The Dawn Phenomenon

As a type 2 Diabetic, I’m well aware of the strange blood sugar measurements I’d see before I learned to control my blood sugar levels by adhering to the Paleo lifestyle but recently I have struggled with seemingly unexplainable high measurements in the morning.

If you frequently monitor your blood sugars then you know what I’m talking about with regard to unexplainable high measurements in the morning but in case you don’t, here is what I mean. I could take my blood sugar measurement before bed and it would be normal after a meal (say around 110 ug/dL) but then when I wake up in the morning the measurement would be above 110 ug/dL even before I ate breakfast.

How can that be? I didn’t sleep walk during the night and eat a bowl of ice cream and during the night my blood sugar levels should’ve dropped like they would during the day if I skipped a meal but miraculously they are higher!

I am well aware of the Dawn Phenomenon (DP), which causes blood sugar levels to spike in the early morning hours, and this is most likely the cause of my higher blood sugar levels in the morning and a nice explanation of the DP can be found here:

“Organs do this to keep blood glucose from going too low at night or other times of not eating. From about 2 AM to 8 AM, most people’s bodies produce hormones, including cortisol, glucagon, and epinephrine. All these hormones increase insulin resistance and tell the liver to make more glucose. The idea is to get you enough glucose to get out of bed and start the day. The whole process is apparently started by growth hormones.”

And somewhere I remember reading where this spike in blood sugar is a holdover from our Paleolithic ancestors. Thousands of years ago we woke up to a long list of physical activities – hunting, fixing shelters, building fires, etc. – so we needed that boost of energy to get us going. Evolution has hard coded this into our bodies and those folks without an insulin sensitivity issue counteract this high blood sugar level in the morning by producing more insulin. But those of us, like myself, who have abused their pancreas can’t produce that much to overcome this spike.

So why all of a sudden did this happen to me?

As you can see from the following graph, my morning blood sugar measurements have spiked within the last few months.

recent morning measurements

I think this recent shift can be attributed to two changes in my lifestyle over the past couple of months – 1) getting more sleep and 2) reducing the alcohol I consume in the evening.

Due to my intense work responsibilities, sleep was one area of the Paleo lifestyle that I had avoided but I made a commitment recently to get at least 7 hours so sleep each night and I have to say I feel so much better. My mind is sharper during the day, my workouts are easier and I generally feel better in all aspects of my life. Maybe the cortisol levels in my body are increased when I get more sleep and this explains part of the change.

But I think the other piece to this puzzle resides with bourbon. I wrote before how I saw lower blood sugar levels in the morning after I had 1 to 2 drinks of bourbon and that correlation was pretty rock solid. When I used to stay up late working I’d have a couple of drinks and once I stopped working at night, the bourbon drinking stopped as well and this also might explain the increase in blood sugar levels.

Over the past couple of months while I’ve been adjusting to this lifestyle change of getting more sleep, there have been periods where I have not been able to do this due to work schedules and as you can see from the graph below (plotting morning blood sugar levels vs. hours of sleep the night before), there is a slight correlation between the amount of sleep I get and the subsequent morning blood sugar measurements.

sleep study no trend line

You can definitely see that there are two distinct populations on that graph!

The correlation is weak (R2 of 0.28) but the average of the two populations is definitely different (96.79 ug/dL when I got less than 7 hours of sleep and 113.10 ug/dL when I got more than 7 hours of sleep).

sleep study

So what does this data lead me to do with my life?

I’m definitely not going back to getting less than 7 hours of sleep every night because the benefits I see from that far outweigh a mild increase in morning blood sugar levels due to the DP. I may start having a drink after dinner or engage in some high intensity exercise after dinner to help offset the DP and I’ll report on that later once I have more data.



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17 Responses to The Dawn Phenomenon

  1. tannngl says:

    This is quite interesting. Before I retired from nursing, we had learned about the Symogyi effect where FBS is higher in the morning. They thought it was due to the type 1 diabetic receiving too much insulin to control the blood sugar during the day. Of course this isn’t true in your case and the theory wasn’t fully accepted.

    The dawn phenomenon is new to me! Your testing, graphs and reasoned explanations are very good. I also took a look at some sites on the phenomenon. That cortisol jump at night should wake you up! I’ve had trouble with waking at night for several years on the ketogenic diet. This may be it. My blood sugar 2 hours after eating was 101. That is very low. So perhaps this is my sleep problem. I’ll think on this and do some research on it.

