Re: the lovely dawn effect

[Guest guest]

Sky

When you don't get up until 8am are you lying in bed awake or are you

asleep?

I have found that if I lie in bed awake then my DP starts during the time I

lie in, but if I get up as soon as I wake up the DP starts a while after I

get up.

Rob

[Guest guest]

At 09:43 AM 11/13/05, Rob Fearnley wrote:

>When you don't get up until 8am are you lying in bed awake or are you

>asleep?

>

>I have found that if I lie in bed awake then my DP starts during the time I

>lie in, but if I get up as soon as I wake up the DP starts a while after I

>get up.

This morning I was actually sleeping. There are times, however, when I lie

awake and seem to spend the time from around 5 a.m. onwards tossing and

turning because I'm awake but just don't want to get up that early. I

sometimes do get up but it makes for a really long day. At those times my

FBG's are still lower than this morning, though.

One thing I remembered after I sent that message was that I had a really

aching back last night...sort of middle back and under shoulder blades and

felt like what I remember of times when I had problems with muscle spasms

in the back a lot. In any event, lacking anything like a muscle relaxant I

took a Tylenol. I wonder if that did the damage.

I shot a very conservative 6 units of Humalog, then 45 minutes later ran to

the pharmacy to get my metformin refill, then, because I forgot to stop by

on my way home, walked to the apartment complex office (just a few blocks)

to set up a work request. So I checked BG's after all of that and they were

116, which is acceptable if not great. I doubt I'll get lower than that in

the mornings unless I start something like Lantus. I've never gotten into

just two digits in the mornings.

Whoa, hear the wind roar. We've a severe wind warning today as yet another

cold front heads towards us. First it's balmy as the southern air wafts up,

then cold as a cold front moves in from the north-west, then balmy. I

suppose it should be too much longer until the balmy air loses. They've

even predicted maybe a few snowflakes next Wednesday. I love snow.

sky-who-rambles-on

[Guest guest]

At 10:14 AM 11/13/05, Gretchen wrote:

>Some people find that fat makes their BG go up the next day. You might try a

>lowish-fat day and a high-fat day, keeping the rest of the food the same,

>and see if you can see any difference.

>

>How many carbs were in the LC ice cream bar? If it had more carbs than it

>was supposed to, plus the fat, that might have contributed.

I've eaten several of those LC bars in a row on weak days...and those late

at night...and still didn't see an effect on my FBG the next day. So I

don't *think* it was the bars or fat. I can't check the carbs for you

'cause it was my last bar and I'd thrown the box away a week or so ago

(more room to stick the bars in odd places in the freezer that way). It's

Byer's brand, if that helps.

I'll tell you, with the diet restrictions already needed for diabetes I

just don't think I could also handle no or little fat in my foods. I often

wish I was one of those people who just eat as an after-thought, but I love

food, love cooking, love reading recipes.... I DO use olive oil where

practical and trim excess fat from things like that piece of steak even

though the crisped up fat was always a favorite. 8-( The cream cheese

was low-fat (one of the few things I've found where I don't mind the flavor

of the low-fat sort).

sky

Belive nothing, no matter where you read it, or

who said it, no matter if I have said it, unless it

agrees with your own reason and your own

common sense.

- Siddhartha Gautama (the Buddha)

http://www.skydancers.com

http://www.skydor.com

[Guest guest]

I eat the Breyer's Carb Smart chocolate-covered popsicles, and each one

has 9 g of carbs, 2 of fiber, and 15 g of fat, 11 g saturated fat, no

trans fat. they have some similar ones called No Sugar Added that have,

IIRC, 18 g of carbs. Sue

>

> I can't check the carbs for you

> 'cause it was my last bar and I'd thrown the box away a week or so ago

> (more room to stick the bars in odd places in the freezer that way).

> It's

> Byer's brand, if that helps.

[Guest guest]

At 02:13 PM 11/13/05, Sue wrote:

>I eat the Breyer's Carb Smart chocolate-covered popsicles

I don't believe I've ever seen a chocolate covered popsicle.

sky

[Guest guest]

At 04:07 PM 11/13/05, Sue wrote:

>Really? They are just vanilla ice cream covered in chocolate.

Oh, I called frozen fruit juice/flavoing a popcicle. Ice cream with

chocolate over I call an ice cream bar.

sky

[Guest guest]

I wasn't really suggesting that you go on a low-fat diet, just that you

might want to find out whether or not fat makes your fastings higher.

