What is the morning dawn phenomenon in diabetes mellitus and why is this syndrome dangerous? The "dawn" effect: what to do? The phenomenon of dawn correction rules

Endocrinologists are well aware of the phenomenon of dawn when diabetes mellitus. Behind the beautiful term lies only a sharp jump in blood glucose that occurs while a person is still in bed in the early morning. Undoubtedly, such a complex disease as diabetes requires total control over the body’s condition, since glycemia can become a serious threat to human health.

Let's look at the causes of the syndrome, as well as ways to combat it. The information will be useful for patients with both type 1 and type 2 diabetes.

Causes

In the human body, everything is interconnected, and every action has its own reaction. For example, the hormone insulin is opposed by its antagonist glucagon. And if the first sugar in the blood is utilized, then its opposite produces it. In addition to glucogon, the body produces other substances, the presence of which provokes an increase in glucose concentration. This is growth hormone, somatotropin, generated by the pituitary gland, cortisol, which is synthesized by the adrenal glands, as well as thyroid-stimulating hormone(it is also produced by the anterior pituitary gland). The peak of their secretion occurs in the early morning, or rather in the period from four to eight. The activity of all systems before awakening is inherent in nature. Thanks to this, the body gets a shake-up before a new day and wakes up to work.

The period of activity of the adrenal glands and pituitary gland varies from person to person and largely depends on age.

In a healthy body, a compensation mechanism is simultaneously activated, that is, the production of insulin, but in the case of a diagnosis of diabetes, this does not happen.

Dawn syndrome is typical for adolescents and children, since it is provoked mainly by growth hormone (somatotropin) synthesized by the pituitary gland. Since children grow in cycles, glucose spikes in the morning will also not be constant. Over the years, the level of somatotropin decreases, the average person grows up to 25 years.

Symptoms

For insulin-dependent diabetics, the morning rise in sugar causes a lot of inconvenience. Considering that the condition recurs periodically, measures have to be taken to improve it. Among the causes of the phenomenon, endocrinologists identify several main ones:

• too small dose of insulin;
• a hearty dinner;
• inflammatory diseases;
• stressful state;
• error in calculating the dose of insulin against the background of Somogyi syndrome.

Treatment is carried out in two directions, but it certainly includes adjusting the dose of insulin, which for some reason was not enough before the morning meal.

In some cases, postponing the injection to a later time is quite sufficient. A similar simple trick works when using so-called “insulins average duration", such as "Protophan" or "Bazal". They have a pronounced peak, which can be shifted so that the effect of the drug will occur during the production of insulin antagonist hormones. Thus, they successfully compensate each other.

“Peakless” analogues do not have such properties, and postponing the time of their introduction will in no way help compensate for dawn cider. In this case, additional administration of the drug will be necessary; the time of injection should be in this case at 4-5 am. The dosage of the drug is calculated based on the difference between the established glucose norm, recognized as the standard, and the maximum increase threshold. To prevent the process of hypoglycemia from starting, the selected dose is adjusted according to how you feel. Short-term insulin before breakfast is also administered taking into account the existing active substance.

The third way to overcome dawn syndrome in type 1 diabetes is the most expensive, using an insulin pump. It will eliminate the need to wake up to get an injection. By programming the device for a certain time, you can inject hormonal drug automatically. Thus, glucose will not rise and the patient will avoid the disastrous consequences associated with this.

Morning glycemia in type 2 diabetes

You need to understand that the dawn effect in type 2 diabetes is not a one-time phenomenon, but a permanent condition. And although not every patient has the syndrome and in percentage terms this indicator is lower than for the disease of the first type, you need to know the reasons for this phenomenon and in no case ignore it. Liver healthy person synthesizes up to 6 g of glucose within an hour. But with a diagnosis of type 2 diabetes, this figure increases. Insulin resistance of body tissues leads to the fact that at rest at night there is high level Sahara. The production of insulin antagonist hormones, which also occurs closer to the morning, leads to the fact that a fasting blood test shows an increased concentration of sugar. For most, the situation improves after eating.

The danger of this phenomenon lies in the fact that against its background various complications of diabetes rapidly progress. Among them are: dangerous illnesses, such as cataracts, nephropathy (impaired kidney function), polyneuropathy (damage to the peripheral nervous system).

It should be noted that hyperglycemia does not simply occur against the background of a one-time diet violation, but is provoked by processes that occur regularly in the body.

That is, in order to get rid of it, it is necessary to adjust the therapy.

