Liver dump, dawn phenomenon and dawn effect are all common terms that describe the same condition. It is an abnormally high early-morning fasting increase in blood glucose. It usually occurs between 4:00 AM and 8:00 AM. It occurs in everyone’s body, but it has more impact on diabetics than normal bodies. It is more common in people with type I diabetes than in people with type II diabetes. Understanding the phenomenon can go a long way towards helping diabetics manage it.
The liver is responsible for the increase in glucose levels in the bloodstream. The brain, vital organs, the creation of red blood cells, and muscle tissue are constantly consuming glucose to function (24 hours per day). When the glucose levels in the bloodstream drop, the brain sends a message, via hormones, to release more glucose.
At the same time, these same hormones signal the pancreas to reduce the amount of insulin that is produced and released into the bloodstream. In a normal body, the balance of glucose and insulin levels will be regulated. However, diabetics have an impaired control over this balance. Type I diabetics and insulin-dependent type II diabetics do not produce, either enough or, any insulin. The insulin in their system is dependent upon periodic injections. When the hormone insulin is out of balance with the other hormones (cotisol, glucagon and epinephrine), the liver will release too much glucose.
Also, as the result of normal hormonal changes. The body’s internal clock recognizes that it is morning, and the wake-up process begins. The hormones cause the increase in blood glucose levels. No one actually knows what the exact cause of the phenomenon is, but many believe that it is increases in the hormones cortisol, glucagon and epinephrine, that causes increases in insulin resistance. Insulin resistance is a breakdown in cellular communication, resulting in reduced amounts of insulin attaching to cell membranes, which, in turn, results in the cells not taking glucose in to burn as energy. Insulin resistance is the primary cause of elevated blood glucose levels. Also, while sleeping, the body carries out a process called gluconeogenesis. During gluconeogenesis, the body converts amino acids into glucose.
Like the release of stored glycogen the creation of glucose from amino acids occurs in response to hormonal signals. The body, during sleep, responds to signals from several different glands. The pituitary gland produces a growth hormone. The adrenal cortex produces cortisol. The alpha cells in the pancreas make glucagons. The outer layer of the adrenal gland sends out epinephrine. Those hormones raise the blood glucose level. ?There are specific methods that can be applied to determine if a patient has the liver dump phenomenon.
There are other possible causes of the dawn phenomenon. Insufficient amounts of insulin taken, or incorrect medication amounts taken the night before, may result in increases in blood glucose levels. High glycemic index foods (certain carbohydrates), can cause an increase in morning glucose levels, especially if eaten just before bed time. The only currently known way to determine if the phenomenon exists, is to take blood glucose readings periodically throughout the night. High glucose readings throughout the night will signify if there are other causes, and eliminate the possibility that the patient has the phenomenon.
If the patient displays high readings throughout the night, it may not necessarily mean that the phenomenon does not exist. The other possible causes should be eliminated, such as the type of snacks eaten before bed, incorrect medication administration, changes in medications, and possible incorrect settings on an insulin pump if one is used. Particularly the early morning dosages settings. A diet that is high in sodium will stimulate insulin and promote hypoglycemia. A diet that is low in sodium can promote hyperglycemia.
In some cases (not commonly), the phenomenon may be the result of a rebound from a low blood glucose level that has occurred during the night. This is commonly referred to as the Somogyi effect. The dawn phenomenon, unlike the Somogyi effect, it is not the result of antecedent (preceded by) hypoglycemia; they are not the same condition. The insulin taken the night before may be wearing off, which is usually due to too low of a dosage. However, larger dosages may easily cause hypoglycemia during the night. Only experimentation with food types and dosage amounts will tell what the overall effect will be.
Carbohydrate blockers, such as PGX, are known to have a drastic effect on morning glucose levels. Another possible remedy may be to increase the amount of water-soluble fiber in the diet, particularly in the evening meal. Some studies have shown that a green apple eaten as a nighttime snack is effective, because the body digests green apples slower than other apple types. Mostly due to the fact that Granny Smith apples are less ripe than others.. However. those that have been diagnosed as having the dawn phenomenon, sometimes will not show any change. Nuts (or other proteins and fats) are a good choice for a late night snack.
Unfortunately, late night snacks can encourage the packing-on of extra pounds.
The practice of taking a dosage of vinegar or acidic products before bed does show a reduction in the morning blood sugars on most people. Unfortunately, the body cannot handle large increases in blood pH, without leaching calcium from the bones. This can prove to be a dangerous practice, especially for women and older diabetics. Vinegar tablets are lower in dosage, and a bit slower in conversion, which can reduce the risk to some extent. However, most of the recommended dosages are as high as six tablets which can cause the same effect. Also, acids promote the increase in fat cells, as the body attempts to eliminate the acids by placing them in fat storage.
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Diabetics that have the dawn phenomenon do not have any symptoms that are associated with it. Nocturnal hypoglycemia (low blood sugars), followed by morning hyperglycemia (high blood sugars) for several nights is an indication of the Somogyi effect. It may be necessary to get help from a doctor to resolve it, because most cases are the result of medications that are mismatched to the patient’s needs. Metformin, a generic form of a diabetic oral medication (Glucophage), is known to curb glucose production by the liver, which makes it a good candidate for patients that have the dawn phenomenon. Metformin also encourages the insulin bonding to cell membranes, which reduces insulin resistance. Diabetics that take these oral medications rarely experience the dawn phenomenon.
While all diabetics should exercise, the timing of doing the exercises may impact the rebound effect of nighttime hypoglycemia. It may be necessary to exercise as early in the day as possible to avoid the rebound effect. Exercise can stimulate the metabolism to be elevated for several hours after exercise.
How long the patient has been diabetic; the quality of the patient’s glycemic control; sleep disorders; exercise; nighttime snacks (especially carbohydrates); high or low sodium in the diet; the state of counter-regulation to hypoglycemia; and the patient’s insulin sensitivity all can contribute to the dawn phenomenon. Start by experimenting with nighttime snacks. Switch to proteins such as nuts. Or, stop the nighttime snacks altogether. Make small adjustments to insulin levels and give the change several days to function. Have a doctor test the metabolic rate. Carefully monitor the amounts of sodium in the diet. If sodium is a part of the diet, it should be sea salt. Insulin resistance is caused by belly fat. It may be necessary to eliminate excess weight to eliminate insulin resistance, and improve sleep patterns. Determining if a patient has the dawn phenomenon, can require the help of a doctor if medications are responsible for the problem.
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Tom E. Nelson. http://www.diabeticshandbook.com
