Explain the Dawn Phenomenon

Is there anyone else experiencing this? Could you please explain it? Does it only happen in growing children? My three year old daughter’s blood sugar readings have been all over the place (not really setting any trends) and I didn’t like how she started to creep up into the 300s during the day (who would, right?) For example…
7:30am 188
10:00am 317 (before swimming lessons)
11:30am 313 (even after swimming lessons)
2:30pm 156
5:30pm 238
9:00pm 169
2:00am 340

First I thought, well her Levemir needs to be increased, but our CDE said that she is experiencing the Dawn Phenomenon. The Dawn what? I never heard of this, but she has only been dx for a year now. She would for example be 161 at midnight, 92 at 3am, and then 146 in the morning and then she would be high for most of the day. Or another day she would be 138 in the middle of the night and wake up a 203. They were afraid to change the Levemir because of this (they didn’t want a low to happen around 2-3am, but something needed to be done to eliminate the increasing amount of highs throughout the day so we increased the Levemir 1/2 unit at dinnertime. We started this new dose for a couple of days and last night she was 143 at bedtime (no shot because she is under 150 and gave her normal 21-22 carb snack), midnight she was 187 which was way better than 300 and something, then she was 62 at 3am. Darn! We are hoping for a better night tonight - maybe I calculated the carbs wrong. It’s like we can’t win!

Sorry if I’m rambling on. It’s frustrating when our monthly average is close to 200 when it’s nomally in the 140s-150s. Our daily goal since she is three is 80-180. Will things go back to normal after she has this growth spert?

Here is some info about the Dawn Phenomenon.

Very high blood glucose in the early morning due to the release of certain hormones in the middle of the night. The body makes certain hormones called counter regulatory hormones, which work against the action of insulin. These hormones, which include glucagon, epinephrine, growth hormone, and cortisol, raise blood glucose levels, when needed, by signaling the liver to release more glucose and by inhibiting glucose utilization throughout the body.

Read the entire article here

With the numbers that your 3 year old has I would consider getting a pump. Then you can really control all of those random weird times with custom basal rates that can change over the course of the day.

I have experienced DP!!! I am on Podding so my Endo adjusted my basal in to .60 from 12am-6am! Funny what our bodies do! I think David is right maybe you should think about a pump to gain more control.

My dawn effect starts at midnight and lasts until about 8 am. I am on a pump and use a basal(background rate the pump gives me every hour automatically) rate during the day of .5 units per hour. At midnight, I go to 2.7 units per hour until 6 a.m. and then it drops to 1.5 until around 9 am.
My breakfast takes much more insulin to cover than does anything I eat during the rest of the day.

I guess you can take a little solace in that the drs will normally run kids numbers a little higher in order to give them a little safety cushion to avoid catastrophic lows.

Thank you all for your help and support.
David - that was a great article that made me understand it more. I just thought it happenend to kids (growing, etc.) - I Learn something new about diabetes everyday (literally).

I’m looking forward to the day that Olivia is on the pump. Our CDE suggested it too, but I admit - I’m scared (I’m already a worrier!!) She won’t even wear a band-aid for more than five minutes so that in itself scares me. Also the little bugger won’t let me near her stomach/outer thigh areas to give injections, so my husband and I usually get these areas in the morning before we wake her up for breakfast (eat at 7:30am). Sometimes she doesn’t even know that she got a morning shot. LOL!

Thanks again you guys - This site is awesome!

I have been dealing with dp all of my diabetic life - 35 years. But, it waxes and wanes - comes on strong for a few weeks and then calms down. It is particularly bad when I’m under stress or when my sleep pattern is off. I think part of it is the body getting ready to start the day - saying “I’ve slept so many hours and now I need to put extra fuel into the engine”. I start to rise about 3. If I wake a few consecutive days high, then I’ll get up at 3 a.m. and test and take a correction if I need to.

Another tricky situation is the somogy effect, where people have hypos at night and then, because they go untreated, the body pours out stored sugar from the liver, causing a high.

Sounds like you are keeping good records. Know that this happens to a lot of people. Maybe the doc has some suggestions on how to deal with it. For me, it used to be really tempting to think “heck, I ate perfectly yesterday and now today wake up high - since I’m already high, I think I’d stop and get a big glazed doughnut for breakfast”. Well, that attitude did not help me in the least. I wake up high, I correct, and I’m back on track by mid morning.

Good luck.