RE: "Dawn Effect"
Posted Thursday, January 13, 2011 at 10:54 AM
I asked our resident nurse and CDE to respond to this. Here's what she said:
The Dawn Phenomenon is a normal physiologic process where hormones released in the early morning hours promote release of glucose from storage in the liver, basically to provide fuel for the tasks involved with waking up. In people with type 2 diabetes, the process may be accelerated. This explains how one can go to bed with a normal reading and wake up higher, even though nothing was eaten during the night.
If blood sugar readings throughout the day are decent, I generally don't get too worried about slightly higher morning readings. I use the A1c reading as the guide in this situation. If mornings are high (let's say 150-160), the rest of the day within normal most of the time (90-130 mg/dl AVERAGE before meals per American Diabetes Association) and the A1c is 7% or lower - you are in good shape and I would not push more medication to further lower the numbers. Realize this is general advice and only for non-pregnant adults: individuals should work with a health care provider who knows their medical history and can set appropriate targets.
If mornings are consistently too high, and there is no further room for improvement in diet or exercise, or the person is symptomatic or about to undergo surgery, then some long-acting insulin at night time may be warranted. Again, this is general, and does not cover all possible contingencies.
I would remind all that blood glucose numbers and the A1c test are but one measure of health. Many improvements that result from a nutrient-dense, low-fat, plant-based diet cannot be measured at home, such as improvements in circulation, reduced inflammation, even improved metabolic processes at the cellular level that reduce insulin resistance and the risk of cancer. Focus on healthful behaviors, don't get too hung up on the numbers, and good health and vitality will follow.
Caroline Trapp, MSN, APRN, BC-ADM, CDE
Director of Diabetes Education and Care
Susan Levin, MS, RD
PCRM Director of Nutrition Education