The Dawn Phenomenon and the Somogyi Effect
Morning readings can be so frustrating! Do you go to bed with a blood glucose of 120 mg/dL (6.6 mmol/L) and wake up with a blood glucose of 170 (9.4 mmol/L) or more? Is this happening in spite of following your diet, exercise and taking your medications as your doctor prescribed?
Well, don't worry; all this may be happening due to the Dawn Phenomenon or the Somogyi Effect (also called rebound hyperglycemia). Let's see what this is all about.
What is the Dawn Phenomenon?
Every human being experiences the Dawn Phenomenon. While we sleep, usually around 3-8 AM, glucose is released in response of the stimulus of some hormones in order to repair and maintain our body.
These hormones are growth hormone, cortisol, glucagon, and epinephrine (also called adrenalin), which are also known as counterregulatory hormones, since they have the opposite effect of insulin: they cause glucose levels to rise.
So, the release of these hormones to repair and maintain your body causes an increase in blood glucose levels during the first hours of the morning.
That is why it is called the Dawn Phenomenon.
What is the Somogyi Effect?
The Somogyi Effect happens when your blood glucose levels are high in the morning due to hypoglycemia (low blood glucose levels) overnight.
This is also called rebound hyperglycemia, since your body reacts to low blood glucose levels by increasing the release of glucose from muscles, liver and fat, therefore causing hyperglycemia.
What can I do to prevent or correct this high blood glucose in the morning?
If you wake up high because your blood glucose levels are high overnight (Dawn Phenomenon) try the following:
* Limit your carbs at night and eat a small snack of fat and protein before bed, like a tablespoon of peanut butter, or some cheese and/or meat. No carbs, just protein and fat in that snack.
* Try to exercise in the evening for at least 45 minutes at moderate pace, like walking or bicycling. This type of exercise has a longer hypoglycemic effect that will help your blood glucose levels keep down during the night.
* Talk with your doctor about an adjustment of your medications in the evening. If you take pills you might need another dose or an increase of the dose before bed. If you use insulin, you might need a little bit more of long acting before bed and/or some more for breakfast. If you use a pump, then it is easier and you just need to adjust your basal rate to prevent the blood sugar from rising during the night.
* You should also eat breakfast. The increase in blood glucose after you eat your breakfast will often turn off the release of glucose from liver or muscles, since your body senses the fuel is coming through food. If you don't eat your breakfast because you are afraid your blood glucose is high, your blood sugar might continue to rise until noon or until you eat again.
* Do not skip taking your medication in the morning. You must always eat breakfast and take your medication, so your body does not feel that it is in a state of emergency.
If you have lows overnight and wake up with high (Somogyi Effect) you can try the following:
* Go to bed with a blood glucose level a little bit higher than usual, which might prevent you from having hypoglycemia over night.
* Also, you might need to add some carbs and fat to your dinner or bedtime snack, in order to have a slower digestion and available carbs during the night, for example yogurt with nuts or a slice of whole wheat bread with peanut butter.
In both cases, you should try to wake up around 2-3 AM and check your blood glucose levels. If you are high and wake up high, it might be the Dawn Phenomenon; if you are low and wake up high, then it could be the Somogyi Effect.
Finally, record all your readings and talk with your health care team so they make adjustments in your treatment to help you achieve better glucose control.
Senin, 02 Mei 2011
High Blood Glucose: What It Means and How To Treat It
What is high blood glucose?
People who do not have diabetes typically have fasting plasma blood glucose levels that run under 126 mg/dl.
Your physician will define for you what your target blood glucose should be — identifying a blood glucose target that is as close to normal as possible that you can safely achieve given your overall medical health. In general, high blood glucose, also called 'hyperglycemia', is considered "high" when it is 160 mg/dl or above your individual blood glucose target. Be sure to ask your healthcare provider what he or she thinks is a safe target for you for blood glucose before and after meals.
If your blood glucose runs high for long periods of time, this can pose significant problems for you long-term — increased risk of complications, such as eye disease, kidney disease, heart attacks and strokes and more. High blood glucose can pose health problems in the short-term as well. Your treatment plan may need adjustment if the blood glucose stays over 180 mg/dl for 3 days in a row. It is important to aim to keep your blood glucose under control, and treat hyperglycemia when it occurs.
What are the symptoms of high blood glucose?
