Which of the following statements about Dawn phenomenon is true:

Answer is C (Morning hyperglycemia due to insufficient insulin): Dawn phenomenon typically refers to early morning hyperglycemia with stable blood glucose levels all night (no Hypoglycemia at night) Although typically Dawn phenomenon is caused by early morning physiological surge of counter regulatory hormones such as coisol, and growth hormone, inadequate night time insulin may also contribute to the 'Dawn phenomenon' (Early morning hyperglycemia). What causes the "dawn phenomenon"? The term dawn phenomenon describes a rise in, blood glucose that occurs during the early morning hours (between 5:00 and 8:00 Am), paicularly among patients who have normal glucose levels throughout most of the night. The rise in glucose is thought to be due to several factors, including the following: The normal increase in the morning coisol level The cumulative effect of increased nocturnal growth hormone Insulinopenia as a result of the length of time since the last injection Strategies for managing the dawn phenomenon Shift more aggressive insulin use to the evening and pre-bedtime hours, using a type of insulin that has a longer duration or peak of action, initiating insulin pump therapy Not eating a carbohydrate snack at bedtime Increasing the amount of vigorous physical activity in the evening hours. The specific strategy or combination of strategies must be tailored to the individual. What is Somogyi phenomenon? The Somogyi phenomenon is rebound hyperglycemia after an incident of hypoglycemia. This rebound is secondary to the release of counterregulatory hormones, which is the natural response to hypoglycemia. As tighter glucose control is maintained, there is an increased likelihood of hypoglycemia and, therefore, of the Somogyi phenomenon. If the hypoglycemia is recognized and treated promptly, rebound hyperglycemia is less like to occur. Thus, the Somogyi phenomenon is commonly repoed more frequently at night because there is the greater likelihood of unrecognized and untreated hypoglycemia when the patient is asleep. When should the Somogyi phenomenon be suspected? The Somogyi phenomenon should be suspected when a person whose blood sugar is in excellent control begins to have intermittent high blood glucoses in the morning. If that pattern is noted, blood glucose should be checked between 2:00 and 3:00 AM on several nights to determine whether hypoglycemia is occurring. If night time hypoglycemia can be documented the likely diagnosis is Somogyi phenomenon. This may require the dose or type of evening insulin or the time that the dose is given to be altered.