Morning exercise peak - Extreme Dawn Phenomenon

[LittleGreyCat]

I'm being very strict on the low carbohydrates at the moment and also wearing a self funded Freestyle Libre.
In general my usual Extended Dawn Phenomenon [EDP] (start to rise at 06:00, rises until 12:00, then drops steeply) has been muted and in general all the numbers look good.

I have in the past noticed that if I take strenuous exercise in the morning my EDP goes higher and longer.

However the trace above is interesting if quite alarming.

The ride was roughly 10:30 - 11:45 to the coffee stop, then about 12:30 after coffee back to base.
The return ride was less strenuous (following wind) but still had a short sharp hill which had me puffing and grunting a lot.
So it isn't the riding per se which is pushing my BG up.
There seems to be something going on in the mornings where my liver insists on dumping glucose into my bloodstream where it is not being removed.

I can see that if I am in ketosis and my muscles are converted to running on ketones then the glucose won't be burnt as energy.
However there seems to be a broken mechanism where my liver keeps dumping glucose into my bloodstream even though the levels are far higher that normal.
This combines with not enough insulin being produced to remove the glucose.

I have talked about this in the past, with my current theory being that the Alpha cells in my pancreas are producing glucagon which does two things. Stimulates release of glucose from the liver and inhibits the release of insulin by the Beta cells in my pancreas. For some reason the glucagon production is not throttled by rising BG.

https://en.wikipedia.org/wiki/Glucagon
This is an interesting description.
It also contains the alarming statement:
"Glucagon production appears to be dependent on the central nervous system through pathways yet to be defined. In invertebrate animals, eyestalk removal has been reported to affect glucagon production. Excising the eyestalk in young crayfish produces glucagon-induced hyperglycemia"

Erk!
So although not an invertebrate (despite some unkind comments from friends and acquaintances) this may point to a CNS issue (though possibly not my eyestalks).

Further:
"
Secretion of glucagon is inhibited by:

• Somatostatin
• Amylin [21]
• Insulin (via GABA)[22]
• PPARγ/retinoid X receptor heterodimer.[23]
• Increased free fatty acids and keto acids into the blood.[24]
• Increased urea production
• Glucagon-like peptide-1

"
which raises some interesting questions.
(1) is the effect due to slow release of insulin?
(2) could ketone fuelled exercise be taking the ketones out of my blood and thus removing an inhibitor?
(3) I note that rising glucose levels don't seem to be listed as an inhibitor to glucagon production - which could explain a lot

Whatever, something somewhere is broken.
Probably in my pancreas.

If the pandemic ever subsides I might get to talk to an endocrinologist who understands this stuff.

Also, in the context of T1 diabetes:

"As the beta cells cease to function, insulin and pancreatic GABA are no longer present to suppress the freerunning output of glucagon. As a result, glucagon is released from the alpha cells at a maximum, causing rapid breakdown of glycogen to glucose and fast ketogenesis.[29] It was found that a subset of adults with type 1 diabetes took 4 times longer on average to approach ketoacidosis when given somatostatin (inhibits glucagon production) with no insulin"

Hmmmm....again.

I can see that when exercising strenuously in ketosis, fast ketogenesis might be a very good thing. However this seems to logical.

I need to look at somatostatin though.
What I could do with is a fast acting short duration pill which I can take just before a morning bike ride.

Edit:
https://en.wikipedia.org/wiki/Somatostatin
"Somatostatin inhibits insulin and glucagon secretion"
Oh, {bother}!
I need something that just inhibits glucagon production.

 

[ianf0ster]

Interesting. I'm not doing keto, just low carb (between 20gms to 40gms per day) with Restricted Time Eating skipping breakfast (sometime lunch too).

I found that when exercising in a fasted state, if it was gentle exercise it tended to lower my BG and if it was vigorous exercise it would raise my BG. I rarely had to take any action to stop my DP, but on those occasions my fasting BG was higher than I would like all it took was eating a little zero carb food (cheese or boiled egg) to tell my liver I was OK to hunt/gather my first meal of the day. I know that some people just use a coffee with double cream, butter or MCT for the same thing.

 

[LittleGreyCat]

I know that some people just use a coffee with double cream, butter or MCT for the same thing.

