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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Chad
Recently diagnosed with Type 2 had an AC1 of 13. I changed my diet instantly basically no carbs/sugar and taking 1000 mg of Metformin twice a day. I averaged 130 for a week is that too drastic of a change. It was very surprising to hear the risks of dropping to fast. What advice would you have in dropping gradually. I know sugary drinks (soda, juice got me to where I am). Should I just cut that out first.
Christel Oerum
That amazing, congratulations on making so many meaningful changes! I don’t think you have to cut out all carbohydrates but that’s something you’ll have to discuss with your medical team. To make sustainable changes most people need some level of flexibility in their eating patterns
tasleem u did
MY recent HBA1C is 7.8. I am taking 750 metform before going to bed. plz guide me how to lower FBS
Christel Oerum
You can find more details on how to lower you A1c here: https://diabetesstrong.com/how-to-lower-your-a1c/
Sheila Ibarra
Hello,I’m 62 and have type two diagnosed after I had a stroke three years ago. and not taking any medication at this time. I do take an aspirin 325 and cinnamon and chromium.
My issue is my levels are great during the day 108-124, at 6 am 159-180.(depending what I eat for dinner, no carbs) I drink 50 oz of water during the day. and walk not run for 15 min twice a day. Having problems losing weight, my body seems to stay at 172. I lose 2 thank gain in back.
Any suggestions on how to lower morning levels. I also found out that I have lacunar infarct.
Thank you in advance for your response.
Christel Oerum
If your doctor isn’t concerned about the morning increase and your A1c is in range you might not need to worry since your blood sugars come down. If not, your doctor might want to start you on a diabetes drug, suggest you cut back on PM carbs or increase activity
Carla
I recently started loosing weight so I checked the doctor and now am checking my sugar levels every morning and levels are like 104, 111 and then some times it drops to 88 or so, my weight is the issue cause I don’t like how am looking and my clothes sag now, how can I gain weight but not too much.
Christel Oerum
If there’s no medical issue to your weight loss it will come down to eating more calories. Try tracking what you eat and add from there
Mari
I am a diabetic, I use novolin R before meals. I also have cholangiocarcinoma and had a liver resection 3/4 of liver taken October 2018. As of late I have gained weight and my sugar has been a bit higher than normal, and I have zero energy. I mainly eat protein and vegetables, a bit of fruit, and a bit of carbs. My morning bg levels have been a bit high lately 169. But throughout the day they’re fine? My Onc says my liver is doing well. I am in MI, I do have a Dr, but I would love to find one that actually is more interested in me instead of their PC. I am finding it harder to get up in the morning when my sugar is higher, it’s like I’m lethargic!
Any advice would be greatly appreciated..
Christel Oerum
The only advice I can really give you is to find a doctor that listens to you and that you feel comfortable with. There can be many reasons to why you don’t feel well, besides diabetes, so a good doctor should talk through your symptoms with you and dial in on a diagnosis from there. I hope you find the care you need and deserve
Valerie
I have type 2.
I take 1000mg Metformin ER at bedtime.
I used to take 500mg BID but it was suggested to me to try 1000mg at bedtime to avoid the morning spikes.
I didn’t know the impact water can have! I’m going to keep water at my bedside and drink any time I wake and try to increase during the day as well.
My morning FBS never fall below 120. They range between 120 and 180ish. Average is usually 150s.
It was suggested to me to eat a snack at bedtime to help lower my FBS, such as a 1/4 of apple with 1 Tbsp peanut butter or whole grain cracker with cheddar cheese. Can this actually help lower my FBS?
I find if I eat small healthy snacks every 2 hours instead of 3 regular meals my glucose levels have improved! I have also lost 30 pounds quickly. I believe it iz due to eating healthy and I tried to cut out white sugar items and increase proteins. The carbs I consume are generally fresh veggies.
Any other suggestions to lower my FBS?
Christel Oerum
Sounds like you’re doing great, well done on your progress!
An evening snack might be an idea but you have to test it out. Try having your snack for a few days and see if you fasting BG improves. If it gets worse you could try only eating the fat (PB) and cheese and see if that makes a difference.
Other options are to include some type of exercise before bedtime, such as walking or resistance training.
Tammy Sloan
I am on 1000mg metformin and 20mg glipizide. My sugar is high (200+) as soon as my feet hit the floor. It is normal before I go to bed. What can I do before I go to bed that will keep it low when I wake up? I Do Not want more medication. Nothing on the market is without horrible side effects. I want a natural solution and all my doctor wants is to keep giving me pills! I will not advance to insulin.
Christel Oerum
There are some different things you can try but if they don’t work you’ll have to change your medication. Using insulin is NOT failure. If you have tried everything and it’s not enough that just means that your body doesn’t produce enough insulin by itself.
You can try: Limiting carbohydrates at night, going for a walk as soon as you wake up, include resistance training 3+ times a week to increase your insulin sensitivity
Vana Mint
My blood sugar kept creeping way high over night for no apparent reason. I finally figured out it was the salt substitute that was causing it. I am working out and quitting all salt substitute and it’s slowly coming down. I recommend making sure you aren’t ingesting anything that will mess with your liver or kidneys too much. Good luck everyone.
Christel Oerum
Sounds like your salt intake might have made you dehydrated which can lead to higher blood sugars
khizer
sir one month later i check my blood sugar on fasting 248..but i feel normly.hb1c is 10.when i cut sweets after two days my sugar is 150 on fasting.after seven it can be normal.if i am daibetes or not….
Christel Oerum
You have to consult a doctor to get a proper diagnosis. However, if you see such a dramatic impact from reducing your intake of sweets it might make sense to continue down that path
Saravanan
I am a type 2 diabetic. I take pills (Metformin 500mgx2 day & night).
Last night my PP reading was 150 mg/dl (had just one chapathi, cauliflower and few nuts). (10 PM BST) . Morning I took a reading again for fasting sugar at 7 AM and it was 180 mg/dl. Any particular reason pls?
Christel Oerum
There can be a lot of reasons why this might happen, such as dehydrates, poor sleep, the meal impacting your blood sugar, etc. If it’s a consistent pattern I’d suggest you see your doctor and discuss an adjustment of your meds. If it’s a one-off I wouldn’t worry to much about it
Carolyn
BS in am fasting at 8am.180. After breakfast it will drop 2(2hr) later to 140. I eat my last meal around 6pm.with no snack before bed at 9pm. Do I need to snack before bedtime.
Christel Oerum
No, you don’t need to eat before bedtime, unless you’re really hungry. If you constantly wake up with a fasting blood sugar of 180 mg/dl you might want to discuss an increase in your medication with your doctor