Dr Aidin Rawshani

Swinging blood sugar in diabetes

Contents

Swinging blood sugar: causes and strategies to counteract this

“Dawn phenomenon” — high sugar in the morning

Individuals with diabetes most often have elevated blood sugar levels in the morning, there are several reasons for this. Dawn Phenomenon is a medical expression of natural increase in blood sugar due to hormones secreted during the night, this leads to the liver secreting sugar into the bloodstream to prepare the individual for the day.

Blood sugar levels rise during the night and in the morning elevated blood sugar levels are seen. This is different from another phenomenon called the Somogyi effect where low blood sugar levels at night trigger a process that leads to rapid release of glucose from the liver to counteract blood sugar drop. The occurrence of the Somogyi effect is significantly smaller than the Dawn phenomenon and Somogyi can occur at any time of the day while the Dawn phenomenon only occurs at night and morning hours.

To diagnose any of the phenomena you simply need to measure blood sugar before bedtime, at night and in the morning, this is easiest to do with a continuous glucose meter that measures blood sugar levels in the interstitial fluid, not in the blood. By adjusting factors such as drug treatment for diabetes or food intake and physical activity before bedtime, you can achieve major improvements in countering blood sugar fluctuations during the night and high blood sugar in the morning.

Dawn Phenomenon occurs in all people regardless of whether they have diabetes. In people without diabetes, the natural insulin secretion of the body prevents blood sugar from increasing. This means that it is mainly individuals with type 1 diabetes who are troubled without these phenomena. Scientists believe that the secretion of the growth hormone called “Growth hormone” (GH) as well as cortisol, adrenaline and glucagon during the night, leads to an increase in blood sugar levels. These hormones are secreted every morning to prepare the body for the day, the hormones cause the liver to split glycogen into glucose which is then excreted into the blood in a process called glycogenolysis.

Strategies to avoid the Dawn phenomenon

Because of the Dawn phenomenon, people are more resistant to insulin in the mornings, and should therefore avoid large carbohydrate intake late at night and morning hours. For individuals with high blood sugar before bedtime, an evening exercise or late workout can be added to improve blood sugar metabolism and insulin response during the night. Also consult your doctor to adjust your insulin or medicine doses.

If you measure blood sugar during the night and notice that this is low on several occasions, this may also be a cause of high blood sugar in the morning when the body responds with an acute secretion of the hormone glucagon to counteract blood sugar drop. In short, the body senses that blood sugar levels are decreasing in the blood and therefore dumps sugar into the bloodstream to try to restore blood sugar levels.

Individuals with low blood sugar at night should consult their doctor to adjust their blood sugar lowering medicines or insulin in the evening. Individuals with insulin pumps rarely develop high blood sugar in the mornings as a result of the Dawn phenomenon when the insulin pump immediately responds to the high blood sugar levels by injecting more insulin. For individuals without insulin pumps, the dose of the long-acting insulin should be reduced primarily.

Constant release of glucose from the liver in response to low blood sugar levels at night may lead to consumption of glycogen stores in the liver and subsequently impaired ability to stabilise blood sugar when it becomes low.

Somogyi effect

The Somogyi phenomenon, also called post hypoglycemic hyperglycemia or chronic somogyi rebound describes a rapid blood sugar rise in response to low blood sugar. The Somogyi phenomenon was named after a Hungarian doctor named Michael Somogyi who theoretized that insulin overtreated patients with prolonged low blood sugar levels develop a defensive response by secreting the hormone glucagon and several other stress hormones such as cortisol and adrenaline. This leads to an immediate increase in blood glucose because the hormone glucagon causes the secretion of glucose from the liver to the bloodstream, while the stress hormones cause temporary insulin resistance for several hours that prevents sugar from getting out of the bloodstream and blood sugar levels are still rising. more.

“Eat to your meter”

Eat to your meter is a phrase used to describe the use of systematic blood glucose testing to adjust dietary requirements and the amount of food to achieve good blood sugar control. Using the “eat to your meter” system is especially useful for individuals with type 2 diabetes, but it can also be applied to individuals with type 1 diabetes, but then care must be taken not to suffer from blood sugar falls.

Test your blood sugar before and after a meal and record the result, also note other factors that can affect blood sugar levels, it includes all activities performed during the day, such as physical activity, stress or pathological conditions. Note that it is the increase in your blood sugar levels that you are looking for. This helps individuals with diabetes to tailor your diet to the foods that help than achieve good blood sugar control.

To determine whether to avoid certain meals or reduce the size of the portion you can create similar tables like this.

Eat to your meter
MealGlucose before mealGlucose 2 h after mealGlucose 4 h after måltid
Sandwich (white bread) with egg6.012.09.0
Fish and chips8.011.010.0

To determine which meal is best for blood sugar, we first examine the columns describing blood sugar levels 2 and 4 hours after the meal. In the example above, it turns out that fish and potatoes lead to the lowest results. It is important to try the same meals several times to create a fair picture of how it affects your blood sugar levels.

Honeymoon phase (“Honeymoon Period”)

Some individuals suffering from type 1 diabetes experience a phase called the “Honeymoon Periode”. During the honeymoon period, blood sugar levels improve and generally become easier to control because the body still has the ability to help, several people with newly onset type 1 diabetes need minimal amounts of insulin.

Some people even experience normal or almost normal blood sugar levels without taking insulin. This occurs because pancreatic disease is still producing insulin and the immune system has not had time to destroy all insulin-producing pancreatic cells, not everyone with type 1 diabetes has a honeymoon period.

There is no definite time frame for when the honeymoon period begins and ends, the phase can last in weeks, months or even years in some cases. Several people with newly onset type 1 diabetes need to consult their doctor about what adjustments you may need to make to your insulin routine.

Some researchers believe that people with newly onset type 1 diabetes who have normal or almost normal blood sugar levels at the beginning of the onset of the disease should take low levels of insulin or gluten-free diet to prolong the life of surviving insulin-producing pancreatic cells. Taking too much insulin during the honeymoon period can cause a drop in blood sugar. When the honeymoon period is over, your blood sugar levels will start to rise again and you will need to raise your insulin doses to normalize your blood sugar.

Other factors that can cause fluctuations in blood sugar levels include poor sleep, high caffeine intake, dehydration, certain medicines (such as antidepressants, contraceptives, diuretics and other psychotropic drugs). Some studies show that even menstruation can affect blood sugar levels.

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