The Dawn Phenomenon and the IDDM Patient

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Slide 1

The Dawn Phenomenon and the IDDM Patient Karina Salvo

Slide 2

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

Slide 3

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

Slide 4

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

Slide 5

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

Slide 6

The Nighttime Upward Spiral

Slide 7

Counter Regulatory Hormones Cortisol Glucagon Epinephrine GH

Slide 8

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

Slide 9

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

Slide 10

The Sleeping Arrangements Animals versus Humans

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Obesity  Insulin Resistance GH Suppressed

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

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

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

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

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Prevention of The Dawn Phenomenon PM Insulin at BEDTIME