Somogyi syndrome - what is its difference

Dawn symptoms are similar to Somogyi syndrome. However, the cause of hyperglycemia will be different for these two cases. To clarify the diagnosis, monitoring of sugar levels is required from three o'clock in the morning to seven in the morning. Some doctors recommend taking measurements starting at midnight, every 1 hour. If morning hyperglycemia is characterized by a smooth increase, without up-and-down fluctuations, we are dealing with a phenomenon that has a romantic name.

To conduct blood tests in children over a short period of time, it is best to use non-invasive (atraumatic) devices. They determine the sugar concentration using thermospectroscopy. Such devices do not require blood sampling. One of the most popular and affordable devices is Omelon. The device takes blood pressure and pulse readings, converting them into an indicator of sugar levels.

With Somogyi syndrome, the change in glucose concentration is uneven and is caused by the fact that too much hormone enters the body with injections.

Simply put, Somogyi syndrome is a banal insulin overdose, which the body tries to neutralize by tapping into its own reserves. That is, the patient himself stimulates the synthesis of insulin antagonists. Throughout the day, with this disorder, changes are observed, often very sharp, from hyperglycemia to hypoglycemia and back. A urine test will help confirm the diagnosis; in case of insulin overdose, acetone appears in the urine.

You can determine that there is a chronic excess of insulin by symptoms such as:

• general deterioration of condition,
• weakness,
• headache,
• veil or bright dots before your eyes,
• prostration,
• depression,
• sleep and sleep disorders
• poor appetite or, on the contrary, a feeling of constant hunger.

Of course, general clinical picture is not a determining indicator, since it can be caused by many ailments. Clarifying the diagnosis of rebound hypoglycemia (Somogyi syndrome) requires additional tests.

Treatment for such a pathology should be selected by a specialist, an endocrinologist, who constantly monitors the patient. He has a complete understanding of the clinical picture of the disease, as well as the therapy being carried out. With this dangerous disease Like diabetes, the key to maintaining working capacity is iron discipline and compliance with all medical recommendations. When it comes to the health of children, a huge responsibility falls on parents.

Diabetes mellitus is a very insidious disease, because to this day no universal medicine From him. The only way to improve a patient’s life is to activate insulin production various methods.

There are 2 types of diabetes, and each type has specific symptoms. Thus, with the first type of disease, thirst, nausea, fast fatiguability and poor appetite.

Signs of type 2 diabetes are itchy skin, blurred vision, fatigue, sleep disturbance, muscle weakness, numbness of the limbs, thirst, dry mouth and poor regeneration. However, the pronounced clinical picture in diabetes at initial stage development does not appear.

It is worth noting that during the development of the disease, the patient is faced not only with unpleasant symptoms, but also with various diabetic syndromes, one of which is the dawn phenomenon. Therefore, diabetics need to know what this phenomenon is and how it develops and whether it can be prevented.

What is the syndrome and what are its causes?

In diabetics, the dawn effect is characterized by an increase in blood glucose levels that occurs when the sun rises. As a rule, such a morning rise in sugar is observed at 4-9 am.

The reasons for this condition may vary. These are stress, overeating at night or taking a small dose of insulin.

But in general, the development of dawn syndrome is based on the mechanism of production steroid hormones. In the morning (4-6 am) the concentration of cotransular hormones in the blood reaches its peak. Glucocorticosteroids activate the production of glucose in the liver and, as a result, blood sugar increases significantly.

However, this phenomenon occurs only in patients with diabetes. After all, the pancreas of healthy people produces insulin in full, which makes it possible to compensate for hyperglycemia.

It is noteworthy that morning dawn syndrome in type 1 diabetes mellitus often occurs in children and adolescents, because the occurrence of this phenomenon is promoted by somatotropin (growth hormone). But due to the fact that the development of a child’s body is cyclical, morning glucose surges will also not be constant, especially since as they grow older, the concentration of somatotropin decreases.

It should be remembered that morning hyperglycemia in type 2 diabetes recurs frequently.

However, this phenomenon is not typical for every diabetic. In most cases, this phenomenon disappears after eating.

What is the danger of dawn syndrome and how to diagnose the phenomenon?

This condition is dangerous due to severe hyperglycemia, which does not stop until insulin is administered. And as you know, strong changes in the concentration of glucose in the blood, the norm of which is from 3.5 to 5.5 mmol/l, contributes to the rapid development of complications. Therefore, the adverse consequences of type 1 or 2 diabetes in this case may be diabetic cataracts, polyneuropathy and nephropathy.

