#378 Defining Diabetes: Dawn Phenomenon
Scott and Jenny Smith define diabetes terms
Defining Diabetes: Dawn Phenomenon
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Scott Benner 0:00
This episode of defining diabetes is sponsored by Dexcom Omni pod, the Contour Next One blood glucose meter touched by type one, and the T one D exchange.
I almost made this one larger episode with three topics in it. And then I decided if I didn't break them apart, future listeners wouldn't be able to find them. So this is a defining diabetes episode about the dawn phenomenon. But there are two others that go with it. The other one's called defining diabetes, feet on the floor. And the third one defining diabetes smokey effect. I know I'm not saying that right. So muchi, some moochie, you'll find it. Anyway, the three of them are oddly similar, but completely different. And every one of these ideas needs to be understood. I'm not going to be explaining them by myself. I'm going to have Jenny Smith with me. I'll tell you a little bit more about Jenny in a second. But first, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. Please always consult a physician before making any changes to your health care plan, or becoming bold with insulin.
If the mood should strike you, and you'd like to find out more about the dexcom g six continuous glucose monitor, please go to dexcom.com Ford slash juice box. If you're looking for a free no obligation demo of the Omni pod tubeless insulin pump my Omni pod.com forward slash juice box. Want to add your voice to some terrific Type One Diabetes Research without ever leaving your home can do it right there from your phone in just a couple of minutes. T one d exchange.org. forward slash juice box. To check out the blood glucose meter that Arden uses the Contour Next One, you go to Contour Next one.com forward slash juice box. And of course touched by type one.org. To see Type One Diabetes advocacy done correctly. My friend Jenny Smith has that type one diabetes for over 30 years, Jennifer holds a bachelor's degree in human nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian, a certified diabetes educator and a certified trainer on most makes and models of insulin pumps and continuous glucose monitoring systems. She is also a frequent contributor to the Juicebox Podcast. And I find Jenny's input about type one diabetes and the management of insulin and things around type one to be completely invaluable. She is my favorite person. This is the one that everyone gets told about right? At some point overnight, I don't know around 3am or maybe all the way up to eight o'clock, your body's just gonna make your blood sugar higher. Maybe
Jennifer Smith, CDE 3:17
I would see in a good. I mean, if I had to give a percent to it, I would say a good 95% of people. Once they know to watch or something and or you know, let's say they've been listening to a lot of like the pro tips episodes. And they're like trying to do bezel evaluation and whatnot. And they're like, Huh, look at that. This is what's actually going on. And I keep fighting it with this and this and this. And it's actually not that problem. It's relative to the basal insulin, right. So the dawn phenomenon is another reason for having a high blood sugar when you wake up in the morning. But it's specific in that these are hormones that are supposed to be being released in this time period of sort of the sleep wake cycle. Yeah. And they're there whether you have diabetes or not. Right, right. It's just that the person with diabetes, obviously with glucose monitor, and we can see what's happening, and it's not controlled. So we have to cover with more insulin in order to offset these hormones, growth factor hormones, cortisol, all these things that are sort of ramping up around to three o'clock in the morning, usually through about eight o'clock in the morning, they're ramping up, and that ramp up in hormone will start to drive blood sugar up if you don't counter it with extra insulin. Most people counter it with extra basal insulin at a certain time period. Their basal rate may go up a notch to impact the coming increase in insulin need.
Scott Benner 4:53
And people on MDI see it more drastically when they inject their Basal insulin in the morning because in those last six and eight hours of a 24 hour basal insulin, sometimes you see a decrease it, especially with the older ones, right level Marin lantis. Correct. And, and so it might look even worse, I have a question that you may or may not know the answer to. What if I'm a shift worker? And I'm awake from three to eight? Do I still see it?
Jennifer Smith, CDE 5:24
No. Again, it's more specific to your typical sleep cycle. Okay, it's attached to sleep not time, right? So if you're a shift worker, and your shift remains pretty stable, right? Let's say that you sleep from noon until 8pm. Every day, your smokey effect might actually be from 3pm until 8pm, then or four 4pm until 8pm. It would be within a sleep cycle, just because it's not technically three o'clock in the morning.
Scott Benner 5:56
You just had smokey, do you mean dawn?
Jennifer Smith, CDE 5:58
What? Oh, Dawn? Yes. Hey, sorry. Yeah, so the dawn really is going to impact you in those waking hours, or those pre waking two waking hours, regardless of when your sleep cycle is. So
Scott Benner 6:12
this 3am to 8am, you know, quote, unquote, norm that people see is probably such a large swath of time, because people go to bed at different times. And so it's maybe more about how long you've been asleep, and how long it is until you wake up, like somewhere in that space. Like, you know, if I went to bed at 10pm, every night, and I saw this increase at 3am, then you're saying that if I was on shift work and went to bed at 10am, every day, I might see the same thing at 3pm.
Jennifer Smith, CDE 6:46
Right, that makes sense. Exactly. Okay.
Scott Benner 6:50
Yep. So that's attached to your sleep, not the time of day. And it would smokey be the same thing, then? Is it? Let me think, hold on, I'm actually have to think this through.
Jennifer Smith, CDE 7:04
That would be a really interesting, I guess it would be the same thing. If you think about high blood sugars in the morning, and you've got your bazel dialed in, you know that it's controlling the dawn phenomenon. And now today, let's say you look at your CGM. And you see that you have a, you had a low blood sugar, you didn't realize you didn't treat it overnight. And now you wake up with this high blood sugar in the morning. That would be more the smoky, regardless, again, of whether or not you're sleeping from 10pm until 8am, or you're sleeping from noon until 8pm.
