Early morning hyperglycemia with increased blood glucose of 3.00 AM suggests:
Correct Answer: Insufficient Insulin
Description: Answer is A (insufficient Insulin): Early morning hyperglycemia with increased blood glucose at 3.00 Am typically suggests inadequate night time insulin dose (insufficient insulin). Dawn phenomenon also presents with early morning hyperglycemia but blood glucose is typically stable (normal) at 3.00AM. If insufficient insulin is not provided amongst the options. Dawn phenomenon may be selected as the Answer by exclusion since several textbooks do not make a distinction between Dawn phenomenon and insufficient insulin and include insufficient night time insulin as a mechanism for Dawn phenomenon. Causes of early morning hyperglycemia in diabetics using insulin: Causes Frequency Mechanism Diagnosis Treatment Insufficient Most common Inadequate night-time basal Blood glucose rises "Ist Night-time insulin insulin dose continuously throughout the night intermediate or long-acting insulin dose Dawn Common Early morning physiologic Blood glucose stable Do not eat a phenomenon surge in growth hormone and all night, then sharp carbohydrate snack coisol rise early in the morning at midnight Somogvi effect Least common Excessive night-time basal Hypoglycemia at 2-3 .1 Night-time insulin dose --> hypoglycemia in the middle of the night --> triggers release of counter- regulatory hormones am* intermediate or long-acting insulin dose *Patients with long-standing DM may not have symptoms of hypoglycemia (discomfo, tremors, sweating, etc) because of autonomic diabetic neuropathy.
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