The “dawn phenomenon” or “dawn effect” is a term that describes the experience of hyperglycemia in the morning by people living with diabetes.
If your blood sugar levels rise before you wake up in the morning, it will be more difficult to manage your diabetes for the rest of the day, so it is important to identify if you are experiencing the phenomenon of dawn and plan to deal with it.
This article provides an overview of what exactly the Dawn phenomenon is and how to better manage it.
What is the phenomenon of dawn?
Dawn phenomenon is a condition experienced in people with either type 1 or type 2 diabetes.
It is the experience of people with morning hyperglycemia levels and insulin resistance, usually from 2am to 8am
Usually, more insulin in the bloodstream is required during those times to stabilize blood sugar levels.
Some people need to double the amount of insulin in their bloodstream overnight to combat the hyperglycemia caused by the dawn phenomenon.
People without diabetes also experience the dawn phenomenon, but the pancreas increases insulin secretion and prevents hyperglycemia. People with diabetes don’t have that much luxury.
It is estimated that over 50% of people with diabetes suffer from a certain degree of dawning!
What is the cause of the Dawn phenomenon?
This biological process dates back to prehistoric times. Humans develop higher blood sugar levels (and more “energy”) in the mornings, and find food for the day through hunting and gatherings.
The dawn phenomenon is mainly caused by hormones. The natural overnight release of anti-regulatory hormones such as growth hormone, adrenaline, cortisol, epinephrine, and glucagon increases insulin resistance, leading to hyperglycemia levels overnight and in the morning.
Additionally, it develops in the liver overnight, releasing glucose into the blood, contributing to higher blood glucose levels.
- Glycogenolysis is fault and release of stored glucose.
- Gluconeogenesis, the creation of glucose from protein or fat components
Other causes of morning hyperglycemia include insufficient insulin in dinner, insufficient insulin basal rate overnight, or even restoring hyperglycemia by lowering it overnight.
It is important not to blame yourself for experiencing high blood sugar levels from the dawn phenomenon!
This is a troublesome problem for everyone living with diabetes, and it is about figuring out ways to manage and prevent it to the fullest without blaming yourself or feeling guilty.
What are the symptoms of the dawn phenomenon?
The symptoms of dawning are the same as hyperglycemia.
- Fatigue
- thirst
- You need to urinate
- headache
- Body pain
- Dry eye
- Haze
How to test the dawn phenomenon
If you notice that high blood sugar is common in the morning, you can set up a test routine several nights to determine if the Dawn phenomenon is causing it.
To do this, test your blood sugar levels at the next time.
- Before going to bed
- Early morning between 2am and 4am (waking up with an alarm clock)
- As soon as I wake up
If you find that your blood sugar is stable from you, you sleep from early in the morning until you rise, then you are probably experiencing the dawn phenomenon.
Note: If you have a continuous glucose monitor (CGM), you don’t need to do this test as you can see the overnight blood glucose graph that this provides.
Such a blood glucose graph is typical of the dawn phenomenon.
What is the blood sugar level considered a dawn phenomenon?
Your diabetes experience will vary, but for you, something higher than normal is considered a dawn phenomenon.
If you are waking up with higher than normal blood sugar levels several times a week, it may be time to contact your healthcare provider to readjust your insulin settings and evening routines to alleviate problems.
You should seek help before experiencing long-term damage or complications.
Long-term outcomes
If left unaddressed, long-standing experiences of dawning and hyperglycemia for the majority of the day can lead to diabetic complications such as:
- Heart disease
- stroke
- Especially the nerve disorders of the feet
- Lower limb amputation
- Kidney disease
- Diabetic retinopathy of the eyes
- Premature death
Tackling the hyperglycemia you may be experiencing while you sleep may be experiencing it until the morning.
How can you manage the Dawn phenomenon?
Work with your doctor to come up with some solutions that work to better manage the dawn phenomenon you may be experiencing, and always check with your doctor before adjusting your diabetic medication or insulin settings.
