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发帖数: 234 | 1 Sometimes we here hear complaints of elevated blood glucose in the early
morning. Here is some information that might be helpful to some of you. I
haven't seen this kind of information in this BBS before. So some of you may
not know it.
Diabetes and Morning High Blood Sugar
For people taking insulin for diabetes, blood sugar levels are often
elevated in the morning. This is likely due to inadequate amounts of NPH/
Lente insulin before dinner or at bedtime. High morning insulin is referred
to as either the dawn phenomenon or the Somogyi effect.
* Dawn phenomenon. The dawn phenomenon is the end result of a
combination of natural body changes that occur during the sleep cycle and
can be explained as follows. Between 3:00 a.m. and 8:00 a.m., your body
starts to increase the amounts of counter-regulatory hormones (growth
hormone, cortisol, and catecholamines). These hormones work against insulin'
s action to drop blood sugars. The increased release of these hormones, at a
time when bedtime insulin is wearing out, results in an increase in blood
sugars. These combined events cause your body's blood sugar levels to rise
in the morning.
* Somogyi effect. Named after the doctor who first wrote about it, this
condition is also called "rebound hyperglycemia." Although the cascade of
events and end result -- high blood sugar levels in the morning -- is the
same as in the dawn phenomenon, the cause is more "man-made" (a result of
poor diabetes management) in the Somogyi effect. The term refers to pattern
of high morning sugars preceded by an episode of hypoglycemia (with no
symptoms). Your blood sugar may drop too low in the middle of the night, so
your body counters by releasing hormones to raise the sugar levels. This
could happen if you took too much insulin earlier or if you did not have
enough of a bedtime snack.
Which of the Two Conditions Is Causing the High Blood Sugar Levels?
To determine which of the two above conditions is causing your high blood
sugar level, your doctor will likely ask you to check your blood sugar
levels between 2:00 a.m. and 3:00 a.m. for several nights in a row. If your
blood sugar is consistently low during this time, the Somogyi effect is
suspected (too much nighttime insulin or too small of a bedtime snack for
the insulin given). If the blood sugar is normal or high during this time
period, the dawn phenomenon (increases in counter-regulatory hormone) is
more likely to be the cause.
How Can Morning High Blood Sugar Be Corrected?
Once you and your doctor determine how your blood sugar levels are behaving
during the nighttime hours, he or she can advise you about the changes you
need to make to better control them. Options that your doctor may discuss
include:
* Changing the time you take the long-acting insulin in the evening so
that its peak action occurs when your blood sugars start rising.
* Changing the type of insulin you take in the evening
* Taking extra insulin overnight if you find that overnight your blood
sugars are progressively elevated. Here, the additional insulin would help
lower high morning blood sugars.
* Switching to an insulin pump, which can be programmed to release
additional insulin in the morning |
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