DP Information – or Why Are My Morning Numbers So High
Dawn phenomenon is a normal early-morning rise in glucose (blood sugar) that occurs before or shortly after waking. Everybody experiences this physiological phenomenon, but it can be troublesome for people with diabetes. Such people may need to adjust their treatment regimen to account for dawn phenomenon.
Between 4 a.m. and 8 a.m., the body increases the production of certain hormones. These natural body chemicals suppress the activity of insulin, a hormone that transports glucose into cells to use for energy and reduces blood sugar levels.
The hormones include:
Growth hormone
Cortisol
Catecholamines
Glucagon
Epinephrine (adrenaline)
These hormones trigger the liver to release enough glucose to give the body the energy to wake up. In non-diabetic people, the body responds to the excess glucose that accumulates as a result of this process by producing insulin. The insulin then moves the excess glucose into the cells. However, people with diabetes either fail to produce insulin or cannot properly use the insulin that is available. As a result, glucose continues to rise to abnormally high levels (hyperglycemia).
The effect of dawn phenomenon on diabetics varies. Some people are strongly affected and have very high glucose on wakening, but others are weakly affected. In addition, some people with dawn phenomenon find that their glucose continues to rise until they eat in the morning. For others, levels will settle down a few hours after waking, regardless of whether or not they eat.
In some cases, high glucose in the morning may be the result of factors other than dawn phenomenon. For example, during sleep people experience falling glucose levels because of the lack of food overnight. To compensate, the body may produce a “rebound effect” response that increases the liver’s production of glucose to levels that are abnormally high. This is known as rebound hyperglycemia, or Somogyi effect.
People who experience symptoms may need to perform glucose monitoring in the middle of the night to distinguish between dawn phenomenon and rebound hyperglycemia. They may be advised by their physicians to test their glucose around 4 a.m. and compare it to their waking glucose level. If glucose is low in the first reading and high in the second, Somogyi effect is likely at work.
Symptoms and diagnosis
People who experience dawn phenomenon are unlikely to detect any symptoms associated with the condition. The condition may reveal itself only after they test their glucose (blood sugar) in the morning and find levels to be high.
If dawn phenomenon or the Somogyi effect is suspected, the person may be asked to perform glucose monitoring between 2 a.m. and 3 a.m. for several consecutive nights. If glucose in these blood samples is consistently normal or high, dawn phenomenon is the likely culprit. If glucose readings indicate nocturnal hypoglycemia, which is followed by morning hyperglycemia, the Somogyi effect is indicated.
Treatment and prevention
Diabetics who need treatment for dawn phenomenon should consult their physician about the best treatment for them. Depending on the case, options may involve adjusting the pre-bedtime diet, exercise plan, oral medication or insulin therapy. The variation in the effect of dawn phenomenon from one individual to another may require differences in how people control glucose (blood sugar). Possible changes may include:
Adjusting medication dosage. Physicians may recommend that patients take more medication in the evening or schedule their dosages of long-acting insulin later in the evening so peak action occurs when glucose starts rising.
Eating a snack before bedtime. Some patients may be advised not to eat late at night. However, some cases of dawn phenomenon are a response to lower glucose that occurred earlier. Their physicians may advise such patients to smooth these glucose roller coasters by eating a snack before bedtime. They may recommend a small snack that contains protein or fat and is low in carbohydrates, such as nuts or cheese.
Exercising earlier in the day. Strenuous physical activity at night can cause lows at night, which may trigger rebound highs.
Taking metformin. This oral medication curbs glucose production by the liver, and has been used effectively to treat people with dawn phenomenon.
Source Information: click here
Lizzy
Knowledge is Power
© EMO 3/12
When I was diagnosed, close to 11 years ago, I was told “you are diabetic”, given a prescription for some medication, and told to wait for a nurse to come in and give me an insulin shot. When I picked up the prescription I was given a 10-page booklet telling me “All About How to Mange Diabetes”, and sent on my way. That was the extent of my “education”. 
Does this differ in people that do shift work? Work at night, sleep during day?