Because fat delays stomach emptying, it can slow down the release of carbs,

so if you're not eating a lot of carbs, your BG will stay lower. But if you

eat fat and also eat a bit too many carbs late in the day, then that delay

might mean that the carbs hit the intestines early in the morning.

Gretchen

[Guest guest]

At 08:57 PM 11/13/05, Gretchen wrote:

>I wasn't really suggesting that you go on a low-fat diet, just that you

>might want to find out whether or not fat makes your fastings higher.

>

>Because fat delays stomach emptying, it can slow down the release of carbs,

>so if you're not eating a lot of carbs, your BG will stay lower. But if you

>eat fat and also eat a bit too many carbs late in the day, then that delay

>might mean that the carbs hit the intestines early in the morning.

okay, Gretchen, thanks.

sky

[Guest guest]

I don't have the dawn effect but, over periods of being out of

control, I can certainly definitively say that fat injested the day

before affects my fastings. When I have wanted to bring my bgs under

control quickly from fasting through pps, it has always been a matter

not only of lowering carbs but lowering fat.

Once I lower both adequately, my bgs will fall into an acceptable range.

Suzz, dx97, d&e, t2

--------------

>

> I wasn't really suggesting that you go on a low-fat diet, just that you

> might want to find out whether or not fat makes your fastings higher.

>

> might mean that the carbs hit the intestines early in the morning.

>

> Gretchen

>

[Guest guest]

> This morning at 8:15 or so when I checked

> FBG's it was 145. I checked again and the

> second reading was 158! I did make the bed

> and get dressed before I checked but I do

> that most mornings. Most provoking. It's

> been running higher in the mornings for several

> weeks now, but normally high 120's or barely

> into the 130's around 8a.m. and if I get up

> and check around 7ish it'll be 115 or so.

Hi, Sky, I have had FBG's between 85 and 100 mg/dl

for many years and then suddenly, about 6 months

ago, I started to get mostly 124-135 mg/dl upon

waking but without having changed my eating pattern

in any way.

Despite the big increase in FBG, my pre-meal BGs

are still the same 90-100 and my HbA1c for the

last two quarters has still been the same 5.4-5.6%

that it always has been.

My physician told me today that it doesn't indicate

a progression if the HbA1c does not change and every-

thing else remains the same. In any event, according

to him,there is no selective treatment for an

increase in FBG that will not also reduce the HbA1c

and although I don't like seeing the 124-135 mg/dl

when I wake up, I also don't want to have HbA1c 4.5%

again because of the increased hypo risk.

He has told me to take a series of readings

immediately before going to sleep and immediately

after waking to see if there is any correlation.

I have searched the Internet but so far have not

found any mention of a treatment strategy for an

independently-changed FBG in a Type 2 diabetic but

neither have I found any reports of a correlation

between FBG rise and diabetes progression in a

treated Type 2.

Regards

Thornton

Pforzheim, Germany

(Type 2 since late 1999, 500mg Glucophage morning and

evening. Diet: 1500 kcal/day, mostly fruit, vegetables,

whole-wheat bread and olive oil. No progression of

complications (microproteinurea treated with Atacand

Plus) since diagnosis. Exercise: 60 minutes fast

walking at aerobic threshold every day. Weight: 15kg

(33lb)overweight, cycling down to 5kg (11lb) overweight

every 3-5 years.)

[Guest guest]

, I would add another test or two to track your nocturnal bgs. Test

about 3 hours before your regular wake-up time. If that doesn't give you

enough information, add another one either an hour before or an hour after.

What you are looking for is a low in the middle of the night that sends a

signal to your liver for more glucose.

The fact that your A1c is remaining the same leads me to wonder if this

is what is happening.

It has a name, the Smoygi, or something like that, Effect.

Helen

[Guest guest]

But isn't that one way that a non-diabetic progresses into full-fledged

diabetes?

But it is strange that your A1C hasn't gotten higher.

Sue

On Monday, November 14, 2005, at 02:52 PM, Thornton wrote:

>

> I have searched the Internet but so far have not

> found any mention of a treatment strategy for an

> independently-changed FBG in a Type 2 diabetic but

> neither have I found any reports of a correlation

> between FBG rise and diabetes progression in a

> treated Type 2.

