4 days ago
Diabetes Detective Work: Dawn Phenomenon
File this column under 'Life with Type 2 diabetes can be a pain.'
Yesterday, my glucometer flashed a message to tell me that over the past week, my morning blood sugars had been trending upwards. This was followed by a programmed question directed at me: 'Has anything changed?'
Look, I know the notification was purely informative and that the inquiry made sense. After all, consistent high blood sugars over time can lead to those nasty complications we all want to avoid.
And yet, for some reason, at that moment, the question seemed less of an innocent question and more of an assault.
'No!' I shouted at her screen (I long ago determined that my meter is 'she/her.'). 'Nothing's changed. Everything is the same.'
'Is someone here?' my husband asked as he entered the kitchen.
Ignoring his question, I stonily reviewed my activities and intake over the past week. As usual, I consumed a lowish number of healthy carbs, enough to fuel my hour-a-day exercise plan and keep my weight in a good range. Of course, there may have been a slice or two of carrot cake with sugary cream cheese icing for my son's 33 rd birthday. And a little more cake on Mother's Day. Plus a glass or two of prosecco.
But nothing horrific. Overall, I decided my exercise, hydration, medications and diet was mostly on target.
'Did I do something wrong?' my husband asked.
Once again, I brushed him aside. In diabetes detective mode, I went to find my computer and typed a quick note to my trusty endo. Did he have any theories why my morning sugars had suddenly spiraled upwards?
'Could be the dawn phenomenon,' he wrote. 'Early in the morning, say between 3 and 8 a.m., everyone – with or without diabetes – has a natural increase in hormones that cause the liver to release glucose (energy) to help you to wake up.
'For people without diabetes, the pancreas produces insulin to combat any excess glucose. But for people with diabetes, their bodies may not produce enough insulin to meet the extra burst of sugar, which can cause hyperglycemia or high blood sugar.'
'Arghh,' I responded.
Back at the kitchen table, I considered my next move. I had heard of the dawn phenomenon, but despite my interest in most things diabetes, it had never captured my attention, in part because it had never been my problem.
'Can I help?' my long-suffering spouse asked.
'No,' I said. This time I left a kiss on his forehead as I went back to my computer. 'This is between me and my machine.'
Coffee in hand, I opened Dr. Google to refresh my memory on the condition. It turned out that it's extremely common. And the symptoms of dawn phenomenon are pretty much the same as other episodes of high blood sugar: dry mouth, increased thirst, blurred vision, headaches, and more frequent trips to the bathroom to urinate.
I also found that the dawn phenomenon isn't always to blame for a series of high morning blood sugars. Other factors can be at work, including taking too little medication that wears off early while you sleep or miscalculating how much medication you need to cover your carb vs. protein ratio at dinner.
Not to mention consuming too many carbs before bedtime.
What I was most interested in, of course, was how to stop my glucometer from asking invasive questions. Which meant finding a solution.
Here, things got a bit trickier.
For people who manage their Type 2 diabetes with a continuous glucose monitor (CGM) or take insulin via an insulin pump, the solution can be simple. A diagnosis of dawn phenomenon can be made by following the trend of high and lows recorded by the CGM and the flow of insulin can be adjusted accordingly.
But for people who use a glucometer and don't take insulin, like me, a solution to the dawn phenomenon can require a bit of trial and error. After investigating the issue further with my endo, I was able to get a handle on the morning highs by adding a bit of evening exercise – a stroll around the block or a quick 10-minute stationary bike ride. Increasing my protein and reducing the amount of carbs at dinner also seemed to help keep my morning sugars in check.
The tricky part is that while you can track your morning highs, there isn't a single way to anticipate and manage them. This means it can take a while to figure out what works for you.
Which is, as I said earlier, a total pain.
However, if you do get symptoms of the dawn phenomenon, don't despair. The key goal is to keep your A1C low, and by taking a proactive stance on high morning sugars, you're doing just that.
Not to mention that once you get a handle on things, those pesky questions from a cranky glucometer might be a thing of the past.
