The Dawn Phenomenon – T2D 8

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The occurrence of high blood sugars after a period of fasting is often puzzling to those not familiar with the Dawn Phenomenon. Why are blood sugars elevated if you haven’t eaten overnight? This effect is also seen during fasting, even during prolonged fasting. There are two main effects – the Somogyi Effect and the Dawn Phenomenon.

Somogyi Effect

The Somogyi effect is also called reactive hyperglycaemia and happens in type 2 diabetic patients. The blood sugar sometimes drops in reaction to the night time dose of medication. This low blood sugar is dangerous, and in response, the body tries to raise it. Since the patient is asleep, he/she does not feel the hypoglycaemic symptoms of shakiness or tremors or confusion.  By the time the patient awakens, the sugar is elevated without a good explanation. The high blood sugar occurs in reaction to the preceding low. This can be diagnosed by checking the blood sugar at 2am or 3am. If it is very low, then this is diagnostic of the Somogy Effect.DawnPhenom2

Dawn Phenomenon

The Dawn Effect, sometimes also called the Dawn Phenomenon (DP) was first described about 30 years ago. It is estimated to occur in up to 75% of T2D patients although severity varies widely. It occurs both in those treated with insulin and those that are not. The circadian rhythm creates this DP.

Just before awakening (around 4am), the body secretes higher levels of Growth Hormone, cortisol, glucagon and adrenalin. Together, these are called the counter-regulatory hormones. That is, they counter the blood sugar lowering effects of insulin, meaning that they raise blood sugars. The nocturnal surge of growth hormone is considered the primary cause of the DP.

These normal circadian hormonal increases prepare our bodies for the day ahead. That is, glucagon tells the liver to start pushing out some glucose. Adrenalin gives our bodies some energy. Growth hormone is involved in repair and new synthesis of protein. Cortisol, the stress hormone increases as a general activator. After all, we are never quite so relaxed as deep sleep. So these hormones gently get us ready to wake up. A good ol’ fashioned hormonal kick in the ass, so to speak. Hormones are secreted in a pulsatile manner peaking in the early morning hours then falling to low levels during the day. DawnPhenom1

Since these hormones all tend to raise blood sugars, we might expect that our sugars would go through the roof in the early morning. This does not actually happen.

Why? Insulin secretion also increases in the early morning to counteract the counter regulatory hormones. In other words, insulin is there to make sure blood sugars do not go too high. However, if you look closely at the blood sugar readings, there is a slight increase in the morning time.

So, in the normal, non-diabetic situation, blood sugars are not stable throughout 24 hours. The Dawn Effect happens in normal people. This is easily missed because the magnitude of the rise is very small – from 89 to 92 mg/dl. However, this effect was found in every patient studied. So, unless you are specifically looking for the DP, you are likely to miss it.

Think about it this way. Your body has the ability to store food energy as sugar (glycogen) and fat. When you eat, you store food energy. As you sleep (fasting), your body needs to release this stored energy. Around 4am or so, knowing that you will soon be waking up, your body prepares you for the upcoming day. It does this by increasing counter-regulatory hormones to release sugar into the blood. You can see that glucose production falls overnight and starts to ramp up around 4 am. In order to prevent the sugars from rising too much, insulin increases to act as a ‘brake’ on the system.

Type 2 Diabetes

Balloon deflatedNow, what happens in the situation where you have T2D, or high insulin resistance? First, the technical explanation. Around 4 am, counter regulatory hormones surge and insulin is also released to counter this. However, in T2D, the body has high insulin resistance, meaning that the insulin has minimal effect at lowering the blood sugars. Since the counter regulatory hormones (mostly growth hormone) still are working, blood sugars rise unopposed, and therefore much higher than the normal non diabetic situation.Balloon inflated

In the non diabetic (normal) situation, the liver is like a balloon. You eat, insulin goes up and food energy is stored as glycogen in the liver. Since the balloon is deflated, the sugar goes in quite easily. As you fast, insulin falls and glycogen is turned back into energy to power the body.

Now, consider the situation of T2D. Over years of overconsumption, our liver is stuffed full of fat and sugar. As we eat, insulin goes up and tries to put more fat into a fatty liver. This is quite difficult. It’s like trying to inflate an overinflated balloon. The sugar and fat simply won’t go in anymore. That’s insulin resistance.OLYMPUS DIGITAL CAMERA

But what happens when insulin starts to fall? You have a huge fatty liver that wants desperately to deflate itself (see last post). As soon insulin falls, sugar comes rushing out of the liver and into the blood. This results in the clinical diagnosis of T2D, when doctors are able to see the high blood sugars. So, what do they do? They prescribe more insulin.

