The dawn phenomenon (DP) refers to early morning hyperglycemia in individuals with diabetes or prediabetes, typically occurring between 3:00 and 8:00 AM, without prior nocturnal hypoglycemia. It impacts up to 55% of those with type 2 diabetes and is linked to poorer outcomes, including higher A1c levels and increased risks of heart and kidney disease. DP arises from an increase in hormones like cortisol and growth hormone, which trigger liver glucose production. In individuals with insulin resistance or diabetes, this process may lead to an uncontrollable blood glucose surge. Research suggests that disrupted circadian rhythms and poor sleep quality contribute to DP, offering potential areas for new treatments.

Management of DP involves both pharmacologic and nonpharmacologic approaches. While increasing medication doses can be risky due to the potential for nocturnal hypoglycemia, insulin therapy—especially continuous infusion or basal insulin—can help control the early morning glucose spike. Dietary interventions, such as higher protein meals in the evening and avoiding large, late-night meals, can reduce the severity of DP. Regular exercise, particularly before breakfast, enhances insulin sensitivity and helps manage glucose levels. A multidisciplinary approach, involving clinicians, diabetes educators, and dietitians, is essential for effective management of DP, with a focus on lifestyle adjustments and careful medication monitoring.

Reference: Yasgur B. Awakening to the Dawn Phenomenon in Diabetes. Medscape. Published November 07, 2024. Accessed January 20, 2025. https://www.medscape.com/viewarticle/awakening-dawn-phenomenon-diabetes-2024a1000kcb