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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Ondrej Franka
Hi, but what about non-insulin patients? I have high morning glucose after 6am and until noon meal. Eat only protein for breakfast, egg and piece of chicken plus half of grapefruit.
My readings at the end of the day are around 110 as well in after midnight sometimes even 90. My latest A1C was 7,8 for which I am concerned.
Thankful for any help,
Ondrej
Christel Oerum
That does give you a bit fewer options. But there are a few things you can try. Some do well with not eating after 7 PM, exercise at night, a walk in the AM, or adjusting any meds you might be on
Birch
I am type 2 diabetic and I have been off my meds under dr supervision for 2 yrs. I have gotten my A1c to as low as 6.2 in these 2 years with diet and fasting. I have always had high morning numbers but lately my morning numbers are even higher. And what is strange to me is my lunchtime numbers are typically higher than my morning number even having not eaten. My doctor had suggested eating protein in the morning but that did not seem to do much. I loved this article but looking for a strategy to reduce my morning glucose numbers.
Christel Oerum
Good job! How you manage your diabetes will most likely change over time. You could try adding a walk to your morning routine or a very small carb snack. The idea of protein is good but maybe your system needs a bit more of an incentive to increase insulin levels (why I’m thinking carbs). Doing resistance training 3 times a week can also be a great way of increasing your overall insulin sensitivity
Birch
Thanks for the reply. When you say a small carb snack in the morning. Do you have any suggestions?
Christel Oerum
I was thinking something relatively low glycemic such as a few berries or a few slices of apple
Roberta Svenonius
OMG! So glad I finally asked the right question in Google to find this article and information. I knew it wasn’t Dawn Phenomenon like my doctor said because I wasn’t crashing in the middle of the night but couldn’t find anything else to explain either. Thank you for the information and the tips. Now to educate my doctor. 🙂
Jean Brown
I am Pre-diabetic this morning my blood sugar was 200 didnt eat anything before going to bed which was 11:30 and blood sugar was 118 what can i do
Christel Oerum
If it happens consistently, you might have discuss medication, with your medical team (such as Metformin). Some people see a benefit from not eat after 7 PM, exercise in the evening, or going for a walk right when you wake up. You might also benefit from eating right when you wake up as fasting for some people can increase the hormone increase that can lead to increased blood sugars
Loujain
Hello! What if I’m not able (or supposed to take) to take insulin right when I wake up? Do you have any other solutions?
Christel Oerum
You can consider Ben’s 2nd or 3rd suggestion instead. Some people also see good results with eating very few or no carbs at night
Katie
What are you thoughts on intermittent fasting? I’m reading “The Diabetes Code” by Jason Fung and he asserts that fasting (daily extended overnight or 2, 30-36 hr fasts weekly) will help manage DT2 and increase insulin sensitivity (maybe help to create more? Not sure yet- haven’t finished the book!).
So here’s my situation- I don’t have diabetes type 1 (we don’t think, getting tested for late onset however), but my A1C keeps coming back in the prediabetic range (6.1). I am 33 yrs old, have a low BMI, active (exercises 5-6x/week), and I eat considerably healthy- I cut out any excess sugar I might have been sneaking in all summer, and have been strictly following a 12 hr eating window, sometimes shorter. I’ve been tracking my sugars manually the past few days and they never seem to go over 120 (mainly between 70-110 throughout day). It’s a real mystery to me. Wondering if my liver is dumping in the early am- even when I’m fasting, it appears that they start to go up after not eating anything in the am. If this is happening, how does fasting help?
My second child was also just shy of 10 lbs; however, I didn’t test positive for GD. But maybe it’s having an effect on my insulin resistance now…
Overall, I’m trying to figure out what else I should be doing beside going very low carb/keto and fasting 16:8! I don’t want to be doing something counterproductive either…Thanks so much, love your informative site! XO
Christel Oerum
I don’t think intermittent fasting or even super low carb is the right move for everyone.
I’ll usually see a liver dump if I do prolonged fasting, especially if I eat my carbs at night. And keto made me more insulin resistant. It might be the right option for you but my point is that we’re all different.
Check out these resources on IF and HCLF:
https://diabetesstrong.com/intermittent-fasting-type-1-diabetes/
https://diabetesstrong.com/mastering-diabetes/
Pervaiz
I am 66 years old wake up early morning do some excercise and walking at least 3kilometer, my fasting sugar is 118 ,/105 doctor prescribe me tab 1050 mg one morning one evening
Christel Oerum
Sounds like a great way to start the day! Hopefully, the meds will work out for you
Sagar
What to do if somebody has type 2 diabetes who is not on insulin and the same thing happens. Although I do not have cgm but , I think my liver dumps sugar in the morning. What can I do to avoid the same?
Christel Oerum
You most likely can’t avoid it but you can try different things to reduce it. The #3 point in the article eat) also goes for people not using insulin. Others things to try could be reducing your carbs at night, adding a walk when you wake up and hydrate
Sally Ann Ely
I dose my Toujeo, long-acting insulin and take synthroid for hypothyroidism on an empty stomach first thing in the morning, then eat breakfast approximately an hour later. When my BG is in the 80s upon rising, it usually doesn’t go extremely high in that hour. Even when it is higher, all I can do is drink enough water with my pill and wait to dose my Humalog and eat breakfast an hour later. The trick is to eat the right carbs and protein the night before to wake up to a reasonable number in the morning.
Dennis Leung
Hi, I am 80 years old with type 2 diabetes. My morning fasting sugar level, after 8 to 10 hours fasting is 150 . Is my fasting sugar level too high? Thanks.
Christel Oerum
For most people that could be considered high but you have to discuss whether it’s too high for you with your doctor