Dawn syndrome is also dangerous because it appears more than once, but occurs in the patient every day due to excessive production of counter-insular hormones in the morning. For these reasons, carbohydrate metabolism is disrupted, which significantly increases the risk of developing diabetic complications.

It is worth noting that it is important to be able to distinguish the dawn effect from the Somogyi phenomenon. Thus, the latter phenomenon is characterized by chronic insulin overdose, which occurs against the background of constant hypoglycemia and post-hypoglycemic reactions, as well as due to a lack of basal insulin.

To detect morning hyperglycemia, blood glucose concentrations should be measured every night. But in general, this action is recommended to be carried out between 2 and 3 am.

Also, to create an accurate picture, it is advisable to take night measurements according to the following scheme:

1. the first – at 00:00;
2. subsequent ones - from 3 to 7 am.

If during this period of time there was no significant decrease in the concentration of glucose in the blood compared to midnight, but, on the contrary, a uniform increase in indicators occurs, then we can talk about the development of the dawn effect.

How to prevent the syndrome?

If the phenomenon of morning hyperglycemia often occurs in type 2 diabetes, then you should know what you need to do to prevent the increase in sugar concentrations in the morning. As a rule, to relieve hyperglycemia that occurs early in the day, it is enough to shift insulin administration by two or three hours.

So, if the last injection before bed was done at 21:00, now the artificial hormone must be administered at 22:00 - 23:00. In most cases, such measures help prevent the development of the phenomenon, but there are exceptions.

It is worth noting that such a schedule correction only works when using human insulin, which has average duration actions. These drugs include:

• Protafan;
• Humulin NPH and other products.

After administration of these medications, peak hormone concentrations are reached approximately 6-7 hours later. If insulin is administered later, the highest concentration of the hormone will occur just at the time when the change in blood glucose concentration occurs. However, it is worth knowing that adjusting the injection schedule does not affect the diabetic syndrome if Lantus or Levemir is used.

These drugs do not have a peak of action, since they only maintain the already existing insulin concentration. Therefore, if hyperglycemia is excessive, these drugs cannot affect its performance.

There is another way to administer insulin for dawn syndrome. According to this method, the patient is given an injection of short-acting insulin early in the morning. To calculate the required dose correctly and prevent the onset of the syndrome, the first thing you need to do is measure your glycemic level throughout the night. The dose of insulin is calculated depending on how much the glucose concentration in the bloodstream is increased.

However, this method is not always convenient, because if the dosage is incorrectly selected, an attack of hypoglycemia may occur. And to determine required dosage Glucose concentration measurements should be carried out over several nights. It is also important to consider the amount of active insulin received after breakfast.

Most effective method To prevent the morning dawn phenomenon is the Omnipod insulin pump, with which you can set different hormone injection schedules depending on time. A pump is a medical device for administering insulin, through which the hormone is continuously injected under the skin. The medicine enters the body through a system of thin flexible tubes that connect the insulin reservoir inside the device to the subcutaneous fatty tissue.

The advantage of the pump is that it only needs to be set up once. And then the device itself will administer the required amount of product at a given time.

The video in this article will tell you about the symptoms and principles of treatment of dawn syndrome in diabetes.

Enter your sugar or select your gender to receive recommendations Searching Not FoundShow Searching Not FoundShow Searching Not FoundShow

diabetes.guru

The morning dawn phenomenon in diabetics

Diabetes mellitus is the most common endocrinopathy among the world's population. The morning dawn phenomenon is an increase in blood glucose levels in the morning hours, usually from 4 to 6, but sometimes continues until 9 am. The phenomenon got its name due to the coincidence of the time of the increase in glucose with dawn.

Why is this phenomenon observed?

If we talk about the physiological hormonal regulation of the body, then an increase in monosaccharide in the blood in the morning is the norm. This is due to the daily release of glucocorticoids, the maximum release of which occurs in the morning. The latter have the property of stimulating the synthesis of glucose in the liver, which then moves into the blood.

In a healthy person, the release of glucose is compensated by insulin, which is produced in the correct amount by the pancreas. In diabetes mellitus, depending on the type, insulin is either not produced in needed by the body quantity, or the receptors in the tissues are resistant to it. The result is hyperglycemia.

It is very important to determine your sugar level several times throughout the day in order to detect the dawn phenomenon in time.

