We’ve all been there before.
You wake up. Lay in bed for a few minutes before getting up. Check your blood sugar. 115 (6.3 mmol/L) stares back at you.
You smile to yourself: life is good.
Forty minutes later, when you sit down to eat, your blood sugar meter or CGM tells you that you are now at 180 (10 mmol/L)! You have eaten NOTHING. All you’ve done is prepare for the day and prepare food. Now you face the grim potential of chasing your high blood sugars all day long.
What is going on??
Let me explain why your blood sugar sometimes can be high in the morning and what you can do about it
This isn’t Dawn Phenomenon
Many people would blame this rise in blood sugar on dawn phenomenon (DP), which has a similar endpoint, but a different mechanism.
Dawn phenomenon is the result of hormones released in the body in the early morning – predominantly growth hormone, cortisol, epinephrine, and glucagon – which in turn increase insulin resistance. The current basal insulin from the pump or long-acting injections is no longer enough, and blood sugars rise.
That hormonal surge happens around 2 am to 6 am, with most of it occurring in the middle of the night. Let’s say you woke up at 7:30 am and aren’t in the “DP zone.” It’s not DP. Then what?
Feet on the floor
The moment your feet touch the floor as you roll out of bed, you signal to your body, “Hey, I need energy for all the stuff I’m about to do!” Your body recognizes you haven’t eaten in many hours. Your body is also lazy smart and wants the most easily accessible source of energy: the liver.
The liver is the Wal-Mart for stored energy since it’s got everything you need. It stores glycogen that can be easily broken down when fasted or needed for activity, AND is the home of gluconeogenesis, a process where protein is broken down to glucose for energy.
Guess what? You’re fasted AND about to move, which is activity. So, your liver decides to dump glucose into the bloodstream. It will also break down some protein to glucose, but to a much lesser extent.
The cells take up the glucose as much as they can, but you may still be insulin resistant from the night before and from the cortisol dump that occurs each day around 7 am (hence why you may need a greater amount of insulin at breakfast than other meals. Food for thought.)
BAM! Blood glucose levels begin to rise similarly to an amusement park ride – it starts gradually and suddenly gets quicker and quicker. Those of you with CGM may see this.
How to prevent high morning blood sugar
Do not fret, friends. There are ways to deal. Here are three simple ways:
1) Take insulin right when you wake up
If it’s 2 pm and you notice your blood sugar is shooting up for no apparent reason, you’d take a correction dose of insulin to prevent that spike, right? (Well, I’d hope so).
The same concept applies here.
To determine how much insulin to take, wake up, record blood sugar values at 30 and 60-minute intervals, and record this for a few days (or use CGM data if you have it). Then, you can use your insulin-to-carb ratio to determine a correction bolus.
2) Increase your basal rate around your wake up time
If you fight Dawn Phenomenon, what’s a common strategy for success? Increasing basal rates in the wee hours of the morning to counteract that hormone-induced spike.
Well, if you’re used to a particular morning routine and know it’ll take you a little while to prepare food and eat, consider increasing that basal rate during that time period. That additional insulin may overcome the liver dumping glucose and blunt your blood sugar spike, or ideally, prevent it in the first place.
3) If you skip breakfast, stop skipping it and EAT SOMETHING
As a registered dietitian, I can regurgitate all the information from the Academy of Nutrition and Dietetics about why breakfast is important. This isn’t about that, but in all honesty here, try eating SOMETHING. I’d love if it were healthy, but if you’re just DYING to have Cinnamon Toast Crunch, by all means, have at it. If you’re about the low-carb life, go for some eggs.
This should, feasibly, prevent an even further increase in blood sugar had you not eaten anything at all and just went about your day.
Pop Quiz: What do these have in common?
If you answered insulin administration, you win!
Insulin, through more biochemistry magic, shuts off the liver glucose output, whether it comes from glycogen breakdown or gluconeogenesis. Thus, the spike should be halted in its tracks. YAY!
Bonus: Just add water!
Let’s pretend you decide to make some Gatorade from powder. It says to add 1 cup of water and mix thoroughly, so you do. You taste it, and it’s WAY too strong and concentrated. You add more water, mix, and now it’s delicious.
SAME THING WITH YOUR BODY.
You wake up in a state of dehydration because you haven’t consumed fluids in hours. Thus, the sugar in your circulation is more concentrated. Even if you wake up to a nice blood sugar, it’s quite possible the liver dump can have an even more accelerated effect because of this, so drinking a glass of water early (or even in bed) may help with this too.
(Also, most people don’t drink enough water each day, so it’s an easy way to sneak some more in)
These strategies should help you get your morning off to a better start, combat those pesky high morning blood sugars, and not allow diabetes to interfere with your plans!
For more actionable tips on preventing high morning blood sugars, watch this video of Diabetes Strong’s founder Christel Oerum explaining the 5 steps she takes to control her morning blood sugars.
