Questions about DP.

No question is daft if you don't know the answer.

I suppose how much it affects the HbA1c depends on how long the abnormally elevated levels last. If they only last an hour a day, then probably not a lot, but if they start early and/or last all morning then probably they will affect it.

If the FBG levels are affected by a liver dump, this may last until insulin resistance has gone or greatly improved. The liver dump has to disappear, and if your insulin can't clear the glucose the liver dumps (due to IR or insufficient insulin) then your levels will be higher until it can. Does that make sense?

Hi @Guzzler,

For the first half year after diagnosis and low-carbing, my liver dump in the morning was quite significant. I wasn't using a meter back then, but for both check-ups, my fasting levels were about 9.0 mmol (albeit after a brisk walk). They don't seem to have impacted my HbA1c much, though.

What @Bluetit1802 says does make a lot of sense and it would seem to depend on how long the higher blood sugar levels last in the morning.

I find it really an intriguing thought that the morning liver dump may be related to insulin resistance. Bluetit1802 -- do you remember where you read or heard this? I would really like to find out more about this.

ziggy_w said:

I find it really an intriguing thought that the morning liver dump may be related to insulin resistance. Bluetit1802 -- do you remember where you read or heard this? I would really like to find out more about this.

Click to expand...

It is all part of how our bodies work naturally. The pancreas and the liver work in tandem, regulated by hormones.

In normal healthy people the liver will dump glucose into the blood stream from its own stores whenever the hormones tell it the body is low on glucose for its immediate needs, such as overnight fasting, between meals etc. The pancreas picks up on this and secretes insulin to get to work pushing this glucose into the cells that need it. Job done. Glucose provided by the liver and carried by the insulin to where it is needed. The hormones then tell the liver to stop dumping (until the next time). We don't die. We don't hypo. No-one has zero glucose. It is a natural event designed to keep us alive.

In diabetics, this system breaks down. In T2s this is either because the pancreas cannot produce enough insulin, or because the insulin it produces is rejected by the cells due to insulin resistance. (Sometimes the reason can also be wonky hormones not giving out the right messages.) So we end up with too much circulating glucose (and insulin)

I have no idea what happens in the case of T1s but imagine it can be a nightmare situation for them having to juggle the injected insulin at the right time to clear the liver dumps.

I am dashing right now, but will try to find some links later.

Thanks so much for taking the time to explain, @Bluetit1802. This is fascinating.

It is difficult to be precise but my own personal experience is that my liver dumps started when I went really low carb, like keto low. Nothing I could do would stop them either and they would go up as I got up and hang around till lunch time (the full arc). They did not go above 7 though.
When I say I could find nothing to stop them - a brisk wall for me ramps my BG right down so if I was able to do so I went for a 20min walk and effectively walked it off.

It could of been coincidence and would of happened at the time in my diabetes journey but it did align when I went less than 20g of carbs a day.

Guzzler said:

I suffer disturbed sleep

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Do you mean you sleep poorly (as opposed to external causes disturbing your sleep ) ?
For about a year now I've definitely improved the quality and quantity of my sleep by taking non-flush niacin.
If you google 'niacin for sleep' you'll get some idea. It's meant to help :
- dropping off to sleep
- getting back to sleep on waking
- sleeping longer
- sleeping better

You'd soon find out if it works. Works for me and my better half.
Geoff

Fleegle said:

It could of been coincidence and would of happened at the time in my diabetes journey but it did align when I went less than 20g of carbs a day.

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That makes sense. The keto diet probably meant your glucose was low on rising from sleep, lower than previously, so your body tried to regulate matters by dumping stored liver glucose to raise the glucose levels, but your pancreas couldn't clear the glucose due to you still being insulin resistant (or because you have insufficient insulin production, but IR is far more likely). As far as I can understand, the best way to stop all that is to get rid of the IR by keeping insulin levels low and losing weight.

I am an underweight type 2 and I have up testing in the morning because no matter what I did I always had a high fb .My liver obviously thinks that I am dying ! Do any other under weight type 2s have the same problem of anyone know why this happens ?
CAROL

carty said:

I am an underweight type 2 and I have up testing in the morning because no matter what I did I always had a high fb .My liver obviously thinks that I am dying ! Do any other under weight type 2s have the same problem of anyone know why this happens ?
CAROL

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Some of us overweight T2s get it too.
My DP is totally governed by stress and sleep levels.
Food, timings and even fasting seem to have no effect whatsoever, unless I fast for prolonged periods - which as a controlling mechanism for DP is somewhat self defeating, lol.

Having said that, I can stop my DP from rising if I have a nut (Brazil) on waking. But I have no way of stopping it from rising before I wake.

