The “Dawn-Phenomenon” – a common occurrence in both non-insulin-dependent and insulin-dependent diabetes mellitus

Bolli, Geremia B.; Gerich, John E.

doi:10.1056/nejm198403223101203

Cited by 235Diabetes Management and ResearchPancreatic function and diabetesDiabetes Treatment and Management

The “Dawn-Phenomenon” – a common occurrence in both non-insulin-dependent and insulin-dependent diabetes mellitus

Bolli, Geremia B., Gerich, John E.·1984·New England Journal of Medicine

DOI 10.1056/nejm198403223101203

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Abstract

The dawn phenomenon is a condition recently described in patients with insulin-dependent diabetes mellitus (IDDM) that is characterized by abrupt increases in fasting levels of plasma glucose or insulin requirements or both between 5 and 9 a.m., in the absence of antecedent hypoglycemia. To determine its potential clinical relevance, we assessed its frequency and reproducibility in 20 patients with IDDM and in 13 patients with non-insulin-dependent diabetes mellitus (NIDDM) during overnight closed-loop (feedback-controlled) intravenous insulin infusion. After 6 a.m., plasma glucose levels increased similarly in NIDDM (89 +/- 2 mg per deciliter, midnight to 6 a.m., vs. 98 +/- 2 mg per deciliter, 6 to 9 a.m.; P less than 0.01). Insulin requirements increased at least 50 per cent for 1 1/2 hours in 77 per cent of patients with NIDDM and in 75 per cent of patients with IDDM. In five patients with IDDM who were studied on four occasions, the phenomenon occurred during 17 of the 20 observation periods, with insulin requirements after 6 a.m. increasing 225 +/- 34 per cent; coefficients of variation in individual patients ranged from 4 to 25 per cent. Thus, the dawn phenomenon occurs commonly in both NIDDM and IDDM, but its potential variability must be taken into consideration when one is attempting to adjust insulin doses.

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In humans, before waking, glucose production and glucose concentrations are increased while at the same time glucose utilization is high.
“A similar situation occurs in humans; before waking, glucose production and glucose concentrations are increased while at the same time glucose utilization is high [61].”
From Circadian control of glucose metabolism (2014) · cites this paper as [61]

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Dawn Phenomenon: Its Frequency in Non-Insulin-Dependent Diabetic Patients on Conventional Therapy
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The dawn phenomenon in Type 1 (insulin-dependent) diabetes mellitus: magnitude, frequency, variability, and dependency on glucose counterregulation and insulin sensitivity
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Authors: Bolli, G. B., & Gerich, J. E.
Affiliations: Mayo Clinic (US)
ORCID: Bolli, Geremia B.
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 1984-03-22
Volume: 310
Issue: 12
Pages: 746-750
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejm198403223101203
OpenAlex: W2317353168
Cited by: 235
References: 21
Citations by year: 2026: 3 · 2025: 2 · 2024: 4 · 2023: 6 · 2022: 3 · 2021: 5 · 2020: 7 · 2019: 3 · 2018: 4 · 2017: 3 · 2016: 9 · 2015: 7 · 2014: 16 · 2013: 7 · 2012: 6
FWCI: 10.49
Type: journal article
Language: en
Open access: closed
Locations: New England Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Health Sciences › Medicine › Surgery › Pancreatic function and diabetes
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Keywords: dawn phenomenon, type 1 diabetes, type 2 diabetes, insulin requirement, fasting blood glucose, nocturnal glucose, insulin dose adjustment
MeSH terms: Adult, Blood Glucose, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Female, Humans, Insulin, Insulin Infusion Systems, Male, Middle Aged, Time

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The “Dawn-Phenomenon” – a common occurrence in both non-insulin-dependent and insulin-dependent diabetes mellitus

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