@CatLady I found a paper on the subject
It is my opinion that the Dawn Phenomenon is a natural part of waking up. There are the release of homones such as cortisol and human growth hormone and glucagon causing a release of glucose from the liver.
The rise in blood glucose levels is keep from rising too high in those without diabetes by the secretion of insulin. Those without this perfect system of glucoregulation such as type 1 DMs and other types using insulin have to respond to the rise of BG with a correction bolus of insulin. Some with closed loop pumps may not need to do this.
I am a type 2 on a Tandem with C-IQ. Since I moved from MDI to the pump I don’t see the classic rise of BG starting around 3AM. What I do get is a steady rise of BG after getting out of bed.
I generally do a correction higher than C-IQ suggests because BG is constantly going up. This morning it suggested a bolus of .3u, but I overload that for .8u. Sometimes I will give as much as 1.2u.
The paragraph below suggests that not delaying breakfast is helpful, but those of us on thyroid meds are suppose to continue fasting for 30 to 60 minutes. It is during this period that I can see BG steadily rising.
I don’t find much correlation between the timing of exercise and DP. Lately I have been doing 30 to 60 minutes cycling after dinner. In warmer months I tend to do that in the morning. DP and FOTF seemed to be unaffected. Also I do not have any snacks before bedtime. I generally don’t have any snacks at all.
This is a real problem for type 2 DMs that are not on MDI or a pump. I used to hate that I would go in for Labs with the draw taking a couple of hours after waking. I would do a fBG finger stick at home and just before the draw seeing BG rise which corresponded to the lab results. I hate seeing those Hs in the report.
Here’s the snip from the paper:
Treatment / Management
When the presence of the dawn phenomenon is detected, especially when associated with the extended dawn phenomenon, an individual patient should be considered for earlier and more aggressive control of glucose. The prevention of long-term sequelae by minimizing exposure to hyperglycemia is key early in the disease process. Optimal insulin therapy is important in type 1 diabetes, but also in type 2 diabetes. Oral hypoglycemic agents have failed to show adequate control of the dawn phenomenon, while insulin therapy has been shown to be much more effective.
Choosing an insulin regimen must, of course, be individualized for each patient, but research has indicated that the presence of the dawn phenomenon must be considered in selecting the type of insulin and the mechanism of delivery. In studies that have demonstrated superior glycemic control with continuous insulin infusion as opposed to long-acting insulin formulations, the dawn phenomenon is likely the reason. The ability for a continuous infusion to provide a bolus in the early morning hours to counteract the dawn phenomenon is a possible explanation, as long-acting insulin preparations have no ability to achieve this. For type 1 diabetes, tight control with insulin must take into account the dawn phenomenon to avoid nocturnal hypoglycemia before the onset of early morning glucose elevations. If insulin adjustments are made based on early morning fasting glucose levels, a larger dose of insulin might be administered than would be appropriate if the dawn phenomenon magnitude was considered.[12]
Management of morning hyperglycemia should be a part of the overall diabetes control strategy. Lifestyle modification is an important component to be considered. Better control of morning glucose levels has been demonstrated by increasing the amount of exercise in the evening and by increasing the protein to carbohydrate ratio of the evening meal. Consuming breakfast is also very important. While it seems counterintuitive, an early morning meal serves to decrease the secretion of insulin-antagonistic hormones.[13][2] In recent study the use of acarbose helped with dawn phenomenon treatment, but not the use of sulfonylurea.[14]
