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)
If you found this guide to avoiding high morning blood sugars useful, please sign up for our newsletter (and get a free chapter from the Fit With Diabetes eBook) using the form below. We send out a weekly newsletter with the latest posts and recipes from Diabetes Strong.
Marilynbostick
I am intermittent fasting trying to manage my type two diabetes. In morning 114 about 2hours later up to 156. I walk down again and I eat up slightly.
You get the picture, how to I get consistency . I don’t want to stop fasting I love it down 10 lbs..
I also removed most alcohol from my diet. Vodka and tonic. Should I stop altogether
Christel Oerum
If fasting works for you then stick with it. I wouldn’t worry too much about temporary increases, but if you do, try consulting with your doctor
Nidhi
I am 38 yr lady..I am prediabetic..m fasting value normally comes 109. I wanted to plan for a baby….what should I do to control fasting sugar..
Christel Oerum
Hi Nidhi – we have a whole article on prediabetes, I think that will be a great place to start (Prediabeteshttps://diabetesstrong.com/prediabetes/)
Claudia
Sorry, maybe I’m dense, but I’m confused about a couple of the suggestions offered here.
1. In suggestion #1, is this basically saying to take a preemptive correction as soon as you wake up (meaning, before the blood sugar has even spiked)? For me, the spike happens about 2 hours after waking, even on an empty stomach, and how large that spike is can vary dramatically. Maybe I’m misunderstanding, but wouldn’t this be like taking a shot in the dark? (No pun intended, lol.)
2. For those of us who take manual injections (in my case, I take Humalog and Toujeo), how would we go about applying suggestion #2? I’m guessing we couldn’t, but again, wanted to make sure I’m not missing something super obvious.
3. The last suggestion has me super confused. How would eating something help solve the problem? Obviously the bolus for whatever is being eaten + any correction would do it, but does eating on its own help lower blood sugar? So for example, if upon waking my BG is good, I do fasting cardio, and then I skip breakfast, and then my BG is high about 3 hours after waking despite having an empty belly AND having exercised, would eating, say, something carb-free that requires no insulin help bring my BG down, even without taking a correction?
Sorry for all of the questions, I’m just very anxious to get out of this viscious cycle! I’ve talked to my doc about it numerous times and we both agreed it could be stress related (I’m very anxious and hate my job; my blood sugar typically only does this on weekdays, save for the 1 day a week I work from home). But this sounds like it could also be part of the puzzle, so I’m just trying to understand it all to see what could help prevent these highs.
Christel Oerum
All good questions.
1) What’s suggested is that you bolus when you see the increase starting (so for you most often 2 hours after you wake up). The dose and if this approach is the right for you will depend on your daily patterns. I know people who consistently (they tracked it over time to be able to say this) shoot up 100 points an hour after they wake up. So when they see the increase start they’d give themselves a correction for a 100 point increase. However, if you don’t see a consistent increase obviously it will be hard to determine the dose.
2) You can’t increase your basal rate as suggested using a long acting insulin
3) Eating can stop the increase because you bolus plus some of the stress hormones some people’s bodies release when they fast will be suppressed.
And for people who still have an insulin production, a small meal often does the trick
Claudia
Ah, that all makes sense 🙂 Thanks so much for your detailed (and thorough!) reply. Really glad I stumbled across this site!
Mike A
Claudia,
Please try talking with your doctor about Cortisol levels. I have had this big problem of morning high glucose and it really isn’t some little thing. I’ve pin it to Cortisol levels and managed to fix it. Irregulary high Cortisol levels are caused by some bacterias and that cause gluco-genesis. But being diabetic and having this, is very exhausting for the way it manifests. Like everybody, you try tot get the blood sugar levels to normal and take a few units of insulin but the result, at list in my case, is that you get a violent hypoglycemia because the insulin you take adds up to lowering Cortisol levels (they are high starting 4.00 am and induce high blood sugar between 06-09am). And not knowing the culprit of it is very consuming.
Karen
How did you correct this ?
