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 releasing 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-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!
Suggested next posts:
- Diabetes and Sleep Problems: Causes and Treatment Options
- Diabetes and Polyphagia (Excessive Hunger)
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Leana Simione
Great post. never knew when DP occurred exactly so its nice to know! This is great information as I have yet to be on a consistent diet and exercise routine. I have done fasted cardio and works great for me to loose weight quickly. I just have to get back in the routine I guess. But great reminders when to bolus and to be able to understand what is happening in my body! I love to learn!
Joseph Fitzpatrick
Hi,. I suffer spikes in the evening between 8.00pm and 10pm, it started months ago
Happening at 4.30am, then after gym at 11.00pm. it spikes to 18mol .
Should I try extra insulin at tea time to counteract.
Appreciated
Joe
RonnieA
great information
Sometimes Im afraid to eat and bolus as I work out in the morning and im afraid to go low
Any thoughts?
Christel Oerum
Lots of thoughts on that, but basically it comes down to you, and what you are comfortable with. You can always (carefully) try things out and see if it works for you. Basically, you have 2 options for managing BGs, adjust insulin or eat
I do the following:
1. I often do fasting cardio (30-50 min.), if my BG is high before I start or it starts to climb I’ll do a small bolus even though I don’t eat
2. I ALWAYS eat before resistance training and do a reduced bolus if needed (read my post on how some types of exercise impacts BGs: https://diabetesstrong.com/why-some-types-of-exercise-can-make-your-blood-sugar-increase/)
Joseph Fitzpatrick
Thank you
I will try your suggestions
Cheers Joe
Paula
Makes a lot of sense. Thank you for sharing.
Bob
Happens to me all the time. I get frustrated, angry, have no idea what’s happening. I usually don’t eat breakfast and have actually blamed my coffee for triggering the rise in blood sugar. Great topic and thanks for the info.
Christel Oerum
Oh, I know that feeling of anger and frustration. It’s not helpful, but it’s being human. Good news is, that as Ben describes, a small bolus or food+bolus can make such a difference
Patricia
This is good for me just got diagnosed with type 1 in my 40s. I like to workout and trying to adjust to this new lifestyle. So so helpful
Thanks
Christel Oerum
Glad this was helpful. There’s a lot to learn, but hang in there and things will get easier
Jaime
Great reminders and tips! Plus, awesome Nate Dogg reference.
Zalina
What a great post! I always thought that what I havery is no dawn phenomenon. Now it makes much more sense!
NatalieG
Will this also explain why when I exercise in the am no matter what my sugar goes high. It’s spikes with no food given. So my liver is just giving me sugar for energy to complete the work out?
Christel Oerum
There’s a high likelihood of that being the case. However, certain types of exercise (most anaerobic types) will increase your blood sugars regardless of the day due to the same glucose production mechanism
Kim
Fantastic post
Thank you
Keep them coming