Written by Dr V Mohan
Source: https://indianexpress.com/article/health-wellness
One of my patients was
worried about the high fasting glucose levels in his 22-year-old son. He was
worried if the dawn phenomenon, when hormones in the body naturally makes every
morning and elevates blood sugar, could be worrisome for non-diabetic people
like his son, too. Is it indicative of diabetes in the future?
Yes, the dawn phenomenon
can affect both individuals with and without diabetes. The human body
experiences the lowest level of blood sugar at 3 am. Then the body releases
hormones like cortisol, growth hormones and adrenaline to prepare us to wake
up, usually between 3 am and 10 am. They signal the liver to boost the
production of glucose, which provides energy that helps you wake up. In
non-diabetic individuals, insulin works efficiently and brings the blood sugar
back to normal. But in people with diabetes — or those with insulin resistance
— the body cannot counteract this hormone-driven rise effectively, leading to
high fasting blood sugar levels.
Does
a slightly high fasting sugar mean a non-diabetic person will get diabetes?
Not necessarily. For
non-diabetic individuals, it can be an early warning sign rather than a
diagnosis. It tells us that lifestyle changes are needed now to prevent
diabetes later. The occasional morning high will have little impact on your
HbA1C, average blood glucose count over three months, which is an indication of
whether your blood sugar management is effective enough. But if those highs
become consistent, they could push up these levels too.
What
is the best way to manage the dawn phenomenon for both groups?
The most effective and
safest strategy is lifestyle management, especially physical activity. A simple
20–30-minute walk after dinner is one of the best activities to combat the dawn
phenomenon in both diabetic and non-diabetic individuals. It helps muscles use
glucose, improves insulin sensitivity and reduces the overnight rise in sugar
levels.
Is
walking really enough, even for people with diabetes?
Yes. Walking is
sustainable and highly effective. Consistency matters more than intensity. Even
light activity after dinner makes a meaningful difference.
What
about morning exercise?
Morning exercise is good
for overall health but when focusing on the dawn phenomenon, intense early
morning workouts can sometimes increase blood sugar temporarily due to stress
hormones. Gentle activities like yoga, stretching, or a calm walk are better choices
in the morning. A Chinese study showed that moderate-intensity aerobic exercise
before breakfast reduced the morning rise of blood glucose in diabetes
patients. It significantly reduced blood glucose fluctuations and improved
blood glucose control throughout the day.
I
usually eat dinner late and go straight to bed. Could that worsen the problem?
Late dinners followed by
immediate sleep reduce glucose utilisation overnight for both diabetic and
non-diabetic individuals. Ideally, dinner should be light and finished at least
two to three hours before bedtime, followed by light movement.
What
to do if lifestyle changes don’t work for people with diabetes?
If fasting sugars remain
high despite walking, timely meals and good sleep in people with diabetes, we
may need to adjust night-time treatment. This can include increasing the dose
of long-acting insulin at night or modifying night-time oral hypoglycaemic
agents (OHAs). These changes help control the early morning hormone-related
sugar rise.
Should
patients adjust insulin or tablets on their own?
They can make
adjustments with the guidance of their healthcare professional. This helps
ensure changes are safe, effective and based on fasting blood sugar trends and
the risk of low blood sugar.
Can
technology help understand this better?
Continuous Glucose
Monitoring (CGM) tracks glucose levels day and night, clearly showing when
sugar starts rising. It helps us confirm the dawn phenomenon, adjust insulin or
medication safely, and also shows how effective walking and meal timings are.
Is
CGM useful as a predictive tool for non-diabetic people?
CGM helps non-diabetic
individuals identify hidden sugar spikes related to late meals, poor sleep or
stress, long before diabetes develops.
Whether someone has diabetes or not, managing
the dawn phenomenon requires timely meals, regular post-dinner activity, good
sleep and stress control. For people with diabetes, medication adjustment and
CGM add precision. Small daily habits make a big difference to long-term blood
sugar health.
