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dawn phenomenon
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2005-12-06>
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taming the dawn phenomenon

posted by david mendosa on 6th december 2005 @ 13:14 in diabetes

<http://blogs.healthcentral.com/diabetes/> | 8 comments
<http://blogs.healthcentral.com/diabetes/david-mendosa/taming-the-dawn-phenomenon-
2005-12-06#comments>

just like diabetes itself, we don’t have a cure yet for the dawn
phenomenon. but unlike diabetes, you can’t completely control it. the
best you can do is tame the dawn phenomenon.

there are a lot of definitions for what the dawn phenomenon is, but the
simplest is the government’s
<http://diabetes.niddk.nih.gov/dm/pubs/dictionary/a-e.htm#d>one, “the
early-morning (4 a.m. to 8 a.m.) rise in blood glucose level.” the best
way to see if you have it is to test your blood at bedtime and then when
you get up, and if it’s higher then you probably have the dawn phenomenon.

but if you take insulin, maybe the effect of the insulin you took the
night before is wearing off. there is even a third possibility, although
it is much less likely. it is a rebound from a high blood glucose level
in the middle of the night. you can see if this is happening by checking
if your blood glucose is low at 2 or 3 a.m.

it’s important to know what causes your high morning blood glucose. if
you have night-time lows, you might need to reduce the dose of insulin
you taken in the afternoon or add a bedtime snack. on the other hand, if
you aren’t running low at night but are high in the morning, you might
need to take more insulin.

a lot of people who aren’t taking insulin also experience the dawn
phenomenon. it varies from person to person. and sometimes you might
have it and other times you won’t.

we know what causes the dawn phenomenon. some of our hormones tell our
liver to release glucose to give us the fuel we need when we wake up.
but when these hormones are out of balance with the hormone insulin, the
liver releases too much glucose.

we don’t know a way for everyone to control the dawn phenomenon. it

would be great, but we can’t just put a lid on our liver.

the only report in the professional literature of a treatment for the

dawn phenomenon was a study four years ago by maryellen dyer-parziale of
casa pacifica medical clinic in camarillo, california. her report,
published in diabetes research and clinical practice
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstrac
t&list_uids=11483228&itool=iconabstr&query_hl=1>,
showed that 28 test subjects who ate an extendbar at bedtime had an
average 28 percent reduction in morning hypoglycemia compared with those
taking a placebo.

it worked for those people. but it didn’t work for me as i wrote in

“extendbars and the dawn phenomenon”
<http://http://www.mendosa.com/extendbar.htm>

extendbars contain uncooked cornstarch

<http://www.foodinnovation.com/pdfs/functresist.pdf>, a naturally
occurring resistant starch. so i wasn’t surprised when ann, a
correspondent in australia, wrote that something called hi-maize
5-in-1-fiber helps control her dawn phenomenon. she said that she takes
about 1/3 cup a day. hi-maize is also resistant starch.

a recent study
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstrac
t&list_uids=16155268&itool=iconabstr&query_hl=5)
> shows that hi-maize improves insulin sensitivity, which may explain
why it can help control the dawn phenomenon.

a company called national starch food innovation

<http://www.foodinnovation.com/5in1fiber/index.asp>produces hi-maize.
honeyville grain
<http://www.store.honeyvillegrain.com/index.asp?pageaction=viewprod&prodid=640&hs=
1>
sells it in 5-pound bags.

i haven’t tried hi-maize yet. still, there are several things to try
that seem to work for some people.

eating a green apple at bedtime lowers the morning reading for many
people, according to john walsh and his wife ruth roberts in their 1996
book stop the rollercoaster: how to take charge of your blood sugars in
diabetes, which is out of print. we digest green apples – like granny
smith apples, not unripe ones – fairly slowly, so this approach makes
sense, and my preliminary trial of eating one at bedtime worked for me.
but i didn’t keep it up, because i just don’t like to eat an apple at
bedtime.

vinegar is another approach that has some good theory going for it and
works for some people. vinegar and other acidic foods can reduce blood
glucose, as i have written in “acidic foods: another way to control
blood glucose” <http://mendosa.com/acidic_foods.htm>.