Sudden changes blood glucose levels are fraught with accelerated development of complications. All diabetics are at risk of developing serious consequences. These include: diabetic retinopathy, nephropathy, neuropathy, angiopathy, diabetic foot.

It is also possible that acute conditions may develop due to sharp fluctuations in blood sugar. These conditions include coma: hypoglycemic, hyperglycemic, and hyperosmolar. These complications develop at lightning speed - from several minutes to several hours. It is impossible to predict their occurrence against the background of already present symptoms.

Table “Acute complications in diabetes mellitus”

How to find out if you have the phenomenon

The presence of the syndrome is confirmed by an increase in the glucose level in diabetics in the morning, given that at night the level was equal to the norm. To do this, measurements should be taken overnight. Starting at midnight, then continuing from 3 o'clock until 7 am hourly. If you observe a gradual increase in sugar in the morning, then the dawn phenomenon is in effect.

The diagnosis should be distinguished from Somogyi syndrome, which is also manifested by increased glucose release in the morning. But here the reason lies in the excess insulin administered at night. An excess of the drug leads to a state of hypoglycemia, to which the body turns on its protective functions and secretes counter-insular hormones. The latter help glucose to be released into the blood - again the result of hyperglycemia.

Thus, dawn syndrome manifests itself regardless of the dose of insulin administered at night, and Somogyi is precisely due to an overabundance of the drug.

How to deal with the problem

WITH high sugar you always have to fight in the blood. And with dawn syndrome, endocrinologists recommend the following:

1. Move your nightly insulin injection 1-3 hours later than usual. The effect of prolonged doses of the medicine will also occur in the morning.
2. If you cannot tolerate the time of night administration of the drug, then you can take a short dose of insulin in the hours before dawn, at 4.00-4.30 in the morning. Then you will avoid the climb. But in this case, a special selection of the dose of the medicine is required, since even with a slight overdose you can cause hypoglycemia, which is no less dangerous for the body of diabetics.
3. The most rational way, but the most expensive, is to install an insulin pump. It monitors daily sugar levels, and you yourself, knowing your diet and daily activity, determine the level of insulin and the time it arrives under the skin.

Get into the habit of constantly checking your blood glucose levels. Visit your doctor and together monitor and adjust your therapy if necessary. This is how you can avoid serious consequences.

In contact with

Classmates

diabetiko.ru

Type 2 diabetes mellitus and the “dawn phenomenon”: what is it?

To the human body Additional glucose production is needed in order to wake up and recharge for the whole day. In the body of a healthy person, the process of glucose production is regulated through the secretion of insulin. For a diabetic, things are different: due to a lack of their own insulin, automatic regulation of blood sugar levels may not occur.

There are also a number of other reasons why your blood sugar may be higher than normal in the morning. One of them is insulin resistance of the muscles and tissues of the body. Insulin is necessary to transport glucose into the body's cells. Glucose is the fuel needed to keep us feeling energized and alert. If cells do not receive this fuel or become less receptive to it, the body may fail.

Insulin resistance also affects the liver. The liver is an organ that stores, produces and releases glucose into the blood. This is especially pronounced at night. In a healthy person, the liver secretes about six grams of glucose per hour. If you are diagnosed with type 2 diabetes, your liver produces more glucose into the blood than is needed. Don’t forget about contivascular hormones, which enhance this effect. With increased insulin resistance in muscles and tissues, this leads to a strong increase in blood sugar levels at night.

Contrasular hormones are biologically active substances, which have the opposite effect of insulin. These include adrenaline, glucagon, cortisol and growth hormone.

As mentioned earlier, this type of hormone increases blood glucose levels. The secretion of these hormones is most pronounced during the period from 4 to 8 am. In the body of a healthy person, this phenomenon is compensated by the production of insulin by the beta cells of the islets of Langerhans of the pancreas, so blood sugar remains normal in the morning. Scientists have dubbed this phenomenon the “dawn phenomenon.”

Why did nature arrange it so that contracular hormones begin to work at this time of day? In order to provide the body with the necessary energy upon awakening. Insulin synthesis in the body of a healthy person begins at approximately 5.30 am, that is, at the same time as the secretion of contravascular hormones. However, in diabetes, there is often no increase in insulin levels at this time. The cells of the body do not receive energy along with glucose. Instead, there is only an increase in blood sugar concentration.

It is important to know that the “dawn phenomenon” does not occur in every diabetic. In type 2 diabetes, this phenomenon is observed in 3.0-50.0% of cases, in type 1 diabetes - in 25.0-50.0% of cases.

