Early morning blood sugar rise immediately before or after waking is known dawn phenomenon. It is normal phenomenon both among diabetes and non-diabetes.
How is my morning glucose so high without eating anything yesterday night?
On seeing this you may amaze, how is it possible to have a raised morning blood-glucose level without eating anything in the previous night? Actually, even if you are in a low-carbohydrate diet, your dietary protein or fat is breaking down into sugar for energy needs and raises your blood-sugar level, your liver stores this excess glucose in the blood stream as glycogen for future use.
When you are in fasting then blood-glucose level drops, your liver responds to this by releasing glucose into the blood stream from its storage. Your body is less capable of moving glucose from your blood stream into the cells at night. Because the hormone cortisol level rises when you are sleeping, this interferes with the way insulin works. These factors altogether make your blood-glucose level to shots up in the morning.
What is Dawn Phenomenon?
Dawn phenomenon is an early-morning blood sugar rise occurs just before or shortly after waking; it is a normal phenomenon for both diabetes and non-diabetes. However, it can become very difficult for some diabetics to manage their fasting blood sugar level. Such individuals may need to modify their treatment to counteract dawn phenomenon.
It is quite natural that your body increases certain hormone production during 4 a.m. and 8 a.m. These hormones include growth hormone, cortisol, catecholamines, glucagon and adrenaline. These hormones (natural body proteins) may suppress insulin activity. Insulin is a hormone help glucose transports into cells for energy thus reduces blood sugar levels.
These hormones instruct the liver to dump enough glucose into the blood stream to provide energy to wake up your body. If you are a non-diabetic, then your body can respond by releasing required insulin, thus your blood glucose level managed to be at normal. However if you are a diabetic with dawn phenomenon, then you either fail to release adequate insulin or improper use of available insulin. Therefore, glucose continues to rise to abnormal high levels.
The dawn phenomenon effect on diabetics varies; some affected most with very high morning blood sugar level and others less affected with marginal BS raise. Additionally few diabetics find their blood glucose rises continuously until they ate something in the morning. For others the level managed to settle down after few hours of waking, regardless of whether they eat or not.
However, in some cases this high glucose level in the morning may be due to factor other than dawn phenomenon known as rebound hyperglycemia or Somogyi effect. Rebound hyperglycemia is during sleep you may experience glucose level drop due to lack of food overnight. To compensate this drop your liver responds by releasing stored glucose, thus blood glucose rebound to abnormal high levels.
Dawn phenomenon symptoms and diagnosis
There is no specific symptom for dawn phenomenon, if you have consistent high blood glucose level in the morning may indicate this condition.
To distinguish between rebound hyperglycemia and dawn phenomenon (both have high blood sugar level in the morning); you need to wake up in the middle of the night at 2 to 3 a.m. to test your blood glucose. If the blood glucose level is consistently normal or high, then it can be due to dawn phenomenon, if otherwise Somogyi effect.
Dawn phenomenon treatment and prevention
There is no standard treatment for dawn phenomenon; instead, the treatment is specific to you (individualized). The DP treatment options are modifying the
- Bedtime diet – do not eat carbohydrate before going to bed, you can eat a snack containing protein or fat and is low in carbohydrates e.g. nuts or cheese.
- Exercise – heavy exercise or physical activity at night can cause lows at night that may trigger DP.
- Medication or insulin – you may need to change medication or insulin dosage, need to change medication, need to change to different profile of insulin, or schedule it properly, so that peak action occurs during glucose level start rising. Metformin can cut down glucose production by the liver, and is in effective use to treat dawn phenomenon.
Insulin and insulin stimulating medications can work effectively to curb DP, when your problem is insufficient insulin production to fulfill overnight body process. However, these medications may itself aggravate the DP if you have not properly adjusted; it can lead to low blood glucose. You need to do lot of test and adjust accordingly to achieve right levels and timing of diet, exercise and medication for your body.