eating at 6pm and that only changed when I introduced the porridge for supper two weeks ago, she blamed the whole thing on me for not taking bolus insulin with that porridge. Seriously, I ask you, is 3oz oats and an 1oz of pecans likely to make you hyperglycemic starting from a target glucose level (specifically from 6.2 at bedtime to 15.8 by the next morning)? So, my question, do Irish diabetics know if the Dawn Phenomenon is a known thing in Ireland? Did I buy into some kind of bad science and should I just forget all about it? It does make it all futile because this is happening and it’s sabotaging my efforts. I’ve addressed the exercise, food, sleep and mental health issues and as far as I can see, it’s the medical dimension that really needs to step up. One last thing. I have hereditary hemochromatosis which, though largely unmanifested, does impact insulin sensitivity and carb tolerance negatively, both things also adversely affected by circadian rhythms (meaning evening carbs cause a wallop of a sugar spike and insulin is largely ineffective in dealing with it. I have found that ten minutes’ challenging exercise with weights can bring my glucose levels down by over four points.). But what I know about that might be bad science - and I have little confidence in this doctor’s ability to hold up her end in a conversation about that.