According to experts, growth hormone has a greater effect on increasing blood glucose levels. If you neutralize the effect of this hormone, then the blood sugar level will remain unchanged. This explains the fact that older people with diabetes do not notice an increase in glucose concentration in the morning, because there is not enough growth hormone in their body. It can be assumed that “early people” - those people who feel full of energy in the morning, have a greater response to growth hormone. Night owls, on the other hand, are less susceptible to growth hormone due to the fact that they feel more productive in the afternoon.

How dangerous is the “dawn phenomenon”?

According to research conducted by the American Diabetes Association, some people with diabetes return their blood glucose levels to normal after breakfast. For others, blood sugar levels return to the optimal level a few hours after waking up, regardless of food intake. However, hyperglycemia persists for a long time. For some, this glycemic indicator rises slightly in the morning, while others experience high fasting blood glucose concentrations.

What to do if you discover the “dawn phenomenon”?

In this case, you should consult your doctor. If you are on a diet, your endocrinologist may prescribe glucose-lowering medications. If you are already taking tablet medications, your doctor may adjust the dosage and reschedule the time of taking the drug.

moidiabet.ru

What is the “dawn phenomenon”?

Let's consider a situation: you have type 2 diabetes, and your glucose meter often shows high fasting blood glucose levels. You are on a diet and/or in addition to it you are taking tableted glucose-lowering medications. What could be the reason?

Let's recall some physiological mechanisms of glucose level regulation

In the early morning hours, hormonal changes in our body lead to an increase in blood glucose levels. For people without diabetes, this increase is compensated by an increase in the production of their own insulin. In diabetes, the automatic regulation between glucose and insulin may not work.

There are several reasons why morning glucose levels may be higher than normal. One of them is insulin resistance, a condition in which muscle and fat cells become less sensitive to insulin. You remember that these cells need insulin to transport glucose, the main source of energy.

Insulin resistance also affects the liver, the organ that produces, stores and releases glucose into the bloodstream. This effect is especially pronounced at night. Normally, the adult liver produces about 6 g of glucose per hour. Most of this glucose is absorbed by the brain, which can use the glucose without the help of insulin. But in type 2 diabetes, the liver releases more glucose into the blood than is needed. At the same time, hormones called contrainsular hormones cause a natural rise in blood glucose levels. In the presence of insulin resistance in muscle and fat tissue, this leads to a strong increase in sugar.

Let's take a closer look at the effect of counter-insular hormones on glucose levels in diabetes mellitus. This phenomenon is called the “dawn phenomenon” in scientific literature. Contrinsular hormones, which have the opposite effect of insulin, include:

• A growth hormone
• Glucagon
• Cortisol
• Adrenalin

As we wrote above, these hormones increase blood glucose levels. The peak secretion of these substances occurs in the early morning hours, from approximately 4.00 to 8.00 am. In healthy people, the peak secretion of contrainsular hormones is compensated by an increase in insulin secretion by the ß-cells of the islets of Langerhans of the pancreas, so they do not experience an increase in glucose levels in the morning.

Why do we need counter-insular hormones, or rather, the result of their action is an increase in glucose levels in the early morning hours? This way our body receives energy to wake up and function throughout the day. The rise in plasma glucose levels begins around 5:30 a.m., immediately after the release of counterinsular hormones. In people with normal level blood sugar, the synthesis and release of insulin also begins at this time. But many people with diabetes will not experience consistent increases in insulin levels in their blood. As a result, instead of providing cells with energy, they will only experience high fasting glucose levels.

Let's consider a situation: you have type 2 diabetes, and your glucose meter often shows high fasting blood glucose levels. You are on a diet or taking tableted glucose-lowering medications. What could be the reason?

Let's recall some physiological mechanisms of glucose level regulation

In the early morning hours, hormonal changes in our body lead to an increase in blood glucose levels. For people without diabetes, this increase is compensated by an increase in the production of their own insulin. In diabetes, automatic regulation of glucose and insulin levels may not work.

There are several reasons why morning glucose levels may be higher than normal. One of them is insulin resistance, a condition in which muscle and fat cells become less sensitive to insulin. You remember that these cells need insulin to transport glucose, the main source of energy.

