Dawn Phenomenon: How to Control High Morning Blood Sugars

The dawn phenomenon is a normal, natural rise in blood sugar that occurs in the early morning hours, between roughly 4 and 8 a.m. The shift in blood sugar levels happens as a result of hormonal changes in the body.

All people experience the dawn phenomenon to one level or another, which can vary day by day. People without diabetes may never notice it happening, as a normal body’s insulin response adjusts for the rise without intervention.

A person with diabetes is more likely to experience symptoms from the rise in blood sugar levels, however.

How does it affect people with diabetes?

Dawn phenomenon is a normal rise in blood sugar released by the liver. The release happens as the person’s body is preparing to wake for the day.

The rise in blood sugar is normally handled with insulin. For people with diabetes, insulin is not produced in high enough quantities, or the body is unable to use the insulin properly.

[woman feeling ill in bed with a glass of water]
Symptoms of the dawn phenomenon include nausea, weakness, and extreme thirst roughly between 4 and 8 a.m.

As a result, a person with diabetes will feel the effects of having high sugar levels in the blood.

These effects can include:

  • faintness
  • nausea
  • vomiting
  • weakness
  • disorientation
  • feeling tired
  • extreme thirst

Managing the dawn phenomenon

Managing blood sugar levels is nothing new to most people with diabetes. A combination of diet, exercise, and medication often help keep the symptoms and problems under control.

In the case of dawn phenomenon, there are some additional changes that may help prevent issues caused by the spike in blood sugar.

Some steps people with diabetes can take to manage the dawn phenomenon include:

  • changing medication entirely or making adjustments with a doctor on existing medication
  • avoiding skipping meals or medication doses
  • avoiding carbohydrates around bedtime
  • taking medication closer to bedtime and not at dinner time

Other steps include eating dinner earlier in the evening. After dinner, some light physical activity, such as going for a walk, jogging, or yoga, is encouraged.

It is likely that a person with diabetes will experience high morning blood sugar levels from time to time. Occasional, mild issues from dawn phenomenon are not too worrisome. However, if the frequency becomes much more regular, then it’s time to call a doctor.

Complications

[elderly woman with diabetes at the doctor]
People who experience the dawn phenomenon regularly should talk to their doctor as it can lead to serious complications.

If blood sugar levels spike too high as a result of dawn phenomenon, the effects can range from mild to a life-threatening medical emergency.

Some complications that a person with diabetes may experience as a result of dawn phenomenon include:

  • nerve damage
  • damage to blood vessels
  • organ damage
  • ketoacidosis, an extremely dangerous buildup of acid in the bloodstream

People who experience repeated high blood sugar levels due to dawn phenomenon should see a doctor to prevent these consequences.

Do options differ between type 1 and type 2 diabetes?

Differences in dealing with dawn phenomenon depend more on the individual person than what type of diabetes they have or what their treatment plan is.

A person with type 1 diabetes may adjust the dosage or type of insulin to account for any changes overnight. In other cases where the person wears an insulin pump, they may adjust the pump to deliver extra insulin in the morning.

What is the Somogyi effect?

Unlike in the dawn phenomenon, the Somogyi effect occurs when blood sugar levels drop too low. This causes the growth hormones, cortisol, and catecholamines, to release into the blood.

For example, if a person who takes insulin or medication to lower blood sugar levels does not eat a regular bedtime snack, their blood sugar levels may drop during the night.

This person’s body then responds to the low blood sugar levels by releasing hormones that trigger sugar levels to go back up. This may cause blood sugar levels to be higher than normal in the morning.

How can you tell the difference?

The major difference between dawn phenomenon and the Somogyi effect is that the latter can occur any time there is extra insulin in the body.

[clock at ten past two]
Checking blood sugar levels between 2 and 3 a.m. can help indicate whether a person is experiencing the dawn phenomenon or the Somogyi effect.

The easiest way to rule out the Somogyi effect is to check blood sugar levels at bedtime, around 2 to 3 a.m., and after waking up for several nights and mornings.

Some people may choose to wear a continuous glucose monitor, which can record the sugar levels throughout the day and night, allowing the user to track the trends.

Here are two possible results and what they might mean:

  • If the blood sugar level is low at or between 2 to 3 a.m., there is a good likelihood the Somogyi effect is the cause.
  • If the blood sugar level is normal or high at or between 2 to 3 a.m., it is more likely that the cause is the dawn phenomenon.

Treatments, home remedies, and prevention

The best treatment is prevention. Treatment for the dawn phenomenon is likely to be the same type that they would use to treat a spike in blood sugar.

Some people may have to inject insulin while others might have specific medication to target increases in blood sugar.

Each person with diabetes should discuss with their doctor what to do when their blood sugar levels spike, regardless of whether it is the dawn phenomenon or not.

