Will someone please explain Dawn Phenomenon to me?

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gma
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Date Joined Jul 2003
Total Posts : 2921
   Posted 1/8/2008 6:21 AM (GMT -7)   
I read a post that mentions it and I have never heard the expression.  I have been diabetic for five years.  I have tried several of the oral medications and my blood sugar just does not seem to regulate.  It seems like my other medications made a difference more than the food I eat.  Stress and worry seems to affect my BS as well as anger.  I do take Lexapro to help even out my upset feelings.  Right now I am on Glimepiride 4 mg and Januvia100 mg.  about three months ago I was changed to these from Glipezide.  I am due to have my 3 months A1c blood work done and from my readings it is going to be higher yet.
 
I am a Moderator of the breast cancer board.  My breast cancer seems to be fine, diagnosis 11 years ago, mastectomy.  My daughter found breast cancer two years after I did and last year she found lymph glands swollen which showed a recurrence.  Now she has learned that it is much worse.  So although she is not yet showing how ill she really is, her prognosis is not at all good.  This is the worst of my stress. 
 
I am also disabled and cannot walk or stand let alone exercise which is no help with the BS.  I am disabled because I got contaminated sutures during surgery for the breast reconstruction which in the end caused all my abdominal wall muscles to become infected and had to be removed.  I live with a hernia the size of twins at nine months pregnancy.  I wear four binders to keep my hernia stable so I can walk a little without too much pain.
 
I read posts here once in awhile but until lately my BS numbers have not been climbing like they seem to be now. 
 
 
Thanks for your help,
Mary K.


metres
Regular Member


Date Joined Jan 2007
Total Posts : 32
   Posted 1/8/2008 10:07 AM (GMT -7)   
Hormones are released at night that cause glucose to be released by the liver in the morning. Diabetics with insufficient insulin don't process the sugar fast enough to avoid a morning increase in blood sugar, thus the "Dawn Phenomenon".

gma
Veteran Member


Date Joined Jul 2003
Total Posts : 2921
   Posted 1/8/2008 12:24 PM (GMT -7)   
OK this is where the bedtime snack comes in? My doctor told me fasting too long causes the liver to increase sugar and I really needed to have a snack at night. The other night I ate bean soup (homemade with ham) and a salad with lots of veggies and an egg chopped up. I did not eat another thing all evening and in the morning my BS was 205 in one finger and 218 in another. It has never ever been that high in the morning and seldom that high after a meal. A few days later, I ate a piece of cake at dinner and then at bedtime I succumbed to a bowl of ice cream with butterscotch. The next morning my BS was 135. I get so confused. MK


fergusc
Regular Member


Date Joined Dec 2005
Total Posts : 230
   Posted 1/8/2008 2:25 PM (GMT -7)   
From a purely personal, Type 1 diabetic perspective, I have to say that the idea of bedtime snack makes no sense to me at all!
The body doesn't experience hunger or metabolise food effectively while sleeping. The rise in blood sugars and the insulin or other agents needed to control it will not be used for energy production (sexual gymnasts aside!). It will therefore be used predominantly for fat storage which will surely increase insulin resistance over time.
My own experience suggests it's a better bet getting one's medication doses right so that blood sugars are in the right zone in the morning. If they're too high or too low in the evening or the morning then the doses need adjustment I would have thought.
The principle of having to eat to match the effect of medication I don't believe is a healthy one. Maybe it's just me again, but I don't see any reason to eat unless you're hungry?

All the best,

fergusc

metres
Regular Member


Date Joined Jan 2007
Total Posts : 32
   Posted 1/8/2008 6:03 PM (GMT -7)   
The evening snack is sometimes used to prevent the Somogyi Effect. That's when the residual insulin in your system drives your blood sugar too low during the night, and your liver dumps too much sugar, causing a rebound high in the morning.

fergusc, as a T1, don't you have to keep a certain level of insulin in your system all the time? Keeping your heart and lungs etc going requires energy, even when you are sleeping.