    Sorry to go off topic but it really turned on a light in my brain.

    I’l be watching for your results after the changes in your behaviors. If I could ask a question, how would exercising after dinner decrease the morning FBS? Seems it would lower you blood sugar, even taking it out of your muscles and making your body replace the muscle and vascular sugar levels even earlier in the night.

    • cosmoscon says:

      I can’t say why exercising after dinner would help offset the DP but anecdotally I’ve seen this the few times over the past months.

      Like you, I have more questions than answers so I’m digging into it too!

  2. blaine says:

    You didn’t say if you’ve gained any weight. You might find if you lost another 10 pounds, all your morning numbers would be lower.

    I’ve found if I lift weights at night, especially working large muscles in legs, squats, etc., blood sugar levels are always lower in the morning. Not so much for aerobic exercise although Seventh Day Adventists swear by a brisk 30 or 40 minute walk after dinner to control blood sugar. I don’t do HIIT workouts at night because of difficulty sleeping after doing them.

    I’ve also found lifting lower then the maximum weights I can lift but lifting them slowly to failure works best.

    For example, my maximum leg press is 450lbs at normal speed but I’ll do 350 lbs full range of motion very slow, using no momentum. 15 seconds up, 15 second down. 5 or six reps and enough weight so the last one is shaking.

    Doing lower weights to failure ensures muscles are fully engaged. Also, lifting lower weights to failure greatly minimises potential injury compared to lifting higher weights to failure.

    • cosmoscon says:

      I didn’t gain any weight.

      And it is funny you mentioned weights as I’ve just started lifting with my daughter to help her improve in track in the spring. I’ll see if that has any effect.

      Thanks as always Blaine for your comments!

  3. Karim says:

    There has to be more to the picture here. Does your glucose level generally go down from your fasting readings? Many of these are high and some squarely in the fasting diabetic range. How quickly do they drop when they are initially over 100? Are you fairly paleo low carb in your meals? Bourbon as any sort of ameliorating element is probably not on many people’s list, but liver damage can certainly effect glucose dumping, so alcohol may not be so helpful. You may be at a strange individual tipping point or some type of biological adjustment which is hard to determine with conventional testing. If you are feeling well and all signs are good, I would go very dense on a nutritious diet and up the exercise level — if you haven’t already. This might reveal another pattern or alter the pattern you are currently experiencing. The closer to “normal” readings — if possible — the better.

    • cosmoscon says:

      Those are great questions Karim, thanks. I did not take hourly glucose measurements to see what it did during the day but I will soon. I do not hole out hope in having alcohol being my remedy for blood sugar levels because as you said, there are other deleterious effects that this can cause.

      I do think there is a dawn phenomenon effect since just this morning I woke up much earlier than normal and my blood sugar level was 95 and I didn’t have alcohol last night. I do think though that exercise has a significant effect as I spent all last night walking many miles in DC looking at memorials.

      I am feeling well and am in good physical health. I’m no overweight, can ride a bike for 2+ hours, lift weights, etc. but I need exercise more frequently and see if that helps. And adding high intensity exercise seems to help too.

      My fear is that my pancreas is starting to ‘die’ and not producing the insulin that it has in the past but I do adhere to a strict paleo diet (high protein, low carb) but lately I’ve ‘cheated’ more with carbs like potatoes. That doesn’t help!

      • blaine says:

        I think you could be wrong on the pancreas dieing thing. Type 2 turning into type 1 is rare.

        It’s more likely, according to Dr. Taylor, that you have too much fat in your liver and pancreas impeding their normal function.

        The threshold varies by individual. Body builders and professional athletes don’t have type 2 diabetes. I mean the incidence is Zero! I haven’t been able to find a single case and I’ve really searched.

        Get down to 10% body fat and you will not have type 2. It’s impossible not to see dramatic improvement, if not normal numbers.

        The diet appears to be less important then loosing weight. It’s possible to reverse type 2 with an extremely low calorie white rice, white sugar and fruit juice diet. You might now be extremely carb sensitive because you have been low carb ingredients for so long.

