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The Dawn Phenomenon and the IDDM Patient

The Dawn Phenomenon and the IDDM Patient

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The Dawn Phenomenon and the IDDM Patient

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  1. The Dawn Phenomenon and the IDDM Patient Karina Salvo

  2. What is the Dawn Phenomenon? Hungry? Sorry…Can’t eat until that am dose of insulin starts working! Why? Morning Hyperglycemia

  3. The Rationale To determine the cause of the Dawn Phenomenon What can be done to prevent the Dawn Phenomenon.

  4. A Few Considerations • Daytime Variations in Glucose Levels • Nighttime Variations in Glucose Levels • Sleep Schedules • Eating Habits • Work Schedules • Weight

  5. The Daytime Rollercoaster AM:  Glu   Insulin PM:  Glu   Insulin

  6. The Nighttime Upward Spiral

  7. Counter Regulatory Hormones • Cortisol • Glucagon • Epinephrine • GH

  8. Counter Regulatory Results SUPRESSION OF: Cortisol , Glucagon, Epinephrine  Dawn Phenomenon SUPRESSION OF: GH  Dawn Phenomenon

  9. Why GH Suppression Works Theory:  GH regulates Lipolysis  increasing [FFA]  FFA compete for Glu  Gluconeogenesis Results: HYPERGLYCEMIA

  10. The Sleeping Arrangements Animals vs Humans

  11. Obesity  Insulin Resistance GH Suppressed

  12. Another Factor To Consider 3am Glu Production>7am Glu Utilization Meaning: Overproduction + Underutilization = HYPERGLYCEMIA “TIMING IS EVERYTHING”

  13. Why the Dawn Phenomenon? Reduced Insulin Sensitivity Increased Insulin clearance in early AM Timing & Utilization Sleep induced GH Excess GH Time of PM insulin

  14. Insulin Availability 2 Types of Insulin: Fast/Short (HYPERglycemic) Slow/Long (HYPOglycemic/ BEDTIME)

  15. Now What? What is Under Our Control? Dinnertime PM Insulin

  16. Prevention of The Dawn Phenomenon PM Insulin at BEDTIME