Dawn phenomenon

Under the DAWN phenomenon (of English dawn = dawn ) is understood in diabetic patients an increase in blood sugar in the early morning hours. The cause of this increase is a relative insulin deficiency , which is caused by the nightly release of opponents of insulin. It reaches its climax in puberty .

definition

The increase in blood sugar concentration usually occurs between 3 and 6 a.m. During this period, the body increases the production of contra-insulin hormones such as growth hormone , cortisol , catecholamines , adrenaline and glucagon ; this intensifies glycogenolysis and gluconeogenesis . The dawn phenomenon can therefore be explained by the interaction of these processes. This feature can basically gets them people to varying degrees, but provides for diabetics often a particular challenge in diabetes therapy . While the pancreas in metabolism healthy the temporarily automatically lower insulin action by increased insulin secretion balances, this results in diabetics by the Lack of the body's own insulin production (type 1 diabetes) or insulin resistance (type 2 diabetes) to increased fasting blood sugar levels .

diagnosis

Example of a continuous glucose measurement (CGMS) showing the rise in blood sugar in a type 1 diabetic in the early hours of the morning (around 1:30 a.m.).

The differentiation from other special features in diabetes therapy is often not easy. High blood sugar levels in the morning can also be caused by nocturnal hypoglycaemia ( Somogyi effect ) or the result of an unsatisfactory blood sugar control. Meals consumed late in the evening should also be considered as a cause. The distinction is usually made through nightly control measurements , but the use of continuous glucose monitoring can be considered as a supplement .

therapy

Treatment varies depending on the extent of the dawn phenomenon. While it may be sufficient to inject (additional) delayed insulin late in the evening with slightly increased values, insulin pump therapy should always be considered in the case of significantly increased fasting blood sugar values , which is the best treatment option to date due to the hourly setting of the basal rate. In some cases, not eating meals late in the evening can be beneficial. Physical activity late in the evening, which has a glucose-lowering effect, is also useful, but less practical.