If you have diabetes, have you ever noticed that your blood sugar levels suddenly increase when you wake up in the morning? You may be wondering why this happens even though you take your medication at night and control your diet. Don't worry, one reason for this could be the 'Dawn Phenomenon' that we're talking about today. Let's see what it is, why it happens, and how to avoid it.
What is the Dawn Phenomenon, this increase in blood sugar in the early morning?
Simply put, the 'Dawn Phenomenon' is a natural increase in blood sugar levels in the early morning due to certain hormones produced by our bodies. This only affects people with diabetes. This is the main reason why you with diabetes experience high blood sugar (hyperglycemia) in the morning.
But remember, this is not the only reason why blood sugar levels rise in the morning. There can be several other reasons:
- Not enough medication: Sometimes the amount of medication taken at night may not be enough by morning, and its effect may be lost.
- Mismatching medication and food: Not calculating the correct amount and time to take medication with dinner.
- Somogyi effect: This is a bit of the opposite. Sometimes, the amount of insulin released at night increases, causing blood sugar to suddenly drop significantly. The body then releases a hormone in response, causing blood sugar to rise again. This is called the 'Somogyi effect'.
How common is this?
Dawn Phenomenon is actually a very common condition among people with diabetes. Research has found that it affects more than 50% of people with either Type 1 or Type 2 diabetes . This means you are not alone.
What are the symptoms of this?
The main sign of the 'Dawn Phenomenon' is an increase in blood sugar levels in the early morning. You can see this when you wake up in the morning and check your glucometer, or if you use a CGM (Continuous Glucose Monitoring) device. Often, the 'Dawn Phenomenon' causes a pattern of high blood sugar levels in the morning for several days in a row.
Depending on how high your blood sugar is, you may experience symptoms like these when you wake up in the morning:
- Feeling excessively thirsty (polydipsia).
- Feeling more hungry.
- Frequent urination.
- Headache.
- Irritability, getting angry.
- Blurred vision.
Imagine, there is a person named Malani, who has diabetes. She checks her blood sugar every morning. For three or four days in a row, her blood sugar in the morning is more than 200mg/dL. She also controls her food intake at night and takes her medicine on time. She feels very frustrated. She feels a little tired when she wakes up in the morning, and she drinks a lot of water. Has something like this happened to you? Then it is possible that it is the 'Dawn Phenomenon'.
Why is this happening?
This is a bit of a scientific fact, but I'll put it simply. In the early morning – that is, between 3 and 8 in the morning – our bodies release a series of hormones. The main ones are cortisol and growth hormone . These hormones signal our liver to make more glucose , which is sugar. This glucose helps to wake us up in the morning and give us the energy to start the day. When more glucose is produced, our blood sugar levels rise.
Now, if you don't have diabetes, your pancreas responds well to this and produces enough insulin to control your blood sugar. But if you have diabetes, your pancreas either doesn't make any insulin at all, or the amount it makes isn't enough to control the high blood sugar. Sometimes , insulin resistance , which means your body's cells don't respond properly to insulin, can also be a cause.
To be precise, when the body is getting ready to wake up in the morning, this natural 'alarm system' in the body causes blood sugar to rise. While this is controlled in the body of a person without diabetes, the body of a person with diabetes cannot do it properly.
How do you recognize this exactly?
The best way to accurately determine whether the 'Dawn Phenomenon' is the cause of high blood sugar in the morning is to use CGM (Continuous Glucose Monitoring) .
CGM is a device that you wear to monitor your blood glucose levels 24 hours a day. To be precise, this CGM device measures your blood sugar levels every few minutes and uses that data to create a graph. This gives you a complete picture of how your blood sugar levels are changing over time.
The advantage of using a CGM, rather than taking blood from your finger before you go to bed and after you wake up in the morning and checking your blood sugar with a glucometer, is that you can tell exactly whether your blood sugar has suddenly dropped (hypoglycemia) during the night. If so, it means that you are not experiencing the 'Dawn Phenomenon', but the 'Somogyi effect' mentioned earlier.
Even if you don't use a CGM, doctors can look at the pattern of your blood sugar readings over several days and suspect the 'Dawn Phenomenon.' That's why it's very important to keep a record of your blood sugar readings.
What is the treatment for this?
The best treatment for the 'Dawn Phenomenon' is to use an insulin pump to deliver insulin. Oral diabetes medications usually do not help much with the 'Dawn Phenomenon'. Also, long-acting insulin injections are unlikely to have much effect on this.
Your doctor can adjust your basal insulin rates and have your insulin pump automatically deliver a little more insulin in the morning. This can help prevent your blood sugar levels from rising in the morning.
However, if you don't use an insulin pump, or if you don't take insulin at all, you and your doctor may need to do some trial and error to find the best medications and lifestyle changes to control your morning blood sugar spikes due to the 'dawn phenomenon.' For example, your doctor may advise you to increase your exercise in the evening and increase the amount of protein in your dinner compared to the amount of carbohydrates.
Can't this be prevented?
Since the 'Dawn Phenomenon' is a result of a natural process that occurs in the body, there's really nothing you can do to completely prevent it.
However, if you use an insulin pump, you can adjust your basal insulin rates according to your doctor's instructions and control future morning blood sugar spikes due to the 'dawn phenomenon' to some extent.
What are the possible side effects of this?
The main side effect of untreated morning high blood sugar due to the 'dawn phenomenon' is an increase in your A1C. An A1C test shows your average blood glucose (sugar) levels over the past three months.
The higher your A1C level, the higher your risk of developing diabetes-related complications. This risk is especially high if your A1C level remains high for many years. Diabetes complications can include:
- Eye disorders (Retinopathy)
- Kidney problems (Nephropathy)
- Neuropathy
- Heart disease
Research has shown that if people with diabetes can consistently keep their A1C levels below 7% , they can reduce their risk of diabetes-related complications.
The 'Dawn Phenomenon' is usually a persistent problem, meaning that if left untreated, blood sugar levels can remain high for several hours each day. This increases the risk of developing diabetes complications over time.
When should I see a doctor?
If you consistently have high blood sugar levels in the morning, it's important to talk to your doctor who is helping you manage your diabetes. He or she can check your blood sugar levels, determine if this is due to the Dawn Phenomenon, and recommend appropriate treatment options for you.
Experiencing the 'dawn phenomenon', a spike in blood sugar levels in the morning, can be really frustrating and upsetting. But remember, it's not your fault. There's no one-size-fits-all approach to managing your morning sugar spikes. So it can take some time to find the right treatment for you. Your doctor can help you come up with the best plan. So don't hesitate to ask for help. Taking action now can help you avoid long-term side effects.
The most important thing to keep in mind
Okay, so I hope you now have a better understanding of the 'Dawn Phenomenon' that we talked about. Remember, if you are living with diabetes, be aware of the increase in blood sugar in the morning.
This is not your fault, and there are solutions to this.
- Talk to your doctor about this openly.
- Keep accurate records of your blood sugar levels, food, and medications.
- If you can use a CGM, the data it provides is very valuable.
- Talk to your doctor about an insulin pump, it could be a good solution for this.
- Don't panic or get discouraged, work with your doctor to find the best solution for you.
Remember, you can live a healthy, happy life with diabetes. It just takes awareness, care, and following your doctor's advice. Have a great day!
` Dawn Phenomenon, diabetes, morning blood sugar increase, hyperglycemia, Somogyi effect, insulin pump, A1C
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