fergusc
Regular Member


Date Joined Dec 2005
Total Posts : 230
   Posted 1/9/2008 2:59 AM (GMT -7)   
Hi metres,
Yes, there must always be some circulating insulin in my system, partly to counterract gluconeogenesis. I haven't produced a drop of my own insulin since I was 18! But the gluconeogenesis carries on regardless where the liver converts amino acids into glucose to keep us ticking over. Without a background level of injected insulin, my blood sugars would constantly be trying to creep up on me.
What I, and most T1's, have to do is inject to cover each meal (bolus), and then also inject a basal dose to keep it all together in between times, either once or twice a day.
I thought the underlying cause behind the Somogyi Effect was excess circulating insulin causing the effects you describe?
It's only my personal experience, but I have found that by reducing my basal dose by 1 unit at a time, I eventually found a level where my blood sugars were neither too high nor too low in the morning. That way, I don't have to eat before I go to bed. What I was trying to say was that reducing the medication is perhaps a better, more predictable and more reliable way of solving the problem?

All the best,

fergusc

gma
Veteran Member


Date Joined Jul 2003
Total Posts : 2921
   Posted 1/9/2008 7:34 AM (GMT -7)   
You all sound so knowledgeable about diabetes! I am sorry to say I am not really good about counting carbs. I could do it, I understand what I am supposed to do but until lately my BS was in legal bounds. The times that it was high was when I was under greater stress. Then my insurance company decided I needed to use a generic blood pressure Rx and for some reason that really spiked my BS. I had no idea what was doing it until a diabetic friend asked if I was taking any new medication. I went back to Brand Only and BS resumed the normal numbers.

Next my mother who was 92 at the time got lost driving around Pittsburgh, PA where she lived at the time. She was refusing to move closer to my brother who lives 50 miles from Pit. I am in TX. So I worried about her and again the old BS went up. Finally we got her into an assisted living home without a car to drive. She'll be 95 soon and complains about living too long. She is in great health. Her short term memory is gone.

Then came the whammy about my daughter and the doc changed my diabetic medicines. Now the numbers are all over the place whether I eat a snack, eat carefully or just have whatever I want. I think my highest reading ever was 229 which is not bad compared to some highest numbers I have heard, but none the less I do not want to lose my eyesight, kidney function, etc. etc. My GP makes sure I have tests and see specialists for annual checks.

Sorry I am long winded and really am trying to figure out if there is anything I can do to keep on an even keel. One day I forgot to take my RX and the next morning my BS was in the 130 range. Makes no sense.

Thanks for listening, MK


Jeannie143
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Date Joined Apr 2004
Total Posts : 6056
   Posted 1/9/2008 7:34 PM (GMT -7)   
Mary K,
If you type "dawn phenomenon" into the google search box at the top of the page it will give you most of the posts on HW for this and let you know what others have posted about it.

For myself (Type2), I used to do the snack thing as a small bowl of cereal and milk. I also used to weigh almost 300 lbs! I am too busy to count carbs so I just do the easy thing and don't eat anything white except cauliflower. So far I've lost about 40 lbs, have been able to discontinue my Lantus insulin, drop my avandia and cut back on my generic metformin. And I didn't even know I was losing weight until my clothes started to get waaaay too big. Now my nighttime snack is a banana covered with about a heaping tablespoon of crunchy peanut butter. Most mornings I awake to 80 to 105. The weight loss seems to have dropped the numbers more than the meds ever could.

Read back in the posts about the low carb food plan and you will see how we do it. I still eat squash and last night I snitched a few french fries from hubby but for the most part I'm doing great without my grains and tubers. Hope this helps.
~ Jeannie, Forum Moderator/Diabetes & Fibromyalgia
I know God will not give me anything I can't handle. I just wish that He didn't trust me so much. ~Mother Teresa

"People are like stained glass windows: They sparkle and shine when the sun's out, but when the darkness sets in, their true beauty is revealed only if there is light within."- Elizabeth Kubler-Ross


sherilou
New Member


Date Joined Jan 2008
Total Posts : 7
   Posted 1/10/2008 3:56 PM (GMT -7)   
hello, I am new - T2 for 20+ years. metres answered your question, gma, but one thing more - eat something small, like a little peanut butter with a couple crackers, 1/2-1 granola bar, etc. I think you might have eaten too much and had nigh nos. in the monring. Anyway, try eating just a little.
Sherilou

sherilou
New Member


Date Joined Jan 2008
Total Posts : 7
   Posted 1/10/2008 4:00 PM (GMT -7)   
OK, I have also been reading about people who don't like to count carbs. If you are not on insulin you could try link removed  It is much easier to do.
Sheilou
 
Sheilou, no advertising links, please. 

