What causes the dawn phenomenon? This is something that is always alluded my understanding. I have found that, without a doubt, the number of units of insulin that I took the previous day (especially in the evening) has a major impact. In my experience, the following four reasons have caused the dawn affect:
I think that all of these things ultimately cause a delay in carbohydrate absorption. I have found that fat intake usually delays my absorption of carbs, and I often find that high fat meals within a few hours of bed time invariably create a low blood sugar at bed time and a high blood sugar when I awake in the morning (unless I have timed m y square wave bolus well). I also find that large amounts of protein, even when not consumed with carbs, can actually raise my blood sugar. Interestingly, though, I usually awake with a blood sugar within the target range but find that it rises dramatically with my first meal. Has anyone else experienced this? Fortunately, my insulin pump allows me to change my carbohydrate to insulin ratio based on the time of day.
I have found that caffeine, especially in the form of coffee, lowers my blood sugar in the short run but often causes it to go up in the long run. This has led me to believe that coffee does not actually have a positive impact on Type 2 diabetes control but instead just delays the absorption of carbs. For example, if I drink coffee, my blood sugar is usually lower than expected in the short run but will then spike several hours later. I think that the timing and impact of coffee and caffeine in general varies significantly depending on the amount.
I will soon undergo a detailed study of my own eating habits and see how each of these factors impacts blood sugar. I will post both the plan and the results on this site. If anyone else has knowledge on any these things, I’d love to hear about your experiences.
Some researchers and commentators have recently suggested that continuous blood glucose monitoring may not improve control for someone with Type 1 Diabetes. This is quite surprising to me, and the view is short sighted. The continuous blood glucose monitoring devices that have been created by MiniMed, DexCom, and others are the first generation of these products. Without a doubt, they will get better in the future. Even now, I would much prefer to have sometimes inaccurate readings that alert me of a low blood sugar during the night than to have a low blood sugar without realizing it. I would much rather wake up a few times during the night (because of the alarm) than to never wake up despite having a potentially life threatening low blood sugar.
I hope that these sorts of studies do not thwart the efforts to improve the lives of people with Type 1 Diabetes. Indeed, any new invention when first released is not perfect, but it is a base upon which great inventions can be built. Only 30 years ago, most people did not even conceive of the idea of a computer that you could fit inside a room of your house. Today, we have laptops that are far more powerful that only weight 3 pounds.
My hope is that the technology can improve quickly and that doctors will see the benefit for people with Type 1 Diabetes. Within only a few years, we will wonder how we ever lived before continuous blood glucose monitoring. It will save lives, and it is the missing piece in the “artificial pancreas”.
Recently, doctors in Calgary discovered a way to create large amounts of insulin at far lower prices than the insulin that is currently being created synthetically. As reported, the insulin, which comes from genetically modified safflower, has the potential to supply the needs of all people by 2010 with only 16,000 acres of safflower plants.
Clearly, people have been contracting Type 2 Diabetes at epidemic proportions, but it’s hard to believe that the worldwide insulin needs would increase by 3.5 times in just four years. Of course, the projected quantity for 2010 could take into account the vast number of people that currently cannot afford treatment and the large number of people that are undiagnosed. Nevertheless, the numbers are pretty scary.
This is great news. Although I hope to have a cure before too long, it is great to hear another early story of a substantial advance in diabetes treatment. When I was in Africa a few years ago, I remember being told that diabetes was “the rich person’s disease”. With this and other advancements, the hope is that treatment will become more available to everyone, not just the privileged.