I am a night person…have been for as long as I can remember. I no longer work my 3rd shift job but, a lot of time I will stay up until my hubby gets home which can be anywhere from midnight-4am depending on the day (or I should say night).
I just started with monitor/tracking and I usually check between 2-4am for a fasting total. Then it is grazing for the next several hours which makes it hard as there is continuous food intake.
The fasting number is first thing when you wake up, no matter what time that is. So if you wake up at noon, that’s your fasting number. You shouldn’t have eaten for some hours since you would be asleep(unless you sleep/eat which is another problem altogether LOL).
Lizzy
Hello Lizzy!
Thank you so much for this article!! I am learning a tremendous amount of helpful information from your blog and the members of the American Diabetes Association type 2 forum. I was trying to determine whether I have Dawn’s Phenomenon or Somagyi effect, and feel a bit confused with my numbers. I’d like to share them with you in my comments here (I hope this is ok).
Any advice you would be willing to share is appreciated. I am new to the ADA community so if posting my question here was not the right place please pardon the post and feel free to disregard it. Here are my stats:
T2 D’xd 2010
A1C Feb 2012 6.8
A1C June 2012 6.4
Metformin 500mg, 1 with breakfast, 2 at dinner
Tradjenta 5 mg, 1 with breakfast
I too struggle with my morning numbers and after reading this article did some testing.
My sugars have been in control at bedtime with numbers like 81 at 11:30 on Friday, and 99 last night at 9:55, and each night I’ve also eaten 1/3 C 2% cottage cheese (a little under 5 g of carb, and 10 g protein) right at bedtime. So here’s what happened-
Fri night with 81 BG—-> 4:17 am —-> BG 135, again at 7:37 am—-> BG 135 and at 10:37 am —> 134 then after up awhile —-> 11:15 am was 152 and had BK and took my Metformin and Tradjenta
Sat night with 99 BG—> 2:25 am —-> BG 128, again this morning at 6:55 am 132.
It would appear from the numbers, to confirm that protein snacks at bedtime do stabilize the numbers somewhat…I’m still not sure though whether this would indicate Dawn’s Phenomenon or Somagyi effect, because between 81 and 135, and 99 and 128, these numbers are closer to the desired range of normalcy and yet I am still seeing a rise. Would the difference be more indicative of Somagyi effect? Or Dawn’s Phenomenon since the rise continues until I eat in the morning and take my Metformin? I’m afraid to exercise close to bedtime because if it’s Somagyi effect, I don’t want the rebound.
I learned four things because of your article and the ADA Type 2 community, for which I am grateful:
1) I need to eat a snack at bedtime NOT abstain from eating as my primary tells me to do (not eating at bedtime causes numbers in the 140-160 range for me)
2) I need to add a metformin at bedtime probably and get off tradjenta. I am going to see my primary Sept. 28th and I will discuss this with her. It appears she may not underdstand Somagyi effect/Dawn’s Phenomenon and the importance of snack at bedtime in my case.
3) My body appears to need some other assistance to keep the numbers in the 100 range upon wakening. What to do here? Suggestions?
4) I may be one of those people who need to exercise in the earlier part of the day
My Endicrinologist feels my primary and I are doing a good job managing my diabetes based upon my food/BG journal and glucometer readings, so he defers my diabetes management to her. He said he is more concerned with my thyroid right now.
Thank you and pardon the lengthy comment!
Hi Nina,
Somagyi effect is from going low overnight and bouncing back high. The only way you can really confirm that is to do some nightly testing. You set the alarm for various overnight hours and do readings to see if you are going low. It appears like DP to me.
Experimentation is called for, and is what most people must do. To eat or not to eat and what to eat, no one else can tell you what will work for you. Your Metformin can still be increased, you aren’t on the highest dose, but the time you take it doesn’t matter much since it builds to certain levels in your system. http://lizzysdlounge.com/2012/03/14/all-about-metformin/
You can also experiment with exercise times, that works for many people. The most important thing is to eat as soon as possible after waking up or the numbers will continue to climb.