pure vinegar is a bit strong. so a correspondent, renee, uses tablets of

vinegar at bedtime to control the dawn phenomenon. recently she wrote
that for best results she uses five to six tablets. earlier i tested
this approach with two tablets at bedtime and got mixed results, as i
wrote in the september 2005 issue of my “diabetes update”
<http://www.mendosa.com/diabetes_update_86.htm>newsletter.

i haven’t started taking the larger dose of vinegar tablets at bedtime,

but i will soon. as john walsh and ruth roberts point out, the morning
reading is the most important one of the day. a typical complaint, they
say, is “if i wake up high, my whole day is shot!” i don’t need that and
you don’t either.

8 responses to “taming the dawn phenomenon”

1. nicky
december 21st, 2005 at 12:20 pm <#comment-437>

a glass of wine and a handful of nuts at bedtime work for me. i

think the theory is that the wine keeps the liver busy, so not
doing a dump; and the slow-digesting nuts provide a few carbs when
the liver checks to see if it needs to put glucose out as part of
the dawn phenomenon.

2. peter polk <http://www.kinderburgshepherds.com>

january 1st, 2006 at 4:25 pm <#comment-441>

i have a real problem with the “dawn” phenomena. some mornings my

sugar is 170 or 180 even after taking my pills. if i eat a small
protein snack at bedtime, it seems to help get my am sugar into
the 120 range.

3. mary
january 1st, 2006 at 7:20 pm <#comment-446>

i’m type 2 and had the dawn phenom. a guy on a diabetes board said
to try eating something before i went to bed. i did and it has
totally gone away…doesn’t matter what i eat either. sometimes i
have a small piece of candy, or fruit or even toast. i never wake
up high when i have a snack before bed. i often use that snack for
some little treat i normally wouldn’t have during the day.

4. lisa johnston
january 3rd, 2006 at 2:49 am <#comment-457>

i have started to drink 4 oz of wine every night with a small

snack an i’ve notice a drop in my before breakfast bs by 15 points….

5. joe
january 19th, 2006 at 4:37 pm <#comment-486>

i have found that having a glucerna drink at night before bed does
the trick.

6. allen
february 1st, 2006 at 3:57 pm <#comment-513>

a better way to do keep your morning sugar down without using

alcohol is by using milk thistle before bed. it works directly on
the liver in a healthy way and prevents the glucagon output that
raises blood sugars. works great.

allen

david’s response

david’s reply:
 i am so glad to hear from you, allen, that milk thistle helps keep
down blood glucose! i am taking it for fatty liver, as i wrote at
“fatty liver” at
http://blogs.healthcentral.com/diabetes/david-mendosa/fatty-liver-2005-11-
09.
someone else wrote me a comment to the same effect earlier and now
i am a believer — particularly after i got my most recent a1c
result yesterday — 6.1.

7. gail <http://blogs.healthcentral.com/diabetes/david-mendosa>
february 23rd, 2006 at 10:23 pm <#comment-555>

how much milk thistle?

/david’s response/

the standard dosage of milk thistle is 200 mg two to three times a

day of an extract standardized containing 70 percent silymarin.

there is some evidence that silymarin bound to phosphatidylcholine

may be better absorbed. consequently, this form should be taken at
a dosage of 100 to 200 mg twice a day.

8. richard petersen
march 28th, 2006 at 1:15 pm <#comment-652>

after reading about the dawn phenomenon i tried an experiment last

night. i ate some dry-roasted unsalted peanuts right before bed.
my reading before doing this was always 125-135. this morning it
was 110! i’m going to talk to my doctor but if this is all that i
need to do to fix this dp, wah-hoo!!

/david’s response/

let us know, richard, if the peanuts at bedtime continue to work

for you. different approaches seem to work better for some people
and at different times. personally, i have recently tamed the dawn
phenomenon consistently. when i went on byetta, as i wrote at
http://blogs.healthcentral.com/diabetes/david-mendosa/going-to-byetta-2006-
02-17,
i found among its many benefits that it also brings down my
morning fasting levels to normal.

url to article:
http://blogs.healthcentral.com/diabetes/david-mendosa/taming-the-dawn-phenomenon-
2005-12-06

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