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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MLG
I’m having difficulties with lows in the middle of the night. I am at a loss, it seems, in being successful. Hence, I don’t sleep well, or am restless. Are there strong suggestions that can be offered, to assist my fears I’m having just about every night? Or is there a comprehensive list of good, helpful suggestions?
Christel Oerum
Have you tried a CGM (continuous Glucose Monitor) such as the FreeStyle Libre 2 or Dexcom. They can not only give you some insights into when you’re dropping (which can help you manage it) but also wake you up before you drop too low.
Freestyle Libre currently has a promotion here in the US where you can try a sensor for free (just go to their website). I’d suggest you choose the Lire 2 and not the 14-day, as only Libre 2 has alarms
Danny
Hi so I started with the metformin 500mg 1 in the a.m and 1 in the evening in November 2020 where my sugar was reading 15.7 by March 2021 my sugar had dropped to 6.1 but now since July 2021 I have been having highs and in august I read the highest I have ever since 16.4. Am still doing my joggings in the mornings, watching my diets, drinking lots of water etc My doctor just keeps telling me to continue with the medication but I feel it’s just not working. Any help?
Christel Oerum
As our bodies change so can our medication needs. If your doctor isn’t willing to address your concerns, if you can, I’d suggest you go see another doctor. Also, make sure that you have been tested for antibodies, just to confirm your type 2 diagnosis
Jessa
You are telling diabetics with a glucose spike—-it is okay to eat high sugar cereal in the morning ? WTF.
Christel Oerum
If you manage your diabetes with insulin, and have a good understanding of how to time and dose your insulin, even cereal can be enjoyed without blood sugars that goes out of range. However, Ben also suggest eggs, so this is not an article promoting any specific way of eating
Adri Pieterse
Hi I’m on the newest medtronic pump! Have a censor also! I have perfect night values and when I start my day the sugars go up and up and up and up! Stays there for up to 4 hours! Driving me crazy! I do eat breakfast! With the pump I’m on I guess the only thing I can do is to pay my Dr a visit!? Does the water drinking really helps with better control of sugar that goes up and up like I described!!??
I will really appreciate your help! No with third wave covid I really want to stay away from Dr’s rooms as much as possible!
Christel Oerum
Sounds like the pump has a hard time keeping up with your morning hormone surge. Yes, you do need to discuss it with your doctor, it might be a question of changing your morning carb ratio to keep up with the blood sugar increase or doing a bolus just for the hormones
Karen 71
Hello
I’ve tried to lower my blood sugar fasting. From 180 to 140 or 145 give or take. I’m not eating anything after 7pm. I drink water at night when I get up and thirsty. Is drinking water triggering it? I do eat the snack small apple with 1 tbsp of almond butter. Or chesse with apple but still high blood sugar. During the day numbers are normal. Any suggestions I’m taking 2x500mg in am 1 x at dinner of metformin.
Christel Oerum
I would bring these observations to your doctor. You can try and add some activity before bed, or skip the nighttime snack, but you might find that it’s your meds that need adjusting (and only your doctor can advise on that).
And no, water would not make your blood sugar go up, if anything it can help bring it down. So drink away
Lisa Wojtowicz
Your articles are helpful, more than my doctor’s advise.
I wake up low, (100-130) take my Basaglar, walk for about 35 minutes, take my Novolog, eat breakfast, and my number does nothing but go up, up, up to the high 200’s. This is a new pattern, prior to this it was working fine. I eat hardly anything for breakfast after the walk, I do drink several cups of coffee. I’m assuming I need to increase my insulin for breakfast. Right before lunch I see a dramatic drop (230’s to 130’s) From lunch on through the remainder of the day, I am fine. This is an ever-changing disease, hard to find consistency.
Christel Oerum
Thank you. And you’re spot on it’s ever-changing. As our bodies and daily patterns change our insulin needs will change with it. If the pre-lunch drop is more than 3-5 hours after your last bolus (Novolog dose) you might be having too much basal onboard, if not (and you’re not correcting) the insulin Novolog dose might be right but the timing off. I’m saying this because if it’s your Novolog that makes you come down to 130 mg/dl you’ll have to be very careful with increasing the dose and you might “just” need to pre-bolus for the meal
Perla Adena George
Thanks for sharing. This is helpful. I do your exercises on Glucozone and have gained so much. I exercise at 7 pm for an hour at a gym and when I check my blood glucose after exercise it will be 100 and when I have dinner and check my blood glucose at 10 pm it is below 70. I then eat something to correct the lows and ends up having blood glucose very high around midnight keeping me up until sometimes 2 am. When I awake at 6 am or 7 am my blood glucose is below 70 again. I have explained this to my doctor and getting little help. This is scary. Any suggestions here.
Christel Oerum
Thank you, I’m so glad you found it helpful. The only reason you go low is when you have too much insulin on board. Rule of thumb is that if you go low within 435 hours of a meal you took too much insulin for the meal if it’s more than 3-5 hours after an insulin dose it’s most likely a basal issue. Since you go low overnight it sounds like your basal insulin is too high. Remember exercise will increase your insulin sensitivity, meaning you’ll need less insulin after workouts and potentially overnight
Mike Cullen
Thank you for all your valuable articles. I read and learn from them when published…
Please keep them coming!!
S.Schwartz
What about those who are not on insulin but on Meformin and some mornings fasting levels are higher than they should be?
Christel Oerum
Some people do well with reducing carbs at night or stop eating after 7 PM. Another option is to add some activity in the evening or morning, such as walking. You can also try some of the recommendations from the article (eat something small, drink more water). Finally, if your blood sugars are very high in the morning it could mean that your doctor needs to adjust your Metformin
Susan H
I’ve been diabetic since 2014 (cancer treatments) and I’m just now getting my numbers controlled. I read somewhere that the right “snack” before bed will keep you from having high a.m. readings. I now have a little cucumber, or mixed nuts, or apple (with or without Natural low carb/low sugar) peanut butter, etc., before going to bed and I’ll have 100’s to 130’s in the morning!
Yesenia M
I was diagnosed with pre diabetic in October 2020 after my blood work showed a high A1C. I lost 20 lbs on my own with no medication. I am still struggling with morning fasting blood sugars around 120-125. During the day 2 hours after eating sugar is usually under 100. What can I do to get that morning sugar under 100. Last A1C was 5.7
Thank you
Christel Oerum
Well done! There are a few things you can try. Some do well with not eating after 7 PM, exercise at night, or a walk in the AM, or as mentioned in the article you might just need to eat or drink a little