I read my post through, and realised that I hadn't mentioned my morning coffee, butter and double cream.
Must have been another post.
Anyway, that doesn't seem to affect my DP as I get the same if I just drink water.
Same DP if I don't exercise and more DP if I do exercise.

 

[LittleGreyCat]

@ianf0ster I've been thinking further on this.
To have an effect on EDP I would have to stimulate insulin production.
Fats won't do this, as they don't prompt an insulin response.
Mainly because there is no immediate need for insulin.

I will now experiment on low doses of fast acting carbohydrates to see if a short burst of insulin production will stop the EDP.
If so, I will then combine this with exercise.

 

[Smallbrit]

No words of advice as I am still experimenting with finding the solution, but just wanted to share that this happens to me too. I've been off the forum for a long while, and also off testing for a long while, but just started up testing again as it'll be my yearly appointment soon (sshhhh.... I know that's not what to do).

I have Zoom exercise classes in the morning three times a week, and noticed my numbers go higher afterwards instead of lowering. It's after coffee but with no eating beforehand. Whereas if I'm a sloth and do nothing numbers slowly go down. They go down a lot quicker if I eat something no carb. So my obvious solution is don't exercise at all but sit on the couch with an omelette

 

[LaoDan]

My exercise spikes are getting lower, from the 9-10s to 6-7s, not sure why, maybe it’s because I’m becoming more fit.

 

[DCB 2]

This it is exactly what I discovered with my swimming when I had a strenuous workout the numbers went up over time when I got into better condition I was not spiking as much. It took me a couple of months to find a happy medium. In my distant past I trained for competition now I swim for my health. It took some time change old habits ......

 

[Bubbleblower]

View attachment 44828 something that just inhibits glucagon production.

How about probiotics to change the expression of your beta cells that are now producing glucagon?
Loss of β-Cell Identity Occurs in Type 2 Diabetes and Is Associated With Islet Amyloid Deposits

Also I use tart cherry extract. It is rich in tryptophan which helps the body to produce melatonin, which should lower cortisol (which I suppose causes DP) a bit.

 

[ziggy_w]

View attachment 44828

I'm being very strict on the low carbohydrates at the moment and also wearing a self funded Freestyle Libre.
In general my usual Extended Dawn Phenomenon [EDP] (start to rise at 06:00, rises until 12:00, then drops steeply) has been muted and in general all the numbers look good.

I have in the past noticed that if I take strenuous exercise in the morning my EDP goes higher and longer.

However the trace above is interesting if quite alarming.

The ride was roughly 10:30 - 11:45 to the coffee stop, then about 12:30 after coffee back to base.
The return ride was less strenuous (following wind) but still had a short sharp hill which had me puffing and grunting a lot.
So it isn't the riding per se which is pushing my BG up.
There seems to be something going on in the mornings where my liver insists on dumping glucose into my bloodstream where it is not being removed.

I can see that if I am in ketosis and my muscles are converted to running on ketones then the glucose won't be burnt as energy.
However there seems to be a broken mechanism where my liver keeps dumping glucose into my bloodstream even though the levels are far higher that normal.
This combines with not enough insulin being produced to remove the glucose.

I have talked about this in the past, with my current theory being that the Alpha cells in my pancreas are producing glucagon which does two things. Stimulates release of glucose from the liver and inhibits the release of insulin by the Beta cells in my pancreas. For some reason the glucagon production is not throttled by rising BG.

https://en.wikipedia.org/wiki/Glucagon
This is an interesting description.
It also contains the alarming statement:
"Glucagon production appears to be dependent on the central nervous system through pathways yet to be defined. In invertebrate animals, eyestalk removal has been reported to affect glucagon production. Excising the eyestalk in young crayfish produces glucagon-induced hyperglycemia"

Erk!
So although not an invertebrate (despite some unkind comments from friends and acquaintances) this may point to a CNS issue (though possibly not my eyestalks).

Further:
"
Secretion of glucagon is inhibited by:

• Somatostatin
• Amylin [21]
• Insulin (via GABA)[22]
• PPARγ/retinoid X receptor heterodimer.[23]
• Increased free fatty acids and keto acids into the blood.[24]
• Increased urea production
• Glucagon-like peptide-1

"
which raises some interesting questions.
(1) is the effect due to slow release of insulin?
(2) could ketone fuelled exercise be taking the ketones out of my blood and thus removing an inhibitor?
(3) I note that rising glucose levels don't seem to be listed as an inhibitor to glucagon production - which could explain a lot

Whatever, something somewhere is broken.
Probably in my pancreas.

