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Need some advice please

J

JW71

Member
Messages
11
Hello everyone,

I have not been on here for a while as things were going well.

I have GDM and I am now 31 weeks pregnant, diagnosed in week 9. My blood sugar has really started to swing in the past week highs and lows all over the place. I rang the Diabetes team today with my readings and mentioned that I have been waking up with high blood sugar, a thumping headache and the general feeling that I had gone 10 rounds with a boxer! My diabetes nurse now wants me to test at 2 am and 4am to check to see if I am having hypos in the night. How could this be if I am waking up with high blood sugar?

Has anyone got an explanation as to how this can happen please? What is the clinical and or physiolocal reason?

Many thanks in advance

Julie x
 
I think what the nurse is looking for is ,if you go too low in the night the liver 'dumps' glucose into your system causing your blood sugar to be too high in the morning. This can sometimes be counteracted by eating a fat and protein based snack before bed. Keep a record of your numbers and see what the nurse has to say about them.
 
Thanks Sue, would this be the "dawn phenomenon" ? I have been having a frantic read on the web after looking at a thread answered by Ken. Is this possible in GDM? The info is mostly related to type 1. x
 
DAWN PHENOMENON

Everyone, diabetic or not, exhibits some Dawn Phenomenon. It is a natural part of our bodies' circadian rhythms. Some have said it is the way our ancestors had the strength to rise and slay a woolly behemoth for breakfast.

Since most of us fast while sleeping, with teenagers a possible exception, our bodies use stored energy during sleep. The body uses all three macro-nutrients (carbohydrates, proteins, and fats) to store energy.

The most easily used is the storage medium of carbohydrates, called glycogen. Glycogen is made from glucose, and is stored in the liver and muscles. Since it is basically nothing more than a complex matrix of glucose, it is easy for the body to store and use, something the body does all day long. The technical term for the act of creating and storing glycogen is glycogenesis. When the body calls for the conversion of glycogen back to glucose it is called glycogenolysis.

Another macro-nutrient that is available to be converted to glucose is protein. Most of us think of our protein as being stored in muscle, but the body has protective mechanisms to make muscle wasting its last choice. One of the most useful and readily available sources of protein storage is in blood components, i.e., albumin (plasma). The body uses a process performed in the liver to convert amino acids, the building blocks of proteins, into glucose. The name for this process is gluconeogenesis, literally "the creation of new glucose".

So, what does all this have to do with a high fasting BG? Overnight, usually between 4am and 11am, your body releases some hormones. These are Growth Hormone (GH) from the anterior pituitary gland, cortisol from the adrenal cortex, glucagon from your pancreatic alpha-cells, and epinephrine (adrenalin). These hormones cause an increase in insulin resistance, raising your BG. In addition, these hormones trigger glycogenolysis and gluconeogenesis, adding stored or new glucose to your bloodstream.
 
Are Dawn Phenomenon and liver dumps really the same thing? DP seems to result in bg levels going up by maybe 3 mmol/l, but a liver dump follows a very bad hypo, seeing bg levels sky-rocket? I once tested at 31 mmol/l the morning after having a disabling hypo the previous night.

So DP would be triggered by hormone release:
sugarless sue said:
So, what does all this have to do with a high fasting BG? Overnight, usually between 4am and 11am, your body releases some hormones. These are Growth Hormone (GH) from the anterior pituitary gland, cortisol from the adrenal cortex, glucagon from your pancreatic alpha-cells, and epinephrine (adrenalin). These hormones cause an increase in insulin resistance, raising your BG. In addition, these hormones trigger glycogenolysis and gluconeogenesis, adding stored or new glucose to your bloodstream.
Click to expand...
and tends to be a mild increase in bg, whereas the trigger for a liver dump is extremely low blood sugar, the body's last ditch attempt to get bg levels up resulting in very high subsequent readings?

Or am I just splitting hairs and the only difference is the degree of the same process?! :roll:
 
Keg.

It has been explained many times before. They are the same process.
Here is a link to just one explanation about it and the article.
http://ezinearticles.com/?Understanding ... id=2422851

An extract:
Liver dump, dawn phenomenon and dawn effect are all common terms that describe the same condition. It is an abnormally high early-morning fasting increase in blood glucose. It usually occurs between 4:00 AM and 8:00 AM. It occurs in everyone's body, but it has more impact on diabetics than normal bodies. It is more common in people with type I diabetes than in people with type II diabetes. Understanding the phenomenon can go a long way towards helping diabetics manage it.
 
Thanks for the article link Ken which I read with interest, sorry for apparently wasting your time. However the following extract from this article suggests the two conditions are quite different:

  • "In some cases (not commonly), the phenomenon may be the result of a rebound from a low blood glucose level that has occurred during the night. This is commonly referred to as the Somogyi effect. The dawn phenomenon, unlike the Somogyi effect, it is not the result of antecedent (preceded by) hypoglycemia; they are not the same condition."
On further investigation I found the following excellent link which explains the difference in more detail: http://xrl.in/2tgr
 
Cheers Keg.

Yes the Somogyi effect and the Dawn Phenomenon are not quite the same. That is mentioned in the article/s that you and I both referred to previously. I thought we were talking specifically about DP and LD's ? Still no matter.

However if you talk to your Endo and ask him/her to explain the Dawn Phenomenon and the Liver Dumps they will explain that they are the same process just at different times. A liver dump can happen at any time and elevate the Bg levels. I'm not an Endo so can only pass on the facts from them to you. If you want further clarification then speak to them. If you find anything different then let us know.
 
Oh that's so annoying, my consultant and GP always refer to the "rebound hyperglycaemia" as a liver dump, and dawn effect separately. I've now also found other references doing the same, hence my confusion. But it sounds to me like they're quite similar in terms of what is happening in the liver (i.e. glycogen released), just with different triggers and severity of action. Anyway thanks for clearing that up.
 
Yeah I read that, but I wouldn't dare - I know next to nothing about Byetta or other T2 medication to offer advice. Hope you get it sorted.
 
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