For people taking insulin for diabetes, blood sugar levels are often elevated in the morning (hyperglycemia). This is likely caused by inadequate amounts of long-acting insulin before dinner or at bedtime. Morning high blood sugar is referred to as either the dawn phenomenon or the Somogyi effect.
- Dawn phenomenon. The dawn phenomenon is the end result of a combination of natural body changes that occur during the sleep cycle and can be explained as follows. Between 3:00 a.m. and 8:00 a.m., your body starts to increase the amounts of counter-regulatory hormones (growth hormone, cortisol, and catecholamines). These hormones work against insulin’s action to drop blood sugars. The increased release of these hormones, at a time when bedtime insulin is wearing out, results in an increase in blood sugars. These combined events cause your body’s blood sugar levels to rise in the morning.
- Somogyi effect. This condition is named after the doctor who first wrote about it. It is also called “rebound hyperglycemia.” Although the cascade of events and end result — high blood sugar levels in the morning — is the same as in the dawn phenomenon, the cause is more “man-made” in the Somogyi effect (a result of poor diabetes management). The term refers to pattern of high morning sugars preceded by an episode of hypoglycemia (usually with no symptoms, but night sweats can be a sign). Your blood sugar may drop too low in the middle of the night, so your body counters by releasing hormones to raise the sugar levels. This could happen if you took too much insulin earlier or if you did not have enough food to balance the insulin.
Which of the 2 Conditions Is Causing the High Blood Sugar Levels?
To determine which of the two above conditions is causing your high blood sugar level, your doctor will likely ask you to check your blood sugar levels between 2:00 a.m. and 3:00 a.m. for several consecutive nights. If your blood sugar is consistently low during this time, the Somogyi effect is suspected (too much nighttime insulin or too small of a meal for the insulin given). If the blood sugar is normal or high during this time period, the dawn phenomenon (increases in counter-regulatory hormone) is more likely to be the cause.
How Can Morning High Blood Sugar Be Corrected?
Once you and your doctor determine how your blood sugar levels are behaving during the nighttime hours, he or she can advise you about the changes you need to make to better control them. Options that your doctor may discuss include:
- Changing the time you take the long-acting insulin in the evening so that its peak action occurs when your blood sugars start rising
- Changing the type of insulin you take in the evening
- Taking extra insulin overnight if you find that overnight your blood sugars are progressively elevated. Here, the additional insulin would help lower high morning blood sugars.
- Switching to an insulin pump, which can be programmed to release additional insulin in the morning
Health-e-Solutions comment: Testing to evaluate which of the above is the likely cause of high morning blood sugars is important. If it is the man-made Somogyi effect, it can probably be more easily corrected. If it is the dawn phenomenon, it may be more difficult to address.
Here is what Dr. Mona Morstein says about treating the Dawn Phenomenon:
A good way for trying to get the Dawn Phenomenom under control could include these recommendations:
- Lose the abdominal fat!
- Do not eat before bed; the longer the fast, the better the control of one’s blood sugar. If, however, the diabetic patient is having hypoglycemic events in the middle of the night, one must do some investigation as to why, to ensure safe and responsible treatment. Ideally, the treatment would not include having to eat at bedtime.
- Adding in various insulin resistance nutrients: Perhaps one might take some chromium (Max: 2000 mcg/day) or zinc (balance with copper) at night. Alpha lipoic acid, and N-acetyl cysteine also decrease insulin resistance and protect the liver, keeping it healthy.
- Add in various insulin resistance herbs: Gymnema sylvestre, bitter melon, holy basil, or berberine. I am especially interested in berberine given recent studies showing its efficacy in safely enabling significant hypoglyemia, equal to Metformin’s treatment effects.
The last thing to remember is patience—be calm if morning glucose numbers are not ideal and realize that they will likely be hardest to consistently control. With education and understanding of physiology, we can work with our diabetic family members in a supportive and positive way, which is even more important than perfect morning numbers.
Health-e-Solutions comment: Mapping, monitoring and measuring are a continuous cycle when living with diabetes. You begin with a certain course of treatment in mind, which you mapped out with the help of your medical professional. You monitor your progress and measure it against your goals. Upon evaluation, you may find a new course must be corrected to compensate for successes and challenges. Evaluating progress and results of the Health-e-Solutions lifestyle is essential for mastering diabetes in the healthiest way possible. This downloadable printable e-publication equips you with the key evaluation tools you need, along with some of the research behind them, to determine where you want to go and how to get there. We give you important tools to help you chart your course and stay on track to reach your destination.