Dawn phenomenon

hello all,

i was wondering if any of you out there have any advice on how to control this. the last few mornings its been espicially bad. i always go to bed between 100-140 and i wake up 240+… with out fail!! what do i do? anything is a great help. open to any and all suggestions. oh im doing dmi’s and testing 8x/day+. so i think ive got those bases covered. thanks in advance!

are you on a long lasting insulin like Lantus?

if i go to bed between 100-140 , then after 2 hours i have to take 2 sugary biscuits , then in the morning i getup with same range … in your case i think u should increase your n-insulin ,by 2-3 units

I notice that you’re on injections and I assume that you take a longer-acting insulin to cover your basal needs. Which background insulin are you on? I think you need to increase it to cover what looks like an overnight “glucose dump”. I also need more background insulin overnight than during the day – the difference in my case is quite dramatic: 8 units of Insulatard at breakfast but 36 units in the evening.

If you do increase your background, I’d also suggest setting your alarm clock for 3am for a few nights just to check your BG is not dipping (or even rising) out of range.

David I had that problem when I was on shots. After the pump & CGM I discovered that when I eat late (8:00pm or so), go to bed around 10:00am with a normal BG my BG would spike around 3 1/2 hours after I ate. I started doing a dual square wave bolus to cover the spike at 3 1/2 hours and I would wake up fine. I only had to do the dual square wave when I ate and then was very inactive. Being active after lunch the “spike” would not occur. I previously thought it was dawn phenomenon. You might want to wake up @ 3am or so and see what your BG is at that time. This is just a thought to at least eliminate a possibility! Good luck!

Is the 100-140 at bedtime later than 2 hours after your last bite of food and drink for the day and about 4 hours after your last shot of rapid-acting insulin? That way, you know the number is a stable one and your nighttime levels are affected by the long-acting insulin in your system–and your hormones.

Or do you eat dinner and/or a snack right before bed? If so, your bg level at the bedtime check isn’t necessarily a stable number. If you take rapid-acting pretty close to going to bed, it’s harder to sort out what’s doing what.

Fairly often on MDI, blood glucose may drop around 3 a.m. then rise into the dawn hours (possibly from a rebound to a low and/or from a.m. hormones).

That 3 a.m. check is a often recommended, but the every 2 hours through the night (yes, it’s a pain) will give you more data.

Good luck, and let us know how it goes!

This is me exactly… I am on Lantus and Novolog and I take NPH to keep my morning #'s nice. If I increased my Lantus enough to keep my fasting #'s in line, I’d be chasing lows all day long. Where I have my dosage now, I am steady throughout the day, but overnight I need more insulin, which is why I use the NPH. I take it before I go to bed… usually 2-3 hours after I take my Lantus shot. It works pretty well for me. I generally take just 4-6u, but that’s enough to keep me from waking up at 250+

Oh, and I should add that I do split my lantus, so for me doing that didn’t make much difference - all it fixed for me was some evening elevation in my #'s before my next lantus shot kicked in again.

Thank you all for the info and tips. i’m currently taking 12-15u of lantus before bed. and i dont eat past 9:30 and am in bed by no later than 11:45 or so.i will try waking up around 3 or so just to see what is going on. Do any of you use sugarstats.com?if so heres my graph of the last 2 days so you can kinda see what is happening. http://manage.sugarstats.com/dsg1987

If it IS Dawn Phenomenon your bg will settle slowly during the night, given a reasonable (suffficient) amount of insulin is in action. Then when you wake up, or more likely when you get vertical, the liver dumps glycogen to give you energy to support the new activity level.
Since there can’t be the right amount of insulin in your system to get that spike of glycogen (immediately converted to glucose) into the cells it sticks in your bloodstream, and shows up when you test. There are 2 possibilities here, onlyy 1 of which seemed to appear in other answers. If you went too low at 3:00AM or so then you dump glycogen, but it needs to be treated as Symogyi Syndrome, as has been mentioned. That would need less insulin effective at that time, or perhaps a bigger snack at bedtime.

If it IS Dawn Phenomenon the thing that usually works is a protein snack at bedtime. This will stick with you through the night and often keeps the glucose level high enough that your liver won’t kick out glycogen when you get up. It seems to be forced by going just a LITTLE too low then from combinations of factors.

