What is the recommended treatment for the dawn phenomenon?

• A. Increase daytime exercise.
• B. Decrease nighttime insulin.
• C. Decrease carbohydrate intake at night.
• D. Increase nighttime insulin.

Answer: (D)

Dawn phenomenon refers to the early-morning rise in blood glucose caused by counterregulatory hormones (like growth hormone and cortisol) that increase hepatic glucose production during the overnight hours. The most effective way to blunt this surge is to provide more insulin coverage overnight, especially by increasing the nighttime basal insulin or adjusting the basal rate if using a pump. This directly counteracts the liver’s increased glucose output before waking.

Increasing daytime exercise doesn’t specifically address the overnight hepatic glucose production and can affect daytime glucose control but won’t prevent the early morning rise. Decreasing nighttime insulin would reduce overnight coverage and typically worsen fasting glucose. Decreasing carbohydrate intake at night might help post-meal readings, but it does not reliably prevent the early morning rise caused by hormonal output, which is why adjusting overnight insulin is the preferred approach.