This big whacking dose of injected insulin keeps the sugar bottled up inside the liver. This means that the doctor is able to congratulate him/herself on a job well done. But nothing is actually accomplished. The underlying cause of insulin resistance is the fact that the liver is overstuffed with fat and sugar, like 10 pounds of sausage meat in a 5 pound skin. Nothing has been done to alleviate this situation. So, patients must inject themselves day after day. Over time, they require higher and higher doses. A year later, the liver is like 15 pounds of sausage meat stuffed into a 5 pound skin.JeffDaniels

In the Dawn Phenomenon, the body is under orders to release some of the stored sugar into the bloodstream. Like the overinflated balloon, the liver puts forth prodigious amounts of sugar in order to relieve itself of this toxic sugar burden. It’s like trying to hold a fart inside. As soon as we get to the bathroom, it’s ‘Fire in the Hole!’. When our liver gets the ‘go’ signal to release sugar, it does so in huge amounts, overwhelming the pitiful attempts of the insulin to keep it bottled up inside. That’s the Dawn Phenomenon.

The same thing is seen during fasting. Remember, there are hormonal changes during fasting that include increases in growth hormone, adrenalin, glucagon and cortisol. These are exactly the same counter-regulatory hormones as seen in the DP. These are normal changes. As you fast, your insulin drops. Your body then tries to increase the glucose in the blood by encouraging the liver to release some of its stored sugar and fat. This is natural. However when you have T2D, there is too much sugar released from the liver which shows up in the blood like an uninvited guest.'This is a 'placebo' line. It serves no purpose but it makes us feel good.'

Is this a bad thing? No, not at all. We are merely moving the sugar from the liver out into the blood. Lots of doctors consider it bad, because they are only concerned about the sugar that they see (in the blood). They do not concern themselves with the sugar that is hidden away.

After all, think about it this way. If you are not eating, where is the sugar coming? It must come from inside your own body. There is no other alternative. You are simply moving the sugar from storage, out into the blood where you can see it. It is neither good nor bad.

Insulin moves the sugar from the blood where they see it, and into the tissues (liver) where they cannot. It is no less bad, but they are able to pat themselves on the back for a job ‘well done’. it is not different from moving garbage from the kitchen underneath your bed. It smells the same, but you can’t see it.

I call drugs like these (insulin, sulfonlyureas) dracebos – placebos for doctors. They are medication that don’t actually help the patient in any way, but make the doctors feel better about themselves. You will still die of diabetic complications, but hey, at least the doctor has saved his/her own ego pretending that he/she did something about it. The history of medicine is the history of the placebo (and dracebo) effect.

In the IDM program, we typically use medications to keep blood sugars in a reasonable, but not low range during fasting. Insulin keeps all the sugar bottled up inside the body. If we stop insulin, there is a risk that it comes out much too quickly (like the overinflated ballon releasing all at once). So we want to use less insulin, but enough to release the stored sugars at a reasonable measured pace. A physician needs to adjust the medications to properly control the flow of sugar out of the liver.

The Dawn Phenomenon, or higher blood sugars during fasting does not mean you are doing anything wrong. It’s a normal occurrence. It just means that you have more work to do.

Some people have normal blood sugars except for the Dawn Phenomenon. This still indicates that there is too much sugar stuffed into their liver. They need to keep burning down that sugar. It means there is much more work to be done before they are cleared of their diabetes.

Think about it this way. The Dawn Phenomenon is simply moving sugar from body stores (liver) into the blood. That’s it. If your body stores are filled to bursting, then you will expel as much of that sugar as possible. By itself it is neither good nor bad. It is simply a marker that your body has too much sugar. Solution? Simple. Either don’t put any sugar in (LCHF) or burn it off (Fasting). Even better? LCHF + IF.

2017-09-02T11:54:11+00:00 111 Comments

About the Author:

Dr. Fung is a Toronto based kidney specialist, having graduated from the University of Toronto and finishing his medical specialty at the University of California, Los Angeles in 2001. He is the author of the bestsellers ‘The Obesity Code’ and ‘The Complete Guide to Fasting’. He has pioneered the use of therapeutic fasting for weight loss and type 2 diabetes reversal in his IDM clinic.