Another idea someone found worked was to stay in bed, take the morning bg test before getting up, and eat a single cracker THEN get up. Seems like the stomach short circuits the liver rresponse enough so that you MAY be able to stop Dawn Phenomenon in it’s tracks. Mind you I’m not real sure about that one, just heard from someone that used it to good effect.

The other thing that you might fnd is that the longer you delay the morning test for whatever reason, the higher it goes. Seems the liver just keeps kicking out glycogen until you DO eat.

Here’s what I’ve done to help tame my dawn phenonmenon. Every now & then I’ll have a high fasting, but mostly it’s under 100. Now that I’ve gone & tempted the diabetes gods, I’ll probably wake up sky high!

I don’t eat anything high fat for dinner & also limit protein because both digest slowly. I don’t eat for at least 5 hours before bed & take basal immediately before bed. If I sleep in, my fasting BG is high. I test, inject, eat as soon as I wake up. When I don’t eat right away, BG continues to climb. I stopped doing strenuous exercise early because this caused further spikes. Moderate activity works better for me in the morning.

Took a lot of tweaking of basal doses to get what seems to be right night dose–for now anyway. Taking higher doses of Lantus (now on Levemir) at night didn’t give me lows during the day & I’ve always taken basal in the morning, in addition to the dose right before bed. I guess my basal gets used up during the night controlling DP.

I have a small high protein snack before bed–a piece of cheese or some nuts.

Gerri, should we count the grams of proteins like carbs ?
Is there any formula for bolusing for grams of protein ?

Hey Ray,

I don’t know of any formula for bolusing protein. Maybe that’s a good thing since who wants to have to count anything else! My endo told me to try to eat the same amount of protein day to day & meal to meal. Doesn’t mean that I had to eat the same exact food, but to keep the amount consistant so I’d know the effect protein had. I was adding protein to meals to gain weight. When I added a couple of ounces of protein to each meal, I noticed my BG went up & I increased my bolus. Perhaps because I’m a small person increasing protein had an effect. So if your numbers are good eating what you do, don’t worry about it. I’ve heard people say that they’ve eaten the same number of carbs at meals & had varying BG. I wonder if it’s because that meal had more or less protein, though we know that just about anything can effect BG.

I found this article explaining the percentages of protein converting to sugar. Sorry, it’s long. Apologies to the author because I can’t find the source. It’s not from a diabetes site. I was searching for something to explain my increased BG from additional protein.

"This is how you can ‘guesstimate’ how much of the protein-food you eat will become sugar: in every ounce (by weight) of protein-food, there are about 6 grams of actual protein. Of that 6 grams, about 58% can become carbohydrate. This means that of every ounce of protein food you eat, your liver can create about 3.5 grams of sugar. This is THE major source of Hidden Carbohydrates.

Additionally, remember that dietary protein is not the only source of amino acids. I explained previously that the blood contains amino acids at all times, and that fasting does not reduce the amount of them. Recall also that all tissues are breaking down and building up constantly. This means that even if you were to eat no protein at all, amino acids would nevertheless be present because of the breaking down of your tissues, and the liver would be able to convert those amino acids into sugar.

What To Do

Now that we are all completely afraid to eat ANYTHING, we still have to try to put together a dietary plan. We want to keep our carbohydrates low, but we don’t want to get all our carbs from the conversion of protein, because we want to get the important vitamins, minerals, and fiber from vegetables. So, we follow a low carb system of eating between 20 and 60 grams of carbohydrates, and we eat protein and fat.

But, often we don’t lose weight, or at least not fast enough to suit us. We can now see that the amount of protein we eat plays an important part in this. We must eat protein, or suffer the consequences of lost muscle mass or worse, but how much protein do we need?

There have been many studies. None of them are terribly conclusive, but we have to start somewhere. A good estimate for adults (not pregnant or breast-feeding women, not children, and not teenagers) is that the protein requirement ought to be about 2 grams of actual protein per 5 pounds of ‘ideal’ body weight.

For example, if you think you ought to weigh 150 pounds, divide the 150 pounds by 5, and multiply that number by 2 grams. The answer to this example is 150 divided by 5 is 30, times 2 is 60. If your goal weight is 150 pounds, you need about 60 grams of protein each day. Remember that this means protein grams, not the weight of the food containing the protein.

