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Question: I take my medication, exercise, and eat right, but when I check my blood sugar in the mornings, it is still high. Why is this so?

Answer: If you wake up with high blood sugar in the mornings, you may be experiencing the dawn phenomenon. The dawn phenomenon is the term used to describe an early morning increase in blood sugar in people with diabetes. This increase in blood sugar usually happens between 2:00 am and 8: am.

Let’s look at what happens in the body overnight so we can better understand the dawn phenomenon. During the night when we are sleeping, the body does not require a lot of energy. However, in preparation for awakening, the body starts to boost up its energy production. The liver has glucose stores that can be quickly released. When we are about to awaken, the body tells the liver to start releasing glucose into the blood. The presence of glucose should stimulate the pancreas to release insulin so the glucose can pass into the cells to give the cells energy. In people without diabetes, this insulin release takes care of the excess blood glucose. However, diabetics either do not produce enough insulin or their cells cannot utilise insulin properly, so the glucose remains in the blood stream, causing high blood sugar.

Overnight, the body releases some hormones such as growth hormone, cortisol, glucagon and epinephrine. These are important for the functioning of the body but they work against insulin. They cause the cells to become resistant to insulin, so the insulin stays in the blood stream instead of being taken up by the cells. If you are diabetic, you already have a problem with your cells utilising insulin, so these overnight hormones only compound the problem.

Apart from these normal body functions, if you did not take your diabetes medication, if you did not take enough night-time insulin, or if you eat carbohydrate containing snacks at bedtime, your blood sugar can be high in the morning.

The dawn phenomenon can elevate blood sugars to dangerous levels and this is not desirable for diabetics.

How to know if you have the dawn phenomenon

If your blood sugar is high in the mornings, you can do a simple monitoring exercise to determine whether it is caused by the dawn phenomenon or not. For several nights in a row, check your blood sugar at 2:00 or 3:00 am. If your blood sugar is high, you probably are experiencing it.

How to prevent the dawn phenomenon

It is important to try to prevent the dawn phenomenon because even the smallest fluctuations in blood sugar can have drastic effects on your overall health as a diabetic and increase your risk of diabetes-related complications. You should take the following steps to avoid it:

1. Don’t eat carbohydrate-containing snacks before bed. Carbs will cause blood sugar levels to rise, making the dawn phenomenon worse. If you must eat a snack, eat some veggies or a protein-containing snack.

2. Eat dinner earlier in the evening so the carbs can be processed before you go to bed.

3. If you take insulin, take it at bedtime instead of earlier in the evening. This will help the insulin to be effective until in the morning when you can take another dose. For example, if the insulin is active in your body for 12 hours and you eat dinner at 5:00 pm and take the insulin, the insulin will be gone by 5:00 am in the morning while you are still sleeping. Hence, if you wake up at 6:00 am and check your blood sugar, it will be high because there is no insulin. However, if you take that same insulin at 8:00 pm, it will still be active until 8:00 am. So, if you get up at 6:00 am and check your sugar, it should be under control because the insulin is still active in your blood stream. Of course, you should discuss any changes in your medication regimen with your doctor.

4. Take your diabetic medications at bedtime instead of earlier in the evening. The same reasoning for the insulin applies here.

5. Use an insulin pump and programme it to give you more insulin in the early morning hours. Of course, discuss this with your doctor so you can get the right dosage and not run the risk of hypoglycaemia.

6. Do some light exercise in the evening after dinner. Be careful not to overdo it because you don’t want to get low blood sugar. However, exercise helps to prevent insulin resistance and it helps to use up some of the glucose from the carbohydrates you ate for dinner. You can also do some exercise in the morning when you wake to help counteract the high blood sugar.

7. Ask your doctor about adjusting your medication regimen.

8. Get good quality sleep. Diabetics who have better quality sleep have fewer incidence of the dawn phenomenon.

Conclusion

The dawn phenomenon happens to over 50 per cent of people with diabetes. This early morning increase in blood sugar needs to be addressed because any fluctuation in blood sugar can be detrimental for diabetics. You can take simple steps to counteract it, but you need to discuss any changes you plan to make with your doctor and monitor your blood sugar closely so you do not have episodes of hypoglycaemia or low blood sugar. All the best in managing the dawn phenomenon.

Novia Jerry Stewart, MSc, RPh, is a pharmacist who specialises in diabetes care. She may be contacted for diabetes care coaching sessions at diabetescarepharmacist@gmail.com.