Scott Benner 7:37
Okay, I have to I have to figure something out in the world and name it after myself. I love that this guy's been dead for 50 years, and we're saying his name. And that is such a fun name. Yeah, yeah. And some doctor in New Jersey got some juice off in the other episode because I googled wrong.
Jennifer Smith, CDE 7:55
Exactly. That's, that's kind of fun. I know, my name wouldn't be very fun to name something after Smith.
Scott Benner 8:00
So so if you're on a pump, and you have dawn phenomenon, you're gonna need an increase in basal insulin, prior to when you see the rise through the rise.
Jennifer Smith, CDE 8:12
Correct. Now, there's an interesting, and you might have thought to maybe bring it up. But here's an interesting thing that some people even see, they might see a small incremental increase. So let's say they adjust their bazel slightly, it's not too much, let's say point 05. It's tiny, incremental change. But then, when they've done their bazel testing, that seems to work. But now that they're noticing more, they see, when they finally do get up, there's this more considerable rise in blood sugar, which a lot of people sort of, and we refer to as like the foot on the floor syndrome. Technically, like a syndrome or like anything, it's, it's just, it's literally you get out of bed and 30 minutes later, your blood sugar could be going from 82, all the way up to 150. And you're like, what the heck yeah, did my bazel testing What's going on here? And I think, in that regard, it's actually easier to pay attention over the course of a couple of days. And see, what is your average Rise of the foot on the floor like impact that you're getting, let's say over the course of three days, you look at this and you're like, yep, my blood sugar went up. 40 points, it went up. 60 points, it went up. 50 points. Great. You're getting an average of 50 point rise in your blood sugar. You know, soon after you wake up in the morning. It's rather than fiddling with your bazel it's actually easier to just Bolus
Scott Benner 9:45
that's what I tell people to do.
Jennifer Smith, CDE 9:47
That's for the rise you're expecting.
Scott Benner 9:49
Yeah, that's what I do for Arden and that's what I that's how I talk to other people about it. Dawn phenomenon, totally tackable with basal insulin, you know on a pump Obviously easier, but making sure that you don't have a deficit of bazel. If you're MDI, in that timeframe, doing that by, you know, moving around on the clock when you inject your bazel. The other one, I guess we're going to do well, okay, so I hope everyone enjoyed that there's going to be another one about feet on the floor, so go listen to that one, too. If you'd like to hire Jenny to help you with your type one diabetes, check her out at integrated diabetes.com. Thanks so much to the Omnipod tubeless insulin pump. If you'd like to get a free, no obligation demo of the Omni pod, do it now at my Omni pod.com Ford slash juice box, learn more about the Dexcom g six continuous glucose monitor, see those trends, see your direction, see your speed dexcom.com forward slash juice box, get the best blood glucose meter on the market, in my opinion, at Contour Next one.com forward slash juicebox. You want to see people doing good things. For other people with type one diabetes, you need to go to touched by type one.org. And of course, to get involved simply in some type one research that helps everyone with Type One Diabetes. And to do that right there from your cell phone or from your sofa without ever leaving your house and just a few minutes, T one d exchange.org forward slash juicebox. You go to those links, you are doing something good for yourself good for somebody else and supporting the podcast. All of those links are available right here in the show notes of your podcast player. And they're also at Juicebox podcast.com. Click the links support the show. You all should know by the way, when I say click the links support the show, the pentameter of that reminds me of save the cheerleader save the world, from heroes to remember that TV show on NBC. Anyway, here's a little look into my head. There are countless other episodes of the finding diabetes available for you right now. And that's probably a lie because they are accountable. There's not so many of them that I can't count them. But I'm not going to count them a couple of ways to get them. Go into your podcast, app search defining diabetes, they'll all pop up. Go into the stream in your podcast app, all episodes, scroll down, you'll see them you can go to Juicebox podcast.com. and scroll down a little bit. Right. And you'll see all kinds of stuff. Let me tell you some of the stuff you'll see on the main page all the after dark episodes. Right now we have after dark divorced, and co parenting after dark sex with type one from a male perspective sex with type one from a female perspective, depression and self harm, trauma and addiction, weed smoking, drinking with Type One Diabetes, there's also all kinds of episodes that are focused on algorithm pumping. And then you know what you get actually click books to look up. Hold on. So Excuse me. Also, I have all the pro tip episodes right there on the front page, and recent episodes. Now if you go to, then you click on a link up top right it says Juicebox Podcast, you click on that. Now all of a sudden, you're looking at the defining diabetes episodes. There's fat and protein rise compression low and interstitial fluid rage, bolus bumping nudge feeding insulin, these little diabetes terms that maybe you're just like, I don't know what they mean when they say insulin resistance. But I have an episode Virginie I explained that to you. ketones stop the arrows brittle diabetes low before high Pre-Bolus trust what you know will happen will happen glycemic index and glycemic load as a defining diabetes. But you know what we have coming up a pro tip about it. There's non compliance and algorithm and on and on and on. If there's a diabetes term that's been set out loud, Jenny and I have defined it on defining diabetes to new ones that are out right now around this, like I mentioned the beginning. I think go together with this one. The other two are feet on the floor. And this Moji effect, the sum Mogi effect. I don't know how to say that word, but you'll see it it'll be the only word that sounds like some Oh gee, when you read it. Looking for a great doctor or other type of diabetes practitioner. Check out check out whoo there goes my voice. Check out juicebox Doc's calm and ever growing list of podcast listeners favorite practitioners? absolutely free go in there, find one or send me one to add.
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