FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 312:1473-1479 June 6, 1985 Number 23 Next

	Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

Abstract

The early-morning increase in insulin requirements of patients with insulin-dependent diabetes mellitus (IDDM) has been referred to as the "dawn phenomenon." To determine the roles of growth hormone levels and sympathoadrenal activity in this phenomenon, we studied six subjects with IDDM on four occasions during a constant overnight infusion of insulin. In control experiments (infusion of insulin alone), plasma glucose increased from 98 +/- 5 mg per deciliter at midnight to 225 +/- 36 at 8:00 a.m. (P less than 0.001), glucose production increased by 65 per cent (P less than 0.001), and glucose clearance decreased by 50 per cent (P less than 0.001). When nocturnal surges in growth hormone secretion were prevented by infusion of somatostatin plus replacement glucagon, neither plasma glucose levels nor glucose production increased significantly, and glucose clearance did not decrease. When nocturnal surges in growth hormone secretion were simulated by hourly intravenous injections of growth hormone (15 to 100 micrograms) during infusion of somatostatin and glucagon, plasma glucose levels and glucose production increased and glucose clearance decreased to values observed in control experiments. During combined alpha- and beta-adrenergic blockade (phentolamine and propranolol), values for plasma glucose, glucose production, and glucose utilization were not significantly different from those in control experiments. Increases in plasma glucose were significantly correlated with peak plasma growth hormone concentrations (r = 0.58, P less than 0.01). We conclude that nocturnal surges in growth hormone secretion are primarily responsible for the dawn phenomenon in patients with IDDM.

This article has been cited by other articles:

• (2006). The Dawn Phenomenon. DOC News 3: 5-5 [Full Text]  
• Kralisch, S., Klein, J., Lossner, U., Bluher, M., Paschke, R., Stumvoll, M., Fasshauer, M. (2005). Hormonal regulation of the novel adipocytokine visfatin in 3T3-L1 adipocytes. J Endocrinol 185: R1-R8 [Abstract] [Full Text]  
• KEENE, J. R., KALTMAN, S. I., KAPLAN, H. M. (2002). Treatment of patients who have type 1 diabetes mellitus: Physiological misconceptions and infusion pump therapy. Journal of the American Dental Association 133: 1088-1092 [Abstract] [Full Text]  
• Pickup, J., Keen, H. (2002). Continuous Subcutaneous Insulin Infusion at 25 Years: Evidence base for the expanding use of insulin pump therapy in type 1 diabetes. Diabetes Care 25: 593-598 [Abstract] [Full Text]  
• Turner, B. C., Jenkins, E., Kerr, D., Sherwin, R. S., Cavan, D. A. (2001). The Effect of Evening Alcohol Consumption on Next-Morning Glucose Control in Type 1 Diabetes. Diabetes Care 24: 1888-1893 [Abstract] [Full Text]  
• Takano, A., Haruta, T., Iwata, M., Usui, I., Uno, T., Kawahara, J., Ueno, E., Sasaoka, T., Kobayashi, M. (2001). Growth Hormone Induces Cellular Insulin Resistance by Uncoupling Phosphatidylinositol 3-Kinase and Its Downstream Signals in 3T3-L1 Adipocytes. Diabetes 50: 1891-1900 [Abstract] [Full Text]  
• Troisi, R. J., Cowie, C. C., Harris, M. I. (2000). Diurnal Variation in Fasting Plasma Glucose: Implications for Diagnosis of Diabetes in Patients Examined in the Afternoon. JAMA 284: 3157-3159 [Abstract] [Full Text]  
• Van Cauter, E., Polonsky, K. S., Scheen, A. J. (1997). Roles of Circadian Rhythmicity and Sleep in Human Glucose Regulation. Endocr. Rev. 18: 716-738 [Abstract] [Full Text]  
• Thrailkill, K., Quattrin, T., Baker, L., Litton, J., Dwigun, K., Rearson, M., Poppenheimer, M., Kotlovker, D., Giltinan, D., Gesundheit, N., Martha, P. Jr. (1997). Dual Hormonal Replacement Therapy with Insulin and Recombinant Human Insulin-Like Growth Factor (IGF)-I in Insulin-Dependent Diabetes Mellitus: Effects on the Growth Hormone/IGF/IGF-Binding Protein System. J. Clin. Endocrinol. Metab. 82: 1181-1187 [Abstract] [Full Text]