This is something that started happening to me earlier this year after a lengthy period of having my blood sugars under control. From having good 7, 14 and 30 day averages of sub 8 mmol/l (145.45 mg/dl) and rarely spiking above 10 mmol/l (181.82 mg/dl) during the day in one of my 4-5 daily blood tests and getting up in the morning with good sub 8 mmol/l levels I started waking with 10+ levels.

As a T2 diabetic I have been controlling my sugars with two injections of Byetta 10ug a day (before breakfast and before dinner) and was also injecting 12 units of Lantus Solostar insulin in the morning - all of this under the supervision of the diabetes unit at our local hospital where I attend a clinic every six months. This combination, together with some other meds I am on, once worked out, kept my sugars in check.

Then a month or so ago I started noticing that my morning levels were elevated, over 10 mmol/l. In consultation with the diabetes clinic it was decided I should start taking my Lantus in the evening before going to bed and increase the dose to 18 units and now my morning levels more often than not are sub 8 mmol/l.

My last HbA1c check in February was 7.8 which both my cardiologist and the diabetes clinic are happy with.

I note the above in relation to the following article:

The Diabetes Dawn Phenomenon: Why It Happens, What To Do

By Jacqueline Marshall, Apr 14, 2014

How frustrating to wake up in the morning with elevated blood sugar when all you did was dream about eating a piece of cheesecake.

A seemingly spontaneous rise in blood glucose during the early morning hours – experienced by many people with type 1 and type 2 diabetes – is called the dawn phenomenon, or dawn effect.

The dawn phenomenon is actually the body’s response to an aspect of its own natural rhythms.

Why It Happens

The human body, with its wired-in wisdom, releases hormones such as cortisol, catecholamines, and growth hormone during the early morning hours. These hormones help maintain and restore the body’s cells, and they trigger the liver to release glucose. The rising glucose is meant to be regulated by circulating insulin.

Many people with diabetes do not have enough circulating insulin during predawn hours to regulate this end-of-night surge in blood sugar, so they are greeted on waking by the rising sun and an elevated morning glucose reading.

What to Do About It

A recent research study suggests that taking basal insulin in the evening is the only effective solution to the dawn phenomenon. However, if you are not currently taking insulin, consult with your doctor, and consider trying one of these possible dawn effect solutions:

• Exercise late in the day. Being active closer to bedtime may lower your blood sugar while you sleep.
• Adjust your medication(s). Talk to your physician about tweaking your medication(s) to counter the higher morning readings.
• Eat breakfast. When you eat breakfast, your body will tell the predawn glucose-stimulating hormones to give it a rest.
• Limit late-night carbs. In the evening, snack on items that have high protein and fat content such as peanut butter, meat, cheese, or nuts. These foods digest more slowly than carbohydrates, keeping glucose levels steadier.

Evidence for Evening Insulin?

The result of one research study does not prove anything, but it suggests something that may prove true.

Researchers at the Université Montpellier in France studied the dawn phenomenon in people with type 2 diabetes being treated with diet alone or with non-insulin medications.

The 248 study participants were examined for 48 hours using continuous glucose monitoring; 50 percent of them experienced the dawn phenomenon. The investigators defined the dawn phenomenon as a greater than 20 mg/dL rise in blood sugar.

The researchers concluded that:

1. The dawn phenomenon is already active in some individuals being treated for diabetes solely by diet; and diet does not regulate the phenomenon.
2. The dawn effect is not effectively blunted with oral hypoglycemic agents such as metformin or sulfonylureas, even in combination.

“We are unable to control the dawn phenomenon with our current armamentarium of oral hypoglycemic agents, even though metformin is probably the one that has the highest potency for reducing [it],” said researcher Dr. Louis Monnier. “My position is that insulin should be considered for the treatment of type 2 diabetes as soon as the A1C becomes greater than 7 percent when patients are already treated with maximal tolerated doses of oral agents.”

Keep Calm and Carry On

Keep calm, consult your doctor, and carry on. Stay informed and continue tweaking your diabetes management regimen to get results you and your professional team are satisfied with.

Link to original article:  http://www.informationaboutdiabetes.com/lifestyle/lifestyle/the-diabetes-dawn-phenomenon-why-it-happens-what-to-do

Latest Cardiac Rehab talk - the need for MOTIVATION

Plugging along when not feeling the best:

Been dealing with a number of health issues over the past 2-3 months and haven't felt a lot like posting. Between doctors and visits to hospitals for appointments, checkups and a procedure it would be fair to say I was not in the right frame of mind to add to this blog.

To date I have had 21 medical related appointments so far this year including attending specialist clinics at both of our hospitals for different conditions, a procedure, xrays and ultrasounds, blood tests and other various appointments. In addition to these I have five more appointments scheduled including two pre-admissions next week for another procedure early in June and I am waiting for a date for another procedure later in the year subject to being cleared by the anaethetist to being able to be 'put under'. And this does not include 25 medical appointments my wife has had this year for her issues including follow-up clinics re: breast cancer surgery and other issues.

Having said this, like many who deal with multiple health issues on a day to day basis, I have kept on (as has my wife) doing what I would normally do and most importantly keeping as busy as possible and when I felt tired due to my sugar levels being out of kilter (I am a T2 diabetic) I would simply take a nap - learnt a long time ago not to fight the urge to take a nap.

Keeping on keeping on through the health issues included volunteering at the Institute for Ultrasound where I am a volunteer patient for doctors, nurses and others learning the techniques involved to doing an ultrasound. Sometimes it is a session where people are simply updating their skills or learning another area of ultrasound that they may not be proficient in.

The other thing that I have kept up with is my six weekly talk to our local cardiac rehab group and I guess it was following yesterday's talk that I got the push, the motivation to post again on this blog.

Whilst giving my talk the question of MOTIVATION came up and the need to KEEP ON GOING even when things seem to be difficult or 'not going your way'. Actually, whilst talking about this I sort of got the motivation to post again and here I am.

The discussion about motivation came up when I was going through my experiences of finding things, positive things, that helped me deal with my recovery after my heart attack and bypass surgery, things like helping my wife look after injured wildlife which I never had time to do before my heart attack and my rediscovering photography, an old high school hobby.

Discussion on motivation covered different topics including giving up smoking, adjusting diet and developing an exercise routine as well as dealing with things like stress, depression and anxiety.

The word MODERATION came up when talking about changing to a healthier lifestyle such as reducing alcohol intake or the number of visits to fast food outlets.

Some talk took place yesterday as it has in previous talks about how sometimes we MASK how we are feeling to give the appearance that we are feeling well and dealing with life without any problems.

However, without question, the keyword yesterday was MOTIVATION and the need for people to find something to give them that 'OOMPH' to keep going when things get tough or when the urge strikes to go back to the 'old ways' crop up - and I related how I earlier this year for a month or two when I was dealing with various issues, personal and health, 'I fell off the wagon' and did little exercise and made some poor food choices like eating chocolate and biscuits and how these combined with my breathing problems and poor sleep resulted in my sugar levels spiking and my angina related pains returning and my feeling tired and lethargic all the time.

Maybe having a fourth grandchild last month was the motivation I needed or maybe it was just the self-realization that high blood sugars would sooner rather than later impact on my heart that shook me up and got me back to my daily exercise routine and eating better.

Whatever the case, with my sugars now back under control and my feeling better I knew it was time to start posting again, especially after those present yesterday gave me a round of applause after my talk - maybe that was the motivation I needed!

Here is a link to a previous talk I have presented to our cardiac rehab unit.
http://my29lives.blogspot.com.au/p/my-cardiac-rehab-talk-september-2011.html