On March’s Diabetes Late Nite podcast we discussed nighttime diabetes management including the answer to this perplexing question:
Do you wake up with a blood glucose level that’s higher than when you went to bed?
The dawn phenomenon, also called the dawn effect, is an early-morning (usually between 2 a.m. and 8 a.m.) increase in blood sugars and can be a constant source of frustration and irritation for people trying to manage their diabetes.
According to the American Diabetes Association the rise in glucose is mostly because your body is making less insulin and more glucagon (a hormone that increases blood glucose) than it needs. The less insulin made by the pancreas, the more glucagon the pancreas makes as a result. Glucagon signals the liver to break down glycogen into glucose. This is why high fasting blood glucose levels are common in people with type 2 diabetes.
According to columnist Wil Dubois, the higher your A1C, the more likely you are to have a significant dawn phenomenon. It could be that spending a number of hours each morning out of control is having a significant effect on your overall control.
So it’s worth trying to get dawn phenomenon under control. How can you do that? You have to figure out what is triggering it and then try some possible solutions.
Some people have high glucose levels in the morning because their medicines wear off overnight. This could be true of medicines like insulin, sulfonylureas, and metformin. If you are taking any long-acting medicine, consider asking your doctor about changing meds, doses, or times.
Mayo Clinic doctor Maria Collazo-Clavell, MD, says avoid carbs at bedtime. She also says an insulin pump can help a lot. You can program it in advance to increase your insulin when the dawn phenomenon starts to kick in. You might have to check a few middle-of-the-night levels to find out when the phenomenon starts for you, or if you are going too low.
“Some people with dawn phenomenon find that their glucose continues to rise until they eat in the morning. For others, levels will settle down a few hours after waking, regardless of whether or not they eat,” according to the American Diabetes Association.
Keep in mind, everyone has a dawn phenomenon. Otherwise they’d be too weak to get breakfast. But in people without diabetes, insulin levels also increase to handle the extra glucose. People with diabetes can’t increase insulin levels that much, so their early morning blood glucose levels can rise dramatically.
LISTEN NOW: My full interview with one of the Charlie’s Angel of Outreach, Patricia Addie-Gentle RN, CDE about the dawn phenomenon on March’s Diabetes Late Nite inspired by Gladys Knight & The Pips.