How can I help my father deal with the "dawn phenomenon," or high blood sugar on awakening?

A fellow caregiver asked...

My father has type 2 diabetes and struggles with high blood sugar levels when he gets up in the morning -- hyperglycemia when he wakes up, or what he calls the "dawn phenomenon." What's going on and what can I do to help him?

Expert Answer

Theresa Garnero is clinical nurse manager of Diabetes Services at California Pacific Medical Center in San Francisco.

The dawn phenomenon, named after the time of day it occurs, is the result of the body's response to hormones typically released between 4 a.m. and 8 a.m., which cause glucose levels to rise. This process occurs in everyone, but people with diabetes, like your dad, may not have enough insulin in their system to keep this added glucose under control. So the end result can be hyperglycemia, a blood glucose level that is unhealthily high, occurring when your dad wakes up and before he eats. This is often referred to as fasting blood glucose -- the level of glucose in the blood after at least eight hours without food or calorie-containing fluids.

Your father isn't necessarily doing anything wrong. In fact, the dawn phenomenon may largely be out of his control. But there are steps you and he can take to help remedy the problem. Start by keeping good track of your dad's glucose numbers to help detect any patterns. Then discuss your results with his healthcare provider, who will have advice about how to best handle the dawn phenomenon. For instance, if your father's fasting blood sugar is high, but the rest of the day it's normal, then his healthcare provider may simply suggest a watchful waiting approach.

However, if your dad's blood glucose is out of his target range all day, his provider will likely recommend changes to his treatment plan. If your dad is experiencing sleep deprivation due to pain, depression, or some other ailment -- which can all raise blood sugar to unacceptable levels -- then his doctor will likely want to address these underlying conditions first.

Other possible ways to address the dawn phenomenon:

  • It may be that your father's medicine regimen needs adjusting.
  • Your father may be able to control his morning hyperglycemia by modifying his diet. For some people, eating dinner earlier does the job, as long as it's followed by a small snack prior to bedtime. For others, having a protein-and-fat snack such as nuts or cheese (and limiting carbohydrates) before bedtime can help. And, as counterintuitive as it sounds, eating breakfast can also limit the dawn phenomenon's effect by signaling to your father's body to turn off the hormones that cause highs in the first place.
  • Sometimes exercising later in the day has a glucose-lowering effect during the night.

It may take some trial and error to figure out what strategy works best for your dad to beat the dawn phenomenon. In the meantime, regular blood glucose monitoring is key. So encourage your father to check his blood sugar regularly and keep a record of his numbers.