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111 Comments on "The Dawn Phenomenon – T2D 8"

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Logan
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“Solution? Simple. Either don’t put any sugar in (LCHF) or burn it off (Fasting). Even better? LCHF + IF.” In cases where “the balloon is somewhat deflated” to borrow your analogy (i.e. where our glycogen reserves are relatively lower) – and even if we stay on a relatively LCHF diet – is protein consumption due to gluconeogenesis a concern? I.e. if low on reserves and our sugar intake is low due to LCHF, if I ate excess protein, would I be in danger of blowing the balloon up if there was enough protein consumed? LCHF + IF would seem to… Read more »
Arveno
Guest

Is it possible that after washing out glycogen reserves from “fat liver” there is start of gluconeogenesis from visceral (dangerous?) fat?

Jane
Guest

I would also like to know the answer to this question!

Would strength training be needed to retain muscles and Bones,etc?

hilda
Guest

Thank you, Jason!
This is the first time that I feel I have really understood DP.
Does this mean that as my morning fasting blood sugars decrease and normalize, that my fatty liver is healing itself ?
Thank you for your posts.
Hilda

Evinx
Guest

In a long term low carb ((<50 gms/day) person, how can one be certain the DP (say 105-115 fasting BG levels) is not from Beta cells starting to fail + unable to secrete sufficient insulin? Many forums have low carb/ketogenic individuals with "pre-diabetic" levels of morning BG. Why would this be considering many have been low carb for 2-3 years or more?

stenB
Guest
The reply to the 2nd question would be “the liver stores did not empty”, extracted from what Dr Jason above wrote. And it is also visible in waist measure I understand. The remaining DP is also probably reason for halted weight loss. Re the first question, hardly an issue on LCHF with substantially lower insulin demand than before, unless type 1 is developed for whatever reason. If you must know, do a small glucose challenge, like eating a (large?) bowl of breakfast cereal with a slice of bread. Measure BG every 30 minutes and if it goes down below the… Read more »
Jane
Guest

Dr. Fung:

So, re Evinx second Q, and stem B’s answer, which i seems to be a good deductive concussion from your explanation:
is IF the only answer to decreasing DP, with waistline till too big, even after extended LCHF ? No doubt exercise would help too?

FWIW, I have gotten my HbA1c down to 5.6 after incorporating IF into my habits, along with long term LCHF, but still have DP and fat around my belly.

Jane
Guest

Autocorrection strikes again: should be “conclusion” not “”concussion”

Is there no better way to edit our comments?

K
Guest

HI STEN B,
LATELY MY B.S. NUMBERS ARE LOWER THE FIRST HOUR AFTER FOOD AND HIGHER THE SECOND HOUR AFTER FOOD ….. IE. ONE HOUR = 6.9 AND TWO HOURS = 7.4 ….. DOES THAT MEAN MY BETA CELLS AREN’T WORKING ????????

Maninder Chopra
Guest

If someone does have type 1 symptoms too, after being with type 2 for long time, how would the insulin/metformin strategy be used during intermittent or longer duration fasting? Would it make sense to bring the glucose level down a little bit, if it getting too high? And what would that reasonable cut off should be? I would really appreciate if someone brings clarity to this question.

Dev
Guest

Dr.Fung-

Thanks so much once again for making Dawn Phenomenon so crystal clear.In my case as I understand…more work to do.I have started seeing results while I am on 24X6 fasting +LCHF & EXERCISE. Thanks.

Dev

Sandra
Guest

Hi Dev
How long did it take you to get rid of dawn phenomenon?

Rene Tewksbury
Guest

After stopping my massive doses of insulin and Metformin in July and 5 months of following your program, my BS stays in the 60s during my fasts with no DP spike. Thank you for giving me my life back.

linda T
Guest
Rene, how long do you fast? and how often? I quit all my diabetic meds 5 months ago but my numbers were in the 300 range for fasting blood sugars with LCHF. I needed to get my A1C better to renew my driver’s license so went on glipizide which brought my blood sugars down for a month and then they started climbing back up. After reading Dr. Fung’s plan I went off the glipizide because I felt poorly on it and had gone from 128 to 140 lbs in that 2 month period. I feel so much better . With… Read more »
Linda
Guest

Did you take yourself off the Metformin?

