Dawn Phenomenon

(Based on research from various sources)

By

Satyajit Dash, LCHF Nutrition Coach

Are you noticing that your blood glucose is highest in the

morning when you wake up and you haven’t even had
anything to eat yet? Don’t worry! This is a very common
effect known as the dawn phenomenon. Let’s look at the
science behind this phenomenon and explore strategies to
help you reduce your fasting glucose.

What causes the dawn phenomenon?

The dawn phenomenon, sometimes referred to as the “dawn

effect,” has earned its name from the recurrence of elevated
blood glucose (a.k.a. sugar) around the hours of waking,
roughly between 4-8 AM. Although the exact underlying
causes of the dawn phenomenon are still unclear, it is known
that hormones, including adrenaline, cortisol, glucagon, and
growth hormone, play a large part. These hormones follow a
circadian rhythm, or a daily cycle, and tend to be found in
higher concentrations in the blood in the morning to help
prepare us for the day ahead.

The hormones that promote glucose release into the blood

include:

 Adrenaline: Known as the “fight or flight” hormone,

adrenaline increases blood flow to the muscles and
promotes the release of glucose into the blood.
 Cortisol: Known as the “stress hormone”, cortisol also
plays a role in increasing blood glucose.
 Glucagon: Signals the liver to release glucose into the
blood.
 Growth Hormone: Important for repair and
regeneration and promotes the release of glucose into
the blood.

Two key processes occur in the liver overnight that result in

the release of glucose into the bloodstream and contribute to
increased morning blood glucose:

1) Glycogenolysis, the breakdown and release of stored

glucose (a.k.a. glycogen)

2) Gluconeogenesis, the creation of glucose from

components of protein (i.e. certain amino acids) or fat (i.e.
glycerol)

One more hormone that plays an important role is insulin.

When blood glucose rises, insulin is released and helps move
glucose out of the blood and into cells for energy use or
storage.

Does the dawn phenomenon occur only in people

with pre-diabetes and type 2 diabetes?

The physiological processes that underlie the dawn

phenomenon occur in everyone regardless of whether they
have diabetes or not. The difference lies with insulin and how
our bodies react to it. Healthy individuals secrete enough
insulin and are insulin sensitive enough to counteract a rise
in morning blood glucose. However, someone with pre-
diabetes or type 2 diabetes is insulin resistant and/or may
not secrete enough insulin, which allows blood glucose to
rise. This may be further compounded in the early morning
hours because our body is more insulin resistant compared
to the rest of the day causing an elevated fasting glucose to
remain elevated longer. Progression of pre-diabetes and type
2 diabetes is likely to result in a worsening of the dawn
phenomenon as insulin function and sensitivity continue to
diminish.

Is the dawn phenomenon something I need to fix?

The dawn phenomenon is not necessarily something that

needs to be fixed. It’s important to keep in mind that even
though your fasting glucose may be elevated, you may have
lower or normal glucose values throughout the rest of the
day. Additionally, it’s not uncommon for patients reversing
their diabetes through nutritional ketosis to experience the
dawn phenomenon and still see improvements in their
HbA1c. Why? Because HbA1c is a measure of your blood
glucose over the last 3 months. The average value matters
more than any individual blood glucose value.

Example blood glucose curve of someone controlling

their type 2 diabetes through nutritional ketosis who
experiences the dawn phenomenon.

How can I combat the dawn phenomenon? Will

reducing my carb intake help?

If you want to understand if elevated morning blood glucose

numbers are a result of the dawn phenomenon or from too
many dietary carbohydrates, all you need to do is test at
multiple times throughout the day. First and foremost, you
should be familiar with what your fasting glucose looks like.
Whether it be your most recent lab values from the doctor or
checking your glucose with a meter, the best way to know
where your fasting glucose falls is to measure it, and to test
it on a few different days. Similarly, testing your glucose
throughout the day, before and after meals, and before you
go to bed can help you understand how your body responds
to the food you eat. Once you’ve tested enough that you
understand your baseline glucose with your current habits,
try incorporating each of the strategies outlined below into
your routine. Continue testing your blood glucose and you’ll
see what impact each change has on your morning fasting
glucose.

Strategies that may help mitigate the Dawn Phenomenon:

 Get a good night of sleep—6 to 8 hours each night—

and go to bed before midnight to help reduce cortisol
and improve one’s ability to tolerate glucose.
 Reduce your overall carbohydrate intake to lower
blood glucose.
 Eat dinner earlier in the evening and avoid late night
snacks to reduce blood glucose in the evening.
 Have your last meal of the day contain the least
amount of carbohydrates to minimize the rise in
blood glucose.
 Do something active after dinner, such as a walk, to
help lower blood glucose.
 Eat a breakfast a lower in carbohydrates since
blood glucose is high and you have greater insulin
resistance in the morning.
 Don’t wait too long to eat breakfast when you wake
up. Eating food early in the morning can help release
insulin which can lower blood glucose.
 Take a tablespoon of Apple Cider vinegar in a glass
of Lukewarm water before going to bed at night.
 If you are a morning working out person, shift your
working out window to evening/ late evening.
 To learn more about how food affects blood sugar;
check out these videos from Virta Health by
Dr. Sarah Hallberg.

Carbs , Protein and Fat, and Their Surpris ing Impact on Blood Sugar

Carbohydrate Intolerance, Ins ulin Res is tance and Revers ing Diabetes

Type 2 Diabetes Epidemic and What We Can Do to Stop

Why 'Eat Les s , Exercis e More' Does n't Work, and Is Downright Ins ulting

His tory & Safety of Nutritional Ketos is

Low Carb Interventions to Revers e Type 2 Diabetes

Low Carb Meals , Des s erts and Tips for Succes s

A note about safety

People with chronic diabetes should not make large-scale dietary

changes without medical supervision, especially if taking
medications for diabetes or blood pressure for a longer time.
Sudden, stoppage or tapering down of medicine, with reduced
carbohydrate may decrease blood glucose and blood pressure.
Therefore, it is important to keep a blood sugar & blood pressure
database on daily basis, when you switch to a low carb protocol
and as you see improvement in these readings, you should meet
your physician with these data, who can then help you to safely
adjust medications so that blood glucose or blood pressure
doesn’t get too low.
References:

1. Porcellati F, Lucidi P, Bolli GB, Fanelli CG. Thirty Years of Research on the Dawn Phenomenon:
Lessons to Optimize Blood Glucose Control in Diabetes. Diabetes Care. 2013;36(12):3860-3862.
doi:10.2337/dc13-2088.
2. Monnier L, Colette C, Dejager S, Owens D. Magnitude of the Dawn Phenomenon, and Its Impact on
the Overall Glucose Exposure in Type 2 Diabetes: Is this of concern? Diabetes Care.
2013;36(12):4057-62: doi: 10.2337/dc12-2127
3. Spiegel K, Leprouit R, Van Cauter E. Impact of Sleep Debt on Metabolic and Endocrine Function.
Lancet. 1999;354(9188):1435-9: doi: 10.1016/S0140-6736(99)01376-8

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