For most people morning numbers are the hardest to control, and it takes experimenting to find what works for you. Metformin is very good with this, but it doesn’t always work without additional efforts on your part.
Lizzy
Thank you Lizzy!
I will do some more experimentation as you suggest, and thank you for the link.
I feel like the puzzle pieces are coming together, thanks to you and the community.
Thanks a bunch, and I now understand how important it is for me to eat right away in the mornings…must be the FIRST THING on my to-do list.
with warm regards and sincere thanks,
Nina
Hi Lizzy,
I am so happy to have found your blog. Now I know what to discuss with my Dr.
I was diagnosed as prediabetic 18 months ago. Since my Dr did not seem overly concerned about it, I ignored the diagnosis. When I saw my A1C rising and my fasting glucose rising I became concerned. Unfortunately I live in a remote part of Maine.
There is no diabetes ed available within 60 miles. Your blog is a life saver.
I have had 2 heart attacks and 5 stents over the past 8 years. One doctor asked me if I was a diabetic back in 2004 and I said ” No “. I asked him why he was asking me if I was a diabetic and his answer makes sense to me now. ” Well, your heart disease is located where diabetics have heart disease. My diabetes stayed hidden as long as I was extremely active in sports. !8 months ago I had foot surgery to remove a broken bone spur. Exercise has gone by the wayside as the surgery made the heel inflamed
and impossible to wear a full shoe so walking and aerobic activity has been on hold .
Serious back problems also curb activity. This entire ordeal has been very difficult for me to accept since I have always played sports and been a runner, speed walker and walker, swimmer and tennis player, you get the picture. Now I have 25 excess pounds on my small frame with a BMI of 29. I do not look obese but I do carry belly fat which I am now losing thanks to your blog and the diabetes diet help of a friend who used to be a diabetes educator. It is most unfortunate my current Dr. is not seemingly interested in telling me what I need to know. Thank you for taking the time to create this blog. It is a life saver.
Hi Margaret,
Does your insurance cover diabetes education classes? They often hold them at local hospitals. If not read all that you can here. It’s the real deal. I’ve been talking with newly diagnosed people for over 10 years in addition to being diabetic myself. I walk the talk.
Lizzy
Hi Lizzy-
May sound silly but I’m going to ask anyway, will my blood sugar levels ever be consistent or will I always have fluctuating blood sugar levels? For example; my blood sugar was 190 this morning and then I did some work around the house, danced to some Rod Stewart while cleaning, tested my BS at 3:30pm and it was 109! Now I did have breakfast and took 1000 mgs of Metformin but that was around 9am. This blood sugar levels stuff has me sooooooooooooo confused. If my type2 was under control would my BS always be in the normal range not matter after eating or waking up etc.?
Thanks so much!
Robin
Hi Robin,
Being diabetic means you have to work at keeping the numbers in the normal ranges, but no ones numbers ever remain at the same levels at all times. They change all of the time depending on many things: food eaten, exercise, hormones, stress, even the time of day. NOT eating often enough can also make them climb.
Keeping them in a normal range is where the work is involved. By testing and experimenting and also learning when and what to eat you learn how to walk this tightrope. Your body no longer does this automatically, so you have to learn to do it on your own. It takes time.
Lizzy
Hi Lizzy, I’m a diabetic newbie, and had basically the same intro you describe – a note from my doctor and a prescription for metformin in the mail. I also have slow gastric emptying, and I found some information on how that affects BG numbers as well. Thanks – I don’t feel so alone now. And I see you have the same attitude I do – keep your sense of humor! It helps you survive the battle.
Hi Mrs Bugsy,
Humor saves many a time doesn’t it?
Slow gastric emptying does add more complications to the issue, did you read the links on Gastroparesis?
You’re never alone, there are lots of us out here, that’s one good thing about the internet because people can find each other for support.
Lizzy
Thanks Lizzy, this is very helpful to me and my problem.
You’re welcome MsDbee,
Just climb back up on that wagon or else get a new wagon that you can ride on long-term.
Lizzy
Great article Lizzy!