Insulin resistance also affects the liver, the organ that stores and releases glucose into the bloodstream. This effect is especially pronounced at night. Normally, the adult liver produces about 6 g of glucose per hour. Most of this glucose is absorbed by the brain, which can use the glucose without the help of insulin. But in type 2 diabetes, the liver releases more glucose into the blood than is needed. At the same time, hormones called contrainsular hormones cause a natural rise in blood glucose levels. In the presence of insulin resistance in muscle and fat tissue, this leads to a strong increase in sugar.

Let's take a closer look at the effect of counter-insular hormones on glucose levels in diabetes mellitus. This phenomenon is called the “dawn phenomenon” in scientific literature. Contrinsular hormones, which have the opposite effect of insulin, include:

• a growth hormone,
• glucagon,
• cortisol,
• adrenalin.

As we wrote above, these hormones increase blood glucose levels. The peak secretion of these substances occurs in the early morning hours, from approximately 4:00 to 8:00 am. In people without diabetes, the peak secretion of contrainsular hormones is compensated by an increase in the secretion of insulin by the ß-cells of the pancreas, so they do not experience an increase in glucose levels in the morning.

Why do we need counter-insular hormones, or rather, the result of their action is an increase in glucose levels in the early morning hours? This way our body receives energy to wake up and function throughout the day. The rise in plasma glucose levels begins around 5:30 am, immediately after the release of counterinsular hormones. In people with normal blood sugar levels, insulin synthesis and release also begins at this time. But many people with diabetes will not experience consistent increases in insulin levels in their blood. As a result, instead of providing cells with energy, they will only experience high fasting glucose levels.

The “dawn phenomenon” does not occur to everyone! According to rough estimates, it occurs in 3-50% of cases with type 2 diabetes mellitus and in 25-50% with type 1 diabetes.

Researchers have found that the trigger for the phenomenon is an increase in the concentration of growth hormone. If growth hormone is blocked, blood glucose levels will remain flat. This explains why some people, especially older people, do not experience an increase in sugar in the early morning - they already have too little growth hormone in their body. It's possible that early risers—those of us who are energized first thing in the morning—have a stronger growth hormone response. "Owls" - those who have difficulty swinging in the morning and feel more comfortable and productive in the afternoon - have less influence from growth hormone.

Another explanation for why some people with diabetes do not experience a rise in blood sugar early in the morning may be the relatively slow rate of rise in glucose levels, which is "covered" by the residual effect of basal or self-insulin.

As a rule, in type 2 diabetes mellitus, the leading dysfunction of ß-cells is the absence or delay of insulin secretion in response to a sudden increase in glucose that occurs during food intake. However, basal insulin secretion outside of dietary carbohydrate may still be strong enough to keep pre-meal glucose levels under control.

How serious is this problem?

According to the American Diabetes Association (ADA), some people with dawn phenomenon have blood glucose levels that continue to rise until they eat breakfast. For others, the indicators return to normal a few hours after waking up, regardless of food intake. In any case, hyperglycemia may persist long time. For some, the levels increase slightly, but there are cases of very high fasting glucose levels.

What to do if there is a “dawn phenomenon”?

Talk to your doctor about possible options solutions. If you are on diet therapy, your doctor may prescribe you antihyperglycemic medications to normalize your fasting blood glucose levels. If you are already taking pills, discuss the dose and timing of your medications. Perhaps adjusting the dose or postponing the drug to a later time (for example, before bedtime) will help get rid of the consequences of the “dawn phenomenon”.

Another explanation for high blood glucose levels in the early morning hours found in the literature is the Somogyi phenomenon or rebound hyperglycemia. Scientists continue to argue about the authenticity of the existence of this phenomenon. Read a detailed article about the Somogyi phenomenon.

The human body needs additional glucose production in order to wake up and recharge itself for the day. In the body of a healthy person, the process of glucose production is regulated through the secretion of insulin. For a diabetic, things are different: due to a lack of their own insulin, automatic regulation of blood sugar levels may not occur.

There are also a number of other reasons why your blood sugar may be higher than normal in the morning. One of them is insulin resistance of the muscles and tissues of the body. necessary for transporting glucose into body cells. Glucose is the fuel we need to feel energized and alert. If cells do not receive this fuel or become less receptive to it, the body may fail.

Insulin resistance also affects the liver. The liver is an organ that stores, produces and releases glucose into the blood. This is especially pronounced at night. In a healthy person, the liver secretes about six grams of glucose per hour. If you are diagnosed, your liver is producing more glucose into the blood than is needed. Don’t forget about contivascular hormones, which enhance this effect. With increased insulin resistance in muscles and tissues, this leads to a strong increase in blood sugar levels at night.