Home remedies

Home remedies do not use medication to lower blood sugar. People with diabetes should speak with their doctor before trying any home remedies or stopping their medications.

Some common remedies that do not require medicine include:

  • eating less refined sugar and avoiding items with added sugar
  • increasing activity and getting regular exercise
  • taking alpha lipoic acid supplements, a natural antioxidant that can be bought over the counter
  • eating more cinnamon
  • drinking green tea
  • taking chromium supplements help the body regulate blood sugar levels

Another potential remedy is eating more protein. Some people consider whey protein to be particularly helpful as it helps control blood sugar levels.

If dawn phenomenon occurs regularly, people with diabetes should seek advice from a doctor for the best options to help prevent the serious consequences of high blood sugar levels.

Meal Planning to Manage Blood Sugar: Carb Counting for Diabetes

Carb counting is one form of meal planning that can help people with diabetes manage their blood sugar levels.

Diabetes is an incurable, yet manageable, a medical condition where the body’s blood sugar levels are too high. This happens when there is not enough insulin in the body, or the insulin does not work properly.

Insulin is a hormone that is made by the pancreas. It helps the body to process glucose (the simplest form of sugar), which is used by the cells to create energy. When this doesn’t happen, sugar stays in the bloodstream. This can lead to serious health problems.

Diabetes and the role of carbohydrates

In the United States in 2014, approximately 9 percent of Americans, totaling nearly 29 million people, were found to have diabetes. Diabetes is classified into different types and includes:

Almost one tenth of people in the U.S. have some form of diabetes.
  • Type 1 diabetes: In this type, the body does not produce insulin. This is due to the body attacking its own insulin-producing cells within the pancreas. It is most commonly diagnosed in children and young adults.
  • Type 2 diabetes: In this type, insulin is either not made in high enough quantities or not used efficiently. This form of diabetes affects people of all ages and is the most common type.
  • Gestational diabetes: Some pregnant women will develop a typically temporary form of diabetes called gestational diabetes. This raises their risk of developing type 2 diabetes later in life. Most times, once the baby is born, this form of diabetes disappears.

What happens after carbohydrates are eaten?

The digestive system breaks down the carbohydrates into sugar. This enters the bloodstream and is used by the body’s cells for energy.

Typically, when the body receives the signal that sugar is in the bloodstream, the pancreas produces insulin. This aids the body’s cells in using the sugar for energy and helps to keep blood sugar levels steady.

However, this doesn’t happen in the bodies of people who have diabetes. These people may need to take an external form of insulin to maintain normal levels of blood sugar.

As they have a condition that affects their blood sugar levels, people with diabetes need to be cautious about how much sugar they take in on a daily basis. This is more involved than simply curbing a chocolate or ice cream craving.

Many people with diabetes need to count the number of carbohydrates in each serving of food. This is referred to as carbohydrate counting, or carb counting, and helps to control blood sugar levels.

Understanding carb-heavy foods

The main nutrients found in food include protein, fat, and carbohydrates. Carbohydrates, like any other nutrient, come in healthful and unhealthful forms. People with diabetes need to take special care of which carbohydrates they eat and how regularly.

Foods such as whole grains, fruits, and vegetables are full of energy producing nutrients, vitamins minerals, and fiber. These are vital for normal physical growth and development. However, carbohydrates in sugary foods and drinks offer little nutritional value.

It is important for those with diabetes to understand:

  • how many carbohydrates they need on a daily basis
  • how to count carbohydrates
  • how to properly read a food label

Foods that contain carbohydrates include:

  • Grains: Including bread, pasta, oatmeal, certain noodles, crackers, cereals, rice, and quinoa.
  • Fruits: Including apples, bananas, berries, mangoes, melons, oranges, and grapefruits.
  • Dairy: Including milk and yogurt.
  • Legumes: Beans (including dried), lentils, and peas.
  • Snacks: Cakes, cookies, candy, and other sweet dessert-type foods.
  • Drinks: Juices, soft drinks, sports drinks, and sugary energy drinks.
  • Vegetables: Some vegetables contain more carbohydrates than others.

Starchy and non-starchy vegetables

Not all vegetables are created equal. They can be broken down into “starchy” and “non-starchy” types. Starchy vegetables contain more carbohydrates than the non-starchy varieties.

[a plethora of green vegetables]
Non-starchy vegetables are low in carbs, therefore people counting carbs can eat much more of them.

Starchy vegetables include:

  • potatoes (including sweet potatoes)
  • peas
  • pumpkin
  • butternut squash
  • fresh beets

Non-starchy vegetables include:

  • asparagus
  • broccoli
  • carrots
  • celery
  • green beans
  • lettuce
  • other salad greens
  • peppers
  • spinach
  • tomatoes
  • zucchini

Healthy sources of protein and fat

To avoid carbohydrate-heavy foods, it is important to understand which foods are healthful sources of protein and fat.