Wenchypoo
Guest
We are merely moving the sugar from the liver out into the blood. Lots of doctors consider it bad, because they are only concerned about the sugar that they see (in the blood). They do not concern themselves with the sugar that is hidden away. After all, think about it this way. If you are not eating, where is the sugar coming? It must come from inside your own body. There is no other alternative. You are simply moving the sugar from storage, out into the blood where you can see it. It is neither good nor bad. This explains… Read more »
David
Guest
Although I still have “more work to do”, I have gotten my best results so far on a ketogenic diet with IF and HITT (High Intensity Interval Training). Before i went on this program, my blood sugars were averaging 15.4. The first time I tried a 24 hour fast my BG kept climbing until I started eating. At that time, it had reached 15.7. What no one seems to mention is that when the liver is synthesizing prodigious amounts of glucose due to hormonal imbalance caused by insulin resistance, liver/muscle glycogen storage is always full to capacity. HIIT depletes muscle… Read more »
kolin
Guest

David

Wondering about your schedule for High Intensity Interval Training (HIIT) while fasting. Would like to know in details as I have hard time in lowering fasting blood sugar while I am on LCHF & Fasting & exercise (Not HIIT). Your suggestions will be of much help.

Kolin

Jw
Guest
For me the Atkins fat fast is what I can stick to, feel best on and get best results from. Blood sugars, hunger regulation and mood are par excellence, but there are dire warnings it is only to be done rarely as its unhealthy and shouldn’t be undertaken for longer than several days. I usually gravitate instinctively towards a higher protein intake after a FF. I would love to know Dr Fung’s thought on this – what if I drifted in and out of a FF what the health consequences would be, would the body catabolize lean muscle in order… Read more »
BobM
Guest

Dire warnings from whom? When I”m not fasting, I eat as much fat — particularly animal fat, as I make an effort to avoid oils from vegetables and nuts — as I can. I add butter (from grass fed cows) to meat, for instance.

JW
Guest

I’m talking about the Atkins Fat Fast which is a short term hack to get into ketosis quickly.

Bryn
Guest
Have only recently,like this week,discovered your website. I’m T2D past 10 years on metformin 1gm went up to 2gm 6weeks ago as my BGL’s were going up. Hba1c since then was 5.2, so actually pretty good. I’m so grateful for your generous giving of information Dr Fung! I have to have my daily read to keep me focused and motivated, and there is so much here to read. Have already started IF on a small scale, hope to do better after Christmas! I found fasting at work difficult as I was light headed and finding concentration difficult. Had to keep… Read more »
Pete
Guest
Bryn, how are you doing now, 1 year and 10 months later? I wonder if your early fasting side effects of light headedness and reduced concentration were a result of overmedication? I’m not a doctor, nor am I recommending self adjustment of doses, but those on medication need to coordinate the doses of medications with a doctor while fasting. The original doses were designed for a person that is eating daily to counteract the effects of incoming food and therefore will generally be too high for a person who is fasting. Do you have any thoughts on this or what… Read more »
Martin
Guest

Hi Dr Fung, I believe that I have read comments you have made in the past saying that the body can only store very little glycogen (the body’s way of storing glucose), so when we fast, how is it that the body maintains any glucose in the blood at all. If we are putting no sugars in and we have exhausted our bodies supply, shouldn’t our blood sugar drop to zero after a while? (a situation that would of course be terminal)
Regards
Martin

Dr. Jason Fung: The liver manufactures new glucose in the process called gluconeogenesis.

Jim Garrison
Guest
On October 4th of this year I stopped 7 years of taking 100 units of Insulin every day since 2008. I read everything in your blog prior to that day, I think it took me 3 weeks to read everything. I started the LCHF diet about 45 days prior to Oct 4th. I started to fast and fasted for 30 days. Nothing but water with lemon and I thought it would be harder than it was. I had increased energy, I cook for my family almost every night and that wasn’t hard either. My very first fast at 58 years… Read more »
Greg
Guest

Amazing Jim!!

Karin
Guest
Thank you Dr. Fung for finally discussing Dawn Phenomena … I have not found much information on it, specifically for people that are not yet taking diabetic meds. I’ve been doing LC on and off for decades, but in the recent 2 years became very lax. I found your website (and Dr. Eenfeldt’s) earlier this year in a search to find a way to avoid becoming diabetic as it runs in both sides of my family. Your research and explanations here convinced me to try IF and ketogenic, and since September I’ve lost 20 lbs. I’ve not gone full fasting,… Read more »
Karin
Guest
January Update – On day 3 of a 6 day fast. My glucose reading this morning was 144, which is on the high side for me as it was usually 115-140 when I doing keto before the holidays. This evening I checked again and it was 88. That is the lowest number I’ve had since I began testing in September! Based on this post, I know my poor liver is just dumping all that accumulated fatty crap… and more importantly I know I’m on the right track!! Thank you, thank you, THANK YOU Dr. Fung for the wealth of information… Read more »
Karin
Guest
May Update – I’ve been tracking my glucose levels and the overall downward slope continues. While I still get morning readings in the 120-140 range, my afternoon readings have now regularly dipped into the 80s and even a 74 the other day… which I never saw previously! My official doctor’s ordered bloodwork two weeks ago showed a fasting reading of 151 (which is suspiciously high) but A1c of 5.6. Overall cholesterol was 224, but my HDL was 74… which contributed to the higher number. Overall excellent bloodwork and no talk of metformin despite the high fasting number. I definitely feel… Read more »
Mary Anne Sautner
Guest