Contrasular hormones are biologically active substances that have the opposite effect of insulin. These include adrenaline, glucagon, cortisol and growth hormone.

As mentioned earlier, this type of hormone increases blood glucose levels. The secretion of these hormones is most pronounced during the period from 4 to 8 am. In the body of a healthy person, this phenomenon is compensated by the production of insulin by the beta cells of the islets of Langerhans of the pancreas, so blood sugar remains normal in the morning. Scientists have dubbed this phenomenon the “dawn phenomenon.”

Why did nature arrange it so that contracular hormones begin to work at this time of day? In order to provide the body with the necessary energy upon awakening. Insulin synthesis in the body of a healthy person begins at approximately 5.30 am, that is, at the same time as the secretion of contravascular hormones. However, in diabetes, there is often no increase in insulin levels at this time. The cells of the body do not receive energy along with glucose. Instead, there is only an increase in blood sugar concentration.

It is important to know that the “dawn phenomenon” does not occur in every diabetic. In type 2 diabetes, this phenomenon is observed in 3.0-50.0% of cases, in type 1 diabetes - in 25.0-50.0% of cases.

According to experts, growth hormone has a greater effect on increasing blood glucose levels. If you neutralize the effect of this hormone, then the blood sugar level will remain unchanged. This explains the fact that older people with diabetes do not notice an increase in glucose concentration in the morning, because there is not enough growth hormone in their body. It can be assumed that “early people” - those people who feel full of energy in the morning, have a greater response to growth hormone. Night owls, on the other hand, are less susceptible to growth hormone due to the fact that they feel more productive in the afternoon.

How dangerous is the “dawn phenomenon”?

According to research conducted by the American Diabetes Association, some people with diabetes return to normal after breakfast. For others, blood sugar levels return to the optimal level a few hours after waking up, regardless of food intake. However, hyperglycemia persists for a long time. For some, this glycemic indicator rises slightly in the morning, while others experience high fasting blood glucose concentrations.

What to do if you discover the “dawn phenomenon”?

In this case, you should consult your doctor. If you are on a diet, your endocrinologist may prescribe. If you are already taking tablet medications, your doctor may adjust the dosage and reschedule the time of taking the drug.

Anzhelika STADNIK, endocrinologist of the 2nd children's department clinical hospital Minsk

Morning high sugar– a fairly common situation in children, and especially in adolescents. There are three main reasons for the rise in sugar in the morning:

• insufficient dose of extended-release insulin before bedtime;
• increased blood sugar levels after nocturnal hypoglycemia;
• "dawn" phenomenon.

It is very important to distinguish between these conditions, since their treatment is fundamentally different from each other. To establish what exactly causes morning hyperglycemia, it is necessary to control blood sugar levels at 2.00–3.00 am and at 5.00–6.00 am.

Before going into detail about the rules for correcting morning hyperglycemia, I would like to note that for good blood glucose levels during the night, it is very important to select the dose of insulin before dinner. We should strive to start the night with good blood glucose levels - to do this, monitor it immediately before dinner, select food and dose accordingly short insulin. This rule works especially well for younger children and for those who go to bed early (do not have active physical activity after dinner).

Research has shown that slightly increased level blood glucose (7 mmol/l, a little more, a little less) before bed or at midnight reduces the risk of nocturnal hypoglycemia. And when using intermediate-acting insulin (Protafan, Humulin N) before bedtime, it’s a good idea to start the night even with a higher blood glucose level (8–10 mmol/l). Then the body has “more glucose to consume” and before going to bed you can safely increase the insulin dose.

TEST BEFORE DINNER

Sugar level Measures in the blood

5 mmol/l Reduce insulin dose by 1–2 units

5–10 mmol/l Give your usual dose

10–18 mmol/l Increase dose by 1–2 units or eat fewer carbohydrates at dinner

18–20 mmol/l Give 1-2 units more and eat less at dinner. You can take the usual dose, but then you need to eat very little or skip dinner altogether and be sure to check your blood glucose again before going to bed.

So, the main causes of morning hyperglycemia (provided that the sugar level is normal before bedtime) are:

1. INSUFFICIENT DOSE OF RELATED INSULIN BEFORE BEDTIME.

In this case, blood glucose monitoring at night (both at 2.00 and 5.00) will show a high blood glucose level. How to proceed in this case? You should either increase the dose of nighttime insulin or move the injection to a later time, for example from 21.00 to 23.00.

