Type 2 diabetes is not caused by being over weight, but they are linked. It is no coincidence that nearly 90% of type 2 diabetics are overweight. Obesity, often the result of unhealthy life style choices, is a known risk factor for this condition and now affects more than one in three American adults. Yet, over the last 20 years, the number of American adults following a healthy life style has declined.

Type 2 diabetes develops from pre-diabetes, which is when the body becomes resistant to insulin. Insulin resistance is a condition where the body does not use the insulin that it produces effectively enough to reduce blood sugar levels.

Your body uses glucose in the blood as its fuel. Supplying glucose to all the cells in your body via the bloodstream ensures that the cells work together and keep functioning normally. Insulin transforms excess glucose into glycogen in the fat, muscle and liver cells. This is how insulin manages to reduce the blood sugar level.

If you are obese, your excessive fat cells make it harder for insulin to work effectively. Gradually more and more insulin is needed to reduce the level of glucose in your blood. If this is allowed to continue unchecked, your body will go from the pre-diabetic stage to type 2 diabetes. That is how obese people, often unknowingly, develop type 2 diabetes.

But it need not be like that. Having a healthy, balanced, calorie controlled diet will aid weight loss particularly when combined with regular exercise. When you exercise, your body burns up glucose, which can help to return your blood sugar levels nearer to normal. This is why taking regular periods of moderate exercise is so important if you want to prevent the onset of type 2 diabetes.

If you are consuming fewer calories than you burn up, your body will make up the calories that it needs by burning fat reserves, which in turn makes it easier for your insulin to work effectively. This is why following a healthy, balanced diet is important.

Obesity substantially increases the risk of developing type 2 diabetes. By having a healthy diet, taking regular amounts of moderate exercise and losing weight you can significantly reduce the risk of developing insulin resistance and type 2 diabetes. 

Pre-diabetes means you have higher than normal blood-sugar levels but that they are too low for you to be classed as being diabetic. It does mean that, if you do nothing about it, you are susceptible to developing type 2 diabetes.

More often than not, there are no physical symptoms to warn you if you are in a pre-diabetes stage. It is a sensible precaution to get yourself checked out by your doctor if you fall into any of these categories:

• You are aged 45 or older and are overweight;
• You are an adult under age 45 and you are overweight;
• You have high blood pressure; low HDL cholesterol and high triglycerides;
• Your family has a history of diabetes; and
• You belong to an ethnic or minority group that has a high incidence of diabetes. These include African American, American Indian, Asian, Pacific Islander, Hispanic or Latino.

Type 2 diabetes is often associated with middle aged and older people, so even if you are not over weight, it is a sensible precaution to get yourself checked out by your doctor if you are aged 45 or older especially if you have any of the other risk factors.

If you are pre-diabetic there is some good news. You can take positive action to reduce the risk of the condition developing into type 2 diabetes by taking the following and other simple, common sense actions:

• Reduce the amount on your plate - eating just a little less helps reduce your risk factor. Piling up your plate piles on the pounds and increases the risk factor. Try having six small healthy meals each day instead of two or three large ones;
• Avoid snacks between meals. If you must snack, have a piece of fruit or raw vegetable rather than the sugar-laden option;
• Drink plenty of water. This make you feel fuller for longer and help prevent you from over eating;
• Choose whole-grain food;
• Take regular amounts of moderate exercise such as walking up the stairs instead of taking the lift or an escalator; and
• Avoid shopping for food when you are feeling hungry as you will be more tempted to buy the foods that increase your blood-sugars. You are also at risk of putting on weight and increasing the risk of moving from your pre-diabetic having type 2 diabetes.

Pre-diabetics can take positive action to reduce the risk of developing type 2 diabetes. Taking simple steps including adopting a healthy, balanced diet, taking regular amounts of moderate exercise and losing weight can reduce the risk of developing type 2 diabetes.

Liver dump, dawn phenomenon and dawn effect are all common terms that describe the same condition. It is an abnormally high early-morning fasting increase in blood glucose. It usually occurs between 4:00 AM and 8:00 AM. It occurs in everyone’s body, but it has more impact on diabetics than normal bodies. It is more common in people with type I diabetes than in people with type II diabetes. Understanding the phenomenon can go a long way towards helping diabetics manage it.

The liver is responsible for the increase in glucose levels in the bloodstream. The brain, vital organs, the creation of red blood cells, and muscle tissue are constantly consuming glucose to function (24 hours per day). When the glucose levels in the bloodstream drop, the brain sends a message, via hormones, to release more glucose.

At the same time, these same hormones signal the pancreas to reduce the amount of insulin that is produced and released into the bloodstream. In a normal body, the balance of glucose and insulin levels will be regulated. However, diabetics have an impaired control over this balance. Type I diabetics and insulin-dependent type II diabetics do not produce, either enough or, any insulin. The insulin in their system is dependent upon periodic injections. When the hormone insulin is out of balance with the other hormones (cotisol, glucagon and epinephrine), the liver will release too much glucose.

