Continuous Insulin Infusion Therapy and Nutrition
Jeffrey I. Mechanick, Elise M. Brett in Nutritional Strategies for the Diabetic & Prediabetic Patient, 2006
Insulin pump therapy has been shown to result in improvement of hemoglobin A1C (A1C) levels with reduced frequency of severe hypoglycemia in individuals with type-1 diabetes mellitus (T1DM) [1], often with a reduction in total daily insulin dose [2]. There are many reasons for a particular patient to utilize CSII, including increased flexibility of lifestyle, avoidance of injections, ease of meal dosing, and the potential for improved control. The strongest indication for CSII is in the patient with a major manifestation of the “dawn phenomenon.” The dawn phenomenon is a rise in plasma glucose or insulin requirements in the early morning hours before rising in the absence of antecedent hypoglycemia [3]. For these patients, the only alternative is to awaken in the middle of the night and take an insulin injection. In one recent study, the use of insulin aspart in the pump resulted in lower glycemic exposure—as determined by a continuous glucose monitoring system (CGMS)—as compared with multiple daily injections (MDI) therapy using aspart and glargine, without increased risk of hypoglycemia [4]. This was attributed to the ability to control the dawn phenomenon with adjustment of nighttime basal rates and the flexibility in mealtime dosing.
The endocrine system
Laurie K. McCorry, Martin M. Zdanowicz, Cynthia Y. Gonnella in Essentials of Human Physiology and Pathophysiology for Pharmacy and Allied Health, 2019
The dawn phenomenon refers to a rise in blood glucose that occurs in the early morning hours. It likely occurs as a result of circadian variations in growth hormone and may occur in patients with type 1 or type 2 diabetes. The dawn phenomenon may occur in conjunction with the Somogyi effect if there is overnight hypoglycemia and lead to significant hyperglycemia in the morning hours. The dose and timing of insulin injection may need to be adjusted in diabetic patients to prevent this occurrence.
On the Importance of Monitoring Blood Sugar and Other “Vital Signs”
Robert Fried, Richard M. Carlton in Type 2 Diabetes, 2018
Readings exceeding these values may be due to the dawn phenomenon. Very high blood glucose in the early morning may be due to the release of certain hormones in the middle of the night. The body can make counter-regulatory hormones that work against the action of insulin. These hormones, including glucagon, epinephrine, growth hormone, and cortisol, raise blood glucose levels when needed by signaling the liver to release more glucose and by inhibiting glucose utilization throughout the body.
Nutrition in the management of type 2 diabetes mellitus: review
Published in Archives of Physiology and Biochemistry, 2021
A complicated, randomised, double-blind, crossover study of 38 patients with or without diabetes consisted of four sub-trials (Johnston et al.2010). The study found that about two teaspoons of vinegar taken with meals decreased postprandial glucose by about 20%. Another small, randomised trial in 27 patients with T2DM showed that vinegar administration resulted in a small decrease in HbA1C (Johnston et al.2009). However, another small, randomised study in 11 people with well-controlled T2DM found that vinegar given at bedtime decreased fasting glucose level (White and Johnston 2007). It has been reported that Vinegar may delay gastric emptying, inhibit disaccharidase activity, and promote muscle glucose uptake (Johnston et al.2009). It may also alter the glycolysis and hepatic gluconeogenesis cycle, which may benefit individuals who experience the “dawn phenomenon” (an early morning increase in glucose level) (White and Johnston 2007).
Synthetic long-acting insulin analogs for the management of type 1 diabetes: an update
Published in Expert Opinion on Pharmacotherapy, 2021
Ulrik Pedersen-Bjergaard, Therese W. Fabricius, Birger Thorsteinsson
Replacement of basal insulin secretion by long-acting insulin is a complex task. All long-acting insulins are administered subcutaneously, and variability in absorption between patients and even between doses is a fundamental challenge. Insulins with 24 hours’ time of action or shorter need to be administered at the same time every day or twice daily to provide consistent treatment effect. This is a challenge for many patients with shifting working hours or an otherwise irregular lifestyle. Even insulins with 24 hours’ time of action may not always provide 24-hour coverage for all patients and will therefore need to be administered twice daily. Beyond this, many patients will require increased basal insulin dosing in the early morning hours (the dawn phenomenon) [5] which is almost impossible to account for by long-acting insulins. Furthermore, some people experience day-to-day variations in their basal insulin need due to days with physical work, exercise, or other vigorous activities, which may require daily adjustments of basal insulin. This may be difficult to accommodate when using an insulin with more than 24 hours coverage. Obviously, patients may have quite different requirements to the properties of their basal insulin, needing a personalized approach to basal insulin therapy in type 1 diabetes [6].
Stepwise approach to continuous glucose monitoring interpretation for internists and family physicians
Published in Postgraduate Medicine, 2022
Emily D. Szmuilowicz, Grazia Aleppo
In contrast, CGM data provide direct information about personalized glucose trends which enable tailored therapeutic adjustments, as well as critical information regarding the timing and degree of hypoglycemia, hyperglycemia, and glucose variability in an individual. Real-time CGM data alert the user immediately to potentially dangerous impending hypo- or hyperglycemia, allowing interventions in real-time to prevent their occurrence or mitigate their severity. In addition, retrospective analysis of either blinded or real-time CGM data enables the recognition, by both people with diabetes and their providers, of important glycemic patterns critical to tailored diabetes management strategies. Common glycemic patterns easily detected by CGM use, but not apparent via HbA1c measurement or periodic capillary blood glucose measurements, include nocturnal hypoglycemia, postprandial hyperglycemia, reactive hyperglycemia following hypoglycemia, and dawn phenomenon.
Related Knowledge Centers
- Diabetes
- Catecholamine
- Gluconeogenesis
- Insulin
- Glycogenolysis
- Hypoglycemia
- Blood Sugar Level
- Chronic Somogyi Rebound
- Hormone
- Growth Hormone