If the pandemic ever subsides I might get to talk to an endocrinologist who understands this stuff.

Also, in the context of T1 diabetes:

"As the beta cells cease to function, insulin and pancreatic GABA are no longer present to suppress the freerunning output of glucagon. As a result, glucagon is released from the alpha cells at a maximum, causing rapid breakdown of glycogen to glucose and fast ketogenesis.[29] It was found that a subset of adults with type 1 diabetes took 4 times longer on average to approach ketoacidosis when given somatostatin (inhibits glucagon production) with no insulin"

Hmmmm....again.

I can see that when exercising strenuously in ketosis, fast ketogenesis might be a very good thing. However this seems to logical.

I need to look at somatostatin though.
What I could do with is a fast acting short duration pill which I can take just before a morning bike ride.

Edit:
https://en.wikipedia.org/wiki/Somatostatin
"Somatostatin inhibits insulin and glucagon secretion"
Oh, {bother}!
I need something that just inhibits glucagon production.

Hi @LittleGreyCat,

I found the same thing. Blood sugar seems to rise more significantly when exercising in the morning (especially fasted) compared to doing the same exercise later in the day.

Personally, I have always put this down to insulin resistance of the liver (not turning off glucose production in the presense of insulin), but this doesn't really explain the difference between morning and evening.

 

[Ronancastled]

That low carb doc who wore the CGM was big on this.
https://threadreaderapp.com/thread/1163546496236752896.html

His first post deals with a spike from a short run

He noted that open water swimming produced a lesser spike

 

[finzi1966]

I have exactly the same problem and wrote about it in a thread a few days ago (Is Exercise doing More Harm than Good). Things I’m starting to realise:

Gentle exercise is better than strenuous
Evening exercise DEFINITELY better than morning exercise
For me fasted or not doesn’t make a difference
A walk after dinner seems to help with BG levels then

(By “better” I mean less likely to spike)

I have to take the dog for a walk first thing so I don’t have a choice but I’ve found doing it at a gentle leisurely pace has been easier on my BG than my usual brisk pace.

 

[Stefans]

@LittleGreyCat, I just saw that you are T2, I'm T1 and assumed you were also, but since I wrote all this I might just as well post it, since it might help anyway.

View attachment 44828
However there seems to be a broken mechanism where my liver keeps dumping glucose into my bloodstream even though the levels are far higher that normal.
This combines with not enough insulin being produced to remove the glucose.

Yes, your Dawn Phenomenon seems to be quite extreme. I have struggled with this for a long time, and I have found no good info on how to improve the situation.

View attachment 44828
which raises some interesting questions.
(1) is the effect due to slow release of insulin?
(2) could ketone fuelled exercise be taking the ketones out of my blood and thus removing an inhibitor?
(3) I note that rising glucose levels don't seem to be listed as an inhibitor to glucagon production - which could explain a lot

Whatever, something somewhere is broken.
Probably in my pancreas.

What I have read is that insulin production stops glucagon production, not high blood sugar directly. I.e. the 'sensor' that controls glycagon productions detects the amount of insulin that is produced/comes out of the pancreas, normally due to rising blood sugar, if you are T1, it will not trigger since your pancreas is 'broken', but as a T2 it should work, interesting.

Back to 'Dawn Phenomenon', for me, it is clear that my blood sugar goes up when exercising.
But also for 'stress full' activities without real exercise, like riding a motorcycle home from the office through bad traffic. In a way just waking up is also a stressful activity, so maybe that's the same thing. I think that Dawn Phenomenon is supposed to start before you wake up, I don't notice that much, my effect happens when I wake up.
The effect in me is often 1.5 to 2 mmol/l raise, but it is not consistent, this morning it was about 1 mmol/l some days it can be 3+ and sometimes nothing. So I can't correct before I have seen the spike.

I feel that I have a lower spike now than 3-6 months ago, my general control during the night is better now, I rarely go above 7, and I wonder if that means that I don't have as much glucagon in my liver and that make this effect less? Anyone have any experience in this?

I'm very low carb/wannabe carnivore T1, but I do treat myself with 85% dark chocolate too often .