[Guest guest]

At 02:52 PM 11/14/05, Thornton wrote:

>Hi, Sky, I have had FBG's between 85 and 100 mg/dl

>for many years and then suddenly, about 6 months

>ago, I started to get mostly 124-135 mg/dl upon

>waking but without having changed my eating pattern

>in any way.

>

>Despite the big increase in FBG, my pre-meal BGs

>are still the same 90-100 and my HbA1c for the

>last two quarters has still been the same 5.4-5.6%

>that it always has been.

I guess I'll find out what mine is in December though I must say I dislike

the thought of having that test done just between Thanksgiving and

Christmas when I know I'm going to do some " cheating " .

sky

[Guest guest]

>

> My physician told me today that it doesn't indicate

> a progression if the HbA1c does not change and every-

> thing else remains the same.

Hi

Did he give any support for that view?

Cheers, Alan, T2, Australia

[Guest guest]

> I would add another test or two to track

> your nocturnal bgs. Test about 3 hours before

> your regular wake-up time. If that doesn't

> give you enough information, add another one

> either an hour before or an hour after. What

> you are looking for is a low in the middle

> of the night that sends a signal to your

> liver for more glucose.

Hi, Helen! Thanks for the comments. I am told

that if my liver was going to respond

to a low at 3 a.m. it would do it right away

and not 6 hours later! What would be the

point of that?

I do test periodically if I happen to wake up

in the night but, with HbA1c 5.4% I never

measured any lows in the night. In the days

when I had HbA1c 4.5% I did get lows - and not

only in the night - but no " dawn effect " !

> It has a name, the Smoygi, or something

> like that, Effect.

Somogyi! Yes, that is what my physician calls

it, too, and says that it is not something that

needs treating, just measure immediately after

waking normally and before getting out of bed

if I really want to see my real FBG, otherwise

forget it.

I measured this morning at 7:55 after waking

naturally and measured 100 mg/dl without getting

out of bed, then I dozed off and measured again

at 10:58 still without getting out of bed and

got 123 mg/dl. So I reckon that the notion that

moving about or doing something energetic brings

on the " dawn effect " is a fairy tale - my BG is

going to rise anyway whether I walk about or

not!

The only aspect that has me puzzled is that I

have been reading about people having a " dawn

effect " for years and I used to wonder why I

didn't have one, too. Now I am wondering why I

suddenly get one while nothing much else has

changed (except that I am a few years older!).

I will assume that it is a sign of progression

of the diabetes and get on with my life!

Regards

Thornton

Pforzheim, Germany

[Guest guest]

> I guess I'll find out what mine is in

> December though I must say I dislike

> the thought of having that test done just

> between Thanksgiving and Christmas when

> I know I'm going to do some " cheating " .

I bet you that two " cheats " in a year cannot

make even the slightest difference to a single

HbA1c, Sky! I would have to be celebrating

Thanksgiving and Christmas for a week or two

each to shift that average very much and it

will probably be the same for you (assuming

that you are Type 2 and otherwise in good

control, of course)!

Regards

Thornton

Pforzheim, Germany

[Guest guest]

> Did he give any support for that view?

No, but then I didn't ask him for any! I

don't believe everything he tells me anyway.

He cannot give me a guarantee that my " dawn

effect " is the same as everybody else's

" dawn effect " and either he has a pill for

it or he hasn't - and it appears that he

hasn't so he is off the hook.

I reckon that it is up to me to look for

information on the subject if I am interested

and I have looked superficially but so far

have not found anybody reliably claiming

that an isolated " dawn effect " is an indication

of anything that needs to be treated, or even

can be treated.

If anybody has any references that I can access

on the Internet then I would be very grateful

to hear about them (evidence that a " dawn

effect " does harm, or does no harm, and if

anything can or needs to be done about it or

not).

Regards

Thornton

Pforzheim, Germany

[Guest guest]

At 07:08 AM 11/15/05, Thornton wrote:

>Somogyi! Yes, that is what my physician calls

>it, too, and says that it is not something that

>needs treating, just measure immediately after

>waking normally and before getting out of bed

>if I really want to see my real FBG, otherwise

>forget it.

It sort of makes you wonder why the periodic fasting BG's we have to do at

a lab are taken seriously at all. We not only have been fasting for at

least 8 hours, but we've gotten up, gotten dressed, and driven to the lab.