* Increased thirst
* Increased urination
* Dry mouth or skin
* Tiredness or fatigue
* Blurred vision
* More frequent infections
* Slow healing cuts and sores
* Unexplained weight loss
What causes high blood glucose?
* Too much food
* Too little exercise or physical activity
* Skipped or not enough diabetes pills or insulin
* Insulin that has spoiled after being exposed to extreme heat or freezing cold
* Stress, illness, infection, injury or surgery
* A blood glucose meter that is not reading accurately
What should you do for high blood glucose?
* Be sure to drink plenty of water. It is recommended to drink a minimum of 8 glasses each day.
* If your blood glucose is 250 or greater and you are on insulin, check your urine for ketones. If you have ketones, follow your sick day rules or call your healthcare team if you are not sure what to do.
* Ask yourself what may have caused the high blood sugar, and take action to correct it. Ask your healthcare team if you are not sure what to do.
* Try to determine if there is a pattern to your blood glucose levels.
o Check your blood glucose before meals 3 days in a row.
o If greater than your target level for 3 days, a change in medication may be needed.
o Call your healthcare team or adjust your insulin dose following well day rules.
o Call your healthcare team if you are currently using diabetes pills.
People who do not have diabetes typically have fasting plasma blood glucose levels that run under 126 mg/dl.
Your physician will define for you what your target blood glucose should be — identifying a blood glucose target that is as close to normal as possible that you can safely achieve given your overall medical health. In general, high blood glucose, also called 'hyperglycemia', is considered "high" when it is 160 mg/dl or above your individual blood glucose target. Be sure to ask your healthcare provider what he or she thinks is a safe target for you for blood glucose before and after meals.
If your blood glucose runs high for long periods of time, this can pose significant problems for you long-term — increased risk of complications, such as eye disease, kidney disease, heart attacks and strokes and more. High blood glucose can pose health problems in the short-term as well. Your treatment plan may need adjustment if the blood glucose stays over 180 mg/dl for 3 days in a row. It is important to aim to keep your blood glucose under control, and treat hyperglycemia when it occurs.
What are the symptoms of high blood glucose?
* Increased thirst
* Increased urination
* Dry mouth or skin
* Tiredness or fatigue
* Blurred vision
* More frequent infections
* Slow healing cuts and sores
* Unexplained weight loss
What causes high blood glucose?
* Too much food
* Too little exercise or physical activity
* Skipped or not enough diabetes pills or insulin
* Insulin that has spoiled after being exposed to extreme heat or freezing cold
* Stress, illness, infection, injury or surgery
* A blood glucose meter that is not reading accurately
What should you do for high blood glucose?
* Be sure to drink plenty of water. It is recommended to drink a minimum of 8 glasses each day.
* If your blood glucose is 250 or greater and you are on insulin, check your urine for ketones. If you have ketones, follow your sick day rules or call your healthcare team if you are not sure what to do.
* Ask yourself what may have caused the high blood sugar, and take action to correct it. Ask your healthcare team if you are not sure what to do.
* Try to determine if there is a pattern to your blood glucose levels.
o Check your blood glucose before meals 3 days in a row.
o If greater than your target level for 3 days, a change in medication may be needed.
o Call your healthcare team or adjust your insulin dose following well day rules.
o Call your healthcare team if you are currently using diabetes pills.
How often should blood glucose levels be measured?
It depends on your lifestyle - the needs of someone with diabetes who's also a PE instructor are quite different to someone who sits at a computer all day.
If you use insulin
In broad terms, people who have Type 1 diabetes should measure their blood sugar levels daily before meals. Some days one or two tests can be done, while on others four or five might be needed.
Measuring blood sugar levels in the morning before any food gives an indication of the amount of insulin needed overnight.
If you have Type 2 diabetes that's being treated with insulin, you should also follow this schedule.
If you take oral treatments
If your diabetes is treated with tablets or a special diet (Type 2), you should measure your blood glucose levels once or twice a week - either before meals or 90 minutes after a meal.
You should also do a 24-hour profile once or twice a month. This means measuring glucose levels before each meal.
Not everyone with Type 2 diabetes needs to carry out regular blood glucose checks.
For elderly people and those with other medical problems, it's often enough to check the urine for glucose - usually before breakfast and the evening meal.
