The Dawn Phenomenon and the IDDM Patient

Presentation Transcript

The Dawn Phenomenon and the IDDM Patient Karina Salvo

What is the Dawn Phenomenon ? Hungry? Sorry… Can't eat until that am dosage of insulin begins working! Why? Morning Hyperglycemia

The Rationale To decide the reason for the Dawn Phenomenon What should be possible to keep the Dawn Phenomenon.

A Few Considerations Daytime Variations in Glucose Levels Nighttime Variations in Glucose Levels Sleep Schedules Eating Habits Work Schedules Weight

The Daytime Rollercoaster AM:  Glu   Insulin PM:  Glu   Insulin

The Nighttime Upward Spiral

Counter Regulatory Hormones Cortisol Glucagon Epinephrine GH

Counter Regulatory Results SUPRESSION OF: Cortisol , Glucagon, Epinephrine  Dawn Phenomenon SUPRESSION OF: GH  Dawn Phenomenon

Why GH Suppression Works Theory:  GH manages Lipolysis  expanding [FFA]  FFA seek Glu  Gluconeogenesis Results: HYPERGLYCEMIA

The Sleeping Arrangements Animals versus Humans

Obesity  Insulin Resistance GH Suppressed

Another Factor To Consider 3am Glu Production > 7am Glu Utilization Meaning: Overproduction + Underutilization = HYPERGLYCEMIA "TIMING IS EVERYTHING"

Why the Dawn Phenomenon? Decreased Insulin Sensitivity Increased Insulin leeway in early AM Timing & Utilization Sleep initiated GH Excess GH Time of PM insulin

Insulin Availability 2 Types of Insulin: Fast/Short ( HYPERglycemic ) Slow/Long ( HYPOglycemic/BEDTIME )

Now What? What is Under Our Control? Dinnertime PM Insulin

Prevention of The Dawn Phenomenon PM Insulin at BEDTIME