However, since you probably don’t yet weigh your ideal weight, more protein may be required to maintain your body’s protein structures the way they are now. To be safe, we can figure a higher protein allowance, say 10 to 20 extra grams of protein per day, depending on how much you currently weigh in excess of your ideal weight.

How Much Protein Will Be Converted To Carbohydrates From Our Protein Intake?

Now, for fun or horror, (depending on how you look at it), we can calculate how many hidden carbohydrates the person in our above example will get from eating her required amount of protein. Since an average of 58% of the protein can become carbohydrate, we multiply 60 protein grams by 58%. The answer is about 35. Depending on how a person’s body uses the protein it needs, as many as 35 extra carbohydrate grams may be available from 60 grams of protein consumed, in addition to the amount of carbohydrates that the person is getting from eating other carbohydrate foods.

There are two questions that you are likely asking yourself right now. The first question is, “Why hasn’t Dr. Atkins talked about all this?” I think the answer is that since everyone must eat their required protein, and since many people can lose weight without concern for how much excess protein they are eating, low carbohydrate plan experts merely avoid talking about it. But, be assured that when Dr. Atkins, the Drs. Eades, Dr. Schwarzbein, or any of the others tell you to start your carbohydrate counting at 20, 30, or 60 carbs per day, they already are taking into account that you will be getting carbohydrates from protein conversion. This is one of the reasons why the amount of allowed ‘regular’ carbohydrates is so small."

dawn phenomenon was one of the reasons my doctor recommended on the insulin pump (omnipod). i can set a temporary basal rate in the night that is slightly higher than my daytime rate and it helps with this tremendously. i’ve only been on it a short time and their are other inconveniences with being on the pump but for this problem it works great.

Thanks, Gerri, for taking the time to explain with all the details.
Apreciate it !

Lots of people have this. With my insulin pump it is so clever that you can set you insulin to carb ratio and insulin sensitivity factor to different times of the day. I often require a lot more insulin in the mornings even if I am eating the same thing for after noon tea. When I add in my carbohydrates and BGL it will automatically tell me to give myself more because it has been programmed. These days I often wake up with the stunning result of 5.5!!! not sure what that converts to in americand BGL but is it a good level.
The higher levels in the morning often occurs in girls more. Something to do with like hormone levels and yada yada kind of like why pregnant women get MORNING sickness. Hope this has helped.
From Hilary

Been through this a lot. The so-called dawn phen. is caused by grouth hormones that occur as a result of not enough insulin around 3 AM. or unknown lows that also cause the liver to produce glucose almost out of control for a few hours. Either way you get high BG levels. If you are on Lantus insulin perhaps two shots a day would help one at 8 AM and one at 9 PM, a split dose. Be carefull with the PM dose check BG at bedtime again around 2 AM and at breakfast. So any lows will not get by you during the night. Make carefull adjustments with the dose. I found the Lantus runs out of gas after 13.5 hours for me. Once you now how long insulin lasts you can make adjustments. When I was on it I noticed a high showed up at 10 PM because it takes about 2-3 hours for the PM dose to get going and my AM dose ran out about 8:30 so I was out of insulin for a couple of hours so me BG went up. So at night you have to find the correct dose to get the right amount of insulin, not too much, but enough to stop the liver from kicking in a raising your BG. It ain’t easy. It took me over a month to get the dose right. Now I am back on a pump again. I got off the cozmo pump because it caused me to have four seizures. Now back on an Animas pump. If you can get on a pump you would be much better off. Dick Meade

Hi David,

I use to have a terrible dawn phenomenon, and was also constantly going low in the middle of the night. When I started on the pump in January '08, both of those problems went away. Being able to fine tune basal delivery with a pump made the difference for me. The peace of mind of being able to go to sleep with a BG of about 100 mg/dl, and knowing that’s I’d wake up with a BG of about 100 mg/dl, is priceless. Well, actually, it is as pricey as the cost of a pump, infusion sets, and all that, but … the peace of mind IS priceless.

Cheers, Mike

Depois que comecei a usar a Lantus meu alvorecer é maravilhoso!!! É um milagre porque eu vou dormir com 150,180 e acordo com hipo 60 ou 70 não passa disso. E olha que tomo a Lantus quando acordo e funciona mesmo a noite toda. E vc usa o que e quanto?

I was never fully able to get my numbers from dawn phenomenon under control until I got on the pump. If you have the opportunity give it a try, it’s a whole new wonderful world.