{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fcharset0 arial;}}

{\*\generator msftedit 5.41.15.1507;}\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
}