This is because while good control of diabetes is important, cardiovascular complications (heart attacks, stroke, angina) are the main cause of serious illness and death in people with this type of diabetes.
So people with Type 2 diabetes will benefit from tackling the factors that contribute to their cardiovascular risk by:
* controlling blood pressure more rigorously
* lowering cholesterol levels with medication
* increasing or starting exercise
* stopping smoking.
If you use insulin
In broad terms, people who have Type 1 diabetes should measure their blood sugar levels daily before meals. Some days one or two tests can be done, while on others four or five might be needed.
Measuring blood sugar levels in the morning before any food gives an indication of the amount of insulin needed overnight.
If you have Type 2 diabetes that's being treated with insulin, you should also follow this schedule.
If you take oral treatments
If your diabetes is treated with tablets or a special diet (Type 2), you should measure your blood glucose levels once or twice a week - either before meals or 90 minutes after a meal.
You should also do a 24-hour profile once or twice a month. This means measuring glucose levels before each meal.
Not everyone with Type 2 diabetes needs to carry out regular blood glucose checks.
For elderly people and those with other medical problems, it's often enough to check the urine for glucose - usually before breakfast and the evening meal.
This is because while good control of diabetes is important, cardiovascular complications (heart attacks, stroke, angina) are the main cause of serious illness and death in people with this type of diabetes.
So people with Type 2 diabetes will benefit from tackling the factors that contribute to their cardiovascular risk by:
* controlling blood pressure more rigorously
* lowering cholesterol levels with medication
* increasing or starting exercise
* stopping smoking.
How can I measure blood sugar levels?
You can learn to measure blood sugar levels simply and quickly with a home blood glucose level testing kit. All kits have at least two things: a measuring device and a strip.
To check your blood sugar level, put a small amount of blood on the strip. Now place the strip into the device. After about 30 seconds it will display the blood glucose level.
The best way to take a blood sample is by pricking your finger with a sharp lancet that's designed to penetrate the skin only as far as needed to draw a drop of blood.
To check your blood sugar level, put a small amount of blood on the strip. Now place the strip into the device. After about 30 seconds it will display the blood glucose level.
The best way to take a blood sample is by pricking your finger with a sharp lancet that's designed to penetrate the skin only as far as needed to draw a drop of blood.
Why control blood sugar levels?
When very high levels of blood glucose are present for years, it leads to damage of the small blood vessels.
This in turn increases your risk of developing late-stage diabetes complications including:
* retinopathy (eye disease)
* nephropathy (kidney disease)
* neuropathy (nerve disease)
* cardiovascular disease, such as heart attack, hypertension, heart failure, stroke and problems caused by poor circulation, eg gangrene in the worst cases.
With Type 1 diabetes, these complications may start to appear 10 to 15 years after diagnosis.
They frequently appear less than 10 years after diagnosis of Type 2 diabetes, because this type of diabetes is often present for years before it is recognised.
By keeping the blood sugar level stable, you significantly reduce your risk of these complications.
This in turn increases your risk of developing late-stage diabetes complications including:
* retinopathy (eye disease)
* nephropathy (kidney disease)
* neuropathy (nerve disease)
* cardiovascular disease, such as heart attack, hypertension, heart failure, stroke and problems caused by poor circulation, eg gangrene in the worst cases.
With Type 1 diabetes, these complications may start to appear 10 to 15 years after diagnosis.
They frequently appear less than 10 years after diagnosis of Type 2 diabetes, because this type of diabetes is often present for years before it is recognised.
By keeping the blood sugar level stable, you significantly reduce your risk of these complications.
What is the blood sugar level?
The blood sugar level is the amount of glucose (sugar) in the blood. It is also known as plasma glucose level. It is expressed as millimoles per litre (mmol/l).
Normally blood glucose levels stay within narrow limits throughout the day: 4 to 8mmol/l. But they are higher after meals and usually lowest in the morning.
In diabetes the blood sugar level moves outside these limits until treated. Even with good control of diabetes, the blood sugar level will still at times drift outside this normal range.
Normally blood glucose levels stay within narrow limits throughout the day: 4 to 8mmol/l. But they are higher after meals and usually lowest in the morning.
In diabetes the blood sugar level moves outside these limits until treated. Even with good control of diabetes, the blood sugar level will still at times drift outside this normal range.
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