Hi Karin, just read your post and was very interested in where you said your morning (fasting) blood sugar was 151 but your blood test a1c was 5.6! That is great! I didn’t realize your a1c can be that low while fasting BG is high. I still have hope!! Going for by blood work in 2 weeks.

Dee Dee
Guest

Thank you for a fabulous explanation of what is happening in my body in the morning. I guess I will add Intermittent fasting to my LCHF and put up with “hangry” (Hungry and angry), to expel the excess sugars still stored in my liver.

Dean
Guest
Awesome article. You have answered quite a few questions I had about “why am I getting these morning spikes?” Or “why is my BS reading high when I’m only eating 20 carbs “or less” each day. It makes sense what you said. Thanks! A Lot!! For the record, I am a T2 diabetic and started about 2-3 weeks ago on a LCHF program/way of eating. So far, so good! I’m hoping that I deflate my “over stuffed” liver sometime soon. I know I can’t force this, but I can keep with the program and the body will hopefully take care… Read more »
Linda Tanner
Guest
I have been off insulin for 8 months now & glipizide for 3 weeks (on glipizide only for 3 months AFTER off all MY INSULIN METFORMEN, ETC. With weighing 130 and having eaten for 2 days pretty low carbs, grass fed beef I want to water fast again but now afraid of the dumping sugars from my still fatty liver. B/s 250 but when fasting it went to 108 & 141. I was diagnosed diabetic 12 years ago. 1 am 74 yrs old and weighed 115 when I married. I had gestational diabetes with first child but not my last… Read more »
Ruthy
Guest

Could cholesterol lowering drugs be the ultimate “dracebo”?
We blame Lipitor for my husband’s T2D.
“Dracebo”: another very clever word coined by Dr. Jason, soon to be on many lips.
Remember, you heard it here first.
“Dracebo” describes in one word one of the biggest scandals in modern medicine. We are being drugged to death by most doctors.

Ruthy

Dev
Guest

Ruthy-

Please read following article :If Statins Cause Diabetes, Why Should ALL Diabetics Take a Statin?
http://www.peoplespharmacy.com/2014/06/09/if-statins-cause-diabetes-why-should-all-diabetics-take-a-statin/

In my case I did developed after taking Statins as it was prescribed by my Cardiologist after I had angioplasty. At one point I decided not to take statins & I stopped taking statins for three months.The results were shocking as my cholesterol levels went up. I was advised to re-start.Since then I am on Fasting +LCHF +Exercise which has benefited so much in bringing down all the levels to normal.

Hope this will help you in understanding “Dracebos………

Ruthy
Guest

Dev
Did you re-start the statin or did fasting etc. bring all your levels to normal without any drugs?
Ruthy

Jane
Guest

Dev,

I do not understand your story. I have the same Q as Ruthy.
Did your LDL go down Without the statins while practicing LCHF + fasting + exercise ?
How much % down? As much as with statins? What type of exercise?

Wenchypoo
Guest
No, it didn’t show up here first–this term is also in the book The Science and Fine Arts of Fasting by Herbert M. Shelton (1934). I’m reading a reprint of this book now (from Amazon), and have run into this term several times, as Mr. Shelton himself opposed what was the conventional medicine back then. Reading about the history of fasting is fascinating to me, and a lot of what is now history is standing true in fasting today. Thank god we have Dr. Fung to reiterate info from the past AND the present (from current research) for easy access… Read more »
Heather Seeker
Guest
It seems that we are being drugged to death Ruthy. Don’t know if your husband has had a heart attack or a stroke? If not, you might be interested in the “Number Needed to Treat” is a tool developed by doctors with no commercial links, to compare the benefits of drugs to their risks http://www.thennt.com/ For statins, for someone without a history of heart attack or strokes, the NNT shows None were helped (life saved) 1 in 104 were helped (preventing heart attack) 1 in 154 were helped (preventing stroke) but 1 in 100 were harmed (develop diabetes*) 1 in… Read more »
Dev
Guest

Ruthy

I had to re-start the Statins (Crestor 20mg) & in order to bring down the Lipids & Sugar & triglyceride levels I adopted three fold strategy i.e. LCHF +Fasting ( 5 : 2) +Exercise & now I have to maintain these levels.I still find that my fasting blood sugar readings in the morning are around 7.5 which should be within normal range. Crestor does causes joint pain but if you take COQ 10 at bed time you should have none.

