.png?la=en&h=700&w=1700&hash=F1DA833A7D1AE5EDA176B62B075C702E)
Living with diabetes means that you'll need to learn how to address changes in blood glucose levels to stay healthy and decrease the risk of long-term complications. And while traditional diabetes management can help keep your average blood glucose levels stable, some individuals may experience unexplained blood glucose rises in the morning. If this is happening to you, and there doesn't seem to be any logical explanation, you may be experiencing the dawn phenomenon. This guide will help you understand the dawn phenomenon and whether or not it's the reason for these mysterious early morning spikes.
What is the Dawn Phenomenon?
The dawn phenomenon occurs when people with diabetes experience high elevations in their blood sugar levels during the early morning hours. This is often due to natural reasons, as your body releases several hormones to help prepare you for the day, typically between 4 a.m. and 8 a.m. Two of these hormones, cortisol and human growth hormone (HGH) communicate with the liver to start producing glucose so that you can have enough energy to wake up feeling refreshed and ready to start the morning. However, this natural rise in blood glucose levels can be problematic when living with diabetes.
Typically, the pancreas balances the rise in blood sugar levels activated by hormones. When the pancreas notices an increase in blood sugar, it releases insulin to help with glucose control. However, the pancreas of individuals with diabetes may not be able to respond to elevated blood glucose levels, ultimately resulting in consistently high morning glucose levels.
While the dawn phenomenon happens due to natural hormonal shifts that trigger an increase in blood glucose, other factors can also cause spikes. In addition to the influence of hormones, some other causes of high blood sugar could be:
- Not enough insulin or diabetes medication before going to sleep
- Miscalculating medication after your evening meal
- Mistiming medication after your evening meal
- The Somogyi effect
The Difference Between the Dawn Phenomenon and the Somogyi Effect
The Somogyi effect happens when blood sugar levels drop during the night, usually due to too much insulin, glucose-lowering medication, or eating certain foods in the evening. In response to this low blood sugar, the body releases counter-regulatory hormones like glucagon and adrenaline to raise blood sugar levels. The primary difference is that the Somogyi effect includes a drop in blood glucose before the spike occurs. Unlike the dawn phenomenon, the Somogyi effect is believed to be caused by ineffective diabetes management plans and may, therefore, be easier to address and treat.
How Common is the Dawn Phenomenon?
The dawn phenomenon isn't something everyone with diabetes will experience, but it's still quite common. Some studies show that over 50% of individuals with type 1 diabetes and type 2 diabetes will experience it during their life.
Unfortunately, the dawn phenomenon is increased blood glucose due to a natural bodily process. There's not much that can be done to prevent it. However, with help from your doctor and a few management tips, you can maintain lower blood sugar levels throughout the early morning hours.
Symptoms of the Dawn Phenomenon
The main symptom of the dawn phenomenon is when you wake up with high blood sugar levels. These morning highs can also cause additional symptoms, such as:
- Increased hunger
- Increased thirst
- Frequent urination
- Blurred vision
- Headaches
- Irritability
If you notice these symptoms, check your blood sugar and take insulin or diabetes medications as needed. If these symptoms occur regularly, contact your doctor to better understand the reasons for high morning blood glucose.
Complications of the Dawn Phenomenon
Untreated high blood sugar can increase your A1C levels and put you at a higher risk for developing complications related to diabetes. Some of the biggest risks for consistently high blood sugar include:
How to Manage Blood Sugar in the Morning
Although it's not necessarily a medical emergency, untreated high blood sugar in the mornings can contribute to complications. Therefore, if you experience any symptoms, working with your doctor and trying some new management techniques is best.
1. Get a Proper Diagnosis
The most important step in managing morning spikes in blood sugar levels is getting the proper diagnosis. If you experience morning blood glucose readings that are higher than normal and accompanying symptoms, your doctor may recommend that you use a continuous glucose monitor (CGM) to help with the diagnosis. CGMs will measure your blood sugar levels throughout the day, every few minutes. This is done without needing finger pricks or manual blood draws, so you'll receive 24 hours of blood sugar readings without effort.
After a few weeks of gathering data, your doctor will see a graph showing your normal blood sugar range and any blood sugar spikes throughout the day. It will also show any instances of low blood sugar.
The dawn phenomenon may be at play if your levels steadily rise toward the morning. If you notice a drop in glucose and then a spike, the Somogyi effect is likely the cause.
If your doctor suspects that you're experiencing the Somogyi effect, lifestyle changes can be made to address morning high blood sugar levels. If the dawn phenomenon causes spikes, you may have to change your insulin delivery method.
2. Exercise Regularly
Exercise is a powerful tool in maintaining stable blood glucose levels. Regular physical activity helps to improve insulin sensitivity, which means your body can use insulin more effectively. This can improve blood sugar control overall, including in the mornings. Aim for at least 30 minutes of moderate-intensity exercise daily, such as brisk walking, cycling, or swimming. High-intensity interval training (HIIT) can also effectively stabilize blood glucose levels if you prefer shorter bursts of activity.
Incorporating strength training into your routine two to three times a week can further enhance insulin sensitivity. By building muscle, your body becomes more efficient at using glucose, which can help reduce morning spikes. However, always talk to your diabetes team before starting a new exercise regimen.
3. Avoid Carbohydrates Before Bed
What you eat before bed can significantly impact your blood sugar levels in the morning. Consuming a meal or snack high in carbohydrates late at night can cause your blood sugar to rise while you sleep, leading to higher levels in the morning. Instead, opt for a snack low in carbs and high in protein, such as a handful of nuts, a slice of cheese, or a hard-boiled egg. High-fiber snacks can also help if they’re low in overall carbohydrates. These options are less likely to cause a blood sugar spike and help keep your levels stable throughout the night.
4. Try Adjusting Meal Times
Adjusting the timing of your meals can also help manage morning blood sugar levels. Eating your dinner earlier in the evening, at least three to four hours before bedtime, gives your body ample time to digest the meal and prevents a nighttime glucose spike. If you’re hungry before bed, opt for low-carb snacks and avoid large meals late in the evening.
5. Adjust Your Medication Regimen
Your doctor can also help you determine the best medication and lifestyle strategy to stabilize blood glucose levels throughout the night. This will typically involve changing your medication times or doses or switching to long-acting insulin. Still, these changes might not be enough to maintain insulin in the morning when you experience the dawn phenomenon. Metformin may also be a good option to discuss with your doctor.
6. Use an Insulin Pump
Using an insulin pump is the best option to manage the dawn phenomenon. An insulin pump will ensure that your body is receiving enough insulin in the early morning when you might still be sleeping. Insulin pumps are most effective when paired with a continuous glucose monitor, as the two can work together to address the dawn phenomenon immediately, thus reducing the risk of high blood sugar due to hormonal shifts or other causes.
If you've never used an insulin pump, your doctor can help you determine the best settings to keep your blood sugar stable throughout the day. Your doctor will begin by measuring your average blood sugar and the changes in your blood sugar overnight, which is your basal rate. This will provide insight regarding the best insulin pump settings regarding timing and dosage.
If your doctor recommends using an insulin pump, it's important to talk to your insurance provider to determine your eligibility for coverage. Byram Healthcare carries some of the best insulin pumps and other high-quality diabetes products on the market, so you can take a proactive approach to managing type 1 or type 2 diabetes. We also have accessible diabetes support and educational materials for those who want to create a more comprehensive care package.