Also, as the result of normal hormonal changes. The body’s internal clock recognizes that it is morning, and the wake-up process begins. The hormones cause the increase in blood glucose levels. No one actually knows what the exact cause of the phenomenon is, but many believe that it is increases in the hormones cortisol, glucagon and epinephrine, that causes increases in insulin resistance. Insulin resistance is a breakdown in cellular communication, resulting in reduced amounts of insulin attaching to cell membranes, which, in turn, results in the cells not taking glucose in to burn as energy. Insulin resistance is the primary cause of elevated blood glucose levels. Also, while sleeping, the body carries out a process called gluconeogenesis. During gluconeogenesis, the body converts amino acids into glucose.

Like the release of stored glycogen the creation of glucose from amino acids occurs in response to hormonal signals. The body, during sleep, responds to signals from several different glands. The pituitary gland produces a growth hormone. The adrenal cortex produces cortisol. The alpha cells in the pancreas make glucagons. The outer layer of the adrenal gland sends out epinephrine. Those hormones raise the blood glucose level. ?There are specific methods that can be applied to determine if a patient has the liver dump phenomenon.

There are other possible causes of the dawn phenomenon. Insufficient amounts of insulin taken, or incorrect medication amounts taken the night before, may result in increases in blood glucose levels. High glycemic index foods (certain carbohydrates), can cause an increase in morning glucose levels, especially if eaten just before bed time. The only currently known way to determine if the phenomenon exists, is to take blood glucose readings periodically throughout the night. High glucose readings throughout the night will signify if there are other causes, and eliminate the possibility that the patient has the phenomenon.

If the patient displays high readings throughout the night, it may not necessarily mean that the phenomenon does not exist. The other possible causes should be eliminated, such as the type of snacks eaten before bed, incorrect medication administration, changes in medications, and possible incorrect settings on an insulin pump if one is used. Particularly the early morning dosages settings. A diet that is high in sodium will stimulate insulin and promote hypoglycemia. A diet that is low in sodium can promote hyperglycemia.

In some cases (not commonly), the phenomenon may be the result of a rebound from a low blood glucose level that has occurred during the night. This is commonly referred to as the Somogyi effect. The dawn phenomenon, unlike the Somogyi effect, it is not the result of antecedent (preceded by) hypoglycemia; they are not the same condition. The insulin taken the night before may be wearing off, which is usually due to too low of a dosage. However, larger dosages may easily cause hypoglycemia during the night. Only experimentation with food types and dosage amounts will tell what the overall effect will be.

Carbohydrate blockers, such as PGX, are known to have a drastic effect on morning glucose levels. Another possible remedy may be to increase the amount of water-soluble fiber in the diet, particularly in the evening meal. Some studies have shown that a green apple eaten as a nighttime snack is effective, because the body digests green apples slower than other apple types. Mostly due to the fact that Granny Smith apples are less ripe than others.. However. those that have been diagnosed as having the dawn phenomenon, sometimes will not show any change. Nuts (or other proteins and fats) are a good choice for a late night snack.

Unfortunately, late night snacks can encourage the packing-on of extra pounds.

The practice of taking a dosage of vinegar or acidic products before bed does show a reduction in the morning blood sugars on most people. Unfortunately, the body cannot handle large increases in blood pH, without leaching calcium from the bones. This can prove to be a dangerous practice, especially for women and older diabetics. Vinegar tablets are lower in dosage, and a bit slower in conversion, which can reduce the risk to some extent. However, most of the recommended dosages are as high as six tablets which can cause the same effect. Also, acids promote the increase in fat cells, as the body attempts to eliminate the acids by placing them in fat storage.

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Diabetics that have the dawn phenomenon do not have any symptoms that are associated with it. Nocturnal hypoglycemia (low blood sugars), followed by morning hyperglycemia (high blood sugars) for several nights is an indication of the Somogyi effect. It may be necessary to get help from a doctor to resolve it, because most cases are the result of medications that are mismatched to the patient’s needs. Metformin, a generic form of a diabetic oral medication (Glucophage), is known to curb glucose production by the liver, which makes it a good candidate for patients that have the dawn phenomenon. Metformin also encourages the insulin bonding to cell membranes, which reduces insulin resistance. Diabetics that take these oral medications rarely experience the dawn phenomenon.

While all diabetics should exercise, the timing of doing the exercises may impact the rebound effect of nighttime hypoglycemia. It may be necessary to exercise as early in the day as possible to avoid the rebound effect. Exercise can stimulate the metabolism to be elevated for several hours after exercise.

How long the patient has been diabetic; the quality of the patient’s glycemic control; sleep disorders; exercise; nighttime snacks (especially carbohydrates); high or low sodium in the diet; the state of counter-regulation to hypoglycemia; and the patient’s insulin sensitivity all can contribute to the dawn phenomenon. Start by experimenting with nighttime snacks. Switch to proteins such as nuts. Or, stop the nighttime snacks altogether. Make small adjustments to insulin levels and give the change several days to function. Have a doctor test the metabolic rate. Carefully monitor the amounts of sodium in the diet. If sodium is a part of the diet, it should be sea salt. Insulin resistance is caused by belly fat. It may be necessary to eliminate excess weight to eliminate insulin resistance, and improve sleep patterns. Determining if a patient has the dawn phenomenon, can require the help of a doctor if medications are responsible for the problem.

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