Like you, I never test my fasting bg. Why start the day with a ?

carty said:

I am an underweight type 2 and I have up testing in the morning because no matter what I did I always had a high fb .My liver obviously thinks that I am dying ! Do any other under weight type 2s have the same problem of anyone know why this happens ?
CAROL

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I doubt whether underweight or overweight makes any difference. You can still be insulin resistant at any weight, or could still have insufficient insulin production at any weight. In either of these cases, your natural insulin isn't coping with the glucose from the liver dump. Or you could have wonky hormones (the hormones mostly involved are cortisol, growth hormones, glucogen) These hormones work to wake us up in the morning, mostly the human growth hormone, and cause a rise in blood sugars.

I have also read that when we have low growth hormones the DP is much less noticeable, and this is often the case in older people whose growth hormones diminish naturally.

Extract from https://www.dietdoctor.com/the-dawn-phenomenon


Just before awakening (around 4am), the body secretes higher levels of Growth Hormone, cortisol, glucagon and adrenalin. Together, these are called the counter-regulatory hormones. That is, they counter the blood sugar lowering effects of insulin, meaning that they raise blood sugars. The nocturnal surge of growth hormone is considered the primary cause of the DP.

These normal circadian hormonal increases prepare our bodies for the day ahead. That is, glucagon tells the liver to start pushing out some glucose. Adrenalin gives our bodies some energy. Growth hormone is involved in repair and new synthesis of protein. Cortisol, the stress hormone increases as a general activator. After all, we are never quite so relaxed as deep sleep. So these hormones gently get us ready to wake up. A good ol’ fashioned hormonal kick in the ass, so to speak. Hormones are secreted in a pulsatile manner peaking in the early morning hours then falling to low levels during the day.

Since these hormones all tend to raise blood sugars, we might expect that our sugars would go through the roof in the early morning. This does not actually happen.

Why? Insulin secretion also increases in the early morning to counteract the counter regulatory hormones. In other words, insulin is there to make sure blood sugars do not go too high. However, if you look closely at the blood sugar readings, there is a slight increase in the morning time.

So, in the normal, non-diabetic situation, blood sugars are not stable throughout 24 hours. The Dawn Effect happens in normal people. This is easily missed because the magnitude of the rise is very small – from 89 to 92 mg/dl. However, this effect was found in every patient studied. So, unless you are specifically looking for the DP, you are likely to miss it.


Think about it this way. Your body has the ability to store food energy as sugar (glycogen) and fat. When you eat, you store food energy. As you sleep (fasting), your body needs to release this stored energy. Around 4am or so, knowing that you will soon be waking up, your body prepares you for the upcoming day. It does this by increasing counter-regulatory hormones to release sugar into the blood. You can see that glucose production falls overnight and starts to ramp up around 4 am. In order to prevent the sugars from rising too much, insulin increases to act as a ‘brake’ on the system.

Now, what happens in the situation where you have T2D, or high insulin resistance? First, the technical explanation. Around 4 am, counter regulatory hormones surge and insulin is also released to counter this. However, in T2D, the body has high insulin resistance, meaning that the insulin has minimal effect at lowering the blood sugars. Since the counter regulatory hormones (mostly growth hormone) still are working, blood sugars rise unopposed, and therefore much higher than the normal non diabetic situation.

ziggy_w said:

Hi @Guzzler,

For the first half year after diagnosis and low-carbing, my liver dump in the morning was quite significant. I wasn't using a meter back then, but for both check-ups, my fasting levels were about 9.0 mmol (albeit after a brisk walk). They don't seem to have impacted my HbA1c much, though.

What @Bluetit1802 says does make a lot of sense and it would seem to depend on how long the higher blood sugar levels last in the morning.

I find it really an intriguing thought that the morning liver dump may be related to insulin resistance. Bluetit1802 -- do you remember where you read or heard this? I would really like to find out more about this.

Click to expand...

If a person isn't type1 or burned out type2 then insulin is produced to counteract liver dump, always.
So that insulin in average type2s produce will most likely will be resistant and therefore not null in void the liver dump.
Insulin injection diabetics may not take enough insulin so still get liver dumps. I give 10units of novarapid on rising. As when I ate a fatty protein before sleep the liver block worked but food lasted too long in my digestive system and often led to less weight loss.

Thanks @bluetit
At 74 K probably don't have much of the growth hormone left !! Our bodies are amazing even when they don't work quite how we would like them to
CAROL

ickihun said:

If a person isn't type1 or burned out type2 then insulin is produced to counteract liver dump, always.
So that insulin in average type2s produce will most likely will be resistant and therefore not null in void the liver dump.
Insulin injection diabetics may not take enough insulin so still get liver dumps. I give 10units of novarapid on rising. As when I ate a fatty protein before sleep the liver block worked but food lasted too long in my digestive system and often led to less weight loss.