Rosemarie Bakshis RN
Very helpful, thanks
Vasantha kumar
I have started finding some explanation to my blood sugar spike in the mornings without eating.i am diabetic for 40 years and I am 85 years old.I am on insulin 38-0-28 and metformin 50/1000
My blood pressure is normal 125-130./75-85
Kathy Cassidy
I have been diabetic for 52 years and touch wood I have been quite successful with it. I have found dealing with it better as things have changed so much. For the better, I add.
I found this info very helpful to me as you seem to get into your own way of dealing with it and sometimes it needs information that has passed you by.
Thank you for this insight into why this happens. I often wondered why my bs spiked so much even though I taken my insulin. As I said I have been diabetic for 52 years but loved reading this and putting myself straight Thank you again
Kathy Cassidy x
Andrea Etchison
Also…I am 2 days into Metformin (reluctantly). She said if I get down to 6.0 then she’d take me off the med. I just wish I could try to do this on my own without a medication. Since I quit the soda and am eating better, I’m losing weight. People with Gastric Bypass Surgery are told once they have the surgery and start losing their weight, the diabetes will go into “remission”. Why can’t I do that by what I’m doing. My A1C is NOT exactly reaching through the outerspace portal! So much doesn’t make since to me.
Andrew
If you can manage your glucose levels without medication…go for it. You could also start with them and ween yourself off…go for it. If you have a continuous glucose monitor it should be easy to keep track. You can take control of your health decisions…that might mean telling your doctor what you want to do…after they tell you what they recommend. I decided to stop taking Rybelsus…too many side affects…and would rather manage with diet and exercise. I’m also trying an experiment where I let my blood sugar level inform when and how much I eat. So I wait for it to get around 100 and then have a small meal. If it’s meal time and I’m at 140, I don’t eat. You can try different experiments too if you’re curious! I want to be in charge of my health care and it sounds like you do too. Good luck!
Andrea Etchison
I was just diagnosed with diabetes. My A1C was 6.9.
My Glucose Fasting was 115
My Estimated Avg Glucose was 151
My doctor is giving me a sense of urgency that I am extremely bad. I am stressing over this and reading everything underthe sun but I’m finding so many ranges on different articles on where my levels should be. I’m having anxiety over the newness of this. WHERE should my levels be? I need one good source!!! And when should I test? I’m using soooo many test strips because I’m going out of my mind!!!!!
Christel Oerum
A lot of people don’t respond well to doctors that use “fear” as a motivator. If you can I’d encourage you to try and find a different provider who can support you in the way you need. An average glucose of 151 mg/dl should result in an A1c of about 6.9%, which is below the American Diabetes Association’s recommendation of 7% or lower. But you might decide for yourself that you want to aim for something else.
As for how often to measure your blood sugar, a good rule of thumb, is to test when it’s meaningful. So for example before and 1.5-2 hours after meals, as well as when you wake up and before bed. Those measurements can help you assess if you need to adjust your care
Andrea Etchison
Thank you. I AM considering switching doctors. I’ve been tracking my blood sugar and it seems I’m kinda all over the place. Last few mornings in a row I’ve been under 130 and this morning I woke up and I’m 160. I’m maintaining during the day below 180 (usually between 117 and 127). Just seems my mornings sometimes are high but they level out during the day. And my bedtime readings have been running somewhere between 125 and 135. Am I way off kilter or am I doing ok?
Andrea Etchison
Also…I am 2 days into Metformin (reluctantly). She said if I get down to 6.0 then she’d take me off the med. I justbwish I could try to do this on my non without a medication. Since I quit the soda and am eating better, I’m losing weight. People with Gastric Bypass Suregery are told once they have the surgery and start losing their weight, the diabetes will go into “remission”. Why can’t I do that by what I’m doing. My A1C is NOT exactly reaching through the outerspace portal! So much doesn’t make since to me.
Gerry
A1c under 7 is normal in my day 130 was normal reading. I am 77 and I’m doing good
D.Marwah
I am not on any anti diabetic drugs , &am prediabetic . My fasting sugar is high between 120-130 . What can I do to lower it ? My current HbA1c is 6.4. Please advise
Christel Oerum
I think you’ll find this article on how to lower your A1C helpful https://diabetesstrong.com/how-to-lower-your-a1c/
Renee
Thanks for writing this article. ?
Natalie Barger
Liked your article about early morning blood spikes. I am 75 diabetic 25 years. Having higher sugar level this year. Working at a desk all my life. Joined a gym jn Dec 2023 and seeing trainer once a week. Encronologist next week for more help.
Kathy
I love this article. Every morning I see my BG rising. The challenge is that sometime if I do correct with insulin, it goes too low. So I wait to take my .2 units until it’s about 100 mg/dl just to keep on the safe side. Thanks for a great article!!
Michael
Taking regular insulin (7 units to 15 units) between 3am and 6am will decrease your blood sugar down. It does work for me successfully. I have T1D for nearly 55 years.
Elizabeth
Afternoon does that mean i can take Insulin on an empty stomach
Christel Oerum
This is something that should be discussed with your doctor. Some medications should be taken with food