Dev

Ruthy
Guest

Thanks for the info Dev.
Ruthy

K
Guest

HI….NORMAL RANGE FOR FASTING B.S. IS UNDER 5.5 .
ONE HOUR AFTER FOOD —- UNDER 7.8
TWO HOURS AFTER FOOD —– UNDER 6.6

Jane
Guest
Thank you for the link to the page discussing the statin Diabetes link and the difficulties exercising while on statins. Luckily, I have had no cardiac problems requiring any intervention. But my internist believes, strongly!!!, that I still need Lipitor for prevention, since my ApoB , LDL-c etc are well above the highest acceptable cutoff. I also did a trial of droppin off the statin, and retesting after a few weeks with newer tests of ApoB and LDL particles as well as the tradional total Cholesteol etc and calculated LDL-C. My LDL-C levels reverted to almost the exact levels they… Read more »
BobM
Guest

Have you read The Great Cholesterol Con by Malcolm Kendrick? It offers another view of all of these tests. I personally think they don’t mean anything.

Wenchypoo
Guest
Hubby completed a 2-week fast, had testing done, and his small LDL-P, and LP-IR scores dropped by half or more from his last testing 6 mos. ago–imagine what a 30-day fast would do for him! He only lost 3 lbs. during the fast, but the INCHES…he had to have more holes added to the inside of his belts, and the belts themselves shortened. I don’t think he’s up for a 30-day fast. It took all his will to complete 2 weeks. I think we may (once again) follow Jimmy Moore’s idea of fasting for a week, going off it for… Read more »
Samir
Guest

Dr. Fung,
Another lovely post!
A question – if fasting is releasing cortisol which is also a big factor in creating/contributing to obesity. Isn’t more fasting equals more cortisol and that means resistance to our anti obesity efforts?
Thanks.

Allan
Guest

for me the dawn phenonmena was a circadian mismatch….I used to skip breakfast and eat lunch dinner but on lowcarb blood sugars in am were 7 to 8…….skipping dinner and eating a big breakfast low carb and a second meal before 4…..my waking blood sugars are 5 to 6…..also I found eating 30 minutes of sunrise and then a walk to get my eye clock tuned to morning uv entrained my master clock with my food clock

Dev
Guest
Samir : While we await response from Dr.Fung Please read following details on Cortisol : Cortisol is both fat storing and fat releasing. It is fat storing because like insulin it increases the activity of the major fat storing enzyme lipoprotein lipase (LPL). It is fat burning because it increases the activity of the major fat burning enzyme hormone sensitive lipase (HSL). I always like to point out that the major fat burning enzyme in our body is called HORMONE sensitive lipase and not CALORIE sensitive lipase. This sort of gives a hint that both calories and hormones are important… Read more »
Stancy Parsons
Guest

Hi Dr Fung

I have a moderately fatty liver, and I am concerned that fasting or rapid weight loss would put extra stress on it. Should I be concerned?

My fasting blood sugar is 6, I’m about 45 pounds overweight, 50 years of age and mildly elevated liver enzyme’s and moderate fatty liver.

Thank you for any feedback you may have.

Stancy

Martin
Guest

Stancy

I’m not a doctor!

If your liver is moderately fat is because it has been working hard converting something (sugars, alcohol…?) into fat (and could not get rid of it fast enough). Now if you fast and/or do a very low carbohydrate diet, the liver will work, not so hard, converting proteins and other precursors into sugar(glucose) using liver and other fats as its primary fuel (for this and all of its other tasks).
At least it is as I understand it

Martin.

BobM
Guest

Stancy, when you fast, you preferentially burn fat from your liver and pancreas. That’s a large reason why fasting causes a reduction in insulin resistance. If anything, you should see an almost immediate improvement in your liver enzymes.

saskoder
Guest

My assumption is that Dawn Phenomenon can be different for different people. It may depend on when you sleep.

Based on my blood Glucose changes, I saw this happening after — Time to bed + 7 hours and it stayed for 3 hours.