Click to expand...

Thanks for your explanation, @ickihun. Much apppreciated.

Bluetit1802 said:

I doubt whether underweight or overweight makes any difference. You can still be insulin resistant at any weight, or could still have insufficient insulin production at any weight. In either of these cases, your natural insulin isn't coping with the glucose from the liver dump. Or you could have wonky hormones (the hormones mostly involved are cortisol, growth hormones, glucogen) These hormones work to wake us up in the morning, mostly the human growth hormone, and cause a rise in blood sugars.

I have also read that when we have low growth hormones the DP is much less noticeable, and this is often the case in older people whose growth hormones diminish naturally.

Extract from https://www.dietdoctor.com/the-dawn-phenomenon


Just before awakening (around 4am), the body secretes higher levels of Growth Hormone, cortisol, glucagon and adrenalin. Together, these are called the counter-regulatory hormones. That is, they counter the blood sugar lowering effects of insulin, meaning that they raise blood sugars. The nocturnal surge of growth hormone is considered the primary cause of the DP.

These normal circadian hormonal increases prepare our bodies for the day ahead. That is, glucagon tells the liver to start pushing out some glucose. Adrenalin gives our bodies some energy. Growth hormone is involved in repair and new synthesis of protein. Cortisol, the stress hormone increases as a general activator. After all, we are never quite so relaxed as deep sleep. So these hormones gently get us ready to wake up. A good ol’ fashioned hormonal kick in the ass, so to speak. Hormones are secreted in a pulsatile manner peaking in the early morning hours then falling to low levels during the day.

Since these hormones all tend to raise blood sugars, we might expect that our sugars would go through the roof in the early morning. This does not actually happen.

Why? Insulin secretion also increases in the early morning to counteract the counter regulatory hormones. In other words, insulin is there to make sure blood sugars do not go too high. However, if you look closely at the blood sugar readings, there is a slight increase in the morning time.

So, in the normal, non-diabetic situation, blood sugars are not stable throughout 24 hours. The Dawn Effect happens in normal people. This is easily missed because the magnitude of the rise is very small – from 89 to 92 mg/dl. However, this effect was found in every patient studied. So, unless you are specifically looking for the DP, you are likely to miss it.


Think about it this way. Your body has the ability to store food energy as sugar (glycogen) and fat. When you eat, you store food energy. As you sleep (fasting), your body needs to release this stored energy. Around 4am or so, knowing that you will soon be waking up, your body prepares you for the upcoming day. It does this by increasing counter-regulatory hormones to release sugar into the blood. You can see that glucose production falls overnight and starts to ramp up around 4 am. In order to prevent the sugars from rising too much, insulin increases to act as a ‘brake’ on the system.

Now, what happens in the situation where you have T2D, or high insulin resistance? First, the technical explanation. Around 4 am, counter regulatory hormones surge and insulin is also released to counter this. However, in T2D, the body has high insulin resistance, meaning that the insulin has minimal effect at lowering the blood sugars. Since the counter regulatory hormones (mostly growth hormone) still are working, blood sugars rise unopposed, and therefore much higher than the normal non diabetic situation.

Click to expand...

Thanks, @Bluetit1802. This makes sense. I was aware of glucagon and cortisol rising in the morning, just never thought about the insulin response not being effective due to insulin resistance.

Don't suppose anyone knows how DP works for T1 do they? 3 days a week I get up at 5 am to commute to my office. On these days I have a normal waking bg (this morning 4.9) but by 7.30 AM it was 12. Nothing to do with my carbs as I boringly always eat the same thing and take the same bolus. The other 2 week days I get up at 7am. Same breakfast, same bolus, similar waking bg, no 2-3 hour jump. I can only assume that my body doesn't like waking at 5am and dumps but doesn't feel the need to kick so hard at 7 am? Any thoughts anyone?

I may be talking through the top of my hat with T1, but we have the same bodies and hormones and liver.
Our livers will only be triggered to dump if our glucose is too low for the immediate needs. Could it simply be dumping because you are rushing about and commuting to your office with all that this entails - stress, rushing, showering and dressing, hurried breakfasts, travelling (are you driving?) Maybe your body feels you are too low for all this hectic stuff so the hormones trigger a liver dump but you have insufficient insulin on board to clear it?

On your non-work days, you will be relaxed and doing things slowly. No need for extra glucose from the liver.

Perhaps you should tag in some T1s for advice. I am a bit out of my depth here!
@tim2000s