Several other strategies include:
- Avoid lots of sugar-added carbs and snacks when you go to bed
- Increases protein to carbohydrate ratio for dinner and snacks
- Get plenty of sleep between 7-8 hours each night
- Drink more water in the evening, add sugar and do not drink liquids
- I’ll have dinner early in the evening
- Eat a low-carb breakfast to manage your blood sugar levels
- Adjust the dosage of insulin and/or diabetic medications
- Exercise before going to bed
- Switch from multiple daily infusions (MDI) to an insulin pump for automatic insulin adjustments during sleep
- Switch from regular insulin pumps to hybrid crop loop insulin pumps, such as TSLIM Control IQ and Omnipod 5
- Change the time you take your night medication
- Divide the nightly dose of long-acting insulin into two doses (check with your doctor)
- Switch to another medication that might be more effective for you
If you are using insulin, read the article for a very comprehensive and detailed guide to managing Dawn phenomenon Managing dawn phenomena using basal insulin
Other reasons for morning hyperglycemia
Dawn is the most common reason for morning blood sugar levels, but that’s not the only reason. Two other phenomena can also increase blood sugar levels in the morning.
Bed syndrome feet
Plant syndrome feet occur when you wake up with normal blood sugar levels, but as soon as you start moving in the morning, your blood sugar levels rise without eating anything.
This is usually because once your body starts moving, it releases reverse-regulatory hormones like glucagon and epinephrine.
Some simple solutions for this are to increase the basal insulin speed in the morning, or to wake up and take a small amount of insulin if you are not using an insulin pump.
Learn more about how to manage your feet with floor syndrome in our guide How to avoid morning blood sugar levels
Samogie effect
The samogie effect also leads to high blood sugar when you wake up, but for a slightly different reason.
If insulin is released overnight, if blood sugar levels get too low, the body will naturally release hormones such as glucagon and epinephrine, spike your blood sugar levels at high rebound.
This is more common among people with type 1 diabetes in people with type 2 diabetes, as everyone with type 1 diabetes takes exogenous insulin.
To counter this, it is helpful to wear a continuous glucose monitor (CGM) and track your blood sugar levels overnight to see if the soaking is too low.
You can help prevent this from happening by reducing the carbohydrate-to-carbohydrate ratio at dinner or by reducing the basal speed overnight.
You can learn how to deal with the samogie effects in our guide What is the effect of samogie?
Other potential causes of morning blood sugar include, but are not limited to:
- New medication you are taking
- Hormonal changes
- pregnancy
- Insulin resistance
- Failed insulin pump and/or CGM sites
- stress
- Lack of sleep
- Bolas’ miscalculation in the evening
Living with type 1 diabetes, Christel Oerum recorded an incredible YouTube video that offers the best tips for preventing blood sugar levels in the morning. It’s worth watching:
When do you seek care?
Morning blood glucose levels are less dangerous than hyperglycemia at other times of the day, and therefore do not require urgent care as they experience the dawn phenomenon.
However, dawning phenomenon can be a persistent problem, which can lead to long-term diabetes complications.
Therefore, the National Institute of Diabetes and Gastrointestinal Diseases and Kidney Diseases (NIDDK) recommends seeing a doctor or endocrinologist if your morning glucose level is higher than three times in two weeks.
Your doctor can help you determine if you are experiencing the dawn phenomenon and suggest changes in your lifestyle, medication, and diabetes management.
Conclusion
Everyone in the world experiences the dawn phenomenon, but people with insulin-dependent diabetes are most susceptible to insulin resistance and stubborn hyperglycemia caused by this natural hormone development.
You won’t feel guilty or embarrassed, but taking positive steps can even alleviate, manage, and prevent the dawn phenomenon from ruining your day and diabetes management.
Dawn phenomenon is dangerous if experienced over a long period of time and can lead to complications of diabetes.
If you are struggling with the dawn phenomenon regularly, implement prevention strategies such as incorporating evening exercise, limiting carbohydrates at dinner, and increasing protein-to-carbohydrate ratios.
Before adjusting your basal/bolus insulin settings (if you are using an insulin pump), always work with your doctor before splitting up long-acting insulin evenings or increasing your insulin dose.