Post Edited By Moderator (LanieG) : 1/10/2008 5:15:45 PM (GMT-7)


sherilou
New Member


Date Joined Jan 2008
Total Posts : 7
   Posted 1/10/2008 5:49 PM (GMT -7)   
Sorry, try the plate method, where you take you 9" dinner plate, divide it in 1/2, then divide 1 side in 1/2 again. Your veggies go in the biggest part, your meat and potato (starch) in the other 2 parts.
Again, sorry.
Sherilou

LanieG
Forum Moderator


Date Joined Nov 2006
Total Posts : 5402
   Posted 1/10/2008 7:01 PM (GMT -7)   
That's ok, Sherilou, and welcome to the Forum.  That's an interesting concept of dividing the plate into sections.  That would make it easier to control portions.  The only change I'd make would be to get rid of the potato (and maybe increase the protein) if you need to control your blood sugar.  Everyone, even non diabetics, needs to understand that starches (carbohydrates) will raise blood sugar and if you're a diabetic, this is a problem.  Actually, the subject of portion control is a whole other topic which I think we should talk about!
yeah
Lanie
forum moderator - diabetes
diabetes controlled so far by diet and exercise
following low/no carb diet, no meds


ericsmom
Veteran Member


Date Joined Jan 2007
Total Posts : 1042
   Posted 1/11/2008 10:41 AM (GMT -7)   
Hi Girls

I just wanted to add one more thing to Sherilou's 9" plate theory.
That is what I was taught as well, 1/2 veggies, 1/4, protein, 1/4 starch, also we were told that the meat you chose should be no larger than the palm of you hand, and no thicker than you palm.
Which explains why the guys get a wee bit more to eat than we do tongue

Take care,
Diane
Fibromyagia, R/A, Diabetes, Atrial Fib, depression

Prednisone(Jan 1, down to 3 mg/daily), methotrexate, folic acid, metformin, diamicron, bisoprolol, plaquinal, fenofibrate, pantoloc, wellbutrin, propafenone, ibprofen, warfarin


What doesn't kill us, makes us stronger


metres
Regular Member


Date Joined Jan 2007
Total Posts : 32
   Posted 1/13/2008 11:58 AM (GMT -7)   
The 9" plate rule is rather moot since I doubt many of us actually own plates as small as 9" any more. I held on to my 25 year old set as long as I could because I knew that my next set would be too big. The smallest I could find were 10", whaich are almost 20% bigger.

gelchick
Regular Member


Date Joined Aug 2006
Total Posts : 477
   Posted 1/13/2008 12:27 PM (GMT -7)   
metres
 
It's funny you should mention that- my daughter came with a friend for Christmas who offered to set the table. My 'good china' is circa 1950- a hand down from my mother. I pointed her to the china cabinet - about 5 mintues later she came and asked me where the dinner plates were. She thought the dinner plates were salad plates and the salad plates were dessert plates-
the size difference was amazing.
 
I have a nice set of Correlle for every day use, but we use the salad plates for our dinner and I use the dinner plates as serving platters. Some of my antique serving bowls are about the same size as the cereal bowls in my Correlle.
 
sandy
I just want to live happily ever after-every now and then. Jimmy Buffett


LanieG
Forum Moderator


Date Joined Nov 2006
Total Posts : 5402
   Posted 1/13/2008 2:54 PM (GMT -7)   
Exactly, Sandy!  Supersized plates!  This is part of the reason why so many people have a skewed idea of what a "portion" means. 

Lanie
forum moderator - diabetes
diabetes controlled so far by low/no carb diet and exercise; no meds

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