Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comment
. 2013 Dec;36(12):3860-2.
doi: 10.2337/dc13-2088.

Thirty years of research on the dawn phenomenon: lessons to optimize blood glucose control in diabetes

Francesca Porcellati  1 , Paola Lucidi, Geremia B Bolli, Carmine G Fanelli
Affiliations
Comment

Thirty years of research on the dawn phenomenon: lessons to optimize blood glucose control in diabetes

Francesca Porcellati et al. Diabetes Care. 2013 Dec.
No abstract available

PubMed Disclaimer

Figures

Figure 1
Figure 1
Overnight plasma insulin and glucose concentrations in normal, nondiabetic subjects (data from ref. 4) and in three groups of intensively treated subjects with T1D that had basal insulin replaced as either NPH (n = 6, NPH three times/day, at breakfast, lunch and bedtime; dose at bedtime 0.22 ± 0.03 units/kg/day), CSII (n = 6, infusion of basal insulin as rapid-acting analog at single rate 0.7 ± 0.1 U/h), or LA-IA (n = 6, dinnertime injection of glargine 0.25 ± 0.02 units/kg/day). Despite the fact that the total daily dose of NPH was fractionated into three times a day, bedtime NPH resulted in early plasma insulin peak and later insulin waning. This increases the risk of hypoglycemia after midnight and results in hyperglycemia before breakfast (dawn phenomenon 55 mg/dL). CSII at single rate prevents early peak and later overnight waning of insulin (dawn phenomenon 17 mg/dL). With LA-IA glargine, there is no dawn phenomenon since BG decreases in the second part of night as a result of continuing subcutaneous insulin absorption at dawn (7–8 h postinjection), which tends to slightly increase plasma insulin bioavailability at this time of day (G.B.B., unpublished observations).
Figure 2
Figure 2
Overnight plasma glucose and insulin concentrations in a group of T2D subjects (n = 8, age 53 ± 4 years, diabetes duration 3 ± 1 years, A1C 6.89 ± 0.05% [52 ± 0.5 mmol/mol], all on metformin only) before and after 6-month treatment with evening dose of insulin glargine (0.20 ± 0.02 U/Kg/day) as add-on to metformin. Basal insulin near-normalized the fasting BG by two mechanisms: partly by reducing the midnight BG and partly by totally abolishing the BG increase of the dawn phenomenon of the baseline study (18 mg/dL), as result of overnight sustained increase in plasma insulin concentration by ∼4 μU/mL. At the end of observation, the removal of the dawn phenomenon resulted in a decrease of A1C of 6.5 ± 0.1% (48 ± 0.7 mmol/mol). This validates the estimated contribution of the dawn phenomenon to the increased A1C calculated by Monnier et al. (7) of 0.39% (4.3 mmol/mol) (G.B.B., unpublished data).
See this image and copyright information in PMC

Comment on

References

    1. Schmidt MI, Hadji-Georgopoulos A, Rendell M, Margolis S, Kowarski A. The dawn phenomenon, an early morning glucose rise: implications for diabetic intraday blood glucose variation. Diabetes Care 1981;4:579–585 - PubMed
    1. Bolli GB, Gerich JE. The “dawn phenomenon”—a common occurrence in both non-insulin-dependent and insulin-dependent diabetes mellitus. N Engl J Med 1984;310:746–750 - PubMed
    1. Schmidt MI, Lin QX, Gwynne JT, Jacobs S. Fasting early morning rise in peripheral insulin: evidence of the dawn phenomenon in nondiabetes. Diabetes Care 1984;7:32–35 - PubMed
    1. Bolli GB, De Feo P, De Cosmo S, et al. Demonstration of a dawn phenomenon in normal human volunteers. Diabetes 1984;33:1150–1153 - PubMed
    1. Kruszynska YT, Home PD. Night-time metabolic changes in normal subjects in the absence of the dawn phenomenon. Diabete Metab 1988;14:437–442 - PubMed