in or give snack before bed Dawn Phenomenon . Morning hyperglycemia present on awakening May be due to release of counterregulatory hormones in predawn hours Growth hormone and cor sol o The treatment for Dawn phenomenon is an increase in insulin or an adjustment in administra on me.
Two counterregulatory hormones (growth hormone and cor sol) which are excreted in increased amounts in the early morning hours may be the cause of this phenomenon. The Dawn phenomenon a ects a majority of people with diabetes and tends to be most severe when growth hormone is at its peak in adolescence and young adulthood. How to tx: adjust insulin amount and me
Careful assessment is required to document the Somogyi e ect or Dawn phenomenon because the treatment for each di ers. The treatment for Somogyi e ect is less insulin in the evening. The treatment for Dawn phenomenon is an increase in insulin or an adjustment in administra on me. Ask the pa ent to measure and document bed me,nigh me (between 2:00 and 4:00 AM), and morning fas ng blood glucose levels on several occasions. If the predawn levels are less than 60 mg/dL (3.3 mmol/L) and signs and symptoms of hypoglycemia are present, the insulin dosage should be reduced. If the 2:00 to 4:00 AM blood glucose level is high, the insulin dosage should be increased. In addi on, counsel the pa ent on appropriate bed me snacks.
Oral Agents: 10-15 slides Works on 3 defects of T2D o Insulin resistance 0 Decreased insulin produc on Increased hepa c glucose produc on
Mechanisms of Ac on on T2D o Pancreas: Increases insulin produc on :Sulfonylureas; Megli nides DPP-4 inhibitors; GLP-1 receptor agonists Adipose Tissue and Muscle: Increases uptake and use of glucose; Decreases insulin
resistance Biguanides and thiazolidineiones Stomach and small intes ne: - Glucosidase inhibitors Delay absorp on of starches DDP-4 inhibitors Increases ac vity of incre ns
GLP-1 receptor agonists and amylin : Decreases gastric emptying
Liver: Biguanides; TZD and DDP-4 inhibitors decrease hepac glucose producon o Kidney: SGLT inhibitors decrease glucose reabsorp on
Diabetes: Nutri onal Therapy Carbohydrates o Minimum of 130 g/day Fruits, vegetables, whole grains, legumes, low-fat dairy All bene t from including dietary ber Nutri ve and nonnutri ve sweeteners may be used in modera on Fats Limit saturated fats to < fi% of total calories Limit cholesterol to < 200 mg/day Minimize trans fat o Healthy fats come from plants Olives, nuts, avocados Protein oShould make up 15% to 20% of total calories o High-protein diets not recommended
Diabetes Exercise Type/Amount Minimum 150 minutes/week aerobic Resistance training three mes/week Bene ts V Insulin resistance and blood glucose Weight loss Triglycerides and LDL , 1 HDL Improve BP and circula on
Self-Monitoring of Blood Glucose (SMBG)
flnables decisions regarding diet, exercise, and medica on
Accurate record of glucose uctua ons
Helps iden fy hyperglycemia and hypoglycemia
Helps maintain glycemic goals
A must for insulin users
Frequency of tes ng varies
Altern