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dawn phenomenon

Diabetes Complications

The Dawn Phenomenon: A Diabetes Puzzle Solved

The dawn phenomenon is one of the most disturbing challenges for those of us who have diabetes. Many of us wonder about the puzzle of why our blood sugar level spontaneously rises during the last hours of sleep each night.

This has also mystified our doctors and medical researchers, so much that they have published at least 187 articles in the professional literature during the past three decades since the first study of the subject appeared. But four new studies by European researchers just published in American professional journals have shown a bright light that clarifies the major questions we have had about the dawn phenomenon. We now know who gets it, how bad it is, how much it impacts our A1C levels, and how to prevent it.

Whether you have type 1 or type 2 diabetes you are likely to have the dawn phenomenon. However, dawn levels among people who don’t have diabetes rise only slightly, if at all, “because they secrete insulin to prevent it,” according Francesca Porcellati, MD, and her associates at Italy’s University of Perugia. Their study, “Thirty Years of Research on the Dawn Phenomenon: Lessons to Optimize Blood Glucose Control in Diabetes,” appears in the December 2013 issue of Diabetes Care, a professional journal of the American Diabetes Association. The full-text of this study is free online.

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Diabetes Diet

The Long Dawn Phenomenon

Our bodies are more sensitive to carbohydrates in the morning. That’s why Dr. Richard K. Bernstein recommends that we eat half as many grams of carbs for breakfast compared with lunch or dinner.

“I usually advise patients to restrict their carbohydrate intake to no more than 6 grams of slow-acting carbohydrate at breakfast, 12 grams at lunch, and 12 grams at supper,” he writes in his book Dr. Bernstein’s Diabetes Solution. He knows from experience that carbs at breakfast will raise our blood glucose level more than at meals later in the day, but his book doesn’t tell us why that is a fact.

This difference has puzzled me for years. But now I understand.

I am in San Diego for the 71st Scientific Sessions of the American Diabetes Association. Yesterday a late-breaking poster here explained it for me.

The poster, “Morning Hyperglycemia: Breakfast or Dawn Phenomenon,” tells us more about the dawn phenomenon than we ever knew before. In the past we understood that it began about 4 a.m. and ended about 8 a.m., the typical start of breakfast. The new study by Dr. Allen King, an endocrinologist practicing at the Diabetes Care Center in Salinas, California, and two of his associates there, had 37 subjects skip their breakfast to see what happens.

The subjects used a basal insulin, Lantus, and a continuous glucose monitor. The CGM showed that in fact the dawn phenomenon doesn’t stop at 8 a.m. The dawn phenomenon does rise at 4 a.m., but it peaks at 10 a.m. and doesn’t return to baseline until 1 p.m.

“The dawn phenomenon contributes a major share to the ‘breakfast’ meal hyperglycemia,” they write.

One of my most popular posts here, “Taming the Dawn Phenomenon,” has 99 comments as of today. That post has many suggestions by me and others about how to keep our blood glucose levels in check.

Now, we know that minimizing carbs at breakfast is another arrow in our quiver.

This article is based on an earlier version of my article published by HealthCentral.

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Diabetes Developments

The Trouble with Glucose Testing

A big new review shows that people who don’t use insulin are wasting their time and money when they test their blood glucose.

I agree.

And I still recommend that everyone who has diabetes test his or her blood.

Do I contradict myself? I don’t think so.

The new review comes from the Cochrane Collaboration, the most respected group that reviews scientific studies. Six European experts reviewed a dozen randomized controlled trials of 3259 people with diabetes. The review, “Self-monitoring of blood glucose in patients with type 2 diabetes mellitus who are not using insulin,” just appeared in the Cochrane Library.

The main conclusion of the study is that, “Glycaemic control in patients with type 2 diabetes who are not using insulin is small up to six months after initiation and subsides after 12 months.” I’m surprised that it has even a small effect.

Actually, blood glucose testing doesn’t have any effect on our levels. Testing is a tool that we have to learn how to use. And few of us are lucky enough to have a doctor or nurse who will take the time to show us what to do.

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Diabetes Testing

Why We Check Our Blood

With all the emphasis on how we check our blood glucose levels using all the new meters that we can choose from, many of us who have type 2 diabetes forget or never learned why we check our levels. Anyone who has type 1 diabetes has to know why he or she checks as do those type 2s who uses insulin. Those of us who inject insulin check their levels so they can take more if their levels are too high or take a glucose tab or something similar if they are too low.But three-fourths of all type 2s don’t take insulin. Some of them still use the first oral medication, one of the sulfonylureas that can cause hypos, a level below about 70 mg/dl. Then they too will need to take something like a glucose tab to bring their level back to normal.

The overwhelming majority of all people who have diabetes rarely if ever get hypos. So why should they go through the trouble of checking their blood glucose? What can they do with that information?

If our doctors and nurses ever told us why, most of us have forgotten by now. As a result, a lot of people with diabetes don’t bother at all any more with blood glucose checks.

That’s a shame, because even people who don’t use insulin or one of the sulfonylureas, can benefit from checking if they do it at the right time.

The most right time is after eating a big meal, especially one that has a substantial amount of starch in it. Nothing raises our blood glucose level as much and as fast as starch — the stuff in potatoes and grains and grain products, like bread, bagels, pizza, or anything made from wheat flour.

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