Further, my BG was lesser with sleep hours >=6.

kolin
Guest
Saskoder I agree with your assumptions. In my case I have seen my morning -Fasting Blood Sugar readings varies with the duration of sleep & quality of sleep & also with the time to bed as to match the release of Cortisol & growth hormone level .The blood sugar stays high around three hours & after that it starts declining. Now these high numbers of FSB ruins my total A1C score & in order to bring this numbers down in the morning before 3 hours…I skip breakfast & take only tea with little cream & exercise for half an hour… Read more »
James Quan
Guest

Hi Dr Fung. So does the a1c get affected? With the higher blood sugar because of somogi or dp does it push the a1c up?

Greg
Guest
Dr Fung, have you seen this study? What are your thoughts? http://www.sciencedaily.com/releases/2015/08/150806151354.htm?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+sciencedaily/top_news/top_health+(ScienceDaily%3A+Top+Health+News) While diabetes can bring with it a host of problems, one of the most dangerous is the infection that can occur in the hands and feet of people with uncontrolled diabetes. High blood sugar can start a process that ends in the destruction of the body’s infection-controllers. Researchers at Case Western Reserve University have been investigating this problem in hopes of finding more effective ways to treat these infections. The researchers found that as blood sugar rises, it begins to release harmful molecules called dicarbonyls, which result from… Read more »
ZenEngineer
Guest

Dr. Fung,
Would it help clarify the diabetes diagnosis and care debate if T2D was renamed to something other than Diabetes? T1 patients need insulin shots to live. Hyperinsulin patients should not be given more insulin, but they are treated as if they are T1 patients.

kolin
Guest

Zen Engineer-

You may wish to study the latest news on Long Acting Insulin therapy for TYPE 2 as well. Here is the link :

FDA Approves Basaglar® (insulin glargine injection), a Long-Acting Insulin Treatment

http://www.prnewswire.com/news-releases/fda-approves-basaglar-insulin-glargine-injection-a-long-acting-insulin-treatment-300194249.html

BASAGLAR is indicated to control high blood sugar in adults and children with type 1 diabetes and adults with type 2 diabetes.

ZenEngineer
Guest

OK. So instead of controlling hyperinsulimia, insulin resistance, and resulting high blood glucose through diet and fasting, you want us to take more medicine? Do you work for Eli Lilly?

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DWO
Guest

Dr. Fung – your way of writing, your perspective, is very easy to understand. Thanks for doing what you do and giving this information to us who are still “standing in the road at night like a Deer in the headlights!” and trying to figure things out. This post really helped me understand the DP.
Best regards to you and [please] keep writing! Thanks again!

Allan
Guest

for me I got rid of dawn phen by eating a big breakfast at the same time getting my morning light setting my peripheral and main circadian clocks…..

Lynn
Guest
I had been trying to figure out the puzzle as well. Blood sugar high, but if you eat you will have too much insulin in the blood. If you are insulin resistant, then blood sugar will rise more, because you are resistant. Especially if you eat the wrong thing. It was such a puzzle to me. I would always think back to what I had eaten when my numbers were good. It was either I hadn’t eaten at all, or it was related to full fat. The problem I find with the vicious cycle is that I was diagnosed with… Read more »
Stu
Guest
This article and subsequent forum comments are very interesting and informative. MY wife (64) had T2D diagnosed 12 years ago and was taking both Metformin and Insulin until two years ago. We then moved to a strong Carb reduced diet and within ten days she needed no medicine at all. We both lost above 10 kilos in weight since then and both feel fitter and active. However Since a couple of weeks, my wife appears to be suffering from Dawn Phenomenenon, with much higher blood sugar levels in the mornings. This seems strange after 2 years of controlled carb-intake or… Read more »
Patrick Foo
Guest

Dr. Fung, I am on LCHF Diet, and please advise shalI I stop taking metformin to alow
My overstuffed liver to deflate ?

RobinG
Guest

Thank you for this excellent explanation of the DP, Dr Fung. I am borderline T2D (no meds) and have always been frustrated by my high (for me) am level of 100+/-. Now I understand. Am trying a 5-7 day (hopefully) fast not.

Thank you for all you do for us! You have a great way of explaining things.

