Videos from Bull Family Diabetes Center

The dawn phenomenon is something that's part of your normal physiology. Hormones work on a cycle. We have hormones that peak at certain times of the day and then fall as the day progresses and that's common in typical, normal physiology of endocrinology.

In the early morning hours, say between two or three o'clock in the morning, through around six or eight o'clock in the morning, some of these hormones are peaking. Those would be things like growth hormone, cortisol, adrenaline and others. These hormones peak at that time, and the normal response that the body would have would be to increase levels of insulin. Insulin controls blood sugar levels and can lower them. Those other hormones can raise them. In normal physiology, we have a balance of those hormones. As those hormones peak, insulin peaks and we can control our blood sugar in a very normal, steady level. In diabetes, you lose the balance, as is true with every disease in endocrinology. There's an excess or deficiency of these hormones and then we can see that as a disease. In this case, an abnormal elevation of blood sugar in the early morning hours.

The effects of dawn phenomenon typically go unnoticed. As far as the way an individual feels, the real feeling is of frustration because an individual's trying to do the right thing in taking their medicines and eating appropriately. Many times, a patient will say, "I didn't eat anything this morning and I noticed my blood sugar escalating." We have to check closely, do questions, try and figure out ... Is it something that you're doing? A stressful event? Is it unaccounted for carbohydrates like creamer in coffee? Is it a healthy meal, but yet a meal that has carbohydrates and you're not really accounting for that, so the blood sugar's escalating? Are your medicines wearing out and you actually just need a change of how or when you're using your medicines? Or, is this dawn phenomenon?

If we can identify it as dawn phenomenon, or separate it from those other causes, then we can try and attack that. As far as feeling poorly, a person might feel an elevation of blood sugar, particularly if it's more extreme. If it's in a more modest, reasonable range, as would be more typical, it may go unnoticed unless you're checking or monitoring the blood sugar.

We have very little ability to influence our hormone levels. If the blood sugar is on its way up, adding fuel to the fire, consuming additional carbohydrates would simply magnify it. If you have medicines that aren't necessarily peaking or working during those times, if your timing isn't appropriate, then the sugar may elevate more than if the medicine were overlapping at that appropriate time. You can have a positive influence on it. Perhaps timing exercise, or timing the types of meals, or the timing of your medications to peak or work in synergy at that time, then the blood sugar may not escalate to the same extent.

A sign that you need help with your dawn phenomenon is if you're making positive changes, and you're still noticing this escalation of blood sugar beyond the goals that you and your provider have set for you. That's something that we could help you with. Sometimes, we'll counsel on further changes of diet. First of all, define: "Is it a problem? Is it to an extent that we need to be worried about it?" Number one. Number two is: "Can we do some lifestyle changes to augment your efforts and overcome the impacts of dawn phenomenon?" Thirdly: is change the timing or types of medicines you're using to control your sugar, particularly during those dawn hours.