Demonstration of a Dawn Phenomenon in Normal Adolescents

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Abstract
To ascertain whether the dawn phenomenon occurs in normal adolescents and, if so, to determine its mechanism, we measured nocturnal plasma glucose, insulin, glucagon, growth hormone, cortisol, and adrenocorticotropic hormone (ACTH) levels between 01.00 and 08.00 h in 10 healthy adolsescents. The prehepatic insulin secretion rate was calculated based on C peptide levels. The metabolic clearance rate of insulin (MCRI) was calculated as the ratio of mean insulin secretion rate to mean insulin concentration. There was no change in plasma glucose, insulin, and glucagon between 01.00–04.00 and 05.00–08.00 h (paired t test). The MCRI was higher at 05.00–08.00 h compared to 01.00–04.00 h (9.30 ± 1.50 vs. 4.87 ± 1.11 ml·kg-1·min-1; p = 0.008). The prehepatic insulin secretion increased at 05.00–08.00 h relative to 01.00–04.00 h( 1.1 ± 0.2 vs. 0.6 ± 0.1 pmol·kg-1·min-1;p= 0.013). Similarly, cortisol and ACTH levels were higher at 05.00–08.00 versus 01.00–04.00 h (323 ± 33 vs. 102 ± 22nmol/l, p < 0.001; 3.6 ± 0.5 vs. 1.8 ± 0.4 pmol/l, p = 0.006, respectively). Growth hormone was higher at 01.00–04.00 versus 05.00–08.00 h (7.6 ± 1.2 and 3.0 ± 0.9 µg/l; p = 0.019). ACTH correlated with MCRI (r = 0.66; p = 0.002) and prehepatic insulin secretion (r = 0.75; p < 0.01). We conclude that (1) the dawn phenomenon, characterized by an increase in MCRI, occurs in healthy adolescents; (2) this increase in MCRI is compensated for by an increase in insulin secretion from the normal pancreas, thus preventing a fall in plasma insulin and a rise in plasma glucose.