        Higher a trainer that will kick your ass.
        It’s a lot cheaper then having diabetes and you may live to see your grandchildren marry and have children of their own.

        With your ability to set goals and track progress, you will be great at it.

        • cosmoscon says:

          Thanks as always Blaine. I suspect you’re right on the exercise thing. I am not overweight by my muscle tone is very poor. Replacing what little fat I have with muscle can only help.

          • blaine says:

            If your muscle tone is poor, you are skinny fat. If there are any Kroger supermarkets near you, they all have free health kiosks next to the pharmacy where you put in your age, sex, height and it will weigh you, check blood pressure, calculate your BMI and there is a BIA test to calculate your body fat %.

            It’s not terribly accurate but great for trending and when you are down to below 12%, your health problems that are preventable or reversible will be gone.

            You know I’m right. Don’t do it for you, do it for your kids and wife. It’s clear from your blog you love them more then anything.

            It’s also clear you take your faith seriously so put 1 Corinthians 6:19 on your bathroom mirror and read it every time you get out of the shower.

          • Karim Miteff says:

            I do not advocate these sugary low calorie diets. Being simple carb insensitive if you otherwise are eating a healthy diet and are maintainin normal glucose levels is not a bad thing. No one is going to tie you down and force Coca Cola and Yodel down your throat. You can eat all the slow carbs you want or can tolerate — broccoli, cauliflower, brussel sprouts, lettuce, asaparagus, etc. –, a good healthy amount of protein, and a good amount of healthy fats. Going low calorie and high sugar or foods that become sugar quickly makes little sense to me. The are nutritionally deficient and you would be reducing your calorie intake to begin with, so it is a double whammy. Besides, you need to build muscle mass, which can only derive from bulk material, not sugars. Try a modified version of Dr. Taylor’s diet and instead of the nutrient shakes, replace them with organic salmon, turkey, chicken, and — sparingly — ground beef in that order. Absolutely no potatoes, bread, soda, juice, etc. For 8 – 12 weeks and stay under 900 calories maximum (you have to have at least 1g of protein for each kg of lean muscle mass you possess). Do resistance training, but avoid cardio during this period. Lots of water and supplementation is vital: multivitamins, cinnamon, apple cider vinegar, bitter melon, Gymnema and tumeric really are effective. Once you get back in balance, with a BMI under 25, you just have to eat less than your used to, I am not sure what that is, but you can determine it by just going about your day and seeing if you continue to lose weight rapidly or stay within a five pound range as time goes on. You might find it is dramatically less than the caloric recommendation for your height and target weight if your heavy or obese for an appreciable length of time in your life. Once you get comfortable with the range you settle in, you can reintroduce things on a small scale just to see if you can go out with the buddies and the family from time to time and eat something impromptu and know how your body will probably react. The reality is that nobody really should be eating breads as they are today, starchy foods, fried batter, soft drinks, or highly processed foods, period. Once you have everything back to the place you want it, you can then look at potential therapeutic options or aids to make sure you stay there, but supplements, diet and exercise –mixed with just a few minutes of high intensity intervals once you tone up — should have a major effect. You definitely want to make your muscles “hard” to the touch when you flex them at the very least. You can work at increasing visible mass over time for added benefits.

            You have already done a lot of this before, you have the determination and I think your pancreas will be pleased! Monitoring your glucose level 1 hour and 2 hours after eating is the key, initially, you should see favorable results again. As far a medication, metformin and acarbose might be considerations (why this combination is not prescribed more often is hard to understand, unless the gastrointestinal issues are way more prevalent than is being told), but only after you have firmly re-established your baseline naturally and if your body tolerates them well.

            Have you ever had your fasting insulin level measured? If you have, you can compare it to what is happening now with your higher fasting glucose numbers. It is definitely something to add to your blood testing panel when you get your labs done with your A1c.

            You are an inspiration to many people and were kind enough to share your detailed results. You have achieved quite a phenomenal recovery in general. You may have to make some course adjustments at this point, but that is what a vessel requires from it’s captain, if weather be fair or foul.

            Keep us posted and stay healthy!

  4. blaine says:

    Ditto everthing Karim just said. The only reason I mentioned you can reverse diabetes with a rice, white sugar and fruit juice diet is that it actually is proven to work so the mechanism has to be low cal, loosing weight.

