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December 21, 2001

Daily Care

Question from Bay City, Michigan, USA:

My friend's eight year old daughter old has type�1 diabetes, and she was wondering what the differences are between rebound and the dawn phenomenon. What test could be done to determine what her daughter has?

Answer:

The dawn phenomenon is a sudden rise in blood sugar level during the early morning hours (3:00-7:00 am generally). This condition occurs more often in people with insulin-treated diabetes and sometimes, but of a lesser degree, in patients with non-insulin treated diabetes. Unlike the Somogyi Effect (rebound), it is not a result of an insulin reaction, but it is believed to be due to a waning of the insulin action associated with a surge in the stress hormones (growth hormone and cortisol) over the last part of the night.

People who have high levels of blood glucose in the morning before eating may need to monitor their blood sugar during the night, and, if sugar levels are rising, adjustments in the evening snacks or insulin dosage may be recommended. Rebound hyperglycemia is a swing to a high level of sugar (glucose) in the blood from an extremely low level, usually occurring after an untreated insulin reaction during the night. The swing is caused by the release of stress hormones to counter low sugar levels. and also to an excessive intake of carbohydrates by the patient. If blood sugar levels are falling or low, adjustments in snacks or insulin dosages may be recommended. This condition is named also after Dr. Michael Somogyi, the man who first wrote about it.

MS