Fish, meat, poultry, many kinds of cheese, nuts, oils and fats do not contain enough carbohydrates to be considered when carb counting.

Healthful sources of protein include:

  • eggs
  • whey protein
  • chicken and turkey breast
  • fish, including salmon, cod, and rainbow trout
  • nuts, such as almonds and peanuts
  • tofu and tempeh
  • pumpkin seeds

Healthful sources of fat include:

  • oils, such as flax, olive, virgin coconut, avocado, and hemp seed
  • grass-fed butter
  • avocado
  • nuts and seeds

Aims of carb counting

Carb counting alone is not a substitute for seeking medical care to make sure that normal or close to normal blood sugar levels are maintained.

Many people with diabetes also need to take insulin or other medications to aid in the process, and should also regularly engage in physical activity.

The goal of carb counting is to keep blood sugar levels steady in order to:

  • help those with diabetes stay healthy
  • prevent complications
  • improve energy levels

How carb counting works

The first step in carb counting is identifying what foods have carbohydrates and how many grams (g) per serving.

Doctors and dietitians may help people with diabetes work out how many carbohydrates they should have each day. This helps them calculate a daily total that they can stick to.

The typical range for carbohydrate intake is between 45 and 65 percent of the total calories taken in per day. After a daily calorie intake is calculated, carbohydrate percentages and servings can be worked out.

Calculating carbs

There are around 4 calories in 1 g of carbohydrate. So, to work out the number of carbohydrates per day, total calorie intake will need to be divided by 4.

Here is an example calculation based on a daily intake of 1,800 calories and 45 percent carbohydrate:

  • 0.45 x 1,800 calories = 810 calories
  • 810 ÷ 4 = 202.5 g of carbohydrate

Based on this calculation, a person can have approximately 200 g of carbohydrates per day. The next thing to work out is how much carbohydrate there is in a single serving of a particular food item.

When reading nutritional labels, it is important to take note of the total number of carbohydrates per serving so that these totals can be added into the total daily carbohydrate allowance.

For example, there are approximately 15 g of carbohydrate in each serving of the following foods.
A slice of bread and a teaspoon of jam both have approximately 15 grams of carbohydrates.

  • 1 slice of bread
  • 1/3 a cup of pasta or rice
  • 1 small apple
  • 1 tablespoon of jelly
  • ½ cup of starchy vegetables

According to the figures used above, an individual can have 13.5 servings of these foods each day:

  • 202.5 g of total carbs ÷ 15 g per serving = 13.5 servings

However, non-starchy vegetables have just 5 grams of carbohydrate per serving, which means that an individual can eat a lot more of them.

Meal suggestions

Those who are carb counting may find it challenging at first to work out carbohydrate totals in home cooked meals, and when eating out. There are some tips that can help make carb counting a little easier, such as:

  • Counting mixed foods by the cup: On average, a woman’s fist is the size of a 1-cup serving. For a mixed dish, this is a good way to approximate the carb totals based on cup size.
  • Count tablespoons: Knowing how many grams of carbohydrates are in a tablespoon of food is helpful. People can simply count level tablespoons to create a healthful plate.
  • Calculate pizza by the crust: If possible, choose a thin-crust pizza. This will save 5-10 g of carbohydrate per serving size compared to a slice of regular or pan pizza.
  • Smoothies may not always be the best bet: On average, a 12 oz. smoothie actually has more carbohydrates than a regular soda if it contains juice, so should be consumed in moderation.

Getting started with carb counting

Carb counting may help many people with diabetes to maintain steady blood sugar levels. However, it is only one way to manage diabetes. In order to know how a certain food will affect blood sugar levels, a person must consider the type of carbohydrate the food contains and how much fiber is in it.

Before trying carb counting, people should always speak with a nutritionist, diabetes educator, or doctor to determine:

  • whether carb counting is appropriate
  • what is the recommended daily allowance for carbohydrates
  • what foods are recommended

Apple Cider Vinegar and Diabetes

For many years, apple cider vinegar has been linked with an array of health benefits. These have ranged from aiding weight loss to relieving cold symptoms. But does taking it help people with diabetes?

What is apple cider vinegar?

Apple cider vinegar
Apple cider vinegar derives from cider or fresh apples and is produced after a slow process that breaks down sugars.

Vinegar can be made from nearly any carbohydrate. Apple cider vinegar is derived from cider or freshly pressed apple juice.

Like most vinegar, apple cider vinegar is produced by a slow process spanning several weeks or months in which sugars are broken down.

Mother of vinegar is a cobweb-like substance made from yeast and bacteria that builds up during this period. Mother of vinegar gives the vinegar a cloudy appearance and it is only present in unfiltered apple cider vinegar. It is thought to boost the vinegar’s nutritional value.

