The dawn phenomenon is characterized by a rise in the blood glucose level between 4 A.M. and 8 A.M. It is thought to result from the release of GH into the bloodstream in the early morning. This release makes body tissues resistant to insulin, causing the blood glucose level to rise.
Signs and Symptoms
The dawn phenomenon produces the typical signs and symptoms of hyperglycemia. However, they usually are not severe because the rise in blood glucose level averages only 30 to 50 mg/dl.
Treatment
The physician first may advise your patient to reduce or eliminate her evening snack. If this doesn’t solve the problem, the physician may prescribe an intermediate-acting dose of insulin at bedtime. If your patient is already administering intermediate-acting insulin at bedtime, the physician may increase the dosage.
Diagnostic Tests
A morning, fasting blood glucose level reveals hyperglycemia. After you determine that your patient has early morning, fasting hyperglycemia, check her blood glucose level at 3 A.M. If she’s experiencing the dawn phenomenon, her blood glucose level will begin to rise around 4 A.M.
Patient Teaching
Tell your patient that the morning rise in her blood glucose level probably is caused by her body’s release of GH. Emphasize the importance of not eating before bedtime and of administering the bedtime dose of insulin exactly as prescribed.
Explain how occasional monitoring of 3 A.M. and fasting 7 A.M. blood glucose levels can help guide insulin therapy. Make it clear that when she goes home, she should monitor her pre breakfast blood glucose level and comply with her prescribed drugs, diet, and exercise regimens. Instruct her to inform the physician of any abnormal blood glucose level.