The Diabetes Dawn Phenomenon: Why It Happens, What To Do
How frustrating to wake up in the morning with elevated blood sugar when all you did was dream about eating a piece of cheesecake.
The dawn phenomenon is actually the body’s response to an aspect of its own natural rhythms.
Why It Happens
The human body, with its wired-in wisdom, releases hormones such as cortisol, catecholamines, and growth hormone during the early morning hours. These hormones help maintain and restore the body’s cells, and they trigger the liver to release glucose. The rising glucose is meant to be regulated by circulating insulin.
Many people with diabetes do not have enough circulating insulin during predawn hours to regulate this end-of-night surge in blood sugar, so they are greeted on waking by the rising sun and an elevated morning glucose reading.
What to Do About It
A recent research study suggests that taking basal insulin in the evening is the only effective solution to the dawn phenomenon. However, if you are not currently taking insulin, consult with your doctor, and consider trying one of these possible dawn effect solutions:
- Exercise late in the day. Being active closer to bedtime may lower your blood sugar while you sleep.
- Adjust your medication(s). Talk to your physician about tweaking your medication(s) to counter the higher morning readings.
- Eat breakfast. When you eat breakfast, your body will tell the predawn glucose-stimulating hormones to give it a rest.
- Limit late-night carbs. In the evening, snack on items that have high protein and fat content such as peanut butter, meat, cheese, or nuts. These foods digest more slowly than carbohydrates, keeping glucose levels steadier.
Evidence for Evening Insulin?
The result of one research study does not prove anything, but it suggests something that may prove true.
Researchers at the Université Montpellier in France studied the dawn phenomenon in people with type 2 diabetes being treated with diet alone or with non-insulin medications.
The 248 study participants were examined for 48 hours using continuous glucose monitoring; 50 percent of them experienced the dawn phenomenon. The investigators defined the dawn phenomenon as a greater than 20 mg/dL rise in blood sugar.
The researchers concluded that:
- The dawn phenomenon is already active in some individuals being treated for diabetes solely by diet; and diet does not regulate the phenomenon.
- The dawn effect is not effectively blunted with oral hypoglycemic agents such as metformin or sulfonylureas, even in combination.
“We are unable to control the dawn phenomenon with our current armamentarium of oral hypoglycemic agents, even though metformin is probably the one that has the highest potency for reducing [it],” said researcher Dr. Louis Monnier. “My position is that insulin should be considered for the treatment of type 2 diabetes as soon as the A1C becomes greater than 7 percent when patients are already treated with maximal tolerated doses of oral agents.”
Keep Calm and Carry On
Keep calm, consult your doctor, and carry on. Stay informed and continue tweaking your diabetes management regimen to get results you and your professional team are satisfied with.