Then we've probably had to sit in a waiting room for awhile before our

blood is drawn. My FBG's are normally at about 145-165 by then, and I try

to get there early.

Mine was 126 this morning around 8. But I don't keep my stuff on the

nightstand to check it before my feet touch the floor. I find that awkward

and the light isn't very good, either. I started a new canister of strips

this morning and the new code was 26. So when I got that 126 reading I

found myself with the completely illogical thought that somehow setting the

new code affected the reading. Odd how our minds want to put meaning in

coincidence. On the other hand, I don't believe in coincidence. Hmmm.

Oh and by the way, thanks to all who explained the fiber thing to me. I

guess I just wasn't really thinking very clearly about that.

sky

[Guest guest]

> It sort of makes you wonder why the periodic

> fasting BG's we have to do at a lab are taken

> seriously at all. We not only have been fasting

> for at least 8 hours, but we've gotten up,

> gotten dressed, and driven to the lab. Then

> we've probably had to sit in a waiting room

> for awhile before our blood is drawn.

That is a good point, Sky! But I am not sure that

they ARE taken seriously! Somebody pays for them so

they are not completely wasted. In a diabetes

clinic, they usually wake the patients up at 5-6 am

to take their FBG while they are still flat on their

backs and those are the readings that get taken

seriously, I reckon.

On the other hand, the people who evaluate your

" FBG " as outpatient know that you have been sitting

in the waiting room and presumably take that into

account. But I bet you that all they are looking for

are the folks with FBGs in the 200s and those couldn't

be blamed onto any " dawn effect " !

> My FBG's are normally at about 145-165 by then, and

> I try to get there early. Mine was 126 this morning

> around 8.

I must say that you sound as if you do not have " good

control " yet, Sky. I remember that it took me at least

six months before my FBGs got down into the " good "

range and then they stayed there. I guess that it

takes the body that long to accommodate to the changed

conditions but I have never seen that discussed

anywhere - why it takes so long to do that.

> But I don't keep my stuff on the nightstand to

> check it before my feet touch the floor. I find

> that awkward and the light isn't very good, either.

I did once seriously consider buying a BG meter for

the blind that calls out the readings in a computer

voice so that I could take them in the dark but

I never did get around to it. Now I take only a few

readings a month so it is no longer an issue for me.

Regards

Thornton

Pforzheim, Germany

[Guest guest]

> If anybody has any references that I can access

> on the Internet then I would be very grateful

> to hear about them (evidence that a " dawn

> effect " does harm, or does no harm, and if

> anything can or needs to be done about it or

> not).

I'm not an expert, but my understanding is that high BG in the morning

can be due to at least two different things. Symogi (response to low

BG) or another effect which is a kind of " getting ready for action "

response of your body.

I just read something a little different from what I've usually found

about the 2nd kind which is kind of interesting. This is talking

about type 1 but I presume this effect would be the same for type 2's.

" The dawn effect is an increase in insulin resistance (or decrease in

insulin sensitivity) caused by hormones released about two hours

before you wake. These hormones are under the control of the pituitary

gland, and thus the brain. The dawn effect is influenced by

testosterone and tends to be more significant in men. It is highly

variable from person to person. Your overnight insulin is taken to

counter the dawn effect, and on average, diabetics take 20% of their

insulin overnight. "

Why worry? If your average BG (probably as measured by your A1c) is

fine, then you are probably fine. They are now talking about paying

more attention to PP BGs, which are probably higher than your morning

BG unless you are on a very low carb diet.

What to do about it? Some people claim that a glass of wine and maybe

some nuts along with it before retiring reduces their morning BG.

My husband is type 2 and I know nothing about type 1 diabetics so what

I wrote may not apply -- to anyone for that matter!

Judy

[Guest guest]

> Why worry? If your average BG (probably as

> measured by your A1c) is fine, then you are

> probably fine.

Why worry? Well, I am not exactly worried but

I feel that I ought to get a handle on why this

has happened to me after five years of having

diabetes and NOT having a " dawn effect " .

Something must have changed and I didn't want

to get into the situation in which I am asked

later: " Why didn't you mention this before? You

have left it very late! "

Being " probably fine " is not exactly where I

want to be if there is a way to get a little

more certainty.

> What to do about it? Some people claim that

> a glass of wine and maybe some nuts along

> with it before retiring reduces their morning BG.