Nadya
Hi,
I`m a bit confused with Fasting (16 hours -not eating till lunchtime) and immediately eat…Once I understood that fasting should keep my BS stable if basal insulin is the correct dose, and now it`s that I need energy and my BGs will increase if I don`t eat and bolus? Where is the difference?
Thank you,
Christel Oerum
Your blood sugar should be able to stay even if your basal is set correctly. If you use injections your basal insulin might not be able to cover the blood sugar increase you might see in the morning which is why you’d need a small bolus. If you’re on a pump your basal settings should be adjusted to take care of the morning increase.
Did that answer your question?
Nadya
Yes, Christel. Thank you very much. Started testing and yesterday I was stable.
Christel Oerum
Great, glad to hear that
Julie
Morning
I’m a 54 year old female. On eltroxin for hypothyroidism. BMI 25. No history of diabetes in family..but I seem to be prediabetic. Hgt readings usually 7 to 9.
Was put on glucophage 500mg at night.
Fasting reading 6.8 yesterday…today 6.6
What do you think?
Thanks
Christel Oerum
I’m not a medical professional so unfortunately, that’s not something I can give you an educated opinion on. If you’re in doubt of what your doctor is telling you I’d recommend getting a second opinion from another doctor. Wishing you all the best
tony
I am 64 and have worked on my cholesterol for the past year taking it from 220 to 115, HDL from 25 to 46, LDL from 123 to 59 and TRG from 130 to 70 with a plant based diet and supplements.
now I find my glucose has been in the 91-114 range. this morning it was 111 and 2 1/2 house after breakfast it was 115
yesterday it was 101 in the morning with the day before at 104
last Friday it was 96
I am trying to maintain with diet and exercise. I run 35 minutes a day at 6mph and really watch my diet.
I am currently on no medications
any suggestions
Thanks
Christel Oerum
Sounds like you’re doing great! It might be as low as you can get it with the tools you’re using. However, you could try and do your 35 min run right when you wake up or just before bed to try and drive down your nightly/morning BGs. Another thing to try is eating something when you wake up
Yvonne
Thank you so much for this information. This is exactly what happens to me. I am just in the prediabetic blood glucose range and frustratingly it is my morning glucose reading that put me there. I have noticed that if I eat just a little something, boiled egg, peanut butter slug etc then the sugars tumble down. I do like to fast in the morning as I feel better but as you said” just eat dammit”.
Christel Oerum
Sounds like you know your body well! Given what you say, I agree, EAT 🙂
Pascale
So do you eat this before going to sleep or when you wake up? Am confused
Sakura
My father is type 2 diabetes.he usually walk 1hour each day in morning and evening
He takes insuline 2 times a day.and do aerobics at evening and pranayam at morning. Still his morning sugar level is high upto 210.what to do.please suggest some thing
Christel Oerum
I’d suggest he has a chat with his doctor about adjusting his medication. Sounds like he’s active enough and if his diet isn’t too carb heavy in the evening he might need another type of insulin or an increase (his doctor should be the one to adjust this)
Monica
I wake up around 5 or 6 every morning then go back to bed for two hours, when should i take my fasting blood sugar?
Christel Oerum
If you measure at 6 AM and again 2 hours later, both readings will be fasting, however, doing both measurements will tell you if your blood sugars tend to risk after you wake up. So when to measure will ultimately depend on what you want to use the information for
Rob W
I have recently been diagnosed with Diabetes. I am taking 1,000mg of Metformin twice a day. According to my Doctor my body makes enough insulin so I do not need insulin shots. I got up this morning and my blood sugar level was 196. In looking through a mass amount of information regarding Diabetes I found that if I take two tablespoons of peanut butter within an hour to hour and a half my level drops anywhere from 20 – 40 points. What can I do to keep levels within range in the morning? Throughout the day I have also tried Glucerna shakes and bars. Is this a good idea or is there something better/healthier I should be doing. Since the beginning of the year I have lost 15 pounds, down to 270, figuring the weight loss would help. Being that this is all new to me and there is so much information out there not sure what is right and wrong. Any assistance would be greatly appreciated. Thanks.