    I do think prolonged very low carbing can make you less tolerant of carbs going forward.

    Loose weight any way you can and don’t be afraid of an occasional cheat if you are exercising regularly.

    • Karim says:

      I think you are right about low carb making people carb sensitive, I have seen readings from people who are totally carb restricted, whole food fanatics that are not diabetic and completely healthy by any measurable means that are quite alarming when they consume a candy bar or white bread. Pretty scary. I am sure they would adjust relatively quickly if they had to, but this condition may be indicative of what may be a natural bias by the human metabolism against these types of foods or I should say edibles, because they really are not natural foods. Bread is highly processed, chocolate bars and sweets are also concoctions as well. Fruits are the closest things to nature’s candy and if you were in an environment where that was essentially the only hyperglycemic food, you would probably be fine. In America, We are surrounded AND barraged by sweet after sweet, fast food and liquid sugar drinks it is no wonder that we are all wearing away from the inside out. I say build yourself up to a moderate carb diet or slow carbs once you have gotten back to your baseline and if you are working out regularly the occasional rice meal or pasta or sweet potato will be of no consequence. But I bet that even in healthy non diabetic and non obese individuals their pancreas shoots out a bit of insulin to fight off those carbs. Those cells are not like muscles. They can wear out and apparently can experience a cascade failure once a limit is reached. I don’t believe enough research has been done, but it is likely that at some point, if certain diabetic individuals catch it in time, they can halt and perhaps reverse the damage. It is not a wild stretch of the imagination to think that keeping sugars low normal and keeping insulin levels low could allow these cells to begin restoring themselves and rebuild to a healthier mass. Considering that these cells also require enervation, means that nerve tissue must also regrow and find these islets so that they can respond not only through hormonal blood mediated pathways, but through nervous stimulation as well. The latest research seems confounding to some, but it does seem like the nervous system is heavily linked to maintaining glucose levels and is becoming a key target for adjunct therapy.

      Stay healthy. Eat natural foods whenever possible. It may not be “fun”, but food is for nourishment. Running around with your kids, jet sking, going to the beach, etc. That’s fun! And grilled chicken and caesar salad on the beach is hard to beat! If you are a non-smoker, then you can start looking at all these products just like you do cigarettes. They are all around, but you don’t have to take them. I remember when cigarettes used to be EVERYWHERE, self serving machines, bus and trains filled with smoke. Crazy. And so many older folks in the 1970’s walking around with oxygen cannisters… So many of the stars of my youth succumbed to smoking related illnesses. People are more health conscious now by far in regards to smoking yet it is still a deadly habit. Cigarettes have warning labels yet people still consume them. Perhaps in a couple of decades future generations will look back and say, “You know they actually ADDED highly refined sugar to their foods and even made beverages of almost pure liquid sugar! What were they thinking?” Pretty much what many people think about smoking today. Leonard Nimoy, who by far was a learned and accomplished person, smoked for years like many of his generation. Even after quitting 30 years prior, the damage the smoking caused took its toll and his quality of life towards the end. Let’s do everything we can to spread the word and help people regain their lives and health. Ultimately, everyone will benefit.

      Peace, good fortune and long life, or as Spock would say, “Live long and prosper”

      • blaine says:

        Unlike the liver, the pancreas doesn’t regenerate. They are trying to regenerate with mice but it’s years away.

        There is evidence there is genetic variation in people’s ability to tolerate excess fat in their liver and pancreas.

        Generally, Asians are more susceptible at lower BMIs.

        There is also some evidence from autopsy studies that diabetic pancreases are smaller the same size non-diabetics.

        Dr. Roy Taylor has done studies that show very low cal/low carb diets and loosing weight reverses type 2 in the vast majority of cases.

        The odds are on Cosmos’ side.

        • cosmoscon says:

          Thanks again Blaine and Karim for the excellent conversation here. I know wheat needs to change in my exercise regime and that has already happened. I’ll see what happen after 30 days of this. I still think there is a Dawn Phenomenon at work here as my blood sugar is lower at bedtime and before lunch than it is when I wake up (fasting). But I think the bigger contributor is my recent addition of carbs (potatoes mainly) and after a couple years of carb restrictions my body is reacting accordingly.

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