Thanks, that is probably a good way to get to feel

better about it but I was hoping to find out

something a little more scientific than what

" some people say " . In other words, it might not

be necessary to do anything about it, I was just

hoping that there had been some serious research

into the subject.

If there is NO clear answer then I can live with

that, too, of course, but in that case then, as

my physician says: I can " forget the dawn effect,

it doesn't mean a thing! "

> My husband is type 2 and I know nothing about

> type 1 diabetics so what I wrote may not apply

> - to anyone for that matter!

I would be interested to know if he takes a glass

of wine and some nuts before sleeping and if it

reduced his " dawn effect " ? I try to avoid taking

anything after 8 p.m. and I go to bed at about

1-2 a.m. (I am retired) - I won't ask you about

his testosterone!

Thanks for the information, Judy. It gives me

some leads to follow up.

Regards

Thornton

Pforzheim, Germany

[Guest guest]

Significant changes in bg should probably be looked into. How long has

it been since you had a thorough physical exam, or the chem panel

bloodtests? A lot of things can cause changes in bg levels - we know

about infection, of course, but seems to me that all those internal

systems talk to each other and there could be something going on

elsewhere that the liver or pancreas or whatever is reacting to.

CarolR - agreeing with for the second time in one day hmmmm.....

Thornton wrote:

> Why worry? Well, I am not exactly worried but

> I feel that I ought to get a handle on why this

> has happened to me after five years of having

> diabetes and NOT having a " dawn effect " .

[Guest guest]

Gil does have some dawn effect. He was only diagnosed with type 2 in

June so we have been experimenting with a lot of different things so

it's hard to tell what does have an effect but he's doing very well on

a relatively low carb diet. So now I'm starting to think about the

" dawn effect. " We have normally had our wine with dinner and we

generally eat late, which is probably not good.

I may give a try with eating dinner a bit earlier and having wine and

some nuts before bed and see how it goes. He did that last night and

his BG was 110 but so was it yesterday when he didn't have a glass of

wine before bed!

Re something more scientific. I'm a retired physicist so I know what

is scientific, but hard information is very difficult to come by. One

reason may be that " diabetes " is not a single thing but more a

syndrome. Which is why something that works well for one person may

not work for another depending on the details of why that person has

high blood sugar.

Even the " scientific " studies can be very confusing and not agree one

with another. All require interpretation and everyone is ready to

apply their interpretation to the data.

Our medical profession is supposed to be " scientific " yet for years

they told us to eat margarine which is full of artificial things and

trans fats (I never listened) and that solvent extracted corn oil is

great stuff but olive oil is not (I didn't listen) or that the

" standard American diet " is healthy (I didn't listen to that either).

Then Gil's doctor had him for years on atenolol which is known to

reduce insulin sensitivity despite his family history of type 2

diabetes. After I inquired he was immediately switched to an ACE

inhibitor...

Judy

[Guest guest]

At 10:18 AM 11/15/05, Thornton wrote:

>I must say that you sound as if you do not have " good

>control " yet, Sky. I remember that it took me at least

>six months before my FBGs got down into the " good "

>range and then they stayed there. I guess that it

>takes the body that long to accommodate to the changed

>conditions but I have never seen that discussed

>anywhere - why it takes so long to do that.

But you have more disipline than I do, ! 8-) Or had. But even when I

had a fairly consistant morning reading it was still around 111 - 115 range.

Oh and on dawn effect...everyone has one, I read. It just shows up with us

because we can't produce the insulin a non-diabetic person does to lower

the morning surge of glucose.

sky

[Guest guest]

- I am curious what you consider " good control " - my FBG is

generally 85 with 95 - 100 being high for me. I do have diabetes caused

by surgery, so my case is different than normal DM. I thought good

control was anywhere up to 110 - I'm just curious since it seems there

are so many numbers around. I have also found that if I have a glass of

Merlot before bed, my FBG will always be 75-85 rather than 85-95. Of

course, 2 slices of pizza last night could be why I was 90 this morning

and not 80 ;-)

Barb in NH

Thornton wrote:

>

> I must say that you sound as if you do not have " good

> control " yet, Sky. I remember that it took me at least

> six months before my FBGs got down into the " good "

> range and then they stayed there. I guess that it

> takes the body that long to accommodate to the changed

> conditions but I have never seen that discussed

> anywhere - why it takes so long to do that.

>

>

> Regards

>

> Thornton

> Pforzheim, Germany

>

>

>

>