Christel Oerum
Congrats on managing your weight and being proactive with your health!
Given you have enough of an insulin production that you don’t need shots I’d suggest you try and use that to your advantage. You can increase your insulin sensitivity (how well your body utilizes your insulin) by including exercise (resistance training is golden) into your routine. If you need to lower your blood sugar here and now, try going for a walk. Walking will help your body move glucose from your bloodstream in a relatively short time (for some it starts working after only 10 min walk).
If you can’t go for a walk, you can try eating a small low carb meal. I don’t think there’s anything wrong with your current food choices but some lean protein (turkey, chicken, shrimp) or yoghurt could also be good options. We all react differently to different foods so you could try it out and measure your blood sugar 90-120 min after and see how you fare. You might find that some food is more beneficial (when it comes to blood sugars) than others
Mike A
ello. I’m 36 years old and I am type 1 diabetic since I was 14. The last couple of weeks I’ve hit this brick of high-morning-sugar and I’ve been told a lot of nonsense to be the cause of it. With all do respect, it’s kind of the same in this post because it is a real problem, external one (I found out the real reason and got better, I’m putting it in writing in this comment) and reading this explanation I just felt really frustrated and felt that it’s just like beating around the bush and not getting to a practical solution, one I felt with all of me that must exist. So, to get to it the cause of irregular high-morning-bloodsugar is Cortisol levels, and in my case it was the Cortisol levels higher than normal due to “ENDOTOXIC BACTERIA”- which include flue bacteria or digestive bacteria.
“Cortisol counteracts insulin, contributes to hyperglycemia-causing hepatic gluconeogenesis and inhibits the peripheral use of glucose (insulin resistance) by decreasing the translocation of glucose transporters (especially GLUT4) to the cell membrane.” ” Cortisol levels are normally lowest around 3 a.m., then begin to rise, peaking around 8 a.m”
So is no “natural body mechanism” to just give you high-morning-bloodsugar for energy, in fact it really is a mechanism of protection against the bacteria having secondary effect of increasing the blood sugar and the best thing is that is is TREATABLE. I have treated it with “Sumetrolim®”-sulfamethoxazole+trimethoprim for 3 days and I’m all better now, the bloodsugar levels are all better even in the morning, even without having breakfast.
And I have had this problem in the past, went to the doctor and got the same nonsense answer that is no solution and just carry on. Then I think I got better with the flue treatment. And that is a very well known fact that during the flue I totally have to increase insulin dosage, and noe with information about Cortizol levels we have the scientific explanation.
I hope this will help you, I know how I felt when not knowing the reason and with this information I recommend you discuss with your doctor and get the wright treatment. May we all have the best blood sugar levels!
Dave
Mike A, Taking an antibiotic for 3 days? All you are doing is helping to create a antibiotic resistance bacteria. Also, the Flu is not caused by bacteria, it is a virus. Antibiotics won’t touch it.
Mike A
The medication I took is not an antibiotic, it is SULPHAMID. As for “Flu is not caused by bacteria, it is a virus” – my mistake, I meant to talk about the cold bacteria and actually without even having a clue, doctors do have the tendency to diagnose “Flu” even the simplest cold. So, bottom line: without a series of testing, it is pretty much impossible to accurate symptoms as clod or flu, BUT the discussion here was about a really delicate matter, one that I as for being 22 years on diabetic and going on have suffered a lot, one that my Diabetes Center doctor have risen her shoulders when presented to and told me to just carry on. That problem was early morning high blood sugar levels. And that is caused by an external factor and is really exhausting for a diabetes type 1 sufferer to deal with. and I have presented a very documented medical study: the culprit being Cortisol levels higher than normal, and I’ve managed to deal with it and be ok. As I would have loved to be given this info when I did not have it, I’ve thought it would help a lot of diabetics dealing with this problem. So, forgive me for posting an accurate mean of treatment. Actually, don’t. Obviously, I’m just being ironic. Do as you wish and just let people think for themselves.
JB
Colds are also caused by viruses, not bacteria.