Breaking Dawn (Continued)
So Dawn Phenomenon can be caused by either too little or too much of a diabetes medication, but it can also be caused by your body itself, independently of your medicine cabinet. Understanding the nuts and bolts biology behind this flavor of Dawn Phenomenon involves circadian rhythms, the thyroid hormones T4 and T4, pancreatic peptides, glucocorticosteroids, glucagon, growth hormone, and catecholamines; but to keep it simple—your body does not like to wake in the morning up any more than you do.
OK, maybe that was too simple.
Like ocean tides, all the various hormones that course through your body have natural peaks and valleys. As it so happens, insulin's low tide is at night; while a number of glucose-raising hormones have their high tide in the wee hours of the morning, cresting at 4 a.m. to help your body wake up and get ready for the day. It doesn't take much imagination, then, to see why many people with diabetes might experience Dawn Phenomena: Our insulin production, insufficient in the first place or we wouldn't have diabetes, is at its lowest when the blood sugar-raising hormones are their highest.
Oddly, research shows that this kind of Dawn Phenomenon is more common in people with higher A1C scores. It seems to be less common and easier to control in dFolks with A1Cs under 7.0, and more common and more difficult to control in dFolks with A1Cs above 7. No one knows for sure why this is, but it may simply be that high sugar begets high sugar. Research shows that people who wake with high blood sugar develop a higher degree of insulin resistance throughout the day than people who wake with lower sugars. So the bottom line to this is that any method for managing blood sugar will likely have a positive impact on Dawn Phenomenon.
Beyond improved overall control, there are also other "fixes" for hormone-induced Dawn Phenomenon. The best fix for type 1s may be an insulin pump. The pump's basal rates can be programed to deliver more insulin in the pre-dawn hours to counteract the rising blood sugars from the surge of pre-dawn hormones.
The fix for type 2s and type 1s unable to get pumps is a bit more complicated, but there are a number of options—some of which make sense and others of which defy logic—and they include an increase in physical activity in the evening, increasing the protein-to-carb ration in the last meal of the day, or being sure to eat breakfast. Other fixes for the Dawn that are championed by various dFolks include eating green apples at bedtime, taking vinegar pills, or ingesting corn starch. Many of these approaches seek to add a slowly digested carb to stimulate insulin activity—if you still have any—later into the evening than would naturally occur. If your body is still digesting something, it offsets the naturally occurring trough in insulin production that's seen at night. This in turn leaves more insulin in play when the hormones kick in. It is, in essence, leaving the pot simmering on the stove.
But my favorite fix, and my morning numbers generally look pretty good, is my drug of choice: Alcohol. Kid you not, research has shown that in those of us who imbibe—sensibly, of course—in alcohol every night have flatter morning blood sugars. It's widely recognized that excessive alcohol causes epic low blood sugars hours downstream from the binge. This is because a liver busy filtering alcohol doesn't filter out insulin, which can allow insulin to super-size in the body, triggering lows. Perhaps smaller amounts serve to stretch insulin, either naturally occurring or injected, so that it retains better potency when the body is ramping up its natural hormone-induced sugars. Or maybe not, but in my book it beats the hell out of a vinegar nightcap.
Although I was using the good-for-my cholesterol argument before, anti-Dawn Phenomena thearpy is my new excuse for my nightly glass—or two—of wine, and I'm sticking to it.
So let's toast the dawn. Cheers!
Wil Dubois is the author of four multi-award-winning books about diabetes. He is a PWD type 1, and is the diabetes coordinator for a rural non-profit clinic. Visit his blog, LifeAfterDX.
NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.
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