Do you know about Dawn Phenomenon?

Diabetics who wake up in the pre-dawn hours (between 3 and 6am) can sometimes find that upon rising, their fasting glucose levels have also gone up, even if they went to bed with normal values.

This is a product of the circadian system, because during this time of night, all people undergo some key hormone fluctuations to prepare them to wake up. (Just as our bodies make chemical transitions between wakefulness and sleep at night, they also do the opposite in the morning… and the process is gradual.)
For diabetics, the mismatch between glucose and insulin is more pronounced because the pancreas doesn’t function in the same way as someone without diabetes.

Some people with diabetes don’t have an extreme experience this phenomenon, but others do. What’s your experience? What did you do about it? And what would you say to someone who also has problems with morning fasting glucose management?

#SLP4Diabetes #diabetes

This is a pet topic for me. I was totally mystified at first about this. I’d go to bed with a reasonable blood sugar in the 120s and wake up with the morning fasting glucose in the high 130s…and didn’t get up even once in the night to snack. Fasting glucose of over 125 is indicative of T2DM, which is what I’ve been diagnosed with. I’ve had this since 2013.

What I learned is that the liver conducts neoglucogenisis (new production of sugar) from its’ store of glycogen in preparation for arising, because you need energy to get up and get on with your day. In folks without diabetes or prediabetes, this is all very helpful as blood sugar, with their dawn phenomena, doesn’t rise over 100. Wouldn’t it be nice if our bodies had a switch to turn off neoglucogenisis if we already had sufficient glucose to start our day? But, they don’t.

I also found out that my liver “perceives” a fasting state anytime my blood sugar suddenly drops 20 points or more and will then initiate neoglucogenisis. My blood sugar may still be in the 160 to 180 range, but my body thinks I’m fasting because of the sudden drop. The blood sugar may drop suddenly because of the stress of strenuous exercise, illness, shock, etc. So…I get sugar on top of sugar…not good for a diabetic.

Here’s what I do to break the cycle up. I test my fasting blood sugar in the morning. If my fasting result is over 120, then I know that my breakfast should be bacon or sausage with eggs and avocado…no carbohydrate and that includes no milk or fruit. This is actually quite filling. If I’m still longing for something starchy or sugary, I comfort myself with the thought that I can have some of those things later in the day…maybe for lunch when my fasting will likely be below 100. I’m able to predict where my blood sugar will be (with the exception of stressful circumstances) and can plan my carbs for a particular time. What I eat is predicated on where my blood sugar goes for the rest of the day.

My initial burst of insulin in response to carbohydrates is severely impaired due to my diabetes. The number of my pancreas’s beta cells is much less now than the sum I was born with. I depend on the “slow trickle” or basal insulin that my pancreas produces to get by. This still remains to me. And this is how I differ from the Type 1 diabetics whose beta cells are entirely destroyed or non-functional.

As long as I control the timing, amount and type of carbohydrates with the meal that they are a part of, I’m handily able to keep my daytime blood sugar readings under 140, which is the level necessary to avoid diabetic complications. At least, that’s the way it was up until a month ago. I switched statins to improve my cholesterol and the statin I was switched to (Atorvastatin) has raised my blood sugar.

I use Metformin to blunt my livers’ neoglucogenisis. I’m over 65 years of age and that appears to be some sort of threshold to my healthcare providers. They now insist that type 2 diabetics over 65 are more likely to die of low blood sugar than from high blood sugar… So, they are very stingy about giving metformin to their patients. I’ve explained to them that I’d rather not live with the diabetic complications that persistent high blood sugar brings. I’ve even asked them if they would like to live that way. You know what those complications are…neuropathy so bad that you can’t walk easily, compromised circulation to the legs and feet, amputations, deafness, blindness, sleep apnea, failing kidneys, failing hearts, gastroparesis, difficulty swallowing, a stroke, immobility and death. I don’t believe I’ve named them all. Who would want to live that way? It all falls on deaf ears.

For me, metformin does not cause low blood sugar. I have yet to experience an episode of low blood sugar. I’m left, for now, with a measly 500 mg of Metformin ER to see after my high blood sugars caused by dawn phenomenon and my atorvastatin. My A1C is stellar (so they say) at 6.1. My brother, with an A1C of 6.2 is nearly deaf, nearly blind, with failing kidneys, congestive heart failure, sleep apnea (yes…he has CPAP too) and neuropathy that you wouldn’t wish on your worst enemy.

I’ll lobby for an increased dosage of metformin ER after 3 months when I’m tested again. This is awful, but I’m actually thinking of doing something stupid and eating all the junk that I can to push my A1C over 8.0 for my next testing so that I can get the medication I need. High blood sugar makes me feel so ill, actually sick, and it takes me days to recover stamina afterwards. This is probably a very poor idea.

So…this is the upshot for me. How is it all going for you?

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