Diabetes Talking

Question:

It’s a bit strange. My readings 1-2 hours after dinner on recent dinner have varied from 80-100. Yet fasting readings taken the following morning have been between 109-122, all noticeably higher than the previous evening. Is this an example of the so-called dawn effect or is my food digesting much more slowly than expected. I also take glyburide twice a day, once at 5PM, just before dinner.

The degree to which one’s bg rises overnight depends on the rate of one’s basal metabolism.  This is different for each person.  If anything can be said to be "normal" about diabetes, it is the matter of bg rising overnight due to basal metabolism.  This is one of this many, many things which you should be discussing with your doctor. Meanwhile, an FBS such as you report shows a relatively small overnight rise, indicating your current therapy is probably working very well.  (But again, this is for your doctor to say.) David Cohler, South Pasadena, CA Media Access Consultancy http://members.tripod.com/~dcohler/

Response:

I’ve no idea how a non-user of insulin would get their pre-breakfast bgs down, I’m afraid, but knowing what the cause is is surely some help. — Pat Reynolds

I am Type II diabetic, having been diagnosed several months ago. Previously, I never ate breakfast, never really wanted anything in the morning. I experienced the ‘dawn effect’ and commented on it to my doctor and she basically told me everything you’ve read here. Then my father moved into our house to live. I would cook him breakfast every morning (he’s Type I diabetic and has his own fairly rigorous schedule) and gradually the stuff I was cooking started to look more appealing and I would eat a little to be sociable. I soon noticed that the ‘dawn effect’ was lessened when I regularly ate a small breakfast. Go figure … Live long, and prosper Jerry L. Gubka

Response:

I’ve no idea how a non-user of insulin would get their pre-breakfast bgs down, I’m afraid, but knowing what the cause is is surely some help.

Well, my experiments on myself are still inconclusive, but here are a couple of things to try: 1. Evening exercise.  My bg is generally nice and low in the morning when I’ve been folk dancing the evening before.  That’s a couple of hours of vigorous exercise; just a walk after dinner doesn’t seem to have any effect. 2. A high-protein evening meal or snack may help.  I’ve found that when I have fish for dinner (more protein than I usually do, since I usually eat vegetarian), I tend to be relatively low the next morning. YMMV, of course. /Janet — "Use every man after his desert, and who shall ’scape whipping?  Use them after your own honor and dignity: the less they deserve, the more merit is in your bounty."  – Hamlet, Act II, Scene 2

Response:

I’ve no idea how a non-user of insulin would get their pre-breakfast bgs down, I’m afraid, but knowing what the cause is is surely some help. Well, my experiments on myself are still inconclusive, but here are a couple of things to try: 1. Evening exercise.  My bg is generally nice and low in the morning when I’ve been folk dancing the evening before.  That’s a couple of hours of vigorous exercise; just a walk after dinner doesn’t seem to have any effect.

Exercise, usually, improves the efficiency of insulin.  So if you dance and get low results, that suggests that your body isn’t able to cope with the amount you are eating … and you need to exercise, or take drugs, in order for it to cope. 2. A high-protein evening meal or snack may help.  I’ve found that when I have fish for dinner (more protein than I usually do, since I usually eat vegetarian), I tend to be relatively low the next morning.

Protein slows the absorbtion of CHO.  So it may be that if you eat a meal with high protein (or fat, or oats, they all tend to have the same effects), you don’t get a marked peak after the meal.  And your body can deal with the slower release of CHO.  Delaying some of your dinner CHO until bed-time could have a similar effect. It could also be that the slower release of CHO stops you going hypo a couple of hours later … unless you test through the night (once a night at different times on different nights, on nights when you eat the fish, and on nights when you don’t), you won’t know which it is. Best wishes, — Pat Reynolds    "It might look a bit messy now, but just you come back in 500 years time"    (T. Prattchet)

Response:

This is the dawn effect. My endo has told me about this but I don’t remember the name of the doctor that discovered it.  Basically what happens is that your bg gets low enough in the middle of the night so your liver kicks in to raise it.  In my case I reduced my last insulin shot and went from 160 to 125 in the morning.  It sounds like you need to talk to your doctor about the timing and quantity of your meds.

Although, as you point out, the dawn effect may well explain the original poster’s high bg readings, what you describe above is not the dawn effect but, rather, the Somogyi phenomenon. —  John Kinsley Remove ** in the ‘Reply To’ e-mail address in header. The address below is correct.

Response:

It’s a bit strange. My readings 1-2 hours after dinner on recent dinner have varied from 80-100. Yet fasting readings taken the following morning have been between 109-122, all noticeably higher than the previous evening. Is this an example of the so-called dawn effect or is my food digesting much more slowly than expected. I also take glyburide twice a day, once at 5PM, just before dinner.

It’s an example of how eating is only one factor in BG readings. You body has a daily cycle of BG levels and eating, medication, exercise all modify that. You may have any sort of pattern, without some round the clock testing, you will not know. I, for an example, have a high period about 10-11 AM and another about 11PM-1AM and low zones at 4-6 AM and 4-5 PM. So, taking a fasting reading in the morning is taking a reading when my BG is naturally rising and it can vary almost minute by minute. I can choose a fasting reading by choosing when I take it if I wanted to be dishonest. Singular readings taken once a day tell you very little. I do wonder how you managed to be so low after eating, unless this eating occurred in one of your natural low periods. It looks like it may also correspond with a maximal effect of your medication. Doesn’t hurt to study your medication’s effective pattern either. Walt

Response:

It’s a bit strange. My readings 1-2 hours after dinner on recent dinner have varied from 80-100. Yet fasting readings taken the following morning have been between 109-122, all noticeably higher than the previous evening. Is this an example of the so-called dawn effect or is my food digesting much more slowly than expected. I also take glyburide twice a day, once at 5PM, just before dinner.

The only way to find out is to measure your bgs through the night (not all on one night: once every two or three nights, at different times). You will either see a gradual rise from bed time to breakfast, which is not dawn effect, or a level, or gradual fall from bed time to some time before breakfast, at which point it zooms up as if you’ld just drunk a glass of coke: that is ‘dawn effect’. Insulin users sometimes spot a third pattern: gradual dip to a hypo at some point, followed by a zoom up. I’ve no idea how a non-user of insulin would get their pre-breakfast bgs down, I’m afraid, but knowing what the cause is is surely some help. — Pat Reynolds    "It might look a bit messy now, but just you come back in 500 years time"    (T. Prattchet)

Response:

This is the dawn effect. My endo has told me about this but I don’t remember the name of the doctor that discovered it.  Basically what happens is that your bg gets low enough in the middle of the night so your liver kicks in to raise it.  In my case I reduced my last insulin shot and went from 160 to 125 in the morning.  It sounds like you need to talk to your doctor about the timing and quantity of your meds.

: It’s a bit strange. My readings 1-2 hours after dinner on recent dinner : have varied from 80-100. Yet fasting readings taken the following morning : have been between 109-122, all noticeably higher than the previous evening. : Is this an example of the so-called dawn effect or is my food digesting : much more slowly than expected. I also take glyburide twice a day, once at : 5PM, just before dinner. : — : Dave — -|| Art Peipher ||- The light at the end of the tunnel is disconnected due to non-payment.

Response:

It’s a bit strange. My readings 1-2 hours after dinner on recent dinner have varied from 80-100. Yet fasting readings taken the following morning have been between 109-122, all noticeably higher than the previous evening. Is this an example of the so-called dawn effect or is my food digesting much more slowly than expected. I also take glyburide twice a day, once at 5PM, just before dinner. — Dave

Response: