Dawn Phenomenon

[scw33]

I am a type 1 diabetic and for the last 6 months have integrated a fairly strict dietary plan into my life. My two 3 month averages since my changes have been respectively 97.2 & 93.6.  Although I am happy with the results I have had confusing disparities regarding my morning blood sugar readings.  I take 20 units of lantus before bed, but wake the following morning with results from anywhere between 60 & 144 despite having consistent ideal blood sugar readings after meals. These are consistent because I have the same number of carbs (45grams) for every meal at the same times every day. My edo suggested that I take less Lantus - 16 or 18 units, in order to counter the possibility of rebound highs in the night.  However, I find that my 3:00AM readings are consistent with my bedtime readings and therefore, somewhat negate his suggestions.  As I am strict about my control, I would appreciate any feedback about how I can further tighten my morning results. I have experimented with injection sights, and having multiple smaller injections to increase the absorbtion efficiency of the Lantus, but find that this does not significantly influence my morning readings. And, as I have pointed out, since my morning readings can be from anywhere between 60 - 144, I am not fully satisfied with the explanation that this "dawn phenomenon" can be simply deduced from having a dorment liver that starts producing its own sugar after 8 to 10 hours - since I would logically be 144 every morning... Thankyou

[xtina9999]

Glucagon is the main culprit, as is a high fat meal.  Glucagon causes the release of liver glucose and a high fat meal( like pork ribs) can cause a delayed elevation.  Both of these situations are frustrating because you can match perfectly carbs:insulin, but still end up higher than you like.  Interestingly, alcohol can suppress the release of glucagon, as you may have noticed a low reading after an evening of a couple of drinks (no carb. of course).  Keeping your meals under about 20 grams of fat could help too.  I also have found that the supplement Alph Lipoic Acid 300-500 mg. before bed helps (increases insulin sensitivity).  I battle this problem a lot and I can't find anyone with a good solution.....Yet I keep  on searching.

[enbridge]

I am a 51 year old male who has had Type 1 for the last 20 years.  I have found that whatever hormone triggers the liver to release sugar is not consistent and can vary in me from occurring between 4:00am and 10:00am or not occurring at all on any given day.  About 12 months ago, I started to take metformin 3 times a day and this seems to stop it from happening almost every night to maybe once a week.  My insulin doses have also been reduced by about 20 - 30% since I started taking it.

[JDRF-Team-LRS]

Another volunteer here to endorse what's been posted already and also to say that females also experience fluctuations due to our hormonal cycles.

Many diabetic women run a bit higher & are more insulin resistant in the days leading up to their periods.  They then will be battling lows for some of the days during their period.

It sounds as tho' you're doing a great job to learn how you body responds to food & insulin.  With your great control, you are also helping to avoid complications.  Be careful of lows (which can also cause harm) if you're regularly waking up around 60.

If you're a data fiend like me (and it sounds like you might be!), consider jotting down your FBS every morning for, say 4-6 weeks.  Then you might see patterns related to hormones, life & health.  That's not to say you can *control* those things, but sometimes it's a comfort to be able to explain some of the variations.  

Truth is, tho', there are those days, weeks or longer where "stuff happens."  I like to say that healthy diabetics are folks who develop "marathon" skills to manage our situation, rather than perfecting "sprint" skills.

[JDRF-Team-cb]

I have to agree with RL.  I have been diabetic for the past 25 years and sometimes your readings aren't want you expect or want.  I don't mean to sound like you can't do anything about your readings, because it sounds as if you are doing a terrific job!  Being diligent is a good thing.

Some mornings I wake up with a reading of 90, then I run on my treadmill and I could have a reading of 200 only an hour later!--with no snack!!--seems bizarre!  But it has happened-sometimes you just have to roll with it and not worry quite so much.  (Just to let you know my A1C's are ussually between 6.8-7.0.)
I just got a newsletter about diabetes that said handling diabetes is an art, not a science. I agree!

RL also mentioned about stress-I have to tell you if I am stressed out about my job or kids or have a disagreement with my husband it affects my blood sugars as well.  If you are sick, even with just a cold it can throw off your readings as well.  
Also I have found that certain foods cause a rise in blood sugar hours later, for example popcorn makes my blood sugars rise hours later and I completely avoid pizza because it always does a number on my readings.  You may have discovered that certain foods react differently for you as well.
This may not have been what you wanted to hear-but I hope it has helped!

[JDRF-Team-RL]

Hi, "Dawn"!  ;-)

I'm not a medical professional, just a parent of a child with diabetes.  You should be commended for following such a strict diet and monitoring regimen, you are certainly working to maintain your continued health.

One thing we've learned with our child is that there are many more factors that go into your glucose readings than just carbs eaten and insulin injected.  Physical activity, stress, the amount of sleep your getting, and many more things affect your scores.  Even the types of food you eat affect your scores.  Research shows that blood glucose levels for non-diabetics vary during the day, so it's fully expected that they will do the same for diabetics, particularly since insulin addition to the bloodstream is not an automatic response to food like it is for everyone else.  Our endo has told us to not get hung up on trying to maintain a specific number, that as long as her a1c's are good (she's been 6.8 and 6.9 consistently) and as long as her numbers stay within the 80-180 range as much as possible, that she's doing well.  

So that's my advice, to understand that there are many factors that determine glucose scores, and that staying within the allowed range is much better than trying to hit a fixed target.  Logic has nothing to do with predicting glucose scores.  Highs and lows will happen, and the type of monitoring that you are already doing will keep those to a minimum.