Michael
Guest
I must have dawn phenomenon at times. My fasting glucose at 5:00 AM can get into the 90’s or even over 100 at times. But if I test at 7:00 – 8:00 AM while still fasted it is low 80’s or in the 70’s. I do have a body clock set to get up to workout early in the morning (6:00 AM workout). Can my cortisol and adrenaline levels which are geared to get me going to face an early workout be the reason my levels can get this high? Sometimes my 5:00 AM glucose level can be in the… Read more »
Izzy
Guest
“However when you have T2D, there is too much sugar released from the liver which shows up in the blood like an uninvited guest.’This is a ‘placebo’ line. It serves no purpose but it makes us feel good.’ Is this a bad thing? No, not at all. We are merely moving the sugar from the liver out into the blood. Lots of doctors consider it bad, because they are only concerned about the sugar that they see (in the blood). They do not concern themselves with the sugar that is hidden away.” Please can anybody tell me how the shifting… Read more »
Heather
Guest

Are there any specific lab results which would indicate that the liver is in fact full of sugar? enzymes or anything else to help verify the DP?

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[…] Dr. Jason Fung: This is similar to the Dawn Phenomenon, Read my post here – https://intensivedietarymanagement.com/dawn-phenomenon-t2d-8/ […]

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[…] my body had higher levels of sugar than when I do eat – how is that possible? (textbook case of Dawn Phenomenon). By December 12th it seemed useless – I reserved myself to the fact I needed medication to […]

Richard Burris
Guest
I have been doing fasting from 8pm to noon the next day for at least 6 or more months. My fasting morning BG is around 200-250 everyday. I do try to use LC diet but LCHF is hard for me and I do eat some carbs, but the noon to 8 pm window has helped my neuropathy in my right foot a lot. I was diagnosed t2d at age 39 and I’m 55 now. I use 500 mg Glucophage at night and one in the morning, I tried 1000 mg twice a day but saw no improvement in BG. I… Read more »
P1
Guest
If I am understanding this post correctly, a prediabetic or type 2 diabetic whose high fasting glucose never comes down before the end off a fast is simply not exhausting their glycogen store in the liver. If this premise is true, then wouldn’t it make sense to test this by extending the fast, to see at what point in time glycogen exhausts? Within an hour of glycogen exhaustion, you would expect to see glucose go down from an elevated range to something more like normal, and ketones should rise at the same time? Is that something Dr Fung could clarify… Read more »
P1
Guest
I went 20 hours into a fast and at about 18 hours my high fasting glucose dropped from around 110 to 85. So I am guessing that this is the place I hit glycogen exhaustion. Unfortunately, as soon as I got to this point I became incredibly weak. My ketones were starting to rise but that did not feel the same as carbs. The weakness continued well into the next day and I’m still trying to recover my baseline in energy. I still very much want to see a study with time graphs that show the metabolites I list in… Read more »
Richard B
Guest
P1, You make some interesting points. I don’t understand why my BG never seems to go lower. I was wondering too if Metformin or Glucophage is correct to take if dumping the liver is the desired effect. Maybe I’ll do longer fasts on my days off, when I’m less active. I am not thin, I weigh about 220 lbs and 190 – 200 would be more ideal for my height. My great uncle died at age 59, diabetic and almost blind, and my grandfather and mother had diabetes too, my mom with clogged arteries and finally stints put in, although… Read more »
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[…] Between Nov 19 and Dec 12, I followed a diet using the Canadian Food Guide. As I continued testing, I found my day time glucose readings were marginally improving, but my night and morning readings were seriously in the “RED” zone. I couldn’t understand – I’m not eating and my body had higher levels of sugar than when I do eat – how is that possible? (Textbook case of Dawn Phenomenon.) […]

Jemi
Guest
I have the Dawn Phenomenon (172 the morning after a 24 hr fast) and I wonder if it is better to continue the fast at that point, or to eat some small amount of protein which, according to some theories, will “give the liver something else to do” and interrupt the hours of DP. If I don’t interrupt the DP, my BG will remain elevated for several more hours. I’d like to fast as much as possible to try to heal my IR (diagnosed with T2 more than 15 yrs ago, no meds, but not controlling it well). Even if… Read more »
Huy
Guest

I do weight lifting in the morning after wake of up. It drastically drop my bs

John
Guest

Ok great, but how about continuing on and complete the article with how to get this eccess sugar out out of the liver and keep it down to eliminate the dawn phenomenon in people who are not level 2 , folks who have normal daily sugar levels other than the phenomenon.
If any one knows where I can read about this it would be appreciated.
Thank you.

N C Pathak
Guest

I am interested to learn more

N C Pathak
Guest

I have been diabetic type2 for last 15 years and under near control with LCHF diet.
Would like to learn more so that I can be free of diabetes and drug free.

Belle
Guest

Nc Pathak
Go to the dietdoctor website

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