If you use NPH insulin (Protafan, Humulin N) before bed, remember that its peak effect occurs 4-6 hours after the injection. Therefore, you should use the blood glucose level at 2 a.m. as an indicator when selecting the nightly dose of this insulin.

Ideally, you should aim for your blood glucose level to be around 10 mmol/L when administering insulin before bed, then allow it to drop to 4 mmol/L to reach 6 mmol/L by 2 a.m.

If the dose of extended-release insulin before bed is insufficient, it is necessary to increase its dose gradually, by 1-2 units at a time, until blood glucose at 2.00-3.00 a.m. reaches 6-8 mmol/l. To avoid nocturnal hypoglycemia, blood glucose levels should not be less than 5–6 mmol/L during the night test at 2.00–3.00.

BEFORE BED TEST

Blood Sugar Measures

6 mmol/l Eat a sandwich or drink milk

6–12 mmol/l Give your usual dose

12 mmol/l Increase insulin before bed by 1-2 units

1. One of the possible reasons for high glycemia in the morning may be INSUFFICIENT EFFECT OF INSULIN LATE AT NIGHT DUE TO THE SO-CALLED “MORNING DAWN” PHENOMENON.

Typically, this condition manifests itself in the form of dawn hyperglycemia (between 4.00 and 8.00), which further intensifies after breakfast and reaches a maximum in the middle of the first half of the day.

The cause of dawn hyperglycemia, or the dawn phenomenon, is insufficient basal insulin levels. The decrease in its level may be due to the increased rate of insulin destruction in the liver in the early morning hours. Other possible reason Insulin deficiency - increased secretion at the same time of growth hormone, which is a counter-insular (i.e., suppresses the action of insulin) hormone.

Growth hormone levels are higher in children than in adults. It is even higher in adolescents, which explains the more pronounced “dawn” phenomenon at this age (doctors call it puberty).

During puberty, when a person is growing rapidly, large doses of growth hormone are secreted into the bloodstream at night, increasing blood glucose, so large doses of insulin are required at night.

Growth hormone secretion increases in the early night, but does not affect blood glucose levels until 3–5 am. The dawn phenomenon contributes to an increase in blood glucose levels at the end of the night and in the early morning, approximately 1.5–2 mmol/L compared with blood glucose levels in the middle of the night when insulin is adequately supplied throughout the night.

In children with the "dawn" phenomenon, the level of glycemia at 2.00–3.00 and at 5.00–6.00 is normal, and by 8 a.m. it is high. How to fix the situation? Increasing the dose of evening long-acting insulin in this situation can lead to nocturnal hypoglycemia. Therefore, with the “dawn” phenomenon, two options are possible:

• administration of an additional injection of short-acting insulin in the early morning hours (at 5.00–6.00)
• or transfer to analogue non-peak insulins.

Dawn hyperglycemia can be confused with the RECOVERY PHENOMENON AFTER NIGHT HYPOGLYCEMIA (post-hypoglycemic hyperglycemia).

Symptoms characteristic of nocturnal hypoglycemia: nightmares, sweating, headache in the morning, tiredness when waking up, involuntary urination.

What causes can cause nocturnal hypoglycemia?

You can probably name the first one yourself: you administered too much insulin before bed.

Another reason is too high dose short insulin before evening meals, which leads to early night hypoglycemia.

In addition, nocturnal hypoglycemia can be caused by intense physical activity(class in a sports section, disco, etc.) in the afternoon or evening.

If you inject short-acting insulin into your thigh before dinner, slow absorption of insulin can also lead to nocturnal hypoglycemia.

If you inject insulin before bed, holding the needle at a right angle to the skin or without lifting the skin fold (intradermal injection), the insulin will be absorbed more quickly, putting you at risk for low blood glucose early in the night.

With nocturnal hypoglycemia at 2.00–3.00 hours it is determined low level glucose, and at 6 a.m. – high. This occurs due to the release of glucose from the liver under the influence of counterinsular hormones. This situation can be corrected by reducing the dose of evening long-acting insulin.

The basic rule for preventing nocturnal hypoglycemia: be sure to eat something extra (for example, fiber-rich bread with cheese) if your blood glucose before bed is below 6–7 mmol/l.

In a short article it is impossible to consider all the issues of correcting glycemic levels. The main thing is to remember that following the recommendations of your doctor can help you avoid complications of the disease and improve your quality of life.