Dawn Phenomenon

6 am. You are enjoying the last moments of a peaceful night of sleep. But, suddenly, the alarm of your CGM rings: after some hours with a pretty stable graph, your BG is now rising! This is something I'm sure every T1D has experienced once in a while. But there are ways to avoid this situation!

But first of all, why does this dynamic happen? What is its cause? The answer, once and again, is one and simple: hormones. Namely, in the very first hours of the day, our body naturally produces high levels of cortisol, the quintessentially stress hormone, which, through the stimulation of ACTH and, therefore, glucagone, determines pronounced hyperglycemic effects. This is an intrinsic and unmodifiable metabolic pathway, which has to be controlled with the help of a well-studied insulin injection plan.

Of course, if you find yourself in the situation of having to face rising BG levels due to this effect, in the precise moment when the inconvenient happens the only thing which has to be done is to correct with a small bolus of rapid insulin. When you calculate the dose, take into account these two factors: in the morning, especially at the early hours, we are a bit more insulin resistant, while, on the other hand, not having ingested anything for many hours, our insulin sensitivity will be, in any case, higher than after our breakfast, when it usually is at its lowest. By balancing these two aspects and proceeding by trial and error you will find your perfect correction bolus.

However, there is a way to act more indirectly yet more effectively: adjusting your basal insulin. If you begin to observe pronounced early morning BG spikes, maybe a rise in your basal dose is what you need. This will enable you to smooth your overnight BG graph, reducing by a lot the effects of the dawn phenomenon. Of course, you have to be careful not to exaggerate with the increase in your basal insulin dosage: an excess will most likely determine huge and persistent drops in your overnight BG, and this is the last thing we want! Again, the way to go is by trial and error: practice will make us perfect. 

Thank you for having read my article! A lot more will come about diabetes management and other aspects of our disease. All you have to do is to stay tuned on this and other sections of my website!