This section is for everyone.
Often you may notice that the blood sugar in the morning is higher than when you went to bed at night even when you have not had any bedtime snack. This can be due to a variety of causes including gluconeogenesis, the dawn phenomenon and delayed stomach emptying which is also known as gastroparesis. There are many other variables that affect blood sugar besides just the macro nutrients of the food you eat.
Gluconeogenesis (Latin for “The making of new sugar”) is the process where the liver converts protein to glucose. This goes on all the time to some extent but is suppressed in the presence of adequate amounts of insulin and drinking alcohol. In type one patients who are no longer able to make enough of their own insulin this process accelerates and is what causes their sugars to rise so high and for them to lose so much weight.
The Dawn phenomenon is called this because the liver clears away insulin more efficiently first thing in the morning compared to other times of the day. At the same time growth hormones and sex hormones are manufactured during the night and these make cells less sensitive to the action of insulin which normally moves sugar from the blood into the cells. These two mechanisms result in higher blood sugars in the morning for most people after puberty gets underway. Various dietary and insulin techniques can be used to minimise the effects of this phenomenon. Another great read on this topic can be found here: The Dawn Phenomenon – Why Are Blood Sugars High in the Morning?
Delayed Stomach Emptying / Gastroparesis
Delayed Stomach Emptying is due to the effects of long term nerve damage on the way the stomach works. The rate of stomach emptying is reduced and the bottom end of the stomach called the pylorus can go into spasm. It can be difficult to know how your stomach will respond from one meal to the next.
For type two diabetics who are not on insulin or drugs which stimulate insulin secretion this may simply give you very unpleasant indigestion.
For insulin users and those on drugs that stimulate insulin secretion, these are usually timed to act over the time the food of the meal is getting digested. When food digestion becomes imbalanced, blood sugars can be too low immediately after a meal only to go too high some hours later.
Special dietary measures are needed to overcome the effects of this condition and they are carefully explained in Dr Bernstein’s book Diabetes Solution.
Like many complications of diabetes it tends to become apparent after 5-20 years of diabetes depending on the level of blood sugar control. Although the condition can certainly make diabetes control much more difficult it is possible to reverse delayed gastric emptying and some other complications by careful maintenance of normal blood sugars for several years.
Blood sugars can rise over the long term from effects you can’t control like inheritance. Excess weight has both genetic and environmental components from the womb onwards. Excess weight gain raises your blood sugars because it makes you more insulin resistant.
Undiagnosed and untreated infections particularly gum and dental infections can raise your blood sugar. Careful examination by a dentist is often needed. Treatment can take months.
Dehydration and acute infections such as gastroenteritis, viral infections, acute injuries, surgical operations or stress can raise blood sugars.
An important consideration is that once the blood sugar is high you become more insulin resistant because of this and vicious circles of high blood sugars, not being able to control them and dehydration can occur. This topic is further explored in the section on sick days in the Type One Section.
Chinese Restaurant Effect
The Chinese Restaurant effect named so by Dr Bernstein is the high blood sugars that rise disproportionately to the carb count of the meal due to the actual bulk of the meal. Moderate distention of the stomach produces the stimulation of the hormone glucagon which acts in opposition to insulin. This makes the liver produce more sugar from protein. The main thing to remember is not to stuff yourself at meals.
Exercise affects blood sugars considerably. Different sorts of exercise can raise or lower your blood sugar. This also varies according to how much insulin you have working at the time. The factors are very complex and there will be more discussion and sources of information on this in the Type One Diabetes Section which follows soon.
Exercise can improve many aspects of your life. Even if you have never been to a gym in your life and like me ran away from the ball at enforced school P.E. sessions there are so many activities you can enjoy. You can be active indoors, outdoors, in teams, alone, with help from instructors or by self discovery. Your mood, physique, strength, stamina and flexibility can all benefit in some way.
Tainting a bottle of insulin or exposing it to extreme temperatures can both cause it to lose some of its effectiveness and hence will increase one’s blood sugar even though the same dosage is administered.
1. The dawn phenomenon affects teenagers and…
a Makes their blood sugars particularly high when they wake up in the mornings.
b Makes them sleepy and unable to get up in the mornings.
c Makes their breakfast digest more slowly than usual.
d Makes their blood sugar high by releasing glucagon.
Have you got it?
1. A is correct. The DP as it is often referred to also affects many adults.
This section is based on the work of Dr. Bernstein’s Diabetes Solution.
Where to Next?
Please all proceed to the How To: Keep Healthy with Diabetes section?