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1507;}\viewkind4\uc1\pard\f0\fs20 summary\par \par the dawn effect is the early-morning increase in blood glucose, usually between 4 a.m. and 8 a.m. in persons with diabetes. the exact cause isn't known, however, it can be responsible for persistently elevated fasting blood glucose and hba1c levels. it is not caused by a previous low during the night and treatment involves limiting fat in the diet at dinnertime and in bedtime snacks. changes in insulin doses during the night are often required and should be made by your doctor.\par \par the simogyi effect is triggered by low blood glucose that causes a release of hormones including glucagon that raise blood glucose too much. low blood glucose occurs most often near an insulin peak so you may need to test your blood glucose levels more often for a few days to see where your lows are beginning.\par \par to prevent or correct high blood glucose levels in the morning, your doctor may recommend:\par \par * adjusting your dosage of medication or insulin\par * switching to a different medication\par * changing the time or fat content of your dinner and bedtime snack\par * testing your blood glucose around 3.a.m.\par ***************\par high morning blood sugars normally mean one of two things : inadequate insulin during the night or a re-bound.\par \par the dawn phenomenon often causes somewhat elevated morning blood sugars. but, especially because you inject your lantus at night, it wouldn't normally cause the blood sugar to go as high as 350-400. up to 200 would be more in line with the dp effect.\par \par a re-bound occurs when your blood sugar drops during the night to the point where your liver comes to the rescue. it releases glycogen into the bloodstream. and this causes a very rapid rise in the blood sugar to the kind of levels you have been experiencing.\par \par the only way to find out what is happening is to set your alarm and test a few times during the night. alternatively, get hooked up to a continuous glucose monitoring system for a few days.\par \par i have found that my blood sugar doesn't have to fall so low that i wake up for a rebound to occur. youyr liver can also dump glucose into your bloodstream simply because you haven't eaten for a long time.\par \par either way, you can avoid this effect by having a snack before bed. eat something that is low gi, like an apple. it should keep you going until the morning.you could also try shifting your lantus shot from 6pm to first thing in the morning.\par ********************\par you might want to substitute gtf chromium for the chromium picolate. the picolate form of chromium has been shown to have negative effects; it's the gtf form that controls blood glucose levels.\par *************\par when is the best time to exercise? i was fascinated with her report of a study showing that blood glucose levels of some men with diabetes who had moderate control dropped dramatically when they exercised two hours after eating breakfast. when they exercised before breakfast, their levels hardly dropped at all. these

finding are based on \ldblquote prior meal enhances the plasma glucose lowering effect of exercise in type 2 diabetes\rdblquote by paul poirier and his associates at quebec\rquote s laval university. medicine and science in sports and exercise published this report in its august 2001 issue.\par }

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