However, most vinegar is pasteurized. This heating process kills bacteria but prevents the mother of vinegar from forming.

Apple cider vinegar and diabetes

In 1980, there were around 108 million people with diabetes worldwide. Its prevalence has increased greatly over the past few decades to an estimated 422 million. Diabetes is a chronic condition marked by an inability to manage blood sugar levels appropriately.

The hormone responsible for regulating blood sugar levels is called insulin. People with type 1 diabetes are unable to produce this hormone. People with type 2 diabetes are unable to produce enough insulin or respond appropriately to the hormone.

People can also develop a related condition known as prediabetes. This is where an individual may have blood sugar levels that are high, but not yet high enough to be diagnosed with diabetes.

Developing methods that help the body to regulate blood sugar levels efficiently is the most effective strategy in managing diabetes. Maintaining a healthful, balanced diet and regular exercise are crucial lifestyle factors that can help to achieve this.

Some evidence also suggests that consuming apple cider vinegar may be useful in helping people with diabetes to control their blood sugar levels.

One study demonstrated that apple cider vinegar reduced blood sugar levels and had a positive impact on cholesterol in rats with and without diabetes.

Type 2 diabetes

Glucometer
Studies suggest that a small amount of apple cider vinegar may help to reduce blood sugar levels after a spike following a meal high in carbohydrates.

In humans, researchers have looked at how consuming apple cider vinegar alongside a meal high in carbohydrates affected blood sugar levels in participants who had type 2 diabetes, prediabetes, or neither condition.

Meals high in carbohydrates typically cause a spike in blood sugar levels immediately after eating. However, less than an ounce of apple cider vinegar significantly reduced blood sugar levels across all three groups following the meal, compared with the consumption of a placebo drink.

Another study in patients with type 2 diabetes compared apple cider vinegar with water. The authors found that consuming 2 tablespoons of apple cider vinegar with a cheese snack before bedtime was enough to significantly lower blood sugar levels the following morning.

This finding suggests that apple cider vinegar could also help to reduce fasting blood sugar levels. This refers to blood sugar levels after 8 hours without eating or drinking anything except water. Fasting blood sugar levels serve as a baseline measure of a person’s blood sugar levels.

It is thought that a component of apple cider vinegar called acetic acid may slow down the conversion of complex carbohydrates into sugar in the bloodstream.

This provides more time for the sugar to be removed from the bloodstream, allowing the body to keep blood sugar levels constant and limit spikes. This is also a theory underlying the effects of several different diabetes drugs.

Type 1 diabetes

While consuming apple cider vinegar could help people with type 2 diabetes control their blood sugar levels, it could be harmful to those with type 1 diabetes.

The inadequate digestion of food is a common complication for people with diabetes. Called gastroparesis or delayed gastric emptying, it means that food can remain in the stomach for an abnormally long period of time without being digested.

These delays in the digestive process make it harder for the body to consistently control blood sugar levels. A team of Swedish researchers found that apple cider vinegar increased the time in which food remains undigested in the stomach of people with type 1 diabetes.

It is important to note that a majority of the studies within this area have been conducted using small sample sizes and findings have not always been consistent.

A large-scale, randomized control trial to find out how apple cider vinegar affects blood sugar levels in patients with diabetes has yet to be conducted.

Any impact that apple cider vinegar might have on the regulation of blood sugar levels is likely to be relatively small compared with maintaining a healthful, balanced diet and regular exercise.

Based on the available evidence, apple cider vinegar could help people with type 2 diabetes to control their blood sugar levels. More research is needed for large-scale recommendations. Its consumption in moderation has yet to be linked with any significant harms or side effects.

How is it consumed?

Apple cider vinegar on a salad
Apple cider vinegar may be consumed diluted in water or used in marinades and salad dressings.

People who wish to consume apple cider vinegar are best diluting 1 to 2 tablespoons of apple cider vinegar in a large glass of water. It should be consumed before meals and there may be benefits associated with consuming it just before bedtime.

As with most vinegar, it is not recommended to consume undiluted apple cider vinegar. When drunk on its own, it can cause stomach irritation or damage to tooth enamel.

Apple cider vinegar can also be used as a versatile cooking ingredient. It is suitable for use in salad dressings, marinades, sauces, and soups. It works well with many types of meat and fish.

People are most likely to see the distilled varieties of apple cider vinegar on sale, which has a clear, see-through appearance. However, it is better to search for the unfiltered, cloudier varieties as they contain mother of vinegar and are more nutritious.

Summary

People with type 2 diabetes may want to consider diluted apple vinegar cider given that it is safe to consume and may provide some benefit to blood sugar level control. However, the evidence behind its benefits is still lacking.

It is important for people to note that apple cider vinegar should not be considered a quick fix for diabetes. Eating a balanced diet low in carbohydrates, high in fiber, and exercising regularly are the most effective methods of controlling diabetes.