The Dreaded Dawn Phenomenon

Written by Jordan R. Wagner BSN,RN,CDCES

The Dawn Phenomenon, aka Dawn Effect or Liver Dumping happens during a state of fasting, primarily during the hours of 2-8am.

The cells of the body need, primarily, glucose to function properly. During the daytime when someone is eating foods, such as carbohydrates, proteins, and fats, the cells are nourished through the diet. However, overnight when food intake is not happening, the adrenal glands produce chemicals such as epinephrine, norepinephrine, dopamine, cortisol, etc… while the pituitary gland releases growth hormone and pancreas releases glucagon (There are many other hormones that can impact blood sugars as well). All of these chemical messengers can increase blood glucose levels with the intent of fueling the cells. In a person who does not have diabetes, insulin produced by the pancreas will drive the glucose into the cell. But when someone is resistant to insulin or not making enough insulin, the result is high blood glucose levels.

What can be done? Well there are many tips that can help to reduce the impact of the dawn phenomenon or at least help to control it. Remember, while human physiology has similar principles in everyone’s body, each person is coming from a different background of metabolic health, therefore response to managing the Dawn Phenomenon can vary from person to person.

Tip1: Do not eat large meals before bedtime, rather a small snack of about 10g of carbs while primarily focusing on getting protein can help. Protein is known to cause a significant spike in insulin levels as well as a rise in glucagon. Since both of these hormones are opposites, the result is often balanced blood sugars.

Tip 2: Diets high in fat can cause insulin resistance. Even a single meal with high fat content can lead to temporary insulin resistance and higher blood sugars. Hence why a meal like pizza can be so challenging for someone with diabetes. This happens because high fat levels in the blood tend to interfere with the transport of glucose into the cells of the body. Therefore avoiding high fat meals before bedtime will help with limiting an early morning blood glucose rise. Remember insulin is like a key that opens a cell to allow glucose to enter to be used for fuel. Picture living in a really snowy state. When a blizzard roles through, it blocks pathways and doors to cars, buildings, etc. In order to go inside the car or building, the snow has to be shoveled away first. Now picture this analogy with body fat. Excess body fat makes it much more difficult for glucose to enter a cell.

Tip 3: Exercise can play a key role in controlling the Dawn Phenomenon. Exercise naturally increases sensitivity to insulin and can make the body pull glucose from its stored forms called glycogen in the liver and muscles. After exercise, the body will attempt to replenish the stores by pulling glucose from the blood, which results in lower glucose levels. Morning and evening exercise has been shown to decrease the impact of the Dawn Phenomenon. Remember you do not have to go out and "run a marathon" for exercise. We all have a tendency of going from zero to a hundred quickly and burning out. The goal with all diabetes management is creating healthy and sustainable habits that will fit your lifestyle. For example, if you haven't been exercising, start small and work up. Walking, light weight arm weights, resistance bands, swimming, etc. are great exercises to start with. Set S.M.A.R.T. goals for yourself!

Tip 4: Make adjustments to your medications with help from your provider. It is possible that an increase to basal insulin may be needed, especially if other hormone levels are off such as during menstruation. If you are using multiple daily injections with a long acting insulin and rapid/short acting insulin, look at the timing of your dose. Although, insulin glargine (Lantus, Toujeo, Semglee, etc.) doesn't have an actual peak level of action, it can take 1 to 4 hours to go active in your blood stream. The timing of when you take your long acting insulin and how you take it (once or twice a day) can impact the Dawn Phenomenon. If you are able to switch, an insulin pump is one of the best ways to control the Dawn Phenomenon, as basal rates can quickly be changed manually and/or closed loop systems can automatically increase or decrease basal rates based on CGM readings.

As a side note, I have personally worn Omnipod, Medtronic, and Tandem pumps. I currently use the Tandem T-Slim X2 with Control IQ technology and am also a certified Tandem pump trainer. Pump questions? Reach out to me!

Unfortunately, there is no “quick fix” to diabetes or the Dawn Phenomenon, it does take work. However, I find that having the knowledge to manage it as well as possible is key to success. If you are feeling overwhelmed and need help, please message me or schedule a consult through my website. We can set up a time to dive into your unique situation. You’ve got this!